Systems-centered supervision

The systems-centered (SCT) approach to supervision frames the dynamics of both groups and individuals as isomorphic systems. In this chapter, the SCT supervisory experience, its goals, and its approach to transference and countertransference are addressed; the orientation of the seven questions that structure the SCT supervisory process are identified; and the thinking that is required to answer them is discussed. SCT supervisees locate their supervision issues in the context of the phases of system development; consider interventions as hypotheses that can be tested in the therapeutic context; and provide feedback to all parties about the validity of the theory of living human systems, the reliability of its systems-centered practice, and the accuracy of the therapist's hypotheses about the isomorphic dynamics of the systems of member, subgroup and group as a whole. Illustrations are taken from tape recordings of supervisory sessions.     

Symposium: A discussion of the videotapes of a difficult group

Three conference participants (Drs. Yvonne Agazarian, Louis Ormont and Saul Tuttman), each an experienced group therapist employing distinctly different styles and theoretical frames, react to a videotape of a Difficult Group and offer their respective critique and suggestions. The material was originally presented before an audience at the Eastern Group Psychotherapy Association Annual Conference (1985) in New York City. The audience first saw the videotape at the conference and then observed the interaction among panelists. This material was submitted for publication because: 1) issues of contrasting technique and theory are heightened by a concrete comparison of different clinicians' reactions to the same material; 2) the serious task of coping with a group of difficult patients is of concern to all group therapists who are faced with such challenges; 3) the circumstances, in which patients who feel needy and neglected chronically put pressure on the therapists, occur with frequency; at the same time, 4) the therapists are also under stress in that their supervisors and evaluators are scrutinizing their work. All of this makes for a fascinating and difficult dynamic situation. Finally, 5) examining this group material resulted in a lively exchange which was stimulating and interesting to both audience and participants.Yvonne Agazarian, Ed.D., is in private practice in Philadelphia, Pennsylvania.     

Group-as-a-whole systems theory and practice

Group-as-a-whole systems theory is presented and applied to the practice of group psychotherapy. The individual and the group are conceptualized as two isomorphic systems in a hierarchy of living systems. The basic component of the group-as-a-whole is its subgroups, which exist independent of individuals whose subgroup memberships may change while subgroups remain stable. Subgroups come together around similarities and separate on differences, and contain differences for the group-as-a-whole to integrate in relationship to primary and secondary goals. The primary goals of system survival and maturation take precedence over the secondary goals, which relate to the environment. Goal achievement and individual change is explained as a function of group dynamics. In a therapy group, the dynamics of each phase of group-as-a-whole development serve as a major therapeutic force. Within each member, salient developmental issues are aroused, which resonate with the issues that the group is in the process of mastering. The task of the group-as-a-whole therapist is to facilitate the developmental process at both the group and the individual level. Therapeutic interventions are designed to facilitate the discrimination and integration of information at the boundaries between systems and subsystems: within the individual member system (intrapersonal) and between individual member systems (interpersonal), within the group-as-a-whole system, within subgroups, between subgroups, and between all systems in the relevant hierarchy and their environments.     

Contemporary theories of group psychotherapy: a systems approach to the group-as-a-whole.

The author discusses how subgroups represent the basic focus of the systems-centered group therapist. Particular attention is given to boundary issues and to how therapy takes place by facilitating the process of discriminating, communicating, and integrating perception of differences in the apparently similar and similarities in the seemingly different. Communication occurs at the boundaries between systems at all levels of the hierarchy: the group, the subgroup, and its members. Clinical vignettes are provided to illustrate important process issues, such as work with difficult patients, levels of intervention, and group resistance and defense.     

Developing the group mind through functional subgrouping: linking systems-centered training (SCT) and interpersonal neurobiology

This article introduces the systems-centered concept of the "group mind" by linking systems-centered thinking and interpersonal neurobiology, building on Siegel's definition of mind as the process of regulating the flow of energy and information. Functional subgrouping, the systems-centered group method for resolving conflicts, discriminates and integrates the flow of energy and information within and between group members, subgroups, and the group-as-a-whole, thus potentiating survival, development, and transformation. This article uses the interpersonal neurobiological framework to discuss functional subgrouping as a tool for developing the group mind: considering how functional subgrouping facilitates emotional regulation, creates a secure relational context, and potentiates neural integration.     

Systems-centered® group psychotherapy: putting theory into practice

Systems-centered therapy (SCT) is derived from a theory of living human systems and practiced in individual and group therapy. Excerpts from an inpatient group illustrate how SCT norms, particularly functional subgrouping and the hierarchy of defense modification, are introduced within the first few minutes of an SCT group. The importance of modifying roles is also discussed, as is the significance of system hierarchy, isomorphy, and energy as applied in the practice of SCT.     

The Red Book and clinical practice

Jung's work is fundamentally an experience, not an idea. From this perspective, I attempt to bridge conference, consulting room and living psyche by considering the influence of the 'Red Book' on clinical practice through the subtle and imaginal. Jung's journey as a man broadens out to have relevance for women. His story is individual but its archetypal foundation finds parallel expression in analytic practice today.     

