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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.)

 

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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.

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Dr. Anton Obholzer, BSc, MB, ChB, DPM, FRCPsych

 

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, Turin and elsewhere in Europe.  He is co-editor and author of several papers in The Unconscious at Work, Routledge, 1994, and has written numerous other pieces on unconscious processes in organisations.  Dr. Obholzer’s special interests are unconscious factors that interfere in interpersonal and intra-institutional communication and change.

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Notes from Tony Page's diary: Wednesday 18th November 1998

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 Tavistock Square where it was located, but is no longer there.

 

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 Leicester. The clinic comprises a number of organisations now including the Tavistock and Portman NHS Trust, where Anton is CE. This is mainly involved in teaching and each year has around 1200 postgrads. Also clinical work, mix of public and private sector and research. Also Tavistock Marital Institute and Tavistock Publications and a few other parts.

 

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 UK. Using homespun stories - you wouldn't tell your mother something that was completely untrue would you, so why tell that to a customer? 80% liked it. 20% switched off.

 

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 China. First you-tell-us phase, then education phase, but did not really get it, until visit to UK which was shock treatment.

 

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 Paris until his midlife crisis, then he moved to Tahiti and the rest is history.

 

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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