Community, Culture and Change – serie

Tackling the difficult issues facing those who work with traumatized and sometimes dangerous young people and their families, this new volume shows how professionals can bring about positive change and growth through the creation of "holding" and healing therapeutic environments. This collection of papers written by established and respected experts with extensive practice and research experience builds a powerful picture of the theory and practice of therapeutic community work with young people. A wide variety of therapeutic community approaches is considered alongside an analysis of the implications of this model for mainstream residential practice. Social work, health care and education professionals will find the text invaluable for its presentation of a well-founded analysis of their work with these most damaged and desperate children and young people.

This guide for setting up a clinical service in the National Health Service is based on the author's experience of leading a nationally funded project to develop two new specialist services in different parts of the country and involving three separate NHS Trusts.The project successfully delivered two services for personality disordered patients based on the template of Henderson Hospital, a democratic therapeutic community (TC). Kingsley Norton takes the reader, step-by-step, through the entire process of setting up these new services. Unpacking Henderson Hospital's complex interpersonal environment into its ideological, 'cultural' and structural constituents, a development team that included ex-service users from Henderson used these ingredients to imprint the TC model in the newly recruited staff teams. The two replicated products were further supported and evaluated by the development team during their first 18 months of operation. The author reveals the complexity of the developmental task and shows that the process was never a case of 'just adding water'.Dr Norton's wealth of hands-on experience and practical advice makes this book essential reading for anyone interested in management and the NHS or public services and attempting to innovate. It is also useful for those wanting to understand more about TCs and how they operate as institutions.

This book gives extensive coverage to work by staff at the Cotswold Community, a therapeutic community of working with the psychodynamic principle, from 1994 to 2000.It Covers every aspect of the therapeutic way of working in great detail and gives good examples of practice and theory. It also lays out the principles that underpin way of working within a therapeutic environment.'- Children Now'Trauma for many, is a fact of life. But is the right kind of human environment, so too is recovery.'- Attributed to Paul van Heeswyck from the foreword'The text draw on the author's experience and wealth of material from staff discussions.The therapeutic framework is applied to this client group and integrated into all aspects of their care. The additional material on child-adult, staff-dynamics, supervision and management, will be of great interest to a wide range of residential staff, social workers, foster carers, therapists and educationalists caring for or working with emotionally needy children and young people.'- Community CareBased on work carried out by staff at the Cotswold Community over a number of years, Therapeutic Approaches in Work with Traumatized Children and Young People provides a clear and comprehensive link between theory and practice. The author shows how practice in residential child care, fostering and other areas of work with children can be developed in a way that is thoughtful and underpinned by a sound theoretical base.Meeting weekly to discuss and review their therapeutic practice in the light of relevant theoretical approaches, the staff at the Cotswold Community produced an invaluable record of working with emotionally traumatized children. The result, brought together here by Patrick Tomlinson, is an in-depth account of a "thinking culture" which provides continual opportunities to respond to children's needs in innovative ways - these include useful suggestions on a range of key issues including education and play, primary provision, sexuality and aggression.

HMP Grendon hosts the UK's only prison-based therapeutic community, inhabited by around 200 residents, almost all convicted of crimes against the person, and about half of whom have killed. This is an inside account of the work, and the theory behind the work, carried out at a prison which not only exemplifies the best in prison philosophy, but also a pioneering approach to the treatment of psychopaths.Previously the Director of Therapies at Grendon, Mark Morris provides a unique insight into the work of this experimental prison regime. He tracks its history from the 1950s, and describes how its approaches have evolved over the decades. He explores Grendon's status as a provider of a psychological therapy, and positions its treatment process as a therapeutic community, explaining why this approach is so appropriate and effective for helping prisoners with personality disorders, and how the prison environment can help in the rehabilitation of offenders.

Asylum to Action offers an alternative history of a libertarian therapeutic community at Paddington Day Hospital in West London in the 1970s. Helen Spandler recaptures the radical aspirations, as well as the conflicts, of the early therapeutic community movement, radical psychiatry and the patients' movement.The author's account of the formation of the Mental Patients' Union, the first politicised psychiatric survivors group in the UK, raises questions about the connections between the service user movement, therapeutic communities, critiques of psychiatry and psychoanalytic models of intervention. In particular, Spandler challenges Claire Baron's dominant account of the subject in her influential book Asylum to Anarchy. She points out that some of the key difficulties that beset Paddington Day Hospital persist in modern therapeutic community practice and, indeed, in mental health services in general. Arguing that these dilemmas require sustained attention, Asylum to Action also informs a wider analysis of the significance of social movements, social action and critical social theory.

