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Psychiatrists as treatment team leaders: Pitfalls and rewards

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Abstract

The multidisciplinary treatment team has become a conventional component of inpatient psychiatric care delivery. Treatment team dynamics and their implications for the patient, the team members, the organization, and the team leader in particular have been generally understated in the training of psychiatrists, however, as has its value as a model for learning about administration. This article highlights the history and evolution of the multidisciplinary treatment team in psychiatry, the mix of mental health disciplines, philosophies, and roles involved, the characteristics of mental health care professionals, the conflicting manifest and latent work group tasks, and the dynamics and functions of team leadership. While reviewing information on which to base a systematic approach to team leadership, the author advocates for application of universal standards for education in administrative psychiatry including supervised leadership of multidisciplinary treatment teams and discussions of complimentary readings, examples of which are provided.

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References

  1. Taxay EP: The health care team. Journal of the American Medical Association 239:1137, 1978.

    Google Scholar 

  2. Crawshaw R, Key W: Psychiatric teams: a selective review of the literature. Archives of General Psychiatry 5:397–405, 1961, pp. 105, 106.

    Google Scholar 

  3. Goffman E: Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. Chicago, Aldine, 1961.

    Google Scholar 

  4. Szasz TS: The Myth of Mental Illness. New York, Hoeber-Harper, 1961.

    Google Scholar 

  5. Brill NQ: Delineating the role of the psychiatrist on the psychiatric team. Hospital and Community Psychiatry 28:542–544, 1977.

    Google Scholar 

  6. Feldman S: Administration in mental health: issues, problems, and prospects. Pan American Health Organization Bulletin 9:212–220, 1975, p. 213.

    Google Scholar 

  7. Rodenhauser P., Segal M: Performance appraisal and organizational issues in a mental setting. Administration in Mental Health 10:181–192, 1983, p. 184.

    Google Scholar 

  8. May WF: Professionals, administrators, and hospitals: moral conflicts. National Association of Private Psychiatric Hospitals Journal 22:38–44, 1980.

    Google Scholar 

  9. Peplau HE: Must laboring together be called “teamwork?” American Journal of Orthopsychiatry 30:103–108, 1960.

    Google Scholar 

  10. Rosenheck R: System dynamics in complex psychiatric treatment organizations. Psychiatry 51:211–220, 1988.

    Google Scholar 

  11. Looney JG, Engelberg SJ, Gode RO, Knesper DJ: The psychiatric chief residency: a preliminary training experience in administrative process. American Journal of Psychiatry 132: 729–733, 1975.

    Google Scholar 

  12. Special Requirements for Residency Education in Psychiatry, Graduate Medical Education Directory 1993–1994. Chicago, American Medical Association, 1993, p. 123.

  13. Adams PE: Psychiatric residents in blurred roles: adaptation. Psychosomatics 15:157–159, 1974.

    Google Scholar 

  14. Chen CL, Glick ID: Core tasks in the resident's mastery of psychiatric administration. Administration in Mental Health 12:207–211, 1985.

    Google Scholar 

  15. Greenblatt M: The use and abuse of power in the administration of systems. Psychiatric Annals 16: 650–652, 1986.

    Google Scholar 

  16. Gutheil TG, Grunebaum HU: The teaching of clinical administration: opportunity and problems of role ambiguity. Psychiatric Quarterly, 49:259–272, 1977.

    Google Scholar 

  17. Berlin R.: The team approach in hospital treatment as a defense of the psychiatrist. Comprehensive Psychiatry 11:147–158, 1970, p. 149.

    Google Scholar 

  18. Green SA: The chief resident as a reluctant staff therapist. American Journal of Psychiatry 132:1078–1081, 1975.

    Google Scholar 

  19. Gomez EA, Ruiz P, Langrod J: Multidisciplinary team malfunctioning on a state hospital unit: a case study. Hospital and Community Psychiatry 31:38–40, 1980.

    Google Scholar 

  20. Hutt, ML, Menninger WC, O'Keefe DE: The neuropsychiatric team in the U.S. Army. Mental Hygiene 31: 103–119, 1947.

    Google Scholar 

  21. Menninger WC: Therapeutic methods in a psychiatric hospital. Journal of the American Medical Association 99: 538–542, 1932.

    Google Scholar 

  22. Greenblatt M., Levinson DJ: Issues in a therapeutic organization. Psychiatric Resident Representing the American Psychiatric Association 11: 13–29, 1959.

    Google Scholar 

  23. Bonn, EM, Kraft AM: The Fort Logan Mental Health Center: genesis and development. Journal of the Fort Logan Mental Health Center 1: 17–27, 1963.

