Towards emotional containment for staff and patients: developing a Work Discussion group for play specialists in a paediatric ward

ABSTRACT

This paper describes the evolution of a staff Work Discussion group run by a child psychotherapist in a teaching hospital for more than 15 years. It offers insight into the emotional experience of both NHS staff and patients as seen through the lens of the discussion of the staff’s work. The author identifies three main stages in the evolution of this group, as trust and the feeling of a safe space gradually developed. The first stage was identifying and understanding the emotional experience of patients, through the use of observational skills and psychoanalytic concepts; the second emerged as staff began to include their own emotional experience in the narrative; the last stage saw a qualitative shift in the staff’s capacity to share the pain generated by the work, knowing about it through holding it in the group’s mind and being able to reflect on it, allowing them to process experience in a way that made the work more bearable – akin to Bion’s concept of ‘containment’. This evolution is illustrated with relevant vignettes in the light of some theoretical and historical considerations. The paper demonstrates the value of Work Discussion groups in terms of indirectly supporting hospitalised patients, as well as promoting staff’s resilience and professional capacities in difficult contexts.

KEYWORDS:

• Work Discussion groups
• applied psychotherapy in hospitals
• child psychotherapy training
• hospital play specialists
• containment
• emotional experience of hospital staff

Acknowledgments

I am very grateful to Barbara Segal for her continued encouragement and support over the years we have known each other. My warm thanks to Tony Lee and Noel Hess, who read drafts of this paper. Special thanks to Margaret Rustin for her generous encouragement and help. I am particularly indebted to the hospital play specialists and activity coordinators who gave me their permission to use their material for the publication of this paper. I am also grateful to the hospital where we worked, which supported the publication of sensitive material.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Notes on contributors

Anggielina Trelles-Fishman

Anggielina Trelles-Fishman originally trained as a clinical psychologist, later as a child psychotherapist at the Tavistock Clinic and subsequently as an adult psychotherapist at the British Association of Psychotherapists (currently BPF). She works at University College London Hospitals within the Paediatric Liaison Service where she sees both in-patients, outpatients, and is involved in presentations, teaching and supervision of staff across the Paediatric Division. She teaches Infant and Young Child Observation on the M16 course at the Tavistock Clinic and is a supervisor for the Foundation Juconi-Mexico, which works with children, young people and marginalised families affected by and violence. Anggielina works in private practice with children, adolescents, parents and adults.