"Planned Barriers" Against Destructive Psychological Processes in Care Organizations
by
Gurli Fyhr
+

The Qualitative Report, Volume 7, Number 2 June, 2002
(http://www.nova.edu/ssss/QR/QR7-2/fyhr.html)


Abstract

This is the first study in a long-term qualitative, theory generating, research project aimed at uncovering conditions that facilitate development of destructive psychological processes in care organizations. Special focus was put on three previously identified problem areas, i.e., staff privileges, conflicting educational traditions/cultures among staff, and psychological reparative work on the part of the staff. A special approved home for teenage boys with serious psychosocial, drug and criminal problems was studied. The strategy used was grounded theory together with abductive reasoning. Data were collected using institutional documents, questionnaires and individual psychotherapeutic interviews. In spite of a target group with serious psychosocial problems, strong institutional boundaries, and staff without professional training in caring, no destructive processes strong enough to obstruct care were found in this institution. The purposed explanation is that the combined effect of history, institutional structure and routines, and psychological conditions has prevented destructive processes from developing. When attention is paid to these conditions, they may be deliberately used as "planned barriers", protecting against destructive psychological institutional processes.

Key Words: Residential Institutions, Criminal and Drug Problems, Youth Care, Psychological Processes in Institutions, Grounded Theory, Unexpected Results, Planned Barriers

Introduction

Vague but persisting destructive psychological processes sometimes constitute serious problems in care organizations, especially when they are powerful enough to obstruct treatment and care. Despite different attempts to solve problems accompanying such processes - for instance staff training, improvement of institutional structures, leadership training, regular professional supervision and other means of support - we still know too little about their nature to prevent them from interacting destructively with the mission, especially since they are often mistaken for superficial and easily solved problems.

In order to study what role some previously identified institutional problems (Fyhr, 1995, 2001), named psychological reparatory work, conflicting educational traditions/cultures and staff privileges, play in triggering and maintaining destructive psychological processes in care organizations, a long-term research project, including, in all, three special approved homes, one school, and one hospital, was initiated. This paper describes the study of the first institution included in the project, a special approved home for teenaged boys, situated outside Stockholm.

The purpose of the entire project was to develop a theory, empirically grounded in the institutions, and sufficiently reliable to genuinely describe and explain the conditions that start and maintain these destructive processes. The aim was to gain a complete picture of each studied institution, including its conditions, structures, routines and psychological processes. By studying entire institutions, the intention was to find the origins of the problems, if they were to be found within the institutions.

Conceptual Framework

The conceptual framework for the study of psychological processes was mainly psychoanalytical. The primary reason was that even professionally planned institutions, using suitable routines and methods, sometimes show signs of harbouring destructive processes that are difficult to address using other theories.

Underlying the psychoanalytical frame of reference is the conviction that unconscious motives play a crucial role in people´s experiences and actions. The motive for a given action is not always clearly reflected in the action itself, but sometimes needs to be interpreted to be understood. The psychoanalytical frame of reference is also based on the notion that mental processes are not random, but instead dependent on, and resulting from, an interplay between current and previous mental processes. By considering the meaning of unconscious mental life, we can see the personality as a constantly developing functional whole, in which everything that has happened affects the present, which in turn affects what will happen in the future. This approach makes it meaningful to study individuals' - and in this context institutions' - history and deeper inner processes in our effort to understand today's situation.

Consequently, unconscious ongoing processes as well as conscious processes were recognized and analysed. The institutions were treated as psychological units, operating and responding as units, although individuals inside the institutions sometimes had different wishes and needs.

Following the British psychoanalytical tradition of Jaques (1955), Klein (1975), and Bion (1968), psychoanalyst Menzies Lyth (1988) developed Jaques' idea about social defences and formulated a way of thinking about social structures as forms of defence - as ways of avoiding experiences of anxiety, guilt, doubt and uncertainty. Menzies Lyth (1988), Hinshelwood (1987a, 1987b) and Obholzer (1987), all of whom studied anxiety and social defences in hospitals and other institutions, found social defences strong enough to obstruct productive work and direct energy away from the organization's task.

Hirschhorn (1988), who built on Menzies Lyth's work, described his experiences as a consultant in organizational questions. He integrated theory and practice to illustrate behaviours in organizations and suggested that, when combining the psychodynamic concepts "splitting" (the individual separates certain feelings), "interpersonal projection" (the individual locates certain of his/her own feelings to another person) and "introjection" (the individual assimilates certain feelings within him-/herself), it is possible to develop a theory about organizational processes that describes individual behaviours.

By paying attention to the limitations of classical psychoanalytical theory, the main focus of which is the tension between individual instincts and defences, and adding modern object-relations theory (Klein, 1948; Fairbairn, 1952; Winnicott, 1969; Erikson, 1969; Kernberg, 1975), which elucidates how people use one another in order to stabilize their inner life, Hirschhorn (1988) suggested that we may understand how psychodynamic processes within people contributes to shape relationships between them. Among other forms of social defences, he focused the theory of "basic assumption" groups (developed by Bion, 1968), which act in accordance with an unconscious and unexpressed assumption that directs group activity. Work-group activity is thereby obstructed, diverted, and sometimes assisted by certain other mental activities, having in common the attribute of powerful emotional drives, which are supposed to have been established in early infancy.

The studies of Bion, Menzies Lyth and Obholzer focus on the collective aspect of institutional processes, characterizing them as a reaction against external stress, although Menzies Lyth makes a clear point of the individual origin of group processes. The characteristic feature of the social defence system is its orientation towards helping the individual to avoid experiences of anxiety, guilt, doubt and uncertainty. Freud (1991/1921) and later Bion broaden the psychoanalytical perspective of the individual, and Obholzer (1987) maintains that, using this perspective, there are no conceptual differences or contradictions in approaching individuals, couples, groups or institutions in order to understand them. The differences depend on where the lines of observation and intervention are drawn. The concepts used are the same and the unconscious processes in all settings have identical origin.

