Whilst Bion (year) has been a key influence in the study of groups and organisations, his theory came early on whilst he was still an officer in the army. His theory focuses on the individual in relation to the group and whilst it has been influential there have also been some critiques of his stance and his theory has been developed upon and built up. Pines (1987) stated:
Bion had an impressive but remote personality, his remarks were often cryptic and difficult to understand…His technique fostered frustration and from the powerful forces of unleashed frustration develop the regressive group mentalities he so beautifully described” (1987:259)
It can be said that an organisation is an extremely complex group of sorts. The reason for this is, by definition, a group can be defined as ‘a number of people or things that are located, gathered, or classed together’ (reference, year). However, the two often seem to be looked at separately, but often link to one another in some way. According to Armstrong (2007), an organisation is comprised of many groups and each of these have their own dynamics, while also running within the dynamics of the organisation. Because of this, each group within an organisation may have their own primary task which may run alongside the primary task of the organisation. If all of the working groups within the organisation are working effectively, then basic assumptions will not need to be employed. However, an organisation may have many unconscious processes going on (Hinshelwood, 1987). With regards to the hospice, or palliative care in general, this primary task may not be easy to see (reference, year) In the hospice, the primary task is to improve quality of life for both the patient and the family (reference, year) but one person’s version of ‘good quality of life’ may differ from another’s version. De Board (1978) believed some of the basic problems within organisations are to do with an increase in psychological pressures, such as anxiety. It is these pressures which prevent the primary task from being completed and a ‘social defence system’ may be present.
In a study looking at a training hospital by Menzies (1960), found the organisation had developed ways to prevent the staff from experiencing the stresses of the physical and emotional intimacy they have with their patients. She theorised that because of this, primitive fears within the nurses were aroused as a response to working with the potential death of their patients, proximity to the patients and the patients’ relatives’ ambivalence towards the nurses. These primitive anxieties are similar to those experienced during infancy, as described by Klein’s (year) theory of development which are experienced in the position she described as the paranoid-schizoid position. Similar to this line of thought, Jacques (1955: 478) states:
‘How much institutions are used by individual members to reinforce individual mechanisms of defence against anxiety and in particular against recurrence of the early paranoid and depressive anxieties described by Melanie Klein’.
In order to cope with these primitive anxieties, a series of primitive defences are (unconsciously) employed (social defence system) such as, splitting (separating the good and bad), denial (refusal of something/reality) and projection (denying something in oneself whilst attributing it to others). Bion (1961) relates this idea again to the primitive defences in Melanie Klein’s (1946, 1959) theory of development. Along with primitive anxieties experienced in infancy, the infant, also unconsciously employed this defences in order to keep the ego (the self) whole. This theory was related to groups by Sigmund Freud (1921) who believed libidinal (love instinct) bonds hold a group together and individuals within a group identify with one another, and because of this, the group itself is able to have a functioning ego. In order to protect this ego, defences are employed to keep it intact, similar to an infancy experiencing libidinal attacks (Freud, 1937).
Now I have explained the ways in which social defences may be employed, it is important to see how they may be used in relation to the hospice. It can be seen why these primitive defences would need to be employed because the nature of the work done by the organisation surrounds all of the scenarios mentioned above. Ultimately, all patients of the hospice will die, the clinical staff must develop intimate relationships to the patients, and there is an ambivalence from not only the relatives of the patients’, but also from society in general. A key example of a social defence system used by the hospice, is the defence of splitting. During times of extreme stress, there tends to be a ‘us and them’ type relationship between the nursing staff, who work to manage to physical symptoms, and the support staff, who work to manage the emotional effects. This, in itself is a split and is also heightened by physical factors like different offices and communicating via electronic devices with people in different offices. Because of this split, it is easy for one to blame the other. For example, if a patient dies unexpectedly, or quicker than expected, meetings are held to see what could have been done to prevent this and if the primary task (for this patient) has not been met, then it could lead to one side holding the blame (an unconscious process) and this is called ‘scapegoating’ (Hinshelwood, 1987).
To understand the role, I have within the organisation (and within my group in the organisation), it is essential to understand every individual has a group within themselves which has been formed since birth, through development. This internal group is based on the internalisation of important figures in an individual’s life, such as, their parents, siblings or any other significant people (Ogden, 1986). Triest (year) believed an individual takes up many different roles, a formal role, and an informal role. The first is the formal role, given to them by their organisation which is in line with the primary task (Obholzer and Roberts, 1994). In my case, my formal role would be a Support Worker within the Patient and Family Support Team which includes providing emotional support to patients and their family members. An informal role is driven by unconscious needs, an individual’s personality and the basic assumptions of the organisation (the need for primitive anxieties to be managed). For example, the informal role I take on could be, performing tasks above and beyond my role when others are unable to perform a task, this may lead to me being seen as someone who is seen as helpful and important. Through personal therapy, I have been able to explore the informal role I take within groups and, it can be said this role tapped into a need of my own, of wanting to be helped or, possibly even rescued.
