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TheRoleofSelf-reflexivityinTransitionLeadership
TrainingintheHealthcareSector
JOANCAMILLERI*
UniversityofMalta,Msida,Malta
Leadersinthehealthcaresector,frequentlyfindthemselvesattemptingtoimproveserviceprovisionbyadoptingevidencebased-bestpractices,asrequestedbypolicy.Notwithstanding,changeimplementationisoftennotstraightforward.Asaninsider-turned-researcherIinitiatedaMalteseNationalHealthcareService-widedoctoralinquiryintothelivedexperienceofleadersduringchangeandtransition,togaininsightintowhichleadershipstylesandmanagerialskillscharacteriseaneffectivetransitionleaderfromapsychotherapeuticperspective.Theinquirywasdividedintotwophases,usingmixedmethodswithanaction-researchelement.Arisingthemesindicatingtheneedforindividualproactiveself-actualisation,developmentatanemotional-transferentiallevelandtheundoingofidentityfollowingorganizational/personalshifts,providedaplatformfortheco-creationofaTrainingManualfocusingonself-reflexivity.TrainingusingtheManualwasofferedtotheparticipantsfacilitatingtheirlookingmorecloselyathowpowerrelationsstalledpersonalandorganisationalgrowthbyhinderingchangeimplementationprocesses.Encounteringtheneedtounblockshame,somemetimpasse,othersmodifiedtheirunderlyingmetaphor/identityenhancingachangeinbehaviourwhileretainingthepowerinherentintheirpreviousidentity,whileothersyetnotedthatthetrainingenhancedtheirmanagerialskills.TheTrainingManualwaswellreceivedinthehealthcarefieldandbeyond.Theresultsoftheinquirysuggestthatself-reflexivityisanessentialelementwhenplanningtrainingforleadersandthatself-actualisation,andself-reflexivityareessentialmanagerialcompetencessupportingtransitionswhileenhancingcreativityandinter-dependence.Thisimpliesthatself-reflexivityneedstobeintroducedinmainstreammanagerialtraining.
Keywords:Leadership,Self-actualisation,Self-Reflexivity,Shame,Power,Identityand
Transitionmanagement.
* Correspondingauthor:JoanCamilleri.Email:[email protected]
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Introduction
AspartofadoctoratebyprofessionalstudiesIcarriedoutaninquiryintothelivedexperience
ofleadersduringorganisationalchange,exploringwaysoffacilitatingtransitionmanagement
training.TheMalteseNationalHealthcareService(MNHCS)wasadoptedasacasestudy.Part
ofthePublicSector,thisorganisationisoneofMalta’smainemployers.Asitmirrorstrends
acrosstheEuropeanUnionandtheUnitedKingdom,wheremanyofitsemployees’trainand
offertraining,resultsobtainedcouldbesharedoutsidetheMalteseIslands.
Theoutlayofthisarticleinvolves:adescriptionofthebackgroundandtheneedforchange;a
literaturereviewwithconsiderationsrelevanttothelocalfieldandresearchdesign;methods
andmethodologydescribehowphenomenologywasadoptedastheoverarchingorientation
andhowCriticalNarrativeAnalysisintegratedwithanaction-researchelementinvolvingan
advocacy-participatoryparadigm,ledtotheconstructionofPhenomenologicalCritical
NarrativeAnalysisasatoolfordataanalysis;Ethicalconsiderationsandmeansusedtoretain
insider-researcherobjectivityfollow;datacollectionincludedparticipative-observationduring
CommunicationsMacroTargetTeam(CMTT)meetings,unstructuredinterviewswith
volunteeringHeadsandreflexiveself-annotations,supportingtriangulation;dataanalysis
supportedtheemergenceofspontaneousthemesformingtheplatformforthewritingthe
TrainingManualincollaborationwiththeparticipants;findingsoftheCMTTsessions,
exploratoryInterviewsandthecollaborativeevaluationoftheManualarethendescribed;a
sectiononself-reflexivityelucidatinginsightsgeneratedfromthestudy,isfollowedbya
synthesis;asectionaboutPost-doctoralworkdescribessomeproducts,thewiderprofessional
influenceofthisresearchandmodificationsinthetrainingmanualinlightofmorerecent
practicesandlearning
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BackgroundandContext–theneedforchange
ReviewingMNHCSworkpractices,andobservingtheneedtofollowinternationaltrends
towardstransdisciplinarycare-plans,andknowledge-sharing(AzzopardiMuscat,etal.,2014;
Grech,2002)theMNHCSPermanentSecretaryrequestedinitiationofaMinistry-wideRe-
engineeringplan,inamechanisticcontextlackinghuman/materialresources.Headswere
encouragedtoadoptacomplementaryshiftinleadershipstyle/managerialskillsfromtechnical
administrationtoteam-management.Technicaladministrationdefinedasensuringresource
availabilitysoclinicalinterventionscouldbeadequatelycarriedout.Team-management
definedasmultidisciplinarycollaborationincareplancreation/implementation,introducing
standardoperationalproceduresandnewservices(NHSS,2014).Theexistingknowledge-
based,labour-intensivecontext,requiredsubstantialrestructuring(Dalmas,2005).
Seniormanagement,seeminglyunawarethatthecollaborativespiritsetforthinpolicy
challengedtheclinicians’individualisticidentity(Micallef,2003),promotedcliniciansto
managers,addingfinancialauditing/businessplanstotheirhabitualinterventions.Facedwith
difficultieswhenjugglingwithachangeinsenseofself/role/style,clinicians-cum-managers
attemptedtochangebehaviour,whilesafeguardingtheirsenseofself/identity(Vassallo,2007).
Work-basedobservationsindicatedthatthetrainingofferedwhilebasedoninternational
standards,metwithlimitedsuccess(Dalmas,2005)asonlyHeadsinterestedinmanagement
attendedtrainingwhichstartedafterchangewasimplemented(Micallef,2005).
AsaseniorpsychologistintheMNHCS,facingsimilardilemmas,Iaskedmysupervisor,“What
canIdo?”Herreply,“Whodoyoubecome?”challengedme.IfIwantedtobecomeateam
managerIneededtoletmytechnicaladministratoridentitygo.Thisinnershiftwasfacilitated
bythenarrativefunctionofthepersonality(Chidiac&Denham-Vaughn,2008),asking“Whoam
I/WhodoIbecome?”duringtheaccommodationphaseofthetransition/developmental
process(Ginger,2006).Identitymodification,requiredcriticalself-reflexivity.Thisobservation
initiatedadoctoralinquiryintotheexplorationofthelivedexperienceofleadersduringchange
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andtransition,togaininsightintomoreappropriatesupportiveinterventions(Barr&Dowding,
2012).
Objectives
Thisinquiryaimedatgaininginsightintoleaders’underlyingprocessesastheydevelopedin
theircontextualchanges;whichmanagerialskillsenhancedthechange/transitionprocess;what
weretheirtrainingneeds/preferredapproaches,andtoco-create/validatearelatedtraining
manual.
LiteratureReview
Changestartsbylettinggocurrentwaysofthinking,feelingandbehaving,sonewwaysmaybe
created,acceptedandadopted(Bridges,2003).Thistransitionprocessentailsmodificationsin
theinterpretationofmeaning(Dima&Skehill,2011;Manderschied&Harrower,2016)which
emotional,transferential,projectiveandspiritualprocessesofbecomingmayhinder/support.
