EFFECTS OF PRESSURE ADMINISTRATIVE
Statement June 2009
OF of institutional psychotherapy
Paris V
Dr. Gilles Simon
What are the effects on the initiative, in all its aspects, within the institution, when administrative pressure is increasingly intense ?
Basically two types of effects:
effects direct such activity or that project can not be achieved simply by virtue of a regulation ; imposed upon us, elsewhere it is the complexity or cost of the procedure to put in place that make us give up.
But there are also effects "indirect" * , "secondary" by analogy with drug treatments, this is when the essence of care, ie the capacity for initiative of each caregiver is located, in different situations and different people, altered, "threatened ;.
We'll see how it has to do with the concept of "margin", space, whether a psychological point of view and / or topographic in line of the texts presented earlier.
can quote two sentences of R. BENEVENT :
When attempting to better figure that can be played in the institutional record; " for the initiative are actually requires that the institutional offer the psychic or moral, in a form strictly first spatial dimension of their deployment. "
Or, " space would be the flexibility available to a subject engaged in a collective desire to carry on his singular and rationality self in favor of the collective ".
The work of Frank GAUTRET we provide valuable understanding in this area.
The current trend, inflation regulations and other procedures, is in line to define "what does should not take place "rather than promote the initiative (Understood in a broad sense).
With this shift of "forbidden to the impediment" we find ourselves at odds with one of the fundamentals of IP.
aspect indirect or pernicious is that it prohibits an activity but not formally the accumulation (and / or cumbersome) procedures are such that it will prevent its realization.
And perhaps its design, upstream?
* For R BENEVENT it is " new challenges that lie ahead " "we entered the era of" soft tyranny "that build their grip not only by small and imperceptible micro require discernment snapshot" of where the complexity not only cope but already identified.
Example: During a meeting with Dr. Pommereau we could measure how difficult it became to do a cooking activity in the hospital, the topography does not necessarily the standards in force (cold chain, the presence of a hot dish, transition zone, living with meals provided by the hospital, etc..), the choice of ingredients can not match what is allowed and I am not talking about financing the purchase of these ingredients can also be random.
A total initially a simple exercise, cook, which can be shared at different levels with children with as many variations as there are possible problems (menu development, provide the budget necessary to buy, shopping, preparing, counting, mixing, heating, wait, eat, etc..).
On arrival an "obstacle course" which, at best, mobilizes energy boundless, at worst, prevents or restricts the development of the activity in question (or even a barrier to upstream design?).
Everyone knows that rules are needed within an institution but confusion "banned / unable" operates as a restriction on creativity necessary healthcare.
Here lies the relevance of About F GAUTRET in the qualitative approach this notion and pejorative implications that it generates in our practice.
He speaks of the "managerial model " which tends to break into the medical field or that the nursing home.
"A oday the managerial model of the institution pays any available space, time and space, the lobby down to the last planning, needs service which could saturate breathing. "
We find the main themes of this model: assess, profitable, be efficient, organize everything rationally, and so on.
So space and time.
First Space :
This can occur especially for example in the use of spaces, we all head in the form of J OURY, " it's a waste, we destroy the" surroundings ", that is to say the spaces that can be create, as they are not yet structured ".
Hence the importance (even the vital necessity) to maintain differentiated places.
Recall also the difference between route (path) and path (invent) approached by Oury, " if there is freedom of movement, there is a possibility to set up for everyone, in a peculiar manner, not directions, but paths that are not drawn advance and from which, by chance, there will be opportunity to meet .
The current administration is going in the opposite direction, should be able to justify the use of any surface, the deduction is then, in this Logically, if an activity room is not used enough, it could be used for other purposes or, another term largely in place, "pooled" with other services and thus lose the singularity its original function.
a profitable, "pool", "estimate", "optimize" " justify " I have already mentioned, it is the "operative words" of the moment.
Next time :
The finding established for surfaces, the space is doubled from same negative psychological effects of the arrival procedures this time on the time, time of care work, time childcare.
Everything must be calculated at the fair in order to "optimize" operation and profitability management.
Software is designed to do, "traded schedules, where the workload for caregivers is cut, in reality, in increments of 15 minutes, then placed in a multitude of items with the idea that they could be together "differently", transversely with a redistribution that would optimize the operation of the service (an accounting point of view of course).
