Isabel Menzies Lyth had been a consultant to the Cotswold Community for several years when she wrote this paper, and clearly the difficult transformation of an Approved School into a therapeutic community provided several examples used by her in this paper. For a full appreciation of her contribution to the development of the Cotswold see, “The experience of external consultancy in a therapeutic community for children”, in the Papers section of this website.
TASK AND ANTI-TASK
By Isabel E.P. Menzies Lyth. Paper read to the Conference of the Association for the Psychiatric Study of Adolescents, July, 1974.
Most of us, as we achieve some seniority in our professions, have to assume managerial responsibilities in institutions. This shift is not always easy since there are inconsistencies between the two roles, but it must be made effectively for many reasons, not least being the contribution of good management to staff support. Rice (1963) has said that the effective performance of a primary task is a major source of satisfaction and that insofar as behaviour is adult and reality-based people are loath to surrender such satisfaction. The responsibility of management for effective task performance is a contribution to staff support, both through positive job-satisfaction and through protecting staff from the anxiety, guilt and depression that arise from inadequate task performance. My concern is not so much with positive activities of management as with the difficulties that beset good management particularly in institutions that care for people.
The primary task can in theory be defined simply as the task which the enterprise must perform in order to survive. But from the point of view of efficient institutional performance it must also be clearly defined in practice. Quite simply, unless the members of the institution know what it is they are supposed to be doing, there is little hope of their doing it effectively and getting adequate psycho-social satisfactions in doing so. Lack of such definition is likely to lead to personal confusion in members of the institution, to inter-personal and inter-group conflict and to other undesirable institutional phenomena which I will return to later, all of which reduce the satisfactions of membership.
In some institutions task definition is quite simple, e.g. in commercial institutions it is to make profit, since without making they will not survive, although the precise methods adopted to make profit may be more open to debate and subject to change in changing circumstances.
Many professional workers, however, have to function in institutions where they do not have the luxury of such an easily definable primary task and where attempts to achieve adequate definition are often countered by pressures from outside the institution. Clearly such factors also make effective task performance and related task satisfactions harder to achieve.
Such institutions may be referred to collectively as the humane institutions. They have also been described as ‘people-changing institutions’ (Street 1966). They have a number of problems which we can now consider.
Frequently there is no single task which has overall primacy but any one of two or more may take priority at a given time and in given circumstances. A very good example of this is a teaching hospital which has many tasks. The care of patients may feel like the primary task but, in fact, it has to yield primacy on occasion to the training of medical students. Large formal ward rounds may be good for students but are rarely regarded as good for patients. Further, since teaching hospitals are also nurse training schools there may be conflict between patient care and the needs of nurse training and conflict between medical and nurse training needs. Mediating the variable primacy of tasks in such institutions is no easy responsibility and calls for frequent decisions about moment-to-moment primacy at all levels in the organization often without adequately defined managerial policy. It also makes it more difficult to sustain adequately the feeling that the total organisation is effective and to provide adequate support through job satisfaction for its members, since the level of performance of each task tends to be reduced by the legitimate demands of the others.
Confusion in Task Definition.
The humane institutions, dealing as they do with human beings as their throughput, are also unusually subject to influence from the wider community in terms of task definition. This can also lead to confusion and doubt. Various penal institutions provide a good example of such confusion. Public pressure orientates them in at least three relatively incompatible directions – punitive, custodial and therapeutic. The incompatible objectives are often reflected internally in the attitudes and personal objectives of both staff and clients. They result in adequate task definition, sometimes explicit and always implicit. At present, institutions both for criminals and delinquents and for psychiatric patients, are tending explicitly to adopt definitions orientated to the therapeutic and rehabilitative, but this by no means prevents the implicit infiltration of custodial and punitive objectives. The overt and covert conflict between the task definitions makes effective performance of the explicitly stated tasks difficult and often leads to staff feeling unsupported in their roles, to low job satisfaction and to high stress. Such institutions show up badly in institutional moral indicators such as staff turnover, student wastage, sickness and absenteeism, not to mention system-provoked bad behaviour by clients.
Inadequate Resources for Task.
