Psychoanalysis and Therapeutic Communities

In the late 1960s, I was on a path towards psychoanalysis. At the time, it had become widely known that Kleinian psychoanalysts had been analysing and understanding psychotic people. It seemed an obvious way to work out the impact of working with such suffering. I started my own personal analysis on 5th November 1969 – an auspicious day, I wondered. At the time I thought it might fit with a certain iconoclastic streak in my personality, and I wondered what would happen to that in the course of my psychoanalysis. I started a job, in April 1969, at a psychotherapeutic unit, the Marlborough Day Hospital, in central London. ‘Anti-psychiatry’ was a buzz word then, coming from David Cooper, who had previously worked at Shenley Hospital, where I worked for 18 months (Oct 1967- March 1969), and associated with R.D. Laing, lionised in popular youth culture, and also with the therapeutic community, such as the Henderson Hospital and the Cassel Hospital (both of which I had visited in 1963 as a medical student). My concern for the old-fashioned mental hospital cultures, and their old-fashioned inmates remained. At the time, the Marlborough was in a state of change from the progressive regime of Joshua Bierer, a benign innovator (they say, back in the 1940s, the Marlborough had been the first day treatment centre in the world).

A conversation –
http//www.pettrust.org.uk/index.php?option=com_content&view=category&id=65&Itemid=191
– with David Kennard about our personal history and relationships with therapeutic communities and the old ATC is available on sthe PETT website. This is was conducted as a blog under the auspices of the PETT Archive, and its archivist, Craig Fees.

1973 A community treatment model
Bulletin of the Association of Therapeutic Communities 6
This was a discussion paper given to the staff of the Marlborough Day Hospital, that took TC principles and attempted to understand them in psychoanalytic terms, but especially in the terms used to apply psychoanalysis to organisations. It relied heavily on Elliott Jaques.

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From 1969. I was involved in importing therapeutic community ideas to the Marlborough, in collaboration with Roger Hobdell who had worked at Claybury Hospital with Elizabeth Schoenberg one of the first generation of those who opened up the large mental hospitals. I made a number of contributions over the years to the work of the therapeutic community movement, including founding the International Journal of Therapeutic Communities in 1980, with the strong support of David Clark (at Fulborn Hospital) another of the very early pioneers of the new psychiatry, and community care.

1975 – (with Sheena Grunberg) The large group syndrome
Group-Analysis 8 republished in Hinshelwood and Manning (eds) 1979
The Association of Therapeutic communities in the 1970s held thrice-yearly meetings circulating from one therapeutic community to another. And this paper was one given at a meeting hosted by the Marlborough Day Hospital, and written with a clinical psychologist about our work in the community meetings which were examined in terms of group analysis and drawing on Pierre Turquet’s work.

1979 Therapeutic Communities: Reflections and Progress
London: Routledge and Kegan Paul
This was the first book I was involved in producing. With Nick Manning, an academic sociologist at the University of Kent, and a researcher at the Henderson Hospital, we edited a collection of papers and Chapters on Therapeutic Communities as they had developed up to that point. The Therapeutic Community originated during the Second World War, and had blossomed during the 1950s and 1960s. By the 1970s it was, like many post-war initiatives, beginning to become a little stale. One reviewer hailed the book with the headline, ‘Have you heard it all before’. The intention however was to represent Therapeutic Communities as a solid achievement, and to reinvigorate the ideas which should persist into the future. A kind of taking stock at that point, and gathering force for the next step. Indeed this is rather what happened, even though the social context was turning against radical experiments, and became slowly more hostile towards psychotherapeutic methods as more and more drugs developed, were marketed, and gave the impression of answering all psychiatric problems. In fact drugs have not given all of the answers, and Therapeutic Communities remain vibrant as the treatment of choice for certain very difficult (though not uncommon) patients who cause disruption to most psychiatric services, and disheartenment to most mental health workers.

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The Journal we founded for the ATC in 1980 was partly on the strength of that book edited by Nick Manning and myself in 1979, a collection of Chapters by old and new colleagues in the area of therapeutic communities. This came a few years after the Association of Therapeutic communities was founded in 1973.

1980 Seeds of disaster
International Journal of Therapeutic Communities 1 181-188
In 1978 the Marlborough Day Hospital therapeutic community closed (though the whole unit remained in a different form). I was exercised by the closure and wanted to understand what organisational dynamics (if any) led to the demise of an active and well-known service. I tried to trace internal flaws, particularly to do with unresolved conflicts about authority, which proved in the long run to be fatal.

* * * *
I had left the Marlborough Day Hospital therapeutic community in 1976, to take up a Consultant post at St Bernard’s Hospital, Ealing. I continued to make contributions on therapeutic communities, and continued reflecting on therapeutic communities through supervision work, ultimately to write my own book, in 1987.

1982 Complaints about the community meeting
International Journal of Therapeutic Communities 3 88-94
Throughout my work at the Marlborough Day Hospital (1969-1976), I remained interested in the dynamics of community meetings,  not just as vehicles for a democratisation, and what ultimately became known as user-involvement, but as large groups with their characteristic negative affects.

1979 Demoralisation in the hospital community (Paper given to Napsbury Hospital Staff) .  Published in Group-Analysis 11 [re-published in Hinshelwood, R.D. (2000) Thinking about Institutions.  Loondon: Jessica Kingsley]
In the late 1970s, I became interested in the dynamics of the whole organisation, St Bernards being a very large group of thousands of staff plus inmates. This paper was about the distinctly quirky kinds of phenomena that occurred in these highly institutionalised old places.

1982 Models of demoralisation
(Paper presented at 4th Windsor Conference: Anglo-Dutch Workshop on Therapeutic Communities, September 1982)
Published 1988 British Journal of Psychotherapy 5 218-227
This was another attempt at understanding the disaffection of the therapeutic community at the Marlborough Day Hospital, and the way that demoralisation became endemic, and the organisation caught in a rut it could not extricate itself from.