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The Transitional Approach in Action

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The chapters in this volume cover a wide range of topics that concentrate around four themes: transitional change in therapeutic communities; in working conferences for professional development or training; in organisation consulting with an emphasis on organisational learning; and in self studies of working systems in action. In all these psychic activities, "time and space" were created to allow for transitional processes to become alive. A therapist, a manager, a consultant or a layman may create conditions that facilitate or hinder human beings to become engaged in these normal, healthy processes, but the persons concerned undertake the basic psychic work.'It is encouraging to notice that more and more clinical institutions, organisations and even professional associations are becoming aware of the important and complex interactions between psychic processes and organisational realities. The engagement in transitional processes, however, demands courage. Courage that is proper to any pursuit of truth and social justice. At times, this search generates excitement, at other times we become scared by the realities we discover. Sometimes we need to cast aside certain realities to imagine and invent new things and subsequently face them again to make effective use of whatever we created. Society and human beings need such pursuits of truth and social justice for genuine development. The courage it takes to become engaged is only matched by the courage to live with the consequences.'- From the IntroductionContributors:Gilles Amado; Rina Bar-Lev Elieli; Harold Bridger; Caroline Drevon; Ernest Fruge; J. Alan Harrow; Marc Horowitz; Dominique Lhuilier; Derek N. Raffaelli; Rafael Ramirez; Dominique Rolland; Andre Sirota; Marie-Jeanne Vansina-Cobbaert; and Leopold Vansina.

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CHAPTER ONE. The discovery of the therapeutic community: The Northfield experiments

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Harold Bridger

Introduction

One of the most important achievements of social psychiatry during the Second World War was the discovery of the therapeutic community. The idea of using all the relationships and activities of a residential psychiatric centre to aid the therapeutic task was first put forward by Wilfred Bion in 1940 in what became known as the Wharncliffe Memorandum, a paper to his former analyst, John Rickman, then at the Wharncliffe neurosis centre of the wartime Emergency Medical Service (EMS). When he tried to put this idea into practice, Rickman got virtually nowhere in the face of strong resistance from medical and administrative staff. It entailed a radical change in staff-patient relations that produced a figure-ground reversal2 in the traditional authoritarian hospital. In order to achieve active patient participation in treatment, power was to be redistributed away from its monopolization by the doctor and shared by other staff and patients in appropriate ways.

The opportunity to test the efficacy of the therapeutic community idea arose in the autumn of 1942 at Northfield Military Hospital in Birmingham, when psychiatrists were invited to try out new forms of treatment that would enable as many neurotic casualties as possible to be returned to military duties rather than be discharged to civilian life. Rickman, by this time in the Royal Army Medical Corps, had been posted to this hospital for some weeks when Bion joined him from the War Office Selection Boards (WOSBs).

 

CHAPTER TWO. A therapeutic community: a space for multiple transitional change

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Marie-Jeanne Vansina-Cobbaert

When, in 1974, the psychoanalytically orientated department for adults was created at the St Joseph’s University Centre in Kortenberg, (Leuven), Belgium, it was not designed with notions like transitional space or transitional change in mind. The psychiatrist-psychoanalyst who initiated the project based it on his knowledge of existing therapeutic communities in Britain and in The Netherlands, and on his understanding of, and trust in, psychoanalytic therapy as a vehicle for change.

The psychoanalytic department for adults had developed for about ten years when I started to work there as a psychoanalytic group therapist. By then, the population was clearly defined: rigid neurotic personalities and severe personality disorders.1 Most patients had tried some sort of ambulatory or residential therapy before, with little or no success. About eighty per cent of them had more or less severe suicidal attempts, and some practised auto-mutilation. An important requirement for acceptance was that the person had some awareness that his problems were somehow related to his way of being and acting, to his experiences and to the way he made sense of the world around him. The department could accommodate thirty-four people in four groups of eight.

 

CHAPTER THREE. The therapeutic community: its potential for development and choice of future

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Harold Bridger1

Introduction

Iwant to introduce my few words with a slightly depressing note. Because in all my experience as a teacher, an army commander, a psychoanalyst, and an organizational consultant there is the need to be aware that what one hears is of very little account unless it is accompanied by what one does. Many people say “I am ready to learn”; “we must always be aware of the need for change”, and so on, but one always find reasons why either one cannot do it now, or perhaps can do a little bit where it does not affect the main stream of work and structure.