Stapely (1996) stressed the significance of institutional boundaries in the development of task-oriented organizational cultures. He suggested a model of cultural development in organizations, and made a developmental psychological comparison between individuals and organizations, maintaining that organizations' developmental psychological needs are the same as individuals'. He stressed that organizations need "basic trust" (Erikson, 1959) and a "good enough holding environment" (Winnicott, 1974) to avoid regression and develop a working task-oriented culture.

We might suggest that basic trust within an institution can exist when the institution has the supplies necessary to meet basic physical and psychological needs. A holding environment can exist when the institution is able to maintain sufficiently supportive boundaries so that the institutional identity can become established.

Obholzer and Zagier Roberts (1994) maintained that all groups working under stress tend to evade their tasks. We can explain some of the destructive processes observed in care organizations as social defences resulting from anxiety or stress, but not all of them, as some institutions show signs of strong destructive psychological processes with no apparent connection to stress whatsoever.

In an empirically grounded study of residential institutions treating emotionally disturbed and socially disadvantaged children and young people, Fyhr (1995, 2001) found that destructive institutional processes can also develop within institutions that are not subjected to external threats or pressure. The proposed explanation was that, when an institution has extremely strong boundaries against the outside world, the holding environment may become sufficiently secure to promote tendencies towards regression into early psychological developmental stages, not only in the residents but also among staff members. It was suggested that a possible psychoanalytical explanation of one of the main causes of this development could be as follows:

Each individual bears a specific quantity of unsatisfied, unconscious psychological need originating from different stages in his or her psychological development. When, within an institution, this need is coupled to those of other individuals, a psychological potential is formed - a need for reparation. This unconscious psychological need for reparation gives rise to a mental force, which is constantly seeking situations that offer opportunities to meet the need. When this joint need for reparation is strong, it may prevent the staff from acting in a task-oriented manner, as it forces their mental energy away from the official task and towards an unconscious task that is hidden behind and obstructs the official institutional mission.

Each institution's joint need, consequently, may have a different psychological content depending on the individuals involved. Staff may, for instance, show unusually strong demands for satisfying basic safety and dependency needs at work. Thus, rituals regarding food and drink, and concerns about "cosiness", may be stronger than is justified by the children's needs and those of a more "normal" staff. There may be unusually strong demands for a wide variety of things, such as invariable and permanent routines, regardless of the circumstances, or that the manager should look after the staff like a mother - be protective, nice, cheery, give compliments, offer rewards, make the staff feel safe, give Christmas gifts, remember birthdays, understand even unexpressed needs and always be at the institution, or that staff should only have to work with one particular colleague or one particular child. There may also be an unusual amount of grumbling or whining, which fades away temporarily, whenever there is a chance to solve the presented problem.

Other signs, concerning ego boundaries and individual identity, may also appear, such as unusual vulnerability among staff regarding questions of competence, following rules or having to make choices, or unusually strong resistance to obeying orders, or strong opinions that, when the staff has a "better" solution to a problem than the manager does, the staff is free to ignore managerial instructions, or unusually strong and constant competition over space, attention or knowing what is right or wrong, or strong fantasies about people at the institution whom the staff may be inclined to choose as scapegoats, or desires for a strong manager, who is later combated.

These are examples of behaviours and needs observed in great concentration among staff in the above-mentioned study. The first set of examples corresponds with the behaviours and needs for physical and psychological comfort, continuity and safety normally associated with infants. The last set of examples corresponds with normal toddler behaviours and needs.

In these institutions such primitive needs were translated into adult demands regarding work matters - demands that were conveyed with compulsive force. When these staff demands were analysed and compared with official task requirements and with the requirements of a normal work milieu, they were markedly stronger and more persistent. These exaggerated demands were therefore assumed to originate from the staff's need for reparation.

In some of the institutions, the entire staff was so involved in regressive processes that the institution was prevented from carrying out its mission. They were classified as non-professional institutions (i.e., institutions that failed to carry out their official task, but that instead effected unconscious psychological tasks that were both hidden behind and obstructed the institution's official mission). The results suggest that the staff unconsciously - by creating psychological reparative situations - carried out psychological reparatory work on their own behalf. The possibility of avoiding this development was suggested to be dependent partly on the quality of the emotional content, i.e., the need for reparation, within the institution, and partly on the methods used to control this need.

It was also found that authorities' measures to solve these problems were taken without a thorough analysis of the nature of the problems. The assumption underlying the applied measures was that the problems were caused by inadequate staff training in professional treatment techniques and that some professional training was always better than none. However, the outcome of the subsequent intensive staff training (carried out during a short period of time with staff who did not have sufficient theoretical grounding) - where professional techniques replaced common sense, intuition and life experience, instead of supplementing them - was that the staff lost touch with their former well-known and reliable work instruments. Their new theoretical knowledge did not provide a reliable professional identity, as was hoped for, because their insufficient theoretical background hampered flexible use of techniques when the circumstances required creativity and flexibility. And, consequently, following this intensive educational investment, the children had poorer chances of receiving adequate treatment than they had had previously. This exemplifies the second problem area, called conflicting educational traditions/cultures among staff.

However, although they describe psychological processes in institutions, none of these studies identifies and explains what conditions trigger and maintain destructive psychological processes in care organizations. Thus a gap in our knowledge can be observed, and the present multi-stage project was designed to try to fill it. Given the complex nature of the question, a qualitative approach was considered the best methodological strategy.