Adaptinghealthilytoshiftsincontextisachoiceonemakeswhenreconnectingone’slife
narrativepre-topost-disruption(Barber,2006).
Integratingmanagerialandpsychotherapeuticchangemodels(Kaplan&Norton,2008;Ginger,
2006)indicatedhow,theoretically,thelivedexperienceoftransitionduringorganisational
changemaydevelop:
Anoverarchingorganisationalgoalissplitintosmalleronesthatmaybecateredforbyits
variousentities/departments.Giventheircentralroleasculturecarriers,leaders,needtobe
thefirsttoadopttherequiredshift(Amado&Elsner,2007;Binneyetal.,2012),topromoteitin
others(Baek-Kyoo,2005;Hawkins&Smith,2013).Asleadersbecomeawarethattheyneed
modifytheirsenseofself/identity,theymayre-enacthabitual,possiblyineffectivecoping
mechanisms(Thomas&Hardy,2011).Increasingleaders’awarenessabouttheirreactionto
change,couldsupportinsight,facilitatingacceptanceandparticipationinthetransitionprocess
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(Gilleyetal.,2011;Farrell,Keenanetal.,2013).Since,transitionmanagersneedtoreform
theirsenseofself/role/identity,tomodelnewwaystoemployees,(Nicholsen&Carroll,2013)
theywouldbenefitfromdevelopingconsciousnessofself-changeovertime(Oysermanetal.,
2004),becomingawareandacceptingwhotheyare,whilerecognizingwhotheyneedto
become.Toachievethis,theycouldengageininnerdialogue,asking:Whataremyneeds?–
identifyingunconsciousaspirations;WhodoIneedtobecome?–enhancingself-awareness,
facilitatingidentitymodification(Gilbert&Orlans,2011);WhatdoIwant?–makingconscious
decisions.Emergenceoftheleader’seffectivestylewouldoccursimultaneouslywithtransition
unfoldingatorganisationallevel,influencedbythewiderfield(Binneyetal.,2012).
Achievingself-changerequiresreflectivethinkingduringwhichonegainsawarenessof
predominantprocessesbycomingintouchwiththeregularinteractionsandpracticestaking
placeinthesurroundingculture(Syedetal.,2012).Thisprocessmaymotivateleadersto
challengethehabitualwayinwhichthingsaredone,andtoadoptrelevantvaluestofacilitate
effectiveserviceprovision(Cartwright,2002).Byreflectingontheirpractices,leaderscould
increaseawarenessoftheirtrainingneeds(Camargo-Borges&Rasera,2013;Gibson&Hanes,
2003).Thisimpliesthatreflectivethinkingcouldimprovegovernancethroughleaders’
appropriateandrelevantself-development(Grey2007).Tothisend,trainingcouldfocuson
increasingself-awareness,understandingtheprocessoneneedstoembarkupontodevelopan
identitywhichenhancesgoalachievementandself-fulfillment(Hawkins&Smith,2013).
Trainingcouldadoptanaction-researchapproachintheformofsupervisedpracticeatthe
workplace,(Hawkins&Shohet,2012)supportingleaderstoreplacecompetencytrainingwith
“learningtolearn”(Gray,2007,478),inaconfidentialsetting,promotingcriticalself-reflection
(Chidiac&Denham-Vaughn,2009).
IfMNHCSleaderscouldcriticallyself-reflectwhileintroducingcare-plans/audits,theycould
facilitateashiftintheorganisation’sunderlyinggoals,policiesandnorms,improving
governance(Kitchenham,2008).SinceBridges(2003)describedtheleadershipstylerelevantto
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transitionandBarber(2006)depictedhowtosupportvariousphasesofchange,itwas
beneficialtofocustheinquiryontheimpactchangeimplementationhasontheleader(Robson,
2002)focusingonlivedexperience,gaininginsightintounderlyingprocessesasHeads
respondedtoorganisationalchange(Reissman,2008).Applyingthisknowledgetotraining
programswouldbenefitallstakeholders(Binney,etal.,2012;Gray,2010;Thomas&Hardy,
2011).
Methodology
Exploringleaders’livedexperiencetobetterunderstandhowtheymaybesupported,required
empathicunderstandingoftheirindividualstory(Cresswell,2007).Thechosenmethodology
hadtoappealtotheirsenseoflogicalstructuresotheycouldfeelsufficientlycomfortablewith
theinnovative.Aphenomenologicaloverarchingorientation,narrativeanalyseswithacritical
thrustincludinganaction-researchelement(Langdridge&Hagger-Johnson,2009)wasdeemed
appropriate.Themethodologyofthisinquirywas,splitintotwophases:
Phase1:–Exploration,description,andinterpretationoftheHeads’livedexperienceswithin
theircontextastheyoccurred,usingfirst-personaction-researchpracticesand
phenomenologicalcriticalnarrativeanalysis.Thisfacilitateddelvingintonewareasof
knowledge,developinginsightintocommonphenomena.Arisingthemeswereusedasa
platformtoco-createaTrainingManual.
Phase2:–Determinationoftheeffectiveness/validationoftheManualwiththeparticipating
Heads,evaluatingitsimpactontheirshiftsofsenseofself/role/identity,usingsecond-person
action-researchpracticesinaparticipatorymanner,andcriticalself-reflective,change-
supportingelements.Narrativeandparadigmicmodeswereemployed.Theformerexplored
Heads’desires,goalsandintentionsthroughtheirstories,thelatterfacilitatedthelogico-
scientificunderstandingofexperiencesthroughempiricalobservation(Langdridge,2007).
Constructionismsupportedtheassumptionofapositionofadvocacy,raisingawareness,
establishingdialoguewithwhatunfoldedinthefieldwhilebeingcriticalofthesame(Camargo-
Borges&Rasera,2013;Figure2).
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PhenomenologicalCriticalNarrativeAnalysis:(PCNA)wasdevelopedbyintegratingcritical
narrativeanalysis(Langdridge,2007)withsecond-personaction-researchpractices(Cresswell,
2007).Criticalmomentswereintroducedintotheanalysesthroughhermeneuticreflexivity
(Langdridge&Hagger-Johnson,2009),involvingacritiqueoftheillusionofsubjectivity.PCNA
supportedtheexplorationoftheHeads’underlyingprocessbyhighlightingidentitychanges,
allowingthemestoemergespontaneouslyinahierarchyofpatternsfromthedatacollected
andflexibleanalysesofHeads’stories/textonacase-by-casebasis,identifyingpatternsof
meaningwithin/acrossdata;presentingthewholeinastructuredmanner(Langdridge,2009).
TheAction-researchapproachentailedtheorganisationsmode,supportingcollaboration
amongprofessionalstoreflexivelyimproveprofessionalpractice(Hughes,2008).Thisapproach
waschosenforitsproblem-solvingfocus,anditsmirroringcoachingmodels’framework
(Hawkins&Smith,2012).Astheinquiryrequiredacriticalself-reflexivefocus,Barber’s(2012)
modelhighlightingactionandcriticalself-reflectionateachphase,wasadopted.
• Pre-contact:Awarenessofconscious/unconsciousprocesses,differentlevelsof
experienceandpersonalpoliticsmanifestedasbehavior,mindset,emotionsand
motivation.
