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BRAINSTRUST WORKSHOP
Tuesday
17 November 1998 , 6.00
p.m. at The Grosvenor
House Hotel
The
Role Consultancy/Therapy Boundary:
Some aspects of a professional conundrum.
Presented
by Dr. Anton Obholzer, Chief Executive the Tavistock and Portman NHS Trust and author, “The
Unconscious at Work”
Chaired
by Tony Page, author,
Diary of a Change Agent.
(This
session will be filmed by BBC television.)
____________________________________________________________________
Dr Obholzer is a psycho-analyst, organisational
consultant and line manager in a Chief Executive position. He has been a leading developer of the
thinking of Klein, Bion, Jacques ,
Miller and Rice as applied to understanding the unconscious factors affecting
change in organisations. He will talk
about some of the very real professional dilemmas at the boundary between role
consultancy and therapy. He writes:
“ The
activity called Role Consultancy by some and Mentoring by others also goes by a
variety of other titles. All have as a
core issue the need for careful management of the boundary between the personal
life and the professional/work role of the consultee. The boundary concerned is less of a clear
line of demarcation, and more of a ‘transitional area’ cum no-man’s-land. How far the consultant ventures into this
area depends on a variety of factors, including the basic orientation and
training of the consultant. Some thus
enter from the ‘organisational consultancy’ side of the boundary,
others enter from the ‘personal’ side.
Either way there are risks and advantages that need to be weighed up. An
additional factor that needs to be taken into account is the state and nature
of the ‘defendedness’ of the client against change,
and whether the choice of one or other approach route might enable a more
facilitating role consultancy to develop.”
This
workshop is an opportunity to share experiences of these issues, and to weigh
up advantages and disadvantages of various approaches.
____________________________________________________________________
Dr. Anton Obholzer,
Psychiatrist
and a fellow of the Royal College of Psychiatry, and a psychoanalyst who
trained at both the Tavistock Clinic and the
Institute of Psychoanalysis. He currently holds the
position of Chief Executive of the Tavistock &
Portman NHS Trust, is Chairman of the Consulting to Institutions Workshop and a
Senior Consultant in the Tavistock Consultancy
Service. He is also Associate Director of
the Tavistock Institute of Human Relations Group
Relations Programme, and has directed residential group relations and
management conferences on many occasions.
Dr. Obholzer consults and
lectures widely on organisational change, and is responsible for organisation
development projects in Madrid,
____________________________________________________________________
Notes from Tony Page's diary:
Anton Obholzer
began by explaining the origins and structure of Tavistock.
It began in 1920 as the Tavistock Institute for
Medical Psychology (TIMP). Mainly comprised of disaffected
people out of the trenches in World War 1. It was multidisciplinary. It
produced the War Officer Selection Board. The counterpart to Tavistock was the Mawdsley which
mainly was interested in rehabilitation. It was named after
In 1948 with the
formation of the NHS Tavistock was split into the Tavistock Clinic which became part of the NHS and the Tavistock Institute which was an organisational
consultancy, non-NHS. The Institute came to promote "action research"
and organisational consultancy, and each year has run the 14 day Group
Relations Conference in
Anton is a large man. Over 6 feet with a large frame. He is probably in his
mid/late fifties. Brown/ginger hair, glasses, looking both
relaxed and serious, but with teeth showing implying a smile and a
lightness/humanity. He was keen to introduce me to the two women from
the BBC, to explain what they were about and to agree how to explain their
filming to the people present. We agreed with one of them, Beth Holgate, she would say something to explain why and to
reassure people about confidentiality.
Next we talked about his
session. He explained that he is not into technology (pointing to the OHP) but
he has prepared just
a couple of slides (pointing to a couple of hand drawn colourful diagrams). He
wanted to talk for around half and hour then to get a discussion going. He
hoped the camera would not impede the discussion. He wanted it to be more of a
dialogue than a series of questions to him and he was wary of idolisation and
of hearing only one side of things. He wanted me to hold the boundaries and to
participate, encouraging the discussion, including batting things to and fro
with him.
Anton's topic was
"The Role Consultancy/Therapy Boundary" which refers to the no man's
land between the client person and their role. When you are coaching a client
it can feel wrong to be talking about matters that concern them as a person,
about their whole life, when you are being paid to do something that is about
business performance and job related, but sometimes you find yourself doing
just that, and sometimes you know that this is exactly where the impact will
arise.
After I introduced Anton he began by
introducing the central notion of ANXIETY. He said this is a very useful
concept to use at the interface of clinical and organisational consultancy. But
he said there may be difficulties with using this term as it is therapeutic in
origin, and we are invited in as "role consultants" not therapists,
therefore you might feel it is not ethical.