Methods

The primary approach chosen was a strategy for generating an empirically grounded theory (Glaser & Strauss, 1967); this was further developed by Strauss and Corbin (1990, 1998). The result may be described as "theory that is derived from data, systematically gathered and analysed through the research process". Using grounded theory strategy and procedures, the scholar does not begin the project with a preconceived theory in mind (unless his or her purpose is to elaborate and extend existing theory). Rather, she or he begins with an area of study and allows the theory to emerge from the data. Theory derived from data is more likely to resemble "reality" than is theory derived by combining a series of concepts based on experience or solely on speculation. Grounded theory strategies - because they build theory directly from the studied problem area - result in a theory that is easily brought down to earth for practical use in the form of guidelines.

Grounded theory tells us primarily what "actually exists" in the empirical data. Another purpose here was to discover what "might be" in the data (i.e., to form new propositions or hypotheses during the research process), and for this reason I added another method (or way of reasoning) called abduction, developed by Peirce (1990/1914) and also described by Fann (1970) and Josephson and Josephson (1996). When abductive reasoning is applied, a new hypothesis is not a mere guess or hunch, but a logical relation emerging from observations and culminating in a new explanatory hypothesis, or a distinct pattern of reasoning in which explanatory hypotheses are formed and accepted. Peirce did not consider this process "a kind of induction"; for him induction was the process of reasoning from a hypothesis, rather than towards one. According to Peirce, only abduction produces new ideas and adds to the data observed, as abduction is the preparatory first step in scientific thinking, whereas induction is the final step. Using abductive reasoning, the scholar analyses the conditions or criteria for the hypothesis that best explains the facts at hand and that can be experimentally tested, whereas when using inductive methods, the scholar seeks facts and corrects and modifies the proposed hypothesis. Abduction seeks theory and explains, while induction seeks facts and classifies. As grounded theory alone is not as far-reaching as the two methods in combination, I used both, alternating between them, that is, first collecting data (grounded theory) and then reasoning towards a hypothesis (abduction), which was tested through the next set of new data and so on in a continuous process.

Stapely (1996) stressed that, in order to understand and manage problems in organizations, we must use research methods that are adequate for collecting data based on unconscious processes. To also recognize and collect data on unconscious psychological processes, a psychoanalytically oriented psychotherapeutic interview technique was used. Data that could not be straightforwardly explained with other methods were interpreted according to psychoanalytic theory.

Selection of the Site

The selection of this particular institution was based on information provided by the National Board of Institutional Care in Sweden. The institution under investigation had a target group with serious psychological problems and staff with little or no education in caring. It had extremely closed boundaries and a low staff turnover. Since opening eleven years earlier, it had developed on its own with very little interference or support from outside. It also had a reputation of having staff who were brutal and hard towards the teenagers.

This information indicated that there would likely be destructive processes at work behind the actively protected institutional boundaries. The fact that the institution was also relatively small, making it possible to study the entire institution, was a decisive factor in the choice.

Permission to Study a Strongly Protected Institution

In institutions of this kind, gaining permission from staff members to conduct intrusive studies may constitute a problem. Lacking professional training, the staff usually use their own personalities as work instruments. As there are no obvious guidelines as to how to use oneself as a work instrument when treating young people, the staff usually mobilize their entire life experience and do as "best they can". Thus, revealing one's personal way of working may involve exposing, not only work techniques, but also certain personality traits. Therefore, to obtain permission to study such an institution, this feeling of vulnerability had to be neutralized.

Permission was granted first from the National Board and then from the head of the institution. The researcher personally informed the entire staff that participation was voluntary, that it was possible to drop out at any time, that the only thing required of them was that they answer the questionnaire and come to the interview room at the agreed-upon time, and that no single person would be identified in the report, as it was not their answers that would be reported but the extracted meaning of the information. Direct citations from the interviews would not be made without permission. During the interviews, the project was further explained in accord with the individual's interest in the matter.

Researcher Bias

According to Strauss and Corbin (1990), familiarity with the field of activities is a necessary condition for generating theory within a complex problem area. This may, however, cause problems if objectivity is not secured. Strauss and Corbin (1998) claim that objectivity consists of: the ability to achieve a certain degree of distance from the research materials and to represent them fairly; the ability to listen to the words of respondents and to give them a voice independent of that of the researcher.

As the grounded theory method is dependent on the skill (Glaser & Strauss, 1967) and theoretical sensitivity (Strauss, 1987) of the analyst (meaning the possession of theoretical insight into the area of work, combined with an ability to make something of this insight), this method can not guarantee that two analysts will obtain the same result. A good theory is produced through a combination of an inquiring mind, rich experience and stimulating data (Glaser & Strauss, 1967). This means that the researcher, when generating theory, does not try to neutralize his or her own cultural competence and earlier experience. Such knowledge is instead actively used during the entire research process, without it becoming part of the data. The crucial question here is maintaining a balance between objectivity and sensitivity. Steps - of the kind suggested by Seale (1999) - were taken to ensure the quality of the study.

As the primary investigator and author in this project, I am an authorized psychologist and expert in organizational as well as clinical psychology, who for many years has studied and also organized different kinds of institutions. I am used to stepping in and joining different organizational cultures, to experiencing and trying to understand them, and then stepping out again to obtain another perspective and conduct my analysis at a higher level (much the same way a psychotherapist may work when trying to examine and understand the inner life of a patient). Moreover, I am well aware of how easily the most experienced expert may be unconsciously drawn into institutional processes. As I am also an experienced psychoanalytical psychotherapist, my training and experience might be considered a means to ensure a certain degree of objectivity. Psychoanalytical psychotherapists are trained, not only in disciplining their own subjectivity, but also to use nearness and distance as work instruments.

Although the informants were rather inexperienced in using theoretical concepts, this was a theory-generating project, and thus I made efforts to counteract my own influence by constantly checking the validity of my interpretations during the interviews. Above all, I wanted to secure the informants' own theories. Like Whyte (1984), I maintain that staff members may develop fairly adequate theories about their own situation given only minimal support from the interviewer. Their theories are often more comprehensive and action-directed than those produced by outsiders, however much expertise the experts might possess.

