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How do we understand this co-constructed phenomenon and the impact on clinicians, treatment processes and organizational climate?
Doctor of Philosophy
School for Social Work
Enactment, System, Organizational dynamics, Relational perspective, Intersubjectivity, Mentalizing
Enactment in the therapeutic dyad is a psychodynamic construct that is robustly described in the theoretical and clinical practice literature. In contrast, there is no comparable knowledge base in the literature to inform clinicians who work in treatment systems and experience complex system enactments, involving patients, multiple staff and the organizational dynamics of the system in which they are embedded. This qualitative research study investigates the co-constructed phenomenon of system enactment from the perspective and lived experience of twenty-two clinicians who hold psychodynamic theoretical orientations and practice in treatment systems across the United States. The four primary findings from this study are: 1) Clinicians conceptualize system enactments from a classical perspective; 2) System enactments have an experiential impact on clinicians in the domains of affect, cognition, behavior and physiological arousal, which may be related to secondary traumatic stress responses; 3) Clinicians demonstrate a collapse of mentalizing associated with ruptures in the patient’s treatment, conflict in the working relationships between staff, and problematic organizational dynamics; and 4) Interconnected and reciprocal interactions among all levels of the system including patient subsystem, individual provider subsystem, intra-staff subsystem and organizational subsystem, are shaped by the impact of system enactments. These findings were synthesized with the literature to inductively develop an operationalized definition of system enactment.
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Morey, Cathleen, "System enactment : how do we understand this co-constructed phenomenon and the impact on clinicians, treatment processes and organizational climate?" (2019). Dissertation, Smith College, Northampton, MA.
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