Merger and Leadership: Containment and Integration in Medical and Psychoanalytic Organizations

In response to the 2009 Symposium themes of containment and integration of differences, we propose to examine mergers in medical settings from psychoanalytic and organizational perspectives with a particular focus on the implications for leadership. We will use cases from the clinical practice of pediatric oncology and from an effort to integrate public and private pediatric cancer centers in Europe as well as from an effort to restore transparent management in a psychoanalytic institute in the USA to illustrate concepts on the continuum of individual to group levels of analysis. The term merger refers to the phenomenological experience of 'oneness'. The term is also a behavioral description that can be applied to the organization of groups (e.g., the combination of entities to form a larger institution). It could be argued that the psychoanalytic study of organizations necessarily entails the analysis of both the individual's experience of merger and separateness with others as well as individual and collective experience in merged organizations. For example, observational research on the process of separation-individuation in infants and Mahler's hypothetical construct of 'symbiosis' are examples of psychoanalytic methods and concepts that may have relevance for the understanding of mergers. (Pine, 2004) More recently, Ogden's work provides a more modern view for examining merger as an experience while Fonagy's work based on attachment theory provides a new developmental framework for this phenomenon. (Ogden, 2004; Fonagy et al., 2005; Fonagy, 2001) Such contributions offer an account of how individual capacities for containment and integration might be formed and fundamentally shape an individual's adaptation (experiences in groups) across situations and time. Group relations and organizational concepts such as primary task (Rice, 1965) and primary risk (Hirschhorn, 1997) offer an account of how purpose and context can shape the containing and integrating functions of groups as whole systems. From Bion's ground breaking description of his 'experiences in groups' (Bion, 1961) to Lawrence's innovative framework of 'groups in experience' (Lawrence, 2000), authors and practitioners in the field of psychoanalytic studies of organizations have been exploring the implications combining these theoretical perspectives in the analysis of thought, emotion and behavior. The field itself may be seen as a promising but complicated and incomplete merger of paradigms that holds the promise of synthesizing useful new conceptual tools such as the idea of social defense.(Jacques, 1955; Menzies Lyth, 1992)These merged (e.g., 'socio-analytic') approaches have been applied to a wide variety of organizations and institutions, but appear to have particular relevance to work that combines complex technical tasks with predictably strong emotions. Medicine and psychoanalytic training certainly fit this description. (Fruge & Horowitz, 2004; Sonnenberg & Myerson, 2007) We will examine a variety of mergers, employing the concepts of containment and integration as a means of understanding how these factors may be uniquely configured in these activities and what capabilities may be required for effective leadership of self and others in these contexts. The paper will conclude with pragmatic suggestions about consultation and professional education in such organizations.