Professional workers are often ambitious in what they would like to do for their clients and so tend to define the tasks of institutions in fairly ambitious terms. Unlike the profit-making institutions, which just go bankrupt and die if they set objectives beyond their means, humane institutions can often survive in this stage, even if not functioning well. Adequate therapy for the total population of clients jointly served is an over-ambitious objective in terms of the total resources the community can devote to such clients. However, in the separate institutions staff tend to pursue such objectives as ends in themselves. They do not, or may not, be in a good position, to relate the defined task or objective to possible means. The result is chronic overwork, chronic disappointment in results, painful and fruitless struggles with resource-dispensing authorities, low satisfaction and high stress. Yet the alternative, a more realistic definition of task in relation to likely resources with less beneficial results with clients, is also painful, or even intolerable. It is possible that confrontation would led ultimately to a greater sense of support and job satisfaction through performing a less ambitious task more effectively.
Society as a whole throws this problem back on the humane institutions. It fails to define objectives realistically in relation to means or to face the problem of allocating resources differentially to different needs. The dominant societal attitude is that everyone should have what help they need or even want, an attitude reflecting Aneurin Bevan‟s basic orientation to the National Health Service (HMSO Command 6502) – every patient has the basic right to all the treatment he needs. One can sympathise with the objective but if one is realistic one must admit it cannot be achieved because resources will not allow it. The failure of society at large to face this problem confronts the humane institutions with the need to do it for themselves, in so doing often having to meet the disapproval and excessive demands of society.
Scarcity of resources may make desirable the devotion of more resources to the best „bets‟ and only limited objectives such as good custodial care for the others. Such discrimination is hard to face in the institutions concerned without society‟s support. The result is more ambitious objectives everywhere and the chronic inadequacy of resources to achieve them, unless management is very tough.
Difficulty in Precise Definition.
For the humane institution it is indeed difficult to define its task precisely and in other than the most general terms. Take, for example, the therapeutic communities. Their objective is therapy. What exactly does that mean? How clear is the typical therapeutic community about the precise change it hopes to achieve in its client population? The problem is clearly stated by Street et al (1966) where all the institutions described are orientated to producing more effective members of society but what they mean by that differs considerable.
Or take schools. The objective can be described as education, but what does that mean? Every pupil, parent and teacher is likely to have his own personal definition of this objective often not easily subject to verbal formulation. Even on the more academic side, the struggle with curricular reform suggests a possible multiplicity of objectives. How much more difficult to define the wider task of schools in educating pupils for life in general or even in a particular society. How precisely is the educational system or even a particular school to define that task? The solution of this particular problem is not aided by the fact that society in general is confused. Moral and value systems, life objectives and career prospects all in a state of flux. Developments in schools seem to reflect uncertainties in the situation. Education for effective community participation seems now to be hived off in schools under the concept of pastoral care, care for the human needs of all pupils or special care for disturbed pupils. To me this represents an opting out by the school system from an important aspect of its primary task, because of the difficulty of relating education to a confused society and also because that society itself is perhaps over-dominated by an unrealistic caring philosophy regardless of resources. It would be a terrible criticism of an educational system to say it is educating its pupils for dependency.
Re-definition of Task into Anti-Task.
There is, thus, a danger of primary task being implicitly re-defined when the task as originally and perhaps more realistically defined becomes too difficult or when societal pressures against realistic task definition are too great. In other words, task may implicitly slip over into anti-task, e.g. the educational system not being realistically orientated to maturation and preparedness for life in society but to providing for dependency needs which may be anti-maturational. In an institution for deprived boys in process of conversion to a therapeutic community to which the author was consultant, real educational difficulties and the related difficulties for staff in achieving educational progress had encouraged an implicit re-definition of the educational task in terms of therapy. The real therapeutic effect of being able to read, write and to do simple arithmetic and of making a contribution to life in the community was in danger of being ignored.
The difficulties do not, however, relieve managers from the responsibility of achieving adequate task definition. It only demands more toughness. It remains crucial that staff should know what they are expected to achieve and should have adequate management support in doing so, which may also imply support in not doing things which may be desirable in themselves but are realistically impossible or too expensive.
The performance of the primary task of an enterprise requires an appropriate organisation. Such an organisation has two aspects:
- the choice and application of an appropriate technology, and
- the choice and application of an appropriate social system, what Trist (1963) and others have called a socio-technical system.
The most appropriate socio-technical system is that which gives the best fit to primary task performance. The basic model is an open system where the organisation imports material from the environment, converts the material into something different and re-exports it to the environment. In the case of a humane institution the most significant import is, of course, the human import of clients who must be „converted‟, ie changed, and sent back to the outside environment hopefully more able to sustain life there effectively.
