OPEN USING A FACIUTATOR AS A CHANGE AGENT IN SOCIAL SYSTEMS
Maxwell
Jones,
M.D.
‘
‘ ‘
.
.
‘
Dr. Jones tems. His
is a consultant in therapeutic address is 5911 East Calle
del
communities Paisano,
and Phoenix,
open sysArizona
85018. C. Argyris, Intervention Theory and Method: A Behavioral SciView, Addison-Wesley, Reading, Massachusetts, 1970. 2 M. Jones, Maturation of the Therapeutic Community: An Organic Approach to Health and Mental Health, Behavioral Publications, New York City, in press. 1
ence
198
HOSPITAL
Problems associated with status, pay, and the like would have to be worked out by the system. There are also natural facilitators’ in every organization. However, they may represent a covert threat to the authority structure and so may remain relatively invisible and ineffective. An open system encourages the emergence of both kinds of facilitators and leaders at all levels of the social organization. A facilitator is analogous to a wise parent who has assumed responsibility and authority for young children and then increasingly delegates these powers to the children as they become teen-agers. I have twice had the ultimate power in an organization, first as medical director at Henderson Hospital near London, beginning in 1947, and then as physician-superintendent at Dingleton Hospital in Melrose, Scotland, beginning in 1962. In both cases my role evolved from that of the leader with power to that of facilitator, and, in the process of change, the responsibility and authority associated with the role of the formal leader was delegated to the system as a whole. This delegation enabled me to leave the system without creating a vacuum; it is worth noting that both hospitals continue to thrive as open systems (or therapeutic communities), although it is 17 years since I left the first hospital and seven years since my departure from the latter. With our present knowledge, we still are not sure what background the facilitator should have. That is, if he is viewed as operating from within the system, can he be an effective change agent without at some time having been associated with responsibility and authority? In other words, is an apprenticeship with power an essential preliminary to being a facilitator? If the facilitator was an effective leader in the past, the qualities of responsibility and authority are still associated with his present image as a facilitator. Even though he has transferred the power into other hands, his associates’ confidence that his leadership qualities still covertly exist helps establish their trust in him as a facilitator. I believe a facilitator can be most effective if he has held a position of power that gave him an overview of the whole social organization, as well as the larger system outside the organization, and if he uses this global information to help the system help itself. “
U My experience as a change agent in social systems associated with hospitals and other mental health facilities, as well as in prisons and schools, has convinced me of the advantages of bringing about change through the role of a facilitator. A facilitator is someone who helps people to help themselves. He is not identified with any one professional discipline bringing specific knowledge and experience to an organization, as would be the case if a consultant psychiatrist is employed to help improve the effectiveness of treatment in a hospital. The facilitator is not an addition to the system from the outside, as is Argyris’s interventionist.” Argyris says, To intervene is to enter into an ongoing system of relationship, to come between or among persons, groups, or objects for the purpose of helping them. The system exists independently of the intervenor. “ In industry such a person is usually called in by the director, who feels the need for an outsider to intervene and diagnose where the system is at fault and to make recommendations aimed at eradicating the problem. A facilitator operates from within the system. Yet he is not a leader with power, as in the case of a director in industry, a principal in a school, or a medical superintendent in a hospital. He may have authority based on respect for his skills and integrity, but he avoids power and keeps a low profile. He may have been in a position of power that he has modified, or relinquished altogether, in order to operate better as a benign facilitator. This is a relatively new concept,Z and such a role is not yet part of our formal organizations. .
