About Me
I have had a very interesting life, but I have not had time to step back from living it to
consider what I have managed to accomplish. What follows is a list of those things and the
rest of the site will gradually assemble the material that falls out from them.
Since truth is a process and not a thing, you will not be surprised to discover that things
that I wrote about in one way at an earlier stage in my life will appear in a slightly
different form in later ‘takes’.
I describe below my professional life in terms of the important things I have learned and
the innovations I have created.
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.
Each idea or innovation is followed by a brief sketch of the relevant, principal elements. Over time each of those will link to a paper, blog or video that will provide a deeper explanation and, in the end, a demonstration of how these all form a coherent whole.
Following those brief descriptions of ideas and innovations, there will be a lengthier summary of my experience at that workplace in which I hope to show what led me to those thoughts, ideas and innovations.
I realise that this is quite a long document, so you can jump between sections using the
links below.
I very much look forward to any thoughts you wish to share as you read, watch or listen
to my work; the discussion is always the best part of all my experiences of giving talks
and lectures.
- 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
- Bibliography
- Further Developments
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.
the boundaries set up at the start of the therapeutic engagement. Thus the clinician usually only realises that there has been a pressure to cross a boundary because it has actually happened. This is often the signal for the clinician to make sense of the event and turn it into a symbol for something that can be spoken about to the client/patient. Thus something unconscious is made conscious.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.
In other words, there is a direct link between this conception of therapeutic work and a principle that is build into my model for the way an organisation must function: The Healthy Organisation Model.
You can read more about Boundaries and the Healthy Organisation Model by clicking on the buttons below
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 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.
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 with and understanding the material.
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
because:
- 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.
Idea 5
Choose your audience, there’s no point in arguing with someone whose ideas are set.
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 people.
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.
St Charles, my experiences
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 group of professionals from Teaching, nursing and residential social work, all of whom were at ‘charge nurse’ level.
You can find the story of my experiences here:
1983 to date, Private work as Organisational consultant
Idea 6
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 task.
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 a lecture here x
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
St Charles, my experiences
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 first attempt at consultation led me to discover a very important principle that I have applied ever since: to work you need authority. This is provided through some sort of contract but essentially it requires the backing of the person who will decide about buying your services. This led to a protocol that I developed later at the Tavistock Clinic, which is always to seek to meet with the ultimate boss and explain that the consequences of a consultation will be a changed attitude on behalf of those receiving the consultation which management will need to understand. Because of this, our advice would be that they should be the first to receive the consultation and only after that should it be addressed towards the original applicants.
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 - Complaints
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.
the boundaries set up at the start of the therapeutic engagement. Thus the clinician usually only realises that there has been a pressure to cross a boundary because it has actually happened. This is often the signal for the clinician to make sense of the event and turn it into a symbol for something that can be spoken about to the client/patient. Thus something unconscious is made conscious.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.
In other words, there is a direct link between this conception of therapeutic work and a principle that is build into my model for the way an organisation must function: The Healthy Organisation Model.
You can read more about Boundaries and the Healthy Organisation Model by clicking on the buttons below
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 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.
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 with and understanding the material.
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
because:
- 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.
Idea 5
Choose your audience, there’s no point in arguing with someone whose ideas are set.
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 people.
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.
St Charles, my experiences
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 group of professionals from Teaching, nursing and residential social work, all of whom were at ‘charge nurse’ level.
You can find the story of my experiences here:
1987 to 1988, Family Welfare Association
Idea 6
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 task.
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 a lecture here x
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
St Charles, my experiences
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 first attempt at consultation led me to discover a very important principle that I have applied ever since: to work you need authority. This is provided through some sort of contract but essentially it requires the backing of the person who will decide about buying your services. This led to a protocol that I developed later at the Tavistock Clinic, which is always to seek to meet with the ultimate boss and explain that the consequences of a consultation will be a changed attitude on behalf of those receiving the consultation which management will need to understand. Because of this, our advice would be that they should be the first to receive the consultation and only after that should it be addressed towards the original applicants.