Problems in establishing socio-technical systems, though not peculiar to humane institutions, are usually more intense there; for example, a system appropriate to custodial care is likely to be inappropriate to carrying out therapy and vice versa.
Further, the humane institutions often have to function in conditions where the available technologies are themselves hard to define and depend on the actual qualities and behaviour of the people who operate them. We are ourselves the instruments of technology. It is usually more difficult to define what a person does than a machine. Clear and realistic choice between technologies, may, therefore, be difficult or impossible. For example, the precise effects of different therapeutic techniques are hard to establish by follow-up study, and one often has to function without clear guidance as to the success of different techniques or technologies. The choice of technology is, therefore, much subject to the personal idiosyncrasies of the people concerned, to their beliefs and hunches and their own models of human interaction.
There is a risk then that the choice and detailed application of technology may be inappropriately influenced by the human needs of the permanent members of the institutions and be less than appropriately related to effective primary task performance. One can be aware of this problem in theory but it is difficult to guard against its effects in practice.
The Social System.
Primary task performance requires a social system that relates technology to task and that relates the people and groups who carry out different parts of the task to each other. Task and technology together do not wholly prescribe the nature of the social system although they put significant constraints on it and may rule out certain types of social system. The chosen social system is likely to reflect strongly the psychological and social satisfactions that members of an institution seeking their membership and work in the institution. These needs are of different kinds and are both positively task orientated and potentially anti-task. Insofar as they are task orientated, they include the satisfactions arising from being able to deploy oneself positively and fully in relation to task, co-operating effectively with others and experiencing both personal and institutional success in task performance. People require such satisfactions and their realisation is an essential aspect of staff support. Such co-operation by the member contributes towards a social system orientated to the use of technology in task-performance.
However, unfortunately for task performance, members of institutions are also likely to seek satisfaction of personal needs that are anti-task; very often they need to mitigate the stresses and strains of the task itself and of confrontation with the human material on which the task is focussed. In other words, members try to establish a social system that also acts as a defence against anxiety both personal anxiety and that evoked by institutional membership. Jaques (1955) has referred to „a socially structured defence system‟. This will appear in all aspects of the institution, both formal and informal, in attitudes and inter-personal relations, in customs and conventions and also, very importantly in the actual formal social structure of the organisation and its management system.
The social system is a mixture of elements, some orientated to primary task performance and some to other implicit objectives, which we can summarise under the term „primary anti-task‟. Good management must obviously be orientated to sustaining task-orientated elements and discouraging anti-task but management in the humane institutions is in more trouble than in the institutions that process things.
There are a number of reasons:
(i) Inadequate distinction between social system and technology.
This distinction is not clear. The social system is itself part of technology, and as part of the experience the institution provides for its clients it has a therapeutic or anti-therapeutic effect. It is important, therefore, that the social system provide a genuinely therapeutic model for clients orientated to helping them develop and cope more effectively with the world outside. The management system is a significant part of the model, as I discovered when working as management consultant to an approved school. A main preoccupation there was the need to develop better ego-functioning in boys with primitive, unintegrated egos and among other things, to provide effective models for identification. We tended to see both the management system in itself and the functioning of individual managers within it as such ego-models, with therapeutic or anti-therapeutic potential, and much work has been done in trying to realise it. For example, we have worked at clarifying the boundaries of sub-systems and the authority within and across their boundaries, and ensuring that managers were really responsible for the staff within their own sub-systems and did not have to operate with staff over whom someone in another system had authority. This is a confusing situation only too frequent in humane institutions, e.g. the confusion between the medical and nursing hierarchies in hospitals and the exact location of authority between them. We also aimed at maximum delegation down the hierarchy to increase the opportunity for staff in direct confrontation with boys to act with management authority, a model of good management ego functioning.
(ii) Inadequate Differentiation of Management and Professional Work.
A danger may arise in the interlocking of the social and technological systems in humane institutions, i.e. the social system and particularly the managerial structure may be excessively infiltrated by attitudes and behaviour derived from the professional attitudes to therapy. The institution may become too permissive, too non-directive, and lacking firmness and boundary control. The staff may, in fact, both lack for themselves and fail to give to clients the firm, authoritative management which is a necessary feature of both staff support and client therapy. Very frequently it seems, the explicit or implicit model for operating units is some version of the family, which may be inappropriate. It denies the reality that this is a work situation which needs management with clarification of roles, responsibilities and relationships. Further, the so-called family model often denies the reality of the family. A well-functioning ordinary family is likely to have a complicated and effective management system even though it would not be described in those terms and is often not noticed because it is implicit and stable over long periods. In institutions the same effect can only be achieved by making explicit the managerial functions and relationships.
