'You get used to it': Working with trauma in a burns unit of a South African children's hospital

I report here on the first stages of my work as a consultant clinical psychologist in a burns unit of a South African children's hospital. I show how the enormous trauma of the work leads inevitably to the adoption of defences on the part of staff against the pain and load of their work. I use the writing of Menzies Lyth and other authors as a basis for understanding staff defences in their daily work. I then describe the process whereby it has become possible to institute a form of group support for the staff. It has been important to think not only of the maladaptive but also of the helpful function of defences, and to recognize the staff's need for continuity and acceptance on the part of the consultant.