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The Girl Who Couldn't Help It
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Perhaps the recent interest in applying chaos theory to human affairs attests that organizational life is becoming chaotic. In terms of Miller and Rice's (1975) approach to organizational structure and dynamics, the "primary task" of many organizations has shifted from accustomed, definitive activities -- e.g. provision of medical care; publishing of metropolitan newspapers; manufacture and marketing of tobacco products -- to bolstering of the organizational capacity to withstand continuous change, while maintaining some identity and self-recognition. Survival may now entail the capacity of an organization to relinquish substructures of activities and/or individuals -- the capacity for radical disidentification. The "primary task" seems to be transition, adaptation to change, no matter what business you're in. From the Tavistock group relations perspective, the emergence of unconscious group-level processes coincides with the obscuration of anchors of conscious identification and self-recognition. Thus in the "temporary institution", devoid of context apart from self-study, primary ontogenic processes come to the surface . From an ecological perspective, this might be seen as a pathogenic process -- the organization or institution isolated from it's environmental context metabolizes itself in a closed loop of self-consumption. See concluding section. To analogize on an individual level, with a threat to one's contextual survival comes involuntary awareness of basic life-supporting processes -- heartbeat, breathing, etc. A primary example of an industry faced with the loss of its socioecological context exists in the field of mental health. Curtailment or elimination of mental health benefits has occurred to the point where clinical care is no longer easily available to the middle and working classes. Hospital administrators cite the unwillingness of major healthplan payers to accept such expenses; "managed-care" is to them simply the disappearance of what they term "the social transfer payment" - i.e. large payers, healthplans and insurers providing funds over and above actual costs via acceptably-inflated hospital and medical billing. This disappearance is experienced by many mental health clinicians as a decreasing opportunity to work. During the past few years, clinics and training sites in California have diminished to the point where the California Psychological Association (CPA), not historically the most radically innovative of organizations, has assigned a task force to deal with the difficulty of licensure. Along with withdrawal of interest in social service provision has come an unprecedented increase in prison population. Prison growth projections in California are at 60% over the next five years, in a system that from 1983 to 1996 grew from 35,000 inmates to around 135,000 Source: San Francisco Focus Magazine, November, 1995 A study by the Rand Corporation estimates that
with enforcement of "three strikes" legislation, the California
Dept. of Corrections' slice of the state's operating budget will grow
from 6% to 18% by 2002. The mood accompanying this growth can be fathomed
in a comment made by Steve Forbes, the recent American presidential
candidate. When a reporter mentioned the severe overcrowding of prisons
concurrent with the move toward harsher sentencing laws, he responded,
"so what?". In an essay for PBS, Anne Taylor Fleming noted
the inversion of California educational and punitive priorities as reflected
by increases in prison construction replacing previous efforts at construction
of the state university system, which has seen repeated drastic cuts
and deprioritization. This 40 year old student-trainee, whom we'll call Sharon, had enrolled at the Graduate Academy of Psychology (GAP), a 175 student, psychodynamically-oriented clinical graduate program in operation since the 1960's, located a few blocks from the state university campus. The previous year, she'd enrolled in a comparable, even competitive program at Western Institute of Psychology Studies (WIPS), later withdrawing. Once enrolled in GAP's program, she was assigned to a newly-implemented collaborative practicum program developed with the Municipal Mental Health Department (MMHD). Her position there was as a trainee with the Emergency Crisis Response Team (ECRT), a mobile unit responding to radio-dispatched calls from the police department for assistance with crisis situations: suicide threats (or completions); decompensations requiring hospitalization; dispute resolution, welfare checks, services for crime victims and the bereaved, et al. -- an unusual mix for a practicum site. The work included case conferences and supervision, attending police squad meetings and riding in a city car with a field supervisor for a weekly 6-7 hour shift, responding to any number of emergencies. The trainees learned radio codes, relevant laws surrounding involuntary commitment and child protective custody. In essence, the training experience was one of functioning at the boundary of care and control, between mental health and law enforcement agencies. Although interns had served as trainees for years (including myself), this jointly-sponsored MMHD/GAP "collaborative practicum" for first year students was in its inception, as was the GAP Psy.D. clinical program. Since the 1960's, the school's Ph.D. had been accredited by both the state and more recently, the American Psychological Association (APA). However, GAP had been confronted with a stiffening of requirements by the accrediting agencies for the continued right to offer an accredited Ph.D.. This challenge was understood by GAP's administration as reflecting the efforts of "academic" psychology to constrain the growth of practice-oriented clinicians within the Ph.D. entitlement. The new demands of the state accrediting agency involved radically-increased research facilities, lowered student-teacher ratios, and reorientation to a more academic, less practice-based conception of psychology. Instead of attempting an accommodation beyond its inclinations and resources, the school changed its "product" to a Psy.D., conceived as a more professional, less academic degree. This change, occurring at freestanding schools around the country, was understood by the school's community as evidence of the separation within psychology of the orientation toward professional, clinical practice from the scientific, research-oriented, quantitative approach pursued at most universities, including the state system. Also, it involved a loss of previously-awarded accreditation: the APA refused to review the new program until it had actually produced graduates. Sharon was among the new first year "Psy.D." students; the upper class students continued with their APA-accredited Ph.D.'s. Sharon remained in the program less than three months. While initially she had impressed people at both the school and the practicum site, her situation deteriorated almost immediately. She frequently missed her ECRT shifts, and demanded impossible scheduling changes and accommodations. She was seen as not only incapable and indifferent, but at times downright deceitful in her fabrication of alibis and extenuating circumstances. During her short stay, people at both locations became infuriated with her, citing her overall conduct as intolerable. Her brief tenure also occasioned considerable conflict among those around her. For instance, within GAP itself, the administration was committed to its newly-articulated "learning alliance" model of education, characterized by the development of a collaborative, empathic relationship between student and teacher, set within a "transitional space" for learning. However, Sharon's case-conference leader was oriented toward a more traditional academic structure, one including censure and discipline when necessary for non-completion of assignments. After a sequence of increasingly vitriolic interactions, Sharon just disappeared -- to the frank relief of those who had dealt with her. She left no forwarding address or phone number save a pager, to which she did not respond. The school administration considered filing a missing persons report, until finally their registered notification to her of her termination was reported delivered. It was generally agreed that her admission to either program had been a mistake, and that she was psychologically unequipped to participate in such activities. This essay examines her brief involvement with these two agencies -- the graduate school and the emergency crisis response team -- with an eye toward the larger context of her unfortunate tenure. Based