From: Dick Blackwell
Co-ordinator of Volunteer Counsellors/Psychotherapists
Medical Foundation for the Care of Victims of Torture
London-UK

To: Simon Carruth


Dear Simon,


Thank you for the email you sent to all of us last
week concerning the letter that has been drafted for the trustees
about the situation with Sheila Melzak. As you have chosen an email to
all of us as a means of communication, I trust that you will be happy
to receive a reply by the same medium.


  There are many dimensions to this issue all of
which need to be taken account of, and there are ramifications which
extend well beyond the details of one individual case. The Medical
Foundation is a flagship organization in the Human Rights movement it
it is necessary to be mindful of that wider context. I also suggest
that we all share an accountability to that movement.


 It is important to be clear that the aim of the
letter to the trustees, and indeed this letter too, is not to attack
or undermine managers. We all, as far as I know, want very much to
work co-operatively and harmoniously with our managers and our
trustees. The purpose of the letter is to recognize and emphasize the
very serious nature of the situation.


 First it is necessary to recognize some of the
sentiments behind the letter to the trustees. We are all, by virtue of
our involvement here, playing a part in the global struggle for human
rights. A number of us have been involved in the human rights movement
for a very long time. For many of us it is this commitment that
brought us to work at the MF. Over the years we have studied and
tried
to understand how injustices and human rights abuses occur, and we
have often been particularly concerned with the role of 'bystanders':
Those people who are not directly perpetrating injustices but who
stand by and say or do nothing, often convincing themselves that
nothing untoward is happening. You may recall a rather famous
statement by Martin Niemoller that begins, "When they came for the
communists................"  With this history many of us feel that
whenever and wherever we encounter what we perceive to be injustices
we are obliged to speak out. If we fail to do so we feel guilty of a
sort of moral cowardice which makes it difficult to face ourselves
when we look in a the mirror and even more difficult to look our
clients in the eye. However much we wish not to rock the boat, however
much we wish to support our managers, it is simply impossible for some
of us to remain silent and still maintain a sense of personal
integrity as members of the human rights movement. Moreover, our
commitment to the Medical Foundation requires us to give voice to our
concerns that this organization is itself being harmed and endangered
by the way the current situation is being handled.


The problem with proper procedures.


 You have said to us that we should go through
proper procedures which you identify as the grievance procedure and
the whistle blowing procedure. There are four reasons why this is a
problematic suggestion. First, I invite you to recall how many times
in the history of the human rights movement have human rights
activists been told to go through 'proper procedures'? -  "You should
not be marching down this road! You should not be sitting in this
building singing, 'We shall overcome some day!' You should not be
standing outside the Houses of Parliament holding a placard! You
should go through the official channels and use the proper
procedures!"


 Such directions towards 'proper procedures'
frequently come from characters with whom I am sure you would not wish
to be associated, and I would not wish to associate you with them. But
I hope you will appreciate the problem that any human rights activist
might have with 'proper procedures'. Just imagine if Rosa Parks had
gone through 'proper procedures'.


 The second problem with 'proper procedures' is the
problem of any organization investigating itself. You may remember a
very long campaign to establish an independent police complaints
authority in this country, because it was simply not satisfactory to
have complaints against the police investigated by other policemen.
This is not to question the good intentions or the personal integrity
of those conducting the investigations. It is instead an
acknowledgement that any organization has its own culture
andsubcultures with their own specific assumptions and perceptions,
its
own complex pattern of loyalties, defences and ways of dealing with
the stresses and anxieties of the work, and much of this operates
outside the consciousness of the organization's members. Thus,
internal investigations may be subject to the same unconscious group
dynamics as those that give rise to the complaint.


 The third problem is that the grievance procedure
and the whistleblowing procedure require complaints against specific
people and take us down a road of blaming individuals, even
scapegoating them, for what is in fact a complex organizational
problem. It goes completely against what is supposed to be one of our
'core values', which is 'no blame'. What signatories to the letter are
trying to do is not scapegoat individuals but provide constructive
criticism and open up pathways for problem resolution.


The last reason is that even if the procedures
were viable, there may not be time to go through them before serious
damage is done to the Medical Foundation and to the Human Rights
movement.

Regrettably it must also be noted in passing that
there is convincing evidence to suggest that the proper procedures
have not been followed by senior management in Sheila's case, which
does little to inspire confidence in the procedures.


The organizational dynamics


 Apart from the concerns about 'bystanders', our
study of human rights violations reveals that some of these violations
can be unwittingly perpetrated by persons acting with the best of
motives and out of a profound desire to improve or defend their
society. Robespierre provides a classic example. It is therefore worth
trying to understand some of the complex dynamics that lead to these
paradoxical scenarios.


