The clinical team: ideology, power, boundaries and the patient

Abstract

Over the last 20 to 30 years, the team, multidisciplinary, approach to psychiatry has become firmly established. Proponents would argue that it is essential that a patient has the benefit of the different knowledge bases, skills and approaches, which come from the various professionals forming the clinical team. Using the common Gestalt concept, one might hope that a well-functioning team would exceed in its therapeutic effectiveness the sum total of the skills of its individual members. Such a team should be able to communicate well, draw freely from particular skills of members and be able to adopt a consistent approach in its relationships and interventions with patients. This, however, is not always the case. In my experience, it is not uncommon for clinical teams to suffer from unresolved conflicts between their members. Such conflicts can diminish the team's overall potential and make difficulties in adopting a consistent approach with patients. When conflicts are severe, the clinical team can sometimes exacerbate, through its own chaotic element, the disturbances in the minds of its patients. In this extreme, patients may be pulled into staff conflicts and used to augment one side or another of a particular staff difference. This paper argues that for the clinical team to endeavour to reach its maximum potential, there has to be a reasonable degree of resolution and agreement around three ‘constructs’ of potential conflict: ideology, power and boundaries.