upon semistructured interviews with those who had worked with her, and upon my own process notes as her ECRT field supervisor, it considers some of the interpersonal and intergroup psychodynamics of this event: projective identificatory processes, scapegoating, splitting, assumption group functioning, and other defenses characteristic of individuals and organizations under severe stress. Finally, in the spirit of constructivist, post-modernist case study analysis, and/or Monday morning quarterbacking, it seeks a more cogent, emotionally resonant meaning to this event than, "Well, the girl couldn't help it". Our question is whether anyone could -- or whether the problematic attempt of this 40 year old woman to find a place for herself as a psychologist was itself overwhelmed by conflicts reflecting broadbased conscious and unconscious dynamic shifts in the conception of such phenomena as mental health, education, law enforcement and social responsibility. The question is how such global variables as "remediation versus punishment", ecological interdependence versus 'survival of the fittest', diversity versus purity, et al. manifest even in a situation involving a distracted yet seemingly capable graduate student who, in the words of a case conference leader, "never could get her act together". Admission to GAP In one of their own contributions to the unconscious at work, entitled, Troublesome Individuals and Troubled Institutions, Obholzer and Roberts (1994) describe institutional difficulties attributed to individuals via projective identificatory processes. The unconscious subtext the authors portray is "It is he, not we who are breaking down". They provide a subtext for an employment advertisement: "Wanted: volunteer required to voice the difficult, disowned, anti-task elements of the staff. Both internal and external candidates are welcome, but only candidates with suitably difficult personalities should apply". Sharon had applied to GAP two years prior to the year in which the Psy.D. was inaugurated, and had not been accepted. Later she'd been admitted to a comparable graduate program -- in fact, one which already had the Psy.D. in place. Arthur, the man who interviewed her for GAP admission the second time, had found her acceptable; he couldn't recall why she left the WIPS program, though he characterized GAP's ambiance as more "family-like" and "closer" than that of WIPS, a larger, multisite institution. Thus he construed her desire to change as congruent with "what he knew to be true" about the two institutions. Arthur recalled that he had been more impressed with her having participated in the other school's program than concerned by her wish to leave it. Admitting that his memory of the interview with Sharon was hazy, he did recall that she identified herself as a Latina who'd been abused as a child and young woman -- factors which she had said drew her to clinical work. Also, she mentioned being in the process of a divorce, with which she felt she was coping adequately. Perhaps the "employment advertisement" which Obholzer and Roberts subtextualize may be adaptable to an ad for students: "Wanted: graduate student required to voice the difficult, disowned, anti-task elements of the staff, during a time of unprecedented turmoil occasioned by a complete program revision and temporary loss of accreditation. Will also perform similar function for municipal mental health emergency crisis team itself undergoing similar revisioning, with whom school is initiating a collaborative relationship. Both internal and external candidates are welcome, but only candidates with suitably difficult personalities should apply". While the influence of such an "advertisement" is hypothetical, circumstances surrounding Sharon's admissions interview are noteworthy. One is the evaluative turnaround. Another is that Arthur, Sharon's admissions interviewer, was also the consultant for launching the new "First Year Collaborative Program" with MMHD. Also, he both worked for the school and coordinated a consortium of graduate programs of which the school was a member . He was himself both a student at the school, completing his Ph.D., and a faculty member -- the only one (apart from teaching assistants) still pursuing a degree. During our interview, he speculated about Sharon's unconsciously-enacted outcry for help in finding herself -- a sensible interpretation of her disappearance. Her unpredictable limit-testing, demands and absences were certainly readable as "guess where I am today..." (an exasperating proposition for those who worked with her). Still, what of Arthur's own "location", and the overlapping institutional boundaries within his role? Interestingly, he couldn't remember the details of his interview with Sharon, although he had been quite aware of her subsequent difficulties, and expressed some chagrin at having been the one to accept her. Frequently he had to resort to his files to see what he'd noted. It was as if facets of himself had become scattered in the multiplicity of functions he'd assumed -- and had to be stored externally in appropriate files. At this point, we might posit a want-ad for his position. Of note are the links between Sharon and Arthur, her admissions interviewer. Perhaps Arthur "selected" Sharon to contain states of confusion and disorientation, the stress reactions of a graduate school (and an admissions interviewer) dealing with deep structural transition verging on disintegration. Lucy Luchtman, GAP's Dean, added that there had been some further doubt as to Sharon's acceptability, with the final decision prompted by a wish to move forward from the admissions process rather than by an arrival at a sense of resolution concerning her fit. Also, Dr. Luchtman noted that given the cancellation of the APA review for the new program, a number of chosen candidates would not accept matriculation. Therefore, the school extended more acceptances than it could actually handle -- it overbooked, so to speak. Sharon's acceptance was within the context of that overbooking. Of note is that whereas Arthur had felt responsible for admitting her, actually, the process itself had been overseen at a higher level -- albeit somewhat anonymously. Assignment to the Collaborative Practicum One new feature of GAP's "collaborative" practicum program was the school's assignment of an admitted student to the field placement site. Prior to this year, entering students found their own practicum, an increasingly daunting task as training sites faced loss of funding and closure. Now, the school's "collaborative practicum" locked in a number of placements for the entering class, without the necessity or (assumed) anxiety of students "beating the bushes". However, another factor, significant for Sharon, was the student's more passive acceptance of the conditions of the placement. While a student might refuse a placement (or a site might refuse a particular student), the operating assumption was that a student selected for the collaborative practicum program would participate at the site chosen by the school. Sharon was selected by the school for participation with ECRT; based somewhat upon her prior experience, but primarily on the logistical need of filling placements. Several coincidental sets of circumstances accompanied Sharon's inclusion into ECRT. As a prospective trainee, she was to be interviewed by the ECRT staff, as were the two other trainees sent from GAP. However, citing a scheduling problem, she missed her meeting. Since under the new program these interviews were basically informational rather than screening, Sharon's absence was not given much thought. Instead, Dr. Suzanne Behrens, the MMHD Training Director also on the ECRT staff, who had negotiated the collaborative practicum with GAP, agreed to do a one-on-one interview. In accepting interns, ECRT was typically much more selective. ECRT work is stressful -- a typical training experience includes a number of "dbf's" (dead body found); attempted or completed suicides, frequent involuntary commitments, cases of child or elder abuse, unsanitary living conditions and the like. Prospective trainees were screened with care to ascertain their inclination and capacity to handle such encounters. However, with the collaborative program, ECRT put much more weight on GAP's recommendation, as applicants were specifically chosen by the school. The other two trainees seemed quite capable and motivated -- one candidate actually had a masters degree from an Ivy League social work program, with considerable field experience. Also, Suzanne Behrens considered GAP students as being "of a certain caliber" -- perhaps not taking into account the change in degree objectives which pertained to