Staff supporting people with learning disabilities and complex needs repress and displace painful experiences


Staff working with people with complex needs relating to challenging behaviours or mental health needs will be dealing with a range of emotions on a daily basis. The authors of this qualitative study were interested to explore how staff dealt with these and what implications this might have for the organisation employing them. They worked with eight staff, interviewing them about their experiences and analysed the text of the interviews using the free association narrative interview approach.

This approach grew out of a response to the common use of survey methodology with Likert scale responses to gather data about responses to abstract events. The Free Association Narrative Interview approach uses open questions to encourage interviewees to remember specific events rather than offer generalised answers. This is because specific events are likely to have emotional meanings for the respondents.

The method is used when researchers want to look at emotionally-charged and identity-based issues rather than issues where only opinions or facts are sought.

It is based on the psychoanalytic principle of free association and researchers using the method also take into account their own subjectivity as part of the process of understanding and use their emotional responses to the interview and the responses in the data analysis.

What the researchers found in this study from the analysis of responses was that the workers reported a range of organisational factors, such as not having enough permanent staff and managing a complex patient mix as major impacts on their work.

The researchers, using the principes of the free association method, interpreted the respondents’ unconscious communications however as evidence that they were experiencing projected anxiety from their patients. Respondents had not been offered time and space by their organisations to reflect on their emotions. The researchers suggest that this meant that they were therefore left to cope by repressing painful experiences or displacing them onto the organisation.

They conclude that staff need to be given more time to think and talk about their work and their feelings and that they

would benefit from exploring their conscious and unconscious reactions to their patients.

A psychodynamic interpretation of staff accounts of working with people who have learning disabilities and complex needs, Storey, J. et al., in British Journal of Learning Disabilities, 40: 229–235

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John Northfield

After qualifying as a social worker, John worked in community learning disability teams before getting involved in a number of long-stay hospital closure programmes, working to develop individual plans for people moving into their own homes. He worked for BILD, helping to develop the Quality Network and was editorial lead for the NHS electronic library learning disabilities specialist collection. This led him to found the Learning Disabilities Elf site with Andre Tomlin as a way of making the evidence accessible to practitioners in health and social care. Most recently he has worked as part of Mencap's national quality team and also been involved in a number of national website developments, including the General Medical Council's learning disabilities site.

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