Newsletters

Welcome to our Spring / Summer 2019 newsletter

In this newsletter

We have reviews of a play and a conference. We hope that these will encourage other members to write about books they have enjoyed, plays or films they have seen or events in which they have taken part.
Our technical team are working hard on the complex business of creating a community site. When it is ready it will be, among many other things, a place where experiences, views and reflections can be shared. Until then —- we have our newsletter.
Di Wells attended an unusual play, based on the work of Isobel Menzies Lythe. Here is what she has to say about it.

Diane Wells has been to a play

“The Liver in Bed 2”  Drama by E15 Drama School
Library Reading Room of The Wellcome Collection. London.
Based on Isabel Menzies Lyth’s paper “The Functioning of Social Systems as a Defence against Anxiety”
A review and reflection

“The Liver in BED 2”  
About twenty of us crowded into the doorway of the Reading Room, at The Wellcome Collection. A young woman stood in front of us holding a large box. “I hope you have done your reading” she announced crisply and beckoned us forward. Then, as if from nowhere, a very starchy looking Ward Sister appeared straight out of the 1950’s. She circled round us, faced us and then called out several names and ordered us to follow. We obeyed and as she hurried across the room she urged us to hurry. Then glancing over her shoulder said “You have been allocated to the surgical ward and are going to learn how to do a “bed wash”.” We crowded into a small bed space where a young female nurse, dressed as crisply as the ward sister, was washing a young male patient who was sitting in the bed. At first he accepted the sponging of his face and arms and seemed appreciative, but then he moved towards the nurse, and tried to be more intimate. She looked embarrassed as she struggled to keep her decorum. There seemed to be no help for her. Her uniform, the procedure and her sense of decorum were all that she had to protect her.

I was reminded of my own nurse training in another London Teaching Hospital in the early sixties about three years after the Menzies Lyth report that informed this drama. There was a huge onslaught of experiences each day in the interactions with patients but this did not seem to be any part of the official work and hence did not appear in the training. We had lists of tasks such as taking temperatures, washing patients, renewing dressings and each task had its own “procedure” which had to be learnt and practised. What went on between us and the patients was for us to deal with. These interactions were often embarrassing and challenged our youth and inexperience.

At times the patient and their emotions came like a shock bursting through my concentration . One day I was renewing a dressing. I had my trolley at the patient’s bedside. I prepared the patient for the procedure. I asked him to lie down and I arranged the bedclothes. Using forceps I carefully removed the dressing from his abdomen. I was concentrating on my surgical technique and the state of the wound: was it healing? Was it inflamed? Was there any exudate? Then the man tolerating this procedure asked “Will I be OK nurse?” I kept hold of the forceps and ensured my hands remained in the right place to avoid contamination. I remember a feeling of surprise. Our training about “procedures” gave little attention to the anxieties of the patients or that in ourselves. We were told to “Reassure the patient”. As Menzies Lyth says in this research report there is a belief that “nurses are born not made”. Hence training or support for this feature of the work was considered unnecessary. What happened to the anxiety in the patients and ourselves?

Senior Nursing staff at Kings College Hospital called in The Tavistock research team to help them solve a dilemma. They felt unable to fulfil their dual tasks of providing a work force for the whole hospital of 700 beds whilst at the same time providing the appropriate experiences in general and specialist placements for the students. The workforce was almost totally composed of student nurses. These “students” needed to be in practice for defined numbers of weeks in each area and to demonstrate competence in a wide range of skills before they could be entered for the State exam at the end of three years training. The wards needed students of different grades to ensure the right numbers of staff with the right level of competence. Year one nurses could do much of the caring work, whilst year two usually did the dressings and year three students administered drugs. The seniors found it impossible to fulfil their tasks.

The report gives a vivid account of the student nurses’ experiences as they faced the full impact of being physically and psychologically close to patients’ distress during illness and at times facing death. Furthermore the research revealed an organisation that had no methods to help the staff. As the first scene showed so well, a student could be behind the curtains performing an everyday nursing task, alone with the patient,  but if the patient ignored the taken for granted boundaries, all she (usually she) had was her uniform, the procedure and her own sense of appropriate behaviour to protect herself and deal with the situation. Uniforms and procedures were just two of the many defences listed by Menzies Lyth. They were short term solutions. In this play we also saw the inability of senior staff to make decisions. There was a poor overworked assistant matron running hither and thither asking every body to help her make an important decision. Here was another defence.

Why, we might ask, does the student nurse have nothing more than her uniform and procedure to manage or perhaps challenge the inappropriate behaviour?
Why does the senior nurse find it impossible to make a decision? or even Why was the decision not made closer to the patient – further down the hierarchy?  I didn’t see these questions answered in this play, but the report suggests that whilst everyone relies so much on the defences, staff do not have the opportunity to mature through the experiences. Instead of helping individuals to explore and think about interactions, responses and decisions the common practice was to find a procedure or another person to ask, or blame a junior. You do not have to work in a hospital in the mid twentieth century to recognize these features. I think they exist in many organisations still.

