Involvement or attachment theory: Exploring the determinants and consequences of individual (work) involvement with particular reference to escape motivation

ABSTRACT

The following research on individual involvement and escape motivation is presented to open the possibility that studies of ‘involvement’ may reveal different areas for psychotherapy than the predominant concept of ‘attachment’, which has formed the basis of new and existing therapies. Particularly, whether notions of ‘involvement capacity’, ‘escape motivation’ and other involvement typologies, as well as the psychological/sociological interplay between individual and organisational/societal perspectives, are pertinent for psychotherapy. The previously unpublished research, a follow-up to a 1979 study, again combining psychological and sociological methodologies for researching involvement, reinforced that a significant theme, not given attention in the literature, was that people also work to escape from their personal problems. Organisational/managerial perspectives are contrasted with individual perspectives and notions as Etzioni’s moral and alienative involvement are re-evaluated. Mixed methods were used including Bruner’s narrative analysis, Weber’s ideal types, and a phenomenological stance influenced by existentialism and psychoanalysis. The results arising from this empirical study of people who are nurses in the context of a subsequent literature review indicate they are motivated to get involved in work: to escape personal problems; earn money; and, for the satisfaction from the work itself. There are also detrimental effects arising from the ‘emotional labour’ required.

ABSTRAKT

Die folgenden Forschungsarbeiten zu individueller Beteiligung und Fluchtmotivation werden vorgestellt, um die Möglichkeit zu eröffnen, dass Studien über “Involvement” andere wichtige Bereiche für die Psychotherapie aufdecken können als das vorherrschende Konzept der “Bindung”, das die Grundlage für neue Therapien bildete und bestehende Therapien informierte.

Insbesondere geht es um die Frage, ob Begriffe wie ‘Beteiligungsfähigkeit’, ‘Fluchtmotivation’, ‘Entfremdung’, ‘moralische’ und ‘kalkulative Beteiligung’ sowie das psychologisch-soziologische Zusammenspiel von individueller und organisationaler/gesellschaftlicher Perspektive für die Psychotherapie relevant sind.

Diese Forschung, die an eine Studie aus den 1970er Jahren anknüpfte und wiederum psychologische und soziologische Methoden zur Erforschung des Engagements kombinierte, bestätigte, dass ein wichtiges Thema, das in der Literatur nicht beachtet wurde, darin bestand, dass Menschen auch daran arbeiten, ihren persönlichen Problemen zu entkommen.

Organisations- und Managementperspektiven werden individuellen Perspektiven und Vorstellungen gegenübergestellt, während Etzionis moralisches und entfremdetes Engagement neu bewertet wird. Es wurden gemischte Methoden verwendet, darunter Bruners narrative Analyse, Webers Idealtypen und eine phänomenologische Haltung, die mehr vom Existenzialismus und der Psychoanalyse als vom Humanismus beeinflusst ist.

Die Ergebnisse dieser empirischen Studie über Menschen, die Krankenschwestern und Krankenpfleger sind, deuten darauf hin, dass sie motiviert sind, sich auf die Arbeit einzulassen: um persönlichen Problemen zu entkommen; Geld verdienen; und für die Befriedigung durch die Arbeit selbst. Es gibt auch nachteilige Auswirkungen auf ihr Leben, die sich aus der erforderlichen “emotionalen Arbeit” ergeben.

RESUMEN

La siguiente investigación sobre la implicación individual y la motivación de escape se presenta para abrir la posibilidad de que los estudios de “implicación” puedan revelar áreas importantes para la psicoterapia diferentes al concepto predominante de “apego”, que ha formado la base de las nuevas terapias y ha informado a las existentes. En particular, si las nociones de “capacidad de implicación”, “motivación de escape”, “alienación”, “implicación moral” y “calculadora”, así como la interacción psicológica/sociológica entre las perspectivas individuales y organizacionales/sociales son pertinentes para la psicoterapia. Esta investigación, una continuación de un estudio de la década de 1970, que combina de nuevo metodologías psicológicas y sociológicas para investigar la participación, reforzó que un tema importante, al que no se le prestaba atención en la literatura, era que las personas también trabajan para escapar de sus problemas personales. Las perspectivas organizacionales/gerenciales se contrastan con las perspectivas y nociones individuales a medida que se reevalúa la participación moral y alienativa de Etzioni. Se utilizaron métodos mixtos que incluían el análisis narrativo de Bruner, los tipos ideales de Weber y una postura fenomenológica más influenciada por el existencialismo y el psicoanálisis que por el humanismo. Los resultados que se desprenden de este estudio empírico de personas enfermeras indican que están motivadas para involucrarse en el trabajo: para escapar de los problemas personales; ganar dinero; y, por la satisfacción del propio trabajo. También hay efectos perjudiciales en sus vidas derivados del “trabajo emocional” requerido.

RIASSUNTO

La seguente ricerca sul coinvolgimento individuale e sulla motivazione alla fuga viene presentata per aprire la possibilità che gli studi sul “coinvolgimento” possano rivelare aree diverse ed importanti per la psicoterapia rispetto al concetto predominante di “attaccamento”, che ha costituito la base di nuove terapie e informato quelle esistenti. In particolare, se le nozioni di ‘capacità di coinvolgimento’, ‘motivazione alla fuga’, coinvolgimento “alienante”, “morale” e “calcolatore”, così come l’interazione psicologica/sociologica tra prospettive individuali e organizzative/sociali siano pertinenti per la psicoterapia. Questa ricerca, che fa seguito a uno studio degli anni ‘70, che combina ancora una volta metodologie psicologiche e sociologiche per la ricerca sul coinvolgimento, ha rafforzato il fatto che un tema significativo, a cui non è stata data attenzione in letteratura, è che le persone lavorano anche per sfuggire ai loro problemi personali. Le prospettive organizzative/manageriali si contrappongono alle prospettive e alle nozioni individuali man mano che il coinvolgimento del tipo “morale” e del tipo “alienante” di Etzioni viene rivalutato. Sono stati utilizzati metodi misti, tra cui l’analisi narrativa di Bruner, i tipi ideali di Weber e una posizione fenomenologica influenzata più dall’esistenzialismo e dalla psicoanalisi che dall’umanesimo. I risultati che emergono da questo studio empirico su persone che sono infermiere indicano che sono motivate a mettersi in gioco nel lavoro: per sfuggire ai problemi personali; guadagnare denaro; e, per la soddisfazione del lavoro stesso. Ci sono anche effetti dannosi sulla loro vita derivanti dal “lavorio emozionale” richiesto.

