Revisión de los análisis de datos de IPAQ

2. One hour observations of interactions on the Unit between members of staff and parents and between members of staff and infants in the incubator. During these occasions I hoped to see individuals' responses to working on the Unit. What was said and done was recorded outside the Unit as was the emotional tone of the meetings.

Some of mv difficulties as a reseracher

I touched on this issues in the previous chapter but I want to add a few words. Trying to be an objective outside observer was and is very difficult. It seems that in order to understand fully what the data is about, one has to be near enough the "heat" of the experience but not too near to think.

A borderline position is needed between being a member of the team and an outsider. The data is very often overwhelming and extremely painful and upsetting. Raw feelings are flooding and the risk of acting inappropriately is there. Projections are powerful and extremely fast. Thinking under these conditions is very difficult.

Menzies Lyth highlights the difficulties in this work writing "one exists most of the time in a state of

partially self-imposed ignorance which may feel profound, frightening and painful.

In another of her papers (1974) she tells us about the complicated difficult transference phenomena and the violent and intensive countertransference feelings she experiences in her work in groups. I found taking notes a useful way of trying to think and contain the data, which in time turned into a research project.

In time my therapeutic role in the Unit was enlarged to accommodate a research role.The data collected in a Neo­ natal unit is not only complicated, painful and upsetting,

like any situation in a factory or other institution, but there are objective facts that generate more powerful responses in this setting than in others. There are tiny babies and their families who are going through a terrifying time. Nurses and doctors are working there and get at times almost swept away by the emotional tide that sweeps the Unit when a life and death drama unfolds. All these generate anxieties and defences that I tried to expose myself to and try to think about in the next few examples of data, collected from this early stage of this project.

Comments

This was an unusual referral.lt came to the Department of Child Psychiatry in the hospital, after the Adult Department had turned it down. It was not a child referred by a psychologist or a G.P. It was a hospital unit refered by the Director of the service.

I took the referral on because of my interest in early infant-mother relation that got stirred up by two clinical facts.

I had a borderline psychotic 9 years old boy in intensive therapy who was a premature baby.The early sessions in

the treatment made me wonder about his inability to metabolise his early life experience. (Some of the work with him is looked at in Chapter 7.)

The other clinical fact was the number of "ex" neo-natal babies who were referred to Child Psychiatry as toddlers. While in the population as a whole the percentage of premature births is no more than 6% to 7% the referral rate to the special play group run by Child Psychiatry where I worked was of the order of 30%.

These facts were in my mind as I made my way to see Miss D. The meeting with the Director and her deputy produced an hypothesis and a plan. Some of the meetings, and the informal observations are looked at below.

3 . 2 A T3 la n n e c l m e e t i i n g w±t:ti s t a f f , D e a l ± n g ; w±t:ti n e g a t i i v e t: a

Introduction

Here I look at the need for "negative capabilities". In other words, when projections and rejection that are part of the resistance to me and what I am trying to do in the Unit and are felt to be almost overwhelming some ability to tolerate,stay the course and think about all this is required (Menzies Lyth 1986). I thought wrongly that there was no relationship as yet between myself and the staff of the Unit.At this stage of the project I had only met the Director, her deputy and the Nursing Officer of the Unit, but the need to reject any object that was threatening with thinking was there before I came in through the door.

The planned meetings

The Director of the Midwifery Service of the Health Authority invited me to meet the Nursing Officer and the Sisters on the Unit. The project was discussed and a

further two meetings were arranged. Times and place were agreed. When I turned up no one was there. I found an empty room and the situation described by the Director as "nurses running with their aprons flapping". I saw staff who appeared to be too busy treating me as if I was not there. I was ignored. Another two meetings were arranged as if nothing untoward was going on.

Countertransference feelings

It is difficult to convey the feelings of confusion and hurt pride that sets in, making it difficult to even try to clarify the facts. I was quite clear about the time and place. There was no doubt at all about the facts ..and yet . . I thought did I make a mistake? The painful attack on my senses, my professional identity made it difficult to try and think about the data.

I knew there was an agreement that some work would start. I was invited in but the fact was that no one was there. Here was evidence of rejection or resistance that occured again and again. It needed to be tolerated and thought about. At the time I felt humiliated, if only I could vanish, blot it out of my memory.

I wondered if Miss D the work group leader who was in touch with reality felt swept aside by the feelings on the Unit. I did not take account of the fact that if that was the case I would be treated like Miss D by the basic assumption group. My feelings on these occasions were of total confusion as if I was carrying the psychotic parts of the team, and the total transaction namely who was mad and who was made to feel mad had to be hidden.

Discussion

The fight flight phenomena in the team unconsciouse defences

It is tempting to think that the pattern of behaviour described by the Director in the Unit was that of a group in a flight away from the "baddies" who are the damaged babies and the angry persecuted and persecuting parents who are so confused with internal damaged half dead objects; that flight was the only option.

Reality of agreed meetings is denied and a strong sense of confusion is present in me. The work group leader. Miss D is feeling ignored, 1 as her representative get the same treatment by the Unit under the influence of the basic assumption fight-flight phenomenon. Put in another way it seems that the team is using paranoid defences to flee a persecution of the parents who produce "nearly dead" babies, are acting out their phantasies of the strength of the death instinct and project their confusion .

Klein in her paper "Notes on some schizoid mechanisms"(1946) writes about the early anxieties "1 hold that anxiety arises from the operation of the death instinct within the organism, is felt as fear of annihilation (death)and takes the form of fear of persecution. The fear of the destructive impulse seems to attach itself at once to an object - or rather it is experienced as the fear of an uncontrollable overpowering object" (p3).

1 will try to show later on how the presence of a dying