Date added: 19/10/20

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Those organizations that pay attention to the need for integration, which is far more difficult than getting one part rather than the whole to work well, are likely to become the most competent type of organization (Tomlinson, 2015).

During the years of my work with traumatized children, I have moved between practitioner, and management and leadership-based roles - moving back and forth between the two. Sometimes I wonder which camp I am in but have realized that I am clearly in the one that is about joining the two together. This ties in with another lesson from many years ago. For a therapeutic service to be effective, management and therapy need to be integrated successfully. Good management is necessary for therapy to take place and sometimes good management is therapeutic.  The same could be said about any kind of practice in the human services.  It can only be truly effective in a well-managed context.

I am sure many of us are familiar with the dynamic of management and therapy being at odds with one another. The same with business and care, and leadership and management.  For example, in one organization, the Executive Director felt frustrated with therapists who would often say that they needed ‘space’ rather than make time to listen to his emerging visionary ideas. And I am sure the therapists felt frustrated that his grand ideas didn’t help much with the immediate realities of their work. Vision is crucial to create an inspiring and important mission. So is doing the job at hand, however mundane or unpleasant it may seem. It is the integration of the two that is critical. I had a vision when I joined a therapeutic community for traumatized boys, of doing ‘therapeutic work’, which would help them to get better. I wondered during the first few weeks why much of my work evolved around cleaning toilets, being shouted and spat at, and looking for ‘missing’ boys in the surrounding countryside. It took a while to fully understand that this was part of the therapeutic work necessary for the vision to be achieved. Thankfully, those ‘in charge’ knew this very well, as well as what was needed to support the task at hand. The vision was grounded.

An important question is why ‘splits’ such as those described above tend to occur. One answer put forward is based on the concept of social systems developing as a defence against anxiety (Menzies Lyth, 1959, 1961, 1970). To briefly explain - the nature of the work task is inherently anxiety-provoking and involves emotional pain. The difficulty is defended against by creating a more simple and primitive solution. The reality of the task is replaced with a more bearable but split solution such as, “we would be able to do this better if it wasn’t for ‘management interference’”, etc.

For instance, it is easy for leaders to have a grand vision and not have to worry about how it will be achieved. It is easy for managers to become focused on methods and practices regardless of whether they help meet the desired vision or not. Leaders with grand visions tend towards charismatic.  Managers focused on methods tend towards bureaucratic. Charismatic leaders may blame the stifling, red tape, bureaucratic managers for failure.  Managers may blame the unrealistic and ‘out of touch’ leader.

It also makes everyone’s job seem easier as only one difficult thing needs to be mastered, rather than the more complex integration of two difficult things. Organizations may fluctuate between the search for a heroic leader or a new management system as if either might provide a magical solution. This might provide short-term relief but in the long-term, it is ultimately self-defeating and unsuccessful. The system as-a-whole is dysfunctional.  In this example, what is needed for effective performance is not the splitting of management and leadership, but the integration of them, whether within the same person(s) or between people. The functions of leadership and management may be separated but they need to appreciate their interdependence and work together in an integrated way.  The same can be said for management and therapy, and business and care.

Splits, which are based on unconscious reactions to deep anxieties and fears are especially likely in the human (or people) services due to the core nature of the task. For example, trying to provide a service to people in great need (sometimes literally a matter of life and death), when it never feels that enough can be done.  This is compounded by harsh financial realities such as those in times of ‘austerity’.  The sense of ‘impossibility’ and ‘hopelessness’ is difficult to bear for everyone involved. Leaders can defend themselves by becoming distant from the reality of the work. Those more directly involved can blame leaders for not caring enough about people and too much about finances. And everyone may be avoiding the painful reality of deep changes that are required in the organization.