It was therefore all the more valued and encouraging to be working with Centro Italiano di Salidarietà di Roma (CeIS) in Rome from the time of that very innovative learning institute, which they initiated in 1984. In very few other institutions have I experienced that same strength of continuous readiness to keep adaptation to change as part of its operational practice. Such qualities can be achieved with vision and effort. In addition, however, one must respect just as much the way the organization is designed so that it fulfils both the vision and the effort.

 

CHAPTER FOUR. A journey towards integration: A transitional phase in the organizational life of a clinic

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A journey towards integration

Rina Bar-Lev Elieli

Introduction

The process that takes place in the life of any group, large or small, that is organized along the lines of any type of scheme, agreement, and connection, is singular due to the very fact that it is occurring within a group. Such processes have a massive direct impact on the unconscious, intensive, inner world of each of us, and the unconscious interaction between all of us.

When asked to intervene with an organization, a consultant, whose function invariably entails representing the group’s tasks and development, is expected to provide answers and solutions to problems and difficulties that the system cannot tolerate. Frequently, that same consultant is not the one who provides the answers, but rather the one who asks the questions; questions which almost always have a bearing on the essence, identity, being, and mode of action of the organization.

Investigation and questioning is related to very primitive phantasies about the contents of the “mother body”. What is there inside the container that we form by our being together as a group? What is projected and introjected in the process of being a group? The attempt to make a rational investigation of any group is therefore perturbed by fears, and the mechanisms of dealing with them, that are characteristic of the paranoid-schizoid position. [Bion, 1961, p. 162]

 

CHAPTER FIVE. A transitional approach to management education: the Sextant experience

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Gilles Amado

Introduction

This chapter provides an example of a “transitional” design as applied to management training. This design was first applied in September 1985 as an experiment at the Institut Superieur des Affaires (ISA)1 at Jouy-en-Josas (France) with a group of second-year students. We called it “the Sextant2 experiment”. It represented a challenge to traditional teaching and a response to both the demands of management and the criticisms that had been raised for several years against management training in business schools (Abernathy & Hayes, 1980; British Institute of Management (BIM), 1988; Cheit, 1985; Mintzberg, 1989; Muller, Porter, & Rehder, 1991; Xardel, 1986).

A study of 600 company presidents undertaken in America (Jackson, 1986) showed that eighty-six per cent of them thought that “business schools teach students a lot about management theory but not much about what it takes to run a company”, and that they produce many more “quantjocks” (quantitative kids) or “cold, number-crunching automatons” than managers worthy of the name. Such managers should be capable of resolving complex problems (for which the case method is too narrow and superficial) and of encouraging all the forces of labour to really participate in the development of the company in which they work. These capabilities require, among others, interpersonal skills. European business schools, following the example of their American counterparts, have proved the quality of their teaching in the logical intellectual abilities (analytic approaches, generation and application of models, formal rigour, and coherence in decision-making processes) but they have not always allowed for the development of personal and interpersonal skills of future managers, which are so crucial in the organizations of today. Thus, the capacity of such managers for personal commitment and their willingness to take into account their identity, their personal feelings, and their ability to communicate are too rarely questioned or developed in this type of teaching. Such factors will, however, constitute the basis for their eventual leadership during their careers. Certainly, the case method tries to make up for these deficiencies and does partially work because of the simulations of professional life that are involved. Nevertheless, it favours more role play than a true involvement in real actions.

 

CHAPTER SIX. Leadership dimensions of the physician’s role: a transitional approach to training in paediatric haematology/oncology

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Ernest Frugé and Marc Horowitz

Overview

While modern medicine and its institutions have been progressively and irrevocably shaped by technology there remains a core task of helping people cope with the challenges and changes posed by physical threat, suffering, and loss. Physicians are in complex leadership roles within these contexts. Some aspects of physician leadership are explicit and primarily technical in nature (e.g., constructing diagnoses, writing orders for medications). Many aspects, however, are fundamentally social and implicit (e.g., guiding a family through difficult choices near the end of life).

