The ‘Narcissistic-We’ model: A conceptual framework for multidisciplinary team working, researching and decision-making with traumatised individuals

Abstract

Greater emphasis is being placed on multidisciplinary team (MDT) working for complex clinical presentations in the NHS. Whilst such integrated working has the potential for considerable benefits for clients, it also raises the issue of constructive and destructive decision-making within teams that bring together different individuals and professional groupings. This paper outlines a model which attempts to address how individuals in a MDT can hold onto their own personal and professional identity whilst simultaneously adopting a team identity. Thus how the ‘me’ and the ‘we’ operate to assist the client. The model, termed the ‘Narcissistic-We’, was developed out of multidisciplinary team working with traumatised individuals in Belfast and has particular relevance for decision-making in MDTs. The model argues that MDTs operate along two continua, the first running from ‘me’ to ‘team’ and the second running from ‘me’ to ‘client’. When overlaid these continua create four quadrants. It is suggested that no clinical decisions should be made in the ‘Me-Me’ quadrant and most decisions should come from the ‘Client-Team’ quadrant. However, there are times when decisions are required from the ‘Me-Client’ and ‘Me-Team’ quadrants. The development, practical implications and research possibilities of this model are discussed.

Keywords:

• Multidisciplinary team working
• trauma
• clinical decision-making

Acknowledgements

We thank Maria Shannon, Bridie McElhill, Bobby Moore, Anne MacSherry, Aisling Curran and Rhonda Elder for discussion and helpful feedback on this work.