Relationships are the work
By Ian McKenzie
Relationships are the work
In Nina’s recent blog she talks about building relationships and trust in teams and organisations, so people better understand one another and give each other the benefit of the doubt. She writes about the importance of reflection, supervision and creating spaces where people feel safe enough to speak openly about what is happening beneath the surface - in effect that ‘relationships are the work’ and we need to invest in them. So with this in mind, I want to share my experience of facilitating regular reflective practice sessions with a multidisciplinary NHS ‘talking therapies’ team.
I have been working with the team for the last five years. It includes consultant psychiatrists, highly experienced psychiatric nurses and trainee nurses and medics, who between them provide a range of therapies. They are supported by administrative and secretarial staff and line managers.
It is a pressurised and stressful environment, often on the verge of overwhelm, all of which contributes to staff illness and turnover making it necessary to ‘reconnect and re-form the team’ regularly to recognise and absorb the impact and move forward together. We use the reflective practice space to surface what is going on for individuals and the team, and as ‘whole people’ bring in celebrations and concerns from personal and family life too.
Being trusted to accompany the team over time and hold a space where we can focus on their experience of being a team is a privilege and enables me to work at depth with an understanding of the team’s particular place in the wider workings of the NHS.
Recently we have been noticing and reflecting on repeating disruptive patterns that show up in the team, causing distress to individual team members. We are trying to make sense of what is happening so that we can break the patterns and move forward.
We are discovering a complex mix of factors in these patterns, located both in differing individual experience and power imbalances embedded in the structures of the institution. These include historical and cultural differences between medics and nurses, between professional practice disciplines, between line management and clinical management/supervision, between accountability and autonomy, and between teams vying for scarce resources.
With these dynamics built into their working environment and surfacing often unconsciously in the life of the team, there is so much room for miscommunication and misunderstandings. We recognise that the lines of authority are not clear and are entangled with personal and group power. This is hard to hold and the tensions show up when anxiety is high. Members can seek refuge in dependence on the leader or another strong member of the team, projecting their own feelings onto others and scapegoating.
Some individuals experience questioning and criticism as personal attacks and withdraw into autonomous practice spaces where they are self reliant and feel safer, while others resist participating in collective decision-making to avoid mutual accountability. Being alert to this means that we can notice how power and authority are actually experienced and exercised in the day to day, how that impacts on the wellbeing of individuals and the team, and consider how to respond together.
We are focussing on what is within the team’s control, and where they can intervene to make a positive difference. We are confident that there is a strong sense of shared purpose around serving patients that grounds the team, and are looking more closely at roles (both formal and informal) and how they relate to one another. The intention is then to move on to re-designing the structures, processes and procedures needed to work well together. We will do this on an iterative ‘test and learn’ basis, use the reflective practice space to check in against how they work in practice, and adapt them as necessary.
In a setting shaped by pressure, complexity and long-standing institutional dynamics, reflective practice has afforded the team the opportunity to pause, make sense of their experience and reconnect around a shared purpose. While many of the forces affecting them sit beyond their immediate control, the work has helped surface what can be noticed, named and changed together. This is an ongoing challenge, but sticking at it will lead to deeper trust and connection, a greater capacity to hold the stress together rather than individually, and ultimately to a happier team, reduced staff sickness and improved experience for patients.
For teams working in complex and pressurised environments, investing in relationships is not an optional extra. It is central to how people stay connected, make sense of difficulty and keep moving forward together. Reflective practice creates space to notice what is happening beneath the surface, understand how pressure and anxiety are shaping the work, and focus on what can be named, shared and changed together.