
About Me
I have organised this ‘professional biography’ into stages of my life, linked to where I was working.
Each stage begins with the new ideas that I developed at the time or the innovations I was responsible for creating.
There follows a more lengthy description of the circumstances that led to these.
- 1975 to 1986; St Charles Youth Treatment Centre
- 1983 to Date Private Work as Organisational Consultant
- 1983 to Date Expert Witness - Complaints
- 1987 to 1988 Family Welfare Association
- 1988 to 1991 Assessment Services, Royal Borough of Kensington & Chelsea
- 1994 to 2012 Adult Department, Tavistock & Portman NHS Trust
- 2012 to Date Private Practice including Philip Stokoe & Associates
Achievements & Innovations
1975 to 1986; St Charles Youth Treatment Centre
Idea 1.
Boundaries are where the work happens.
In all psychological, therapeutic work, the most important part is the unconscious communication between patient and clinician. These processes have been described as transference, counter-transference, projective identification and so on. My discovery as I describe (in a paper to be attached soon) is that ...
This realisation led me to develop a model for therapeutic work that is based in an ethical approach that is different to the simple ‘right and wrong’ assumptions of current complaints procedures. The subsequent ‘innovation’ is summarised under the Family Welfare Association section.
Idea 2
Secure Therapeutic Environment , in which Walls are Replaced by Relationships.
- The containment provided by a secure building is artificial and the only security it offers is for the public, not the young person
- Security for the young person derives from that sense of containment in ...
This led to the concept of a secure therapeutic environment in which walls were replaced by relationships.
And it worked.
Idea 3.
Role of the Teacher
The learning of the student is the responsibility of the teacher, not the learner.
The best teachers prepare their lesson and then locate themselves alongside the students during the delivery so that they can understand how the student is engaging ...
Idea 4.
The hierarchy of decision-making.
Healthy organisations pass authority (to make decisions) downwards and receive anxiety upwards in the knowledge that all work has an unconscious impact on the worker that manifests as anxiety but can be turned into information through the process of a benign enquiry.
This works ...
- The best organisations benefit from the delegation of authority to make decisions to the lowest sensible level.
- This only works if the person given this authority is expected to provide an account for his activity to his manager.
- This only works when the manager is committed to a benign enquiry; this is because all accounts deliver both a conscious component and an unconscious one, the latter is always in the form of anxiety.
Innovation 1.
The creation of a relationship-based alternative to young people's prisons.
The security that initially came from the buildings and locked doors became a dynamic sense of security based upon staff offering and young people gradually accepting a sensitive, emotionally-based relationship informed by psychoanalytic understanding of the conscious and unconscious process that are constantly at play both between and within ...
This was based upon the staff group holding and sharing a deep understanding of all the ideas described above. For example, once you understand how important boundaries are, you feel confident about taking very seriously the smallest assault on them; not to seek to punish the young person but to seek to understand what is really going on at a deeper level.
At the start of the 'experiment', violent confrontation was common place at the end it was very rare.
Background development
Following on from the case of Mary Bell, a child who killed other children (ref) an inspired Social Services Inspectorate came to the view that there are likely to be a significant number of children who commit violent crimes but might benefit from a therapeutic regime which would be highly preferable to being committed to the prison system where the recidivism rate was known to be very high. They purchased a site in Brentwood, Essex which had been designed as an approved school, and made it more secure. Then it was handed over to a Director who was a consultant psychiatrist and staff drawn from teaching, nursing and residential social work; all of whom were expected to have a grade equivalent to charge nurse ...
The first attempt closed within a year and the focus on the model moved from psychiatric towards therapeutic. When I arrived as part of the second attempt (1975), the Director was Treve Edwards, whose background was approved schools. I still use him as the best example I’ve ever worked with of an inspired senior manager.
……..
