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The walls within: working with defenses against otherness

Online Conference 5-11 July 2021

The Girl Who Couldn't Help It

Perhaps the recent interest in applying chaos theory to human affairs attests that organizational life is becoming chaotic. In terms of Miller and Rice's (1975) approach to organizational structure and dynamics, the 'primary task' of many organizations has shifted from accustomed, definitive activities -- e.g. provision of medical care; publishing of metropolitan newspapers; manufacture and marketing of tobacco products -- to bolstering of the organizational capacity to withstand continuous change, while maintaining some identity and self-recognition. Survival may now entail the capacity of an organization to relinquish substructures of activities and/or individuals -- the capacity for radical disidentification. The 'primary task' seems to be transition, adaptation to change, no matter what business you're in. From the Tavistock group relations perspective, the emergence of unconscious group-level processes coincides with the obscuration of anchors of conscious identification and self-recognition. Thus in the 'temporary institutio ', devoid of context apart from self-study, primary ontogenic processes come to the surface . From an ecological perspective, this might be seen as a pathogenic process -- the organization or institution isolated from it's environmental context metabolizes itself in a closed loop of self-consumption. See concluding section.To analogize on an individual level, with a threat to one's contextual survival comes involuntary awareness of basic life-supporting processes -- heartbeat, breathing, etc. A primary example of an industry faced with the loss of its socioecological context exists in the field of mental health. Curtailment or elimination of mental health benefits has occurred to the point where clinical care is no longer easily available to the middle and working classes. Hospital administrators cite the unwillingness of major healthplan payers to accept such expenses; 'managed-care' is to them simply the disappearance of what they term 'the social transfer payment' - i.e. large payers, healthplans and insurers providing funds over and above actual costs via acceptably-inflated hospital and medical billing. This disappearance is experienced by many mental health clinicians as a decreasing opportunity to work. During the past few years, clinics and training sites in California have diminished to the point where the California Psychological Association (CPA), not historically the most radically innovative of organizations, has assigned a task force to deal with the difficulty of licensure. Along with withdrawal of interest in social service provision has come an unprecedented increase in prison population. Prison growth projections in California are at 60% over the next five years, in a system that from 1983 to 1996 grew from 35,000 inmates to around 135,000 Source San Francisco Focus Magazine, November, 1995A study by the Rand Corporation estimates that with enforcement of 'three strikes' legislation, the California Dept. of Corrections' slice of the state's operating budget will grow from 6% to 18% by 2002. The mood accompanying this growth can be fathomed in a comment made by Steve Forbes, the recent American presidential candidate. When a reporter mentioned the severe overcrowding of prisons concurrent with the move toward harsher sentencing laws, he responded, 'so what?'. In an essay for PBS, Anne Taylor Fleming noted the inversion of California educational and punitive priorities as reflected by increases in prison construction replacing previous efforts at construction of the state university system, which has seen repeated drastic cuts and deprioritization.With these trends as contextual backdrop, the present essay examines the balance between care and control, between remediation and punishment, integration and expulsion in a local clinical and educative setting. It concerns the sudden, disturbing disappearance of a graduate student in clinical psychology from both the school she was attending and the field placement site where she was a practicum student. It considers the circumstances surrounding her disappearance, focusing upon the operation of parallel processes through which psychosocial conflicts involving compassion and exclusion, care and control, rehabilitation and punishment -- love and hate -- are expressed.This 40 year old student-trainee, whom we'll call Sharon, had enrolled at the Graduate Academy of Psychology (GAP), a 175 student, psychodynamically-oriented clinical graduate program in operation since the 1960's, located a few blocks from the state university campus. The previous year, she'd enrolled in a comparable, even competitive program at Western Institute of Psychology Studies (WIPS), later withdrawing. Once enrolled in GAP's program, she was assigned to a newly-implemented collaborative practicum program developed with the Municipal Mental Health Department (MMHD). Her position there was as a trainee with the Emergency Crisis Response Team (ECRT), a mobile unit responding to radio-dispatched calls from the police department for assistance with crisis situations suicide threats (or completions); decompensations requiring hospitalization; dispute resolution, welfare checks, services