8 Psychotherapy8.5 Group therapies
8.5.4 Organisational anxiety and defences
2 min read
Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Anxiety in care systems
Health care work brings regular contact with suffering, uncertainty, responsibility and limited resources. This causes organisational anxiety. It can shape how staff relate to each other and how routine work is done.
Isabel Menzies Lyth described social defences. These are shared ways of working that keep anxiety down. They help staff cope, but they can get in the way of the organisation's care task.
A systems-psychodynamic view looks at unconscious processes like these alongside staffing, leadership, roles and the material conditions people work in.
Defensive patterns
Pattern | What it can look like | Cost to care |
|---|---|---|
Splitting | One team is idealised and another is blamed | Information and responsibility become fragmented |
Depersonalisation | Patients are described only by bed or diagnosis | Individual needs become harder to see |
Diffused responsibility | Decisions pass around and nobody owns them | Needed action is delayed |
Ritualised activity | Procedures are followed without asking what they are for | Apparent order replaces thinking about the patient |
Avoidance | Difficult incidents or feelings are not discussed | Learning and repair are limited |
Two cautions:
Calling something a defence is a formulation to explore. It is not an accusation that staff deliberately neglect patients.
Structural problems such as unsafe staffing need action by the organisation. Interpreting staff anxiety alone will not fix them.
Containment and resilience
Containment gives staff reliable spaces, relationships and authority where distress can be thought about and turned into action.
Reflective meetings explore emotional reactions and different points of view. They should not require personal disclosure, and they do not replace operational decisions.
Clear roles make it plain who decides, who carries responsibility and how concerns are escalated.
Language can encourage curiosity or feed blame. Replace labels such as "manipulative" with a description of the behaviour and its context.
Organisational resilience means learning, support and the capacity to adapt after strain. It does not mean expecting individuals to cope with unmanageable workloads.