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Emotion work in a mental
health service setting
Qualitative Social Work
2017, Vol. 16(3) 317–332
! The Author(s) 2015
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DOI: 10.1177/1473325015610181
Hege Sjølie
Faculty of Health Sciences, Buskerud and Vestfold University
College, Norway
Per-Einar Binder and Ingrid Dundas
Department of Clinical Psychology, University of Bergen, Norway
The purpose of this article is to describe emotion work within a crisis resolution home
treatment team in Norway. As defined by Hochschild, ‘‘emotion work’’ refers to managing one’s emotions according to what is culturally acceptable within a particular situation. A crisis resolution home treatment team is of particular interest when studying
emotion work, because it represents a working environment where mental health crises
and suicidal threat are common and where managing emotions is necessary for the
team to function well. We aimed to expand current knowledge of the particular ways in
which emotion work may be done by observing and describing the daily work of such a
team. Our analyses showed that team members’ emotion work had five main features:
(1) emotional expression was common and there seemed to be an informal rule that
‘‘vulnerable’’ emotions could be expressed; (2) emotional expression was most commonly observed in post-event discussions of challenging events or service users; (3)
emotional expression facilitated digesting or processing of the event with the help of a
fellow team member; (4) emotional expression was met with validation and support;
and (5) this support seemed to increase mentalization and understanding of the situation and could be offered only by other team members. An implication of these
findings is that informal exchanges of emotion are a necessary part of the work and
cannot occur outside of the work context.
Mental health, crisis resolution, home treatment, staff, emotion work, observation
Corresponding author:
Hege Sjølie, Faculty of Health Sciences, Buskerud and Vestfold University College, Trondheimsveien 95,
Oslo 0565, Norway.
Qualitative Social Work 16(3)
Crisis resolution home treatment (CRHT) team workers in Norway make crucial
decisions on a daily basis. The team mandate is to respond to requests from service
users experiencing an acute mental health crisis related to mental pain, suicidal
thoughts, psychosis, family, or social crisis (Karlsson et al., 2011; The Directorate
of Health and Social Welfare, 2006). Such teams work with service users who live at
home, making rapid assessments based on the information that they can collect in a
short period of time (Johnson, 2007). Suicide assessment is a weekly – if not daily –
occurrence and is involved in a substantial number of the assignments undertaken
by such teams.
To make good decisions, team members rely on their ability to handle strong
emotions, including both their own and others’ emotions, to ensure that these
emotions do not interfere with decision making but can instead be used as information to strengthen their decisions. It is therefore of great importance that team
members have functional ways of managing their own and others’ emotions. Based
on this understanding, we chose to undertake the important task of exploring
emotion work in an empirical study. The present study explores emotion work
between the team members in an interdisciplinary team in mental health service.
While 3 of the 13 team members are social workers and 2 are psychologists, the
majority of the team members are nurses with additional education in various
psychosocial disciplines.
Emotion work and emotional support
We drew on the seminal work of Hochschild (1983, 2001, 2003), whose research has
focused on ‘‘emotion work’’ and ‘‘feeling rules’’. According to Hochschild (1983),
every context will have specific ‘‘feeling rules’’ that give direction to emotions by
providing social guidelines for how we try to feel (Hochschild, 2001). Hochschild
emphasizes the significance of managing emotions that deviate from the cultural
script or moral stance that she calls ‘‘feeling rules’’ and focuses on efforts to direct
emotions that deviate from these rules towards the given framework. She describes
the management of emotions as ‘‘emotion work’’ (1983, 2001, 2003). ‘‘Emotion
work’’, which she uses synonymously with ‘‘emotional labor’’ (Hochschild, 1983:
7), ‘‘emotion management’’ or ‘‘deep acting’’ (Hochschild, 2003: 87), refers to the
act of trying to change an emotion or feeling either by degree or by quality
(Hochschild, 2001). In any cultural context, individuals may need to work on
managing emotions to ensure that the emotions felt and expressed are in accordance with the prevailing feeling rules. Emotion work occurs in face-to-face interaction (Hochschild, 1983; Zapf, 2002) in which people can help each other, cope
with emotions or in which emotions can be handled privately without being
Psychological theories have focused on how individuals can help each other
regulate emotions that do not fit within the cultural norms or feeling rules
Sjølie et al.