    Google Scholar 

  24. Medical and Psychological Teamwork in the Care of the Chronically Ill, edited by Harrower M, Springfield, Illinois, Charles C Thomas, 1955.

    Google Scholar 

  25. Marshals JA, Schlesinger HJ: Some implications of the concept of structure for the psychiatric team. Winter VA Hospital, Presented at the Americal Psychological Association, Denver, September 1949.

  26. Bonn EM, Schiff SB: Clinical supervision of psychiatric residents. Bulletin of the Menninger Clinic 27: 15–23, 1963. p. 19.

    Google Scholar 

  27. Jabitsky IM: Psychiatric teams and the psychiatrist's authority in the New York State mental health system. New York State Journal of Medicine Nov: 577–581, 1988.

    Google Scholar 

  28. Sifinoes, PE: The interdisciplinary team. Psychiatric Quarterly 43: 123–130, 1969.

    Google Scholar 

  29. Trute B, Macpherson AS: Psychiatric teams: the sport of mental health practice. Canada's Mental Health 25: 15–17, 1977.

    Google Scholar 

  30. Goldstein S, Birnbom F, Miller B: The team approach in a psychogeriatric unit. Journal of the American Geriatric Society 23: 370–375, 1975.

    Google Scholar 

  31. Bowen WT, Marler DC, Androes L: The psychiatric team: myth and mystique. American Journal of Psychiatry 122: 687–690, 1965, p. 689.

    Google Scholar 

  32. Ryan, RM: Managing mental health professionals: an alternative future. Administration in Mental Health 3: 68–73, 1974.

    Google Scholar 

  33. Dolgoff T: The organization, the administrator, and the mental health professional. Hospital & Community Psychiatry 21: 45–52, 1970.

    Google Scholar 

  34. Moore WE: The Professions: Roles and Rules. New York, Russell Sage Foundation, 1970.

    Google Scholar 

  35. New PK: An analysis of the concept of teamwork. Community Mental Health Journal 4: 326–333, 1968, p. 327.

    Google Scholar 

  36. Nyman, GW, Watson D, Schmidt D, et al.: Training the secretary in community mental health: a simple model for integrating secretaries into the therapeutic team in community mental health. Community Mental Health Journal 11: 163–169, 1975.

    Google Scholar 

  37. Ishiyama T: Role clarification and sense for staff in mental hospitals., Mental Hygiene 52:103–109, 1968.

    Google Scholar 

  38. Gaitz CM: Multipdisciplinary team care of the elderly: the role of the psychiatrist. The Gerontologist 27: 553–556, 1987.

    Google Scholar 

  39. Siegel C, Haugland G, Fischer S: The comparison of work activities of mental health professionals among disciplines and environments. Hospital and Community Psychiatry 34: 154–157, 1983.

    Google Scholar 

  40. Frederick PE: The psychiatrist/psychologist as team leader: what about social workers and nurses? Hospital and Community Psychiatry 29: 326, 1978.

    Google Scholar 

  41. Shaw SJ, Herron WG, Poland HV: Team approach in mental health services: generalists or specialists? Perceptual Motor Skills 61: 423–432, 1985.

    Google Scholar 

  42. Koeske GF, Koeske RD, Mallinger J: Perceptions of professional competence: crossdisciplinary ratings of psychologists, social workers, and psychiatrists. American Journal of Orthopsychiatry 63: 45–54, 1993.

    Google Scholar 

  43. Firman GJ: The psychiatrist-nonmedical psychotherapy team: opportunities for a therapeutic synergy. Journal of Operational Psychiatry 13: 32–36, 1982.

    Google Scholar 

  44. Rodenhauser P: Group psychotherapy and pharmacotherapy: psychodynamic considerations. International Journal of Group Psychotherapy 39: 445–456, 1989.

    Google Scholar 

  45. Modlin HC, Faris M: Group adaptation and integration in psychiatric team practice. Psychiatry 19: 97, 1956.

    Google Scholar 

  46. Modlin HC, Gardner RW, Faris M: Implications of a therapeutic process in evaluations by psychiatric teams. American Journal of Orthopsychiatry 28: 647, 1958.

    Google Scholar 

  47. Williams TG: Problems in the team treatment of adults in state mental hospitals. 2. Possible effects of the introduction of team treatment in state mental hospitals. American Journal of Orthopsychiatry 30: 95, 1960.

    Google Scholar 

  48. Brown BS, Ishiyama T: The role of leader in formal staff process. Comprehensive Psychiatry 8: 217–226, 1967.

    Google Scholar 

  49. Greiff SA, McDonald RD: Role relationships between nonphysician treatment team leaders and team psychiatrists. Community Mental Health Journal 9: 378–387, 1973.