There is a very large body of work within the
study of organizations and organizational behaviour which predicts
that organizations will tend to enact in actual or in metaphoric form,
dynamics derived from and specific to, the fields in which the
organization operates. Thus, marriage counselling organizations are
likely to have within them conflicts which take the form of marital
conflicts, or they may follow patterns of making and breaking
relationships as in marrying and divorcing. Similarly organizations
involved with rehabilitating offenders will tend exhibit delinquent
patterns of behaviour, and organizations working with homelessness may
find ways of preventing their staff feeling 'at home' in their
workplace.


So what might we expect in our field? What would we have a tendency to
reproduce? Socio-political upheavals, moving
people around a lot, people feeling unwanted and ndervalued, and, of
course, various forms of torture, violence, covert operations and
disappearances. Also, perhaps, failure to negotiate conflicts, and a
readiness a resort to coercion. Given the emotional intensity of our
engagement with our clients, our organization is likely to be more
prone to this sort of re-enactment dynamic or 'parallel process',
than
most other organizations. It is therefore imperative that we
familiarize ourselves with this way of thinking and develop a capacity
to reflect on these dynamics at all levels of the organization. You
have said in a staff meeting that you objected to the use of the term
'disappearance' because we were not throwing people out of aeroplanes
into the ocean. But this is being far to literal, and it thereby
avoids and even prohibits the possibility of thinking metaphorically
about the deeper significance of the events in question. In my view,
in an organization such as ours, to have a management that is not at
least sympathetic to, if not entirely familiar and conversant with
this way of thinking makes the organization a dangerous place in which
to work, for both staff and clients.


May I refer you to page 5 of the  consultant's
report where they state "In any organization dealing with torture and
violence,there will be a likelihood that punishing unconscious
impulses are acted out, where cruelty is focused on individuals and
the capacity to be curious about alternative realities about any given
person or situation gets lost." It is not on the whole an impressive
piece of organizational consultancy, but this is undoubtedly one
thing
they were right about. Their whole section on the organizational
context and staff dynamic might be worth a careful re-reading. We seem
to be almost desperate to implement other recommendations they made,
while this bit seems to have been overlooked. May I also add that only
a couple of years ago, I recall Alex expressing concern in a staff
meeting at the level of conflict amongst staff and particularly the
readiness to resort to formal procedures. He reminded us of the 'toxic
material' that we routinely absorb and suggested that we pause to
reflect on how it might be getting into our interpersonal relations,
before we rushed into precipitous action.


Impersonal processes and neglect of the person


You refer in your email to the suggestion that
'some small corner' could have been found for Sheila, and you say that
you were not trying to find corners for anyone, but simply defining
what structure and posts were required, without reference to
individuals. First, there is something slightly worrying in the human
rights context about an approach that is so oblivious to individuals
and their contributions and needs, and I am sure that is not your
intention. Nevertheless it does seem that Sheila losing her job, and
our organization and our clients losing Sheila, has become some sort
of 'collateral damage' in the new re-organization. I thought it was a
human right not to be 'collateral damage'.


But it is of further concern that the whole
proposition seems so bizarre. Sheila  has an international reputation
for her work with unaccompanied children and child soldiers. Does it
really make sense that in the course of our quest for excellence we
get rid of one of our most distinguished clinicians. How exactly are
we proposing to deal with this client group under the new structure?
Is it being seriously suggested that all this can be done by one child
psychotherapist working two days a week? And if so by whom? And from
where precisely are we going to get a child psychotherapist with
Sheila's experience and expertise?


Enslaved by unimpressive consultancy.

We do seem to be rather constrained at present by
what was, by any standards of organization consultancy, a rather
unimpressive piece of work. The two consultants were of limited
experience relevant to the needs and context of the MF. But both would
appear, from their cvs, to be significantly committed to a multi-
disciplinary team model. Indeed it would also appear from their cvs
that they may have little experience of any other kind of model. To
come to an organization as a consultant and transplant one's own
preferred model of organizational functioning, is not what consultancy
is supposed to be about. The proper term for this process is not
'consultancy but 'colonisation'. The fact that some of the staff are
prepared to go along with it, or have even welcomed it, does not make
it any less colonial. For many years the MF has been developing a
kind
of 'human rights therapy' that earned us the respect of colleagues
similarly engaged in places like, Argentina, Chile, Mozambique, USA,
Canada, Apartheid South Africa and Australia. We consciously developed
an approach that was different from clinics like the Marlborough Day
Hospital and the Tavistock Clinic. We avoided the marketisation and
bureaucratization of the NHS, almost universally recognized as
disruptive to good therapeutic practice. Yet now, by some
extraordinary historical process, we are colonised by the Marlborough
and the Tavistock from whence we seem to be being governed in
absentia. No-one would suggest that we did not have things we could
improve on. But a good consultancy would have helped us identify those
areas and work out for ourselves how we could remedy them. Instead we
have someone-else's grand design.


