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Work Discussion

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'Work Discussion brings together a combination of close observation of, and personal and interpersonal responses to, the minutiae of the work setting and its dynamics, both internal and external. Such a model depends on the development of hard-won capacities, and the descriptions offered here, both by students and by experienced staff, fully demonstrate the immense relevance of the approach, both to training and to a wide variety of work situations. The book first outlines the process of the method itself, followed by descriptions of a range of settings, both in Britain and abroad, in which that method has been successfully applied. The contributors draw on experiences across age, culture, and race in, for example, schools, hospitals, residential homes, in a prison, and in a refugee community. The final chapter explores the implications of work discussion for research and policy-making more generally. Many of the situations narrated here are extreme, whether in terms of disturbance or of vulnerability, but these pages offer often moving insights into how effective the method can be and how truly impressive a developmental model it provides.'- Margot Waddell, from the Series Editor's Preface

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11 Chapters

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1 Work discussion: some historical and theoretical observations

ePub

Margaret Rustin

Despite its rather prosaic and literal nomenclature, work discussion as a component of professional education and practice has flourished in varied contexts since it began to figure as a systematic element in advanced training courses in the mid-and late 1960s. This chapter attempts to elucidate where the concept came from and discusses its significance. Although there has been an expanding literature on psychoanalytic infant observation (for example, Briggs, 2002; Miller, Rustin, Rustin, &Shuttleworth, 1989; Reid, 1997) and its later observational derivatives-young child observation, observation of the elderly (Davenhill, Balfour, &Rustin, 2007), and institutional observation (Hinshelwood &Skogstad, 2000) being particularly important developments-there has not, as yet, been a parallel growth in writing about work discussion. Perhaps its unglam-orous name has had something to do with this, but probably more significant is the way in which it can disappear as a distinctive category and become subsumed under more familiar educational activities: it is easily placed as part of the now widespread notion of “reflective practice”, and much of it can be relabelled as “clinical supervision”. However, quite a lot is lost if the particular meaning that work discussion originally had is put aside, and within many courses offering opportunities for professional development and now validated as postgraduate degrees it holds a central position.

 

2 The work discussion seminar: a learning environment

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Jonathan Bradley

This chapter considers the potential for and process of learning in a work discussion seminar. The relationship between the seminar leader and the members of the group is at the heart of the learning experience. The material brought to the seminar is often profoundly painful and upsetting for both presenter and listeners. The crucial role of the seminar leader is in finding a way for the group to become aware of the nature of the distress being communicated by the worker, and by client to worker, to be able to hold on to it for long enough to get beyond immediate defensive responses, and ultimately to understand more about how the worker's relationship to the client may be able to modulate the emotional situation helpfully.

This kind of learning becomes possible as the seminar leader directs members' attention away from learning additional facts and towards reflection on practice. Those taking part in a seminar may well find that no one else there shares their profession. This could lead to a view of their being the undisputed expert in their field or, by contrast, allow them to become part of a group where they are free to reflect on their work in a different way. The seminar leader's task is to help the group to move in this direction.

 

3 What';s happening? Some thoughts on the experience of being in a work discussion group

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Katie Argent

A

rriving at my first work discussion seminar, I had some idea, gleaned eagerly and anxiously from conversations with other students, about this seminar being to do with conscious and unconscious communication in work with children or young people. I was aware of feeling relieved that as a consequence of my own hard-won experience as a patient in psychoanalytic psychotherapy, I thought I knew a thing or two about unconscious processes that I could now put to good use in what I comfortably imagined would be a fairly abstract though not, of course, impersonal discussion. In other words, I did not arrive with the expectation that this would be a seminar that would touch me emotionally, let alone play a part in changing my perspective on and approach to working life.

As we introduced ourselves in the seminar group, the first surprise was what varied working backgrounds we came from, with widely differing kinds of experience and levels of expertise in work with children and families in areas such as education, health, mental health, social services, and community development. I quickly realized that the array of notepads and pens with which I had armoured myself would not be particularly useful. Rather than studiously taking down references and making notes, we were going to be looking in detail at each other's descriptions of interactions with children and other members of staff in our workplaces, including descriptions of the way in which we ourselves behaved and expressed ourselves in these interactions. Not safely theoretical, then.

