System Enactment: An Individual, Interpersonal, and Organizational Perspective

ABSTRACT

Enactment is primarily conceptualized as a phenomenon occurring in the therapeutic dyad. This paper presents a relational construct of enactment as it manifests in the individual, interpersonal and organizational matrix of a clinical system. System enactments are ubiquitous phenomena that emerge with clients and staff in the relational field of a system that involves multiple participants with mutual and intersecting subjectivities; yet, there is little information about this type of enactment in the literature. This phenomenon often occurs in the context of power struggles and ruptures in the alliance with the client, and difficulties in the working relationships between treatment staff, which if not engaged, can result in negative therapeutic outcomes. A fictionalized case example demonstrates how this construct guides systems-based clinical practice. Implications for social work education, practice and training, and suggestions for future research are discussed.

KEYWORDS:

• Enactment
• system
• organization
• social dynamics
• therapeutic alliance
• treatment rupture
• relational perspective

Acknowledgement

This manuscript was first accepted for publication by Smith College Studies in Social Work in March 2018. Advanced scholarship and research on the construct of system enactment can be found in this author’s dissertation: Morey, C. (2019). System enactment: How do we understand this co-constructed phenomenon and the impact on clinicians, treatment processes, and organizational climate? (Doctoral dissertation). Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/2099 .

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Notes on contributors

Cathleen M. Morey

Cathleen M. Morey, PhD, LICSW, is the Director of Clinical Social Work at the Austen Riggs Center, a therapeutic community, open psychiatric hospital, and center for education and research, promoting resilience and self­direction in adults with complex psychiatric problems. She provides direct patient care, family consultation and family therapy, clinical supervision and training, case consultation, and administrative management for clinical social work services. Dr. Morey has 19 years of clinical social work practice experience in various mental health settings, including hospital and residential programs, community mental agencies and forensic settings. Her scholarship and teaching are focused in the areas of system enactments, power, privilege and oppression in organizational settings, interdisciplinary treatment teams, suicidality, family therapy, dynamic assessment of family functioning, intergenerational family dynamics, and clinical social work education. Dr. Morey is a member of the adjunct faculty of the Smith College School for Social Work and she maintains a private practice in Stockbridge, MA focusing on psychotherapy and clinical consultation.