Audit in psychotherapy: the concept of Kaizen

When any organisation is exposed to pressure to change, this not only mobilises considerable anxie ties within the organisation but calls a variety of defensive operations into play. The work of Jaques (1955) and Menzies Lyth (1959, 1988) has demon strated that this can result in the central problem ceasing to be the focus of attention, with primitive defensive mechanisms (often of an obssesional or paranoid kind) being mobilised. This process may either lead to energy being devoted to isolated elements of the situation, or staff withdrawing into a state of passivity and hopelessness. Indeed, Jaques has observed that when changes are imposed on an institution in a way which fails to take account of the functions that existing structures serve in relation to the deeper needs and anxieties of those working within the institution, such changes are likely to be resisted, and may even fail. When, by contrast, the needs, motivation and anxieties of the members of the institution are properly taken into account, and changes are intro duced by working with staff, they are more likely to succeed, and efficiencyand morale may improve. The Japanese concept of 'Kaizen', which has proved of