• Orientation:Researcherandparticipantsdrawacontractengaginginpreparatory
activities.
• Identification:Problemsareidentified,remediesdiscussedandsolutionsattempted.
• Exploration:Monitoringtheimpactofstrategiesimplementationonallstakeholders.
• Resolution:Measuringsuccess,terminationoftheallianceandfinalreflections.
EthicalpermissiontocarryoutthedoctoralinquiryinMaltawasobtainedfromtheMaltese
DataProtectionBoardandtheMaltaUniversityResearchEthicsBoard.Theresearchproposal
wasapprovedbytheMetanoia/MiddlesexEthicsCommittee.Beinganinsider-turned-
researcher,whileplacingmeinapositiontogainvaluableinsights,raisedethicalconcerns
(Czarniawska,2004).Acknowledgingmypresenceinthefieldcouldinfluencestudyoutcomes,I
adoptedapsychotherapeuticapproachtointerviewingtodecreasemyimpact,while
attemptingtobeascriticallyreflexiveaspossiblebydistancingmyselffromfeelingpartofthe
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organisation(Frambach,2003).Iadoptedaheuristicapproachtoensurepersonalintegrityand
ethicalexpression(Finlay&Evans,2009)whilefocusingonnotelicitingdesireddata(McLeod,
2010).Democracywasattainedbyadoptinganaction-researchapproach(Hughes,2008).
MethodsandResearchDesign
Theinquiryrequiredaflexibleresearchdesignlendingitselfsystematicallytothecollectionand
analysesofdata-richinformation,facilitatingworkingwithshiftsinsenseofself/role/identity
producingthemes,allowingtheresearchquestiontobere-shapedbysubsequentquestions
(Robson,2002).Datasourceandmethodstriangulationwereadoptedateachphase
(Langdridge&Hagger-Johnson,2009).Itbecameamulti-strandedmetastory,(Bamberg,2006)
diversefromthatofferedbythepoliticallypowerful(Czarniawsa,2004).
SamplingandParticipants:Namesofpotentialparticipantswereobtainedfroman
organisationalconsultant,andaletterwassenttoall.Volunteeringparticipants,heldvarious
postsintheMNHCSrangingfrompublichealth/medicalconsultantstoexecutivemanagersto
healthcareadministrators.Agesrangedbetween31and58years.Theageofappointmentto
leadershippositionsvariedbetween22and47years.Theirlengthofstayinleadershipranged
from9monthsto36years.Allheldapositionrequiringcontractrenewaleverythreeyears.
TheirextentofleadershiptrainingrangedfromnonetoMaster’s-level.Motivationto
participateincluded:-interestintheresearchtopic,findingsolutionsformanagementissues
andintroducingstaffsupport.Fourparticipantsdroppedoutandwerereplacedforthe
evaluationoftheManual.
DataCollection:
Macro-level(socio-cultural)datawascollectedduringattendanceofanInternal
CommunicationMacroTargetTeam(CMTT)sessions.Adoptinganobserver-as-participant
stanceIheardthevoicesofmanagementundergoinganxietywhenfacedwithchange
(Czarniawska,2004).Participants,permittingmyattendance,vetoedaudio-recordingof
sessions,soItookdownconversationsverbatimonanotebookcomputer,notingthepersons
involved,eventsnarratedinatimesequence,andemotionsexhibited(Robson,2002).Thefirst
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HeadtospeakwascodedCMTT1andsoforth.AttendingtheCMTTmeetingsallowedmeto
observetheoutcomesofnon-reflectivechangeimpementation,providingsupportive
informationfortheexploratoryinterviews(Cresswell,2007),.
Micro-level(emotional-projective)datawascollectedthroughexploratoryinterviewsduring
transition,beforethesense-makingretrospectiveprocessandcontextualinfluencesetin,
decreasingfaultyrecall.ImettheHeadsapproximatelyonceeveryfourmonthsatT1-T2-T3
overayear.Interviewsscheduledbyappointment,wereconductedattheiroffices(Gray,
2007).Headsallowedmetorecordtheinterviews.ThefirstinterviewedHeadwascodedH1
andsoforth.Thisprocessgavethemtime/spacetonarratetheirstoryfromtheintroductionof
theorganisationalshifttotheirnewrolesfollowingcontractrenewal,demotionordismissal
(Nicholsen&Carrol,2013).Reissman’s(2008)fivephasesofrepresentationwereadoptedfor
theinterviewing,transcriptionandrelatingprocesses:
T1theresearchquestion;“Whatisyourlivedexperienceofchangeandtransition?”wasasked
atthestartoftheinterviews.“Whatmetaphorsymboliseswhoyouareinyourcurrent
position?”wasaskedattheend.Interviewsweretranscribedandanalysedbetweensessions.
Arisingthemesfromindividualparticipantsweresenttothempersonallyforfeedback.
T2andsubsequentinterviewscommencedwiththequestion“Whatareyourreflectionsonthe
themesarisingfromthepreviousdiscussion?”Trainingneeds/desiredapproacheswere
explored.AdraftTrainingManualbasedonarisingthemeswassenttotheparticipants
betweenT2andT3.
T3-themesarisingfromT2andthedraftTrainingManualwerediscussed.
AnamendedTrainingManualwasSharedamongstparticipantswhovolunteeredfortraining.
TodeterminetheeffectivenessoftheTrainingManual–Ifocusedonprocessstudies,
encouragingstakeholderstoparticipateindecision-makingatallstagesoftheaction-research
cycle(Fillery-Travis&Lane,2006).Theevaluationconsistedof:training-in-activitywitheach
participantindicatingwhatwaslearnt;thePCNAofexitinterviews;andmetaphoranalysis
(Lawley,&Tompkins,2013;Figure3overleaf).
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Figure3:ActionResearchSpiralforDeterminingtheEffectivenessoftheManual
DataAnalysis:DuringthePCNAofthetranscribedmaterialtopic-centerednarratives,linkedby
themeswereadopted(Reissman,2008).Commonpatternsofmeaningwereidentified,
appreciatingwhatfelloutofthispatternandworkingwithboth.Datasetswereplacedinto
codesproducingathematicmap.Narrativesweredeconstructedasking‘Whichothervoices
needtobeheard?Thesynthesis,intertwinedmyinterpretationsofthedescriptions,withmy
observations(Langdridge,2009).
Findings
Participative-observationofCMTTsessionsfacilitatedinsightintotheHeads’experienceof
ongoingchange/implementationandoutcomesofnon-reflectivefacilitation.Exploratory
interviewssupportedinsightintoHeads’underlyingprocesses,trainingneeds/preferred
approachesandtheoutcomesoftheirnon-reflectivemanagerialinterventions.Findingswillbe
presentedusingthePCNAstructure.
