This summer, after 48 years of work as a psychotherapist, I said farewell to my last patients. But I did not really retire. Instead, I continued the systems and organizational part of my practice, on a limited scale. It has been a long, demanding and difficult transition. 

Two years ago, I told all my patients that I planned to retire from clinical practice. I stopped accepting new referrals, gradually sent to colleagues the people who would need longer work, and continued with those who appeared likely to terminate in the time remaining. The groups followed a similar process, with concurrent termination work and deciding both group and individual disposition. To handle all this, I leaned heavily on my close colleagues, family, and friends, plus some short-term personal psychotherapy. The overt conflict was that I am in general good health and loved my work intensely. But, at my age of 72, I was in the zone of some possible illness or disability, which would disrupt my obligation to the people I worked with. Also, I had seen a number of therapists valiantly, and I believe unwisely, carry on a sporadic practice while fading from illness. I never wanted that to happen to me and to my clients. The less conscious conflict had to do with letting go of being needed, being seen as important by various communities and ties, and fearing a reduction in income.

Fortunately for me, I had developed since the early years, a small, non-clinical part of my practice in organizational and systems consultation. My clients included a laundry and dry-cleaning chain, a road construction company, a design studio, a state motor vehicle department, and a hospital. At first I was largely self-taught. Later I attended many workshops on management, organization, and consultation. Some were sponsored by psychological associations; others by business and management schools. It was personally and intellectually exciting, as well as a relief from the intensity of long-term psychotherapy.

I was challenged by understanding and conceptualizing the bridge between clinical and non-clinical application of group skills. I dared ask naive-sounding questions, such as if group dynamics is a fundamental part of the human condition, why do we not use the same methods across the board? Is the “anti-group” in the clinic group somehow different from the destructive forces in the motor vehicle department? Do the subgroup phenomena in the laundry work teams differ from those in the therapy groups? Although these questions had been addressed in the literature, I needed to ask them all over again of myself. In my dual work life, I conducted some safe experiments. I would sense, think, and intervene in the clinical group as if they were a business or government group. Then in a business group, I would intervene as though they were a clinic group. The appropriateness and effectiveness taught me that in many (not all) cases the basic contents and process were fundamentally identical.

So what was the difference, and why did it matter? For starters, the ethical situation sets different boundaries. In work with organizations, the consultant could not be as abstemious about social contact as in the clinical setting. Knowing who was working with whom and why was a necessity in the organization as opposed to the clinic (except for supervision). Yet, paradoxically, there was a large area of discretion and privacy in non-clinical work, which the consultant maintained despite the demands of management. Reports and process notes are handled in a similar way, and publication likewise does not identify the client without permission. The bulk of the rest of the ethical provisions are shared. 

Next, the depth of the material involved was often the same, but not dealt with in an uncovering way in organizations. Rather, it is handled by metaphor and by psychoeducational language. Great care has to be exercised by the consultant not to overstep the depth and content boundaries. Clinicians new to this area make their biggest mistakes here, by slipping into therapy. Then we have to ask who is the client? It is basically the whole business or agency, but transacted by the owner or director. Here you begin to experience the full force of generic group psychology. Leadership exists at many levels and in many roles. There is an official table of organization, as well as the covert way things are really done. There are subgroups with multiple and overlapping and fluctuating memberships. There are multiple transferences everywhere. As a consultant, you see the powerful role of the organization’s history and how it is imbedded in the related communities. There is always the interplay of declared goals and their opposing forces. My first assignment to new students is to take one day’s local newspaper and try to find a news item that does not report a group or systems event.

I still miss the unique bond and struggle of psychotherapy. To me, the values and rewards of working with men and women, families, and other people in groups are the deepest. The rewards of improving the morale and the work effectiveness of an organization with many people are great, but of a different order. Perhaps a word should be added here, that as a consultant, you exercise your social and political conscience in choice of clients. You also should give notice and reason, and quit if the original goal has been subverted. 

The field of organizational consultation is wide. I believe well-trained and qualified group psychotherapists are uniquely equipped to enter it. We can offer what few of the colleagues from business, management and accounting and engineering can. We offer a range of insight, tools and interventional skills that span the whole range from the person to the subgroups to the large group. As I find my place in this arena, I encourage my group therapy colleagues to enter, because you are much needed and have much to give.

This article was published in the August/September 2002 issue of The Group Circle.