 

4 Work discussion groups at work: applying the method

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Emil Jackson

A

s we know, not all children or adolescents are able to ask for psychological help-at least not directly. We are familiar with the worrying ways in which young people can be propelled into action by their difficulties, while finding the prospect of any reflection pretty terrifying. For example, adolescents are often unaware of how much help they need; even when they are, many can't make the leap of faith necessary to get themselves to an unfamiliar outpatient setting-however young-person-friendly it might be. So, if we are serious about helping and engaging with young people, we need to build therapeutic bridges into their communities and particularly schools, where a more familiar setting might reduce anxieties sufficiently to enable them to make contact.

However, within schools, this relies on the assumption that staff are able, interested, or encouraged to develop supportive relationships with pupils whose education or emotional development is at risk. In reality, this is simply not always the case. While most teachers believe that the teacher-pupil relationship lies at the heart of learning, there is a striking absence of any significant input within initial teacher training relating to personality development, the emotional factors affecting teaching and learning, or the management of teacher-pupil relationships. For example, in a needs assessment carried out by the Brent Centre for Young People in ten secondary schools, only 12 out of 145 teachers (6.9%) reported that they had “received sufficient training in adolescent development” (Salavou, Jackson, &Oddy, 2002). It is therefore no great surprise that many school counsellors and therapists find themselves approached as if they were simply providing a depository for the badly behaved-providing only temporary relief for despairing teachers.

 

5 Work in educational settings

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Elizabeth Nixon

Idescribe the work of a drama therapy group for adolescents with learning disabilities-that is, an often non-verbal group using an often non-verbal medium. Because of all that has to be engaged with, adolescence becomes a time when disillusionment takes on a particular force. Bion (1970) describes disillusionment as being the desire to know and understand about the truth of one's own experience, on the one hand, and having an abhorrence of knowing and understanding, on the other. On many levels, the work of adolescence is disillusionment. Maturity entails tolerating the frustration of being other than what we desire.

My concern is with the difficulties faced by adolescents with a learning disability in managing the adolescent tasks. Working through these tasks is greatly complicated by the reality of being born damaged or different. To be seen to be different is bad enough, as Sinason (1992) says, but unfavourably different can feel catastrophic. The sense of being unfavourably different puts an obstacle in the way of emotional growth, to the extent that such growth depends upon relinquishing omnipotence and addressing reality. The reality of a learning-disabled adolescent is one that few would ever choose.

 

6 Work in health and residential settings

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Claudia Henry

This is an account of work I did as a hospital play specialist (HPS). I worked on a high-dependency 12-bedded surgical ward, which I shall call Badger ward. The problems the patients presented were mainly gastric, and there was a mixture of short- and long-stay patients. The children varied in age from neonates to 16 years old. I worked closely with the children, but also with their siblings and parents.

There was a playroom on the ward where much of my work took place. It was a safe area for the children, and I tried to ensure that no invasive procedures were performed on them in this room. I also worked with the children by their bedside when they were too unwell to come into the playroom.

In my role as a play specialist I had no specific structures to my day. Things on the ward were forever changing—children who seemed well enough to be in the playroom could, from one moment to the next, become very ill. There was an endless sense of vulnerability and anxiety, which I sometimes found overwhelming. I will focus on my battle to keep on thinking in spite of this anxiety and to keep on holding on to all the signs of life where there was often a real risk of death.

 

7 Work with vulnerable families

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Fadumo Osman Ahmed

In this chapter I describe the work I do in a community centre, responding to the needs of refugees. Unusually, both staff and clients originate from the same country, most having come to this country within the past 10–12 years. For many, adapting to new circumstances has led to many emotional and exposing moments. It is a community that has experienced loss in a profound way: most of the clients are “single” mothers struggling to bring up 5 or 6 children on their own. It is a life made worse by not knowing what has happened to their husbands, homes, financial assets, and even other children who had become separated in the panicky flight from danger.1

There was a paradox in the way the community as a whole dealt with these shocking events: they produced traumatic reactions, but it was difficult for them to be fully acknowledged. I will describe my own attempts to understand quite complex feelings. I became aware that both staff and clients disregarded mental illness, and in fact it seemed to me that the staff deprived their clients of the mental health services they needed, perhaps because it was too painful to face up to these issues.

 

8 “Sibonye is stuck …”: the work discussion model adapted to South African conditions

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Sheila Miller

Sibonye is stuck”, said his crèche principal, and she went on to add that she meant this literally, as he “spends all his time in the ‘block area’”, playing rather mechanically with blocks and small vehicles, and he simply cannot be persuaded to take part in any other activities. At mealtimes, she said, he ate voraciously, never seeming satisfied. The only place other than the block area that he would go to was the classroom of a teacher of an older group of children. She let him sit close to her while she worked and, in the eyes of the rest of the staff, was “spoiling” him. Tandi, the principal, an experienced and calm person, conveyed a sense of deadlock. This 3-year old was obviously engendering desperation and despair. Her comments showed that she had genuine concern for the boy himself but was also worried about what it meant to other children that he was allowed to miss the story ring and other activities. The “problem” was affecting crèche routine and also causing staff tension between herself and the member of staff who was “spoiling” him. The staff had all been patient with him thus far, and now that the end of his first year was approaching, she felt that something needed to be done.

