As covered in my previous blog for Revaluing care OXPIP provide parent-infant therapy to people with babies from conception to age two. So why am I writing a blog which features someone who is famous for trying to understand the internal dynamics of hospitals and nursing? Isabel Menzies Lyth helped found the Tavistock Clinic but was most famous for her paper, ’Social Systems as a Defence Against Anxiety”. The paper studied trainee nurses and gave rise to concerns about how many nurses were failing to complete their training. She came to the belief that organisations working with trauma and illness developed defences to prevent front-line staff becoming overwhelmed by the distress and suffering they were experiencing on a day-to-day basis. I want to explain why I believe her thinking is still highly relevant to the provision of care and our work in Children’s Centres.
I will start with a bit more context about OXPIP and how we work. We are one of the pioneers of parent-infant psychotherapy. We have been working in Oxfordshire for the last fifteen years looking at how to support the development of more positive early relationships between parents and their babies. Founded by Sue Gerhardt and others, and building on emerging knowledge about early brain development we now work with 300 families a year and consistently see improvements in maternal mental health and the quality of the parent-infant relationship.
What distinguishes the work of our therapists, aside from their considerable expertise and knowledge, is their focus on the relationship as the subject of therapy. Improving the relationship between a mother and her baby has benefits for both sides on every front from mental and physical health and wellbeing through to reduced criminality and better academic attainment later in life.
So, aside from being heavily influenced by Bowlby’s theories of attachment, how is Isabel’s work to better understand ‘institutional anxiety’ relevant to our work with parents and infants? The answer is that while our therapeutic work with parents and their babies is at the heart of what we do, there is a great deal around that which is also of value. We know from countless enquiries following tragic deaths that communication between professionals is critical to identify and respond to abuse and neglect. We also know, although it gets less prominence, that there is a natural human tendency not to think about horrific or unthinkable acts which are close to us, to not see that which should be apparent or not to act when rationally it is clear we should.
It is only through giving front line staff the time and space to think through the issues they are faced with that we can reasonably expect them to respond sensitively and appropriately. It is only by developing people’s understanding of human relationships and how to respond supportively to distress or dysfunction that we can hope to reduce the number of such tragedies.
Children’s Centres vary hugely and they include some highly skilled and experienced staff, but the jobs are often poorly paid and under-supported. We offer both formal supervision and informal consultation to staff in children’s centres which helps them to contain and understand the challenging emotions and behaviours they can be presented with on a daily basis.
For two years after leaving university I worked in front line care roles: an older people’s care home and a geriatric hospital. I have seen, and fought to resist, the institutional apathy and indifference which can so easily come to inhabit such places. Poorly paid staff, too many demands on their time, and little support from management will inevitably lead to people becoming numb and ignoring of the people in their care. I fought to resist it but for me it was a short-term job. Had I had to fulfil such a role for a living, for life, I would have struggled to retain my humanity and compassion for the people in my care.
It is this emotional exhaustion that leads to detachment and organisational anxiety. It is the need to acknowledge and address anxiety, despair and depersonalisation that makes the work of Isabel Menzies Lyth important. How do we ensure the health of the organisations that provide the care in our society? How do we care for the carers? How do we prevent organisations from sinking into malaise?
N.B. This blog is adapted from the introduction I gave for Jeremy Holmes when he gave the inaugural Isabel Menzies Lyth Lecture ‘Malaise in the NHS’ for OXPIP on 22 October 2013. For more information do drop me a line.