Re-reading Winnicott in times of disappearing containers…

A defining feature of our times is the struggle of contemporary social and care structures to meet the minimal requirement to guard against overwhelming experiences. Even though practitioners know how to do this, a range of psychodynamic and systemic obstacles prevent them from effectively containing anxiety, managing vulnerability and working through traumas. The Tavistock Institute of Human Relations (TIHR) offers practical tools, support and conceptual frameworks to help organisations in building resilience in their clients, their teams, their networks and the society as a whole.

As Bessel A. van der Kolk et al. (1996:25) emphasise, one core function of human societies is to provide their members with traditions, institutions, and value systems that can protect them against becoming overwhelmed by stressful experiences. Among the greatest discoveries in the post-war social and health care system was Donald Winnicott’s finding of the holding function- of the mother but also the wider society with its institutions, interpretations, norms and regulations.

Winnicott thought that a mother does not have to be a perfect mother- that is without failures – to provide emotional holding and to contain the child’s overwhelming experiences in a way building its resilience to adversity later in life. Instead, he found, she needs to be able to respond to the needs of her child by being present when it needs her and even more importantly by not being there when a protection is not necessary. We can expand this holding function to a ‘good enough’ society.

A recent collection of papers (Brunning and Perini, 2010) warns that we live in times of disappearing containers. Indeed, our social structures fail to address contemporary issues: ageing populations, scarcity of resources and the limits of leadership in a globalised world. Learning from past containing frameworks, and how they satisfied the minimal requirements for resilience against overwhelming experiences, the TIHR aims are supporting organisations and care systems in responding to contemporary needs based on three pillars: containing anxiety, managing vulnerability and working through traumatic experiences.

Containing anxiety

A wealth of work in the Tavistock tradition shows that at their core social systems develop as a defence against anxiety- this can both enable and disable the capacities of the practitioners to contain the overwhelming experiences of the people they serve (Menzies Lyth, 1960, 1988; Obholzer and Zagier Roberts, 1994; Armstrong, 2005). Considering these issues is particularly important in order to maintain a healthy society in a late modernity that is characterised by increased preoccupation with safety (see the concept of ‘risk society’ e.g. Beck (1992, 1998, 1999) and Giddens (1998, 1999).

There is a significant debate among various social theorists on the extent to which the risks in a risk society are real risks or a social construction (see Ekberg, 2007). Regardless of which camp we join, the lived experience is that of an increased awareness of what natural disasters, viruses, fellow humans (both our closest people as well as those considered most alien to us), social processes, technologies, food, age, sex, money, etc can bring to us – one that exposes us to an unconstrained awareness of our vulnerability. As Beck has urged more than ten years ago, there is a need of ‘a new sociological imagination which is sensitive to the concrete paradoxes and challenges of reflexive modernity’ (Beck, 1999: 134). This includes new practical tools to contain anxiety in and by organisations, institutions and systems.

Managing vulnerability

Imperfect though care organisations may be, we nonetheless entrust ourselves to them when faced with immediate vulnerability. This entrusting goes along with society keeping the trust in care systems alive, which are themselves, as our colleague Tim Dartington has shown, ‘subject to pervasive dynamics of integration and fragmentation, as they address contradictory pressures for positive intervention in a context of dependency’ (Dartington, 2010: 3).

At TIHR we aim to link practitioners’ tacit knowledge to theoretical findings on the organisational structures, values, norms and culture, and the organisation’s conceptual framework and philosophy. The goal is to ensure the availability of service components and working procedures, to maintain the quality of case management and referral systems and to connect them with the experiences of working with clients to ultimately improve the outcomes for the end beneficiaries.

Working through traumatic experiences

The study of trauma investigates how mental disorders and their somatisations arise from the human inability to derive meaning from real experiences that have overwhelmed the coping capacities of the affected individuals (van der Kolk et al, 1996). The practitioners tasked with working through the trauma thus have access to experiential knowledge that can help them reach higher levels of awareness and wisdom (post-traumatic growth) as much as put them at an increased risk of vicarious traumatisation.

Examples of recent research into trauma deal with the specific nature of the defences mobilised when groups encounter traumatic experiences affecting the accomplishment of their working task (Hopper, 2003), and the phenomenon of burnout among staff working with high-need children (Cf. Pryce et al, 2007; Collins, 2009; Conrad, 2006; Jones, 2005; Osofsky, 2004).

Holding traumatised people ‘is directed towards connectedness, towards emotional contact, towards the search for meaning in the seemingly meaningless, and towards the search for new good objects’ (Garland, 1998:28). In this process, the practitioners themselves require a stable and reliable containing framework which may be hard to provide in periods of re-structuring and re-organisation, possibly exacerbated by increased demands to demonstrate value for money and to quantify outcomes.

The Tavistock Institute Offer

In order to strengthen organisational and systemic response, we work with you and your environment to explore:

• the effects that the working task of your organisation brings into your everyday personal and working life, into the functioning of your organisation and its interactions with the wider system to which it belongs;
• the aspects of the context- socio-political, cultural, systemic and organisational – that influence the ways you do or do not carry out effectively your work responsibilities for the purposes of learning from your practice and your clients;
• the links between end beneficiaries, front-line workers, their management and the highest organisational level of executive and trustee boards: how through each of these levels the organisation as a whole can optimise its functioning to provide a better service for the clients of the organisation and an improved work environment for its employees;
• the ways in which organisations tasked with containing anxiety, managing vulnerability and working through trauma can help employees utilise their potential, understand better and employ in practice the learning about their own anxieties, traumas and vulnerabilities;
• how we can measure the quality of services provided by such organisations and how this knowledge can be linked to organisational growth and efficacy.

List of Key References

Beck, U. (1998) World Risk Society, Cambridge: Polity Press.

Brunning, H. and Perini, M. (2010) Psychoanalytic Perspective on a Turbulent World, Karnac Books.

Garland, C. (1998) ‘Understanding trauma’, London: Karnac Books.

Giddens, A. (1999) ‘Risk and Responsibility’, Modern Law Review 62(1): 1-10.Dartington T. (2010) Managing Vulnerability: The Underlying Dynamics of Systems of Care, Tavistock Clinic Series, London: Karnac Books.

Menzies Lyth, I. (1988) Containing Anxiety in Institutions: Selected Essays, London: Free Association Books.van der Kolk, B., McFarlane, A. and Weisaeth, L. (1996) Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society, The Guilford Press.

For further information on the content of this article please contact Dr Milena Stateva m.stateva@tavinstitute.org