Clinical and administrative synthesis in adolescent treatment: search for a sane integration of thought and action.

In working as administrator and clinician (co-director and head psychologist) of a day and residential treatment facility for disturbed adolescents, I have become acutely aware of some of the difficulties of integrating both roles. To keep rooted in the concrete, I have described the program with which I am involved in particular as to crucial client and staff dynamics. By drawing on concepts from systems theory (as system integrity and cross-boundary interactions) and psychoanalytic theory (unconscious testing), I have tried in this paper to sketch a framework for bringing the two separate roles into a single way of thinking and give some examples of how this kind of synthesized approach can be useful and powerful. The two concrete examples focus (1) on the more administrative issue of program design, and (2) on a more clinical case of child abuse.