Recognizing that the goal "real" approach to planning is to "do more" with "less".
Each of us is a witness, there is growing talk " confinement, choking, in grids, in or protocols, "in frameworks combined with cages ", R BENEVENT has formulas that tell us immediately when it lists," pressure manager terrorism, an obsession with the assessment itself fascinated with an accuracy which ultimately does not measure anything, the feeling of being tied more closely by technostructures that crush the human. "
The combination of these factors has a derogatory effect on our practice in particular, by erasing what made the "margin " more quantified, including the a priori was not in terms of mental health care, the more restricted the possibility of the existence of a margin consistent enough.
GAUTRET But as said it is in the margin that is consistently creative capacity, the creativity of people, " the register of the functional and in production under performance alone can no longer support themselves in any transgressions by agreeing to meet, but leaves them in the secular equivalent of blasphemy .
This coincides with the formula of Benevento, " for the initiative are actually requires that the institutional offer to the psychic or moral, in a form first strictly spatial dimension of their deployment. "
To resume synthesis GAUTRET, "move of the forbidden to cause ", it can be argued it translates, on the side of caregivers, by slipping the equivalent of commitment as a person to a disengagement ; of accountability toward accountability; it works little by little with the fear of accident.
is a return to a functional hierarchy to a hierarchy of office, most likely in the best sense of that term and responsible, but a conformist as a result of new procedures respect.
One of the essential IP is threatened.
To measure the current challenges we must return to fundamental " the institution does is not a place in the material sense or administrative, it is instead the sense that it derives a vital process, order, language, responding to that described and Michaud G, "a mediation system for exchanging international human to a plurality of levels ".
On this drift F ROUSSEAU distinguishes between established / establishing, "the organization face set, replaces the institution in its face because the links instituent institutions are dormant and need space where they can articulate. "
With these ticks can return to this issue slip of the forbidden to the impediment
" The ban is a because of language does not exclude the transgression but can locate a document and to consider compensation in respect of the debt it opens. "
" Preventing instead leans an idea supported by the effectiveness of an ideal machinic .
The "what should not happen, this translates into an institution that happen in the era of" zero tolerance " , meaning zero defects, zero accidents, zero incidents or hazards "facing protocols that invade more and more the scope of our practices.
The zero risk, viewed in this light, actually involves many disturbing aspects, " it is more accountable for its actions but to undergo the assessment and expertise ", the dynamic state of mind is" abandoned dam processes or selection in favor of the image of the place, its statistics compliance and promoted public health issue. "
The confusion is intensified prohibited and prevented a further confusion between events and people between established / establishing, with substantial risks in terms of violence.
For work in the "impediment" creates a power struggle between him and preventing him who is prevented.
What do we see when you listen to the experiences of professionals from institutions that receive those in need, regardless of these difficulties on this subject R. BENEVENT evokes the notion of "resistance " as an imperative felt by the care team;
"C e is no coincidence either that more In addition, the objects of frustration that arise during the sessions of "support the support" are no longer the nasty student who makes us the miseries, the parent who supports him in his drift, colleague peer, with whom I can not work, but the superstructure that stifles our initiative and ransacking the individual and collective projects that we build to put on a life path a student in distress. "
The question then arises, "what to do with this complaint," A way to find him? There is a risk, "we must constantly dynamite hidden or obvious enjoyment of this complaint by developing openings that are not called" solutions "but the" editable " he adds," without any concession on the "straight talking", assuming the same time a critical function. "
To quote the original theme, space / initiative / freedom is measured very well that we are " increasingly prevented leaders of initiatives , without space initiatives, "citing F. GAUTRET , "today the managerial model the institution pays any available surface, spatial and temporal; the lobby down to the last schedule, service needs which could saturate respiration institution seems increasingly formatted by a social model without border : there would be more than disaffiliated or criminals. "
JL Godard on the occasion of a ceremony where he was awarded Caesars differentiate in response to a reporter who asked him if it was not too difficult be a filmmaker marginal " not, we must not forget that the margin is important in a notebook is the margin that holds the leaves in the culture is like."
BIBLIOGRAPHY
Frank GAUTRET "perfumes banned "in" the child and its institutions "
2006 number 63
Raymond BENEVENT "transfer to the school," same journal.
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