Getting back to connectedness: an exploration of a team reflective practice group in a personality disorder service

Staff who work in emotionally challenging environments require time and space for team-based reflection to support their wellbeing and the standards of care they provide. This is particularly true for staff working with clients with a personality disorder diagnosis. These staff can experience powerful feelings and behaviours and respond with defensive practices and/or withdrawal. These reactions to the psychological disturbance encountered can manifest at an individual staff, team and organisational level.
Staff support groups (SSGs) are often employed to reduce staff distress and address team dynamics across a broad range of fields (including health, mental health, social care), however to date there is a paucity of research examining staff experiences of these groups. Using a constructivist grounded theory approach, a cooperative inquiry was undertaken with a team of 7 psychological therapists and 1 psychiatrist who attended a weekly, externally facilitated SSG as part of their work in an NHS personality disorder service.
A theory of ‘connectedness’ was developed through a systematic analysis of the data. Connectedness was derived through the emergence of 7 inter-related actions occurring within the SSG: (1) Security and danger (2) Emotional awareness and obscurity (3) Relational witnessing and turning away (4) Integrating and splitting (5) Belonging and isolation (6) Developing a therapeutic atmosphere (7) Energising and depleting. These actions are represented within a higher order model, delineating the processes that are included in each of these relational domains.
The findings are discussed in relation to the unconscious manifestations of attachment trauma at service-user, staff, team and organisation levels. These can be understood as a systemic propensity for disconnectedness as a means to manage overwhelming experience. It is proposed that an SSG provides a critically needed reflective space to re-introduce connectedness back into this disturbed relational context. The implications for group reflective practices that support staff to remain meaningfully engaged in their work are explored.