ABSTRAIT

Les recherches suivantes sur l’implication individuelle et la motivation d’évasion sont présentées pour ouvrir la possibilité que les études sur « l’implication » puissent révéler des domaines importants pour la psychothérapie différents du concept prédominant d’« attachement », qui a formé la base de nouvelles thérapies et a informé celles existantes. En particulier, les notions de « capacité d’implication », de « motivation d’évasion », d’« aliénation », d’« implication morale » et « d’implication calculatrice », ainsi que l’interaction psychologique/sociologique entre les perspectives individuelles et organisationnelles/sociétales, sont pertinentes pour la psychothérapie. Cette recherche, qui fait suite à une étude des années 1970, combinant là encore des méthodologies psychologiques et sociologiques pour rechercher l’implication, a renforcé le fait qu’un thème important, peu abordé dans la littérature, était que les gens travaillent également pour échapper à leurs problèmes personnels. Les perspectives organisationnelles et managériales sont contrastées avec les perspectives et notions individuelles à mesure que l’implication morale et aliénante d’Etzioni est réévaluée. Des méthodes mixtes ont été utilisées, notamment l’analyse narrative de Bruner, les types idéaux de Weber et une position phénoménologique influencée davantage par l’existentialisme et la psychanalyse que par l’humanisme. Les résultats issus de cette étude empirique auprès de personnes infirmières indiquent qu’elles sont motivées à s’impliquer dans le travail : pour échapper à des problèmes personnels ; gagner de l’argent; et, pour la satisfaction du travail lui-même. Le « travail émotionnel » requis a également des effets néfastes sur leur vie.

ΠΕΡΊΛΗΨΗ

Η ακόλουθη έρευνα σχετικά με την ατομική εμπλοκή και τα κίνητρα διαφυγής παρουσιάζεται για να διευρύνει τη δυνατότητα των μελετών της “εμπλοκής” να αποκαλύψουν διαφορετικά σημαντικά πεδία για την ψυχοθεραπεία πέραν της κυρίαρχης έννοια του “δεσμού”, η οποία έχει αποτελέσει τη βάση νέων θεραπειών και έχει παρέχει γνώση για τις υπάρχουσες. Ειδικότερα, εξετάζεται το κατά πόσον οι έννοιες της “ικανότητας εμπλοκής”, του “κινήτρου διαφυγής”, της “αλλοτριωτικής”, της “ηθικής” και της “υπολογιστικής εμπλοκής”, καθώς και η ψυχολογική/κοινωνιολογική αλληλεπίδραση μεταξύ ατομικής και οργανωσιακής/κοινωνικής οπτικής είναι συναφείς με την ψυχοθεραπεία. Αυτή η έρευνα, μια συνέχεια μιας μελέτης του 1970, που συνδυάζει και πάλι ψυχολογικές και κοινωνιολογικές μεθοδολογίες για την έρευνα της εμπλοκής, ενίσχυσε ένα σημαντικό θέμα, το οποίο έχει παραμεληθεί στη βιβλιογραφία, και αφορά το γεγονός του ότι οι άνθρωποι εργάζονται για να ξεφύγουν από τα προσωπικά τους προβλήματα. Οι οργανωσιακές/διοικητικές οπτικές αντιπαραβάλλονται με τις ατομικές οπτικές και οι έννοιες όπως η ηθική και η αλλοτριωτική εμπλοκή του Etzioni επαναξιολογούνται. Χρησιμοποιήθηκαν μεικτές μέθοδοι, συμπεριλαμβανομένης της αφηγηματικής ανάλυσης του Bruner, των ιδανικών τύπων του Weber και μιας φαινομενολογικής στάσης επηρεασμένης περισσότερο από τον υπαρξισμό και την ψυχανάλυση παρά από τον ανθρωπισμό. Τα αποτελέσματα που προκύπτουν από αυτή την εμπειρική μελέτη αναφορικά με το νοσηλευτικό προσωπικό δείχνουν ότι τα κίνητρα εμπλοκής τους στην εργασία αφορούν: τη διαφυγή από τα προσωπικά τους προβλήματα, το να κερδίσουν χρήματα, καθώς και τη λήψη ικανοποίησης από την ίδια τους την εργασία. Υπάρχουν επίσης δυσμενείς επιπτώσεις στη ζωή τους που προκύπτουν από την «κοπιώδη συναισθηματική εργασία» που απαιτείται.

KEYWORDS:

• Psychotherapy
• escape motivation
• nurses
• organisational vs individual perspectives
• involvement
• attachment

SCHLÜSSELWÖRTER:

• Psychotherapie
• Fluchtmotivation
• Pflegekräfte
• organisatorische vs. individuelle Perspektiven
• Engagement
• Bindung

PALABRAS CLAVE:

• Psicoterapia
• motivación de escape
• enfermeras
• perspectivas organizacionales contra perspectivas individuales
• involucramiento
• apego

PAROLE CHIAVE:

• psicoterapia
• motivazione alla fuga
• infermiere
• prospettive organizzative vs individuali
• coinvolgimento
• attaccamento

MOTS-CLÉS:

• Psychothérapie
• motivation d’évasion
• infirmières
• perspectives organisationnelles vs perspectives individuelles
• implication individuelle
• attachement

ΛΈΞΕΙΣ-ΚΛΕΙΔΙΆ:

• Ψυχοθεραπεία
• κίνητρο διαφυγής
• νοσηλευτικό προσωπικό
• οργανωσιακή έναντι ατομικής οπτικής
• εμπλοκή
• προσκόλλησης

Introduction

This research is presented for psychological therapists to evaluate the usefulness of the concepts of involvement when working with clients. The research presented indicates that the concept of involvement is not being given the attention it deserves, and that since the 1970s there is an ever decreasing interest in individual involvements other than some from organisational and managerial perspectives. Research is presented here regarding the determinants and consequences of involvement of people who are nurses in order to provide a preliminary basis to explore whether involvement concepts developed may be applicable not only to other occupations but also the involvement processes of people, and consequently therapeutic clients, in general.