Orientation:Discussing identified topical life
stories, translating key issues into a training
manual
Implementation: Training participating Heads over a
three-month period
Exploring the impact through constant feedback
from participants & supervision
Critical Reflection on the outcomes with various
stakeholders
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Participative-observationofCMTTsessions:ElevenCMTTsessions,werefacilitatedbyCMTTF
betweenJune–July2012.Headsnominatedbyadministration†astheirrepresentatives,were
taskedtocreateguidelinesenhancinginter-employeeandinter-entitycommunication.CMTTF
plannedtoconvincetheHeadsthatitwouldbenefitMNHCStobecomealearningorganisation,
andintroducethepositionofCommunicationsCoordinatoratDirector(CCD)level.Onehoped
someHeadswouldbecome“multipliersoftheprocess”(Session#2,line1).StatingthatCMTT
outcomesdepended“onthepersonalityoftheleader”(Session#9,line17)CMTTFsetthe
canonicalnarrativeasherowhoenterstoturntheorganisationaround.Oneappearedunaware
thattheHeadsregardingCMTTFasrepresentingMNHCSadministration.Theywerecautiousof
embracingtheprescriptivedocument,sincetheyhadtoaccountfortheiractionstotheabsent
decision-takers.Rhetoricincludeddistancingthroughsecond-andthird-personpronouns,and
self-referentialitythroughtheegocentricI.Verbalisationssuchas“people...donotliketosee
change”(CMTT10,Session#6,line127),coupledwithawarytoneofvoice,indicatedattempts
toplayfortimeuntilthepicturebecameclearer,whileappearingtosupportthe
communicationsdocument‡settingthecounter-narrativeaschangeterrifiesusintoinaction;
anonymityprotectsus.
TheMNHCSnon-reflectivechangeimplementationprocessesinvolved:Seniormanagement
leadingthroughpersonalitycult(shadownarrative)createdcoregroupstocarryouttheir
directions,precipitatingasilo-mentality,usv.themculture.Reportedly,theyadoptedthisstyle,
tocamouflagelimitedmanagerialskills,whilecontrollingotherHeads.Middle-management
belongingtothecore-groups,encounteringanoppressiveattitude,feltdeterredfromvoicing
theirfeelings/initiatives,asmanifestedwhentheCMTTHeadsadoptedverytentativelanguage
todescribepotentialinitiativesverbalizing,perhaps,if,maybe.Headsrespondedfroma
perspectiveoffearofsanctions/self-gain,withunderlyingfeelingsmorelikelytobeenvy/spite:
“Managementwantsanemployeeto...becreative,butwhencreativitydoesnotwork,[they]
be-Headhimwithascimitar”(CMTT2,IntroductorySession,line39).Livinginconstantfearof
† Senior management and administration are used interchangeably in this section. ‡ Reference to document in the text means the communications document.
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beingshamed,mistrustingtheirstaff’sabilitytomaintainconfidentiality,CMTTHeadsshifted
blameoflimitedefficiencyontosabotagecarriedoutbysubordinates:“Theproblemiswhen
lowerworkersdoharmonpurpose”(CMTT9,Session#2,line78).Heads,identifyingwiththeir
oppressorsbecameoppressiveand/orinfantile.“Goodcommunicationisthatwhichgetsyou
whatyouwant”(CMTT11,IntroductorySession,line36).Apparentlylackingself-reflexivitythey
distancedfromself-growth-theshadownarrative.Lowerechelons,excludedfromcore
groups,reportedresentment,withbottom-uprebellionand/oradaptation,joiningtheirunions
inanattempttoredressthepowerdifferential,severingcommunication.
CMTTF,infact,didnotconsultwiththeCMTTHeads.Onedeflected§theirseveralwarnings
abouthowtheyfelt,erroneouslysupposingthatonecouldchangetheirmind-setduringthe
documentationprocess.Oneappearedunawarethattheproposals,triggeredtheshow-
stoppingoverallnarrative-Wewillalldowhatwehaveto,sowhenchangeimplementation
fails,weallsaveface,andpredominantthemeMNHCSpiècedurésistance,propose,stop
(silence),wait(togaintime),abort(tosafety).OnegavethepoliticallypowerfulHeadswhat
theywantedtoavoidconflict,solesspowerfulHeads,gainedtimethroughstrategicrequests
forclarification,makingcounter-suggestions,untiltheygaverisetoascenariotheycould
control.Discouragedbythepercievedlackofcollaboration,CMTTF,exclaimedthatunlessall
agreed“wecanforgetit”(Session#11,line34).CMTTFimposedtherecruitmentofaCCD
deeminghimnecessarytocreate“asingleperspective”(Session#7,line,19).Headsvoiced
resentmentthatanotherDirectorcouldbegivenpowertotellthemwhattodo.CMTTF,
negotiatedtheinsertionofthetermcooperationinthedocument,allowingthemtocollaborate
if/whentheydeemedfit,renderingCCDdependentonindividualgoodwill.Adilutedversionof
theoriginalproposalwasrubberstamped,gettingthejobdonebutonlyonpaper–shadow
narrative.
§ In gestalt psychotherapy this means turning away either an internal stimulus or one from the environment, preventing awareness (Ginger, 2006)
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ThemainobstructiontoaneffectiveoutcomeemergedinSession#3whenCMTTFaskedthe
Headstodiscusstheiridentity.Overwhelmed,mostprojectedanimageofcompetence,
emphasisingprideintheirprofessionalstatus:“Wearethosewhoarecontributingtoachieve
thegoals...”(CMTT5,line5).InSession#7,askedtoreflectabouttheiridentityandvalues,
Headsreiteratedthattheirsenseofselfemanatedfrom“prideinthe…professionalstate”
(CMTT10,line74).CMTTFgaveup:“Ifwehaveaproblemunderstandingwhoweare,we
cannotgoforward”(line,43).EnjoyingprideintheirstatusHeadsdefendedthemselvesfrom
commitmenttochangefearingitsloss:“Thisisego”(line104),verbalisedCMTT5.
ExploratoryInterviews:occurredbetweenJanuary–December,2013whileparticipantswaited
foradministrationtoeitherrenew/terminatetheirthree-year-termcontractorre-
instate/demotethemafterchangesinpoliticaladministration.Narrativesevidencedanxiety,
fear,anger,frustration,resentmentandfeelingirrelevant.Feelingswereattimesovertly
expressedwhileatotherscamouflagedasover-composureand/ordeflectedintoabitter
humour.InterviewedHeadsalsodistancedfromtheirnarrativesusingsecond-andthird-
person,singularandplural,adoptedtheself-referentialegocentricI,projectedanimageof
excellence,hidinginternalconflict.DistancinganddetachmentappearedtobeMNHCS-wide
copingmechanisms.Incoherencebetweenverbalandnon-verbalprocessesre-elicitedthe
themepublicv.privateselves.
a) HeadsUnderlyingprocesses
DuringInterview#1,Headsfeltchallengedbytheresearchquestion“Whatisyourlived
experienceofchangeandtransition?”askingabouttheirexperienceofratherthanhowthey
implementedchange.Evaluatingtheirimpactontheenhancementofthequalityofservice
provision,Headsassessediftheyweregoodenoughforre-instatement.Theynarrated
adjustingtocircumstancesthroughaseriesoftransitionalcrises,habituallyjuggling(shadow
narrative)inaconditionedmanner.Narrativesechoedperusedliterature(Gilbert&Orlans,
2011;Thomas&Hardy,2011).Viewingtheinquiryaschangeagencyseniormanagement
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belittled/ridiculedit,evokinganexpert–amateurinteraction:“Youcan’tmakethenervous
calm.”(H13,line40)verbalisedsarcastically.Middle-managementtendedtoevokeadominant
teacher–studentinteraction:“Look,letmetellyou!”(H2,line11;H8,line6).Caughtinthe
sameorganisationalshame/blamenarrativeasCMTTHeads,theyalsowerereluctanttodiscuss
theirprivateselves/identity.Tore-establishpowerdynamicssomerequestedacopyofthe
methodology,othersalistofreferencestoensuretheresearchhadsolidscientificbasis.
