IN MY END IS MY BEGINNING '' The Changing Context of Psychoanalytically-oriented Consultancy"

The early years of working life of most of us here today were a time of hope - the peace movement, civil rights, women's liberation, participation in the workplace, and welfare provision. Growing up in the United States and Britain in the 50's and 60's, we 'knew' that employment and promotion were sure, as long as we were prepared to work for it; for the educated middle classes, the main question was how fulfilling a career we could plan for ourselves. Change was assumed to be for the good, often the greater good; after all if change was not about making things better, then there would be no reason to change. It was also the era of the individual: finding oneself, fulfilling one's potential - with widespread engagement with psychoanalysis and a host of other therapies and emotional development programmes.Over the past couple of decades we have seen a considerable crumbling, in human service provision generally, and psychoanalytically based treatments in particular. In the United States insurance companies no longer paying for extended therapy and analysis has led to a severe decline of private practice, while in Britain dwindling resources have meant that public sector providers such as the National Health Service (NHS) or colleges and universities offer ever less long-term treatment. Shorter-term alternative therapies, many of them borrowing substantially from the psychoanalytic tradition even while criticising it, have gained in popularity. At the same time, the workplace has become unpredictable, even unrecognisable, as organisations restructure and downsize over and over: far from looking forward to promotion as inevitable, we can no longer be sure of being employed at all, let alone be fulfilled by our careers. The large human service systems - health, education, social services - are providing less and less to more and more, with demand outstripping resources everywhere. Through our work in the public sector we are only too aware of the widespread lack of job satisfaction, the rising tide of desperation, and the sense of lots of fingers stuck in lots of dykes.This is being met to a considerable extent by denial, people continuing to talk and behave as if the current changes were temporary, a blip before we return to the steady state, rather than being indicative of massive irreversible trends. The polar caps are melting, not for a season or a decade, but as the beginning of a new era; it is our belief that our social systems are breaking up under the weight of trying to operate on the basis of outdated models and assumptions. For example, denial of the degree of change means that many teachers are trying to teach ever larger classes of children with increasingly complex needs using the same methods as before, and hospital staff are spending a huge proportion of their time desperately looking for beds for patients in need of admission. The favoured remedies would seem to be listening to each child read for less time each week, or altering discharge criteria to shorten patients' length of stay in hospital - tinkering with the old systems while waiting for the next election to increase resources so that things can get back to normal. Charles Handy (1989) uses the image of the frog which, if placed in boiling water, would jump out, but when placed into cold water which is then gradually heated up to boiling point makes no move to save itself. The water is getting hotter, but we behave as if we need only survive the discomfort for a time.Since, however, we are not frogs, we do adapt to the changing temperature, adopting different defences even if we do not fundamentally alter our views of the context within which these changes are taking place. In the 1980's, people studying organisations began to comment on the phenomenon of psychological withdrawal from work, as redundancies and associated casualties became widespread. Given how fused self-esteem and sense of self are with work identity, the risk to individual well-being of losing one's job is considerable. Even for those still in employment, their relatedness to their employing organisation began to shift dramatically, partly to cope with the constant changes in their organisations, partly in an attempt to feel prepared for whatever might hit them next. Far from causing employers consternation at the hidden costs of this psychological withdrawal, it seems to have been actively encouraged in many instances, for example by tendering out services which were previously provided internally, or making staff redundant only to hire them back in as consultants - often at a higher rate of pay but without commitment on either side. Losing one's job brings with it loss of the defences against psychotic (paranoid-schizoid) anxieties which the organisation provided; losing familiar structures, working practices and colleagues brings about a not dissimilar loss. Stokes (1994) notes, for example, how aggression in the workplace tends to be directed more at individuals when the departments we used to hate no longer exist. One prevalent response has been a psychological withdrawal from work, reducing libidinal investment to avoid burnout and anguish. Closely linked with this is another phenomenon: the development of portfolio careers, reinvesting one's energy to be ready to move on to the next project, managing oneself by keeping dependency to a minimum and hiring oneself out as 'Me Ltd.'. even when one is technically a full-time member of staff. Thus on the one hand we find employees becoming more compliant, as well as more disaffected, especially at lower levels of the organisation; on the other hand, senior personnel, typically on short-term contracts, often operating in maverick ways, focused on short-term outcomes, and with no binding psychological work contract (Miller 1995).Inevitably, this is accompanied by changing attitudes to leadership. Freud (1921) wrote of the surrendering of the ego-ideal to the leader, unconscious anxieties about survival elevating leaders into saviours of mythical proportions. This is less than typical of the world of work as we now know it. People in leadership positions may still have vision, but there is less and less followership. Rather we find disillusion - sometimes enraged, sometimes apathetic - but certainly a disinclination to believe enough in anyone to follow them with commitment, not least because today's boss may be history in a month or two, and the new boss will have other ideas. Similarly, bonding to one's work group also seems to be on the decline (Roberts 1994). Efforts to motivate the workforce and win loyalty through induction, slogans or mission statements often seem to have a reverse effect, fuelling cynicism, mockery and resentment. Added to all this, we are living in a society that through most of our lifetime's has had a readily identifiable external hated object that was available for our bad projections. This was so from the 1930's when National Socialism was rampant through to the fall of communism in recent history. However, we now live in a society that no longer has such a clearly defined external enemy available for these societal projections. So where do these projections get located? It would appear that central government is rapidly becoming the receptacle for these projections, the bad breast which deprives instead of feeding us. Obviously, this has implications for any organisation such as the NHS that is funded and controlled by central government. In an age of such complexity, turbulence, even chaos, roles require psychological 'presence' or - to borrow Winnicott's (1971) term, 'pre-occupation' - more than ever. This means that tasks and roles need to be meaningful, and that the environment must be experienced as providing some safety. This will not be the old safety of stability and job permanence - the work-force are not children to be lulled with fairy tales. But we do feel that we should strive for a work-place where it is safe to think, where we can look forward to being heard, and therefore can re-discover a position from where we can make a meaningful contribution. Of late there has been endless experimentation with different organisational structures such as flattening hierarchies, devolving budgets, and multiple leadership. But playing with external structures is not enough; indeed, we suggest this cannot work unless there are alternative containers for anxiety, new ways of meeting dependency needs, and other sources of meaning are also found. In the remainder of this paper we shall be focusing on the British National Health Service. As the largest employer and as an organisation with which every citizen inevitably has contact,it serves as a good example to illustrate the phenomena we have been describing.