Data Collection, Coding and Analysis

Structural data were first collected using documents concerning institutional mission, formal institutional status, structure and internal work of the institution. Then a questionnaire with open-ended questions was answered individually by all 18 staff members. This was supposed to supply a rough focus on possible problem areas. To obtain psychological data every staff member was then interviewed individually and tape-recorded. The interviews lasted from 1 to 1.5 hours, and were conducted during a period of four months. Unstructured psychoanalytically oriented psychotherapeutic interviews were used. To direct informants' attention to problems in the work situation, the signal words problems, needs and wishes regarding work were used. To facilitate approaching and investigating sensitive problem areas - towards which the informants might feel protective - and to allow unexpected information to enter into the interviews, the psychotherapeutic experience and interview technique is particularly useful, as it is aimed at detecting even small signs of problems, inconsistencies and protected information. In psychoanalytical psychotherapy, elaborated techniques have been developed to narrow down, approach and explore protected areas in peoples minds (see Freud, 1991/1915-1917; Greenson, 1967; MacKinnon & Michels, 1971; Malan, 1981; Kleinke, 1993). From psychotherapy I also borrowed knowledge of how to quickly make and maintain contact with respondents.

The ambition was to be as probing as possible and to collect as much information as possible without trespassing. Using this technique, it is possible to collect a great deal of information about psychological phenomena in a short time period. The technique is effective, but still harmless to the informant, as long as the interviewer does not force the informant's emotional defences. Defended problem areas were investigated as far as possible with each respondent. In some cases a possible problem area was noted, analysed psychoanalytically and investigated further in later interviews.

The unstructured form of interview allows unexpected information to enter into the interview. But this open form does not suit every informant. Instead of increasing contact and providing more information, it may result in increased hesitance and less information. When this happened, I quickly shifted technique. To give more structure without inhibiting information collection, I invited the informant to tell me the story of the institution such as he had experienced it. During the story telling, I was able to deliver the signal words as well as supplementary questions. In this way, the informant had a main thread to stick to and I was able to focus special areas of information.

Another purpose of this technique was to locate the areas the informant protected from observation. These areas, I assumed, were sensitive areas tied to either the personality or the institution. When I encountered such a defence, I probed cautiously with questions or "questioning suggestions" (suggestions interwoven with silent questions) without pushing so hard that the defence increased or the informant began to suspect what I might want to hear. I proceeded into the area as far as the situation allowed without offence, using interpretations, and sometimes even opinions, arguments or suggestions of other ways of looking at the phenomenon in question in order to experience how genuine the answers were. This was a planned strategy also aimed at finding out whether the emotional meaning in a particular question was strongly defended, which might imply that there was an important problem area to investigate.

If the defence was very strong, I increased the distance using a more general question - or I left the area for the time being.

I did not begin practising psychotherapy, nor did I jeopardize my contact with the informant by pushing more than he was comfortable with. When a problem area had been identified, there was always the possibility to investigate it further in later interviews with other informants.

It appeared as if the interviews, which did not have a psychotherapeutic purpose, still had a mild therapeutic effect as the informants had the opportunity to stop, reflect, formulate thoughts and feelings and tell an outsider about their experiences. In this relatively permissive and "summing up" situation, they were able to give words to their experiences, and in doing so, see their situation more clearly.

A main strategy when generating grounded theory is to collect data, code and analyse at the same time. It is the interplay among the collected data, the researcher and the analytical process that directs what to study next. When a new question is chosen, the researcher is guided by the questions the data produces at each stage of data comparison.

The present analysis was qualitative, i.e. a non-mathematical interpretation was conducted to discover concepts and relationships among notions emerging from the raw data. The main analytical process involved asking questions and making comparisons. Data that could be interpreted and explained without requiring the help of psychoanalytical theory were explained in non-psychoanalytic terms.

The elements of the theory, which emerge from the comparative analysis, consist of conceptual categories and their properties and dimensions, and hypotheses or generalized relationships among the categories. What emerges in the comparative analysis is the meaning of the data. The meaning is then given a name and forms theoretical concepts that are successively lifted to higher levels of abstraction.

By "coding" Strauss & Corbin (1998) mean the analytic process through which data are fractured, conceptualized, and then integrated to form a theory. The coding consists of "open" coding, which is done to "open up" information and uncover thoughts, ideas or meaning in order to create theoretical concepts. Using "axial" coding, data are collected again, theoretical categories are developed and linked to subcategories (i.e., concepts that pertain to a category, giving it further clarification and specialization.) Using "selective" coding, the theory is integrated and refined. The central category is chosen and the remaining categories are organized around it. Finally, the result was validated by comparing it to raw data and by presenting it to respondents for their reaction.

In this project, validation and analysis began during the very first interview, leading to similar but somewhat more elaborated processes in the next interview, and so on. To avoid taking respondents' intended meanings for granted, every statement was immediately checked during the course of the interview. To test out assumptions with respondents, I explained and summarized the perceived meaning in the data and asked whether the interpretation matched respondents' experiences of a given phenomenon - and if not, why. Data were also constantly validated against new data in subsequent interviews or observations. A question raised in one interview was also dealt with in subsequent interviews.

Results

Because this study represents the first phase of a long-term theory generating research project, results are presented in a relatively early analytical stage. A presentation at this analytical stage might be called a "high level description" or "conceptual ordering" (Strauss & Corbin, 1998). The description of the findings is based primarily on the constant comparative analysis that the grounded theory strategy demands, including data from all sources used.The present findings will be further analysed along with those of studies from the later stages of the project.