Proposingpolicyupdateswasviewedasanopportunityto“Increaseconsistent,reliable
services...”(H1,Int,#1,lines14)enhancingquality,accessibility,andsustainabilityofservice
provisiontotheserviceuser(canonicalnarrative).Creativechangewasdiscouragedwith
“innovations…thrustuponyou...mostofthetime,youjustabsorbthechange”(H5,Int.#1,
lines14,18).
InterviewedHeadsechoedCMTTHeadsnarrativesofnon-reflectivechangeimplementation
processes.Thoughseniormanagementpreferredadoptingevidence-basedresearchmethods
whenattemptingtoimplementchange:“thatdoesnothappenmuch”(H9,Int.#2,line28).
Peerswereapproachedwith“scientificargument”(H2,Int.#2,line26),however“personal
psychologyandtheotherperson’spsychology”(H5,Int.#1,line73)wereessentialtoelicit
individualgoodwillgivingrisetotheoverallnarrative:It’snotwhatorhowmuchyouknowthat
mattersbuthowwellyougetonwiththosewhomatter.Middle-management,deemed
“incompetent…[had]…tothinklike…”(H2,Int.#2,line26)seniormanagement.Lowerechelons
wereapproachedthroughchangeagentsadoptingmanipulativetechniques.Whenpersuasion
failedseniormanagementresortedtoimpositionsettingtheshadownarrativepowerisin
givingdirectionnotinbeingofservice.Shiftingblameontolowerechelons’resistanceto
change,Headsjustifiedtheneedforautocracy,andlackoftransperancy.Theyfailedto
acknowledgethattheadoptionofconstrainingcommunicationstyles,ledtoelectivemutism
(silence)and/orfrustratedacting-out(unionisation),settingthecounternarrativestrivingfor
consensusorchestratesinaction.
HeadsalsogotcaughtintheMNHCSviciouscycle:“evolvingandchanging[notnecessarily]into
somethingbetter”(H4,Int.#2,line88),becomingslowlybutsurelydesensitized,detachedand
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alienatedand/orleaving.Theyrealizedthatgoinghighercouldentailmeetingmore
constraints,precipitatingfrustration.ThemoredistantHeadsbecamefromthecorebusiness,
themoretheyriskedidentitycrises:“It’s…easier…toempathise…whenyoumeet…the
person…usingtheservice”(H6,Int.#1,line26).Speakingoftheirlifeasleaders,theytookdeep
self-supportivebreathsfollowedbysilence.Self-actualisationsloweddownspiritual-emotional
regression,providingsufficientintrinsicrewardsandenergytoprotectoneself:“Surviving
is...momentofreflection...beinghappydoingwhatIdo”(H3,Int.#1,line116).
ByInterview#2,havingreadtheemergentthemesfromInterview#1Headsfelttheywere
losingcontrolovertheresearch.Thisprecipitatedfurtherpoliteannihilation/ridiculeaspartof
abelligerentdiplomaticargument.Whilefeelingdispleased/furiousatwhatemerged,they
couldnotdenyit:“Iwastakenaback…IwasmoreofaguineapigthanIrealised”(H5,line8).
Toretaintheirtop-downexpertidentityintact,participantssplitmeintobadlistenerwhenI
questionedandgoodlistenerwhenIempathised,beinghappiestwhenwhatIsaidwas‘exactly,
exactly’whattheyintended.Theinterviewsendedonarelievednoteforre-instatedHeads,
disappointmentforHeadswhoaccepteddemotionwithambiguousgraceandfuryforHeads
whoexperiencedtheirdemotionasnarcissisticinjury.**
DetachedfromtheirinnerselvestosurviveMNHCSpractices,hidfrustrationandanxietyunder
aveneerofover-composureandego-centricity,livinginfearofbeingshamed.
b) Managerialskillsandvaluesforchangeimplementation
DuringInterviews1#and#2Headsdisclosedencounteringdifficultywhenpracticingskills,they
learntduringtraining.Theyactedasiftheywerefollowingmanagementtheorybuttheintent
wassurvival,theavoidanceofshameandblame.
Activelistening,acknowledgement,andequityaimedatensuringloyalty,ratherthan
understanding.Heads,disseminatedinformation/knowledgeabouttheorganisationcautiously,
disclosingevenlessaboutthemselves,believingthatthiscouldleadtolossofpower:“sharing
** A narcissistic injury occurs when a person reacts negatively to perceived or real criticism or judgment, boundaries placed on them, and/or attempts to hold them accountable for harmful behaviour (DSM-5, 2013)
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innerfeelingsenoughgains...trust,toomuch...becomesshaky”(H15,Int.#1,line10).Heads
notedthatbuildinggoodworkingrelationswithpeersresultedingreatercollaboration,
howevertheysetclearpowerdistancesbetweenthemselvesandthestaff,reducingthelatter
toanamelessmass;“…thestaffhastobenefitaswell…givehimawin-winsituation”(H2,Int.
#1,line83).ForHeadsoutcomeevaluationwasanongoingexerciseassessingwhetheronewas
attainingthedesiredresults.Thisapproachentailedbeing“abletoaccept,failures,mistakes”
(H15,Int.#1,line52),“...find[ing]waysofimproving”(H1,Int.#2,line12);saying“…‘look,this
didn’twork,’weneedtoadapt”(H3,Int#1,line17).Negotiation,persuasion,andorganisation
techniquesaimedatachievingawin-winsituationforasmanystakeholdersaspossible;“Idon’t
trustthemandtheydon’tunderstandme….so,youbuildtrust”(H1,Int.#2,line48,53).
Whileacknowledgingthatbeingauthenticandhonestcouldgeneratetrust,Headsnotedthat
survivalrequiredflexibilty,shrewdnessandopportunism,possiblyalsomanipulation:
“sometimes…youmayneedtosayahalf-truth(H13,Int.#2,line49);“Youcan’t,(triplicated)
occupycertainpositionsandnothaveathickskin”(H9,Int#1,line30).Commitmentand
passion,involvedowningaprojectwhichreflectedone’scause:“Ifyoudon’tsucceedtryand
tryagain”(H13,Int.#1,line11).Whenpassiondiedone“movedon”(Int.#1,H3,line116;H12,
line83).Patience,tenacity,perseveranceandresilience,wereessentialgiventheslow,
unfoldingofchange.Acceptingthesituationand,workinginthehere-and-nowwererelatedto
lackofcontinuityratherthanmindfulness:“constantly,understandtheconstraints...results
taketime”(H15,Int.#1,lines56,57).Self-controlinvolvedbeinglogical,awareofnegative
feelingstoretainclarityofvisionandthought,focusingonwhathadtobedone:“recognizethat
asituationisabouttoescalate…thecircleofenemiesneedstobeconvertedintoacircleof
friends”(H1,Int.#1,line84,96).
RespondingtothedraftTrainingManualsentbetweenInterview#2and#3,Headsnotedthatit
wasevidentthattheManualhadbeenwrittenbysomeonewhoknewthefieldverbalising
“you’veinvented…anadapterplug…wecanthinkaboutchangingourprocesses”(H14,Int.#3,
line28).
