Leadership in Group Practice
The paper has as yet analyzed clinical leadership in general as well as in organizational contest. There are two other cases that remain which apply to the therapists: physicians or therapists in a group practice, and solo therapists with a private practice. The latter will be analyzed in the following section. However whiever the case might be one thing is common to both of the practices: the entrepreneur tendency.
While this is not required for every physician in a group practice, the individual who is appointed as a leader must be aware of the business aspect of things. He should not only have strong ideas and creativity, but should also have a future oriented attitude and a sting judgment. Presently there are an overwhelming number of physicians who for various reasons have opted for practicing in groups. This has brought about the issues of leadership, which in the absence of the formal guidelines present in an organization, might prove to be tricky issue.
Richard Burton (1997), in his book examines such cases focusing on the challenges faced by such a group of physicians, method for selection of leaders, cost effectiveness, efficient running of the practice, leadership skills needed, and the job requirements
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He however points out towards the modern day trend where the solo practices and even small two-three physician-practices are seen to be waning away. This means that the existing group practices are not quite as informal as they were in earlier days. Hence, for group practices to fulfill the role expected out of them, their leaders must be able to deal effectively with a number of diverse challenges (Burton, 1997, p 71). It is obvious that leadership in case of a therapy lies in the hands of the psychiatrist or the therapist because of his medical background.
In addition to this he also has to be concerned with the social and legally recognized responsibilities of for the treatment he is performing. Clinical psychologists on the other hand find themselves in the leadership position because of their preoccupation with research on the different investigative approaches on how and what treatment to perform. In addition to this, the leadership is due to the competence of the person and just because of his or her professional associations, even though they are important from the business point of view (Shakow, 2006, p. 182).
Therapists generally resist from seeing themselves as leaders, yet effective leadership is crucial. This is because a therapist who is not in command of the therapy is not ht leader of the therapy. This may be either because the therapist may have been in charge for a while but let the leadership slip or that the therapist may not have been in charge of the therapy ever. However, one fact is clear that without an effective leader, the consultation and hence the treatment suffers.
While both therapist and patients are ambivalent towards authority figures, recognizing a need for consultation itself is a clear first step towards leadership and hence progress in therapy (Kramer, 2000, p. 222). It might happen that the patient gets restless during the course of therapy and might even request for a second opinion to check the course of treatment. In such cases the response of the therapist becomes all-important. Becoming defensive in such cases or not at all heeding to the request is a clear sign of a person who is uneasy with his authority being challenged.
Such a person might resent criticism and resents being exposed. However, a therapist who welcomes such a request and manages anxiety, is acceptable to criticism and is comfortable to share leadership is open with authority. This is indirectly an assertion of leadership, and once this is done the therapy moves forward (Manthei, 1997, p. 155). It can hence be concluded that therapy is directly related to leadership. When leadership is weak therapy falters. When leadership is autocratic, success of therapy is limited.
When the leadership is empathic and confident the therapy successfully moves forward. To bring about change, good leadership is more important than theory or technique (Kramer, 2000, p. 222). However, the conscious of leadership is almost negligible in clinical field. However, as is seen in above, the theory and its necessity is implied in therapy. Leadership is not discernible when a therapy is going smoothly. Exchanges and sessions seem to be seamlessly blended into each other without a break or pause.
And during this entire occurrence, like in any other field, leadership cannot be recognized by observation, though it is very clearly implied. The alternative consultation, which was described above, usually occurs in therapy when the patient feels a loss of leadership though this is not explicitly stated. When such a breakdown occurs, the leadership dynamics come into picture. After such a scenario, the leadership is resumed through either co- or multiple-leadership scenario, thought the therapist still remains as one of the leaders (Kramer, 2000, p. 223).
According to some of the therapists, the need for good leadership is evident, though some other therapists do not think so. Many of the therapists do not consider themselves as leader and reject the whole theory. Many of the patients too do not believe in the leadership scenario. Such patients feel that they are working with the therapists instead of following them. This attitude on the part of both the therapist and patient does not show a lack of leadership.