Despite the use of refined psychoanalytical techniques and considerable effort to find areas of problem evasion, which could indicate the presence of destructive processes, this institution surprisingly did not show signs of harbouring destructive psychological processes. It did, however, possess qualities often accompanying such processes, for example closed institutional boundaries in combination with low staff turnover, and staff lacking professional training in treatment and care. What instead became apparent was that this institution possessed institutional qualities that serve to prevent the invasion of destructive processes into treatment and care.

Although the result is not finally analysed together with those concerning other institutions, it should not be mistaken for a description of the views of the staff. The staff, although they communicated well with the teenagers, vere not verbally sophisticated. They were quite able, however, to describe sophisticated emotional as well as other observations that were then interpreted and formed into concepts by myself and repeatedly checked concerning their genuine meaning.

This institution was a closed emergency and short-stay home with six residential, single rooms for teenage boys with severe psychosocial, emotional, drug and criminal problems. The boys stayed for approximately six to eight weeks. The institution was not supposed to treat deeper psychological problems. The only psychological treatment performed consisted of a consistent pedagogical programme, based on the everyday behaviour of the individual youth. The institution offered the teenagers firm and predictable limits for their destructive actions, as well as good model behaviour provided by the staff, and ample possibilities for reflection on alternative ways of acting. The aim was to help the boys become sufficiently well behaved that they might be accepted in an open treatment unit.

The institution had one manager, one assistant manager and 16 male staff members, organized in four teams. Every team worked for two days and nights and was then off duty for six days and nights. There was no special room for the staff in the house, except for the manager's office. The staff cooked, cleaned the house and engaged in physical exercise along with the boys. There was plenty of physical training and some outdoor excursions were taken along with one or two boys at a time, depending on the risk for escape. These were the only regular, organized activities.

The institution opened about eleven years ago. Ten staff members, working as guards in a detainment centre, wanted to influence - not just lock up and interrogate the prisoners - especially as the newcomers seemed to be getting younger every year. The staff did not want to copy existing, seemingly ineffective treatment programmes, so they developed entirely new routines. In order to test new routines and develop an institutional identity without pressure from the outside, they as good as closed off the institutional boundaries. Five staff members who did not agree with this development left, and new members were employed according to the new routines. The result was that an unusual institutional identity developed. Today the institution could be described as "a place where staff know how to cope with any violent youngster, using respectful but resolute and strong as well as gentle means, depending on the situation at hand".

Since 1994, the institution has been run by the National Board of Institutional Care in Sweden. Because the institution accepted and managed to take care of the most violent and problematic criminal youth, the staff was trusted and given the responsibility to develop the institution more or less on their own. They have succeeded in maintaining very unusual routines, for example, a unique timetable and method of selecting new staff. The staff had to accept the presence of a manager, however, after not having had one during the first years. When this study was performed, in 1998, the institution was cautiously beginning to open up its boundaries.

Surprisingly, there were no traces of any kind of destructive psychological processes to be found in this institution. No processes originating from the staff, and strong enough to obstruct work, were found. Moreover, no such resident-initiated processes were found that were not taken care of at an early stage by staff or through routines. The staff showed no signs of conflicting educational traditions and staff privileges were adequate, considering the institutional mission.

The inner structures of the institution were well balanced and well integrated, for example: amount of staff, timetable, staff-meetings, access to the manager, information routines, amount of residents, admittance routines, transfer to other institutions, indoor activities, outdoor activities, cleaning, cooking, visiting and so on. Every crucial part of the institution was designed to support the mission and every single routine was integrated with the rest of the work. Although the routines were elaborated, they were still flexible enough to be developed or altered when they, for some reason, were outgrown.

This collection of conditions - which served to prevent and stop destructive processes at an early stage - was named "planned barriers against destructive processes".

Planned Barriers against Destructive Processes

Those routines that were found to be important as means to prevent or stop uncontrolled development of destructive processes are listed and described below as "recommendations for success". A few citations from the interviews have been included.

- Staff privileges were motivated by and adjusted to the institutional mission.

Over time, staff privileges tend to be protected, nurtured and maintained as goals per se, even when they have long since lost their original purpose and no longer contribute to constructive institutional management and development.

The privileges at this institution were adjusted to and supported the mission. The staff considered it a privilege to work alongside other serious team members who were equally committed to this mission and who shared the same basic view. "If you don't have the same basic view about your work, then you don't feel good at work. A common foundation is also the very base for working with youth with serious problems. You have to feel that everyone agrees in basic matters". This gave them the feeling of being well qualified to do the work. Their ability to feel good at work was also considered to be the result of mutual and high work ethics, along with good routines and structures in the institutional design. "We have a set of rules that are clear as glass all the way".

Other highly appreciated conditions, which were considered as privileges, were the method used to recruit and select new staff members and the unusual timetable. "When you stay two whole days and nights at work, you can't ignore the problems coming up. You just have to deal with them right away, and that is good. And with six days and nights off, you are always fresh when you go back to work".

The relative freedom to plan and practice daily work and the chance to participate in the design of work routines were important factors. The small size of the institution, allowing close work with the boys and other team members, and the real opportunities to influence institutional development were also considered as privileges. These privileges did not have a destructive effect on work because, although considered unusual and great, they were motivated by the mission and they were not great enough to attract people who did not like working with this demanding target group or who had less work ethics and sense of responsibility than the present staff.

- Staff were selected primarily on the basis of personality criteria and secondarily on the basis of necessary educational criteria.

Educational criteria have a tendency to overshadow psychological criteria in selection of staff, although neither competence can compensate for the other.

