The Briar Patch:  Thorny Challenges for Directors

Functionally Dysfunctional: Where’s the Payoff?

Vic Pantesco, Ph.D.

The Thorn

There is no such thing as a “dysfunctional family” or organization, or system, or couple, or individual, or clinic, right?  If you doubt that, just try to change it.  All the parts are usually well honed and practiced, functioning as usual.   Whether or not the system is healthy is another matter.  And as we well know, just announcing that sacred, unassailable label “dysfunctional” doesn’t get us anywhere except for some comforting commiseration maybe from those of like mind as we are in the assessment. 

   At times I have observed some clinic cohorts to be on the weightier end of the “dysfunctional” spectrum.  It’s similar to when I taught in high school and faculty fairly collectively regarded whole classes as having a personality.  In the non-clinical diagnostic inquiry: “what is it with this group?”  That may be the right question but may lead up a wrong tree in response. 

To Ease the Pain

In both therapy practice and directing a clinic, I really enjoy challenging folks with a basic fact of organic human life: the brain does NOTHING without a perceived payoff.  It never sleeps in this pursuit.  If we turn in our sleep, the brain and body have decided that’s a better payoff than the previous posture.  We did not need behaviorism to discover this. 

   An example in the clinic:  I notice that too many clinicians are not diligently entering notes and other data into the case management program.  This creates headaches of various stripe and vigor.  As time passes and this continues, conversations with selected individuals, yielding little or no progress in the desired direction, I once again seek my dark chocolate stash and other comforts.

   But consider this: taking the matter to a team meeting and instead of berating, pleading, shoulding, or threatening – I speak from experience with these - we offer instead:  “I have noticed that there is much not being put into the case management system as required.  I am convinced it is because the payoff or benefit to neglecting this duty outweighs the benefits of compliance.  What are these payoffs and how might we shift the balance?”  This allows for even deeper access to the team’s dynamics but through a much safer, graded pathway.  Regardless of what we may call the formulation or its enactment, it seems, at least for me, to have a much bigger payoff than the other tactics.