Then he made what to me
is a very powerful statement:
"All theories and models are
systems for containing anxiety
and the fear
of not knowing!"
He said this thought
derives from Wilfred Bion, who was one of the Tavistock people. Anton went on to say that theories and
models can be useful but we must recognise they diminish our opportunities for
seeing phenomena afresh. In a consultation he is always interested to notice
what issues are being swept under the carpet, so seeing clearly is important to
him.
The broad framework of
what followed was WORK, ANXIETY, HOW TO MANAGE
ANXIETY.
First
WORK. I found what Anton said
really interesting and relevant to managing change. Anton asked what function
work has in society. He said work is necessary for society's survival. Since
the family and other institutions (church?) have been in decline, work had
become one of the central pillars supporting people's IDENTITY. Take away our
work and increasingly we feel loss, we are subject to mental illness and death.
Clear, plainly put. No frills or justifications. These
conclusions were not disputed since they were supported by his vast experience
(he undertakes 1000 role consultations per year, and spend 25 hours per week as
a psychoanalyst).
Then came
another big statement on RESISTANCE TO CHANGE:
"Changes in the structure of
firms shake the pillars of identity
and
therefore will always give rise to resistance".
I want to use this in my
sessions on resistance and defensiveness in Navigating Change etc.. He said that he is constantly amazed to find managers
don't expect resistance and are not aware of it occurring.
He said work enables us
as individuals to participate in institutions. This can be very positive for
us, but also brings with it the negative aspects of institutionalisation,
highlighted by Goffman and Eric Miller. The positive
aspect of belonging to an organisation is "relief from the strain of
thinking". As an example he spoke of the new person walking down the
corridor with their boss after a few days in a new job:
Boss: "it's really
great to have you here, everyone is really impressed
with what you have to offer our work"
New person: feels terrific, their heart swells.
But the other side of
what is happening here is that the new person has stepped over a threshold and
become thoroughly institutionalised. They are no longer a threat.
The key to
institutionalisation as an individual is to retain some sort of balance between
individuality and membership of the institution. There needs to be a creative
tension operating here.
When CHANGE happens, it
severs the bond of belonging. So change is not possible without resistance and
turbulence. ..but many managers are blind to this or
in denial about it.
This brings us to the
role of ANXIETY. The conscious side of work, is
perhaps that we are there to do a job which we get paid for, and maybe get
satisfaction from. The unconscious side is that work gives you a sense of
identity, it removes you from the "heat of thinking", it provides a sense of comfort. There is a conflict between
the unconscious and conscious sides of work which gives rise to anxiety.
In a MANAGEMENT role,
your work is always coupled with CHANGE, because organisations operate in a
turbulent world. If you only manage the status quo, not change, then you are
managing yourself and your organisation out of existence.
"Your choice as a manager is
not about whether to manage change,
it is only
about the speed of change".
That was a big and profoundly true statement
and here comes another!
"CHANGE is always associated
with ANXIETY,
and
RESISTANCE is always associated with that anxiety".
So let's look more
closely at the nature of anxiety. Psychoanalysts are interested in the
unconscious mind, and in anxiety. What we have is the unconscious mind acting
out, disturbing our conscious mind, and our behaviour. There are three levels
of anxiety:
1. PRIMITIVE
anxiety
This is ever present and
all pervasive. It is experienced by a baby left alone in the dark, by an early
experience of object loss. Social institutions are devices to protect us from
primitive anxieties. For example the health service is a misnomer. It is there
really to protect us from a primitive anxiety about death, and each time someone
tries to change it, there is lots of heat and strong feelings. These are our
defence mechanisms. The health service will never be good enough to banish
death.
Similarly the church,
police, education - all of these institutions exist at some level as a defence
against our primitive anxieties about, for example, crime etc.
Story. 3 year old. Putting him to bed.
Little leap. Why? Looked at father as if questioning can I trust you? Yes.
Child whispers There's a crocodile under the bed! Is
there really? What does it look like? Lots of teeth.
No. How could it get in? Through that vent up there.
Oh.
Teeth
significant. First form of aggression, biting the nipple.
Stories
like this perfectly normal in 3 year olds. We still carry remnants of our early struggles with anxieties in the
way we approach Friday 13th, not walking under ladders, cracks on
pavement etc. There's a 3 year old in
all of us, but deep underneath 40 layers of lacquer, our defences learned over
the years are layered on top.
2. Anxiety
FROM THE WORK ITSELF.
Elliott
Jacques and Isobel Menzies. Industrial & health.
Miners lung. Mad as a hatter. Occupational
hazards. Professional burnout in medicine, police,
psychiatry, police. This anxiety is not in the client themselves but in
the nature of their work. Work in the health sector often generates
psychological toxins in people working there.