On the contrary they show a presence of a particular style of leadership, where the leaders and followers join together to achieve goals. From the type of theories, which have been so extensively described in the sections earlier, the best fit for this scenario is probably the participative leadership theory. The leadership in this case involves accompanying, joining, facilitating, enabling, reflecting and enabling (Kramer, 2000, p. 224). As is seen above, autocratic and laissez-faire type of leadership does not prove to be very successful in this case
Kramer in his book Therapeutic Mastery: Becoming a More Creative and Effective Psychotherapy has painstakingly analyzed the organizational leadership and tried to fit the principles of therapy in this. He has extensively studied the principles of organizational development and leadership. He has come to the conclusion that leadership in the field of therapy is just as important and similar to organizational leadership. He says that the main reason why therapists consider leadership as not applicable to their field is because they are thinking about authoritarian style of leadership.
However, being at the other end of the spectrum is not completely good either. Therapists who behave as completely egalitarian leaders are just as unsuccessful because they have an excess of ideas and but cannot convince patients of any of these ideas (Kramer, 2000, p. 228). Hence Kramer gives yet another type of leader the therapists to be: nurturant leader. Such a leader wants everyone to be happy and gets personal satisfaction from his work. Such leaders encourage follow-up of the ideas and expects loyalty and friendship in return.
Structure is like an inverted pyramid and with the leader at the bottom, connected to and supporting others. While the people are productive here, they get burnt out easily and are depressed and uneasy. However, the patients feel closest to such type of therapists because of the very close relations they have with their therapists (Kramer, 2000, p. 229). According to Kramer, each leadership style has its own effectiveness and drawbacks, and a successful leader is one who is not locked into one style but flexibly and appropriately uses the strengths of each, integrating them and shifting effortlessly.
As the circumstances change, a successful therapist changes style to serve their needs (Kramer, 2000, p. 230). This type of change in leadership style was discussed above, in the contingency theory of leadership. The leadership style is considered to be effective and has faced many successful empirical research experiments. The environment in any field is dynamic, and this is true for therapists also, who face different patients, who during the course of their counseling undergo different phases, each requiring the therapists to treat them differently.
Kramer in his book Therapeutic Mastery: Becoming a More Creative and Effective Psychotherapy has also analyzed around 17 therapists each of whom followed various leadership traits. He found that the results were absolutely disappointing with very less number of members showing any type of positive results. In contrast with this he found that the group led by fellow therapist Bob Goulding showed very high levels of success. Bob used participative type of leadership and gave equal responsibility of improvement to his patients, followed moderate level executive functionality.
He also stimulated the members with a moderate intensity of emotional involvement (Kramer, 2000, p. 231). Leadership in therapeutic groups has also been studied from the gender point of view. This is because of the tendency to respond differently to men and women leaders. Researchers such as Greene examined group members’ perceptions of male and female therapists in co-led groups. They found that although the therapists have very little difference in their therapeutic skills and qualifications, male co-leaders were perceived as significantly more potent, active, and insightful that female co-leaders.
Researchers say that leadership and gender expectation are both prescriptive and descriptive. Thune also examined various co-leaders in different psychotherapy groups and found that gender was a more important determinant of status than either professional experience or professional affiliation. These studies suggest that such gender stereotypes may cause status problems for women. To overcome these problems, many women work initially with a male co-leader (Hogg, Tindale, 2001, p. 640). Maxwell Jones gave the principle of multiple-leadership in the therapeutic community.
In this theory various member sled the group at different times, using their different styles for different purposes. During the course of counseling a patient too the concept of shared leadership, albeit in controlled amount, is necessary. This is seen with Bob Goulding’s group, which showed much superior performance than any other group following different leadership traits. Kramer feels that multiple leadership, if it carried out properly is far more effective and richer than being a sole leader of any kind (Kramer, 2000, p. 231).