Although the leadership dimensions of the physician’s role may be obvious to an observer, traditional medical education does not offer formal training for this facet of a physician’s role. Physicians typically acquire leadership skills through observation, trial, and error with little or no reflection and conceptualization of principles. This chapter describes a seminar designed to teach paediatric haematologists/oncologists about the psychological, social and organizational aspects of paediatric haematology/oncology through reflection and analysis of the leadership dimensions of their role. The seminar’s theory base and design is rooted in the Tavistock tradition of group relations training and incorporates basic elements of transitional thinking and the transitional approach to change. This seminar may offer a model of training for other health related disciplines.

 

CHAPTER SEVEN. Intermediate cultural space

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André Sirota

Every human being leads a dual existence, as he is both an individual and a social being. He has his own unique personal project that is appropriate to the period in which he grew up, while at the same time he is a link in a genealogical chain to which he is subject (Freud, 1914). Though in order to live in his own generation he must separate from his predecessors, he still needs to maintain continuity with them (Kaës, 1987, p. 153). Thus, both cultural and psychological work are needed to deal with the inevitable tension that results from the effort to co-ordinate inner and outer reality, self and non-self (Winnicott, 1951) and past and present. This work, when carried out with other people in structured contexts, fosters inner change and enables the individual to adapt to and innovate within the public arena. These contexts constitute intermediate spaces, the practice and theory of which must constantly be revised.

While everyone needs stability to keep alive the desire to grow (Racamier, 1992), the current generation does not live in the same cultural universe as did the parental generation. Chaos, insecurity, discontinuity, absurdity, change, and crisis (Barus-Michel, Giust-Desprairies, & Ridel, 1996; Mendel, 1969) are everyday ills. The youngest members of society, confronted with the blurring of ideological models, the collapse of the socioeconomic base and a society that seems to have closed its doors on them, suffer not only from an identity crisis (Castoriadis, 1990), but also from a crisis in the very meaning of existence. When a sense of worthlessness overrides uncertainty and conflict about identity, then social structures may arouse psychotic, perhaps even more than neurotic, features of the personality. To manage these terrible disturbances, we need to develop intermediate spaces, the contemporary equivalent of the rites of passage (Van Gennep, 1909) of the past. The latter facilitated passage to or through the major age sets, stages, and crises of life. A contemporary place of passage, which would give both youth and older adults the feeling that they were being taken seriously, might then enable them to work on their ambivalence towards the later, adult cultural areas, and to mourn the loss of the advantages offered by the earlier cultural areas of childhood and adolescence, or even by marginality and future exclusion. They would then be able to emerge better prepared from periods of psychological vulnerability or indeterminate periods of social marginalization. Without these spaces in which to develop a sense of meaning, many young people feel left out. Without activities related to their environment, inner exile and regression replace the necessary transformation of the movement towards growth. There is a weakening of ties in place of bonding. The increasing violence in the major cities and their working-class suburbs, in the schools (from elementary school to university) and in public buses might well be considered the acute expression of a demand, crude because it is not thought out, for a place of passage which would truly lead toward social integration, work, and the co-construction of the meaning of life in society. For those who are left out, those schools and those buses, which every day transport other people to their enviable destinations, are totally unbearable.

 

CHAPTER EIGHT. Action research and transitional processes: risk prevention in a hospital in Burundi

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Dominique Lhuilier and Dominique Rolland

The action research1 we will present and analyse here is aimed at understanding in order to change, and changing in order to understand. It is in line with Kurt Lewin’s (1959) message: “In order to understand a reality, you have to try to change it”. In doing so one can identify resistance and the areas of conflict, and then try to discover or invent ways to overcome the obstacles or difficulties.

The context, in which the hospital organization is embedded, is an essential element for the construction of a diagnosis of the local situation.

Burundi is a country on the African continent in the region of the Great Lakes. Armed conflicts have profoundly disturbed the traditional organization of the Burundese society. The last conflict, which started in 1993, still continues.

Today this country has to deal with multiple problems. The situation became even more troublesome when international aid was stopped. In an unstable socio-political context and a civil war climate, the economic crisis produces pauperism and precarious-ness. The civil war has led to a displacement of the population and a strong decrease in agricultural production and cattle breeding. The degradation of life conditions and hygiene as well as the deterioration of health and educational programmes are perceptible. The increasing mobility of populations that try to flee from insecurity or look for means of subsistence adds to the multiplication of sanitary problems: malnutrition, epidemics of malaria, cholera, and typhus, as well as HIV AIDS. At this point in time 9-12% of young adults in urban areas are HIV positive and in rural areas 2-7%. Endemic tuberculosis related to HIV AIDS and socio-economic conditions show a similar deterioration.

