Monday, July 16, 2018

Emotional Containment (Relevant from Families to Presidents)

Edwin H. Friedman (1999) in his outstanding book, Failure of Nerve: Leadership in the Age of the Quick Fix, made the point that leadership qualities are necessary in all walks of life, from “Families to Presidents”. He discussed how self-differentiation is the key quality required of leaders at home, work and in society.  A well-differentiated person achieves a healthy balance between the needs for individuality and togetherness.  The emotional containment provided by this is essential for healthy functioning, whether we are thinking about the leader as a parent or president.
…. a leader functions as the immune system of the institution or organization he or she “heads”. (Friedman) 
So, what does this look like? A secure sense of self, self-confidence, ability to relate well with others, ability to tolerate difference?

An insecure person tends to need sameness, agreement and compliance to affirm their fragile sense of identity. A secure person is more able to hold onto their own identity, opinions, views, self-worth, while allowing others to be different and even directly challenging. They tend to remain calm and thoughtful when challenged, rather than become defensive and reactive. They are able to be separate and close in relationships at the same time.  

Being clear without being certain, recognizing that for the most part, views and beliefs are opinions rather than absolute truths. Any truth is usually truth with a little t. Whereas insecure people tend to act as if their views are the Truth. This is an anxious defence, as the thought of not knowing or being wrong is too threatening. These initial thoughts begin to show how we might develop ways of identifying whether a person has a secure, but not rigid sense of self.

A secure sense of self develops through attachment to others, primarily parents and other caregivers during the formative years. Such a person tends to have a coherent narrative of their life history. A coherent narrative that might include serious difficulties, is a more reliable indicator of healthy development, than absence of difficulty on its own. It is the coherence that is most important. This most likely means that the person has been able to integrate their life experiences.  It is not difficulty or adversity that is the issue, but the person’s ability to make sense of and integrate experience. We can only make use of experience that has been integrated into our personality.

That which is not integrated is split off and unavailable. These split off and unconscious parts of our history, can also disrupt and inhibit healthy functioning.  The reason that experience is not integrated is usually to do with it being overwhelming. Not that the event itself was impossible to integrate, but it overwhelmed the person’s capacity at that moment in time. Capacity is related to the combination of individual resource + support available. Trauma is in the system not the event. ­­­­­­The event cannot be experienced and that is why disassociation is a common reaction to trauma. Disassociation can be thought of as putting the event outside of the self, as if it is not happening to the person. The response to the event becomes a bigger long-term problem than the actual event.  Back in 1893 Freud and Breuer said that,
Psychological trauma or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as the agent that still is at work.
Contemporary trauma research by neuroscientists such as Bessel Van der Kolk, Peter Levine and Bruce Perry confirms this. This does not mean that trauma always prevents adequate functioning in life, relationships and work. It does mean that psychic and physical energy may be taken up as a result, depleting an individual’s energy and mental space.

When life around us is challenging, it is more likely that we become overwhelmed. This also correlates with the quality of support available. Given the environments that many people live and work in, where challenges are great, and support is little, unresolved trauma can be a significant difficulty. Therefore, it makes sense to recognize this and build in ways of supporting people.

Events that can lead to trauma may not have increased over the years, they may have even reduced, but our collective capacity to cope with these events has reduced. For example, by the fragmentation of family, industry and community life. This is what has led to an increase in trauma. Solutions need incorporating into many spheres of life, including the workplace. Leaving trauma simply as a ‘medical’ issue to be taken up only when symptoms become unbearable is not adequate. In the workplace the consequence is often a workforce unable to carry out its task efficiently, prone to its own symptoms of dysfunction. Leaders and managers must be healthy in their own functioning, and able to maintain and grow their abilities.  They must have a strong support network around them - family, colleagues, friends, mentors, consultants, etc.  Friedman goes as far to say, 
That all leadership begins with the management of one’s own health.
A secure person is more likely to stay reasonably calm in challenging and threatening situations. Staying with and being able to think about a difficult situation is more likely to have a positive outcome. Reacting, which by nature is thoughtless does not bode well for finding constructive solutions. Acting firmly and decisively in an informed manner, is different to reacting.  However, there may be a fine line between the two and it is a matter of judgment to know when one may be reacting. Not reacting does not mean being indecisive.