The first attempt closed within a year and the focus on the model moved from psychiatric towards therapeutic. When I arrived as part of the second attempt (1975), the Director was Treve Edwards, whose
In 1978, just as I was preparing to follow the hippy trail to India, the job of manager of one of the therapeutic houses came up. One of the advisory staff, our Consultant Psychiatrist, ? – who almost immediately left, suggested I should apply and for reasons that I don’t understand I did. To my immediate shock and subsequent horror, I was successful. I have written in my book about what happened next (ref) but the point of this brief biography is how this led to my first innovation. It was the job of the senior staff to build a model of how to work with these young people. I was helped enormously by following another senior colleague’s advice and getting a training in organisational consultancy at the Tavistock Clinic. Here I discovered the ubiquity of projective identification and developed and understanding both of it’s potential power (put simply: you cannot exaggerate the power of PI). My colleagues at St Charles made me realise that I had a special skill for conceptualisation; I discovered that I was able to understand very complex ideas and convey them in a digestible and helpful form. Gradually it fell to me to draw together what would become the model for how to work with these difficult adolescents.
Projective Identification
- Can’t exaggerate the impact
- Consequence is that the closest approximation to truth about a client is the narrative that takes every staff member’s view as accurate.
Containment and security
- The containment provided by a secure building is artificial and the only security it offers is for the public, not the young person
- Security for the young person derives from that sense of containment in which they feel cared about and are the object of a benign enquiry.
- This is a dynamic containment; breakages are always capable of repair and the repair always provides an opportunity for growth (on both sides).
This led to the concept of a secure therapeutic environment in which walls were replaced by relationships.
And it worked.
Teaching
- The best teachers prepare their lesson and then locate themselves alongside the students during the delivery so that they can understand how the student is engaging with and understanding the material
- The worst teachers prepare their lesson and then keep it between themselves and the students so that it becomes the student's responsibility how much they can learn and the teacher feels personal attack when the student rejects their lesson.
The consequence is a principle that I have taken into every aspect of my work, the principle that the learning of the ‘student’ (or client or patient) is the responsibility of the teacher (or consultant or therapist).
Decision-making
- The best organisations benefit from the delegation of authority to make decisions to the lowest sensible level.
- This only works if the person given this authority is expected to provide an account for his activity to his manager.
- This only works when the manager is committed to a benign enquiry; this is because all accounts deliver both a conscious component and an unconscious one, the latter is always in the form of anxiety.
So, I discovered the principle which would become the centre of my model of the Healthy Organisation Model; namely that health organisations pass authority (to make decisions) downwards and receive anxiety upwards in the knowledge that all work has an unconscious impact on the worker that manifests as anxiety but can be turned into information through the process of a benign enquiry.
This model, which has been refined and developed over the years has been the basis for all my work.
I was helped towards this model by the observation and the relationship with Treve Edwards, the Director of St Charles Youth Treatment Centre, who provided this sort of leadership as part of his personality.
The Youth Treatment Centre functioned very well, violent incidents were reduced to a rarity because staff knew that they would be backed in their decision-making about the work with the young people, especially when they were able to sense the unconscious communication from the residents and, therefore, act to provide containment before the adolescent in question was forced to escalate his behaviour in an attempt to be heard and held.
However, this required a sophisticated level of work and that depended upon experienced staff. Margaret Thatcher considered the cost of this ‘so-called expert’ opinion too much and was convinced by people like Masud Hoghughi, who ran an approved school called Aycliffe Centre for Children on behalf of County Durham, that a behaviour modification programme would work just as well but didn’t need staff to be so highly trained because they would be following a behavioral plan. This led to the setting up of a sister Youth Treatment Centre, called Glenthorn, in Birmingham that was set up to follow Hoghughi’s model. It also meant increasing pressure on St Charles to reduce costs. I might, at a future date, described the consequences of this for both YTCs but, for now, this is simply about my ideas and innovations and I shall leave it here that my experiences led to the innovation of an alternative to prison for young people that could be described as a way of working in which relationships between staff and young people provided both security (replacing the security apparently provided by the physical building) and the conduit for therapeutic treatment based on a psychoanalytic understanding of the mind.
