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The walls within: working with defenses against otherness

Online Conference 5-11 July 2021

AM22-PP1: The Role of the Functioning Consultant Couple in Consulting to a Traumatised Paediatric Unit

Parallel Papers Session 1
Friday 1 July 10.15am-11.30 CEST
Paper Code: PP1
CE credits available

The Role of the Functioning Consultant Couple in Consulting to a Traumatised Paediatric Unit following a Series of Serious Incidents.

Presenters: Charlotte Williams, Jennie McShannon

This paper discusses the importance of two consultants operating as a functioning couple when consulting to a traumatised hospital paediatric unit.

It will discuss and demonstrate how the dynamics of the unit impacted on their capacity to function as a containing couple and how working with and through the countertransference in their relationship was key to successfully facilitating healing and integration between the doctors and nurses.

The assignment was to work with senior leaders on a paediatric unit following numerous critical incidents on the ward resulting in a number of child patient deaths. An external investigative report concluded that poor working relationships between doctors and nurses had contributed to clinical negligence and errors. Alongside recommendations for structural and procedural changes which were being addressed in-house, it recommended they seek specialist assistance to address the toxic team behaviours impacting on, performance, efficiency and effectiveness of service delivery.

Trauma -past, present and future- underpinned the consultancy. The patient deaths, working (online) with senior staff during the first year of the pandemic and preparing for the inevitable feelings of loss when working with sick and dying children. From the outset both consultants experienced strong, painful countertransferential responses and found themselves holding conflicting and polarised positions that they soon discovered resembled those witnessed in the medical couple – the doctors and nurses. Their relationship as a consultant couple was intense and intimate, they shared dreams, dread, tears, fears about the work and they fought. The extent of their immersion in the countertransferential experience enabled them to get in touch with the pain, shame, terror and rage evoked in staff by the nature of the task (Menzies-Lyth 1961; Halton 2015) and the resultant splits, polarisations and conflict. Through finding ways to manage their own conflicts and integrate the splits particularly in moments of high pressure, they came to understand the staff behaviours and assist them to process painful emotions and become more integrated.

They hypothesised that the positions inhabited by senior nurses and doctors were a countertransferential response to the dynamics often witnessed in parental couples of sick/dying children (Da Silva et al, 2010; Landolt et al, 1998). This was then projected through the system at each level up to the Clinical and Nurse Directors and onto the consultant couple for containment. They concluded that key to the success of the intervention was their capacity to receive these projective identifications (Gilmore & Krantz 1985) and inhabit the defensive positions before regaining the capacity to function as a couple in the face of traumatic material and support senior staff to bear the reality of their work.

We wish to explore conference members’ experience of working through conflict and polarisation in the consultancy couple and of using this in the service of supporting organisations to function and innovate for the future in the face of inevitable uncertainty, trauma and death.

Key words:

Consultancy, functioning couple, defensive mechanisms, projective processes, paediatric, trauma.

Learning Objectives:

After this session participants will be able to:

  1. recognize the importance of the functioning consultant couple when consulting to an organisation whose task is related to the care of children.
  2. recognize the importance of allowing oneself to experience the full range of emotions evoked by the work and have the courage to speak to them in service of the work.
  3. recognize the value of the experience projected into the consulting relationship and it's potential contribution to the success of the work.


Da Silva FM, Jacob E, Nascimento LC. Impact of childhood cancer on parents' relationships: an integrative review. (2010) Journal of Nursing Scholarship. Sep 1; 42(3): 250-61.

Gilmore, T. N., & Krantz, J. (1985). Projective identification in the consulting relationship: Exploring the unconscious dimensions of a client system. Human Relations, 38(12), 1159–1177

Halton, W. Obsessional-punitive defences in care systems: Menzies Lyth Revisited. In D. Armstrong and M Rustin (2015) Social Defences Against Anxiety Karnac: London

Landolt, M., Boehler, U., Schwager, C., Schallberger, U. and Nuessli, R. (1998), Post-traumatic stress disorder in paediatric patients and their parents: An exploratory study. Journal of Paediatrics and Child Health, 34: 539-543.

Menzies-Lyth, I. (1960). A case study in the functioning of social systems as a defence against anxiety: A report on a study of the nursing service of a general hospital. Human Relations, 13 (2): 95-121.

Biographic Summary

Charlotte Williams is an organisational consultant and executive coach. She works with clients across sectors and organisational levels. Her approach is systems-psychodynamic and she is particularly interested in the impact of the task of the organisation on the team and the notion of leader as emotional container. Prior to working as a consultant she had twenty years of experience working as a clinician and leader in Higher Education. Charlotte is a visiting lecturer on the Tavistock and Portman’s Masters in Consulting and Leading in Organisations and the Masters in Psychoanalytic Studies.

Jennie McShannon is also an organisational consultant and executive coaching at Tavistock Consulting working with executive and emerging leaders in government, NHS corporate, business and not for profit organisations. She brings both her formal training and 20 years senior and board level experience as CEO of a national charity. She supports coaching clients to find their own identity as effective, influential, resilient and collaborative leaders, able to take up and maintain their authority under the most challenging circumstances. Her interest lies in working with groups within and across systems in order to support successful and sustained change. Jennie teaches on the Tavistock’s Masters Programme on consultation and leadership in organisations and faculty member of Tavistock Consulting’s Executive Coaching Programme.