FORUM
a
COMMUNITY
PSYCHIATRY
‘
The transition from the role of a powerful leader to the role of a facilitator does not mean that all decisions made or all goals adopted will originate de novo from a process of group consensus. Any decision or goal that is adopted must have a point of origin. It is often the input of one individual, perhaps the facilitator; if it is meaningful to the group, it may be adopted through a process of consensus as a group goal. It is true that those inputs can be loaded in favor of the most powerful individual or individuals in the group, but if such manipulation occurs, it is as much the responsibility of the group as of the leader. Here the concept of multiple leadership is all-important: an alternate leader is always available to challenge any attempt at manipulation and turn the confrontation into a learning situation for everyone present. In my experience, the most persistent critics of the concept of a facilitator-those who see it merely as a device to achieve the appearance of shared decisionmaking without the substance-are the very people who cannot relinquish the reins of power but nevertheless like to profess belief in a democratic system. They talk about consensus and about processing information through the group, but they retain their formal power. If a risk-taking member of such a system chooses to operate as though a truly open system existed and threatens or even challenges the authority structure, he might jeopardize his job. The concept of a facilitator may have little appeal in our present world where success tends to be measured in terms of money and power. It may be more appealing if being a facilitator might also be considered being an educator. For, in the final analysis, education is basic to facilitation. The facilitator’s function is to help each individual in the group realize his latent potential in relation to the group goals.
MENTAL HEALTH PLANNING FOR CHILDREN: A PROCESS DISORDER
Paul
Lozanoff,
Ph.D.
UThe problem of planning and organizing community mental health programs for children is both simple and complicated-simple from the standpoint of understanding the problem and complicated regarding its solution. Mental health planning is circumscribed within a historically based and traditionally maintained political system that has developed with minimal cognizance of the needs of children and maximal concern for perpetuating the established system. Paradoxically, children for the most part make every effort to convince adults what they are; adults make every effort to convince them what they are not. That
Dr.
Lozanoff is assistant commissioner in the office Department of Mental Health and Mental Kenny Road, Columbus, Ohio 43221.
services, 2929
of children’s Retardation,
relationship is reflected in the social institutions established to serve children. The service is definitively vague, thoroughly perplexing, and ultimately exclusive, primarily because caring for children is a relatively new social experience that is contaminated by historic influences. Yet, since it is a new social experience, community mental health planning for children does have one unique advantage. It can wed itself to the idea of a single child advocacy system, thus ensuring a progeny that subscribes to the needs of the whole child rather than part of the child. Such a system concerned with the whole may well reduce the need for treatment of the parts. Mental health planning in Ohio is moving toward that end, but the marriage’ cannot succeed without strong “family” support. How may the courtship proceed? In Ohio the number of children under 18 years of age is close to 4 million and represents 35 per cent of the total state population. In 54 per cent of the state’s 88 counties, more than 35 per cent of the population are under 18. The basic mental health needs of the vast majority of these children are completely ignored or only partially met; the effect of such neglect needs no elucidation. The report of the Joint Commission on Mental Health of Children clearly states that From all of its studies, the Commission concludes that it is an undeniable fact that there is not a single community in this country which presents an acceptable standard of service for its mentally ill children, running a spectrum from early therapeutic intervention to social restoration in the home, in the school, and in the A significant factor in the failure to meet the needs of children is the isolation of the various state agencies. In Ohio there are at least seven agencies that address themselves unilaterally to the problems of children. There is essentially no cooperation or meaningful collaboration between these agencies either on the local or state level. Thus approximately 35 per cent of our population are without a responsible and responsive advocacy system. The institution and agencies that do provide services for children and youth who deviate from the norm are crisis-oriented for the most part and are poorly coordinated. Children and youth find little continuity or coordination of services as they are directed from hospital to clinic, from welfare to medical care to psychiatric clinic to rehabilitation program. The services fail to take into account the essential considerations involved in effective child care, that is, developmental, curative, rehabilitative, and comprehensive verage. There is inadequate linkage to normal community institutions such as schools, health-care services, recreational services, and the informal systems of peer group, family, neighborhood, and work. There is a need for new strategies that are related to action rather than reaction. ‘ ‘
‘
“
“
1
The
Child York
Joint
Commission
Mental City,
VOLUME
on
Mental
Health: 1970,
27
Challengefor pp. 6-7.