Idea 5
Primary Care General Practice works better when all staff feel connected to the therapeutic/clinical process.
Often the different jobs of the different members of staff, although clear in terms of job description, aren't lodged in a shared conception of the structure that links everyone to the main ...
Innovation 2
The Healthy Organisation Model
This is my version of the ideas I was taught during my training a the Tavistock, especially influenced by Elliott Jaques, Isabel Menzies Lyth, Eric Miller and the founders of the ‘Tavistock Consultancy approach, based in a combination of psychoanalytic and systems theories. It developed from my lived experience of the work and my discovery of the need always to start an understanding of anything at the beginning (see under the ‘Expert Witness’ section). You will find a paper about this model here x and ...
Innovation 3.
The Short Course Intervention.
A combination of training and consultation that can be delivered in different forms, although the best is through a series of 10 weekly meetings, each divided into two sections by a break of a minimum of 20 minutes. The section before the break is a lecture ...
Background
As a result of very helpful advice from two senior colleagues, Kabir Padamsee (Consultant Psychiatrist) and the Consultant Clinical Psychologist Tony Collins, I applied for and was accepted on the Advanced Course in Consultancy and Training in Mental Health (Tavistock Clinic) (1981-1983). It was this experience that taught me first about projective identification as I described in my book.
My ...
Although I found the training at the Tavi very stimulating and wonderfully helpful, over the years I have found myself developing other ideas about both the scientific basis for organisational consultation and the means of delivery. I shall be writing about
these differences on other pages of this website later. This section is supposed to be about innovations.
It wasn’t long before I realised that many of the staff of organisations to which I consulted could not really use the consultation. It seemed clear to me that this was because there was no shared idea of what makes a human being and particularly how the conscious mind of human beings is created. I discovered that I was spending more time at the beginning of consultations teaching the clients about a psychoanalytic way to understand human beings, so it occurred to me that a more useful intervention might be to build in a teaching part into a consultation.
I developed a model for combining teaching and consultation.
of the change from being in the role of the tutor to being in the role of consultant for the second part of any consultation event. In other words what I was offering was an intervention, usually weekly, usually lasting 10 weeks, divided into 2 sessions on each occasion; the first being the teaching, the second an open group discussion that had no agenda and allowed me to understand what might be going on in the team or organisation to whom I was consulting.
I called this “what makes the work so difficult?” And began to use it in almost all of the work that I was doing which was essentially care work provided in a range of environments. Meanwhile I had started training to be a psychoanalyst with the British psychoanalytical Society and one of my fellow students, Marilyn Lawrence, was interested in my model for consultation and thought that it might be possible to set something up in the adult Department of the Tavistock clinic.
1983 to Date Expert Witness consultant to people going through complaints procedures.
Idea 6
Formula to complaint
”You never told me you were going to …”
Those who complain describe something ‘that has happened at a certain point in time’. This is usually experienced so powerfully by anyone hearing the complaint that they start their enquiry at the point of the complaint. This not only ...
Idea 7
Always start at the beginning
The realisation that all complaints have the same underlying formula, led me to the idea that the most important approach to understanding any problem is not to start from the presentation of the problem but from the beginning of the process out of which the ...
1987 to 1988 Family Welfare Association
Innovation 4
Healthy Organisation Model
Set up a new service based entirely on the Healthy Organisation Model. I am very grateful to Mary Morgan who, with me, was appointed as co-leaders of this brand new service called the Special Housing Service. I’m also grateful to our line manager, Walter Finn, who gave ...
As a result we were able to show that it really worked.
Innovation 5
Secondary Container model
Although I had formulated the concept at St Charles, this was the first time we could build it into an organisation from the outset.
A full description of the concept will be added to the ...
