The Challenge of Leadership in Front Line Clinical Teams Struggling to Meet Current Policy Demands

Abstract

Teams, and their managers, working at the interface between government policy and service to clients are subject to high levels of anxiety arising out of the persecutory manner in which well-intended policy demands are delivered and cost efficiencies imposed. Informed by Bion's ideas about group behaviours, these responses can be understood as a form of defensive behaviour and identified as Basic Assumption Me-ness. Basic Assumption Me-ness in team managers takes the form of managerialism at the expense of leadership, developing a shell that acts as a protection for the lonely, overburdened, vulnerable and soft inside. This hardness, evident through increased unavailability and a rather sadistic use of boundaries, is communicated to staff, who in turn pass it onto clients. In this manner, it infects all relationships thus stifling emotional engagement, creative thinking and practice. This paper then explores ways in which team leaders, courageous enough to take up their authority in an emotionally engaged manner, can reverse these dynamics to the relief and benefit of all concerned. Leaders need to insist on attendance at meetings and supervision where cases can be properly considered; demonstrate an ability to think about risk as ever present in the work because, as all are well aware, no amount of form filling can eliminate this; and acknowledge that the work requires constant assessment and judgement as well as an ability to stay with the unknown. The aim is to be responsive to the daily struggles of team members working face-to-face with clients and to remain aware of ‘the reality on the ground’ when engaging in an equally lively way with senior management.