this particular entering class. Thus, Dr. Behrens did not conceive her interview with Sharon as a selection interview as much as a confirmation meeting, an occasion for introductions, questions, etc. Actually, neither the school nor the placement site had given Sharon the screening typically accompanying such placements. So to speak, she slipped in through the cracks. Sharon had been accepted into GAP under the impetus toward softening the traditional requirements, examinations, evaluations, etc. of the Ph.D. program. The focus was now upon working collaboratively, rather than within traditional hierarchical roles. In contrast, the field placement site, ECRT, interacted with a police culture -- rank, status, etc. figured prominently in identity and role performance. Within the ECRT/Police Dept. interaction, assumptions regarding the scope of services provided ranged from treatment to isolation and confinement. As Sharon's handling of her participation began to unravel, regard for her performance ranged from "she's acting out unconscious processes" to "she's breaking every rule we have" -- i.e. "empathy vs. containment", the spectrum of responses to unfortunate souls with whom ECRT often came in contact. Certainly these ongoing alternatives involving mental health vis a vis law enforcement pre-existed Sharon's arrival on the scene. Cast of Characters The collaborative plan was for field supervision, case conference participation and evaluation from within ECRT, as well as individual and case conference supervision from the school. Thus there were parallel structures in the school and the field placement site, in contrast to the typical assumption by the field placement site of sole responsibility for such provisions. Having met with Sharon as discussed, Suzanne Behrens assigned her to a particular shift, to work with a particular field supervisor -- as it happened, myself. While I myself came from GAP, the primary criterion was that my established shift was Sunday day (10:30 am-4 pm), one of the times for assignment to a first-year trainee. Along with Suzanne and myself, ECRT personnel included Allison Jones, an experienced ECRT clinician, as her case-conference leader; and Harold Yeng, the newly transferred Acting Director of ECRT, who had previously directed the Adult Outpatient Clinic at MMHD. GAP simultaneously assigned Sharon to a case conference and an individual supervisor. Mary Wesley was the individual supervisor; Sharon's case conference leader was Maria Garcia, the newest and youngest of the case conference leaders in the new practica. Several additional features distinguished Maria vis a vis the other leaders: one, she was pregnant and would be going on maternity leave during the term. Also, she was married to a psychologist who worked at the adult outpatient clinic at MMHD. Thirdly, Lucy Luchtman speculated during our interview that her Latin educational background might have made the "collaborative learning process", with it's "learning alliance" orientation and lack of grades, directive syllabus, etc. somewhat new and challenging for her. Again, Sharon had also identified herself as Latina (though neither her name nor appearance had suggested such a background); the possible significance of which will be discussed below. Finally, Dr. Luchtman herself worked in closer proximity to the ongoing, day by day implementation of the new degree program, particularly this new collaborative field placement, than she had in the past. Indeed, the school's continued viability rested heavily upon the success of this program; it was highly visible. The Unraveling On the night previous to the first Sunday morning shift, Harold Yeng, the ECRT Director, called, requesting that I start early the next day, and go to the firehouse to give a critical incident debriefing regarding a recent fire which had entailed several violent deaths. These debriefings, which ECRT staff had begun to provide to emergency services personnel throughout the city, offered a whole new mode of service provision and funding; and were considered top priority. I called Sharon, to discuss the work we would be doing. The number I had been given for her turned out to be the number of her estranged husband, with whom she still stayed occasionally. He had no idea where she was, "didn't keep her schedule", and didn't know whether she'd be returning. I called Sharon's pager; no response. Next morning I went by myself to the fire dept. and conducted the debriefing. I met up with Sharon several hours later at the Police Station; initially she'd wondered where I was. We discussed the need for possible communication prior to shifts, and proceeded with our first day together. This incident showed what may have been a training oversight concerning the need for sudden communication; however, it also introduced Sharon's characteristic elusiveness. The following week, Sharon asked Suzanne Behrens for another shift day; Sunday wasn't convenient. Sunday was not a popular ECRT day; Suzanne had received similar requests from the other two GAP "collaborative practicum" trainees when shifts were assigned. One had said he couldn't work Sundays because of employment commitments; the other stated that her family gathered on Sundays to be with her father in law, who was critically ill. Sharon's reason involved wanting to edit schoolwork on Sunday rather than Wednesday. To Suzanne, the choice regarding who should work on Sunday was obvious -- she refused Sharon's request, explaining the more deserving situations of the other trainees, adding that Sharon could do her editing on Wednesdays instead. Significantly, she left this response on a phone message, advising Sharon to recontact her if there were remaining concerns. Sharon never called back, so Suzanne assumed the issue was resolved. In fact, it had just begun: Sharon was late or absent to shifts several times within the next month; she also began to attempt to negotiate on her own behalf with other trainees for switching shifts. All the while, she insisted that her schedule was too heavy, that she was working a six-day week and found the pressure too much to bear. As Suzanne also worked a six-day week (as did many of the people involved with ECRT, who also had private practices), she did not feel especially sympathetic toward Sharon's predicament, but was already becoming annoyed by Sharon's pleas for special consideration. Although my own relationship with Sharon was also difficult, we were able to work together. Sharon's clinical presence in the situations we encountered was satisfactory. While respectful and empathic, she was capable of limit setting, reality-mirroring, and fending off verbal abuse, and wasn't intimidated by rage or by tears. However, there were continued odd moments and oversights. On the second week, she could not recall the municipal worker number she'd been assigned -- she'd left it at home. She also missed the weekly plenary staff meeting without calling; later claiming that she hadn't understood these meetings to be mandatory. One Sunday in the middle of October I learned from the dispatcher that a man had reported Sharon in an auto accident. I called his number; he said that she'd rear-ended a car on the way into the city. He described her as badly shaken, in shock. When finally he let me speak with her, Sharon herself seemed composed, stating that the accident was minor, assuring me with a slight touch of annoyance that she was all right. Several days later, I noticed her car at the clinic; I could not detect any damage. Despite such occurrences, Sharon and I got along amicably -- the hours between calls spent in the car, in bookstores, coffeeshops, etc. waiting for dispatch, at the clinic filing previous work, or writing up case reports, went by easily. Actually I was initially somewhat disappointed in having to work with anyone at all -- I was used to working alone. Still, the adjustment had been fairly easy -- with the exception, of course, of these odd occasions -- the lateness, the unavailability, the problems with Suzanne and with other trainees whose times she wanted. Generally she strove to cover herself, to keep all her concerns out of our working relationship. Particularly, she never mentioned her disinclination to work on Sunday directly to me. Of significance in this regard was a recent ECRT decision: trainees were informed that while their comments to their field supervisors would be treated with respect and discretion, there was no promise of confidentiality. In fact, staffmembers would discuss any reports of problems with other staffmembers, issues with cases, etc. which might relate to the team as a whole. This rule had been established the previous year, when several interns had complained