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Alternative Title

How do we understand this co-constructed phenomenon and the impact on clinicians, treatment processes and organizational climate?

Publication Date


Document Type


Degree Name

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.


©2019 Cathleen Morey Access limited to the Smith College community and other researchers on campus. Smith College community members also may access off-campus using a Smith College log-in. Other researchers may request a copy through Interlibrary Loan for personal use.


vi, 195 pages : color illustration. Includes bibliographical references (pages 155-170)