Identifying meaning by Pippa Gough

It is wonderful to welcome our guest blogger Pippa Gough to share her thoughts about finding meaning in what we do. Meaning is a cornerstone of salutogenic theories, and is arguably the most important factor in sustaining resilience and wellbeing. If you can truly find the meaning in your life experiences then these experiences offer the opportunity for transformational change. Pippa speaks from the heart and I am certain you will find both Pippa and her words inspirational.

Pippa is a qualified nurse, midwife and health visitor by background. She has held a number of senior nursing positions, including that of Director of Policy at the Royal College of Nursing before joining the Kings Fund as a member of Senior Faculty in 2001. Pippa has 15 years experience of providing consultancy in organisational and leadership development, coaching, and policy research (mostly on health labour market), initially whilst at the Kings Fund, then at the Health Foundation where she designed and commissioned the successful Generation Q programme. She has run her own consultancy business since 2011. 

Pippa and colleagues are running the Spring Leadership Retreat in May in Andalucía.  Details here:



Pippa Gough

As an executive coach, I am frequently asked to help people address challenges in their work, namely issues of stress, work/life balance, and difficult or dysfunctional relationships.  After initial discussion, my response is often to raise questions about meaningfulness: what does the job mean to them; how does it align to their values and beliefs – and what are these; what are their motivations and drivers; how are they enabled to express and fulfil these?  My reasoning for taking the conversation in this direction is simple; if you’re spending an enormous amount of time and energy doing something that doesn’t actually have any meaning, then what’s the point?  Working in our health and social care services, or third sector, is a tough job. Sometimes people are working so hard they’ve lost sight of what they are good at, why they are doing what they do, and how they could do things differently and better – if only they could stop for a moment and think.

Both my parents had dementia.  It was a hard ten years watching first Dad, then Mum, change from being intelligent, sociable, capable people to a couple wrought by increasing disorientation, isolation and frank fear.  I was lucky, though – they only developed the disease in their mid 80s and the sands of time had almost run through.  They had enjoyed, before this, a brilliantly vibrant, fierce and wonderful life together.  That they loved and cared for each other, and me and my sisters, was beyond doubt.  I was fortunate to grow up in an environment that placed value on the need to support and care for others in order to be happy.

Although I was born in England, I grew up in Africa.  Dad had been in the air force, seeing active service during the Suez crisis, and on reaching forty decided to take his pension and step back into civilian (less stressful) life.  Being tired of post-war austerity in Britain, he convinced Mum that they should take their young family (I was five) and seek a new and more exciting life, in Africa.  My childhood became one of bright blue skies, hot sun, red dust, bare feet and wide open spaces.  We moved through Zambia, Zimbabwe, Swaziland, South Africa and finally Botswana.  My parents were intrepid, adventurous, and kind.  We conjured up life out of uncertainty every day. 

I trained as a nurse in Cape Town and came back to England alone when I was twenty.  I didn’t know then that my subsequent career within nursing was equipping me ultimately to walk more ably alongside my parents during their long and difficult journey ahead.  Nursing provided me with the knowledge, skills and behaviours that allowed me to care for others – and now for my parents.  As anyone who has experienced it, this is an enormously difficult, stressful and emotional task.  My resilience and survival, I now realise, derived from the meaningfulness of what I felt was rightly ‘my job’.  I had a finite time to care for and be with Mum and Dad, and I only had one shot at it.

Their situation grew increasingly unstable and unpredictable.  Finally, Dad went into care and he died a year later at the age of 92. Mum followed him into the same nursing home and died within nine months at the age of 90.  My feelings of grief at their loss were overwhelming; but there was relief as well.  

Whilst Mum and Dad received ‘good enough’ care, I observed the difficulty some of the carers had with finding meaning in their task of caring for, and loving, people who ultimately were never going to go home.  I often saw defensiveness against becoming ‘too involved’ – because of the resultant grief when a resident died.  The trade-off between emotional involvement and self-preservation often made the job of caring overwhelmingly unrewarding.  Why put your arms around a confused resident who was weeping for his mum if it was easier to shut him in his room and distract him with the TV? Compounding this was a lack of support and training to enable carers to feel confident in the care that they were giving.  Mostly they felt deskilled and frustrated.  This situation was precisely as Isabel Menzies described in her groundbreaking research into ‘the functioning of social systems as a defence against anxiety’[1] – a case study examining how nurses developed an approach to task orientation that allowed them to de-humanise their patients in order to cope with the distress of the patient condition.  Sitting at my mother’s bedside as she was dying, I found myself pondering on what it would take to allow carers to immerse themselves emotionally and fully in the difficult, distressing and messy work of care.  The answer I feel is not complicated – but neither is it simple.  It has two parts: to allow the space for carers to talk about their experiences and identify how these connect to their values and ultimately align to their actions; and secondly to provide carers with the skills, ability, support and resources necessary to imbue them with the confidence to manage events and take care of things within their designated sphere of control.   Both of these things would surely lessen the anxiety that often robs us of compassion.   

Pippa Gough, Coach and Leadership Development Consultant

Menzies, Isabel (1960) ‘A Case Study in the Functioning of Social Systems as a Defence against Anxiety: A Report on a Study of the Nursing Service in a General Hospital’, in Human Relations (1960; 13; 95).   The online version of this article can be found at   Accessed on 25 Jan 2019