about a particular staffmember, whom they considered incompetent and therefore capable of putting them at risk. Nobody complained to him directly, yet he became regarded as sort of a loose cannon. Soon Sharon had another request for Suzanne: she wanted "real" clinical cases -- i.e. clients seen in an office on a weekly basis. She expected opportunities for "dyadic" work; she even mentioned to Suzanne that she was under pressure from her GAP case conference to work on "actual cases" (in contrast to which were ECRT cases: we'd recently had to commit an elderly man with advanced Alzheimer's disease. I'd suggested that Sharon might report to her case conference on the reactions of family, neighbors, friends to our intervention). Suzanne advised her that the contract between MMHD and GAP was for ECRT work -- not individual casework, a separate MMHD function. Again, Sharon seemed to assume I was not informed about her difficulties with Suzanne, her wish for "real cases" or her troubles with the program as a whole. At times she would seem almost too enthusiastic, too intent upon impressing me with her interest in the work and her wish to succeed. In turn, I would find myself feeling hesitant to ask about the issues I knew she was raising with others. Often I wanted to confront her with what seemed her need to avoid revealing her dissatisfactions to me, given the information I received regularly concerning her conduct. At these points I felt our relationship was evolving from a supervisory to a more clinical one, i.e., she herself was becoming "a real case". With these concerns, I wrote a memo to Harold Yeng, the Director of ECRT, with a copy to Suzanne Behrens. I discussed Sharon's difficulties -- temporal, supervisory/clinical, etc. and my own confusion in fulfilling the "field supervisory" relationship as defined -- or left undefined -- by the agency. Sharon had an individual supervisor at GAP, who assumedly kept track of her. Still, I felt more responsibility than I would feel toward a paid, albeit less experienced partner. My concern was with her high level of floating, unfocused, yet unmistakable anxiety. And without doubt, my own anxiety regarding my intense emotional reactions to her -- my angry resentment of her elusiveness, and even more troubling wish to reach her, to pull her through all this chaos --to save her. The unresolved intensity of my reaction to Sharon and to the circumstances of our own "collaboration" led eventually, I think, to my resignation -- and to this presentation. Soon after the memo, I left town for three weeks; upon my return I learned that the "Sharon situation" had gotten worse. Per my substitute, Sharon had once been 45 minutes late, had continually complained of flu symptoms, had shown no inclination toward mastery of the radio codes or even the mechanics of retrieving phone messages -- had in toto presented a portrait of confused, hapless disinterest, while attempting to make assurances that all was fine. I also learned from Suzanne Behrens that she had been given probationary warning at the Graduate Academy of Psychology, and was becoming a source of irritation to her GAP case conference. Sharon's difficulties at GAP paralleled her problems at ECRT (perhaps mirroring the structural parallels within the program). Her case conference leader, Maria, reported that Sharon soon began missing classes and not doing the class readings. In Maria's opinion, Sharon could not empathize beyond her own personal issues. Unless the subject under discussion were, say, divorce, Sharon didn't contribute. According to Maria, the other students in the class had also become frustrated with Sharon. Maria recalled the occasion when Sharon was first due to present a case. She declared herself unable to do so, insofar as the "cases" at ECRT were not therapy sessions, but field crises. A student whom Maria called "one of my best" suggested that Sharon present a particular shift, as for example, the one involving the elderly man with Alzheimer's. Per Maria, Sharon's eventual presentation was scattered and superficial, comprised of only the bare review of a previously distributed outline. Worse for Sharon's relation with Maria was an occasion where Sharon had called in during the case conference to say she was stuck in traffic and would not attend. On another matter, the Dean called her home, presumably to leave a message: Sharon answered the phone. Upon hearing of the call from Lucy Luchtman, Maria decided that Sharon's "stuck in traffic" excuse was simply a lie. Maria found this unconscionable. She also grew resentful towards Lucy, the GAP Dean, whom she felt was slower to respond to Sharon's dissembling than was appropriate. Maria resented that this student could lie to her, lie to the Dean, for that matter, and get away with it. "There had to be consequences", was how Maria put it. Disturbances between the two programs -- GAP and ECRT -- soon followed. Per Suzanne Behrens' recollection, Sharon had become resentful toward her, regarding the scheduling and case changes she'd requested. Mary Wesley, Sharon's individual supervisor at GAP, called Suzanne to say that Sharon was so upset that "she would probably continue to "act out" (sic) unless some accommodations were made". Suzanne felt she was being blackmailed, even threatened. Several phonecalls between the two agencies led to a joint meeting regarding Sharon and the effect she was having. This meeting took place, with Sharon, Suzanne, Maria, Mary, Sharon's individual supervisor, and Lucy, the Dean, shortly after I returned from my travels. I was not invited to this meeting; presumably, within the 'collaborative model' such issues went beyond the scope of field supervision. The meeting was characterized by resentment and anger coming from Suzanne and Maria toward Sharon, with the Dean and the individual supervisor acting in more moderating roles. Sharon was placed on formal academic and clinical probation, and required to sign agreements to maintain her commitments to both GAP and ECRT programs. During the next shift, Sharon described the meeting as if its goal had been to help Suzanne get a handle on her anger. She did tell me she'd been put on probation -- but she related this with a remarkable lack of concern, seemingly indifferent toward the reactions which others who were important to her career were having toward her. Later, she mentioned a stress management-based program at Stanford, which she thought might possibly serve her aspirations better than the psychodynamically-oriented program at GAP. As she talked, I felt a sense of transference-testing -- that is, I felt challenged to hold onto her. I found her apparent obliviousness painful to countenance, and wondered if it was this very pain that was being communicated. I also felt more troubled in the "field supervisor" role. I was receiving no supervision, working under an hourly, temporary agreement, entirely without benefits (as were many of the staff -- an accommodation to the era of budgetary reductions). And those who were in charge seemed not so concerned with whether this training position was appropriate for Sharon. The emphasis centered more on determining an appropriate response to her apparent inability to meet its demands, as well as to their own wish to be rid of her. Meanwhile, I had to do the best I could in both managing Sharon and providing assistance to whomever might need the sorts of crisis services we provided. A month or so later, Sharon had completely disappeared. I should add that about a month after that, I myself resigned. Prior to her departure I wrote a second memo to the ECRT director. I described my concern that not only was Sharon presenting a critical degree of unconscious anxiety, but that the "probationary" approach seemed to exacerbate that anxiety. At this point the tone of collaboration among the ECRT staff began to decay, polarized particularly by my discord with Suzanne Behrens concerning two particular occurrences. Around the time of my second memo, Sharon and I were summoned by the fire dept. to the home of a 45 year old man whose 23 year old daughter had called in a false alarm. When we arrived, the young woman, dressed unmistakably as a sex worker, was fuming that she could no longer stand living with her father, who was meddling in her business. The father, for his part, seemed to be denying his daughter's allurement as best he could -- though given the situation, the call to the fire department made a certain symbolic sense. As we talked, he complained about her intractability and unruliness, much as if she were a latency-aged little girl. As our shift time was coming to an end, the daughter threatened to call an ambulance to save her from her father's "intrusions". I