NUMBER
3 MARCH
Health
the 1970’s,
1976
of Children, Crisis In Harper & Row, New
199
Maxwell
Jones,
M.D.
‘
‘ ‘
.
.
‘
Dr. Jones tems. His
is a consultant in therapeutic address is 5911 East Calle
del
communities Paisano,
and Phoenix,
open sysArizona
85018. C. Argyris, Intervention Theory and Method: A Behavioral SciView, Addison-Wesley, Reading, Massachusetts, 1970. 2 M. Jones, Maturation of the Therapeutic Community: An Organic Approach to Health and Mental Health, Behavioral Publications, New York City, in press. 1
ence
198
HOSPITAL
Problems associated with status, pay, and the like would have to be worked out by the system. There are also natural facilitators’ in every organization. However, they may represent a covert threat to the authority structure and so may remain relatively invisible and ineffective. An open system encourages the emergence of both kinds of facilitators and leaders at all levels of the social organization. A facilitator is analogous to a wise parent who has assumed responsibility and authority for young children and then increasingly delegates these powers to the children as they become teen-agers. I have twice had the ultimate power in an organization, first as medical director at Henderson Hospital near London, beginning in 1947, and then as physician-superintendent at Dingleton Hospital in Melrose, Scotland, beginning in 1962. In both cases my role evolved from that of the leader with power to that of facilitator, and, in the process of change, the responsibility and authority associated with the role of the formal leader was delegated to the system as a whole. This delegation enabled me to leave the system without creating a vacuum; it is worth noting that both hospitals continue to thrive as open systems (or therapeutic communities), although it is 17 years since I left the first hospital and seven years since my departure from the latter. With our present knowledge, we still are not sure what background the facilitator should have. That is, if he is viewed as operating from within the system, can he be an effective change agent without at some time having been associated with responsibility and authority? In other words, is an apprenticeship with power an essential preliminary to being a facilitator? If the facilitator was an effective leader in the past, the qualities of responsibility and authority are still associated with his present image as a facilitator. Even though he has transferred the power into other hands, his associates’ confidence that his leadership qualities still covertly exist helps establish their trust in him as a facilitator. I believe a facilitator can be most effective if he has held a position of power that gave him an overview of the whole social organization, as well as the larger system outside the organization, and if he uses this global information to help the system help itself. “
U My experience as a change agent in social systems associated with hospitals and other mental health facilities, as well as in prisons and schools, has convinced me of the advantages of bringing about change through the role of a facilitator. A facilitator is someone who helps people to help themselves. He is not identified with any one professional discipline bringing specific knowledge and experience to an organization, as would be the case if a consultant psychiatrist is employed to help improve the effectiveness of treatment in a hospital. The facilitator is not an addition to the system from the outside, as is Argyris’s interventionist.” Argyris says, To intervene is to enter into an ongoing system of relationship, to come between or among persons, groups, or objects for the purpose of helping them. The system exists independently of the intervenor. “ In industry such a person is usually called in by the director, who feels the need for an outsider to intervene and diagnose where the system is at fault and to make recommendations aimed at eradicating the problem. A facilitator operates from within the system. Yet he is not a leader with power, as in the case of a director in industry, a principal in a school, or a medical superintendent in a hospital. He may have authority based on respect for his skills and integrity, but he avoids power and keeps a low profile. He may have been in a position of power that he has modified, or relinquished altogether, in order to operate better as a benign facilitator. This is a relatively new concept,Z and such a role is not yet part of our formal organizations. .
