Systems, Roles, and Relationships: Reflections from Dr. Edward Shapiro

Estimated Reading Time: 10 minutes

We live and work within systems: Every individual is shaped by and contributes to the institutions they inhabit.

Mission provides meaning: Shared values and purpose align emotional life with organizational mission.

Containment comes from reflection: Institutions must process their collective anxiety to function effectively.

Listening is leadership: Presence and empathy foster trust, cohesion, and repair.

Avoid creating “the Other”: Curiosity and compassion sustain community and prevent fragmentation.

In a deeply reflective series of lectures, Edward Shapiro, MD, Medical Director/CEO of the Austen Riggs Center, invited staff and clinicians to consider how we understand ourselves—not just as individuals, but as participants in a larger system of meaning, roles, and relationships. His talks, collectively titled An Introduction to Systems Psychodynamics, combined psychoanalytic insight with systems theory to illuminate how human emotion, organizational structure, and institutional mission intersect. You can view the presentation and receive free CE/CME credit here.

Shapiro began by challenging listeners to ask, “Who do you think is being spoken to when someone talks to you?”—a deceptively simple question that reveals how our multiple identities and roles shape perception.

Are we hearing as clinicians? As colleagues? As human beings? How do we listen through our roles?
Each of us, he explained, carries different versions of self—professional, personal, cultural, historical—and these versions affect how we hear others and how we are heard in turn.

“There’s no such thing as an individual,” Shapiro said. “We are always representing the groups and systems of which we are a part.”

This framing underscores a core systems principle: every institution is an open system, negotiating meaning between its internal community and the larger world.

Shapiro described institutions as living organisms with missions that address social needs. Those missions both reflect and shape the people within the institution. At Austen Riggs, that mission focuses on helping our patients take charge of their lives. It is anchored in relationships, respect for individuality, and the therapeutic use of community.

He emphasized that values—such as dignity, learning, and responsibility—are not static ideals but dynamic emotional forces that influence how teams respond to stress, change, and conflict.

When institutions lose sight of their values, they risk disconnection between task (what we do) and purpose (why we do it). The result, Shapiro warned, is organizational anxiety, projection, and “institutional irrationality.”

Drawing on psychoanalytic and systems theory, Shapiro explained how institutions function as containers for collective anxiety. Staff and patients project feelings into one another, and without reflection, these projections can harden into blame or idealization.

He invited participants to think about how authority, dependency, and trust are negotiated in daily work—how too much control fosters dependency, while too little containment breeds chaos.

“We are always negotiating,” he said. “Getting it wrong is inevitable—but how we use those mistakes to learn and restore trust is what matters.”

A central theme of the talk was the art of listening. Through a moving story about a woman retelling a childhood trauma, Shapiro illustrated how each repetition revealed new emotional meaning—first fear, then anger, then trust.

He urged staff to listen not just for what is said, but for how it is said—and for what is evoked in the listener.

“She was inviting me into her experience,” he recalled. “Not just to understand it with my mind, but with my presence.”

This kind of “presence-based listening,” he noted, is foundational to all therapeutic and team relationships. It transforms care from a transaction into a shared human experience.

Shapiro distinguished between relationships (personal connections between individuals) and relatedness (the larger pattern of interdependence that binds people within a mission).

In institutions like Riggs, every person represents both themselves and their role within the mission—a nurse, therapist, administrator, or clinician is always carrying the function and emotional weight of their role.

Recognizing this helps staff avoid personalizing conflict or projecting frustration onto individuals. Instead, they can ask: What function am I serving in this moment? What meaning might this interaction hold for the system as a whole?

“There’s no such thing as a patient apart from the institution,” he said. “We all enact roles that serve—and sometimes strain—the system we’re part of.”

A recurring warning throughout the talk was against creating “the Other”—the person, group, or department onto which we project unwanted feelings.

When we treat someone as the problem, Shapiro explained, we stop seeing them as part of the same human system. This psychological distancing leads to polarization, splitting, and moral certainty—the enemies of reflective collaboration.

He drew parallels between this process in institutions and the social divisions in the wider world, from political extremism to cultural exclusion.

“The moment we believe we fully know the other person,” he cautioned, “we stop being curious—and that’s where both treatment and institutions begin to fail.”

Shapiro presented a clinical team example in which conflict between a team leader and a social worker mirrored the dynamics of a struggling patient and his parents. Once the team recognized this parallel process, they were able to step back, reflect, and regain alignment around the patient’s treatment.

This case, he noted, exemplifies how systems thinking reveals the unconscious echoes of our work: what happens “between us” often mirrors what happens “within our patients.”

Reflective practice, therefore, is not optional—it’s essential for sustaining mission and morale.

Language, Shapiro said, is one of the most powerful containers we have. When painful or chaotic experiences are put into words, they become thinkable, shareable, and manageable.

Institutions that foster reflective dialogue—where staff can name tensions and explore meaning—create the conditions for growth and containment. Silence or avoidance, by contrast, allows anxiety to proliferate.

To illustrate systemic interdependence, Shapiro drew on a story about his son’s reaction to his wife’s concern about the boy’s walking near a cliff—an allegory for roles, protection, and developmental tasks. Each family role, he explained, serves the developmental mission of the family, just as institutional roles are functions of the institution’s mission.

Healthy systems allow movement between dependence and autonomy, authority and care, safety and freedom. This model, he suggested, applies equally to families and organizations.

Toward the end of his talk, Shapiro turned to the question of leadership. True leadership, he argued, is not about control but about holding the anxiety of the system—the fears, projections, and uncertainties that accompany meaningful work.

He called on Riggs staff to engage in collaborative reflection, cultivating a culture where disagreement sparks curiosity rather than division, and where everyone contributes to containing the institution’s emotional life.

“Our patients teach us how to listen,” he concluded. “But we also have to listen to what our institution is trying to tell us.”

To hear the full presentation and receive CE/CME credits, please visit the Systems Psychodynamics course page.