Interestingly, if we look at the new team structures, they do not
appear to be so significantly different from the old that we could not
have managed the adjustments ourselves with
far less pain, anxiety and disruption.

Yet on the basis of this re-organization, implemented, in the absence
of its architects, by managers who may or
may not fully appreciate its clinical and human rights implications,
we are about to dispense with the services of a senior clinician with
an international profile who has been with us almost from the
beginning. She has no wish at all to leave MF and wishes only to
continue in her work with her clients and to take the clinical lead in
work with unaccompanied children. If she leaves the MF it is not
obvious where else she could continue this work. So not only are her
clients and her potential clients at the MF deprived of her services
but the whole professional and Human Rights field is deprived of her
special contribution. If this were being done consciously and
deliberately it would be called 'sabotage' of the work and the cause
we all claim to believe in.

The dynamics of our care for the clients


Unaccompanied children, who form a significant
number of Sheila's clients, have suffered in many different ways, but
they have one particular traumatic experience in common. They have
been suddenly separated from the most significant adults in their
lives. Now, the Medical Foundation, which was set up to care from
them, has somehow contrived to once again separate them from the most
significant adult in their lives, their psychotherapist. In technical
terms it's called the loss of good internal objects or benign
unconscious psychic representations. The loss is invariably traumatic,
and what the MF has done has a good chance of re-traumatizing these
clients. Yes, it mitigates things somewhat that they can maintain
contact with Sheila by mobile phone, but there is still a traumatic
interruption to their therapy and their face to face contact with her
which will inevitably resonate with previous trauma to have a re-
traumatizing effect at an unconscious level. I hesitate to speculate
on the effect of them now being seen by Sheila in what is effectively
a form of quarantine.

How has all this come about? The problem goes back
to the days of Malcolm Smart and his desire, for unspecified reasons,
or for alleged reasons that made little sense, to merge the Child and
Adolescents Team with the Family and Marital Team. The clinical review
seems to have further promoted this idea, though once again without
offering any coherent reasons for it. Sheila opposed the idea and
repeatedly sought to have it properly discussed. I too tried to raise
the issue and can testify from my own experience that there was
considerable resistance to having a proper discussion about it. As a
result of the interpersonal tensions that built up around this issue a
situation arose between staff that led to Sheila's suspension. There
is no suggestion as far as I am aware that clients need to be
protected from Sheila, and indeed she is now being allowed to see
them. So it would appear that the clients have suffered because the MF
was unable to manage internal conflicts between staff. And it might be
claimed that it has taken an inordinate amount of time to find an
alternative time and venue where Sheila could see her clients.


Managing or getting rid of 'difficult' people.


It has been suggested to me, that a contributory
factor in all this is that Sheila is a 'difficult' person. Whether or
not this is true, whatever it means, is entirely beside the point. But
what is interesting is the implication that being 'difficult' might
have some relevance. The history of  pioneering work in psychotherapy
is full of 'difficult' people. Freud and Jung were 'difficult' people.
Melanie Klein was 'difficult'; so were many of the founders and
pioneers of family therapy. As for the history of the human rights
movement, it might be easier to count the people who were not
'difficult''. Moreover, we all come to the MF to do difficult
work.Many of our clients are among the most difficult clients one
could find in any kind of counselling or psychotherapy. We clinicians
aim to manage them in a way that aspires to excellence. Is it really
too much
to expect that our managers should be able to manage 'difficult'
members of staff? If we are going to achieve the excellence that we
talk about, we are not going to get there only by having efficient
systems, even if they are excellently efficient systems. Excellence
is
ultimately achieved by people not by systems. And a lot of excellent
people are 'difficult'. So we are going to need excellent management,
which means, visionary, creative and imaginative management, not
management enslaved by procedures, rules, protocols and structures.
The purpose of any worthwhile structure is to serve and facilitate,
not to constrain the creativity of an organization and the people in
it.


Moreover, getting rid of difficult people is one of
the activities for which Joe Stalin became infamous. Tyrants generally
do not get rid of people because they are easy going and pose no sort
of threat. So explanations that rest on someone being difficult are
not very encouraging unless we intend to start campaigning for human
rights only for nice people.