FORUM
a
COMMUNITY
PSYCHIATRY
‘
The transition from the role of a powerful leader to the role of a facilitator does not mean that all decisions made or all goals adopted will originate de novo from a process of group consensus. Any decision or goal that is adopted must have a point of origin. It is often the input of one individual, perhaps the facilitator; if it is meaningful to the group, it may be adopted through a process of consensus as a group goal. It is true that those inputs can be loaded in favor of the most powerful individual or individuals in the group, but if such manipulation occurs, it is as much the responsibility of the group as of the leader. Here the concept of multiple leadership is all-important: an alternate leader is always available to challenge any attempt at manipulation and turn the confrontation into a learning situation for everyone present. In my experience, the most persistent critics of the concept of a facilitator-those who see it merely as a device to achieve the appearance of shared decisionmaking without the substance-are the very people who cannot relinquish the reins of power but nevertheless like to profess belief in a democratic system. They talk about consensus and about processing information through the group, but they retain their formal power. If a risk-taking member of such a system chooses to operate as though a truly open system existed and threatens or even challenges the authority structure, he might jeopardize his job. The concept of a facilitator may have little appeal in our present world where success tends to be measured in terms of money and power. It may be more appealing if being a facilitator might also be considered being an educator. For, in the final analysis, education is basic to facilitation. The facilitator’s function is to help each individual in the group realize his latent potential in relation to the group goals.
MENTAL HEALTH PLANNING FOR CHILDREN: A PROCESS DISORDER
Paul
Lozanoff,
Ph.D.
UThe problem of planning and organizing community mental health programs for children is both simple and complicated-simple from the standpoint of understanding the problem and complicated regarding its solution. Mental health planning is circumscribed within a historically based and traditionally maintained political system that has developed with minimal cognizance of the needs of children and maximal concern for perpetuating the established system. Paradoxically, children for the most part make every effort to convince adults what they are; adults make every effort to convince them what they are not. That
Dr.
Lozanoff is assistant commissioner in the office Department of Mental Health and Mental Kenny Road, Columbus, Ohio 43221.
services, 2929
of children’s Retardation,
relationship is reflected in the social institutions established to serve children. The service is definitively vague, thoroughly perplexing, and ultimately exclusive, primarily because caring for children is a relatively new social experience that is contaminated by historic influences. Yet, since it is a new social experience, community mental health planning for children does have one unique advantage. It can wed itself to the idea of a single child advocacy system, thus ensuring a progeny that subscribes to the needs of the whole child rather than part of the child. Such a system concerned with the whole may well reduce the need for treatment of the parts. Mental health planning in Ohio is moving toward that end, but the marriage’ cannot succeed without strong “family” support. How may the courtship proceed? In Ohio the number of children under 18 years of age is close to 4 million and represents 35 per cent of the total state population. In 54 per cent of the state’s 88 counties, more than 35 per cent of the population are under 18. The basic mental health needs of the vast majority of these children are completely ignored or only partially met; the effect of such neglect needs no elucidation. The report of the Joint Commission on Mental Health of Children clearly states that From all of its studies, the Commission concludes that it is an undeniable fact that there is not a single community in this country which presents an acceptable standard of service for its mentally ill children, running a spectrum from early therapeutic intervention to social restoration in the home, in the school, and in the A significant factor in the failure to meet the needs of children is the isolation of the various state agencies. In Ohio there are at least seven agencies that address themselves unilaterally to the problems of children. There is essentially no cooperation or meaningful collaboration between these agencies either on the local or state level. Thus approximately 35 per cent of our population are without a responsible and responsive advocacy system. The institution and agencies that do provide services for children and youth who deviate from the norm are crisis-oriented for the most part and are poorly coordinated. Children and youth find little continuity or coordination of services as they are directed from hospital to clinic, from welfare to medical care to psychiatric clinic to rehabilitation program. The services fail to take into account the essential considerations involved in effective child care, that is, developmental, curative, rehabilitative, and comprehensive verage. There is inadequate linkage to normal community institutions such as schools, health-care services, recreational services, and the informal systems of peer group, family, neighborhood, and work. There is a need for new strategies that are related to action rather than reaction. ‘ ‘
‘
“
“
1
The
Child York
Joint
Commission
Mental City,
VOLUME
on
Mental
Health: 1970,
27
Challengefor pp. 6-7.
NUMBER
3 MARCH
Health
the 1970’s,
1976
of Children, Crisis In Harper & Row, New
199