This article reports on a previously unpublished 2015 research study of the involvement processes of people who work. A central theme that emerged was the finding that people work in order to escape from their personal problems, as well as switching off from work involvements when they get home. This is contrary to the literature on work–life balance (Guest, 2002), stress (Lazarus & Folkman, 1984), burnout (Maslach, 2003) and workaholism (Bakker et al., 2008; Oates, 1972) where the concern has only been about people being caught up or involved in their work in non-work time. This ‘escape motivation’, other than occasional references to concepts such as a ‘workaholic’ (Bakker et al., 2008; Guest, 2002; Oates, 1972), appears to not have been given attention in the literature where the focus is primarily on organisational/managerial perspectives (Becker & Huselid, 1998; Levy & Powell, 2000; Shantz et al., 2015). Here, the emphasis is on how organisations can motivate individuals to be more involved in their work (Herzberg et al., 1959; McClelland, 1988; McGregor, 1960). Individual perspectives, when considered more phenomenologically through humanistic theories (Allport, 1943; Maslow, 1962; Rogers, 1967) tend to be limited in their theoretical avoidance of negative connotations for working. Instead, a phenomenological stance is attempted, but with theoretical implications influenced more through existentialism and psychoanalysis allowing, for example, for the despair of wishing for a new self (Kierkegaard [1848], 1954) and unconscious motivations, such as the death drive and the defence mechanisms of repression and displacement (Freud, 1937).

A separate study was undertaken by one of the researchers in 1979 (Loewenthal 2002) and some comparisons are made following the review of subsequent social and psychological literature. The focus in the 1979 study was on involvement as defined through its ordinary usage of ‘the state of being complicated, tangled, obscure; causing great difficulty’ (English Dictionary, 1969, p. 397); together with Etzioni’s (1975) definition of involvement as a ‘cathectic evaluative orientation’. Thus, what might be seen as ‘emotional involvement’, that could also be considered as ‘affect’, is the focus here, although the intertwining with other involvements such as ‘physical’, ‘intellectual’, ‘social’ and ‘spiritual’ can be seen to varying extents to also be present (Strout & Howard, 2012). It was hoped that by bringing these same concepts from the research described above into the later 2015 study, it would open up the possibility that studies of ‘involvement’ may reveal different important areas for psychotherapy than the predominant concept of ‘attachment’ (Ainsworth et al., 1978; Bowlby, 1969), which has formed the basis of new therapies and informed existing ones. Attachment is considered to be a helpful concept in psychotherapy (Slade, 1999), but is there a way it has concealed the notion of involvement? Furthermore, whilst attachment theory has been applied by some researchers to investigate the lives of individuals who work, these studies have tended to focus on the correlation between attachment styles and job satisfaction and job security (Hazan & Shaver, 1990) or the effects attachment anxiety and attachment avoidance have on relationships with others at work (Fraley & Waller, 1998).

The researchers considered the literature on involvement since the first study and subsequent to the second, with particular reference to the psychological/sociological interplay between individual and organisational/societal perspectives. This is to ascertain whether concepts such as ‘involvement capacity’, ‘escape motivation’ and other involvement typologies might open some new registers in psychotherapy.

The 1979 research project led to a revaluation of Etzioni’s (1975) ‘moral’ versus ‘alienative’ involvement which has formed an unquestioned underpinning of such seminal works such as Goldthorpe et al. (1968) ‘The Affluent Worker’ (xxxx, 2002). From an individual perspective, ‘moral involvement’ can be considered as a socialising pressure to ensure individual conformity and, whilst possibly providing some solace, can be seen as a form of enchainment (Nietzsche, 2008). ‘Involvement capacity’ was a term used in the 1979 study to describe why it is that a particular input leads one individual to becoming totally involved, whilst it leads another individual to only a partial involvement and this would vary in accordance with the involvement ability of that individual. The study concluded that Etzioni’s involvement continuum typologies needed to be redefined, where ‘moral involvement’ becomes ‘involvement alienation’ and ‘alienative involvement’ becomes ‘calculative alienation’ (xxxx, 2002).

Interest in the 1979 study was in exploring how an individual can potentially have involvements that could have beneficial and/or detrimental consequences, looking at the quality of the overall life of the person who is the worker, rather than a focus more on work performance from only an organisational perspective and not an individual perspective. The later study reported here reinforced an exploration of this question that was previously considered; and again, an interplay of sociological and psychological concepts was found to be useful.

There appears still to be little conceptual integration in the study of involvement, since Kanungo (1982a) identified the lack of it over the previous seven decades. What follows is therefore to present separately, and for the most part chronologically, psychological and sociological definitions of involvement, which has led more recently in organisational psychology to engagement (Kahn, 1990) and its meaning, antecedents and outcomes (Bailey et al., 2017).

Organisational vs individual definitions of involvement

There appears a decreasing attention in the academic literature to individual perspectives at the time of the 2015 study versus the 1979 study to the extent that the literature on any subsequent research on the sociology of work appears to have almost disappeared. Furthermore, where ordinary usage of terms such as involvement could provide more an individual perspective, they have been harnessed by sociologists and psychological therapists alike to serve organisational perspectives/ideologies. The case of Etzioni’s moral involvement is focused on here, but it can also be seen how other concepts which could act as an antidote to organisational ensnarement have been perverted. For example, Hochschild’s (1983) emotional labour as in Mann and Cowburn (2005); Henderson (2001); Gray (2009). This process, however, is most evident in the management literature where in the 1960s the call for involvement has moved to engagement, defined as ‘the harnessing of organisation members’ selves to their work roles’ (Kahn, 1990, p. 694), with more recent trends to focus within such engagement on ‘meaning’ (Bailey et al., 2017). As will be seen from at least the early 1990s the concept of involvement has also been taken up by organisational psychologists interested in the impact of work-place human resource management systems on organisational performance. What follows is a chronological summary of the changing psychological and sociological definitions of involvement as found in the literature, and then the involvement literature on people who are nurses.

