Securing a base on the frontline: of a Primary Care Counselling Service

Abstract

The author begins this paper by noting the continued growth of counselling in Primary Health Care and that increasingly counselling is being delivered in Managed Care services. He describes his own role as a manager and supervisor of one such service operating on the front line of an inner city. He outlines the contribution that a regular meeting time for the counsellors has made to their ongoing support. The fortnightly Organizational meeting has provided a reflective space for the counsellors in which it has been possible for them to share the pain and the difficulties of their work in their respective surgeries. This in turn has contributed to their ability to maintain depressive-position functioning in the face of the complex emotional demands of their work. The author goes on to describe how he applied open systems theory in identifying and defining the nature of his own role and tasks as manager of the service. By placing himself at the boundary of the service, and attending to the various boundaries that the service had with the external environment, he shows how he was thereby more able to facilitate the counsellors in their own work and practice in the surgeries. This in turn contributed to the ability of the service to remain focussed upon its Primary Task, and to lessen the likelihood of it developing a self-assigned impossible task. The author explores the compatibility of his role as supervisor with his role as manager in a counselling service where the managerial role is facilitatively placed on the boundary. The paper concludes with a description of a crisis in the counselling service that required a re-focussing of attention on new boundaries with the external environment.

Keywords:

• Containment
• organizational meeting
• open systems theory
• management
• primary task
• boundaries
• self-assigned impossible task
• supervision

ACKNOWLEDGEMENTS

I would like to acknowledge the invaluable support and assistance of Tina Hardy, Head of the Psychology Department for the Mental Health Trust in which the Counselling Service has been established. I would also like to acknowledge the hard work and thoughtfulness of all of the counsellors who have contributed to the service.

Notes

Fonagy (2001) suggests that the ability of an infant to bear anxieties relating to the depressive position and to relate to the mother as a whole object can be linked conceptually to secure attachment and to the availability to an infant of a secure base. It is posited here that this theoretical integration can be elaborated further and usefully applied to an understanding of organizational processes.

I have needed to be carefully selective in the illustrations that I have used in this paper in order to preserve confidentiality. I have not included details of the events leading to the withdrawal of the service from two surgeries because these details would be too easily identifiable and would therefore jeopardize confidentiality.