Reflective Practice
Situation
Tavistock Consulting was approached by a Consultant Psychiatrist of a liaison psychiatry team within a large diverse NHS Trust to commence reflective practice for several teams. They made contact following incidences of difficult team dynamics and increasingly high-level sickness and concern about staff wellbeing. The liaison psychiatry service is often the first point of contact for mental health services, working closely with other services including A&E, GP, Drug and Alcohol, Housing, Acute and Forensic.
Our approach
We worked collaboratively with the psychiatrist, senior nurse and team leader in each team to set up the reflective practice groups, as spaces that were distinct from other group spaces, such as team meetings or supervision. The specific context of each team was held in mind, allowing flexibility for in person or online groups where appropriate and times that could accommodate the multidisciplinary team working primarily in shifts, whilst acknowledging that unfortunately not all staff could not all attend every meeting.
The reflective practice groups were set up to offer a space for team members to bring anything of concern from their role. This included thinking about the very intense engagement with patients who were often in distress at first point of contact, and who often had multiple complex concerns (physical health as well as mental health presentation, as well as housing needs too for example).
There were also significant traumatic experiences the teams had endured together. By sharing these experiences including, serious incidents, patient suicides and deaths of colleagues during the pandemic, the reflective practice contained both individuals and the team to withstand and process these losses. It became possible to acknowledge that some of the team tensions were in relation to very different individual responses to trauma, due to personal experience as well as cultural background, as well as noticing a parallel between their own reactions, to those of the patients they supported.
The team held a great deal of trauma from their roles and our organisational consultants provided a consistent thinking space to think about and process the impact of each individual in role, as well as the meaning and impact of what they were holding as a group. Often this meant also holding the ambivalence about reflective practice, with team members having mixed feelings about wanting to engage and lean into these difficult conversations, rather than remain silent or a wish to avoid. Reflective practice provided over time therefore enabled a space to safely surface and process differences across the team and some of these more challenging dynamics.
Impact
The sessions helped me stayed connected with my colleagues, and able to reflect on our practice.
It enabled us a team to share our fears and worries. I liked the togetherness.
It was a good opportunity to share thoughts in a safe place
Feedback from evaluation surveys
Through ongoing reflective practice, the teams were able to acknowledge their mixed feelings in attending and at times a wish to avoid thinking about the pain that they came into touch with, in their roles. They were able to think together about the high level of risk in their work and what it felt like often having only brief intense contact with patients, not always knowing what would happen next, and that it often left them holding a great deal of anxiety.
There was greater sense of the whole system in the minds of the teams, connecting to other services in their roles. Therefore, whilst they often felt under pressure, each team was able to reflect on where their service fitted within the larger organisational NHS system as well as their own liaison psychiatry system.
They began to be able to feel and hold onto the sense of their team as a resource, building resilience in their roles.
Please note: This is an anonymised and amalgamated case study, broadly based on various Reflective practice pieces of work with NHS clients.