(iii) The Impact of Human Material: Socially Structured Defence Systems.
The second problem that faces the humane institutions stems from the effect on staff of the human „material‟ they work with and what they are required to do with it. The difficulties are especially great in institutions whose clients are people in trouble. The clients are likely to evoke powerful and primitive feelings and fantasies in staff who suffer painful though not always acknowledged identifications with clients, intense reactions both positive and negative to them, pity for their plight, fear, possibly exaggerated, about their violence and harsh, primitive, moral reactions to their delinquency. The acknowledgement and working through of such feelings is not easy, although it is in itself an important part of staff support and primary task performance to do so. Insofar as feelings cannot be worked with personally or institutionally, they are likely to be dealt with by the development of defences against them and insofar as they relate to institutional phenomena, they will tend as I suggested above, to become institutionalised through collusive, implicit interaction between members. They come to be built into the structure, culture and mode of functioning of the institution and through that impair task performance.
The danger is that, since the anxieties defended against are primitive and violent, defences will also be primitive. The authority has described this elsewhere in a study of the defensive system in the nursing service of a general teaching hospital (Menzies 1970). Such social defences are inevitably anti-task. They relate the institution to its members, clients and task, in a way which is not fully realistic. They may deny the full implications of the client‟s problems, often preventing the full deployment of staff‟s capacities. Anti-therapeutic systems of inter-personal relationships between staff and between staff and clients are built up. They are also resistant to the change and development in institutional functioning, which is essential in a changing society to ensure effective task performance.
Such problems are illustrated in an organisational model which is only too common in humane institutions and which the changing ex-approved school where the author worked struggled to change. It is common for resources directly used by or on behalf of clients to be controlled centrally and dispensed in kind by someone like the matron. Several things tend to follow. Such resources are often rather scanty in relation to need and this is likely to lead to complaints against the person-in-role who dispenses them, who may well become notorious for her meanness and lack of understanding of need. Staff more directly involved with clients may well go into collusion with them in developing a paranoid system defensive against the pain and difficulty of confronting the problem of scarce resources with clients, and opt out of their own responsibility for the situation. Such a situation is anti-therapeutic in that it stabilises a paranoid defence system in clients who are prone to that anyway and militates against the opportunity to develop more ego-based confrontation with the reality of scarce resource, surely a problem in real life in the community at large. The author was invited by the matron to help her in dealing with a situation she was coming to find intolerable, the image projected on to her or more correctly her role. Effective dispensing of food resources was very difficult ad she felt she was not carrying out her task effectively. What we gradually evolved was that the control of food resources was delegated downward and across sub-system boundaries into the residential units who were given the money for food to be dispensed as they saw fit. The matron no longer controlled the resources but took up an advisory and service function to the housemothers. The central store became a shop which housemother could use or not as they saw fit and which had to compete with other shops. The central kitchen provided easy cooked food at the house-mother‟s request and for which she paid. Very interesting and, hopefully, positive developments resulted. The paranoid defence system was greatly weakened. House-mothers were now in a position to confront scarcity with boys. Their previously under-used capacities were more fully deployed, their authority and professionalism increased. Staff satisfaction increased arising from doing a realistic job well, with subsequent increase in staff support. Incidentally, food was no longer seen in such short supply.
Defence systems are in the end likely to be anti-supportive to staff. This is not only because they reduce the level of staff performance and the satisfaction from it, but also because they tend towards the personal diminution of staff. Comments about such personal diminution were common among the nurses in the teaching hospital who were aggrieved by it and felt unsupported in their efforts to discharge their responsibilities efficiently.
(iv) Client intervention in Socio-technical Systems
Clients may intervene in the development and maintenance of the socio-technical system in a way that is powerful and anti-task and provoke related powerful, anti-task, reactions from staff. One formulation of this is the concept of the anti-task subculture. It can develop quickly and powerfully and can also be sustained over long periods, if staff do not intervene in a task-orientated way. Too often, indeed, staff collude with it because of the difficulties of confrontation or because they get satisfaction from it themselves. They do this minimally by denying the existence of the subculture or, if aware of it, by trying to keep it as a separate encapsulated entity. At worst they may be drawn into it, for example meeting violence or threats of violence by harsh punishment or themselves being drawn into homosexual acting out.