For example, intensive
care units for babies. Menzies studied these units
throughout the world. Lots of risks to babies
survival. Wired up in incubators. Doctors
away doing research, others off doing exams, parents visit but rush away from
the pain of not being able to cuddle their babies, leaving nurses in charge.
Bleep on screen stops and baby dies. Young nurses often at a stage in their
lives when they are thinking about whether to have babies - Achilles heal. Stress. Many of these units are not working well in
psychological terms.
3. PERSONAL
anxiety.
This is the interaction
between the person's inner world and the work they are doing.
Example. Young solicitor. Weird behaviour to clients. Partners referred him for Role
Consultancy because he was acting "off role". Explanation for this
emerged that it was arising from how the divorce of his parents had been dealt
with many years previously. In effect it had never been dealt with. The man's
recollection was that he dealt with it well, but this meant he never thought
about it and never talked about it. He never worked at it in emotional terms.
So something, a sort of land mine encapsulated itself in his personality and
was waiting to be trodden on. Eventually a client came along with a suitable
difficulty and the solicitor got sucked in, became over involved…and his
partners referred him to Role Consultancy.
HOW TO MANAGE ANXIETY
So what does a consultant
do about anxiety? Wilfred Bion produced a useful
diagram of a didactic relationship, originally between mother and baby, but
also between therapist and patient or consultant and client. This is the
process of containment, of how anxiety gets managed or contained.
End result is baby is
relieved. Mother has coped. Baby feels when I'm in trouble I get helped. But not always. There are other scenarios. For example when
I'm in trouble, mother panics, situation escalates, it gets dangerous. Ongoing
experience of this interaction produces an internalised picture of the world,
an inner representation in the mind. Then later when we get in a situation, we
interpret the possibility of overcoming trouble by reference to this inner map.
As we grow up through
life we get "successor parents" in the form of teachers, bosses, leaders in all walks of life. We keep encountering in
different settings, a certain state of mind, a task to be done, difficulties to
be acknowledged and in some way dealt with.
Building on this, as a
consultant or therapist we might be in some way a successor parent: client
brings to us difficulties which we acknowledge and in some way help them to
deal with. This is containment. Now building a larger picture of it:
Family may be the
"family in the person's mind", "family of origin" or
"present family".
Key question for the
consultant is where are you working as a role consultant? Unable
to answer precisely but somewhere in the middle. Ask yourself where in
the system am I? What are the risks of being there?
Remind yourself of from
which side did you enter: consultants from left and
therapists from right. Bound to come across stuff from other
side too. Question of LEGITIMACY. You might not
be licensed to tread into personal area. At what point do you stop and refer
client to a therapist?
Question of what LANGUAGE
to use? It is possible to use a different language from the client. There can
be a defensive, collusive use of language in which both of you are hoping not
to understand one another! Question of is it legitimate to talk about symbolism
eg. headmaster, planting out
seedlings, destroyed by vandals.
Subtlety: giving client
options "Might there be a side to you that could see it in this way?"
Is it legitimate to talk
about the here and now "We're having this kind of conversation.
Does this also happen elsewhere when you are talking to…."
Sometimes hop from one
sphere to the other because an item that is undiscussible
may be discussible in the other sphere. Eg. Induction for a new member of staff
inadequate, often poor even with very senior and expensive people.
Thrown to wolves in effect, but not recognised as an issue. "Have you
noticed in your own personal life how a 4 year old carefully prepared by his
parents will sometimes treat a new baby, hugging it till it is almost strangled. What is happening? Natural
human response to a threat. Could the same principle operate in a 40
year old? Might it be possible that…"
Then it was time for
questions. Here are some notes of these and my reactions to them.
Q. When do you recommend
we stop and refer a client to a therapist?
Anton: Example. 25 hrs per week as a psychoanalyst. Confession.
Took on a therapeutic assignment. Carefully drew
boundaries, to contain it. Person came in, dumped suitcases, plugged in mobile
phone, got nowhere. Discussed how stuck we were. Was
PR Director - spinning stories, lost truth.
Me: Is this a bit like
the 3 year old you mentioned earlier. Looking at you and deciding to trust you
with something personal. If you then panic, this breaks trust and raises
anxiety.
Anton: Yes, containment
is a little like Russian dolls.
Q. When you are engaged
as coach isn't there an implicit understanding you will get into some personal
issues?
Someone then spoke about
"shame territory" and how it is difficult to deal with publicly.
Anton: Often the client
is implicitly saying "Would you please make it painless, and banish the
difficulty altogether?" Contracting with the client sometimes produces a
mutual defence pact!