As this institution was not supposed to treat deeper psychological problems, professional education in treatment and care was not considered most important. The present staff was highly involved when selecting new staff, and new staff members always had a probationary period. The choice was based on the ability to cope efficiently and respectfully with irrational and violent behaviour as well as with delicate situations. "Our strength is that we accept that the boys are both violent and soft and adjust our behaviour to both situations". It was also based on an ability to co-operate with the present staff. "You can see very quickly when a colleague runs his own race. We don't compete and we have no need to be better than our colleagues. We simply have to agree. Otherwise the boys don't have that safe place they need".

New staff also had to contribute skills lacking in the work team. Different skills were necessary in each team, as they needed to be able to cope with a range of situations from dangerous to delicate. Personal skills were therefore compared with those of other team members in terms of important work demands. "There are four people in our team so the chances are good that one of the others has what I don't have. Someone might be needed who can tell how things must be dealt with and someone who can openly discuss solutions". However, some similarities in staff qualities were also considered necessary. Every staff member had to have a high level of work ethics and a sense of responsibility and alertness to security matters, otherwise the frictions in the team would grow too large.

You could say that staff selection was based on personality criteria, such that the most important selection instruments and norms were the personalities of the present staff.

The most important quality needed to work at this institution was that the staff members should possess "grown up", stable and sound personalities with a certain self-respect and an ability to distance themselves from certain situations. "If a boy violates the rules he has to take the consequences. It is not possible for him to cry a bit and then be forgiven. But when it's over, it's over. There are no hard feelings afterwards. You don't let yourself be provoked and you are not angry, hurt or offended by his behaviour. You might very well play cards with him a while after".

Staff also had to be good communicators, or know how to deal verbally with critical situations that could be handled without physical force. "You have to be able to talk with people or to use some means of dealing with conflicts verbally. You can´t just stand there at a loss without being able to open your mouth".

Alertness to security matters and an ability to hold and touch people were also necessary. If a staff member avoided physical contact, he might build up a psychological resistance, that could prove dangerous if he were suddenly forced to hold someone.

A certain intuitive skill was also required, as the boys seldom expressed their feelings verbally, and staff had to look for cues of what was "going on" between the boys at as early a stage as possible. "You have to have a certain 'ball sense', that is an ability to feel if there is something going on among the boys. Most often you know that something is growing among them but you don't know what it is. They don't tell what they feel but they give different cues that we have to pick up".

Also important was the ability to judge which incidents should be dealt with and which were best left alone.

The criteria used may be summed up as "personal suitability". The personality of the proposed new staff member was considered "good enough" as in "good enough adult personality" (cf. Winnicott's concept "good enough mother", Winnicott et al., 1989, p. 44). Because the institution had no mission to treat the boys using professional techniques, no specific theoretical education was required. Consequently there were no major conflicting educational traditions.

- The institutional mission, the predominant problem of the target group, the treatment methods, the length of the stay, and the aim of the stay corresponded with one another.

Every aspect of these building blocks in treatment and care fitted together. All these elements proved to be extremely well matched and integrated. The mission was not to treat the boys' psychological problems, but to make their behaviour acceptable in a more open institution. The boys' predominant problems - those appearing in this restricted surrounding - where misbehaviour, lack of respect for existing rules, lack of trust in adults and in adults' ability to uphold rules. All this was handled with a consistent pedagogical programme that was planned contingent on the individual boy's daily behaviour. "Everyone wants a calm and safe atmosphere. If the boys behave, then you have that, otherwise not. The absolute minimum lies in the demands that make it possible to live as a human being together with other human beings".

This institution - consistent with its mission, aim, goal, the problems of target group and length of stay - directed its measures towards the boys' predominant needs, which correspond well with the developmental needs of the second phase, as described by Erikson (1959) in his developmental model. In that phase, the growing child between two and four years of age is supposed to develop his willpower, find his own ego boundaries and learn to tolerate authorities and respect behavioural limits. According to Erikson this is accomplished when the child, without winning the battle, fights the authorities and limits, restricting his actions.

It is not considered possible to complete this unaccomplished early developmental task in a teenager during an eight-week stay, but it constitutes a start that reaches its intended goal. The admitted boys usually make one attempt at breaking the rules. Then they realize that they will perhaps not succeed in winning this fight. After a while, they usually make another attempt, which also fails. Then they realize that they will not succeed in breaking the rules, and that the staff maintains the rules without being vengeful. At this stage, they have usually also realized that they can differentially influence their own stay by choosing to either yield to or continue to fight the rules. "These boys fight till they meet limits they have not met before. That is why we uphold the limits here. It happens automatically that they test the limits. You don't need to provoke. It takes as long as it takes, but it will happen. But simply the fact that they notice that the limits are not invented to provoke them, makes them calmer. You have to grant these boys respect. This is about limits and respect. Regardless of what a boy has done, he is a human being".

- Staff knew what anxiety reactions were to be expected from the target group, and were prepared for unexpected reactions.

Because of the risk of violence in this particular target group, the staff had to be constantly prepared for violent outbursts. "Most of the boys are upset when they arrive and very angry. We feel that, and it is not always possible to communicate normally. Maybe it's not possible to talk or even to raise your voice. You might suddenly have to hold him".

Equally important was that the institution had routines that prevented outbursts at an early stage. Because the staff members were nearly always with the boys, they could easily pick up cues as to when tension was building up among them. "The boys are specialists in splitting up the staff". Because all staff members always used the same policy, and because the very few existing rules were never negotiable, they were fully predictable and, once learned, caused no tension. Staff turnover was very low, which had a calming effect, as did the fact that one team started working and another team left at the same time every second day. This contributed to minimizing uncertainty about staff comings and goings. Most staff members were also physically well trained and stronger than the boys, which was considered to have a calming effect. All these routines contributed to lowering the rate of incidents.

- The institution had realistic goals for care.

Many groups of staff do not want to remain within the institutional task but strive to improve the mission. The staff may, for example, desire to use professional treatment techniques they are not sufficiently trained in or try to cure the boys' psychological problems with the help of exceptional amounts of love and care.