More subtly they can react by establishing or trying to establish another sub-culture to counter the first which is, however, equally anti-task. Rice (1963) following Bion (1961) has described this feature of group and institutional life.
Interesting developments took place in the approved school when it had had an unusually large intake of boys reputed to be potentially violent and where there had also been several unusually severe outbreaks of violence. Staff felt threatened, not only by the boys‟ violence but also by the temptation to counter-violence they experienced in themselves. They were working at the problem in a task-oriented way but also subtly developing a counter sub-culture to counter violence, i.e. a move to provide unusually and probably unrealistically, for dependency needs, dependency to counter violence. This succeeded in concentrating the problems to an unrealistic extent in those staff who job it was to meet real dependency needs in domestic provision, and who became distressed because they could not meet the unrealistic demands on them by other staff perhaps more than boys, to provide for dependency. This was not, of course, contributing much to a solution, which could only be done by confronting staff and boys with the violence. It was, of course, also anti-staff-support because it was defensive rather than task-orientated.
(v) Threats from Anti-Task Phenomena.
The real task of these institutions can in a sense be described as relating to dependency needs, for example, in adolescent institutions dealing with young people in trouble or meeting educational needs. Neither task can, of course, be effectively accomplished only by gratifying dependency needs, but the dependency needs are there and the institutions must relate to them somehow. These institutions have, therefore, as their work task a function that is close to an „anti-task‟ phenomenon. This puts them at risk. Their efforts to function on a realistic work level will be unduly infiltrated by phenomena that derive from anti-task group dynamics. The effectiveness of task performance will thereby be reduced, for example, by gratifying dependency needs rather than by struggling for maturity, towards independence and realistic functioning. Both staff and client are diminished by such situations and will feel unsupported in their performance of their common task with likely negative reactions. Elizabeth Richardson (1973) quotes a staff member at Nailsea school who thought the behaviour problems of upper school pupils might be related to the lack of appropriate courses rather than simply the problems of the pupils as people. This is an interesting comment and can be generalised, i.e. how far are the behaviour difficulties in our schools linked with the relative failure of schools to carry out the primary task of education effectively? If so, neither pastoral care nor school counselling or individual pupils are likely to improve matters much. Work orientated to better task performance might.
It seems therefore, that the management of humane institutions has an unusually difficult task in ensuring the best fit between socio-technical systems and primary task. This calls for an unusual degree of management skill from people who do not easily see themselves as managers at all.
This paper has stressed the importance of effective institutional management as a major factor in staff support. We have concentrated mainly on one particular aspect of management, that is it‟s responsibility for effective task performance. Incidental mention only has been made of other aspects of good management that support staff, for example, clarification of roles, task and responsibility and the relationships involved in them, and the support arising from being given fully challenging tasks with the authority to carry them out.
In discussing the importance of primary task performance attention has been mainly concentrated on the difficulties that hinder effectiveness rather than the positive means that achieve it. This choice was made deliberately since it appears that there is less understanding of interference to task than of positive activities in management not least because the negative features are indeed hard to cope with and we are tempted to deny them ourselves.
A very important characteristic of good management seems, therefore, to be a developed capacity to keep oneself and others out of the kinds of difficulties discussed, to struggle with task definition, to get it as precise and realistic as possible and to sustain the values that go with it, to protect the institution and its staff from undue pressures across the boundaries, to mitigate anti-task phenomena such as those in the socially structured defence systems or sub-cultures, to effect such institutional changes as are desirable for task effectiveness, to reconcile the needs of tasks and the psycho-social needs of the members of the institution, both staff and clients.
This may perhaps be seen to advocate a somewhat ruthless preoccupation with task. The management of an institution requires some measure of that ruthlessness but this concern for task need not and should not necessarily be linked with lack of concern for people. In the main, it is likely to prove the contrary. Much of the task-orientated activity is, in fact, directly good for people. For example, striving for adaptive and mature defences rather than primitive and counteracting the development of destructive sub-cultures are rewarding for people. Above all, such task-orientated activities facilitate the support given to staff through belonging to an institution that functions well and gives both the rewards for work well done and the rewarding relationships that go with them.
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