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c) Trainingneedsanddesiredapproaches
DuringIntervew#3declaredtrainingneedstendedtoself-referentiallyaddressthe
developmentofpre-existingpredispositions,safeguardingpositionsofpower.Skillsrequiredto
functionwithintheMNHCSwerenotfoundinmanagerialbooks/trainingas:“newmanagersdo
notevenknowwhatskillstheyaregoingtobeneeding”(H1,line46).Theseskillscouldbe
impartedtochosenacolytes:“Youcannotinclude...aday-to-daypersoninthis...da”(H2,line
39).
However,whenrequestingfurthertrainingaboutethics,moraldevelopment,facilitatingthe
emergenceofthetrue-self,focusingonenhancingprofessionalismandincreasingawarenessof
howfartheyhaddevelopedintheseaspects,Headsexhibitedawarenessoftheirneedto
develop/rediscovertheirhumanity:“thepatient[asactiveparticipant]needstobecomethe
ethosoftheorganisation”(H2,line43),
Trainingapproachesrequestedincludedinteractiveseminars/workshopswhereinHeadscould
discussissues,exchangingsolutions.One-to-onecoaching/mentoringsessionsby:“someone…
wiser…atthesamelevel...tosharegrievanceswith”(H9,line89),would“allowthesituationto
growanddevelop”(H15,Int.#3,line119),avoidingsufferingassociatedwithlearningfrom
one’smistakes.Reflectionasaformofpersonaldevelopmentwashighlighted:“It’svery
difficulttobringaboutchangewhenyouyourselfhavenotgonethroughshortstopofsuspense
changes.Thenyoucansaythatyouleadbyexample”(H9,line67).Headsrequesteda“training
manual[offering]sufficientflexibilityforthepersontorevisitwhatonehadlearnt”(H1,line
44).
PCNAofInterview#3highlightedthatareflexive-tool,couldcircumventtheorganisational
narrativetellmewhattodosoIknowwhattoresist.ThiswasaddedtothedraftTraining
Manual.
WritingtheTrainingManual:Discussionswithstakeholdersindicatedthatitwouldbe
beneficialiftheTrainingManualdrewon:-Gray’s(2006,2007,2010)executivecoaching
approachwhereintrainingwouldfocusondailyworkplaceinterventions:Denham-Vaughnand
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Gawlinski’s(2012),coachingmodel,sotrainingwouldbebasedonfield-relationalandgestalt
theory:NicholsenandCarrol’s(2013)suggestionsthatthetrainer/researcher,practicingself-
awareness,wouldempathisewiththeleaderwhopractices:a)self-observation,followedby
self-disclosure;b)self-examinationthroughreflection/feedback;andc)self-development
throughtransformationbynewknowledge:andBarber’s(2012)multidimensionalapproach
whichfacilitatedengaginginfiveformsofinterventions,helpingparticipantsdevelopformsof
intelligence/skillatvariouslevels.Table1outlinesthefacilitativeskills,relationshiplevels,and
typesofintelligenceaddressed.
Table1:Multi-LevelAmalgamationforHolisticInquiry
FacilitativeSkill RelationshipLevel Intelligence FosteredSkill
Engagingthephysical-sensory
environment.Facilitatingawareness.
Negotiatingthe
workingalliance
Sensory
intelligence.
Observation
andlistening.
Respondingtosociocultural
environment.Organisational
dynamicsandethicalboundariesare
exploredandrecognised.Strategies
arecontracted/implemented.
Asabove. Social
intelligence.
Inquiryand
communication
Acknowledgingtheemotional-
transferentialclimate.Focusingon:
client/organisationbiography,
resources,learningorientations,
discoveringemotionalblockages.
Idealiseddimensionof
relationshipvspower
politics;shadowside
ofcontractual
relationship.
Emotional
intelligence.
Coachingand
counselling.
Surfacingtheimagined-projective
shadow.Drawingattentionto
unconsciousprocessesanddynamics.
Asabove. Self-
intelligence.
Mindfulness
andself-
awareness.
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Locatingintuitive-spiritualqualities.
Theattitudeoflisteningwithout
fittingwhatonehearsintopre-
packagedconcepts.
Authenticrelationship,
accurateperceptions,
willingnesstobe
honest.
Transformation
occurs.
Intuitive
intelligence.
Reflectiveand
envisioning.
TheTrainingManualdevelopedintothreesections:
Introduction:-Theconceptofleadershipandhowsynergisticlearningsupportsself-
developmentwerediscussed,exploringhowthereadercouldadoptcriticalself-reflection
duringtransition.
Self-ReflectiveTool:-Replyingtosetquestions,onecouldidentifyproblems,seekingremedies,
criticallyself-reflect,attainingbehaviouralclarityandawarenessthatone’spracticeischanging.
Self-ReflectiveManual:-Supportedthereadertolearnfrompersonalobservationandcritical
self-reflection,facilitatingthecultivationofanewsenseofself/identity,andthedevelopment
oftransitionalleadershipskills/relatedroles.Conceptualframeworksandmodelsuponwhich
thetoolwasbased,werediscussed.
d) TrainingOutcomesandEvaluationoftheManual
TrainingcommencedMarch2014,withthirteenparticipatingHeadsandtwonewvolunteering
Heads–fifteeninall.Duringaninitialmeetinganup-datedversionoftheManualwas
presentedtothemofferingthemachoicetoreaditontheirown,orworkthroughitwithme.
FiveHeadsoptedtoreaditandmeetfordiscussions.TenHeads,identifiedareastheyrequired
traininginandweworkedtogether.Thissectionwilldiscussresultsobtainedfrom:training-in-
activity;PCNAofExitinterviewsandmetaphoranalysis.Exitinterviewsoccurredonemonth
followingtrainingallowingHeadstimetoworkontheirrespectiveprojects.Metaphors
verbalisedduringInterview#1werecomparedtothoseofferedduringtheExitInterviews
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evaluatingpossibleshiftsinsenseofself/identity,managerialskills/leadershipstyleand/or
learningstyle,notconsciouslyverbalized,onacase-by-casebasis.Asprojectivetechniques
mayrevealwhatparticipantsdonotnecessarilyknoworwantknownaboutthemselves,Iasked
thempointblankwhichmetaphorsymbolisedwhotheywere,demystifyingtheprocess,
increasingtrust(Edgar,2004).
Training-in-activity:Heads’projectswerediscussedduringthree/fourmeetingsheldovera
three-monthperiod.Processnoteswerekept.AllHeadsindicatedthatorganisationalissues
arosewhenprojectsreachedtheexplorationphase(Barber,2012)-monitoringtheimpactof
strategyimplementationonstakeholders,possiblybecauseadoptingatop-downapproachwith
subordinatesrenderedmonitoringdifficult.H14notedthatwhenbuildingcommunication,the
bestplanwas“comingdowntoearth,onlevelwiththestaff.”H15startedhavingcoffeeinthe
kitchen,togivethemessage“Iamapartofyouatlowerlevel.”Trainingsupportedthemto
developawarenesssotheycouldidentifytheirvalues,andthensupportthedevelopmentof
awarenessinothers,soallcouldbecomeawarewhichvaluetheymightneedtochange/adopt
tosuccessfullyachievedesiredoutcomes.