This institution stayed well within its limits. "This emergency short-stay residential institution is supposed to start something new, not complete it".

- The institution had an inner institutional structure that protected the mission and other easily damaged, constructive processes.

This protective inner structure consisted of meetings and spaces that were aimed at and designed to take care of every vital aspect needed to carry out the mission.

The staff had ample possibilities to discuss everyday care, rules and routines as well as improvements and future development of the institution. The routines were fragile, however, as there were some important weak spots. The present managers upheld the structures and routines mainly through their personal authority. The structure was supported by word of mouth only and not by written outlines. If a new manager were needed, he or she would be recruited and employed by an authority outside the institution, which today has no professional recruiting policy or procedure.

Discussion

Why is this institution to be considered well-functioning?

What makes this institution function so well - despite the pressure of the potentially violent residents, living in relative freedom inside the institution - is that every single one of its essential components are in good order. There is balance in the institution and the different parts are well integrated. Today there are no weak points in crucial places. There are only potential risks due to lack of a supporting structure.

The most important condition - which is not sufficient alone, but necessary when treating and caring for young people - seems to be that all staff members possess relatively sound, adult personalities, capable of providing physical care and a psychological adult-child relationship as well as a model of morally sound behaviour. Consequently, this particular staff did not show any signs of the very common adult expressions (Fyhr, 2001) of dependency needs developed during the first development period in Erikson's (1959) developmental model, or unsolved authority conflicts originating from the second period. These expressions of unmet needs were only observed among the boys and were managed by the staff or through routines. This means that this institution showed no excessive signs of a need for psychological reparation, which may strongly interfere with the mission. The institution began with a staff lacking these needs and appearently has continued to keep free from them by consistently choosing new staff members with similar good qualities.

This approach to staff selection has worked out well at this particular institution, presumably because it started with a staff possessing "good enough grown up personalities". With a group of staff that is not "good enough", however, this approach is risky, as this method shows a tendency to attract people with similar psychological needs.

Another important aspect is that the staff trusts the managers. The managers may also be considered as "grown up" people. They have accepted the authority that is invested in their role while allowing considerable influence from the staff. Although the present managers at this institution were apparently as sound as the rest of the staff, the routine used to employ managers is hazardous.

Another important contributing factor is that the rules for the boys are clear and the goals are realistic. The staff members manage to behave in a "grown up" manner and are able to work towards the same goal without trying to individually improve the goal. They are able to accept democratic decisions regarding changes in routines, and thus very little energy is required to sort out problems among the staff.

But, although the care today is extremely good, it rests on fragile ground. If any crucial part weakens, for instance, if an unfit manager were employed, or if the hiring of good staff were to fail a few times, the situation could rapidly deteriorate.

The result of this study suggests that personal commitment and "grown up" staff, together with enough time to develop adequate routines for protecting institutional boundaries offering a secure enough holding environment, may raise the institutional care to a level of considerable quality. But it also suggests that this quality is vulnerable if it is not supported by inner institutional structures that serve as protection in times of weakness or excessive pressure. This knowledge may be used for developing practical measures that strengthen positive institutional progress and prevent development of destructive institutional processes.

Destructive psychological processes develop in all kinds of institutions that care for human beings. There are needs for reparation - originating from the target group - that generate predictable processes (Obholzer, 1987) and unknown needs - originating from staff members - that may also trigger and maintain destructive, regressive processes.

If the institution does not have effective and integrated barriers, strong enough to hold the psychological processes at a manageable level, the destructive psychological content from such processes may spread into the entire institution, undermining the primary task.

If an institution has many demands originating from the need for reparation, they must be controlled by an institutional structure and routines that are designed to support the official task. The routines must be strong enough to counteract any excessive primitive needs originating from the staff's need for reparation. The more immature the need for reparation within the institution, the more effective the barriers against it must be to manage it and to allow the institution to perform its mission. Although the processes may be inconspicuous on the surface, they may still be powerful enough to direct the institution away from its task. In order to avoid development of destructive processes, planned barriers need to be built in at different locations and levels of the institutional structure.

The unconscious need for reparation, if it is not identified and controlled, may dominate an institution's activity. If residential institutions are planned and managed without consideration for the strength and hidden expressions underlying the need for reparation, institutions may do reparatory work with the residents - or the staff - or neither of them. The needs originated from the residents must be anticipated, controlled, and treated. Strong needs for reparation on the part of the staff must be avoided, prevented and controlled. Without planning and control, treatment and care may in reality be governed by these destructive processes rather than by the goals of the official task.

As this outcome was not at all expected, an important question has been raised. Apparently the research design and techniques were such that they allowed unexpected data to enter into the results despite fairly strong expectations of obtaining data of the opposite kind. This might support the notion that the design was strong enough to counter possible researcher bias, a factor worth considering in qualitative research.

However, it is not clear what part of the design might have had this effect. Was it the research methods used? Or was it the fact that a psychoanalytical psychotherapist, trained to notice disguised and evading cues, was the interviewer? Perhaps psychoanalytically trained psychotherapists are particularly sensitized to noticing signs of unhealthy processes. If this is so, another question is raised. What training do interviewers investigating complex psychological problem areas, for example destructive psychological processes in institutions, require in order to notice unexpected data or data revealing that expected data are not at hand? Must the research methods be good enough to accomplish this, or does the responsibility lie with the researcher? Or is the crucial point simply that the whole research design - similar to the studied institution - must be in good balance and in good order, without weak points and with methods and procedures adequate to treat different sorts of data?

These results - although not contributing data that illustrate destructive psychological processes - are an important part of the ongoing project. The conditions that served to prevent and stop destructive processes at an early stage can be used as a contrast to conditions promoting and upholding destructive psychological processes in other institutions.

