Motsättningar i vårdarbete : en fallstudie av ett försök till samarbete mellan psykisk barn- och ungdomsvård och vuxenpsykiatri

Sammanfattning: During a period of over five years two psychiatric teams have attempted to develop a programme for cooperation between child and youth care and adult psychiatric care in common premises in a local community just outside Stockholm. The thesis docu­ments, in six parts, the experiences from these experimental working conditions and how they were used to reach the desired goals of change in the organisations and in the activities of the teams. The thesis also shows how this special situation and the circumstances which followed created obstacles to change. The research-programme was carried out by field-research me­thods, i.e. a combination of direct observation and inter-viewing.The two teams went through different phases of mutual rela­tions. Initially they had to face severe difficulties. During the first 1 1/2 years the level of conflict was high. Indivi­dual members of the staffs became more and more paralyzed. At the same time, however, they could manage to work together with client-fami1ies and with other social welfare institutions. Individuals from different teams could exchange experiences with one another but, at the same time, they were unable to genera­lize and to share these experiences consciously.In the following 1 1/2 years the teams were integrated. New ways of handling therapeutic issues were developed. There were signs of change in the therapeutic identity of the staffs.The last years of the experimental period were characterized by growing reactions against the earlier developement. The teams were again split up, both administratively and in relation to working methods,The first part of the thesis describes the developement of the experimental issue in general. It also gives a presentation of the research-programme. The working pre-conditions are examined in the second part. In the third part the cause of the paralysis of the staff's capability of action is analyzed by viewing the problem from different theoretical perspectives and as a result of a clash between the different "activity-matrices" of the teams. In the fourth part some experiences of the research-methods used are documented. Some difficulties connected with preparation, re­alization and evaluation of experimental work conditions are examined in the fifth part. The sixth part is a summing up of the earlier parts and presents an analysis of the contradictions actua­lized during the experimental period.