for crime victims and the bereaved, et al. -- an unusual mix for a practicum site. The work included case conferences and supervision, attending police squad meetings and riding in a city car with a field supervisor for a weekly 6-7 hour shift, responding to any number of emergencies. The trainees learned radio codes, relevant laws surrounding involuntary commitment and child protective custody. In essence, the training experience was one of functioning at the boundary of care and control, between mental health and law enforcement agencies. Although interns had served as trainees for years (including myself), this jointly-sponsored MMHD/GAP 'collaborative practicum' for first year students was in its inception, as was the GAP Psy.D. clinical program. Since the 1960's, the school's Ph.D. had been accredited by both the state and more recently, the American Psychological Association (APA). However, GAP had been confronted with a stiffening of requirements by the accrediting agencies for the continued right to offer an accredited Ph.D.. This challenge was understood by GAP's administration as reflecting the efforts of 'academic' psychology to constrain the growth of practice-oriented clinicians within the Ph.D. entitlement. The new demands of the state accrediting agency involved radically-increased research facilities, lowered student-teacher ratios, and reorientation to a more academic, less practice-based conception of psychology.Instead of attempting an accommodation beyond its inclinations and resources, the school changed its 'product' to a Psy.D., conceived as a more professional, less academic degree. This change, occurring at freestanding schools around the country, was understood by the school's community as evidence of the separation within psychology of the orientation toward professional, clinical practice from the scientific, research-oriented, quantitative approach pursued at most universities, including the state system. Also, it involved a loss of previously-awarded accreditation the APA refused to review the new program until it had actually produced graduates. Sharon was among the new first year 'Psy.D.' students; the upper class students continued with their APA-accredited Ph.D.'s.Sharon remained in the program less than three months. While initially she had impressed people at both the school and the practicum site, her situation deteriorated almost immediately. She frequently missed her ECRT shifts, and demanded impossible scheduling changes and accommodations. She was seen as not only incapable and indifferent, but at times downright deceitful in her fabrication of alibis and extenuating circumstances. During her short stay, people at both locations became infuriated with her, citing her overall conduct as intolerable. Her brief tenure also occasioned considerable conflict among those around her. For instance, within GAP itself, the administration was committed to its newly-articulated 'learning alliance' model of education, characterized by the development of a collaborative, empathic relationship between student and teacher, set within a 'transitional space' for learning. However, Sharon's case-conference leader was oriented toward a more traditional academic structure, one including censure and discipline when necessary for non-completion of assignments.After a sequence of increasingly vitriolic interactions, Sharon just disappeared -- to the frank relief of those who had dealt with her. She left no forwarding address or phone number save a pager, to which she did not respond. The school administration considered filing a missing persons report, until finally their registered notification to her of her termination was reported delivered. It was generally agreed that her admission to either program had been a mistake, and that she was psychologically unequipped to participate in such activities.This essay examines her brief involvement with these two agencies -- the graduate school and the emergency crisis response team -- with an eye toward the larger context of her unfortunate tenure. Based upon semistructured interviews with those who had worked with her, and upon my own process notes as her ECRT field supervisor, it considers some of the interpersonal and intergroup psychodynamics of this event projective identificatory processes, scapegoating, splitting, assumption group functioning, and other defenses characteristic of individuals and organizations under severe stress. Finally, in the spirit of constructivist, post-modernist case study analysis, and/or Monday morning quarterbacking, it seeks a more cogent, emotionally resonant meaning to this event than, 'Well, the girl couldn't help it'. Our question is whether anyone could -- or whether the problematic attempt of this 40 year old woman to find a place for herself as a psychologist was itself overwhelmed by conflicts reflecting broadbased conscious and unconscious dynamic shifts in the conception of such phenomena as mental health, education, law enforcement and social responsibility. The question is how such global variables as 'remediation versus punishment', ecological interdependence versus 'survival of the fittest', diversity versus purity, et al. manifest even in a situation involving a distracted yet seemingly capable graduate student who, in the words of a case conference leader, 'never could get her act together'.