ThreeHeadsadoptingguidelinesexplicatedbytheManualcommencedprojectsdiscussingthe
wayforwardwithcolleaguesandsubordinates.Theyfoundthisexercisedemanding,however
agreedit,‘unexpectedly’facilitatedthesmoothflowoftheproject.TwoHeadsrequested
team-buildingfortheirentity.Thoughthisachievedthedesiredmanagerialgoal,itset
subordinatesonthepathtodifferentiation.Feelingtheywerelosingcontroloverthestaff,the
Headsdevelopedinternalconflict.Notwithstanding,theyreportedthatthisactivitylefta
positiveimpressiononseniormanagement,promotingmanaging-up.Headsseekingto
enhancetheirinteractionswithsubordinates,ratherthantheirownself-development,became
moreeffective.
ExitInterviews:Headswereaskedsetquestionstoevaluatethetrainingoutcomes:
Askedwhattheyconsideredtobeofsignificantlearningforthemselvesandhowtheybest
learnedfromthemeetings,Heads,voicedappreciationforthewaytheManualintegrated
managementwithpsychotherapy,logicalthinkingwithempathy:“thewayitisstructured[and
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the]questions[madeyou]reflect...renderingyoumoreempathic”(H1,lines5,7);“Itcameat
therighttime...he...he...sometimesit’sgoodtohavesomethingthat...helpsyoufilteryour
thinking”(H13,line34).Heads,notedthattheyfoundtheManualtime-consuming,requiring
in-depththinkingpriortoinsight.
Askediftheywereawareofanyself-growth,duetotheworkcarriedoutthroughtheReflective
tool,Headsreportedalimitedincreaseinself-awarenessandself-reflexivity,whichtheytended
tointellectualise,justifyand/orrationalisetosomedegree.Headsdeemedtheoutcomeshad
commencedduringtheexploratoryinterviewingprocess,wherein‘hard’questionshad“started
self-reflection...maybebeforeIdidnotgiveitanyattention”(H10,line4).Focusedonself-
reflection,theManualcouldnotbeusedasasetofmodels/directionsindicatingwhatHeads
weremeanttothinkand/orhowtoreply.Headslackinganinternallocusofcontrolfoundthis
difficulttodigest.SoundingsurprisedH10andH13respectivelyverbalised;“Thatthingmade
me…stop,thinkandplan…IhaveatoolIcanuse”(H10,line2);“You…makethetimeto
actually…reflect”(H13,line3).Blamefortheincreaseinundesiredself-awarenessandself-
reflectionwasattimesshiftedontome,asauthorof‘thething.’
OtherHeads,whileappearingangryatunplannedpersonalchange,reportedfeelingcontent
whentrainingsupportedachievementofmanagerialgoals.ThismirroredtheCMTTnarrative–
theywantchange,wedonotwantself-growth.Self-reflection,whilegivingresultsmighthave
precipitatedunblockingofshamewhichHeadswantedtoavoid:“Itexposedmetomy
deficiencies...Ithink(H2,line5);“Iwasfindingithardtoadjust[todemotion]…Longreflective
silence…BecauseI…I…neverreallythoughtaboutit”(H13,lines4,20).OtherHeadsyetused
theManualtoservetheirpurpose:“Theformsofthinking…helped…wecanmakeabetterteam
witheachother”(line11).WebeingH3andmyself,asH3distancedfromthestaffwho
neededtraining;“You…needtoresistthetemptationthatafterthingshavereachedfullcircle,
yousay‘Didn’tItellyou?’...otherwiseyougetintotrouble”(H6,lines26,29).These
verbalisationsimpliedthatthemainthemebehindresistancewasprofessionalnarcissism.
Askedifthisworkhelpedthemdeveloptheircurrentformofintelligenceand/orexposed
themtootherformswhichtheyalsodevelopedandtowhatextentitdidso,eightHeads
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reportedashiftinoneofthevariousintelligences:self-,emotional-,social-,imaginative-,
and/orspiritual;fivelearntanewlearningstyle,shiftingeitherfromabstract
conceptualisationtoactiveexperimentationorviceversa.Activeexperimentationofthe
guidelinessupportedsomeHeadstodiscoverindividualneedsformanagerialtrainingand
otherstoobservethattheyneededtostop,stepback,andthinkpriortoplanning,actively
counteractingtheMNHCSnon-reflectivechangeimplementationprocess.
ElevenHeadsclaimedthattheManualhelpedthemachievetheirtrainingneeds;tenHeads
claimedithelpedtheirpersonaltransition;thirteenHeadsnotedthattheToolsupportedtheir
abilitytoself-reflect,enhancingawarenessofwhotheywereandwhotheywantedtobecome.
IdentityworkandMetaphoranalysis:Metaphorschosendistinguishedbetweenmaleand
femalearchetypes(Morgan,2006)echoingCMTTandExploratoryInterviewnarratives:-
• malearchetypesincluded:Gandhi,MandelaandRobinHood:Thesecounter-culture
metaphorsechoedtheCMTTandInterviewedHeadsrespectivenarratives:theherowho
turnstheorganisationaround,wantsapersonalitycultandpowerisingivingdirection
notinbeingofservice.
• femalearchetypesincludedtheoldhumpedtree,thegnarledpineandthewiseold
person:Relatedtodeformityandoldage,theanti-thesistoHealthwhoismale,these
metaphorsechoedtheHeads’narrativestheywantchange,wehavetojugglearoundto
survive.
Pre-andPost-metaphoranalysisevidencedhowHeadsveeredtowardschangethatmaximized
power.H3describingoneselfasthecaptainofaboatwithholesinit,gatheringateam
togethertofixthem,evidencedone’sintenttoextendone’spersonalitycult.Morefrequently
howeverchangewascarriedouttoretainpower.FollowingdemotionH15shiftedone’s
metaphorfromarideronaroller-coasterbeingmainlyatop,toawiseoldpersonadoptinga
lowprofiletryingtoblendwithone’ssurroundingsstillexertinginfluence.Powerretentionalso
tooktheformofminimisingshamefulconnotationsbyusingeuphemisms:holesratherthan
shortcomings(H3)
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SomeHeadsfounditeasiertospeakabouttheirprivateselvesthroughmetaphor.The
oppressedHealthcareadministratorschosedeformityagnarledpinebatteredbytheelements
andahumpedtreeofwisdomwhichcouldspiraloutofcontroltodescribewhotheyhad
becomeasaresultofcopingwithseniormanagement.
DuringtheevaluationofthetrainingmanualsomeHeadsappreciatedtheintegrationof
professions,becomingmoresensitivetothefeelingsofothers,andmoreempathicwiththe
paceofthechangesoneiscarryingoutwiththeother.Theadoptionofempathy,andco-
creationwasstalledbythedominant,masculinearchetypalorientationoftheexistingculture
anditsunderlyingnarrativeswhichwereintrojectedbyotherHeads.Thediscoveryofthis
issuecouldonlybecarriedoutthroughdialogueandself-reflexivity(Chidiac&Denham-
Vaughn,2018).Headsagreedthatdespitebeinglimitedbytime,theircolleaguesand
themselvesneededtostopandthink,andthattheManualhadfacilitatedthatprocess.
