Clinical social work practice in organizational settings: a psychodynamic systems approach

ABSTRACT

Clinical social work practice in organisational settings is complex and challenging. Effective practice is contingent on knowledge and skills that are particular for systems-based work involving multiple interprofessional mental health practitioners and clients interacting in a relational matrix. Yet, not all social work theories and constructs that were developed for application in individual, group, and family modalities are directly transferable to the practice environment of a treatment system. This paper offers a conceptual framework that synthesises contemporary psychodynamic theory with systems theory – referred to as a psychodynamic systems approach – to inform and advance knowledge of systems-based social work practice. This approach considers the interplay of dynamic processes among the four levels of the socially co-constructed system which constitute the system as a whole. It examines how five key clinical phenomena – transference, countertransference, splitting, projective identification and enactment – are actualised in systems. Definitions of these phenomena formulated from a dyadic perspective and a contemporary psychodynamic systems approach are offered, and their similarities and differences are discussed. A composite case example is provided to illustrate how several of these phenomena manifest in clinical practice.

KEYWORDS:

• Systems-based social work practice
• organisational dynamics
• transference/countertransference in systems
• defences in systems
• system enactment

Acknowledgments

The author wishes to acknowledge and thank Kathryn Basham, PhD, LICSW for her rigorous and invaluable feedback on this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethical approval

Research findings reported in this paper were from a study that was performed in line with the principles of the Declaration of Helsinki and its later amendments. Approval was granted by the Ethics Committee of the Smith College School for Social Work (Date: 30 April 2018/Number: 1718–076).

Additional information

Notes on contributors

Cathleen M. Morey

Cathleen M. Morey, Ph.D., LICSW is the director of clinical social work at the Austen Riggs Center, an open setting psychiatric hospital and residential treatment center for adults with complex psychiatric problems located in Stockbridge, MA, USA. She has over 20 years of clinical social work practice experience in various mental health settings, including hospital and residential programmes, community mental health agencies and forensic settings. Her scholarship, research and teaching are focused in the areas of system enactments, interdisciplinary treatment teams, family therapy, ethics in social work supervision, and clinical social work practice and education. She has presented on these topics at national and international conferences. She is an adjunct assistant professor at the Smith College School for Social Work and the University of Connecticut School of Social Work. She also maintains a private practice focusing on psychotherapy and consultation. She volunteers as a peer reviewer for Clinical Social Work Journal and is an international social work volunteer with the non-profit organization International Social Work Solutions.