promised another team visit later in the evening. Back at the police station, Suzanne, whose shift followed ours, seemed annoyed, even angry -- suggesting to Sharon that the father/daughter situation was being "left for them (Suzanne and Connie, her intern) to clean up". I defended our promise of a follow-up, as the daughter was still threatening to abuse 911 services. Suzanne felt that we should have simply stayed until the situation had been resolved, regardless of the shift ending. She then declared that she would not follow up on the case unless they had time. They never returned to the father and daughter that night. The daughter did indeed call an ambulance; however, by this time the dispatcher recognized her voice and established that there was no actual, concrete need for one. The following week, Sharon and I visited a 35 year old mother and her teenage daughter, both with histories of psychic instability. The daughter was clinging desperately, incessantly to her mother, who had called the police in order that her daughter be hospitalized -- the woman seemed beside herself. As we arrived the mother and daughter were both screaming, the mother refusing the daughter's outstretched arms, beseeching us to hospitalize the daughter. We tried to establish sufficient calm to learn what had precipitated this outbreak. We worked nearly an hour to develop some perspective concerning the daughter's clinging and the mother's distancing, hoping that the rhythm of conversing might itself create some stability. I felt uncomfortable committing the daughter for the sake of restoring peace; problems in this family seemed clearly systemic. Sharon and I worked to reframe the outcries of the pair into something approaching talk, until the time came for our shift to end. I was not ready to hospitalize the girl; however, I felt more attention was needed. Again we asked Suzanne and Connie to follow-up on our visit. At the staff meeting the following Friday, the ECRT staff polarized around the issue, with some of the more "law enforcement" oriented contingent (versus those inclined toward more clinically-conceived interventions) stating that as a matter of policy, shifts should not change during an active situation. While understanding the point, I grew intensely irritated, feeling that the whole responsibility of dealing with Sharon had been dumped on me without recourse to support. This issues surrounding the boundaries between my shift and Suzanne's were causing considerable acrimony to surface among staffmembers. Sharon became quite anxious herself over these cases. During the following week, she presented the father-daughter case in her ECRT case conference, specifically mentioning the follow-up request, and asking Connie, who was also in the case conference, for details concerning the follow-up. This infuriated Suzanne, who fumed that Sharon was mounting a personal vendetta around the issue of follow-ups. Meantime, Sharon was growing fearful and resentful of Suzanne, and on our next shift described her as persecutory. Several days later, Suzanne phoned me to discuss Sharon. We first mentioned the mother-daughter case; while Suzanne agreed that the hospitalization should have been delayed, she still felt that the case should have been handled by us. Suzanne then mentioned her intern's feeling "pressured" by Sharon regarding the follow-up of the father-daughter. I agreed that Sharon was acting inappropriately -- that is, acting out something. However, I also commented that we'd both felt unsupported in the past few weeks during the shift changes. Suzanne declared that she refused to be "set up" by this woman, who seemed dedicated to causing her as much grief as possible. In turn I cited the lack of support I felt I was receiving concerning the task of handling Sharon on shift. Our discussion grew heated, until quite furious, Suzanne suggested I talk with Harold Yeng, the Director, if I had problems concerning Sharon or Suzanne herself. Amidst shouting and "now just a minute's" on both our parts, we hung up. Actually, Suzanne and I have known each other personally for years. My own acceptance onto the staff had been influenced by her. Finally, she and I were the only Ph.D.'s on the staff; which except for two other doctoral candidates consisted of MFCC's and social workers. At the following sr. staff meeting, Nancy, self-described as the most situational, order-restoring, least psychodynamic of the crisis workers, presented the county policy regarding personal and financial conservatorship, and the prerogatives of the several types of conservators regarding hospitalization of their charges. This presentation of stable lines of authority seemed to me a temporary distraction from the rancor and confusion that was in the air. Finally, Suzanne presented the case of the mother and daughter. In her description, I felt she hadn't observed the daughter's particular need to hug the mother, only her generally disruptive behavior. My comment was cut off by Nancy, who took it upon herself to begin directing verbal traffic, manually shushing and permitting speech. I recall thinking that the daughter's clinging had something to do with Sharon's counter-dependent way of relating; however I didn't consider the climate conducive to such remarks. Soon Suzanne brought up Sharon, sharing her concerns about being "set up to look bad" -- a term she used repeatedly. She continued that she was unwilling to regard Sharon as the "dark side of ECRT", a view she attributed to me. Upset myself, I responded that I felt an intolerable pressure to get Sharon through the shifts while realizing that she would undoubtedly soon be dismissed. Harold, the director, commented summarily that it was only a few more weeks until her next academic review was scheduled; given her academic probation, she was undoubtedly on her way out. Finally, a staffmember commented, as if bringing us news, that the other interns were deeply split over Sharon. The next day, Saturday, Harold called me, asking that I keep in touch with him during the next day's shift to let him know if Sharon "was behaving herself". I agreed -- however, she never showed for the next day's shift, nor was she ever seen again by anyone at either ECRT or GAP. Still, her effect continued on for some time. At a mid-December sr. staff meeting, it was mentioned that the interns seemed anxious about Sharon's disappearance. Several had specifically inquired what had happened; the other GAP "collaborative practicum" students had noticed that she was no longer there either. Suzanne mentioned that there were legal obstacles to discussing Sharon with interns, as assumptions regarding confidentiality pertained. Other staffpeople, including myself, felt that not mentioning Sharon's disappearance would itself be unethically anxiety-provoking. At the Graduate Academy of Psychology, Sharon's situation had deteriorated in a nearly parallel way. She was late on several occasions following the probation meeting; polarizing the GAP faculty reaction toward her and her behavior. Maria wanted a demonstration that there were consequences to her lying, to her lateness, to her "not getting it". Lucy, the Dean, saw a failure of the "learning alliance" between Sharon and Maria; who she saw as unnecessarily punitive and unempathic. Lucy did not envision students being disciplined for not keeping up with assignments -- in the new program, problems in comprehension or participation were to be resolved collaboratively. Lucy doubted Maria's ability to rise above the sort of enmity into which she and Sharon had fallen. Especially as Maria was about to go on maternity leave, and undoubtedly had other concerns than Sharon. In truth, Maria and Sharon did not work well. Near the time of her probation, Sharon had become interested, per my suggestion and others', in learning about how Alzheimer's disease is viewed in African American culture. At the start of the semester Maria had offered to search her own library in case any of her students wanted references regarding specific issues. However, when Sharon approached Maria requesting literature on African American culture and Alzheimer's, Maria felt that Sharon really only wanted to impress, and to avoid researching herself. Maria suggested that Sharon learn to use the library; Sharon rewarded her with an unannounced absence. Especially infuriating to Maria was Sharon's acting as if she were too advanced to require weekly supervision, or monitoring. Early in the semester, on account of her previous study, Sharon was afforded 2nd year status, as part of an advanced group of Psy.D. students (there were complicated issues behind this, to be discussed). However, because she lacked a masters degree, which the other advanced Psy.D. students had, she was not, after all, promoted (Lucy Luchtman had referred to Sharon as having been "a good sport" about the promotion and demotion). During this time, Maria felt that Sharon was putting on airs, even suggesting that the material in Maria's case conference was too elementary. Maria told Sharon that "if you were really qualified for the second year class, you'd be there. But you're not, you're here". When Lucy had reached Sharon at home after the "traffic" alibi, Sharon came to school, but instead of going to the case conference,