The ability to set clear boundaries that are not too rigid is a crucial skill. One way of dealing with anxiety and risk is to create tight restrictive boundaries. To give a simple example – someone not allowed to get out of bed for a day risks little chance of injury. If a child is not allowed out of sight, an accident may be less likely. Anxiety led environments tend to focus on the immediate rather than the longer-term bigger picture. Too much control may reduce risk in the short-term but can have negative long-term side effects. What starts as risk-reducing and survival enhancing, if it is prolonged becomes life limiting and risk producing. Again, the balance between the two can be a fine line and a matter of judgment.

In the case of the over-protected child, development will be stifled, with possibly serious consequences to potential and well-being. An anxious environment will not be too concerned about this as the main priority is to survive the next minute, hour and day. Once an individual, family, team, organization or any system becomes locked into this state, effective decision-making is compromised with potentially disastrous long-term consequences.

The ability to think about complex issues, the short and long-term is very important. Many decisions and interventions that might seem appropriate in the short-term can have negative consequences down the road. For instance, an appropriate boundary is one that allows enough space for consistency and exploration, but not so open ended that it leads to a lack of safety. The skill is in the judgment, supported by processes of assessment and risk management.  To some extent this skill can only be demonstrated.  The ‘proof is in the pudding’ as the saying goes. And because each situation is new and unique, what was demonstrated to work before, is not an absolute guarantee of success now or in the future. This is one reason why we might be surprised by a leader who achieved great success in one situation, only to fail in another.

A person who can set appropriate boundaries will also recognize that those boundaries need to change and adapt over time. Effective boundary setting will facilitate development, and development will push the boundaries. For example, a parent does not usually have the same boundaries with a five-year-old as with a teenager. At each point of growth/change, where the boundary needs to adapt, there is always the uncertainty of ‘by how much’. This means anxiety is inevitable.  Being able to manage the anxiety is an essential task of parenting and leadership in general.

The easy and unhelpful solutions are 1) have rigid and unchanging boundaries, or 2) have none. In other words, to be overly authoritarian or overly permissive. Both are likely to produce fear and not promote development. As can be seen with this issue of boundaries, the environment needs to be interconnected and integrated. For instance, an insecure person is likely to struggle with changing boundaries, with all the new territory, risks and uncertainty involved. The fear of things ‘falling apart’ both internally and externally is great. Awareness and consistency of everyone involved is essential.

Understanding and conceptualization can inform the way we think about everything we do. Kurt Lewin’s (1943) view, that there is nothing so practical as a good theory, rings true. For instance, we can look at how we understand a child’s needs and how this will then inform a chain of connected matters.

Clifford-Poston in her book ‘Successful Parenting’, stated that the foundation of child development is a secure base and the permission to be curious. If our view is that children need understanding and encouragement, as well as clear boundaries to develop curiosity – what kind of people do we need for the child?

In the workplace if we know the qualities needed for a specific task - how might we look for these qualities in the process of staff selection and development? Do we have the right process, are we asking the right questions, looking in the right areas? If we are confident about our selection process, how do we then support development? 

While I have referred to child development, the principles apply widely. People tend to do better and grow, in well led and organized environments – which provide emotional containment.

References
Breuer J, Freud S: On the Psychical Mechanism of Hysterical Phenomena: Preliminary Communication (initially published in Neurol Zentralbl 1893; XII:4-10, 43-47); in The Standard Edition of the Complete Psychological Work of Sigmund Freud, London, Hogarth Press and The Institute of Psycho-Analysis, 1966, vol II, pp 13-17

Clifford-Poston, A. (2001) The Secrets of Successful Parenting: Understand What Your Child’s Behaviour is Really Telling You, Oxford: How To Books

Friedman, E.H. (1999) A Failure of Nerve: Leadership in the Age of the Quick Fix, New York: Church Publishing, Inc.

Lewin, K. (1943). Psychology and the process of group living. Journal of Social Psychology, 17, 113–131. Reprinted in The complete social scientist: A Kurt Lewin reader, (Gold, Martin, Ed) (1999) (pp. 333–345). Reprinted (in part) in Cartwright, 1951, Chapter 7

Patrick Tomlinson Contact Details and Information







Saturday, May 5, 2018

Caution: This Article does not provide 14 Steps to Guarantee you Success in Anything!