Next step in this long-term project is the study of a junior level school that has been subjected to a seemingly uncomplicated organizational change. This study indicates strong destructive processes upheld by traditional teacher privileges, which after the organizational change are no longer adequate.

The whole project, including all five institutions, will be analysed together in a final step and summarized through a detailed description and evaluation of the methods and procedures used throughout the project.

References

      Bion, W. R. (1968). Experiences in groups. London: Tavistock Publications.

      Erikson, E. H. (1959). Identity and the life cycle: Selected papers. Psychological Issues, 1(1). New York: International Universities Press.

      Erikson, E. H. (1969). Childhood and society. New York: Penguin Books.

      Fairbairn, W. R. D. (1952). An object relations theory of the personality. New York: Basic Books.

      Fann, K. T. (1970). Peirce's theory of abduction. The Hague: Martinus Nuhoff.

      Freud, S. (1991/1921). Group psychology and the analysis of the ego. Harmondsworth: The Penguin Freud Library (Vol. 12).

      Freud, S. (1991/1915-1917). Introductory lectures on psychoanalysis of the ego. Harmondsworth: The Penguin Freud Library (Vol. 1).

      Fyhr, G. (1995). Vårdinstitutioner söker handledning. En teoretisk analys av ett empiriskt studerat problem (Residential institutions asking for supervision: A theoretical analysis of an empirically studied problem). Stockholm: Department of Pedagogy, University of Stockholm.

      Fyhr, G. (2001). Residential institutions requesting supervision: a theoretical analysis of an empirically studied problem.Child and Family Social Work, 6(1), 59-66.

      Glaser, B. G., & Strauss, A. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine de Greuter.

      Greenson, R. H. (1967). The technique and practice of psychoanalysis. New York: International Universities Press.

      Hinshelwood, R. D. (1987a). The psychotherapist's role in a large psychiatric institution. Psychoanalytic Psychotherapy, 2(3), 207-215.

      Hinshelwood, R. D. (1987b). What happens in groups: Psychoanalysis, the individual and the community. London: Free Association Books.

      Hirschhorn, L. (1988). The workplace within: Psychodynamics of organizational life. London: The MIT Press.

      Jaques, E. (1955). Social systems as a defence against persequtory and depressive anxiety. In M. Klein, P. Heimann, R. E. Money-Kyrle (Eds.). (1985), New directions in psychoanalysis (pp. 478-498). London: Tavistock Publications.

      Josephson, J. R., & Josephson, S. G. (Eds). (1996). Abductive inference: Computation, philosophy, technology. Cambridge: Cambridge University Press.

      Kernberg, O. (1975). Borderline conditions and and pathological narcissism. New York: Aronson.

      Klein, M. (1948). Contributions to psychoanalysis 1921-1945. London: The Hogarth Press.

      Klein, M. (1975). On the theory of anxiety and guilt. In Envy and gratitude and other works,(1946-1963). Dell, 1975, 25-42.

      Kleinke, C. L. (1993). Common principles of psychotherapy. Pacific Grove, CA: Brooks/Cole Publishing Company.

      MacKinnon, R. A., & Michels, R. (1971). The psychiatric interview in clinical practice. London: W. B. Saunders Company.

      Malan, D. H. (1981). Individual psychotherapy and the science of psychodynamics. London: Butterworts.

      Menzies Lyth, I. (1988). Containing anxiety in institutions: Selected essays. London: Free Association Books.

      Obholzer, A. (1987). Institutional dynamics and resistance to change. Psychoanalytic Psychotherapy, 3(2), 201-206.

      Obholzer, A., & Zagier Roberts, V. (1994). The unconscious at work: Individual and organizational stress in the human services. London: Routledge.

      Peirce, C. S. (1990/1914). Pragmatism och kosmologi (Pragmaticism and cosmology). Uddevalla, Sweden: Daidalos.

      Seale, C. (1999). The quality of qualitative research.Thousand Oaks, CA: Sage.

      Stapely, L. F. (1996). The personality of the organization: A psycho-dynamic explanation of culture and change. London: Free Association Books.

      Strauss, A. L. (1987). Qualitative analysis for social scientists. New York: Cambridge Universities Press.

      Strauss, A. L., & Corbin, J. (1990). Basics of qualitative research: Grounded theory procedures and techniques. London: Sage Publications.

      Strauss, A. L., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory. London: Sage Publications.

      Whyte, W. F. (1984). Learning from the field. A Guide from experience. London and Beverly Hills: Sage Publications.

      Winnicott, D. W. (1969). The child, the family and the outside world. London: Tavistock Publications.

      Winnicott, D. W. (1974). Playing and reality. Harmondsworth, England: Penguin Books.

      Winnicott, C., Shephard, R., & Davies, M. (Eds). (1989). Psychoanalytic explorations. D. W. Winnicott. London: Karnac Books.

Author Note

+Gurli Fyhr, Ph.D. in Pedagogy at Stockholm University and Associate Professor in Psychology at Karolinska Institute, is now a lecturer, researcher and Head of the Section of Psychology, Department of Clinical Neuroscience, Karolinska Institute, KS, Z6, 171 76 Stockholm, Sweden. E-mail: gurli.fyhr@ks.se. She is also a practising psychologist, specialist in Clinical Psychology, Organizational Psychology and Educational Psychology, as well as psychoanalytical psychotherapist. The author would like to thank The National Board of Institutional Care in Sweden for financial grants.

Article Citation

      Fyhr, G. (2002, June). "Planned barriers" against destructive psychological processes in care organizations. The Qualitative Report, 7(2). Retrieved [Insert date here], from http://www.nova.edu/ssss/QR/QR7-2/fyhr.html

Gurli Fyhr
2002 copyright


Return to the top of the paper.

Return to the Table of Contents.