described by Hochschild (1983, 2001) or emotions that can be so overwhelming
that they impede health workers’ ability to make good decisions. This phenomenon
may be described as ‘‘interpersonal emotion regulation’’. ‘‘Mentalizing’’ emotion is
one description of how emotions may be regulated in interpersonal relations (Allen
et al., 2008; Bateman and Fonagy, 2012). ‘‘Mentalizing emotions’’ can be defined as
identifying emotions and what they mean, modulating them, and then expressing
them in an appropriate manner (Allen et al., 2008; Bateman and Fonagy, 2012).
Mentalizing is a central concept in the work of Allen, Fonagy, and Bateman (Allen
et al., 2008; Bateman and Fonagy, 2012). We suggest that these ways of handling
emotions reflect emotion work as described by Hochschild (1983, 2001, 2003).
Another concept that is relevant for understanding emotion work is the concept
of ‘‘social support’’. West (2012) identified four main types of social support, where
‘‘emotional support’’ is described as being an active and open listener, providing
space for expressing emotions, having a sense of caring for the person and containing the emotion without giving advice or directions. This type of support takes
the form of empathic understanding of emotional pain in the other person and is
expressed by sympathizing with or encouraging the other person.
The concept of emotional intelligence (Goleman, 2006) can illuminate aspects of
emotion work. In our opinion, this concept represents a framework that to a certain degree decontextualizes emotion regulation skills. We regard emotion work
not as an individual skill but as the interaction between individuals that helps them
regulate and live with their emotions. However, Goleman’s concept draws attention to the possibility that emotion work between people can depend partly on
certain individual skills as well as capabilities developed through teamwork.
In summary, this article aims to study the emotion work performed in a CRHT
team using the concepts of emotion work (Hochschild), interpersonal emotion
regulation (mentalizing), and social support – specifically, emotional support –
within the team. We analysed field notes with the following questions in mind:
(1) Which emotions are expressed? (2) When are these emotions expressed? (3)
What purpose does this emotional expression serve for the individual? (4) How
does an individual receive and respond to these emotions? (5) How does this support functioning within the team?
Prior studies relevant to the topic of emotion work in mental health teams
Prior studies have used emotion work or emotional labour to describe the interaction between health workers and their clients. Studies have included a variety of
professions, such as the service industry (Grandey, 2003; Zapf and Holz, 2006), the
helping professions (Zapf, 2002), helping industries (Grandey, 2000), health workers (Grandey et al., 2012), and nurses (Karimi et al., 2014; Pisaniello et al., 2012).
These are all professions that have some elements in common with a CRHT team.
These studies report that emotion work in the client–helper relationship is crucial
for service providers’ psychological well-being (Karimi et al., 2014; Pisaniello et al.,
2012; Zapf, 2002; Zapf and Holz, 2006) and risk of burnout (Grandey, 2000;
Qualitative Social Work 16(3)
Grandey et al., 2012). Of particular relevance for the present study is a study by
Grandey et al. (2012) that describes the emotion work occurring amongst coworkers. Grandey et al. (2012) proposed that a ‘‘climate of authenticity’’
that involves accepting and respecting the expression of felt emotions amongst
co-workers is beneficial for their mental health.