she went to the Dean's office to see Lucy, at Lucy's invitation. Maria
felt countermanded. According to both Maria and Lucy, Maria's concern
with the need to set limits, have consequences for infractions, etc.,
was at odds with the collaborative approach. Sharon's last interaction with the school involved her offering to do a presentation as part of her "remediation", on the father and daughter we'd encountered. Having already planned the schedule of presentations, Maria's substitute declined her offer. Both Maria and Lucy mentioned this episode to me. To Maria, it illustrated once again Sharon's lack of understanding of appropriate behavior, her unreasonable demandingness. To Lucy, the instance was tragic; the student had indeed tried to "remediate", bringing forward a case which (for whatever reason) had effected her -- and had met with absolutely no faculty support. And just like that, she was gone. What Sense It Made: In the aforementioned volume, the unconscious at work, Christopher Clulow discusses the precarious balance of care and control in the British probation service. Noting that tension surrounding this balance is endemic to caregiving organizations, particularly those involved with marginal populations, he finds this tension mirrored in supervisory relationships within the organization. Clulow quotes Woodhouse and Pengelly (1991), stating that within the probation services "officers have to manage within themselves and their organizations tensions which their clients have manifestly failed to do". Such tensions between care and control also involve dependency and autonomy, individuality and conformity. These patterns of conflicting polarities recall Erikson's developmental stages, e.g., "trust-mistrust", identity-diffusion, et al. (1968). Other authors (Diamond, 1993; Gilkey, 1993) contextualize Erikson's stages organizationally, linking traumatic stresses to organizational regression along Eriksonian lines. Thus when duly exacerbated, tension involving the polarities of care and control exert a regressive pull. Presumably accompanying this pull are the sorts of defensive positions formulated by Bion (1960) and elaborated as "social defenses" by Hirshhorn (1988) -- e.g. assumption group functioning, organizational splitting, scapegoating and projective identification, covert coalitions, etc. Certainly the present study rests on the assumption that abetting the "disappearance" of a vulnerable graduate student were regressed organizational dynamics. Both of the institutes linked through the "collaboratory practicum" were confronting potentially terminal stressors, e.g. "managed-care" economics and mental health deprioritization; loss of a formerly held, nationally-accredited Ph.D. program. The "care vs. control" tensions addressed by Clulow certainly apply to conflicts surrounding treatment of the socially-marginalized, an ECRT priority. The issue of polarization is especially endemic to ECRT, itself a collaboration between the departments of mental health and law enforcement. In formulating its new Psy.D. program, GAP had opted for a derivative of the concept of "therapeutic alliance" intrinsic to the analytic approach upon which the school rested. Significantly, though, the school chose for its "collaborative practicum" partners organizations largely involved with the containment and confinement of the psychosocially disturbed. The involuntary commitments initiated by agencies such as ECRT constitute the steepest withdrawal of civil rights in civic practice -- there are no phone calls to lawyers, etc. For a period of up to 72 hours, one is under complete control, pending diagnostic and procedural formulations. A kind of institutional splitting and projecting occurred at GAP -- our "want ad" seeks newly matriculated participants for a "collaborative practicum" involving the removal of hierarchically-based, control-oriented psychic elements from a graduate school reformulating its mission, and depositing them in a suitably control-oriented institution. An essential tenant of psychoanalytic thought assumes that even on an unconscious level, events occur as planned (Freud, S, 1940; Weiss, Sampson, 1986). That is, Sharon's enactments may have been exactly what was asked of her, including even her departure. The remainder of this essay will consider some of the psychodynamics which occurred across individual, dyadic, within-group, between-group, interorganizational, and cultural spheres of psychic functioning. Finally, we consider the implication of the persistence of these dynamics with respect to our current historical moment, often described as one of paradigmatic transformation. Certainly within this microcosm of the mental health industry -- training ground, clinic, theoretical repository, community of clinicians -- much was confused, overripe with overdetermined significance. For example: Sharon had presented herself at her admissions interview as an "abused woman" -- which had perhaps contributed to her admissibility. She also claimed an Hispanic heritage, though her name and appearance suggested another culture. She interviewed under one name, was enrolled under another, creating a lapse in the flow of her documentation. Soon after enrolling, she was offered tentative second year status. Behind this offer were the needs of the school to graduate a class under the new program in order to speed up the process of qualifying for accreditation. Later, when a master's degree became a requirement, this offer was rescinded; she was demoted back to first year -- like a deflated balloon after a holiday. So after all that, what can we make of her wish for a "dyadic" psychotherapy structure? While enrolled in an academic program focused upon collaborative softening of status/hierarchy differences, she was simultaneously placed in a practicum focused upon control of disruptive behavior. The environment included police officers, sergeants, lieutenants, etc. -- professional authority symbols -- and a six hour shift wherein one took orders continually, often under stressful circumstances. Thus the school split its "control" from its "care" aspects, depositing the former within the municipal agency. As for Sharon, she exhibited a remarkable capacity to function at the vortex of a complex projective structure: for Maria and Suzanne, she both stimulated and contained the dread of incompetence. Maria couldn't "ally" with her; instead, she engaged in mutual projective identification, playing the abusive, uncaring parent to Sharon's insubordinate child. Suzanne struggled with Sharon's potential to "set her up" -- as indeed she had by gaining admittance into the program, evading the screening process for which Suzanne was responsible. Again, each got "worse" with the other; projective identification abounded. Arthur, Mary Wesley, and myself related to her more as a victim than a villain: even though she was unreliable, there were always mitigating circumstances. In retrospect, I myself tended toward splitting the cruel mother and the hapless child, whose increasing disability only bore testament to the cruelty she received. Also, in having to get the little girl through the dangerous shifts, I could desexualize her, somewhat as the father we saw had attempted with his daughter. Also, my own sense of helplessness, aroused by a number of situations in which we found ourselves, could be managed merely by asking Sharon if she was all right. All in all, Sharon proved a remarkably efficient vehicle for the dystonic projections of others. In Maria's impending childbirth, in her deference to the opinions of her "best students" concerning Sharon's inadequacy; in Suzanne's deference to other trainees with "better reasons" for special consideration -- how many times did Sharon play the unfavored child! One wonders what sort of inkling Arthur had as to the criteria for admitting her to GAP. A relevant aspect of ECRT and its parent organization, MMHD, was its culture of temporary workers. The Director of ECRT was in an "acting" position, as was that of his immediate superior, the Director of Mental Health Services. While ostensibly supervising someone, I was actually employed in