Roles, Boundaries and Vulnerability
Concepts and Methods
Wilfred Bion is one of original founders of what was later referred to as the Tavistock method of studying group dynamics and social systems. Bion developed his theory about group dynamics by applying psychoanalytic method to understand how groups can or cannot stay on task during stressful situations. While much of his initial work was in an English military hospital during World War II – all groups provoke some level of anxiety in individuals since we both have a hunger to belong to them as well as a fear of being consumed by them. While this may be in part representative of early family experience this dynamic continues throughout our lives in groups. The omnipresent anxiety of group membership significantly impacts the balance between a group’s ability to function productively on an agreed upon task or defensively – often as cross purposes to the stated task. Bion makes this distinction with the terms “work group” and “basic assumption group.”
According to Bion, groups, like dreams, have a manifest, overt aspect and a latent, covert aspect. The manifest aspect is the work group, a level of functioning at which members consciously pursue agreed-on objectives and work toward the completion of a task. Although all group members have hidden parts or particular areas of vulnerability, they rely on internal and external controls to prevent these hidden parts or more regressive elements from emerging and interfering with the announced group task. They manage their irrational thinking and combine their skills to solve problems and make decisions.
Groups do not always function rationally or productively, nor are individual members necessarily aware of the internal and external controls they rely on to maintain the boundary between their announced intentions and their hidden parts and vulnerabilities. The combined hidden parts of group members constitute the latent aspect of group life, the basic assumption group. In contrast to the more rational work group, this group consists of unconscious wishes, fears, defenses, fantasies, impulses, and projections. The work group is focused away from itself, toward the task; the basic assumption group is focused inward, toward fantasy and a more primitive reality. Tension always exists between the two; it is balanced by various behavioral and psychological structures, including individual defense systems, ground rules, expectations, and group norms.
While in the helping professions, especially those connected with illness and end of life, there may be awareness of vulnerability and powerful unconscious forces, there may be less attention given to the multiple systems and various groups that interact, intersect and impact the task of helping. These influences include the present and absent family members who may come and go over time, the other health care professionals with equally variable presence and their complex authority relationships (for example, doctors & nurses), the hospital or institutional structure, the relationship between the Chaplain or Counselor and the institution (for example, in-house or freelance), the political and economic forces operating (for example, healthcare system and insurance) and many other forces that can complicate the ability to stay present with a patient at a critical moment in their lives.
ROLE OF STAFF
While the staff have more proscribed roles than the members (participants) they too are participating in the emerging temporary organization and are experiencing the same systemic and personal forces at play. Their role is to discern the group forces at play and then to reflect them back to the members only when such reflection would be helpful to the learning. Staff do not function as facilitators to make things go smoothly or manage social conventions nor do they, during most conference events, provide consultation to individuals. This is done intentionally in order to highlight the full life of the group and all its visible and hidden parts and avoid reinforcing the usual understanding that a group is only a collection of autonomous individuals. This may at first be off putting since we are accustomed to being individualized however once we see this as intentionally shifting an automatic pattern of perception, it can be revelatory. Staff also operates in most events with a “here and now” approach. That is, maintaining a primary focus on what is happening in the present rather than past and future.
Staff are chosen for their ability to maintain an intense and reflective focus on the primary task. Staff development and training during the conference further supports that focus.
As part of the conference design, the way in which the staff exercises leadership and authority, as individuals and as a group, is available for study.
While the use of the term “conference” to describe this event has its origins in early group relations work, it implies a more traditional type of learning than the one we describe. Roles, Boundaries and Vulnerability in Care Providing Institutions will in fact be a temporary organization created by staff and participants (referred to as members in our terminology) for the purpose of both experiencing and studying the birth, life and death of this temporary organization. During our time together we will have the opportunity to see how we take up various roles, how we find authority, leadership, connection, vulnerability, creativity, confusion and clarity. While this is a temporary creation, apparently artificial, members and staff will find it to be a startlingly real representation of our work environment and a unique opportunity to experiment and learn proportionate to our willingness to engage in the process.
Some of the Learning Possibilities
The conference provides a variety of group events through which the primary task may be explored. These events are briefly described below:
Plenary events bring the entire institution together
Small Study Group: SSG
Each member participates in a group of 6-8 individuals. The task of the Small Study Group is to study its own behavior as it emerges in the “here-and-now”. The group is assisted with its task by a staff consultant.
Large Study Group: LSG
The entire membership meets together as a single group with the task of studying its own behavior as it happens. It is an opportunity to experience how membership in larger groups impact our abilities to take up authority and leadership. The Large Study Group is assisted with its task by a team of staff consultants.
Institutional Event: IE
All members of the conference and the staff group participate in the Institutional Event in order to examine the evolving conference institution. In order to more organically understand what is emerging in the institution members form themselves into groups of their own choosing and interact with other groups, including the staff to study how the system can be understood from it parts.
Opportunities are available to examine the processes of group formation and to consider the dilemmas inherent in representing, or exercising authority on behalf of, one’s group. Members may request staff consultation during this event.
Role Analysis and Application Groups
5-6 members meet with a staff consultant to explore the roles they have taken on during the conference and what they might want to change or maintain. Later in the conference the groups will explore outside work roles and the application of conference learning to them.
Post-Conference Video Group
An open opportunity for staff and members to continue exploring conference learning and its application to work roles.