The title is partly tongue in cheek as what is often desired today is exactly that – a step-by-step guaranteed success. How often do we see and get attracted to an article heading something like, the 14 things you need to become an outstanding (or even world class!) manager. It seems that putting a number in there is part of the appeal. Maybe because it alludes to the finite and quick fix, rather than the infinite and ongoing.

Having some guiding principles may be helpful, but every situation, including everything within it is a unique moment in time. People and the dynamics between them are less predictable than the laws of gravity. In life and work we need to hold onto a balance of knowing and not knowing. In general, too much certainty tends to be an unhelpful position when working with people. There is an irony if we take that too far too – like the only thing certain in life is that nothing is certain.  McNamee and Gergen (1999) go as far to claim that,

Certitude walks hand in hand with the eradication of the other.

And Adam Phillips talking about child development says that,

....the parents, the authorities, are at their most dangerous when they believe too militantly that they know what they are doing. 

Confidence is important, but real confidence includes having an open mind. An open mind includes the ability to doubt, question and not know.  Learning from experience is powerful. Mentors and Gurus are most useful when they help mentees make sense of and learn from their own experience. This might include taking something useful from the mentor but not being instructed. Instruction has its place but can be unhelpful where development is the task. People, teams, organizations cannot be instructed how to grow, change and develop.

These are processes that take place within what can be called a facilitating environment – where under the right conditions people learn and grow from their own experience. In my working life, this concept has its roots in the work of child psychiatrist and pediatrician Donald Winnicott (1965). He developed the concept in his work on child development and treatment of developmental disturbances. A facilitating environment is a place from which things unfold, emerge and evolve. Winnicott captures the essence of it, which I think can be applied to many settings,

….it has as its aim not a directing of the individual's life or development, but an enabling of the tendencies which are at work within the individual, leading to a natural evolution based on growth. 
Increasingly I come across concepts like this being applied in business organizational settings. What I mean is that rather than focus on fixing and managing people, there is a shift to creating environments in which the capabilities of people will emerge.  Back in 1996, the organizational consultant and executive coach, Lionel Stapley argued, 
…what Winnicott refers to as ‘A Facilitating Environment’ one which encourages (or facilitates) the development of the child - seems to be the sort of organisation holding environment that is required in today’s organisation.

Winnicott’s work which spanned 1920s-1970s was focused on the issue of change. What change is possible? And what might make it possible? Much of the 20th Century work environment was dominated by manufacturing industry and means of production that went with it. Instruction and repetition were central to this. Now that the pace of change in the world is rapid, constant innovation and adaptation are vital for success and survival.  In this environment, curiosity and thinking outside the box are increasingly important.

These qualities can be facilitated, encouraged and supported but not instructed. They require freedom rather than restriction of thought. Instruction by its nature is confining and limiting. If the above qualities are important when do people feel at their best to work in that way? What are the ingredients of a facilitating environment?  Firstly, safety and security are essential. This is why John Bowlby (1988) in his work on attachment theory, defined a ‘secure base’ – i.e. a caring and reliable parent, to be the starting point for human development. And after that the permission to be curious is the second vital ingredient, just as the secure infant begins to discover and explore the world around her.

In the workplace this means that people must: feel connected in relationships; feel safe and trusted; be encouraged to be curious and innovative; be listened to; be encouraged to express themselves. Clearly there also needs to be boundaries. A lack of boundaries is generally not containing and does not feel safe. The challenge is working out where the boundaries should be. For instance, what is safe and clear, but not too restrictive? What is the line between innovation and recklessness? Working this out is a matter of judgement. And once it is worked out it won’t stay the same for long. Systems that are working well, grow, and the boundaries need to adapt accordingly, or the next stage of growth will be hampered. So, the process of boundary setting is one of continual review and negotiation.

Unfortunately, what many people experience at work is the opposite of what is needed. They experience constant disruption of relationships, reactive cultures and decision making, a lack of communication and trust, and an autocratic leadership style that puts people tightly in their little box. Of course, this is not universal, but it is common. The primary reason is that the rate of change has inevitably raised societal anxiety levels. We have not simultaneously raised our ability to live and work with the increased anxiety. 