To our knowledge, previous studies of emotion work or managing emotions in
CRHT teams specifically have not been conducted. A study of Gregor (2010)
mentioned emotional labour as an unspoken component of the work for an
Approved Mental Health Professional.A study by Freeman, et al. (2011) sought
to explore staff experiences working in CRHT teams in general, but that study did
not use the term ‘‘emotion work’’ explicitly. Freeman et al. reported that participants spoke positively about the support provided by other team members and
support through supervision. Team members also spoke about coping strategies for
regulating emotions in difficult situations. Examples of these strategies included the
process of ‘‘moving on’’ emotionally, acceptance and humour.
This ethnographic study is inspired by narrative ethnography as described by
Gubrium and Holstein (2009), with the aim of exploring CRHT team members’
accounts and actions by performing multistage focus group interviews, individual
interviews and observations of 1 CRHT team over a period of two years (Atkinson
and Hammersley, 1994; Hammersley and Atkinson, 2007). Multistage focus group
interviews were conducted monthly for the first three semesters. By exploring the
discourses and practices of how the team worked, we collected broad empirical
material on the team members’ thinking, discussions, assessments, interaction, and
practical approach to their day-to-day work. Individual interviews were conducted
with all team members during the second semester. These interviews provided
knowledge about the team members’ individual narratives of how their personal
family- and work-related experiences as well as their personal qualities and interests
had affected their professional role. Finally, participant observations were conducted for 19 days during the fourth semester. The focus of the observations was
on the team members’ reflections, discussions, and actions as well as how they used
their individual resources and supported each other in solving cases.
The participant observation part of this study might be considered short for a
traditional ethnographic study, and this short length of time may be criticized for
its impact on the findings. A longer stay in the field could have yielded other stories,
situations, or knowledge of the team. However, there may be good reasons why
shorter field work is sufficient: when the field is available for only a short period of
time (Patton, 1990), when short fieldwork yields sufficient empirical material
(Album, 1996), or when the observation period is prepared by other forms of
empirical data collection in advance (Baines and Cunningham, 2013). As described
Sjølie et al.
above, this study had a long period of empirical data collection before beginning
the observation phase. This ethnography approach might be closer to what Baines
and Cunningham (2013) call rapid ethnography than to traditional ethnography.
In our experience as researchers, we had extensive empirical material even before
commencing the participant observations (Atkinson and Hammersley, 1994;
Hammersley and Atkinson, 2007). Nevertheless, we obtained new knowledge
from the observations that had not been discovered from the multistage focus
group interviews or individual interviews. Our aim was to collect empirical material
from different vantage points that could complement and differentiate the picture
of the team.
The empirical material for this article comes from the participant observations
conducted by the first author in a participant-as-observer role (Gold, 1958). The
observer documented her observations by writing field notes, reflections, and clarifications of conversations with the team members (Gubrium and Holstein, 1997).
Field notes were taken on the scene during meetings and conversations. The work
was inspired by Gubrium and Holstein’s narrative ethnography (Gubrium and
Holstein, 2009) in that the observer paid close attention to how her own and the
participants’ understanding of what had happened during an event was developed
and nuanced through conversations between team members after the event.
The observer followed the team in their day-to-day work in an open office
environment and in the backseat of the car as two team members visited different
service users. She was allowed to observe meetings, discussions, reflections, and
interactions during the teams’ daily routines at work. She largely listened and
watched but sometimes asked for clarification.
Researcher reflexivity
The ideal of pure knowledge production free from the subjectivity of the researcher
is questionable (Atkinson and Coffey, 2003; Gubrium and Holstein, 1997).
Researcher reflexivity may reduce the degree to which the researcher unknowingly
influences the data in a biased way (Gough, 2003; Kvale and Brinkmann, 2009).
Kvale and Brinkmann (2009) described the researcher’s attempt to be reflective in
his or her own contribution while striving to be objective about subjectivity.