 

9 Parenting a new institution

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Simonetta M. G. Adamo, Serenella Adamo Serpieri, Paola Giusti, &Rita Tamajo Contarini

The Chance Project is an initiative whose main purpose is the educational and social re-integration of a group of teenage drop-outs, aged between 14 and 16. It aims to enable these adolescents to obtain a school diploma by combining academic education, focused on the achievement of literacy, with the learning of social and practical skills. The range of activities is designed to re-instil a fundamental motivation to learn through an educational programme that is wide-ranging and personally meaningful, and through opportunities for developing cooperative skills.

Chance consists of three centres set up within schools in deprived areas of Naples—the historical centre and two outlying districts. Each centre has a coordinator, and there are also two head teachers, one of whom holds responsibility for the legal and administrative aspects, while the other coordinates the educational activities. Each year 80–90 children are involved, so over the nine-year period over 700 have passed through the project.

 

10 Work discussion seminars with the staff of a children';s home for street children in Puebla, Mexico

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Gianna Williams

This chapter describes the use of work discussion in Casa Juconi, a home for street children in Mexico that I have visited and kept in touch with regularly over the past eight years. Juconi stands for “junto con los niños“ [together with the children], and Juconi is an NGO devoted to “retrieving” street children and bringing them to Casa Juconi—a very unusual children’s home—for a long stay. Casa Juconi is unusual because it has opened itself to a keen interest in the emotional life of the street children, and this is not a frequent occurrence in the many organizations devoted to street children’s welfare in Latin America. I have been to Puebla, the town where Casa Juconi is located, six times for an average period of ten days, since 1999. My work with the group started with my presence in Puebla—but it has continued with “distance teaching”, via email, during the intervals between visits. I have been joined in the task of “distance teaching” by two child psychotherapy colleagues. There are regular staff meetings where our email input is discussed by the group.

 

11 Work discussion: implications for research and policy

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Michael Rustin

The method of work discussion is highly particular—it depends on a single individual practitioner observing himself or herself while actively involved in a work situation and reflecting on the implications of what is being seen and experienced. A work discussion seminar supervises and reflects on each member’s observations and reports, and in that way there is a sharing of knowledge and understanding between practitioners whose work situations will usually have something in common. Nevertheless, it is the individual’s experience of a situation that is the focus of exploration according to this method.

Work discussion, since its inception, has had two major purposes. The first of these, which it shares with the method of infant observation, is educational and formative. It is intended, like infant observation from whose procedures it derives to a substantial degree, to enhance the psychoanalytic understanding and capacities of those who undertake it, outside or prior to their use by the learner/practitioner in a clinical context. Its usual participants are students engaged in work in educational, health, or care settings who are invited to conduct “participant observations” in their places of work and reflect on them in small seminars originally modelled on those that take place in infant observation programmes. The similarities lie in the method of presentation of detailed observational reports followed by supervisory and peer discussion, in the small scale of the activity (ideally five or so seminar members in a group, permitting two presentations per student in each term), and in its continuity of experience (with participant observations preferably continuing for a year or more). This method has been found to provide an opportunity to observe, reflect on, and learn about the emotional and unconscious aspects of work in these settings, which no other activity comparably provides. This has been a context in which some of the most valuable of contemporary psychoanalytic ideas could be learned in their use, and in their relation to experience, rather than merely “learned about” as abstract concepts. Such complex ideas as those of the relations of containment, the mechanisms of splitting and projective identification, “attacks on linking” (Bion, 1959) and on thought, and the varieties of defences against unconscious anxieties have, through this form of learning, become resources for understanding the dynamics of work-settings where human relationships are central. Just as with infant observation, it is found that a combination of the experience-based learning of work discussion, with some parallel learning of relevant psychoanalytic concepts and theories, enables students to find meaning in emotional and unconscious aspects of their experience and to achieve significant development in their capacity for thoughtful practice. In some educational programmes infant observation, and work discussion, and sometimes young child observation too have been undertaken in parallel, together with a course in psychoanalytic theory. The different balance between reflection and activity called for by these settings is often helpful to the learning process.1

 

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