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Audit in psychotherapy: the concept of Kaizen

  • M. M. Feldman (a1)
Extract

When any organisation is exposed to pressure to change, this not only mobilises considerable anxieties within the organisation but calls a variety of defensive operations into play. The work of Jaques (1955) and Menzies Lyth (1959, 1988) has demonstrated that this can result in the central problem ceasing to be the focus of attention, with primitive defensive mechanisms (often of an obssesional or paranoid kind) being mobilised. This process may either lead to energy being devoted to isolated elements of the situation, or staff withdrawing into a state of passivity and hopelessness. Indeed, Jaques has observed that when changes are imposed on an institution in a way which fails to take account of the functions that existing structures serve in relation to the deeper needs and anxieties of those working within the institution, such changes are likely to be resisted, and may even fail.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Berwick, D. M. (1989) Continuous improvement as an ideal in health care, New England Journal of Medicine, 320, 5356.
Jaques, E. (1955) Social systems as a defence against persecutory and depressive anxiety. In New Directions in Psycho-Analysis (eds Klein, M., Heimann, P., and Money-Kyrle, R. E.) London: Tavistock Publications; paperback, Tavistock Publications, 1971.
Menzies Lyth, I. E. P. (1959) A case-study in the functioning of social systems as a defence against anxiety. A report on the nursing service of a general hospital. Human Relations, 13, 95121.
Menzies Lyth, I. E. P. (1988) A psychoanalytic perspective on social institutions. In Melanie Klein Today (ed. Spillius, E.) London: Routledge.
Plamping, D. (1991) The new NHS: Better to go forwards than backwards, Editorial British Medical Journal, 302, 737738.
Smith, R. (1990) Medicine's needs for Kaizen: putting quality first, Editorial, British Medical Journal, 301, 679–80.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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Audit in psychotherapy: the concept of Kaizen

  • M. M. Feldman (a1)
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