The individual can use a role as a defence against anxiety (Isabel Menzies Lyth 1988, “The Functioning of Social Systems as a Defence against Anxiety”, in Containing Anxiety in Institutions, Free Associations, London). For example, the nurse holds onto the professional notion of her role in order to avoid becoming overwhelmed by being personally open to the trauma being suffered by her patients (For an excellent summary on the nature of trauma as something beyond understanding, see “Trauma and the Material Signifier” by Linda Belau). From the point of view of the patient, this feels like not existing as a person.
The hierarchy of roles set up by the organisation is not only the organisation’s means of defining what is to be ignored in making happen what it wants to happen (This results in an understanding of strategy as the management of ignorance – by organising what must be paid attention to over time, the organisation is also organising what is to be ignored). It is also the way the organisation represses its anticipation of that which would be traumatic for the organisation – that which it does not want to happen. For example, in a hospital ward for supporting the rehabilitation of elderly patients, the death of a patient would be a trauma for the hospital ward: it cannot be allowed to happen.
The hierarchy of roles is defined by power-at-the-centre in relation to a generalised relation to demand – symmetric demand. Patients become customers for the services that the hospital is offering. This power-at-the-centre can also be defined by its relation to that which cannot be allowed to happen – to its anticipation of that-which-would-be-traumatic for the organisation.
In taking power-to-the-edge, the relation to demand is being changed to one which can respond to the particular context in which a demand arises – asymmetric demand. With power-at-the-centre, the customer’s ‘deal’ with the supplying organisation is that the customer’s anxieties and avoidance of trauma be displaced onto the supplier. As this begins not to work well enough for the customer, so the customer’s demand becomes increasingly asymmetric i.e. as the customer expects the role of the supplying organisation to become increasingly particular to his or her situation/context-of-use.
This requires that the supplier’s relation to that-which-cannot-be-allowed-to-happen has to be transformed from that which is repressed to that which can be acknowledged and worked with in a way that is particular to the relation to the particular demand – albeit still with an irreducible core of that-which-would-be-traumatic. Thus, for example in the rehabilitation of elderly patients, the avoidance of the anticipation of the trauma of the bed occupant’s death becomes the engagement with (and support in relation to) the family’s anticipation of the death of a family member.
With power-at-the-centre, the leader identifies/is identified with implementing the strategy which is also the means of repressing the relation to the anticipated trauma. However, in order to lead from where power needs to be at the edge/is placed at the edge, this relation to the anticipated trauma has to be transformed in the leader’s leadership. Reflexive Consultation is the means of bringing this transformation about in a way that is particular to the organisation.