Psychological definitions of involvement

For psychology, ‘job involvement’ is considered as a work-related behaviour, and its ‘outcomes’ are ‘job satisfaction’, ‘job commitment’, and ‘employee job performance’ which comprise the most studied areas in organisational behaviour and human resource management research (Kahn et al., 2011).

Rabinowitz and Hall (1977) conducted a large scale literature search of job involvement exploring terms such as ‘work attachment’, ‘ego involvement’, ‘work centrality’ and ‘self-esteem’. They concluded that a definition of ‘job involvement’ can be grouped into two distinct categories: (1) the extent to which the self-esteem of individuals is affected by their level of performance at work (Allport, 1943; Kanungo, 1982b), and (2) the degree of psychological identification of employees with their job (Lodhal & Kejner, 1965; Rabinowitz & Hall, 1977).

Whereas the first category sees job involvement and job satisfaction as the same, Lodhal and Kejner (1965) do not view ‘job involvement’ and ‘job satisfaction’ as the same and conclude that a ‘job-involved’ person may be happy with her/his job, or they may feel dissatisfied. Lodhal and Kejner (1965) also developed a Job Involvement Scale. This scale (or a subset of items from it) is still commonly used (Diefendorff et al., 2002; Ettington, 1998) despite being frequently criticised for ‘measurement deficiencies’ (Reeve & Smith, 2001).

The related concept of ‘employee engagement’ was introduced by Kahn (1990, p. 694) who defined it as ‘the harnessing of organization members’ selves to their work roles’. In relation to job involvement, Kahn (1990) differentiates his conceptualisation of ‘engagement’ as the connection or interaction between the person and the organisation and what it means to be psychologically present. He asserts that there are ways in which people can become personally engaged (or disengaged) in their work physically, cognitively and emotionally which in turn have implications for performance.

The more recent use of the notion of engagement is considered by the authors to be a continuation of the involvement theme, rather than as Hallberg & Schaufeli (2006) consider it, as being empirically distinct. As with the concept of job involvement, work engagement is mainly considered to be something positive for the individual. Here, being involved and engaged in work is seen as evoking positive emotional and/or behavioural responses from the individual (Kahn, 1990), both in the work place and outside of work. Subsequently, definitions of involvement and engagement have moved away from consideration of the effects of work on the individual, and have become more concerned with employee performance and how it can benefit the organisation (xxxx 2002). For example, a study on engagement conducted by Bakker et al. (2008) asserts: ‘engaged workers perform better’.

According to Bakker an ‘engaged worker’ is not that same as what has come to be known in contemporary society as a ‘workaholic’ (Bakker et al., 2008). The term ‘workaholic’, first used by Oates (1972), describes how, for some people the need for work becomes overly excessive, just like an addiction. According to Bakker et al. (2008), workaholics willingly choose to spend an excessive amount of time engaged in work activities due to obsession and compulsion – whereas engaged workers lack a compulsive drive. Furthermore, workaholics tend to become involved in work at the expense of other activities, whereas engaged workers experience work as ‘fun’ (Schaufeli et al., 2001). Guest (2002) notes how in its early use, the term ‘workaholism’ described the phenomenon as a disease akin to alcoholism (Baylin, 1977 in Guest, 2002) but further research carried out by Machlowitz (1980, in Guest, 2002, p. 260) ‘suggested that it was more properly viewed as a form of extreme work involvement’. Thus, the majority of the psychological definitions of involvement are devised from an organisational perspective. One possible exception to this is the research work of Kühnel et al. (2009) who separate the concepts of job involvement from work engagement and examine how a short respite and general job involvement contribute to work engagement. They conclude that whilst work engagement and job involvement can increase after short respite at home, the quality of the respite at home is diminished by job involvement.

Sociological definitions of involvement

Both of Rabinowitz and Hall’s (1977) above definitions appear to encompass the psychological elements of ‘job involvement’, but Allport’s (1943) concept was also taken up by sociologists. Sociological perspectives can be seen as being more concerned with aspects of the socialisation process that lead to the incorporation in the person of work-relevant norms and values.

The sociologist Dubin (1956) defined a person’s involvement in their job in terms of work as a ‘Central Life Interest’ (CLI); the degree to which individuals see their job as a major source of satisfaction of important needs in their life. Job involvement and job satisfaction are therefore not differentiated in this definition as being separate. Dubin (1956) developed a measurement scale that assessed the extent of an employee’s work involvement in relation to non-work activities and found that, for three out of four industrial workers then engaging in manual labour, both work and the workplace were not CLI’s.

Using Dubin’s (1956) measurement scale, Orzack (1959) replicated the CLI study with nurses and found that four out of five participants indicated that work was a CLI for them. Orzack argued that there are various factors in the nature of professional work (as opposed to manual labour) that could account for this, such as specialised, prolonged training (inevitably increasing status) and development within a professional community. Following Orzack (1959), Dubin (1992) concurred that members of occupations that can be classified as ‘professional’ are more likely to view their work as a CLI and invest emotional energy in it. Dubin added that professional work was more likely to promote autonomy, creativity and responsibility than manual labour and his revised definition of a CLI included ‘that portion of a person’s total life in which energies are invested in both physical and intellectual activities and in positive emotional states’ (Dubin, 1992, p. 41).

However, it is Etzioni’s conceptualisation of involvement that is of particular interest. He defines involvement as ‘the cathectic evaluative orientation of an actor to an object, characterised in terms of intensity and direction’ (1975, p. 9) and observes:

We refer to positive involvement as commitment and to negative involvement as alienation. (The advantage of having a third term, involvement is that it enables us to refer to the continuum in a neutral way.) Actors can accordingly be placed on an involvement continuum which ranges from a highly intense negative zone through mild negative and mild positive zones to a highly positive zone. (Etzioni, 1975, p. 9)

Yet how ‘neutral’ is this framework? Etzioni’s reference to positive and negative involvement can be seen to be from an organizational perspective, but much more questionable from an individual one where the individual’s agency is least when he or she has involved his/her self and internalised the organisation’s values.