1988 to 1991 Assessment Services Royal Borough of Kensington & Chelsea
Innovation 6
Process to reduce the number of Children coming into care
Supporting parents and social workers (details to follow)
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1994 to 2012 Adult Department Tavistock & Portman NHS Trust
Idea 8
Supervision - the task of the supervisor.
The supervisor’s role is to look after the supervisee, not use him/her as a conduit for their own clinical work.
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Idea 9
The difference between Management and Leadership
I believe this is an important but subtle difference which we might suggest by saying that the manager is not required to provide leadership but to facilitate the appropriate expression of leadership from within the ...
Idea 10
How to design a healthy organisation structure - from the top down.
This has been my approach to helping organisations restructure, especially in the context of moving from an entrepreneurial shape into ...
Idea 11
There is a problem with the way professionals convey the psychoanalytic understanding of the mind.
If psychoanalytical ideas about the functioning of the human mind are true, they should be capable of simple exposition that feel familiar to ordinary (i.e. untrained) people. Conversely, if such an explanation does not seem ...
Innovation 7
The Short Course Intervention
A combination of training and consultation.
I had been developing this approach to my organisational work over many years as a result of the experience that many of the organisations to whom I was providing consultation were unable to use the direct experience of the provisions of ...
Innovation 8
Masters Course in providing a psychoanalytic and systems based understanding of organisations for the practitioner.
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Mauris ultrices blandit odio. Fusce sit amet interdum ex. Phasellus congue massa quis turpis vehicula aliquet congue id metus. Fusce felis augue, imperdiet ullamcorper augue vitae, finibus elementum massa. Praesent velit lectus, semper at rhoncus id, tempus quis dui. Quisque tincidunt lacus nibh, ut euismod est varius vel. Vestibulum a commodo tortor. Nunc fringilla tortor in leo tincidunt accumsan. Nullam a mollis lorem. Curabitur tempus ligula arcu, ac sollicitudin elit feugiat a. Duis pretium ligula tortor, nec efficitur ante bibendum vitae. Integer volutpat dui quis arcu vulputate, id hendrerit magna varius.
Integer posuere mi quis feugiat tristique. Suspendisse facilisis at mauris vel blandit. Proin ac leo mauris. Duis sodales velit et urna tincidunt vulputate. Etiam consectetur commodo ipsum. Curabitur aliquet lacus ut libero auctor laoreet. Cras tortor metus, iaculis id magna quis, auctor congue ligula.
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Curabitur neque odio, condimentum a lacinia ut, lacinia vitae urna. Praesent scelerisque felis augue, vitae venenatis tortor pretium eu. Duis dapibus et quam nec porta. Integer eget mollis lorem. Cras ultrices turpis diam, ultricies placerat est lacinia ac. Nam iaculis, enim a pharetra feugiat, ipsum purus posuere leo, vel vulputate nisi metus in orci. Vivamus ante odio, viverra ac facilisis a, ultrices eget orci. Etiam ultrices, libero sed condimentum sollicitudin, mi leo sagittis sapien, non hendrerit mauris turpis in urna. Nunc id lectus varius, vestibulum neque et, rutrum nibh. Pellentesque suscipit tortor est, a eleifend ex pretium quis. Sed faucibus, neque vitae volutpat tempor, augue sapien cursus justo, sit amet vestibulum nunc dolor dignissim ligula. Fusce ultrices, arcu sit amet dapibus aliquet, justo felis auctor nulla, sed rhoncus massa lacus id nunc. Aenean sit amet cursus augue.
Innovation 9
Masters Course: Training in psychoanalytic approach to residential work with children and adolescents.
This was the second Masters course to develop from the Short Course intervention. This time, encouraged by the Association of Therapeutic Communities, providing a psychoanalytically informed training in residential work with young people.
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Featured Book
The Curiosity Drive: Our Need for Inquisitive Thinking
Nominated for the Gradiva Award 2021
Author: Philip Stokoe