a temporary, hourly position, one which could be terminated without notice, and one which carried no employment benefits. Ultimately, this "temporary culture" and its lack of essential cohesion lay behind my own resignation: supervision would have been helpful. Dynamically, the "acting" leadership never became an active one; paradoxically, considering how highly valued control was, issues such as how to deal with Sharon were left to settle themselves. Certainly Sharon's "acting out" was linked to the "acting capacity" of the leadership. The GAP movement toward the "learning alliance" model was occasioned by the reduced standard of the degree awarded. Thus one might expect a certain resistance, or countervalence from those most attached to "the old standards" (as seen in the "old militia"). And who better to carry this counterweight than one of the newest, least experienced of the faculty, about to give birth, married to an employee of the clinic which worked closely with law enforcement -- and which sponsored Sharon's practicum. Who better than someone who came from a traditional academic orientation, and clearly identified as belonging to the culture to which Sharon had unconvincingly proclaimed her own membership? The relationship between Lucy, the Dean, and Maria grew to encompass the split between care and control, polarized both within GAP and between GAP and ECRT -- which itself wrestled with the same polarities, seemingly activated by Sharon wherever she went. As to the "collaborative practicum" itself: while GAP moved toward its learning alliances and non-hierarchical collaborations, the ECRT culture would hardly have entertained the notion of letting the trainees deciding among themselves, for example, on scheduling matters. Again, Gap "collaborative practicums" were shared with agencies whose "task" was often to separate psychic decompensation from criminal malfeasance, a process more often than not involving confinement, detainment or confrontation. The collaboration held a hint of the maneuver frequently executed by two police officers, or by an ECRT worker and an officer: "good cop/bad cop". To summarize: a school which has lost the full authority of its degree seeks to soften its authoritative style, thereby exporting its authority identifications into a shadow side, a nether realm. Lucy and Maria's relation symbolized this movement; Maria and Sharon played the issue out, vis a vis Sharon's "collaborative" participation in a culture where individual authority was temporary and somewhat unstable, yet where the authority of the agency itself was conceived in terms of involuntary commitment to the "county facility". In such a matrix, defensive enactments such as projective identification and splitting were unavoidable. Here we arrive at the notion of "parallel process" -- meaning, one which transects several domains of psychic functioning. An example might be the splitting at GAP around the issue of "learning alliances" and the export of aggression by a nation whose domestic agenda was that of becoming "kinder and gentler". Another might be the screaming child with her arms out driving her mother away, and Sharon wanting to work in an "office setting" -- or for that matter, the projective use of Sharon and that to which children in this society are frequently put (Feuchtwang and Ramsay, 1995). Certainly, it can be argued that parallel processes don't really exist -- that the lines or patterns hypothetically linking phenomena within individual and group psychic domains are completely speculative, or at most products of personal perceptive inclination. Of course, the idea of there being no connections in the apparent patterns is also volitional, even so far as it invokes "scientific" parsimony. Indeed, talk radio may have nothing whatsoever to do with either psychopathology or insomnia. The concept of parallel process mitigates the notion of the isolated, independent self. Instead, it supports a world view involving interdependent meanings and dynamics, positing an ecology of significance linking the private and the universal. My own urge is towards a teleological, heuristic reading: if we see so much craziness within the "mental health" profession, what might we make of it? Certainly there is no lack of evidence for enactments of primitive defenses within the helping professions: one of the editors of the unconscious at work (again, a series of studies of group-level processes manifesting as individual behavior within mental health-related organizations) expressed a wish behind the project to stimulate recognition of similar processes within other organizations. Returning to Sharon and the GAP/ECRT relationship: one sees everywhere themes of abandonment, encapsulation, qualities and attributes projected and split-off. I hope that at this point the parallel levels of splitting and projection within the individuals and groups I've been discussing are apparent. Again, in this context the statewide polarities within the overall scope of mental health between "learning alliances" -- e.g. the university system -- on the one hand, and prisons and punishment -- "remediation" -- on the other, become recognizable, clarified. One might further generalize to the national polarities regarding universal healthcare as an entitlement and the "managed-care" agenda of capitation -- i.e., capping the provision of services to any particular "carveout". When it was realized that Sharon was gone and her whereabouts were unknown, there were concerns on both the school and placement side that a missing persons report should be filed. There were also fantasies that she'd suffered a breakdown and had been hospitalized. Yet the same lack of information which brought such fears also brought reassurance: surely if something were really wrong, someone would have been in contact. As it was, she was never heard from again, nor had anyone attempted to locate or contact her. The idea of a student/trainee becoming a "missing person" or a psychiatric patient signifies as well the psychic climate of the organizational matrix wherein such possibilities occur. No wonder the interns were nervous. The "acting directors" were at best lieutenants -- placeholders. As for the patients -- the people who (per the industrial model of mental health) were processed into states of recovery and/or minimal social functioning and medicinal compliance -- were they not -- are they not -- part of the same matrix? Recognition and integration of Sharon's potential "patient" identity might potentially change the whole notion of mental health delivery from one of transitive object processing to one of shared experience, or mutual recognition. Earlier I mentioned my concern with the significance of the "postmodern" paradigm (for lack of a better identifier) for the mental health industry and for socioanalytic theory. Perhaps -- hopefully -- postmodernism vis a vis mental health calls forth a positive, eluctable quality, rather than only the shadow, or absence of psychiatric symptomotology. Perhaps a truly "collaborative practicum" might occur when the focus of the practitioners become "we" rather than "they". Where a clinical entity purporting to practice public mental health might begin with its own -- specifically, with the cultivation of the capacity to identify all of its parts, at least on a social or organizational level. However, as yet psychoanalytic diagnoses are made primarily on developmental trauma, rather than on current social or ecological deprivation. Certainly there are uses for this -- the psychoanalytic sense of "knowing" a person derives from a recognition of vicissitudes of primary developmental events. Yet this way of knowing the other is limited -- in practice, the knower and known are separated by a division of labor. One becomes the object of the other; both are removed from their common ecological context -- their being in the same room, the same occupation, the same mood, or the same boat. In organizational practice, the consultant studies and to an extent joins the host organization. Still, the objectification persists: the culture is studied, patterns are delineated, interventions follow, a job is completed, the outsiders return to their own organization to await reassignment. The therapeutic community, an enduring yet endangered fantasy of clinical culture, a refuge for patient, client, clinician and consultant alike, remains an unattained ideal. A fantasy institution, where projections, introjections and identifications occur playfully, leading to an at once more differentiated and more integrated matrix of subjects and objects, selves and others (Edelson, 1970). Ideally, ultimately, an identification by everyone with everyone else. No misfits, no