Children and Adolescents in Trauma presents a variety of creative approaches to working with young people in residential children's homes, secure or psychiatric units, and special schools. The contributors describe a wide range of approaches, including art therapy and literature, and how creative methods are applied in cases of abuse, trauma, violence, self-harm and identity development. They discuss the impact of abuse and mistreatment upon the mental health of 'looked after' children, drawing links between psychoanalytic theory and practice and the study of literature and the arts. This indispensable book provides useful insights and a fresh perspective for anyone working with traumatised children and adolescents, including social workers, psychotherapists, arts therapists, psychiatrists, counsellors, psychologists and students in these fields.

Mental health services tend to view and treat mental health problems in an individual-centric way. This book argues for an alternative route to recovery that is cognizant of our social nature, needs and difficulties. Focusing on the therapeutic value of meeting others with similar experiences, it explores how mutual support can help ease the distress of mental health problems and foster emotional and psychological wellbeing.The author provides an overview of the theory, history and processes of mutual support, including how it can be understood from a developmental perspective and its importance in normalising and validating experiences and lessening feelings of isolation. She provides in-depth summaries of various approaches that harness mutual support including group therapy and therapeutic communities. Clear guidance is given on how to access, set up and facilitate mutual support groups, along with detailed information on services and organisations that utilise mutual support in the UK and beyond.This book will provide both mental health professionals and those experiencing mental health difficulties with essential information on mutual support, and the positive impact it can have on people's lives.

Beginning with their first meeting in 1956 and ending with Maxwell Jones' death in 1990, A Life Well Lived follows the growth of a friendship between two key figures in social psychiatry and tracks the evolution of therapeutic communities from their experimental beginnings to the established practices that exist today. As a close friend and frequent collaborator, Briggs is able to recount in detail Jones' revolutionary work in mental hospitals, prisons, communities and schools, and offers a rare and engaging insight into the mind of one of the most important pioneers in the therapeutic community field.

Therapeutic communities provide, in addition to safe accommodation and twenty-four hour care, a highly structured environment with set rules and timetables. Within this environment they establish a set of relationships and meetings that provides a safe emotional container for distress. Members play an active role in all decisions affecting them, which can include voting on the admission and discharge of other residents, allocating daily domestic tasks to all members of the community, and holding members accountable for the breaking of rules. The range of institutions included in the term 'therapeutic communities' means that each community is unique and adapted to the particular needs of its residents.This comprehensive introduction to the nature and work of such communities sets them within their historical and social context, looking in detail at the influence of leaders in the field, such as Maxwell Jones, to create a backdrop against which current practice can be viewed. The author examines communities specifically aimed at certain sectors of society, including drug abusers, offenders, those with a diagnosed mental illness and people with a severe personality disorder. The second part of the book describes the day-to-day running of a therapeutic community and the responsibilities, rewards and anxieties experienced by members of staff.

Examining the tradition of therapeutic communities, their principles and their context, Therapeutic Communities: Past, Present and Future is a wide-ranging introduction to both theory and practice. Including contributions by some of the most eminent figures working in therapeutic communities, the book explores the creative and original approaches of such communities to psychiatric care. It describes the historical and social backgrounds from which the therapeutic community movement has grown, and the diversity of the institutions which embrace its ideas. Good practice is discussed from different perspectives, and the contributors look forward to future developments. Their book acts as a stimulating and inspiring challenge to all those who work in the mental health field.

Concept-based therapeutic communities emerged out of the informal group meetings of Charles Dederich and a number of former Alcoholics Anonymous members in California in the late 1950s. The model was exported worldwide and has not only become the most widely used approach to residential treatment but has proved enormously influential in the development of many other treatment approaches; both residential and ambulatory. Concept-based therapeutic communities are hierarchical, and the staff and residents form a chain of command. Staff are often qualified for their work by virtue of having been residents in such a community themselves. Like other types of therapeutic community, a central tenet of the approach is the emphasis on self help and the belief in the influence of the group dynamic in facilitating therapeutic interventions.Written by academics and practitioners from around the world, this is a comprehensive overview of the development of therapeutic communities and their benefits in the treatment of drug users. Contributors describe how the model operates in the community, and how it has been modified over time to fit different settings, different types of client and different referral requirements. Illustrated by descriptions of staff and client experiences, this book also provides an inside view of how this sort of therapeutic community actually operates.This authoritative study concludes by examining the research evidence for treatment effectiveness.It will be of interest to policy makers, managers and researchers in the field of drug abuse treatment.