 

CHAPTER NINE. The role and limits of methods in transitional change process

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Rafael Ramírez and Caroline Drevon

Introduction

In this chapter we outline how certain methods may be used to support transitional change in organizations. The transitional approach to organizational change is one in which management attempts to enhance organizational learning as much as possible. This is not just learning by individual organizational members. As de Geus (1988) put it: “Institutional learning is a process whereby management teams change their shared mental models of their company their markets, and their competitors”.

In our consulting practice and research activities, helping organizations to change, we have found this learning metaphor to be a helpful way of thinking about organizational change management (e.g., Argyris & Schön, 1978; Garvin, 1993; Morgan & Ramírez, 1984; Ramírez, 1983). The challenge in many settings is to ensure that this approach to change is carried out as a normal part of everyday management. Rather than being manifested only in specific time and space situations where it is experienced as some sort of special event, it should also be embedded, almost without being perceived, in everyday practice.

 

CHAPTER TEN. The art of reviewing: a cornerstone in organizational learning

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Leopold S. Vansina

Ihad assumed that reviewing an activity carried out by a group of people was a normal process within the reach of any consultant or manager. That naivety was quickly lost when we asked the members of our International Professional Development Programme: Leading Meaningful Change to carry it out, at the end of each day in the programme. The importance I attach to reviewing matches my concern to fill this gap in knowledge and skills. This chapter is an attempt to share with you my current understanding of the reviewing process and the difficulties to institutionalize learning from experience as one important step in the development of a learning organization.

Reviewing

Harold Bridger and many others predominantly active in group relations conferences make a distinction between the primary task (task one) and how the team has been working on that primary task (task two). The latter refers to reviewing or, in more general terms, the study of process. This distinction, although useful in practice, lacks some conceptual clarity. Being an organization consultant, I prefer to use the concepts of task work and teamwork on the one hand, and reviewing through self-reflection after the events and the study of what is happening in the “here-and-now” on the other hand. Task work refers to how the activities have been carried out to achieve task accomplishment, while teamwork refers to how the people involved have been working together to achieve task completion. This conceptual distinction has some benefits. Indeed, it makes explicit that self-studies and reviews should cover both domains: the task work and teamwork. Indeed, task work with all the required task knowledge, heuristics, and logistic principles is often—but wrongly—left out of the self-study in favour of teamwork when there is a preoccupation with group dynamics and a belief that all performance loss is due to “faulty process” (Kaplan, 1979). Teamwork, on the other hand, is likely to be skipped over when a rational objective and factual framework dominates. The importance of self-study of both domains is on the increase whenever people have to change their mind-sets or representations of managing, organizing, and working; for instance, when an organization moves from working from a hierarchical position to working in a network-like or a knowledge organization. Changes in mindsets and mental representations are made possible through regular confrontation with the enactment of these representations, expressed in observable behaviour, within a trusting and supportive group.

 

CHAPTER ELEVEN. Self action research: An institution reviews itself

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Derek N. Raffaelli and J. Alan Harrow

… to try to love the questions themselves like locked rooms and like books that are written in a very foreign tongue. Do not now seek the answers which cannot be given you because you would not be able to live them

Rainer Marie Rilke (1875-1926), Letters on Love and Other Difficulties

Introduction

This is an account of an organization’s attempt to review its way of functioning, through self-reflection, by having a critical dialogue with itself, by—so to speak—being its own action researcher. The organization is the Scottish Institute of Human Relations. It is a psychoanalytically based institute principally concerned with training in the psychotherapies (child, adult, family, and group) and their application via therapeutic services such as personal analysis, counselling and organizational consultancy. It was established in Edinburgh in 1969 by Dr John Sutherland and a small group of locally based colleagues. Dr Sutherland retired to his native Scotland from the directorship of the Tavistock Clinic, London—one of the main institutional vehicles for the development, practice, and application of psychoanalysis. At that time all such institutions in the United Kingdom were located in London.

 

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