    Google Scholar 

  50. Crawshaw R: Team operation, in study. In A Study in Adjunctive Therapies Coordination. Topeka, Washburn University, 1958.

    Google Scholar 

  51. Hartocollis P: The hospital team and the conflict of professional disciplines: psychologists vs. psychiatrists. Journal of the National Association of Private Psychiatric Hospitals 9: 42–43, 1978.

    Google Scholar 

  52. Harding GT: Patient care: conflict or collaboration? Journal of the National Association of Private Psychiatric Hospitals 9: 47–48, 1978.

    Google Scholar 

  53. Gralnick A, D'Elia FG: Social forces and patient progress in the psychotherapeutic community. International Journal of Social Psychology 14: 105–112, 1968.

    Google Scholar 

  54. Fiorelli JS: Power in work groups: team member's perspectives. Human Relations 41: 1–12, 1988.

    Google Scholar 

  55. Schectman F, Harty MK: Mental health disciplines in conflict: the patient pays the price. Bulletin of the Menninger Clinic 46: 458–464, 1982.

    Google Scholar 

  56. Bion WR: Experience in Groups. New York, Basic Books, Inc., 1961.

    Google Scholar 

  57. Kernberg OF: Leadership and organizational function: organizational regression. International Journal of Group Psychotherapy 28: 3–25, 1979.

    Google Scholar 

  58. Schutz W: The Interpersonal Underworld. Palo Alto, Science and Behavior Books, 1966.

    Google Scholar 

  59. Berger DM: The multidiscipline patient care conference: learning in groups. Canadian Psychiatric Association Journal 21: 135–139, 1976.

    Google Scholar 

  60. Modlin H, Faris N: Follow-up study of a psychiatric team. Bulletin of the Menninger Clinic 18: 242–251, 1954.

    Google Scholar 

  61. Warner WL: Democracy in Jonesville: A Study of Equality and Inequality. New York, Harper and Row, 1949.

    Google Scholar 

  62. Sills D: Voluntary associations: sociologic aspects, in International Encyclopedia of the Social Sciences, Vol. 16, edited by Sills D. New York, The Free Press, 1968, pp. 362–379.

    Google Scholar 

  63. Blau PM, Scott WR: Formal Organizations: A Comparative Approach. San Francisco: Chandler Publishing, 1962.

    Google Scholar 

  64. Rodenhauser P: The life cycles of professional associations: organizational and administrative dynamics. Administration and Policy in Mental Health 18: 411–420, 1991.

    Google Scholar 

  65. Zaleznik A: Power and politics in organizational life, in The Irrational Executive, edited by Kets de Vries MFR. New York, International Universities Press, 1984.

    Google Scholar 

  66. Spiro HR: Psychodynamic theory, in Psychiatric Administration: A Comprehensive Text for the Clinician-Executive, edited by Talbott JA and Kaplan SR. New York, Grune and Stratton, 1983, pp. 147–165.

    Google Scholar 

  67. Hanlon MD, Gladstein DL: Improving the quality of work life in hospitals: a case study. Hospital & Health Services Administration Sept–Oct: 94–107, 1984.

    Google Scholar 

  68. Ribner DS: Psychiatrists and community mental health: current issues and trends. Hospital and Community Psychiatry 31: 338–341, 1980.

    Google Scholar 

  69. Ruiz P, Saiger G: Partial hospitilization within an urban slum. American Journal of Psychiatry 129: 121–123, 1972.

    Google Scholar 

  70. Herbert GK, Chevalier MC, Meyers CL: Factors contributing to the successful use of indigenous mental health workers. Hospital and Community Psychiatry 25: 308–310, 1974.

    Google Scholar 

  71. Felton GS, Wallach HF, Gallo CH: Training mental health workers to better meet patient needs. Hospital and Community Psychiatry 25: 299–302, 1974.

    Google Scholar 

  72. Lomas P (Ed.): The Predicament of the Family—A Psychoanalytic Symposium. Hogarth Press, London, 1967, p. 12.

    Google Scholar 

  73. Gray S, Diers D: The effect of staff stress on patient behavior. Archives of Psychiatric Nursing 6: 26–34, 1992.

    Google Scholar 

  74. Hirshhorn L: The Workplace Within: The Dynamics of Organizations. Boston, MIT Press, 1988, p. 10.

    Google Scholar 

  75. Roeske NCA: Stress and the physician. Psychiatric Annals 11: 245–258, 1981.

    Google Scholar 

  76. Harlow M, Jones D, Roberts W, Thompson P, Wheeler F: The Therapeutic Environment Provided Through A Multidisciplinary Approach, in Group Work in a Psychiatric Setting. New York, Whiteside, Inc., 1956, p. 138–139.

