As an executive coach working with business and public sector leaders during the 2008-11 recession, I was struck by how some groups of employees coped much better than others during difficult times. Certain organisations seemed able to maintain productivity, motivation and trust during the crisis while others in the same sector were characterised by high levels of stress-related illness, absenteeism, rumours and blame. It became clear that people did best in those organisations where the leaders provided good emotional containment. This concept stems from child psychology yet is highly relevant to organisational life. Human beings are programmed from birth to seek a sense of psychological safety and this continues throughout life as we look first to our parents and later to those in authority to help us feel reassured, understood and supported. Without this, our defences are triggered and we struggle to be our most resilient and skilful selves. [1,2]
Experience suggests that there are four interconnected steps that leaders should take to provide emotional containment during anxious times:
- Prompt and visible action
- Clear and honest communication
- Empathy and understanding
- Inspiration through highlighting organisational strengths 
As a nation we recently experienced how poor containment feels when the Government failed to demonstrate these behaviours during the initial relaxation of the lockdown. The absence of transparent explanation and the confused messaging left many people experiencing heightened anxiety and frustration. It also triggered a marked fall in support for the Prime Minister whereas the clarity of the original lockdown’s rationale and rules had led to a rise. Since then, the exposure and condoning of Dominic Cummings’ questionable approach to lockdown rules have led to anger, loss of trust and a reduction in cooperation, as so often results from a perceived lack of honesty and empathy on the part of those in charge.
Emotional containment is of particular relevance to those working in healthcare. A key part of the medical professional’s role is to provide vulnerable and dependent patients with a sense of safety through taking and explaining appropriate action, showing empathy and providing encouragement. During the pandemic, the ability of those on the COVID-19 frontline to deliver this has been compromised by the need for PPE, the severity of illness, the high mortality rate and the ban on bedside visitors. Making patients feel safe and reassured is a central and rewarding aspect of the carer’s role. Being less able to do this, along with the huge sense of overwhelm that many on the frontline will have experienced, will have corroded their own sense of psychological safety, while failures in organisational and governmental leadership will have made this feeling even more acute.
Yet as infection rates begin to fall and doctors and nurses are moved from COVID-19 wards, the greatest pressures on their wellbeing are likely still to come. In the midst of the crisis, fuelled by adrenaline, canonised by the country and supported by a strong esprit de corps, their coping capacities have come to the fore. As the pandemic slows down, many will struggle with feelings of let-down and exhaustion, painful and intrusive thoughts, feelings and flashbacks and even PTSD.
The ability of clinical and managerial leaders at all levels in health and social care to provide emotional containment – and thereby rebuild or retain trust – will be critical during the coming period. They must:
- Explain the steps they are taking to address the evolving crisis, be transparent about what they can and cannot do, and why
- Communicate honestly, frequently and in detail through multiple channels, e.g. a weekly email even if there is nothing new to report
- Demonstrate empathy by acknowledging and legitimising the staff’s experiences
- Provide hope through affirming strengths, e.g. by highlighting individual success stories
In addition, where mistakes were made, particularly around provision of life-saving PPE, genuine apologies will be hugely helpful.
Failure to demonstrate this suite of behaviours will undermine trust, impact morale and fuel anger and distress at a systemic level within organisations; this in turn risks eroding staff performance and patient care. If all leaders – from line-managers to national officials – adopt them, much will be done to provide staff with a greater sense of safety and containment, thus helping them to rebuild their mental and physical resilience as quickly as possible.
- D.W. Winnicott, The Child, the Family, and the Outside World (1964)
- J. Bowlby, Attachment and Loss (1969)
- C.Sandler, ‘The Psychological Role of the Leader in Turbulent Times’, Strategic HR Review (2009)
Dr Catherine Sandler
Dr Catherine Sandler is one of the longest-established executives coaches in the UK with 25 years’ experience of working with senior leaders across all sectors. She is a qualified counsellor, has taught at leading business schools and published widely in the field, including her book Executive Coaching: A Psychodynamic Approach (McGraw-Hill, 2011).
Conflicts of interest
I have read and understood the BMJ policy of declaration of interests and have the following interests to declare: none.