Q. Don't we have a duty
of care towards a client?
Anton: My view is that
people are entitled to their own defences. As consultants we are not open cast
mining machines (although some behave as if they are)
Q. What do you do when a
manager says I don't have an issue with X, but my staff do, so will you please
work with them?
Anton: Difficult. I see
this as "splitting". I try to gather in some reality to reduce the
splitting. I would ask a question like "Do you remember when you were more
junior, in a position like theirs?"
Q. Are we kidding
ourselves when we are contracting, thinking that we can prepare the ground but
we can't know what will happen?
Anton: Yes. Interesting
question to consider is why did the client choose you? Beyond all the stuff about
being the best, most wonderfully brilliant etc….maybe they chose you as the
person likely to do the least damage! Maybe you have the same blind spots as
the client.
Q. Executive coaching is
burgeoning. More and more firms. Can
map them onto the two spheres. Question of standards.
When we're hired, remember there are 3 parties involved: us, organisational
sponsor who is paying and individual who is client. What is the sponsor paying
for? How would they feel if we were working on the right, on personal life when
they want impact in job role.
Q. Don't we need to
challenge the client not just follow?
Anton: Story. Father and son duo. How far into therapy can you take the
conversation? Anxiety level tells you when you have crossed the barrier. There
is a boundary somewhere and you only know when you bump into it.
Anton: In a way it is
like a doubles tennis match, you need at times to be
right up against the net experiencing the intense game, reacting, returning the
ball. But you also need the other position, seeing the game from a distance,
noticing where the lines are.
Q from
Anton. We all seem to be
agreeing. But not everyone has said anything. What is the other side of this
debate?
A participant: Story of
US marine operating in
Anton: Story of talking
to barristers about work stress. Barristers didn't get it. Wives said thank you.
Q from
Anton. When to acknowledge
personal life and when are you being intrusive?
A participant: In Coopers
now we are removing the stigma, personal development is becoming a reward
rather than a remedial area. Question for me/us as consultant is what do I feel
competent and comfortable doing?
Q. How do you cope with
difficult CEOs who do not acknowledge their part in
the problem. Anton. There is a 3 year old in all of
us. Feeling omnipotent. This is in the client too.
They do not like to acknowledge their difficulties. Ambivalence
about becoming involved in role consultancy/therapy. Sane to do personal development but also
miffed at the same time.
Q. Isn't it becoming more
common now to have old codgers coaching young people?
Anton: Raises question of
transference.
Q. Group facilitation and
boundaries. Asked to do teambuilding with Fire Service people
in home office. Drawn to do it, but acknowledge it is beyond experience
base. How to make it an ethical proposition. Is it
off-limits or not?
Anton. Raises question of
does it help to know something about the business. Yes and no. Yes but there is
a risk of getting sucked in, getting institutionalised like them. No, there is
a view of organisational consultancy as "licensed stupidity". Anthropologist
is fascinated to observe how you people do this and that.
Q. Is there a risk of
creating a self-serving professional elite.
Me: All relationships can
be therapeutic. 70% spontaneous remission from neuroses.
Psychotherapeutic agents in community. Relationships containing certain human qualities.
Process review in which
client and consultant both reflect on progress and feelings, is corrective to
worst excesses, as giving both client and consultant control, accessing
learning, experience of the conversation, opportunity to steer.
Anton. Need to avoid
narrow professionalisation. Profession needs to be
porous, osmotic.
Q. We are part-timers and
amateurs. Installing accounting package produced change in roles and
perceptions.
Anton: International
consulting firm observed two models of consulting
-
UK/US,
accompanied companionship, someone who thinks differently to join you on the
journey
-
Spain/Italy/Latin
countries, being given the answers by the experts
Q. Story from
Anton. Yes moved from
dependence to autonomy state.
Q. What about mid-life
transitions? Aren't we likely to be called on at such times? Triggered
from work or home crisis, or just that 3 year old gnawing away from inside you.
Anton: Vital for me to
operate from a state of being that is "Not knowing and fascinated".
Elliott Jacques called this "casting a beam of darkness". Elliott
Jacques wrote the best paper on this - Death and the Midlife Crisis. The crisis
happens when you pass a watershed from believing in your own immortality to
realising it is your turn next. A feeling of "unless I do something now….". Brilliant things can come from these crises. Gauguin
was a bank clerk in
Organisations and
professions have midlife crises too. There is a developmental pattern: after
flags are raised and success is celebrated, then you become a dinosaur. Good to
ask the question "Why am I being called in now?", "Where is the
client in their developmental pattern?" Sometimes client may be thinking
of leaving and finding it difficult, and feeling guilty. They get a consultant
in and quietly slip out!
The end.
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