On (not) listening for theory: the trainee’s use of theory as defence against the stress of beginning psychodynamic practice

This paper offers reflections on the trainee’s relationship with, and use of, theory in the early stages of psychodynamic practice. It addresses the issues of ‘listening for theory’ in the face of the unsettling, yet inevitable, stress and insecurity of beginning psychodynamic practice and the daunting awareness of the work being assessed by the training institution. While theory makes psychodynamic work possible and applying theory is explicitly welcomed in psychodynamic training, the paper argues that the unexamined use of theory is problematic as it, albeit unconsciously, is used by the trainee as a defensive retreat into a private mental sanctuary from the intimate, relational space of the consulting room and from the felt incompetence and inexperience aroused in the immediate encounter with the client. Exemplified through accounts of working with a particular client during my training, the paper examines the trainee’s evolving relationship with theory, in the light of what impedes and promotes therapeutic progress, as a significant marker of the trainee’s development to work psychodynamically.     

WD 40: Historical Insights of Ellen White and John Dewey into Three Dualistic Concerns: Implications for Current Practice

Abstract

The dualisms between theory and practice, individual and society, intellectual and manual, as identified by John Dewey in the 19th century, find their direct correspondence in the writings of a contemporary Christian writer of his era, Ellen G. White, whose publications and life work led to the development of what is now one of the single largest Protestant private education systems in the world. This paper provides an outline of these three historical dualities, identifies the shared insights of Ellen White and John Dewey relating to these dualities within their historical context, and delineates the implications for current practice.     

Countertransference and Large Group Dynamics in the church: Reflections on Pamela Cooper-White’s, Shared wisdom: Use of the self in pastoral care and counseling

This article was presented as part of a 2005 American Academy of Religion book panel on Pamela Cooper-White's recent book on countertransference in pastoral care and counseling. A response to Dr. Cooper-White's contribution is offered from the perspective of large group dynamics and their countertransference implications for pastors and church consultants.Wallace N. Fletcher is an instructor in pastoral counseling at Newman College. He also teaches psychoanalytic theory at the Philadelphia School of Psychoanalysis in Philadelphia, PA.     

A national survey of candidates: I. demographics, practice patterns, and satisfaction with training

To better focus efforts in recruiting psychoanalytic candidates, current candidates' demographics, practice patterns, and satisfaction with psychoanalytic training were investigated. An anonymous web-based survey was distributed by e-mail to all candidates subscribing to the affiliate member e-mail list in 2009-2010. Surveys were completed by 226 of 565 affiliate members, for a return rate of 40%. The majority of respondents were women 45 to 64 years of age, married, with a doctoral degree, in private practice, with an annual household income of over $100,000. Most candidates devoted 11 to 30 hours a week to training and had no analysts or candidates in their workplace. Almost half had considered training for more than four years before matriculation, with financial issues cited most frequently as delaying entry. Over 80% of respondents were satisfied with their training. The most frequently cited reasons for dissatisfaction were a negative institute atmosphere, concerns about teaching or the curriculum, and difficulty finding cases. Candidates in training for eight years or more accounted for almost 20% of the group and were more often dissatisfied with training. This study demonstrates that the majority of current candidates are satisfied with training but suggests that recruitment may become increasingly difficult unless factors related to time, cost, case finding, graduation requirements, and institute atmosphere can be addressed.     

Post-decision consolidation in large group decision-making

Decision-makers tend to change the psychological attractiveness of decision alternatives in favor of their own preferred alternative after the decision is made. In two experiments, the present research examined whether such decision consolidation occurs also among individual group members in a large group decision-making situation. High-school students were presented with a decision scenario on an important issue in their school. The final decision was made by in-group authority, out-group authority or by majority after a ballot voting. Results showed that individual members of large groups changed the attractiveness of their preferred alternative from a pre- to a post-decision phase, that these consolidation effects increased when decisions were made by in-group members, and when participants identified strongly with their school. Implications of the findings for understanding of group behavior and subgroup relations are discussed.     

Commitment Shift during Organizational Upheaval: Physicians' Transitions from Private Practitioner to Employee

This longitudinal study examines the individual transition journeys of physicians as their private medical practices are acquired by a large integrated health care system. We test the proposition that transition patterns (trends in an individual's commitments to organization and profession over time) are a function of individual differences in years in profession and perceived organizational enabling characteristics (change involvement, openness to ideas, and work discretion). Three years of survey data were obtained from a panel of 48 physicians who transitioned through an organizational change process. Results challenge traditional assumptions that tenure reinforces commitment and cast doubt on the effectiveness of current medical school curricula in preparing medical graduates to practice in an administrative environment. In addition, results strongly suggest that enabling characteristics of organizational change are critical for compatibility between the organizational and professional attachments of transitioning physicians.     