Potential misuse of Marx’s (1844/1964) concept of alienation from work to describe the disengagement of self from the occupational role with ‘involvement’ at the other end of the spectrum, representing the ideal to be attained, can also be found in various forms in the works of Parker (1965), Goldthorpe et al. (1968), Berger and Berger (1976), and Schein (2010). While the ‘sociology of work’ was a prevalent terminology from the 1950s to the early 70s (Caplow, 1954; Fox, 1974; Parker, 1965), there is subsequently little reference, and then usually in text books (Grint, 2005; Watson, 2011). One possible exception is the continued exploration of Marx’s theory of alienation in management journals, though there is criticism of this multidimensional approach (Soffia et al., 2022, p. 837).

The involvement of people who are nurses

With regards to existing research, reference has already been made to Orzack (1959) who found then that for 80% of people who were nurses, work was a central life interest. Also of interest is Goffman (1968), both in terms of the notion of nurses working in ‘total institutions’ and an involvement cycle (Goffman, 1968, p. 79) where student nurses learn to restrict their emotional involvement; and, Davis (1975) findings of an involvement process where nurses in training either ‘psych out’ or ‘get out’. Also of interest is Menzies (1960), whose work can be seen as pertinent in attempting to limit nurses’ emotional involvement with their patients.

Further significant research on the involvement of nurses has been provided by Habenstein and Christ (1963). Their ‘utilizer’ has similarities with Etzioni‘s calculative involvement and both their ‘traditionalizer’ and ‘professionalizer’ can be seen as having different forms of moral involvement.

Also, in examining the literature on the motivation to nurse (Newton et al., 2009; Toode et al., 2011) no reference is given that could pertain to escape motivation.

The implications of emotional labour have also been considered regarding the work of nurses. Hochschild (1983) work on emotional labour applied Marxist alienation theory in examining the harm brought by the commodification of human feelings. According to (Vilelas & Diogo, 2014), the development of the theme of emotional labour in nursing has given rise to numerous theoretical approaches and perspectives explaining this concept. However, as Bolton (2005a, p. 53) remarks, there is an ‘emotional labour bandwagon’ including studies of nurses. These have moved more towards feminist perspectives, yet away from the idea of commodification (Colley, 2006; Fineman, 2005; Lewis & Simpson, 2007). The 2015 study returns to Hochschild’s reading of Marx such that when workers emotions are commodified in the labour process, the experience is of something intrinsically alienating.

Method

Data presented in this article were collected (2013–2015) as part of a qualitative study. Qualitative research methods purport to be mainly derived from philosophical theories and firmly rooted in a narrative style of knowing (Davidsen, 2013; McLeod, 2011) allowing them to remain open to participants’ rich descriptions of their lived experiences.

Similarly to the 1979 study, one-to-one semi-structured interviews were carried out with people who are nurses, as this method of data collection aligned with the researchers’ phenomenological stance, considered to be influenced more by existentialism and psychoanalysis than humanism. Here there were set questions, where participants were then encouraged to expand further on their responses and share their own stories, ‘designed to encourage meaning-making by narrative recounting rather than the more categorical responses one obtains in standard interviews’ (Bruner, 1990, p. 123). There was no limit on the number of years’ experience or nursing specialities. Nurses who expressed interest were sent a consent form regarding confidentiality and the right to withdraw from the research.

A total of nine participants were interviewed individually and the recorded interviews were later transcribed verbatim to produce the anonymised data for analysis. A sample of this size is considered to be valid within a narrative methodology, due to the focus on rich descriptions of the lived experience of participants (Sandelowski, 2000).

Bruner’s (2004) qualitative method of narrative analysis was introduced to analyse the data in this study. In this process, themes were identified within each individual narrative. Subsequent readings were then carried out to identify themes across narratives, looking at the similarities and differences in each.

The final sample of nurses is summarised in the following Table 1 and all names used here are pseudonyms:

Table 1. The Sample of people who are nurses

Name	Job Title	Banding	Dept/ Speciality	Experience
Angela	Student nurse	Supernumerary	NA	1 year
Susan	Staff Nurse	Band 5	Neonatal	6 years
Maria	Clinical Team Leader	Band 6	Mental Health: Acute Admissions	10 years
Rita	Senior Staff Midwife	Band 6	Community	37 years
Anna	Practice development Midwife	Band 7	Maternity	13 years
Kate	Senior Sister, Registered General Nurse	Band 7	Neonatal	28 years
Patricia	Ward Manager	Band 7	Mental Health/psychiatric	13 years
Francis	Clinical Nurse Specialist	Band 7	Oncology	18 years
Bianca	Matron / Senior Clinical Nurse	Band 8a	Mental Health/psychiatric	20 years

Findings

Four non-mutually exclusive themes were identified across the narratives, where involvement in work: (1) enables escaping from personal problems (escape motivation), (2) is for satisfaction from the work itself (other intrinsic rewards), (3) is in order to earn money (extrinsic rewards), (4) can be detrimental. These themes are presented below in a descriptive form, consistent with Bruner’s (2004) approach.

1) Where involvement in work enables escaping from personal problems (escape motivation)

The theme of becoming more involved in work to escape personal problems was found in the narratives of five participants.

Kate was a mum of three young children, but had felt the need to go back to work soon after her first child was born:

As much as I love my children … I’d gone straight from school to nursing … being qualified, working full time and then suddenly I’m at home with a child … There’s only so much cleaning and shopping and going out you can do.

Her work as a nurse offered her respite outside of the family home; an escape from what she saw as the boredom and monotony of childcare[?].

The construction of work as being a welcome respite from the difficulties of one’s personal life was echoed by Bianca and Susan. Bianca spoke about an unhappy period that she went through in her relationship with her partner. Additionally, around that turbulent time, her father had passed away. Not only was she coming to terms with his death, but she felt her relationship had become ‘mundane, monotonous, repetitive’. She reflected on how she had thrown herself into her work, moving out of her family home and in with her mum and she found herself doing as much over-time as possible. She was unclear in herself whether it had been a ‘conscious or unconscious thing’, but clearly remembered that her involvement in taking on additional work and extra shifts was rewarded by the hospital, consolidating a promotion by her being ‘ever-present and available’. Bianca had escaped the turbulence of her personal life by working extra hours, but she constructed her work involvement as something positive because she was rewarded by the hospital she worked at and given a promotion.