In recent decades, where every type of business and industry has had to deal with a rapidly changing and more complex world, the same kind of anxieties and fears are becoming common in most workplaces. How many people can say with confidence they expect their job to last for 3 years?  A ‘job for life’ has left the employment landscape. The life span of jobs at all levels has reduced massively and this is just one of the insecurities affecting the modern-day workplace. Survival on an individual and organization level is precarious. Constant change in a complex and highly competitive market is the norm. Without good management, which is in effect good technology, people, methods, procedures and policies, an organization will fail to achieve its vision. Without visionary leadership that is motivating, inspiring, creative and stretching – performance will fall short in today’s demanding environment. To do something well, on its own is not ‘good enough’. There also must be an outcome that can compete with what anyone else can do at the same cost or less.

What is needed is an improved capacity to face the very real difficulties involved in the work task. This means being more in touch with complexity, fears, threats, and anxieties. To achieve this, it is necessary to have a culture with structures and processes that enable these difficulties to be acknowledged and worked with. This requires capability and time, and the difficulty of putting it in place cannot be overestimated.  Short term thinking will see this as an extra cost and use that as an excuse to avoid it.  When space is created to think about the difficult realities involved – this will be hard work, with potential vulnerability and conflict for all involved.  Therefore, it might feel as if the process isn’t helping. There may be a tendency to give up rather than a determination to work through difficulties. This requires strong leadership, belief in the process and perseverance. 

Those organizations that pay attention to the need for integration, which is far more difficult than getting one part rather than the whole to work well, are likely to become the most competent type of organization. It can be argued that the key task of leadership is to provide the conditions in which organizational integration takes place. The difficulty of this is captured very well by Friedman (2007) in the title of his book on Leadership, “A Failure of Nerve: Leadership in the Age of the Quick Fix”.

I will finish with a brief example that captures much of what I have said. A few years ago, I was on a course in Strategic Leadership for Social Care. As part of this, I had the fortune to visit Bromley-By-Bow in London, which had been heralded as an example of community regeneration based on social entrepreneurism. The picture is of the Bromley-By-Bow Health Centre.  It is in Bob’s Park named after the local man who led the transformation of derelict wasteland into a green space, which has become an inner-city haven. The Health Centre is a model of integrated health care.

We met Andrew Mawson who was the church pastor, who had played a lead role in the regeneration of the run-down community. He seemed without a doubt to be a charismatic, visionary leader. He talked about the stifling bureaucratic red tape and the need to break rules, to get anything done. In his book (2008) ‘The Social Entrepreneur’, he also describes how he was impressed by Paul Preston, the businessman who successfully brought the McDonalds chain to England. Mawson says, ‘the devil is in the detail’ and describes how Preston succeeded by first focusing on every practical detail in just one shop. Down to exactly where the milk came from and how long it took to be delivered. This shows an understanding from the top of how the reality of the work and what is required must be integrated with the vision. The question isn’t so much about styles of leadership and management, whether it is either or, but about successful integration between the two.

Friedman, E.H. (2007) A Failure of Nerve: Leadership in the Age of the Quick Fix, New York: Seabury Books

Mawson, A. (2008) The Social Entrepreneur: Making Communities Work, London: Atlantic Books

Menzies Lyth, I. (1959, 1961, 1970) The Functioning of Social Systems as a Defence Against Anxiety, in Containing Anxiety in Institutions: Selected Essays (1988) Vol. 1, London: Free Association Books

Siegel, D.J. (2006) Series Editor’s Foreword, in, Ogden, P., Minton, K. and Pain, C. Trauma and the Body, New York: Norton

Winnicott, D.W. (1962) “Ego Integration in Child Development”, in, The Maturational Process and the Facilitating Environment, Hogarth Press and the Institute of Psychoanalysis: London (1972)


An interesting brief video with Andrew Mawson talking about social entrepreneurism and the challenge of creating something positive out of a nearly bankrupt economy as he put it.

I think the most important issue is learning to work together, actually, and building teams of people who understand how to do that in creative ways. Because we have all got to move out of the silos that have been put down for us by the public sector and they are often there in business and learn how to join things up.

Dr. Dan Siegel video - On Integrating the Two Hemispheres of Our Brains


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