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Co-constructing a Conceptual Understanding of System Enactment
1Austen Riggs Center, Stockbridge, MA 01262 USA.
Clinical Social Work Journal
|January 18, 2022
Summary
System enactments, complex interactions in clinical settings, significantly impact clinicians
Area of Science:
- Psychology
- Clinical Social Work
- Systems Theory
Background:
- System enactments are co-created phenomena in clinical settings, involving complex patient psychopathology, staff vulnerabilities, and organizational dynamics.
- While enactment in therapeutic dyads is well-documented, system enactments transcending the dyad remain under-researched in psychodynamic literature.
- Understanding these broader enactments is crucial for effective clinical practice and organizational functioning.
Purpose of the Study:
- To investigate how psychodynamic clinicians perceive the phenomenology and impact of system enactments.
- To explore the effects of system enactments on clinicians, treatment processes, and the organizational climate.
- To develop a conceptual framework for understanding system enactments within clinical systems.
Main Methods:
- Qualitative study employing thematic analysis of data from psychodynamic clinicians.
- Exploration of clinicians' understanding of system enactments and their experiential impact.
- Analysis focused on identifying major themes related to the phenomenon and its consequences.
Main Results:
- Clinicians conceptualize system enactments from a classical perspective.
- System enactments cause experiential impacts on clinicians (affect, cognition, behavior, physiology), potentially linked to secondary traumatic stress.
- Clinicians exhibit a collapse of mentalizing during treatment ruptures, staff conflicts, and organizational issues, with system enactments shaping all system levels.
Conclusions:
- System enactments profoundly affect clinicians and organizational dynamics, often conceptualized traditionally.
- The study highlights the need for a systems-based understanding of enactment phenomena in clinical practice.
- Findings have implications for clinical social work education, practice, policy-making, and future research.
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