Psychoanalysis and Therapeutic Communities


Marlborough Day Hospital (1969-1976)
 
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: 99-101
(Republished in Hinshelwood and Manning (eds) 1979, below)
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. With Nick Manning, an academic sociologist at the University of Kent, and a researcher at the Henderson Hospital, we edited a collection of papers on Therapeutic Communities as they had developed up to that point. The Therapeutic Community had originated during the Second World War, and 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, intending to reinvigorate the ideas which should persist into the future. A kind of stock-taking 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 a heart-sink reaction to most mental health workers.
The Journal we founded for the ATC in 1980 was partly on the strength of this book edited by Nick Manning and myself in 1979 (above). This came a few years after the Association of Therapeutic communities was founded in 1974.
 
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.
 
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.
 
1987 What Happens in Groups
London: Free Association Books
The title was not mine, and the ‘groups’ it refers to were exclusively therapeutic communities. Nevertheless, the many illustrations do in fact survey a wide range of group phenomena, not in an orthodox group-analytic way, nor in a precise Bion-Tavistock way but it does retain the use of Kleinian ideas, especially projective identification which serves as an important bridge from the individual to social phenomena. This idea spawned a notion of the internal worlds of individuals dramatised in the external figures of the group and organisation, and owes a lot to Jaques view of the ‘phantasy form and content’ of the organisation.