Welcome to a series of posts directed at young psychologists thinking about becoming managers.  Although I had a successful twenty-five year tenure as Chief Psychologist, I entered the position extremely unprepared for the managerial tasks I faced.  Hopefully, sharing my experiences will help others become better managers.

In my first post I addressed the topic of commonly held fantasies about job promotion.  In this second post, I come face to face with what it means to be a middle manager in a large organization.

I always thought of myself as Chief Psychologist, it had a nice ring and it seems parallel to various medical counterparts in the hospital. However, there was a key difference between those real docs and me – I was a hospital employee, they weren’t.

In Quebec, physicians can work in the hospital but do not work “for” the hospital in the sense that, except for certain directors, they are not paid from the global hospital budget.  As Chief Psychologist, I was more on an organizational parallel with the head of maintenance than I was with the Psychiatrist-in-Chief.  As a result, I met regularly with my administrative boss who reported through a long chain of command to the director general.  On the hospital’s organizational chart, I was a cost center manager or CCM.

I never wanted to be a “cost center manager.”  In fact, I wasn’t quite sure what such an animal did. I quickly discovered the real purpose of my job from my boss’ perspective was obvious -CONTROL COSTS!

I found this out quickly for the only things written in my agenda when I began the job were monthly CCM meetings.  Their process was quite apparent – the senior administrator would go around the table and ask about “progress.”  The latter meant cutting so-call “fat” for budgets – almost invariably the adipose tissue involved staff salaries.

The tenor of these CCM meetings differed dramatically from the regular department meetings of my own staff where I heard impassioned complaints about excessive demands, the poor quality of the offices and a meager budget for psychological testing supplies – and this was in the first staff meeting!

I quickly discovered what “middle” in middle management meant. It meant sympathizing with the underlying aspirations of both sides but invariably saying “no” or “not now” to their demands.   In short, it’s a game of balance.

Both sides were partially right, but both missed critical aspects.  For example, I often felt that upper management was often detached from the actual day-to-day work of the clinical psychologists.  To the hospital “being busy,” that is seeing lots of clients was their major metric of productivity.  Actual outcome – whether patients improved or not – seemed irrelevant.

On the other hand, psychologists trained to do therapy, and often suffering from the narcissism that can infect those who are constantly giving advice to others, had little patience for budgets or cost overruns.  They simply wanted to “do their therapy thing” and be left alone.

The psychologists’ position was understandable but wrong.  No therapy is delivered without an administrative and organizational context.  That’s something that they don’t teach in graduate school or even in internship.  Clinical training is restricted to clinical skills – be it learning how to assess or do CBT or Dialectic BT or whatever therapy.  But, that’s not the real world.  Assessment or therapy is always delivered by people who are employed by some organization with its own financial constraints and its own priorities.   Psychologists have to be taught to understand that and work with, and not ignoring, administration.

What does it mean for someone stepping into the “hot seat?”  Well, it means that you constantly have to live with two antagonistic forces.  At times, both sides will consider you as not being strong enough- strong enough to get rid of people or strong enough to stand-up to management.  My advice, don’t fall for it; wars don’t help.  It’s not a question of strength.

In my opinion, one survives by clearly stating what one is doing and why –and expressing this to both sides.  It also means living and working with people who might be unhappy with you.  Never make it personal, realize that it is largely organizational. Again, don’t expect to be loved.