of the preferred stories of people’s professional lives (White, 2007). The loss of heads of discipline


represented an attack on the structure of professional identity aff orded by the head’s role of leadership and containment of the group. ‘Soundings’ allowed individuals to explore their response to the changes and fi nd another ‘safe place’ to be. It also allowed a cross discipline sharing of response, at a time when competition for discipline representation was potentially divisive, given that the confl ating of all heads into one psychological therapies lead post eff ectively gave over leadership of the disciplines to one discipline.


The survey The staff working group initiated an


internal survey which showed that over 80% of staff who completed the survey found their job interesting, but that only 40% felt satisfi ed often or all the time. 70% reported working over their contracted hours often or all the time. Most striking were the levels of stress reported in the preceding three months, including anxiety, irritability, lack of concentration, feeling angry, intrusion in sleep, forgetting and feeling overwhelmed. All were reported higher than we would have expected. These results confi rmed our view that the changes were aff ecting staff signifi cantly and we raised the question of how clinicians could maintain their ability to stay on task whilst experiencing work targets as pushing them beyond their limit. Therapeutic skills such as listening, being curious and empathising were identifi ed to be at risk. The group raised the issue of how a CAMHS unit relied on the people working in it. They were the ‘engine’ and therefore consideration given to the ‘workings’ of the engine was essential if the service was to continue to function optimally (or at all). Staff were also questioning their work-life balance and the costs to them as people working in the service. The results were fed back at directorate level and there is now evidence of an incorporation of language generated by the group with regard to staff as the key resource of the service who have needs to be met without which the delivery of the service suff ers.


The power of hope Whilst the staff working group didn’t hold


special powers to elicit change, I think it became a generator of hope. Studies in the nineties understood hope in terms of how


Context 164, August 2019


people think about goals, their ability to produce and begin movement en route to a goal. This model views stress and diffi culties in coping as evidence of a lack of hope and, more specifi cally, of having one’s goals blocked (Snyder et al., 1999). Helping to build pathways towards a goal is thus hope generating. Comprehensive studies have demonstrated how hope yields enhanced performance in students and athletes (Curry et al., 1997). Hope has also been identifi ed as one of the signifi cant common factors in what works to achieve therapeutic change (Hubble et al., 1999). Similar to the therapeutic relationship in therapy, the group developed a therapeutic alliance with staff and generated action to achieve goals related to improvements in work targets and conditions. Although lots of staff didn’t attend the


monthly meetings, when we attempted to disband the group, many people requested we continue. We understood this to mean the group’s existence represented something mindful of staff ’s experience and that being held in mind was important at that time perhaps for all the reasons outlined above. It was in April 2018 that we fi nally announced the end of the group, but this was only after the birth of the ‘Encounters at Work’ group. This was an amalgamation of the existing refl ective group (facilitated by Tomasz Fortuna) and the staff working group. It’s designed for staff to refl ect on events which are disturbing in nature, stay ‘in mind’ or simply leave one curious. The aim is to explore complexity within relational exchanges, both clinical and otherwise, and has become part of the staff calendar.


A model for management of traumatic loss


How successful was the staff working


group in producing signifi cant positive change? I’m not entirely sure, but I think it demonstrated a model for managing anger and loss. My involvement in the group helped channel my sense of disempowerment and anger in a constructive way. It gave me hope and, as a consequence, energy to protest, to take action and feel heard. Without it, I believe I would have suff ered more from the impact of the changes and been less eff ective as a member of staff . I’m convinced others experienced a similar aff ect. We are still experiencing the hard edge of austerity in many parts of the NHS and strategies to


navigate one’s way through this are essential to maintain an optimum working life.


Acknowledgements I’m indebted to all members of the staff


working group, the senior management group, but most signifi cantly to my highly- valued colleague, Liz Bodycote, without whom most of it would not have been possible.


References Boyd, E. (2010) Voice entitlement narratives in supervision: Cultural and gendered infl uences on speaking and dilemmas in practice. In: C. Burck & G. Daniel (eds.) Mirrors and Refl ections: Processes of Supervision. London: Karnac. Curry, L.A., Snyder, C.R., Cook, D.L., Ruby, B.C. & Rehnquist, M. (1997) Role of hope in academic and sport achievement. Journal of Personality and Social Psychology, 73(6): 1257. Hubble, M.A., Duncan, B.L. & Miller, S.D. (eds.) (1999) The Heart and Soul of Change: What Works in Therapy. Washington DC: American Psychological Association. Snyder, C.R., Scott, T.M. & Cheavens, J. S. (1999) Hope as a psychotherapeutic foundation of common factors, placebos, and expectancies. In: M.A. Hubble, B.L. Duncan & S.D. Miller (eds.) The Heart and Soul of Change: What Works in Therapy. Washington DC: American Psychological Association. Turner, V. & Bruner, E.M. (eds.) (1986) The Anthropology of Experience. Urbana & Chicago: University of Illinois. White, M. (2007) Maps of Narrative Practice. New York: Norton.


Elizabeth Boyd is a consultant systemic psychotherapist who, until recently, worked in a London CAMHS as acting psychological therapies lead. She is a clinical supervisor (and previously was a theory tutor also) at the Tavistock on the Masters course in Systemic Psychotherapy. Elizabeth (Beth) has been in private practice in South East London for a number of years and sees individuals, families and couples. Email: elizabethvboyd@yahoo.co.uk


41


Holding onto hope in the midst of austerity: A staff response to serial cuts and restructuring of a CAMHS


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