Self-reflexivity:Supervisionandkeepingajournal,protectedmetemporarilyfrombecoming
ensnaredinMNHCSpractices,assumingtheroleofrebellious/adaptedchildand/oridentifying
withtheoppressors(Evans&Gilbert,2005).Findingmyselftryingtoremaincalmand
composed,despitetheridicule,belittlingandsplitting,Igainedinsightthatsenior
management’scoldindifferencecouldbeaformofself-defence.InformedbyEtherington
(2004),thatresearchersneedtodelicatelytreadthepathwaybetweentheirownpossible
narcissismandneedforcontrol,andthatoftheirparticipants,Ididmybesttoholdmy
presuppositionsatbay,whileadoptingpsychotherapeutic,activelistening.TheHeads,unused
tothisapproach,apparentlymistookitasasignofweakness.AsIdidnotactasanexpert,I
wasanamateurtowhomsomeHeads,impartedtheirskills.Beingcognisantoftheasif
managerialtacticsIbegantorecognisethemwhentheywereusedbymydirectlinemanagers.
Asaninsider-researcher,Iwassurprisedattheextentofthenegativeimpactfromtheongoing
lackofcontinuity.Headsweregiveninsufficienttimetolettheircurrentsenseof
self/roles/identitygobetweenoneshiftandanother,sobynecessity,theylivedinthehere-
and-now,practicingsecrecyasasurvivaltactic(Shapiro,2013).Thisworldviewprecipitateda
senseofinsecurity,pervasivemistrustandfearoffailureleadingtotheshame-blamenarrative
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resultinginthealienation-demotivationprocess.Consequently,Headsdevelopedegocentric
self-referentiality,personalitycultleadershipstylesandcoregroups,limitingpolicy
implementationatstrategiclevel,decreasingthequalityofserviceprovision.Thisprocess
resonatedwiththepointraisedbykeynotespeakersattheJointActiononMentalHealthand
WellBeing:DrivingMentalHealthatWorkinEurope(2014),thatevenifpolicyweredrawn
followingprofessionalresearchandinterventionsrespectethicalevidence-basedbestpractice,
implementationisnotstraightforward.
Synthesis:InlinewithNicholsenandCarrol’s(2013)conclusions,thisresearchconfirmedthat
theundoingofpowerisadifficulttaskforHeads.Findingitdifficulttolettheiroldgrandiose
identitygo,evenwhenthisbecamenecessary,Headsdevelopednewidentitiestoretaina
semblanceoftheirlostpower.Adherencetothesocialcontract,andself-transcendencewas
limitedasHeadsdistancedfromaprofessionallyethicalidentityforsafety(Hamilton,2008)
resortingtoegocentricself-referentiality(Langdridge,2007).Thisisnotrestrictedtothelocal
scene.Encouragingmanagementtoinvolveemployeesatanearlystageofthechangeprocess,
Psy-ga(2013)advicesmanagerstomodelonchameleonsevokingtheherothatentersthe
organisationtoturnitaroundwhileappearingtomergewiththe
background/company/employees.Thisresonateswiththeidentityleader(Haslametal.,2011;
Steffensetal.,2014)whocreatesanimageofwe-nesstobringaboutchange.Thisleadership
stylelackingself-reflexivity,ledCMTTFtoachievelimitedoutcomes.Deflectingfeedbackfrom
theCMTTparticipants,CMTTFremainedunawarethatonewaslosingtheirtrustand
collaboration(Stetler,2014).Theconceptofthechangeimplementeraschangecatalyst,
remainingunscathedbytheimplementationprocess,wasandisstillfoundinmainstream
managerialtraining(NHS,2010).MNHCSHeadsmightbenefitfromheedingPsy-ga††(2013,105
-109)thatwhen“managerialstaffexpectfromemployees,conductwhichtheyarenotyetable
todeliver,employeesmaysimplyfeeloverloaded.”Leadersviewinghumandevelopmentasa
valuearemorelikelytoachievedesiredgoals(Huppert&So,2013:Leggett&James,2016).
†† Published under the auspices of the Federal Association of Company Health Insurance Funds and supported by the German Federal Ministry of Labour and Social Affaires under the New Quality of Work Initiative.
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Post-DoctoralWork:Productsandthewiderprofessionalinfluenceofthisresearch:
FollowingtheHeads’suggestion,Iwentoutand“explained[themanual]to[others]”(H1Int.
#3,line18).H2’sverbalisationthattheManualcould“bridgebetweenprofessionswhichare
notnecessarilywithinhealth”(Int.#3,line13)foretoldtheManual’sfuture.Wantingtoshare
theirdevelopmentinself-awarenessandself-reflectionMNHCSHeadsaskedmetostartteam-
buildingsessionsintheirrespectivedepartments.Knowledge-sharing,meaning-making,self-
actualisation,andcriticalself-reflectionprovedessentialtocreateacollaborativeenvironment
inwhatwasessentiallyadominant-submissive,shame-blamescenario.
Movingbeyond:CollaborationwiththeCommissionforDomesticViolence,in2017,ledtothe
settingupofthePeer-to-PeerCaseStudyResearchGroup,promotingself-reflexivity,
knowledge-andmeaning-sharinganddiscussingevidence-basedbestpracticewithinarelated
taskforce.Commissionersprovideduswithplatformstodisseminateoutcomes.Wehelda
WorkshoponMarch2019sharingourfindingswithpeersandHeadsofDepartments.
Workshopsinself-reflexivitywerealsocarriedoutwithemployeeshailingfromvarious
MinistriesincludingHomeAffairsandEducationaswellasattheUniversityofMaltawhereI
amnowemployedasHeadofCounsellingServices.
Modificationsinthetrainingmanualinlightofmorerecentpracticesandlearning:The
TrainingManualisbeingpreparedforpublication,andisthebasisofapost-doctoralstudyto
furtherexploretheroleofself-reflexivityintransition-managementtraining,supportingleaders
todevelopahybridpractioner-researcheridentity(Barber,2012).Armsby(2013)highlightsthat
theintegrationofprofessionalandacademicidentitiesisbeneficialasoneidentitysupportsthe
other.ThisresonatedwithmydoctoralexperiencewhenIfoundmyself‘reflexively
understandingasaperson,expressingasaprofessional,repositioningmyresearcherstance
intothatoftheacknowledgedparticipant’(pg.15).Inhindsight,Irealisedthatself-
actualisationthroughthedevelopmentofadoctoralidentityprotectedmefromembarkingon
thealienation-demotivationprocess,whilemyidentityofpractitionerprotectedmefrom
gettinglostinavortexofhelplessnessuponlosingsightofthecorebusiness,theclient.The
Manualwouldcontinuetotraintheleaderinself-reflexivedialogueasatoolfortransition-
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management-thepractitioner(Chidiac&Denham-Vaughn,2018);whilesupportinghim/herto
developresearchskills,particularlyappreciative,holisticinquiry–theresearcher(Breslowet
al.,2015).Thiswoulddistancefromtheproblem-solvingapproachriskingdevelopmentof
shame/blame,focusingonapassion-centredmindset,fuelledbytheperson’sneedforself-
developmentandtranscendence(Waters&White,2015).
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Notesoncontributors
JoanCamilleri
JoanCamilleri,M.ClinPsy.D.Psych.Prof.Stisaresearcherandpractitionerworkingattheinterface
betweenpsychology,wellbeing,andorganisationaldevelopment.Sheiscurrentlyemployedatthe
UniversityofMaltaasHeadofCounsellingservices.