Managing Vulnerability: The Underlying Dynamics of Systems of Care

257 Pages·2010·0.939 MB·English

by  Tim Dartington

MANAGING
VULNERABILITY
Tavistock Clinic Series
Margot Waddell (Series Editor)
Published by Karnac Books
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“What Can the Matter Be?”: Therapeutic Interventions with Parents, Infants, and Young
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MANAGING
VULNERABILITY
The Underlying Dynamics
of Systems of Care
Tim Dartington
KARNAC
First published in 2010 by
Karnac Books
118 Finchley Road
London NW3 5HT
Copyright © 2010 by Tim Dartington
The rights of Tim Dartington to be identified as the author of this work have
been asserted in accordance with §§ 77 and 78 of the Copyright Design and
Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording, or otherwise, without the prior written
permission of the publisher.
British Library Cataloguing in Publication Data
A C.I.P. for this book is available from the British Library
ISBN: 978–1–85575–888–9
Edited, designed, and produced by Communication Crafts
Printed in Great Britain
www.karnacbooks.com
Dedicated to
Eric Miller and Anna Dartington

CONTENTS
SERIES EDITOR’S PREFACE ix
ABOUT THE AUTHOR xiii
ACKNOWLEDGEMENTS xv
PREFACE xvii
I
Individual survival and organizational life
1 Thinking about systems of care 3
2 The gang in the organization 14
3 Self and identity: defences against vulnerability 29
4 The question of dependency 41
5 The pursuit of common unhappiness 51
vii
viii CONTENTS
II
The survival of the unfittest
6 The management challenge 63
7 The isolation of care services 74
8 Mediating between systems 87
9 The case for integration 98
10 Human nature and organizational change 110
11 True and false relationship in health and social care 119
12 The costs of care 129
III
The personal and the professional
13 An Alzheimer’s case study 139
14 My unfaithful brain:
a journey into Alzheimer’s Disease
Anna Dartington (with Rebekah Pratt) 154
15 Learning to live with dementia 166
16 Two weeks in 2006 176
17 The realities of care 189
18 Postscript—learning from experience 197
IV
Conclusions
19 Reflections on partnership:
can we allow systems to care? 205
REFERENCES 215
INDEX 227
SERIES EDITOR’S PREFACE
Margot Waddell
Since it was founded in 1920, the Tavistock Clinic has
developed a wide range of developmental approaches to
mental health which have been strongly influenced by the
ideas of psychoanalysis. It has also adopted systemic family ther-
apy as a theoretical model and a clinical approach to family prob-
lems. The Clinic is now the largest training institution in Britain
for mental health, providing postgraduate and qualifying courses
in social work, psychology, psychiatry, and child, adolescent, and
adult psychotherapy, as well as in nursing and primary care. It
trains about 1,700 students each year in over 60 courses.
The Clinic’s philosophy aims at promoting therapeutic
methods in mental health. Its work is based on the clinical exper-
tise that is also the basis of its consultancy and research activities.
The aim of this Series is to make available to the reading public
the clinical, theoretical, and research work that is most influential
at the Tavistock Clinic. The Series sets out new approaches in the
understanding and treatment of psychological disturbance in chil-
dren, adolescents, and adults, both as individuals and in families.
This fine volume, Managing Vulnerability, is essentially about the
management of anxiety, both institutional and personal. It is about
ix