Edwin H. Friedman (1999) wrote about this in his book, A Failure of Nerve: Leadership in the Age of the Quick Fix, when he claimed that society had become riddled with anxiety. Since then it has only got worse! It could be argued that we now live in a culture of alarm. Going back to the false solution of 14 steps, it can be argued that what is needed more than ever, is a focus on the containment of anxiety. For example, a leader who can do this effectively, provides the beginning of a facilitating environment. Just as a parent’s ability to think about, make sense of and respond to an infant’s anxiety provides the beginning point of human growth, emotionally and physically.

If we agree with this, the next question is to consider what it looks like? How do we identify the qualities and skills involved? In an already anxious system this task might feel too challenging. For instance, when it comes to recruiting a suitable person, ticking a few easily measurable boxes might seem more desirable, however much we know it doesn’t work. How do we strive towards what will work and create environments where it is safe to use our judgement?

As Friedman said with the title of his book, the biggest problem of leadership from families to presidents, is a failure of nerve. He also pointed out that those leaders who do hold their nerve, can expect to be derided and attacked to an extreme level. Exactly as we now see daily in the media. These are symptoms of a chronically anxious society or system.

For these reasons leadership in the modern age is extremely difficult, whether we think of it at the level of family, organization or society. It is also why the concept of the facilitating environment is so important and relevant.

References
Bowlby, J. (1988) A secure base: Parent-child attachment and healthy human development, New York: Basic Books

Friedman, E.H. (1999) A Failure of Nerve: Leadership in the Age of the Quick Fix, New York: Church Publishing, Inc.

McNamee, S. and Gergen. K. (1999) Relational Responsibility, Thousand Oaks, CA: Sage

Outside of the Box pic - http://gritnwit.com/

Phillips, A. (2013) On Tantrums: The Magical Act of a Desperate Person, London Review of Books, Vol 35, No 5, 7 March 2013, p.19-20.  For podcast of this article,
https://www.lrb.co.uk/v35/n05/adam-phillips/the-magical-act-of-a-desperate-person

Stapley, L. (1996) Personality of the Organisation, London and New York: Free Association Books

Winnicott, D. W. (1990) The Maturational Process and the Facilitating Environment, London: Karnac Books.

Saturday, January 20, 2018

Why Integration and Connection are so Important in Well-Being and the Healing of Trauma


Integration has been central to my work for over 30 years. That is as a practitioner working with traumatized children and young people, as a leader and manager, as a consultant and as a writer. I think integration is vitally important, whether thinking about the developing individual, family, community and societal systems. It is also essential in a well-run organization.  Most of what is included here was written in four blogs during 2015. 

The Need for Integration, 1. Integration and Connection in Well-Being and Recovery from Trauma; 2. Leadership and Management; 3. Integrating and Connecting – The Essence of Trauma Recovery Environments; 4. Why we all Need an Integration Agenda

Since 2015 I have had the benefit of returning to a leadership position. This experience has been hugely reaffirming of the importance of integration. So, I have reorganized the material and added some. I have also been inspired by the way integration is emerging so strongly as a concept in the present. This is happening on both a micro and macro level, for example, in understanding needs of the individual and the organization.

You can download the blogs here in one PDF, – please feel welcome to share. 

As well as my own thoughts on this subject, there are numerous references and links to videos and articles. There is plenty more to consider. A future blog may focus on the major challenges and resistances to Integration – what makes it so difficult? 

Here are a few excerpts from the blogs that highlight the meaning and importance of Integration and Connection.

Child Development and Attachment Child development is centred on the integration of emotional and physical aspects of relating. For this to be achieved the primary caregiver must be reasonably integrated as a person, but also connected within a wider environment. Ideally, there are positive connections with partner, family, and community. These connections provide the holding environment within which the caregiver and infant connect physically and emotionally.    

During infancy, the attunement and emotional regulation of the caregiver is central to the developmental process. Mirror neurons in the caregiver and infant connect with the detail of each other’s feelings and behaviour. The infant's neurons fire, connect and become wired. This kind of connected being 'in tune' with the other is called attunement. (Stien and Kendall, 2004) 

Moreover, it has received influential support in the last two decades from neurobiological research which has found that secure attachments produce a growth-facilitating environment that builds neuronal connections and integrates brain systems.