For Susan too, not only working, but also training as a nurse had provided an escape from an unhappy relationship. She had decided at age 33 to leave her husband, which seemed to have prompted the start of her nurse training in what she called a ‘knock-on effect’.

Temporally, the focus on her involvement in her training and the logistics of it, seemed to take her mind off thinking about leaving her husband at that time in her life. In reflecting back on the events of her past during her interview, perhaps the reality of the situation becomes more obvious to Susan, and she justified her actions by saying:

the closer I get to forty the more I realise actually, I’ve done half my life now … you need to be living your life the way that you want to … I’m getting everything I need to from work, which is good … it’s lucky …

The resolution to her narrative is not that she reconciled with her husband, but rather that she is now in control of her life, living her life out the way she wants to.

For Kate, Bianca and Susan, involvement in work as a nurse offers a way for them to escape unpleasant situations or thoughts, most notably those in their personal lives, but in each case this is constructed as something positive.

Some participants like Francis, however, feel that involvement with work has led to something more negative arising. Francis, a lymphoma Clinical Nurse Specialist, talked about the painful time in her life when her mum was terminally ill. Before her mum died, Francis found herself becoming ‘really involved’ emotionally with a male patient she was caring for. She allowed herself to not only spend more time with him than was required and get to know him personally, but was also introduced to his wife, twin daughters and his parents and said, ‘I just got so wrapped up in that case’. The implications of this emotional involvement resulted in a situation that was overwhelming and untenable, with Francis suffering from what she called ‘complete burnout’ at work, where she found it impossible to do her job.

Maria spoke in her interview about the death of her maternal grandmother, to whom she was extremely close. Following her death, she carried on working, but ‘took some annual leave days and dotted them in’. It is unclear why she felt she had to use up her own annual leave and not take compassionate leave, but when she had time off at home by herself, she seemed to be conflicted with different emotions, saying: ‘I felt like I tortured myself for 3 days because I wanted to be at work … I didn’t want to let them down’. Paradoxically, Maria said that when she returned to work, she had felt constantly anxious and unable to concentrate on tasks fully. There still seemed to be a pull towards being involved with work, as a way to escape from dealing with her grandmother’s death, yet this involvement meant that she had not been able to grieve as she had intended.

2) Where involvement in work is for satisfaction from the work itself (other intrinsic rewards)

The participant nurses spoke about being rewarded for doing their work in ways that were not necessarily a financial or monetary gain. The narrative of feeling satisfaction from their jobs and the work that they did as nurses was spoken about by six participants.

Anna, Susan and Bianca all exclaimed at some point in their interviews ‘I love my job’. It seemed a reward to be able to say this about one’s job and that perhaps not all other people and other professions might not feel this way about working. Susan believed that ‘if you have to work, you should do something that you love’. She said that because she ‘loved’ her job as a nurse a lot, she felt ‘lucky and happy’ a lot of the time. Bianca said ‘70% of the time I love my job’ and for her this was compensation enough to ‘get [her] through’ the other 30% of the time when she ‘hated’ it.

For some, a feeling of enjoyment of the work itself was a reward. Anna said ‘I thought … if I’ve got to work for financial reasons it would be really great to do a job that I could really get my teeth into and enjoy’. Maria felt that if she had to work to survive, she did not just want ‘any old job’, and saw nursing as a job that she was ‘going to enjoy … going to get something back from’. Patricia also talked about ‘enjoying’ her work as a nurse because she felt like she was doing work for a living ‘that gives back to others’.

Working as a nurse appeared to evoke other feelings in participants such as feeling fulfilled in one’s life. Susan said:

‘I feel fulfilled by my job, I feel like I work in an environment where I’m really fortunate which is really uncommon in the NHS, but I go home every single day knowing I’ve done my job well’.

This sentiment was echoed by Bianca who spoke of work as providing ‘fun … fulfilling … and challenging experiences’.

For others there was a narrative where working as a nurse provided a sense of purpose, and according to Angela, ‘and something to get up for in the mornings’. Participants constructed meaning around ‘progression’ in their work and working towards something, as summarised by Maria: ‘Working as a nurse gives me a purpose, it gives me … goals, it gives me something to work towards which is really important to me … ’

Rita was the only participant who spoke about work as being a ‘calling’ for her. She elaborated on this saying ‘they used to talk about the word “vocation” which has a sense of “calling” to me, although I’m not sure the word vocation is fashionable any more’. Rita discussed her spiritual involvement in her work many times during the interview, reflecting a narrative of Christian values:

I have a faith in a loving God and that is very important to me and colours … my life … my life and my faith are very intertwined and therefore my job is very intertwined …

While feelings of love, enjoyment and fulfilment seemed to evolve from participant’s emotional involvement in their work, Bianca and Patricia also described an intellectual involvement. Bianca valued working as a nurse for ‘pushing me, stretching me … making me think in different, wider ways’. She wanted to be challenged intellectually by the work that she did. Similarly, Patricia felt that she was a person who became bored quite easily and that ‘intellectually … nursing keeps [her] interested’.

3) Where involvement in work is in order to earn money (extrinsic rewards)

Earning money was referred to by seven participants, though it varied in its importance between them. For Susan, Bianca, Kate, Anna and Patricia, working is not considered optional as there were living expenses to be paid such as ‘bills’ (Bianca), ‘the mortgage’ (Kate), and ‘children to look after’ (Susan). Maria does not get into the specifics of what her wages were used for, but says ‘I have to work for money to live, to survive’.

For these participants, the financial need to work is a necessity to ensure continuation of the lives they lead. Some participants saw their basic wages as not being enough to fund the type of life they wanted. Susan said that she worked lots of extra shifts, both at the hospital and externally for an agency. It was not something that she wanted to have to do, ‘but it funds really good holidays and you know good stuff with the kids and they have everything they want’. Susan believed that she did not earn enough in her job. She felt that taking on extra work shifts created a stronger bond with her two children through the ‘good holidays’ and the ‘good stuff’ that the extra money allowed her to give them, yet paradoxically the more extra shifts she took on and the more involved she became with her work, the less time she has to spend with her children.