    Google Scholar 

  77. Yalom ID: Inpatient Group Psychotherapy. New York, Basic Books, Inc., 1983, p. 177.

    Google Scholar 

  78. Mullen B, Copper C: The relation between group cohesiveness and performance: an integration. Psychological Bulletin 115: 210–227, 1994.

    Google Scholar 

  79. Yoon J, Baker MR, Ko JW: Interpersonal attachment and organizational commitment: subgroup hypothesis revisited. Human Relations 47: 329–351, 1994.

    Google Scholar 

  80. McGregor D: The Human Side of Enterprise. New York, McGraw Hill, 1960.

    Google Scholar 

  81. Wilkinson CB and O'Connor WA: Human ecology and mental illness. American Journal of Psychiatry 139: 985–990, 1982.

    Google Scholar 

  82. Bronfenbrenner U: The Ecology of Human Development: Experiments by Nature and Design. Cambridge, Harvard University Press, 1979.

    Google Scholar 

  83. Barton WE, Barton GM: Mental Health Administration: Principles and Practice. New York, Human Sciences Press, 1982.

    Google Scholar 

  84. Bennis W, Nanus B: Strategies for Taking Charge. New York, Harper and Row, 1985.

    Google Scholar 

  85. Greenblatt M: Management succession: bridge between two regimes. Psychiatric Opinion 15: 36–40, 1978.

    Google Scholar 

  86. Bikales V: The effects of leadership upon morale in the group therapy setting. Bulletin of the Menninger Clinic 16: 202, 1952.

    Google Scholar 

  87. Kernberg OF: Regression in organizational leadership. Psychiatry 42: 24–39, 1979.

    Google Scholar 

  88. Behavioral Science: Concepts and Management Application. Conference Board Report No. SPP 216, New York, The Conference Board, 1969.

  89. Feldman S: Problems and prospects: administration in mental health. Administration in Mental Health Winter: 4–11, 1992.

  90. Lipton AA, Loutsch, E: A reconsideration of power in psychiatric administration. Hospital and Community Psychiatry 1985; 36: 497–503, p. 502.

    Google Scholar 

  91. Silver MA, Akerson DM, Marcos LR: Critical factors in the professional development of the psychiatrist-administrator. Hospital and Community Psychiatry 41: 71–74, 1990.

    Google Scholar 

  92. Leibenluft E, Summergrad P, Tasman A: The academic dilemma of the inpatient unit director. American Journal of Psychiatry 146: 73–76, 1989.

    Google Scholar 

  93. Pattison EM: Young psychiatrist administrators. American Journal of Psychiatry 131: 154–159, 1974.

    Google Scholar 

  94. American Psychiatry Association Committee on Certification in Administrative Psychiatry. Information Bulletin for Applicants. Washington, D.C., American Psychiatric Association, 1993.

    Google Scholar 

  95. Talbott JA, Hales RE, Keill SL (Eds.): Textbook of Administrative Psychiatry. Washington, D.C., American Psychiatric Press, 1992.

    Google Scholar 

  96. Greenblatt M: The Anatomy of Psychiatric Administration. New York, Plenum Press, 1992.

    Google Scholar 

  97. Williams SJ: The integration of management education into a medical school curriculum. Journal of Medical Education 47: 234, 1972.

    Google Scholar 

  98. Talbott JA, Sacks M: Teaching psychiatric administration to senior residents. Administration in Mental Health 9: 281–288, 1982.

    Google Scholar 

  99. Rodenhauser P, Bashook PG: On education in administrative psychiatry. Administration and Policy in Mental Health 18: 285–298, 1991.

    Google Scholar 

  100. Burchell RC, White RE, Smith HL, Piland NF: Physicians and the organizational evolution of medicine. Journal of the American Medical Association 260: 826–831, 1988.

    Google Scholar 

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Authors and Affiliations

  1. Tulane University Medical Center, School of Medicine Department of Psychiatry and Neurology SL23, 1430 Tulane Avenue, 70112-2699, New Orleans, Louisiana

    Paul Rodenhauser M.D.

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  1. Paul Rodenhauser M.D.
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Professor of Psychiatry, Director of Medical Student Education in Psychiatry, and Assistant Dean of Admissions and Curriculum Management

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Rodenhauser, P. Psychiatrists as treatment team leaders: Pitfalls and rewards. Psych Quart 67, 11–31 (1996). https://doi.org/10.1007/BF02244272

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