Northfield was referred to in tones of awe when one joined Group Relations work of the Tavistock Institute in the mid sixties, but there was never any detailed discussion, no flesh to the bones of the story. It was a mystery. Now, Tom Harrison has written of the myth and given it a substance that makes it more exciting than the myth itself... Harrison offers in his exposition of the myth a well documented, seduously researchedm gripping tale. Using his knowledge of groups, contemporary documents and personal interviews, he seamlessly unfolds the history... Harrison reaffirms in his book the importance of the ideas of Northfield but, more importantly, spells out its consequences for a democratic society.'- Organisational and Social Dynamics'Taken over as a psychiatric military hospital in April 1942, Hollymore Hospital, Birmingham, treated a large number of servicemen suffering from so-called "war neuroses" until it was vacated by the army 6 years later. It has become well known for the so-called "Northfield Experiments", the first run by Wilfred Bion and John Rickman, and the second by Michael Foulkes, harold Bridger, Tom Main and others.Tom Harrison himself worked at Northfield as a consultant psychiatrist and this study is the outcome of 15 years of dedicated research. The history of the institution is clearly a great passion and has led him to painstaking archival research, together with numerous interviews of patients and staff. The best chapters deal with theorganization and running of the theraputic community, revealing the considerable contribution of Bridger, the original work of Laurence Bradbury as an art therapist and the tensions and rivalries that existed among the psychiatrists. However, it may be that Bion and Rickman are given too much credit for theoretical innovations. This is curious as Harrison's wide-ranging study provides evidence that others played important roles, notably Delahaye in the War Office Selection Boards, Rees as Director of Army Psychiatry, and in the field of group therapy the roles of Joshua Bierer, Maxwell Jones and Foulkes are clearly documented. This is possibly a reflection of the pressure exerted by psychoanalysts to establish a position of prominence in the field of analytical therapy.Northfield played an important part in the development of group therapy and rehabilitation techniques. Its success plausibly saved the UK exchequer considerable sums in war pensions as servicemen were returned to duty rather than discharged with a disability pension. This is a readable and thorough account of the institution, its personalities and theraputic interventions.'- Psychological Medicine, Volume 31 - 2001'essential reading for anyone interested in the history of therepeutic communities in adult mental health services... a truly important book'- Thereputic Communities.The Northfield Experiments, which were conducted during the Second World War, mark an important moment in the development of psychiatry and in the therapeutic community movement. This is the first book to record the experiments in detail. Through work with soldiers suffering from neurosis, two new forms of group psychotherapy were developed. These challenged the traditional view of psychiatric patients as passive recipients of treatments. The First Experiment, conducted over the winter of 1942-43, was led by Wilfred Bion and John Rickman and emphasised the importance of the here-and-now experience, relationships within groups and the relevance of the social setting to the patient. The Second Experiment was based on more traditional psycho-analytic concepts and was evolved by Sigmund Foulkes during his work at the hospital.Bion, Rickman, Foulkes and the Northfield Experiments locates the experiments within the progress of social psychology during the early twentieth century, and the development of a new theory of military psychology.

Research is an increasing priority for workers throughout the mental health sector, and therapeutic communities are no exception. Those working in TCs increasingly have to justify the success and efficiency of their methods to outside bodies, and the prime means of doing so is through research. This volume collects a wide range of papers by experienced contributors discussing all aspects of TC research. They consider questions of which methods are most appropriate in the unique environment of TCs, how research studies affect the TC environment, as well as practical and ethical questions. The book also includes accounts of several research studies undertaken at, among other places, the Cassel Hospital. Taken as a whole, the book will be an invaluable resource for anyone involved in researching therapeutic communities - whether undertaking a study, attempting to anticipate its clinical impact, or seeking to understand the kinds of results which TC research produces.

A major question facing therapists today is how to treat psychosis effectively while maintaining patients' dignity, self-respect and, as far as possible, their psychological and social functioning. The authors of Beyond Madness have all been associated with the Arbours Crisis Centre in London, a unique facility established in 1973 where therapists and patients, or guests, live together in order to establish a space where extremes of distress can be tolerated, understood and ameliorated. This book provides important and engaging accounts of the special personal and interpersonal care offered by the Arbours Crisis Centre and kindred facilities.The authors demonstrate different ways of working with psychotic persons within individual, group and community settings. They describe the extraordinary experience of living and working at the Centre including the five stages of stay that guests invariably pass through. In addition, they discuss different strategies for intervening, especially with people who self-harm, and provide a theoretical framework for their interventions. They explore issues of power, authority and money, and show that the work of the Centre is cost-effective in comparison to other treatment modes.At a time when biological treatments predominate, Beyond Madness illustrates and argues for a humane, useful and cost-effective alternative to traditional, physical, psychiatric interventions.