The first author, who conducted the observations, was known to the team members as a researcher prior to the observations. The advantage of being familiar with
the work and the team members is that this familiarity may enable trust and
understanding between the researcher and the participants. It may also represent
a limitation, however, as the participants may feel a greater need to withhold
sensitive information that they might believe the researcher could convey to
others. A familiar researcher might also make participants more likely to ‘‘help’’
the researcher by telling her what they expect she wants to hear. However, the
observer’s profession as a sociologist rather than a health worker and the role of
researcher contributed to ensuring some professional distance to the team members
(Delamont et al., 2010). Our impression was that the researcher’s presence had little
Qualitative Social Work 16(3)
effect on the team members’ day-to-day work and the emotions that they expressed
to each other during the work day. The frequency of and manner in which they
expressed their emotions and supported each other made us believe that these
efforts were made regularly rather than being made in response to being observed.
Setting and participants
Data were collected from a Norwegian CRHT team that was typical in that it
participated in an official training programme for CRHT teams, involved members
with different professional backgrounds, was mobile, performed home treatment
duties and worked in a network-oriented manner.
Thirteen team members participated, including 11 women and 2 men. The participants’ ages ranged from 27 to 59 years. Their professional backgrounds were in
nursing, social work, and clinical psychology. All nurses and social workers had
completed one or more extended courses on mental health issues, such as psychiatric nursing, cognitive therapy, or family therapy. All but one team member had
more than two years of work experience related to mental health, including both
hospital- and community-based mental health. All but two members had attended
a training course on CRHT and had been members of the team since it was established in October 2007. The team uses an open dialogue approach that encourages
members to reflect together on their practices, themselves and the service users
(Seikkula and Arnkil, 2006).
The participant observation method may be used to capture the activity of everyday life as it occurs in a natural environment. We applied a combination of thematic analysis and linkage and collaboration from narrative ethnography for the
analysis (Gubrium and Holstein, 1997, 2009; Hammersley and Atkinson, 2007;
Silverman, 2006). The first author started with the general aim of observing and
describing how the team members worked, i.e. their communication and practices
during working hours. Realizing her own part as an observer of the stories when
the participants constructed their realities, she aimed to be reflexive regarding her
own common-sense understanding of what was occurring and attempted as much
as possible to bracket this analytically as she sought to grasp how the participants
constructed their realities (Gubrium and Holstein, 1997, 2009).
After the observations were made, the analysis of the field notes was conducted
using NVivo 8 computer software (QSR, 2009). The first two authors commenced
the analysis by examining the field notes and looking for contexts and situations as
well as interactions between team members. A range of themes related to practices
within the team was identified. For us, ‘‘support’’ was one of the themes that
appeared in the material in different forms. We chose to focus on contexts, situations, and interactions where emotions were expressed and emotional support was
given or not given. We read the field notes and looked for emotions and emotion
Sjølie et al.
work. By considering the context as well as the individual stories and the interaction between team members, we sought to determine how these aspects were
revealed among the team members in their everyday work. Narrative ethnography
lists different elements that show how individuals construct and elaborate their
stories. When analysing themes from the field notes, we focused on how the participants engaged in active meaning making together within the team by using
linkage and collaboration (Gubrium and Holstein, 2009). The participants’ understanding of what had happened in an event was developed, nuanced and given
meaning through conversations between them after the event. Linkage refers to
how the bits and pieces were developed and combined in a meaningful way through
reflections, conversations, and discussions over time. Collaboration refers to how
this meaning making is performed by the team members together.
We have chosen to present these findings as descriptions rather than as excerpts
from field notes, because we consider descriptions to provide more nuances and
details than we could present using excerpts in the format of an article.
Emotion work is an abstract concept that is not expected to address an explicit
experience in participants’ minds but that may be elicited from the observational
field notes made by a third party, as in the present study.
When we had established that emotional support and emotion work were some of
the prominent themes in the empirical material, we examined how team members
used linkage and collaboration in their emotion work and emotional support.
Individual reflections, presentations, discussions, and conversations between the
team members evolved over time. Difficult questions were reflected on and debated,
sometimes for hours during a work day and other times …
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