When looking at the formal and informal roles I have taken, it can be seen that I have possibly taken on this role within other groups. For example, in a therapeutic experiential group I was a part of for a counselling training course I currently do, I was often the person who helped other’s in the group by asking questions and I was seen as helpful and an important member. This can also be seen as leading the group with another, which may relate to the basic assumption of Pairing (mentioned previously). Bion (year), would have used the term valency to describe this. Valency suggests we all have an unconscious tendency towards one basic assumption which helps fulfil the functions of that specific role. Or as he said himself, ‘the individual’s readiness to enter into combination with the group in making and acting on the basic assumptions’ (Bion, 1961, p.116). This seems to go hand-in-hand with Obholzer and Roberts (year) theory, in that every individual is pulled into the role they have a strong affinity with in order to perform the function of the group.
The combination of my own valency and the roles I have taken in the organisation and group mentioned above, it is important to look back to the first relationships. As mentioned previously, the significant internalised figures from infancy play a part in the valency we have, as well as, the roles and positions we hold in groups. In my tentative opinion, it is important to understand the significant figures in my own life, in order to understand why I have a tendency (valency) towards the basic assumption of pairing. As I am a twin, the first relationship I experienced was before birth, with my twin, and I believe, the internalisation of my twin led to me possibly (unconsciously) seeking a pair in a group when anxiety situations are present, and also fulfilling the groups need for a pair (reference, year). Maybe, when being a part of a basic assumption group, the only way to move back into a work group, is to be aware of the role individuals take (myself included), thus allowing the unconscious to become more conscious (reference, year).
When the basic assumption of pairing occurs, it is difficult to avoid the topic of projection and projective identification. Introduced by Klein (1946), she identified projection and projective identification as an unconscious defence, used by infants in early development. Projection, as mentioned earlier, is when an individual denies something in oneself whilst attributing it to others. This defence can also be seen within adults and within a group setting. This leads into projective identification, which is the process whereby the individual or group receiving projections unconsciously act them out. This may be because of a ‘hook’ or a valency (a capacity to be hooked) by these projections. Only when the recipient realises they have received and are acting out these projections, will they be able to return them in a form that can be absorbed and managed by the other. An example of this can be seen within the hospice setting. A staff member may suddenly feel emotional and want to cry, for no apparent reason. If the staff member is left to sit with this feeling, it may develop into a situation whereby they need time off work with stress. However, when looking at projection and projective identification, it may be the staff member is feeling the emotions the patient is unable to hold and has unconsciously rejected these feelings and placed them within the staff member.
It would be interesting to note at this stage, De Board’s (year) theory that many younger people are graduating and choosing to join organisations which place great emphasis on caring for people, whether it be education, social services, healthcare or palliative care. When reading this, it is impossible not to think of the roles and positions individuals choose in groups in relation to the role they played in their infantile groups. With this, it may be important to consider relating this to the idea of the ‘wounded healer’ which was initially introduced to the world of psychotherapy by Jung (year) who believed an analyst is compelled to treat patients because the analyst himself is also ‘wounded’. This, perhaps, can be shown in the role I take of ‘rescuing people’, in a sense. By this I mean, if people appear to be struggling, I will go out of my way to try and ease this. Perhaps this stems from a need within me, a sense of wanting to be rescued and I search for this feeling in the rescuing of others. The ‘wounded healer’ can also be seen throughout the hospice organisation. Volunteers who work there have often experienced a significant loss prior to working at the hospice. It can be said, as a result of this significant loss, the volunteer may be looking to deal with their loss, by helping patients and their family deal with their own loss.
In conclusion, I believe a group and an organisation, whilst appear different initially (consciously), follow similar unconscious processes (defences). The social defence system employed by an organisation, is similar to the basic assumptions employed by a group. Following on from this, whilst a group is made up of people who have their own individual identities, within a group setting, those different identities work together, or against each other, to form the whole group. Perhaps, because of this, the only way for a basic assumption group to return to a work group, is to make these unconscious processes conscious in a way that can be managed and maintained. Similarly, knowing and understand ones’ role and position within a group (and organisation), and why it has been chosen appears to be a key factor in whether a work group is able to meet the primary task or if a valency will be hooked into an a basic assumption group will form.