castaways, no scapegoats. There was little room for play at the organizations under discussion. During the acrimonious phone conversation between myself and Suzanne, she exclaimed, "I'm tired of Sharon! Tired of giving her so much time! Tired of having to deal with her -- it's like she's draining me!". This was in response to my own complaints about having to deal with getting her through six or seven hour shifts, all the while sensing that she was soon to be gone (though not knowing how this eventuality might come about). What was it that was driving us to such distraction? What was being drained? In retrospect, I think it had to do with the collapse of the boundary between the patients...the clients...those in need of services, and ourselves, who defined by our function were not the patients. But the protective barrier between ourselves -- here the ECRT staff, though I think this idea applies elsewhere -- and the sorts of confusion we were dedicated to "remediating" was failing. Had Sharon been encountered as a patient seeking services, it would have been easy. She would have fit right in. Again, what of the difficulties surrounding human services practice? We can analyze each instance as the vicissitude of unresolved, unconscious individual and/or group processes, and attempt to heal them by insight, on a per case basis. However, my experience with the above organizations leads me to wonder if the "industrial" model applied to human services is itself crumbling, i.e., the idea that by somehow processing out "illness", health can be generated. While I often stand in awe of psychoanalytic insight, I've come to doubt its capacity to see beyond itself, to suggest an alternative to its own vision. I've also come to sense the need for one, as the awareness of boundaries between agencies, between individuals, between spaces within the individual psyche, pales in significance compared to the realization of ecological embeddedness, interdependence, and the appallingly radical implications of genetic replicability. At a pre-conference A.K. Rice group I once attended, the question of when a collection of individuals becomes an organization was approached vis a vis a crowd of sunbathers on a beach. A cry for help is heard from the water; the crowd becomes a group, with a primary task around which it functions. It has a mission. It is organized. But preceding the task itself -- the organized rescue -- is a collective experience: the sound of a cry for help partakes of a universal recognition, a response contextualized simultaneously within and beyond the space and time of its imminent occurrence. We all know what that sound means, though not how, or where we've gained such insight. Perhaps it is at exactly that point that we gain or lose our individual identities. As industrialism, job definition, employment security, careers, and patriarchy fade from view, the concept of primary task may be losing its organizing capacity. Task involves doer and done to, processor and processed, even container and contained. As the problematic occurrences we've considered among a school, a city agency and a few individuals suggest, it's getting more difficult to know who's doing what to whom. Perhaps there are other, more immediate ways of defining organization. >From within the postmodern sensibility, that spectacular, genetically encoded, fractal-consciousness (whatever that is) domain of Indra's Web, one might answer the question regarding when individuals are organizations as -- simply -- always. Healthcare provision in its current context is defined as something provided to a care recipient by a care provider. Different people -- always. Mental health viewed in this fashion -- i.e., professionally -- depends inevitably on mental illness -- the former as an industry entails the processing and transforming of the latter. We speak of "delivering" health, like delivering a life raft to the swimmer imperiled in the water. But as so many reports, including this one, indicate, we're all to some extent drowning. If to that extent this is indeed everyone's subjective experience, perhaps we can reconsider the definition of a group as defined by a task. If the answer to the question of when a number of people, lying on a beach or walking anonymously along a city thoroughfare, constitute an organization is -- again -- always, what then becomes of the distinction between organizational consultation, psychotherapy and meditation? Perhaps Sharon's enactments of the sort of processes usually associated with "patients" signaled a weakening of the barrier between clinician and patient. She was indeed disruptive; and quite probably better off gone. Nonetheless, her (so to speak) "pathology" became a mirror of everyone else's, and via parallel process, projective identification, et al., a mirror of the disowned conflicts belonging to the two organizations joined through her. Perhaps also, of those belonging to her family of origin. Yet this level of insight seems suddenly insufficient. The message of the 'girl who couldn't help it' portends more than the existence of unconscious processes crossing the self-identifications of various psychic entities. Perhaps Sharon's disappearance is understandable as the reappearance of the essential, if symbiotic, link between patients, or clients, and clinicians -- between caregivers and care receivers. When viewed from an ecological perspective, not only part of the same community, but per postmodern awareness, part of each other. To help someone else, we must first see them as requiring our aid -- thus, an industrial enterprise composed of "healers", "problem-solvers", care-givers, etc. takes form. And especially in stressful times, an industry which generates, as well as locates, wounded, problematic, uncared-for potential service recipients. This seems to be what Sharon's story was about. Once we realize this, though, what then? Epilogue Around two months after Sharon had vanished, a month after my own departure, the fire department asked that ECRT visit an elderly man recuperating from a stroke. It was the sort of "welfare check" staffers felt good about doing, a visit seldom stressful and usually appreciated. However, it was also the sort of request which usually became deprioritized whenever something more urgent occurred. Several shifts went by without anyone getting to it. People grew accustomed to seeing the request in the "follow-up" folder, awaiting someone with a relatively idle moment. Finally, a pair of workers on an evening shift went by. They noticed some mail in the mailbox, and rang, but the door wasn't answered. As the man had no phone, they decided they would leave a card in the mailbox, go have dinner, and check back later in the evening. Upon their return, an ambulance was there, as were the paramedics. A neighbor had called in to say the man had not been seen; he was found having died several hours previously. It was reported to me that a period of almost obsessive follow-up response took place; the several workers who'd let the call go by as "non-urgent" were given time to surface their feelings of failure and guilt. Again, Sharon, who had so angered people by, among other things, her anxious harping on follow-ups, had by this time disappeared. Bibliography Bion, W.R., Experience in Groups, Tavistock Publications, London, 1961. Diamond, Michael A., Stresses of Group Membership: Balancing the Needs for Independence and Belonging, in Organizations on the Couch, Kets de Vries & Associates, Ed., Jossey Bass, San Francisco, 1991. Edelson, Marshall, The Practice of Sociotherapy - A Case Study, Yale University Press, New Haven, 1970. Feuchtwang, Miranda and Ramsay, Sheila, In Fagin's Kitchen: Social Defences as a Protection Against Children in a Post Modern World, paper presented to International Society for the Psychoanalytic Study of Organizations, London, 1995. Freud, Sigmund, An Outline of Psychoanalysis, Hogarth Press, London, 1964 [1940]. Gilkey, Roderick, The Psychodynamics of Upheaval: Intervening in Merger and Acquisition Transitions, in Organizations on the Couch, Kets de Vries & Associates, Ed., Jossey Bass, San Francisco, 1991. Hirshhorn, Larry, The Workplace Within, MIT Press, Cambridge, MA 1988. Miller, E.J. and Rice, A.K., Systems of Organization, in Group Relations Reader 1, A.K Rice Institute, Washington D.C., 1975. Obholzer, Anton, and Roberts, Vega Zagier, The Unconscious at Work, Individual and Organizational Stress in the Human Services, Routledge, London, 1994. Weiss, Joseph, and Sampson, Harold, The Psychoanalytic Process, The Guilford Press, New York, 1986 Winnicott, D.W., Playing and Reality, Tavistock Publications, London, 1971. |
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