Secure attachment promotes neuronal connections, helping to strengthen and integrate key brain structures. (Stien and Kendall, 2004).

Connection What enables an infant’s mind, body and brain to develop is connection with others. Throughout our lives development takes place within a relational context. As Bessel van der Kolk (2014) says,
  
 Most of our energy is devoted to connecting with others……We are profoundly social creatures; our lives consist of finding our place within the community of human beings.

It could be said that human connection is the glue that enables integration to take place. Different parts become integrated through connection. For example, a person with an integrated sense of their identity can connect the different parts of their life. An integrated and coherent autobiographical narrative, which is such an important indication of mental health is one that is connected. Like a story with a beginning, middle and end, the different parts are joined together coherently.   
Networks of connections provide a potentially stronger level of support and emotional containment. This powerful network is then internalized and integrated by the child as part of his internal model. A good support network is the single strongest protection against becoming traumatized (van der Kolk, 2014). The architecture of the brain comes to represent the architecture of the social environment. 
Integration A healthy person is an integrated person. If we think of the developing brain, we can think of neurons connecting and forming integrated neural pathways. We can think of different parts of the brain, connecting and functioning together in an integrated way. We can think of mind body integration. Integration of our senses with our mind and conscious awareness. Integration with the world around us. From the beginning of life integration is interwoven with attachment. 

 If we can connect our own ongoing need for integration to the tasks we are involved with, there is more potential for growth than through anything else we could put on the agenda. We only need to think about the many ways in which better integration might benefit our own life and work. If we are working on integration, development and achievement are likely outcomes.

Separation and differentiation are central to the process of becoming integrated, so that healthy relationships are connected and separate at the same time. Siegel (2012) sums up the importance of this very well,

…a summary of the entire field of attachment in one sentence, secure attachment is based on integrative communication, honoring differences promoting linkages.

Well-Being Before connections can be achieved, safety must be established. Only when the disconnected or unconnected person begins to feel safe will he be able to take the risks involved in connecting. Once the process of connecting begins the person is moving towards integration. The foundations of well-being can be considered as safety, connection and integration. 

Trauma Among many negative impacts on the brain-body system, trauma interferes with the integration of left and right hemisphere brain functioning. Rational thought cannot be accessed in the face of overwhelming emotion. Emotional and social disconnection can begin a spiral that leads to further isolation and alienation. On the other hand, emotional and relational connection creates a positive spiral. It leads to the conditions that bring about more connection.  

Recovery If neural integration is as Dan Siegel (2006) says, ‘at the heart of well-being’ and trauma disrupts healthy development, then recovery is about completing the process of integration. A person or any living system that is integrated is one where the different parts work together in a functional way. For individuals, there is mind-body and sensory integration, and an effective balance where emotion and reason complement each other. The same analogy can be applied to social groups, such as families, teams, communities and societies.
In the healing of trauma, just as in ordinary development ‘it takes a village to raise a child’. Or as Perry and Szalavitz (2006) said, “What maltreated and traumatized children most need is a healthy community to buffer the pain, distress and loss caused by their earlier trauma. What works to heal them is anything that increases the number and quality of a child’s relationships".
The aim of recovery is to create connections that can be personally integrated. Connections can be thought of in relation to oneself, between internal and external worlds, in relationships with others, and the wider community. The level of connection that traumatized children need means that those who are involved in the therapeutic work must be highly attuned. Emotional attunement is receptive to connection and creates secure attachment. 

Recovery from injuries perpetrated in a social context must occur in a social context. These centers, responsible for healing, must become therapeutic communities where recovering is more important than control, and compassion and empathy drive out fear and coercion. (Farragher and Yanosy, 2005) 

Therapeutic Models Strong models are ones where everyone whatever their role is involved in the process of integration and connection. For example, a therapist or carer might be doing what Dan Siegel recommends – working to improve the integrative functioning of a child’s prefrontal neocortex. While the task of the organization leader might be about building integrative connections inside and outside of the organization.  
Einstein’s view that ‘example isn’t another way to teach it is the only way to teach’, provides a good principle for how we approach the task. If integration is the aim of trauma recovery, then we must practice integration in every aspect of our work.
Organizations and Communities All relationships and roles in the community were considered part of the healing environment. The role of the maintenance staff and domestic assistants were considered equally alongside the work of teachers, care workers and therapists. This is one of the features of trauma-informed environments – everyone’s role is important and therefore needs to be integrated into the whole system.