In contrast, Maria felt that, although a nurse’s salary ‘is not massive’, it was more than enough for her to be very comfortable in in terms of ‘materialistic things’ and she said, ‘it’s enabled me to have quite a comfortable, quite a secure life … which is definitely valuable to me’.

Francis and Rita were not primarily motivated to work for financial reasons. Francis felt that she earned a minimal salary and joked ‘if I was in this for the money I wouldn’t be a nurse specialist!’ For her, there were no extrinsic rewards gained from her work, but value is placed solely in what she perceived to be a job than enabled her to ‘help others’, and that made her feel good about herself. Rita was approaching retirement age and said that she did not have to work for money, because she could just retire and claim her pension, yet she hastily added ‘but I’m not ready to yet!’ Her involvement in her work as a nurse took up such a big space in her life, she felt unclear what she would do without it.

Angela, a student nurse in her third year working in a hospital placement, did not receive a monthly wage. Like all student nurses then she received a bursary, which she felt ‘actually doesn’t even cover rent and bills’.

4) Where involvement in work can be detrimental

The theme regarding the detrimental effects of involvement at work was found in the narratives of seven participants. For Bianca, Anna and Kate, the day’s events at the hospital could directly have an impact on their families when they arrived home from work. Bianca felt that her husband was able to tell immediately what type of day she’d had by her mood and mannerisms:

‘ … so I’ll come home from work and I’ll be all chatty and jibber-jabbery and he’ll go: “you’ve had a good day at work haven’t you?” Whereas it will be: “you’ve had a bad day today, you’ve been in meetings” because I’m all like grrrr [grimaces]’.

Similarly, Kate said that, although she tried very hard not to ‘bring work home with her’, she also felt various family members could tell if she’d had a ‘bad day’, especially if she was ‘a bit quieter’ than usual.

Kate did not elaborate what exactly constituted a ‘bad day’ at work, but for Anna, it was the ‘sad events’ at work had the potential to spill over into home life. She felt that on the maternity ward events could happen that were ‘really difficult to think about or cope with’ and that it would be impossible to turn those thoughts and feelings off. She said: ‘sometimes can’t not take those feelings home … that’s the difficult part’. Events at work also occupied her mind at night and disrupted her sleep, particularly after very busy days. On such days, she said that sometimes she would wake up in the middle of the night, realising that she had forgotten to do something. In such cases she would get out of bed and phone the hospital. She justified her actions, saying: ‘If I don’t phone, I wouldn’t be able to sleep because I’d just worry … and although it’s usually something very minor, where they just go “yeah it’s fine”, I just have to say it to someone’.

For Patricia, it was the shift pattern of the work that had the perceived detrimental effect of her being tired and less present at home. She spoke of her struggle with the negative impact of shift work and how she felt that she missed out on much of family life because of ‘doing shifts and nights’.

Maria also felt that her work as a nurse still had a great impact on her life outside of working hours. Her narrative was constructed around her social life and the way she was perceived by others in public, and she stated several times in her interview that nursing ‘is not just a job it’s a career’. She spoke about valuing professionalism, and to her this meant that even if you were not working ‘you are always a nurse’ and she believed that the expected code of conduct for a nurse included that nurse’s ‘behaviour at home, on Facebook, in the pub … ’. For her the consequences of not adhering to such codes would have a lasting detrimental effect on her career, yet it also seemed to imply that she could never fully disengage from being involved in work.

As reported in an earlier theme, ‘escape motivation’, Francis had spoken at length about a time when she had become really close to a dying patient. She felt that she ‘couldn’t get him out of [her] mind’ no matter where she was. She found herself worrying about him when she was at home with her family and would contact his sister after-hours, yet she felt her response was justified and a very ‘human’ one:

there’s a side of me that thinks how can I not go home and be thinking about a 22 year old dying of cancer? How can I really, as a person, a human that does the job I do, NOT think about him?

Susan, unlike the other participants, stated that she felt able to ‘leave work at work’ and did not see that involvement had an impact on her home life either in a positive or negative way. She attributed this to her being used to the shift patterns of nursing, as her mum was a nurse. Yet when it came to working shifts, Susan said that she much preferred to work fewer shifts for longer hours, rather than more frequent shorter shifts:

I would rather work three mind numbingly long days than work five short days, especially with kids … I’m more present at home when I’ve got those good long days off rather than they see me tired every evening

It became apparent that there would be detrimental effects in either scenario; that if she chose the longer shifts she would experience them as ‘mind numbingly long’ but get to spend more time with her children, or if she chose shorter shifts, she would spend less time with her children and feel ‘tired every evening’.

Discussion: Comparison of 1970 and 2015 studies with former and subsequent literature reviews

Whilst it is recognised that both were small sample studies and further research is required, it was considered useful to compare their findings in the context of prior and subsequent the literature reviews.

In the current study where there was concern expressed when emotions became too much, Susan spoke about those situations on the neo-natal ward when the prognosis was poor:

It’s giving enough of yourself without giving all of yourself … you don’t want to be best friends with everybody that you meet … you compartmentalise … I remember so much from the beginning and then the last couple of years are a bit hazy because you just come and detach …

Here, Susan uses the term ‘compartmentalise’ and there is also a sense that perhaps the need for involvement with patients decreases the longer participants work in their roles. This need to compartmentalise and switch off was raised by other interviewees. For example, Maria (an acute admissions mental health nurse) described her reluctance to ‘get too close to’ her patients, because she felt that a consequence might be that it puts her in the firing line to potentially be abused. This process of compartmentalising involvements reinforces the 1979 study where using Weber’s ideal types (Weber, 1930) some people who were nurses were seen to end up spending most of their time around a compartmentalised turning point of their involvement cycle.

