Guest blogger Dr. Karl Mack, Senior director of programs for residents with developmental disabilities

In addition to the work that has been completed by staff in creating a model for relationship development, there are other important things for new staff to consider, such as projective indentification. 

Projective identification is a complex process that involves our deeply rooted perception of oneself, ones world view, and the perception that one has of others. It occurs in circumstances 'where A experiences feelings that belong to B but that B is unable to access; and instead "projects" them into (not just onto) A'.  There is evidence that the results of projective identification take place at an unconscious level and the brain processes information in milliseconds, and before the staff become consciously aware of how the encounter is affecting their behaviour, the staff have already returned a message to the client indicating a lot of information regarding the initial encounter. 

In the event that this initial encounter is misread, there is the potential for the relationship to get off on the wrong foot. Correcting this process later on is complex and requires a set of intervention skills that are challenging. During the earliest of encounters, the new worker must be coached and told of the importance of facial expression tone and other non-verbal messages. 

These early encounters between the residents and a new staff member can be overwhelming for the staff. As a staff member gains more awareness of their job and the nature of the challenges facing them, they can easily become overwhelmed with the social histories and personal conduct of the residents.  Most new staff members have little work or educational preparation for the job. The importance of having a smile on their face and a warm and nurturing tone is essential if one is going to avoid some of the pitfalls that are difficult to repair. 

Besides facial expression and tone, the following is a list of concepts and interventions that need to be utilized by staff in their interactions with clients. 

• Affect synchrony


• Autoregulation


• Moment-to-moment state sharing


• State complementing

Not all of these ideas are mine, the exchange of ideas and knowledge being offered is a plethora of gifts that have been passed on by many. Of most significance is the contribution that has been made by the various staffing groups who took the time to put their thoughts into a format that is intended to help others gain some valuable insights. Dr. Pawson said on many occasions that it takes leadership at all levels of an organization to create excellence.