Those organizations that pay attention to the need for integration, which is far more difficult than getting one part rather than the whole to work well, are likely to become the most competent type of organization.

Neural integration is not assisted – indeed is actively impeded – by unintegrated human services which are not only compartmentalised, but which lack basic trauma awareness. (Kezelman and Stavropoulos, 2012)

I think the most important issue is learning to work together, actually, and building teams of people who understand how to do that in creative ways. Because we have all got to move out of the silos that have been put down for us by the public sector and they are often there in business, and learn how to join things up. (Mawson, 2012) 

Leadership and Management For a service to be effective, management and therapy need to be integrated successfully. Good management is necessary for therapy to take place and sometimes good management is therapeutic in itself. The same could be said about any kind of practice in the human services – it can only be truly effective in a well-managed context.

It can be argued that the key task of leadership is to provide the conditions in which organizational integration takes place.

Vision is crucial to create an inspiring and important mission. So is doing the job at hand, however mundane or unpleasant it may seem. It is the integration of the two that is critical.

Micro and Macro In work with traumatized children both the micro and macro levels are important, but it is when there is a synergy between them that there is greatest potential for recovery. For a child, this synergy would be like having a safe and attuned relationship with a primary carer, within a healthy partnership between parents, within a caring extended family, within a safe and thriving community.   

My first three parts on integration have moved between the micro level of the individual brain to the macro level of leadership, organizations and society. While this might seem a little awkward I think it is essential. We can’t consider the individual as an isolate. We are all part of a wider system. As Prilleltensky (2006) has shown, well-being is about the integration of the individual, relational and collective levels.

Both the individual and the community are 'plastic', i.e. capable of recovery and growth, however difficult and traumatic their histories. 
The network patterns of the outside world mimic a lot of the network patterns of the internal world. (Johnson, 2010) 

Postscript: A couple of days after I posted this – I saw the Ted Talk by Susan Pinker (2017), “The Secret to Living Longer may be your Social Life”. Pinker refers to the research of Psychologist, Julianne Holt-Lunstad on the factors that contribute most to well-being and a long life. Top of the list after close relationships is social integration.

References
Farragher, B. and Yanosy, S. (2005) Creating a Trauma-Sensitive Culture in Residential Treatment, Therapeutic Communities: The International Journal for Therapeutic and Supportive Organizations, 26(1):93-109

Johnson (2010) TED Talk, Where Good Ideas Come From | Steven Johnson | TED Talks, https://goo.gl/iYVldv

Kezelman, C. and Stavropoulos, P. (2012) The Last Frontier: Practice Guidelines for Treatment of Complex Trauma and Trauma Informed Care and Service Delivery, Australia: Adults Surviving Child Abuse (ASCA), http://goo.gl/t9o3lA

Andrew Mawson, Water City CIC, Connecting People, Business and Place - Water City Legacy, http://www.water-city.com/

Andrew Mawson (2012) Lord Mawson, Andrew Mawson Partnerships: APM Project Management Conference 2012, https://www.youtube.com/watch?v=EOFKR5c7-NE

Perry, B.D. and Szalavitz, M. (2006) The Boy who was Raised as a Dog: And Other Stories from a Child Psychiatrist’s Notebook New York: Basic Books


Pinker, S. (2017) The Secret to Living Longer may be your Social Life, Ted Talk, https://www.youtube.com/watch?v=ptIecdCZ3dg&t=216s

Prilleltensky, I. (2006) ‘Psychopolitical validity: Working with power to promote justice and wellbeing.’ Paper presented at the First International Conference of Community Psychology, San Juan, Puerto Rico, 10th June 2006.

Siegel, D.J. (2006) Series Editor’s Foreword, in, Ogden, P., Minton, K. and Pain, C. Trauma and the Body, New York: Norton

Dan Siegel video (2012) - How to Successfully Build an "Integrated" Child

Stien, P.T. and Kendall, J. (2004) Psychological Trauma and the Developing Brain: Neurologically Based Interventions for Troubled Children, New York, London, Oxford: The Haworth Maltreatment and Trauma Press

van der Kolk, B. (2014) The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, Viking: New York