It was concluded that, in the 1979 study concerning involvement in work monetary and other considerations are more than outweighed by the individual‘s escape motivation. Such behaviour, which is encouraged both by the organisation and by the individual‘s need to maintain reduced awareness of her lack of integration, is most pervasive for the compartmentalised individual, and it is this compartmentalised type that the majority of nurses are inclined towards. However, in the 2015 study whilst finding ‘escape motivation’ a significant factor it did not appear to be the dominant one, with more clear accounts when seven of the nine participants spoke of the detrimental effects on their home life as opposed to five who directly spoke of work helping them escape from their personal problems. It was also found that when using the concept of ‘emotional labour’ involvement can have some perceived beneficial as well as detrimental consequences. Again the 2015 study appeared to support the findings of the 1979 study that there was a ‘psyching out’ (Davis, 1975) over time (xxxx, 2002). For example in the 2015 study, where the student nurse, Angela, reported:

‘I was helping out my tutor … and he was interviewing first year student nurses and then second year and third year and he said that there were huge differences between [them] … in the first year you’re full of ideas and by the third year a lot of us feel quite burnt-out already, before we’ve even started’.

This reinforces Goffman’s (1968) account of the changing involvement cycle of the new student nurse.

Another contrast with the 1979 study concerned going into management. In the 2015 study, there seemed less attempt to rationalise the integration of the management role. Instead going into management was regarded as more personally detrimental, as in the case of Bianca who said her partner could tell if she’d been in meetings all day by her bad mood. There was a strong tendency that going into management was a way of earning more money through promotion though it was better if this could be resisted. It is as if management is deliberately compartmentalised, as it is not really believed in, substantiating Bolton’s (2005b) work on nurse managers, but rather a necessity to go along with it in order to keep employment or increase salary (rather than, for example, an interest in the management of healthcare). It is this compartmentalised place, in which if individuals are involved for too long can, according to the 1979 study, detrimentally reduce their own agency (xxxx 2002).

Conclusion

The current research suggests the following narrative themes where involvement in work: (1) enables escaping from personal problems (escape motivation), (2) is for satisfaction from the work itself (other intrinsic rewards), (3) is in order to earn money (extrinsic rewards), (4) can be detrimental.

These themes are not considered to be mutually exclusive. Additionally, themes (1), (2) and (3) are to do with the motivation to go to work, whereas theme (4) has to do with the consequences, or effects, that work has on these people who are nurses.

An important distinction between the 1979 and 2015 study was that escape motivation was found in the 1979 study as being the predominant motivation for getting involved in work, whereas in the 2015 study it was found to be significant but not a dominant theme. This may be due to the changes in our society in those 40 years or it may be due to the research methods in the 1979 study being more able to ascertain this through measures which were not dependent on narrative analysis.

Thus whilst escape motivation, where individuals are motivated to escape from their selves into work, was not as prevalent in the 2015 study when compared with the 1979 study, it nevertheless suggests that it is significant and is an important omission in the existing literature. Furthermore, the 2015 research continues to echo this alienating aspect of the work. The participants not only ‘psych out’ (Davis, 1975) because of the nature of their work (for example carrying out shift work or being caught up with a dying patient), but they also ‘psych out’ to forget their personal problems. There is a pull from the organisation and the push from individuals (they also want to escape things in their own lives) which may be beneficial or detrimental through involvement/engagement in work. What is postulated is that if that situation is sustained then individuals will not come to their senses and will lose the ability to make the right decisions for themselves. They are not able to allow thoughts to come to them because they are ‘drugged’ by work – there is a continuous involvement in work from which it becomes difficult to get unentangled (A change cycle is envisaged following Goffman (1968) and Hegel’s (1977) where through involvements an individual moves from being embodied to increasingly disembodied/compartmentalised). An individual’s abilities to be involved in a way that is not overall detrimental could also be considered in terms of an individual’s ‘involvement capacity’.

A further re-evaluation is also suggested of such notions as ‘work-life balance’ again from an individual perspective on involvement. It would also be of interest to study the involvement processes of managers and in particular new public managers (Barzelay, 2001; Gruening, 2001) where the involvements and motivations for them might be different to those nurse managers here. Instead managers might be seen as part of a hierarchy where they are both involved, and attempt to involve others, with potential emotional consequences for their own and others’ lives.

The change in the dictionary definition of ‘involvement’ since the late 1960s demonstrates how difficult it is to maintain an individual perspective and use ordinary language that does not get redefined by organisational perspectives. The organisational and management literature predominates in a way that attempts to maximise the individual’s contribution to the organisation. With such perspectives there is little lasting room for an individual one. The study reinforces the position that whilst work can always be seen as alienative, contradicting Etzioni’s (1975) notion that moral involvement is an alternative to alienative involvement, it can nevertheless have different detrimental and beneficial consequences for the individual, one of which is to escape personal problems. Whilst these findings primarily reinforce the larger 1979 study, they nevertheless only arise from a small qualitative study and any claims are at best tentative and must be subject to larger scale research using various methods. Other suggested areas for research include consideration also to be given to a notion of an individual’s ‘involvement capacity’ and the extent to which the pattern of escape together with intrinsic and extrinsic rewards might also be similar for what are regarded as romantic involvements. The implications of this research on involvement might also be compared to the similarities and differences of Bowlby’s (1969) attachment theory, where an individual would be able to assess for themselves both the beneficial and detrimental consequences of an involvement in their own terms, and not according to the needs of the organisation.

Further research is now required in order to consider the relevance of such involvement theory and associated concepts for the psychological therapies. This could include concepts such as ‘involvement capacity’, ‘escape motivation’ and other involvement typologies, potentially to assist clients not only with regard to the effects on their overall lives of work involvements but their involvements in general, including personal.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Notes on contributors

Del Loewenthal

Del Loewenthal is Emeritus Professor of Psychotherapy and Counselling at the University of Roehampton and is Chair of the Southern Association for Psychotherapy and Counselling (SAFPAC), London, UK. He is an existential-analytic psychotherapist, and chartered psychologist, with a particular interest in phenomenology. His books include Existential Psychotherapy and Counselling after Postmodernism (Routledge 2017). www.delloewenthal.com; www.safpac.co.uk.

Catherine Altson

Catherine Altson is a BACP Accredited counsellor, currently working in private practice and as an awarding organisation Counselling Qualifications Professional. She holds a Master’s degree in Counselling and Psychotherapy from the University of Roehampton and her main research interests revolve around the nature of relational psychotherapeutic work and the ways in which counsellors’ and psychotherapists’ lives are influenced by their clinical practice.