This has become such an important piece of writing. It is still used for organisational understanding.

Afterthoughts
I was alerted to this paper in the early 1970’s and it made so much sense of my own experiences. I had by then discovered The Cassel HospitaI, a therapeutic community based in Psychoanalytic ideas where we  noticed, discussed and worked in the relationship domain with our patients. It was a great relief and a long way from my nurse training of procedures, porringers  and getting the crest on the counterpane in the right place. It had taken several years and a detour to university before I found The Cassel.

In a later interview (quoted in Lawlor, D. 2016) Menzies Lyth said she thought people had often misunderstood this paper and thought she was saying “nurses need discussion groups” but, she argued its “containment” rather than discussion groups that is needed. I guess both are valuable since the staff need the understanding available in discussion groups to perceive and support the development of containing features within the organisation. Menzies Lyth may have argued for “containment” being the most important feature in order to  place the responsibility clearly near the top of the organisation.

I have heard that when the report came out the staff who had called the researchers in and many senior staff in other establishments rejected the Tavistock’s findings. This is not surprising since they were well used to using defensive responses and the researchers themselves, as depicted in this drama, seemed to be rather opinionated and unyielding women. Both Isabel Menzies and her assistant appeared to be quite stiff and starchy, similar to the nursing staff, but their uniforms were tweed suits. When starch meets tweed ….
The Liver in Bed 2 was movingly performed, and then we the audience discussed the play and our responses with the author and actors. For me it was the best kind of theatre. I hope E 15 drama group and their tutors continue to draw on The Tavistock archives at The Wellcome and provide us with more like this.

A fuller version of this review will be placed on the community website

Richard Pratt  has been to a conference:

From the Broads to the Estuary – introducing a new network to East Anglia.

On 23rd February, I was fortunate to attend the inaugural conference for a new professional network of psychoanalytic and psychodynamic practitioners in East Anglia. The conference, which took place at NorwichCathedral, was set up Dr Tim Fox and Anne Jennings, both experienced psychoanalytic psychotherapists practising in the region. The conference was oversubscribed, highlighting the need for support and affiliation, which is a shared aim and function of APPCIOS. There were 80 practitioners from across the region: the majority of whom are psychotherapists from various backgrounds and orientations; as well as some trainee psychiatrists and clinical psychologists with an interest in psychodynamic practice.

The two keynote presentations addressed the conference’s aim to offer a “renewed perspective to the fundamentals and common ground that inform our work”. The first speaker, Hannah Curtis, is a psychoanalytic psychotherapist with a social work background, who lectures at the Centre for Psychoanalytic Studies, University of Essex. She spoke of how the aim of psychotherapy is to go beyond the relief of symptoms and enable greater psychological freedom. She drew an interesting parallel to truth-seeking political processes such as the anti-apartheid movement “long road to freedom” and the need for the client and the analyst to undertake their own journey in a therapeutic context. In this situation, both are required to take the risk of challenging the “internal” oppressor or bully who works against psychological freedom. Hannah also reinforced the key arguments of her book,Everyday Life and the Unconscious Mind (2015), which explores “psychoanalysis without the jargon” and the challenges and value of psychotherapy where the truth is often denigrated and denied.

The second speaker was Bob Hinshelwood, Emeritus Professor in the Department of Psychosocial and Psychoanalytic Studies, University of Essex.  Well-known to many members of APPCIOS, Bob provided a thought-provoking presentation, which drew from his book,Countertransference and Alive Moments (2016). Initially he discussed enduring and living issues about the clinical application of countertransference. He highlighted how Sigmund Freud himself sometimes expressed contradictory views as to whether the analyst should disregard their own feelings stirred up by the patient or attend to them. Bob explored how countertransference is best used in the “here and now” therapeutic relationship – where effective interpretations will influence the course of the therapy by opening up new associations for the patient.  Like Hannah’s presentation this highlighted the overarching purpose of psychotherapy for therapists and clients alike to better know their own minds.

Following on, Gary Fereday, Chief Executive of the British Psychoanalytic Council (BPC), gave a brief talk about the collaborative efforts of different boards to ensure better co-ordination and support for practitioners who can often feel isolated. He showed a map highlighting the relative scarcity of BPC members in East Anglia. However the fact that the conference was oversubscribed indicated that there is a high level of interest in further developing a regional network.

The small group discussions explored this further. In my group, participants included psychotherapists from different orientations, psychotherapists and a psychiatrist- in-training. And in the plenary at the end, groups agreed for the network to prioritise:

  • offering mutual support
  • improving awareness of existing resources regionally
  • informing about local training available due to the relative scarcity of experienced supervisors locally.
  • providing more psychotherapy training locally (see box for details of training currently available).
  • To raise awareness and interest in psychoanalytic ideas and practice – in part to ensure increased commissioning .

Whilst recognising the wide-ranging training and career backgrounds of participants; the limited diversity, in terms of age, class gender and ethnicity was also acknowledged.  Some concerns were expressed about “clannishness” amidst local groups historically, based upon their varied orientations and training.

