The Defended Self: Psychodynamics & communication in the workplace.

1. The Defended Self: Psychodynamics & communication in the workplace. Professor Kenneth Walsh School of Nursing, Midwifery and Indigenous Health University of Wollongong. Illawarra Shoalhaven Local Health District. Professor Jackie Crisp School of Nursing University of Technology Sydney Associate Professor Cheryle Moss School of Nursing Monash University

2. The Change Discourse in Organisations • Bureaucracies are of course, archetypes of [technical] orientation. This…orientation encourages managers … to view their role as being responsible for controlling any disturbances to the status quo. The emphasis is on formality, rules and regulations. People are regarded as atomistic, passive and rational in their responses; and assessments of results/outcomes are based on technical efficiency (Carr, 2000:289). • Our experience of organisations is that people do not respond to this technical orientation in passive or rational and predictable ways. And paradoxically the administrators, managers and staff themselves, whilst appearing to hold this world view, do not conform to it either; although they may expect it of others.

3. The Psychodynamic Perspective • Human beings adopt various defensive mechanisms in order to avoid mental pain or conflict, or to control unacceptable impulses. • These mechanisms vary from being almost wholly conscious, in which case they can be undone by a few words, to being so totally unconscious that they are only revealed by years of psychotherapy. • The end-product of these mechanisms is often a form of maladaptive behaviour or a neurotic symptom. • The behaviour or symptom often has an expressive as well as a defensive function, containing the avoided feelings or impulses in a disguised form.

4. The Psychodynamic Perspective • The behaviour or symptom often has damaging consequences for everyone, not least for the individual in whom the mechanisms are occurring. • Although the individual may well be aware of the self-destructive consequences of what is occurring, the forces involved are so strong that he/she is usually powerless to control them. • One of the ways in which damaging consequences occur is through the setting up of vicious circles between the individual and the people in her/his environment. • (Malan, 1982)

5. Defence Mechanisms • Our Ego’s defences allow us to continue to function even when we are in significant psychological pain. • But just like pain killers they only mask the symptom and leave the cause untouched (Kets de Vries, 2007). • These defences are essential to our ability to do our jobs. • Paradoxically they are also the very mechanisms which, (in the absence of other outlets for our anxiety) can distance us from the humanity of the patient and ultimately lead to a lack of compassion (Goodrich and Cornwell, 2008).

6. The Triangle of Conflict Defence Anxiety Hidden Feelings

7. Three Paradoxes Paradox 1: • The technical structural-functionalist view of organisations and the way they behave and cope with change,does not accord with the reality of change. However we still tend to ignore this fact and favour overly simplistic perspectives. Paradox 2: • Health care environments are highly emotional yet we tend to strip them of emotion and fail to acknowledge the anxiety inherent in the system. Paradox 3: • Anxiety is a dominant emotion in heath care. The causes of this anxiety and the defence mechanisms they trigger, make communication and change difficult, yet we try to cope with these issues using a technical structural-functionalist view which is blind to this (see paradox one).

8. Splitting or the “Manic Defence” • When anxiety is high people may manage this anxiety by splitting off the good and the bad elements of their existence. The good elements are introjected into the self and the bad elements are projected onto others (Voyer et al 1997) who are often unconsciously punished through an emphasis on doing and measuring. • “through this emphasis on metrics, the managers deplete the organization of the physical, financial, and perhaps most importantly the psychological, resources its members need to succeed. (Voyer et al, 1997: 480).”

9. Resolution of the Paradox • Firstly, recognise that not all communication and decisions in health services are made from a conscious and “rational” perspectives. • Secondly use processes which break down the underlying assumptions behind the binary thinking of “Us” Vs “Them”. • Thirdly recognise the triggers of anxiety in ourselves and others and consciously adopt communication and behaviours that maximise inclusion and minimise the need for defensive manoeuvres

10. In Conclusion • “We can start to overcome our defences when we stop acting and start thinking, when instead of working to sustain normality we let go to extend and deepen our awareness (Hirschhorn and Young 1993:162)”.

11. Walsh, K., Crisp, J. and Moss, C. 2011. Psychodynamic perspectives on organisational change and their relevance to Transformational Practice Development. International Journal of Nursing Practice, 17 (2): 205-212