Do we really believe in negotiation and conflict resolution?


In the human rights movement we expect the
government of Sudan to sit down with the rebels and negotiate. We
expect the government of Uganda to do something similar with the
Lord's Resistanc Army. These are situations in which thousands, even
hundreds of thousands of people have been killed and tortured. Yet we
call on the protagonists to negotiate and make peace. In places like
Rwanda, people are expected to go on with daily life side by side with
people who have killed members of their families with machetes. Yet
what do we do ourselves, here in the MF? No-one as far as I know has
been killed. No -one has been physically harmed. Yet here we have a
situation where Sheila is banned from the building like a dangerous
terrorist, because we cannot negotiate a resolution to a relatively
minor interpersonal problem. It is hard to think of a more effective
way of undermining our own credibility as campaigners for peace and
human rights.


Sheila's 'redundancy'


Much has been made of the fact that Sheila has 'accepted' redundancy,
with its implication that she has made a more
or less free choice, with little acknowledgement of the sense that she
was made 'an offer she couldn't refuse'. Sheila has always ben
extremely dedicated to her clients. In these recent circumstances she
seems to have struggled quite heroically to maintain contact with them
and find ways to continue her work with them. She accepted redundancy
in the belief that this was the only course of action in the context
of her suspension that would gain her the opportunity to see her
clients again and work towards a proper ending with them. It is
arguable that given her professional and personal commitment to her
clients, and the amount of her life that she has given to the MF and
its work, that she has suffered a kind of psychological torture in the
way that she has had to listen on the phone to their suffering
without
being allowed to see them. It would also seem that in her experience
they were hostages whose liberation could only be achieved by
accepting redundancy. The observation that this is a most bizarre
situation for a human rights organization to have arrived at should
take us back to consideration of how our organization is
unconsciously
reflecting the very scenarios with which we work, and against which we
campaign.


Dangers to the MF and to the cause of human rights


What we must consider finally is our reputation and
its implications for the human rights movement. At a conference
earlier this year, I was introduced to a worker from another refugee
organization. On being told that I was from the Medical Foundation,
this colleague said, "That's a strange place isn't it, you keep
getting rid of people." This is the harsh reality. This is the
reputation that we are really getting out there on the street. Not as
a campaigning human rights organization which aspires to excellence,
but as a place which excels only at 'getting rid of people'.

Given Sheila's international reputation and connections, it is only a
matter of time before people from Gaza to Sydney learn that we've got
rid of her. It is going to be rather hard
to convince them that she just chose redundancy because she didn't
want to work at the MF any more. And the suggestion that there was
just no place for her in the new reorganization is going to be equally
unconvincing. They know all about 'collateral damage'. Apart from
being acutely embarrassing for those of us who might attend
professional meetings and conferences and have to face colleagues who
will ask us for some sort of explanation, this aspect of our
reputation will sooner or later reach our funders. Then it will only
be a matter of time before we are facing shrinking resources and
consequently, further redundancies.


Indeed the current situation is quite precarious.
It only needs one of the sixty or so clients whose therapy has been
'traumatically' interrupted to find their way to a 'no win, no fee'
lawyer, and we could be looking at rather heavy damages, especially if
others decided to follow suit. Even if the MF won the case, the bad
publicity could do substantial damage to our income. Similar damage
could be even more rapidly inflicted if a client were to go straight
to a journalist. This is why many of us believe it is important that
the matter is rapidly addressed in a very different way.


A way forward


The solution is in fact relatively simple. If a
sensible compromise if not reconciliation can be brought about to
solve the problem that led to the suspension, then Sheila can return
to work and start seeing her clients properly. There can then be
proper discussions about work with unaccompanied children and Sheila's
future role, which with a modicum of good will and creativity ought to
be fairly easily achievable.

May I suggest that the best way for the trustees to
be informed of the situation in a way that is not felt to be
undermining of our senior management, would be for you to be the one
who informed them, perhaps by forwarding to them copies of the letter
drafted by Gillian and Jane, your response and this reply .


I hope you will recognise that the above points are
made in a spirit of shared concern for the future of the MF, its
clients, its staff and its role in the human rights movement, and in
the belief that constructive criticism and observation can open up a
pathway to problem resolution, and I hope you will receive them in
this way.


                        With best wishes


                            Dick


 Dick Blackwell
Co-ordinator of Volunteer Counsellors/Psychotherapists
Medical Foundation for the Victims Of Torture