Finally, thanks were given to Dr Tim Fox and Anne Jennings for the initiative and hard work they had put into setting up the conference.

The next steps agreed were:

  • further mapping of individuals and organisations with psychodynamic orientation and the sharing of contact details of participants.
  • sharing information about current providers of relevant training within the region and the viability of additional training.
  • meeting next year – with further consideration of local groups.

I was struck by the similar aims and ethos of the emerging regional network and APPCIOS. Both have the potential to bring practitioners with a psychodynamic orientation together in an inclusive, “ecumenical” way. And whilst there wasn’t opportunity at the conference to detail the scope of APPCIOS, I was approached a few attendees at the end wanting to find out more.

Jenny Sprince comments:
As Richard says, this inaugural conference was oversubscribed. But when Tim Fox invited Bob Hinshelwood to speak at this conference, Bob – who is our chair of trustees – talked to Tim about the work of APPCIOS. As a result, Tim kindly ensured that Richard was able to attend, so that he could report back to APPCIOS members. Tim and I have since met,and we both hope to be able to find ways of collaborating at some point in the future.

For more information about psychotherapy training available in East Anglia, visit:

Catalyst, Lowestoft, provides training in psychodynamic counselling.
www.catalyst-wcs.org.uk

University of Essex, provides training in psychodynamic counselling. www.essex.ac.uk/courses/pg00750/3/ma-psychodynamic-counselling

Cambridge Society for Psychotherapy offers training in psychoanalytic psychotherapy
www.cambridge-psychotherapy.org.uk

Information was also provided about the two-year course in Infant Observation provided by the British Psychotherapy Foundation, Cambridge
www.tinyurl.com/bpf-infant-observation

Mentoring

Mentoring for Associates and Senior Associates
We were delighted to have people stepping forward to become mentors after the Autumn newsletter. As new associate and senior associate members join APPCIOS there is a continuous need. If you can spare a couple of hours per term please contact Anne Marie:anniembwight@gmail.com.

Full Members
Tiziana Bassini and Fiona Henderson are working hard to network with full members and have introduced the practice of contacting and getting to know all new full members.
We wish all our members a happy and productive summer.

Webinars

The six-week low cost webinar ran with four participants coming, as is often the case with APPCIOS, from all parts of the country: Edinburgh, Essex and London. The geographical diversity was valued by members who also commented on the similarity of issues: e.g. unacknowledged anxiety leading managers to be ever more controlling and keener to have statistics and reports in a defensive way. The need for a peer group as well as good supervision was articulated and of course chimes with what APPCIOS wishes to provide. Although apprehensive about technology at first members expressed an appreciation of being able to take part from the comfort of their own homes after a demanding day at work.
Susan Maciver hopes to run another short term, low cost webinar in the autumn and would be pleased to have expressions of interest.   Susan.maciver@hotmail.com

Therapeutic Supervision Webinars

I am pleased to report that I have a webinar group running this year with four practitioners from social work, fostering and adoption, and looked after children’s services. We are reading papers together and discussing our therapeutic supervision work with organisations and teams.
This is a continuing professional development resource that meets online one evening a fortnight. The aim is to develop skills and confidence in providing therapeutic supervision to staff in vulnerable and stretched services where morale is often under strain. We are thinking a lot about how to help teams sustain professional pride and expertise when austerity and managerialism are creating cultures where clients are seen as units of production and specialist skills are camouflaged in generic clothes. In these challenging times it seems all the more important to have ways of meeting up to engage and enthuse our thinking around relationship-based work.
Fiona Henderson (hendersonfal@gmail.com)

Fiona Henderson and Susan are poised to run an information session for members thinking about offering a webinar. As they wrote: “A few years ago, if anyone had told us that we would be running webinars online we would have been incredulous. It has been for both of us a very interesting and worthwhile journey.”
If you have missed the information session, please feel free to get in touch. hendersonfal@gmail.com and Susan’s address as above.

Fundraising appeal

We are raising funds to enhance our web site development, specifically for our on-line campus to enable our members and partners to connect through virtual learning communities.

If any member works for a Charitable Trust, we would be very grateful if you could find out whether your organisation would be in a position to make a ‘Charity to Charity’ voluntary donation, either one off or annual.  if you could let us know we can then make further contact.

 Thoughts, ideas, new projects?
We’d love to hear about them!
Keep in touch as we will with you.

Organisational accreditation and training

APPCIOS can accredit your training.  Whether you are an established training organisation or a new provider, we can help you write or enhance your bespoke training programmes to meet APPCIOS criteria. We would be very pleased to hear from you.

Find out more…

APPCIOS events

Take a look at the webinars we offer and view upcoming events from our partner organisations.

Find out more…

The thinking together principles that APPCIOS encourages and promotes mean that I maintain self-confidence as a professional and can continue to grow in my work.
APPCIOS Member

Help us to recruit new members…

If you know of anyone who would benefit from APPCIOS membership, please ask them to contact us at info@appcios.com.

 

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