Clinical Praxis and the Place of the Analyst: A Chilean Perspective<Superscript>*</Superscript>

Since its inception, psychoanalytic theory has considered that, conceptually, it is impossible to maintain the division between the individual and society and that the constitution of one necessarily involves the other. Despite this clear legacy of Freudian thought, followed by most of the first and second generations of psychoanalysts, analytic clinical practice started to change almost exclusively into private practice by later generations of psychoanalysts. As a result, a space for information, data gathering, and theoretical production has been gradually configured that is structured in a slanted way. An analytic working environment has thus developed in Chile that tends to eschew contributions from other disciplines that could both enrich and challenge psychoanalytic theoretical–technical developments.     

Cognitive career counseling for women

Developmental theories of career counseling conceptualize individuals proceeding in a sequential, orderly fashion throughout their career lives. Specific tasks are confronted and resolved as individuals pursue their career goals. Issues faced by women at each stage of the career cycle are often overlooked. This article describes the negative influence societal demands, role conflicts, and individual attitudes can have on women seeking careers. RET provides an essential cognitive component for reducing the internal and external attitudinal barriers in treating women for job related problems.Diana Richman, Ph.D. is Supervising psychologist at the Institute for Rational-Emotive Therapy. She maintains a private practice in Manhattan and Queens.     

Modified group psychotherapy with chronic renal dialysis patients

Renal dialysis is a life saving, chronic medical procedure for those patients whose kidneys no longer function. However, the psychological reactions to this procedure, which necessitates a state of passivity for several hours, often overshadow the medical implications, and, in some instances, are decisive in terms of the patient's adjustment to treatment. Frequently, patients are unable to utilize individual psychotherapy to its maximum because of their need to perceive their illness as only medical. Group therapy however provides a less threatening psychological milieu and tends to give rise to peer support and mutual interaction.Barbara Halin Willinger, M.S.W., A.C.S.W., was the social work supervisor of the Renal Dialysis Unit at Metropolitan Hospital at the writing of this paper. She is a private psychotherapist and is affiliated with a mental health clinic where she also practices individual and group psychotherapy.The author wishes to thank Martin Saltzman, M.D. and Haley Glazer, M.S.W. for their suggestions.     

‘Plaining’: The social and cognitive practice of symbolisation in the religious society of friends (Quakers)

This paper seeks to establish that Quakers, who are often presented as and who often present themselves as disinterested in ritual and symbolism, do indeed practice symbolisation. However, it suggests that this practice is best understood not as a simple series of one‐to‐one correspondences between signifieds and signifiers, but a cognitively‐based process which we call ‘plaining’. This process is shown to be a manifestation of the more general social process wherein one group defines its identity through playing the vis‐à‐vis with another. The paper describes how Quakers’ practice of symbolisation, of plaining, began with the first Friends and has continued to the present. This discourse is manifested across a range of sign systems and is, therefore, a possible unifying resource amongst British Quakers.     

The prostitutes' syndrome

When female patients, at critical periods in their lives, receive suggestions regarding promiscuous and unacceptable behavior, they may at a later time in life act upon these suggestions. However, involvement in promiscuous sexual behavior results in guilt, which will often be seen clinically in the form of depressive neuroses or psychosomatic illness. Several case histories are presented, and implications for treatment are discussed.M.D. is a psychiatrist in private practice in Memphis, Tennessee, maintaining an active inpatient and outpatient practice of psychotherapy.With Dr. Sexton, he maintains a private practice in Memphis.     

Systems-Centered Therapy: A Protocol for Treating Generalized Anxiety Disorder

The systems-centered short-term therapy protocol was adapted and applied in three single case studies with generalized anxiety disorder (GAD) patients in a ten-session individual treatment over a two week period. All three subjects showed substantial improvement and no longer met diagnostic criteria post-treatment. Changes were maintained at follow up both six months and one year later. These results are promising and suggest the importance of further research on SCT as a viable, alternative treatment for generalized anxiety disorder.     

Selective mutism in children: A structural family therapy approach to treatment

When children refuse to speak in some social settings, but can understand and speak in other settings, the diagnosis of selective mutism must be considered. A review of the literature describes the disorder, the various types of mutism, and related family dynamics. A family systems approach to treatment using structural family therapy is suggested. The case history presented illustrates one type of mutism as well as the family rules and hierarchy which appeared to be maintaining it. Structural and strategic family systems theory techniques that were used to move the family toward resolution of this problem are discussed.Diane Wolf Tatem, MA, MS, completed graduate work in marriage and family therapy at New Mexico State University, Las Cruces, NM. She is employed at Life Management Center of El Paso's Child Development Services and also has a private practice in marriage and family therapy in El Paso, Texas. Robert L. DelCampo, PhD is a professor of family science at New Mexico State University and maintains a private practice with Associates for Marriage and Family Therapy in Las Cruces, NM. Please address all correspondence to Dr. DelCampo at Box 3470, New Mexico State University, Las Cruces, NM, 88003-3470.Appreciation is expressed to Dr. Charles Huber, New Mexico State University in Las Cruces, for his insightful critique of the final draft of this paper. This paper was presented at the Texas Association for Marriage and Family Therapy Annual Conference, January 25–29, 1995 in Dallas, TX.