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.
1988 to 1991 Assessment Services, Royal Borough of Kensington & Chelsea
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.
the boundaries set up at the start of the therapeutic engagement. Thus the clinician usually only realises that there has been a pressure to cross a boundary because it has actually happened. This is often the signal for the clinician to make sense of the event and turn it into a symbol for something that can be spoken about to the client/patient. Thus something unconscious is made conscious.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.
In other words, there is a direct link between this conception of therapeutic work and a principle that is build into my model for the way an organisation must function: The Healthy Organisation Model.
You can read more about Boundaries and the Healthy Organisation Model by clicking on the buttons below
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 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.
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 with and understanding the material.
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
because:
- 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.
Idea 5
Choose your audience, there’s no point in arguing with someone whose ideas are set.
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 people.
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.
St Charles, my experiences
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 group of professionals from Teaching, nursing and residential social work, all of whom were at ‘charge nurse’ level.
You can find the story of my experiences here:
1994 to 2012 Adult Department, Tavistock & Portman NHS Trust
Idea 6
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 task.
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 a lecture here x
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
St Charles, my experiences
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 first attempt at consultation led me to discover a very important principle that I have applied ever since: to work you need authority. This is provided through some sort of contract but essentially it requires the backing of the person who will decide about buying your services. This led to a protocol that I developed later at the Tavistock Clinic, which is always to seek to meet with the ultimate boss and explain that the consequences of a consultation will be a changed attitude on behalf of those receiving the consultation which management will need to understand. Because of this, our advice would be that they should be the first to receive the consultation and only after that should it be addressed towards the original applicants.
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.
2012 to Date Private Practice including Philip Stokoe & Associates
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.
the boundaries set up at the start of the therapeutic engagement. Thus the clinician usually only realises that there has been a pressure to cross a boundary because it has actually happened. This is often the signal for the clinician to make sense of the event and turn it into a symbol for something that can be spoken about to the client/patient. Thus something unconscious is made conscious.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.
In other words, there is a direct link between this conception of therapeutic work and a principle that is build into my model for the way an organisation must function: The Healthy Organisation Model.
You can read more about Boundaries and the Healthy Organisation Model by clicking on the buttons below
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 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.
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 with and understanding the material.
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
because:
- 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.
Idea 5
Choose your audience, there’s no point in arguing with someone whose ideas are set.
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 people.
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.
St Charles, my experiences
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 group of professionals from Teaching, nursing and residential social work, all of whom were at ‘charge nurse’ level.
You can find the story of my experiences here:
Bibliography
Idea 6
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 task.
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 a lecture here x
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
St Charles, my experiences
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 first attempt at consultation led me to discover a very important principle that I have applied ever since: to work you need authority. This is provided through some sort of contract but essentially it requires the backing of the person who will decide about buying your services. This led to a protocol that I developed later at the Tavistock Clinic, which is always to seek to meet with the ultimate boss and explain that the consequences of a consultation will be a changed attitude on behalf of those receiving the consultation which management will need to understand. Because of this, our advice would be that they should be the first to receive the consultation and only after that should it be addressed towards the original applicants.
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.
Further Developments
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.
the boundaries set up at the start of the therapeutic engagement. Thus the clinician usually only realises that there has been a pressure to cross a boundary because it has actually happened. This is often the signal for the clinician to make sense of the event and turn it into a symbol for something that can be spoken about to the client/patient. Thus something unconscious is made conscious.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.
In other words, there is a direct link between this conception of therapeutic work and a principle that is build into my model for the way an organisation must function: The Healthy Organisation Model.
You can read more about Boundaries and the Healthy Organisation Model by clicking on the buttons below
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 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.
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 with and understanding the material.
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
because:
- 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.
Idea 5
Choose your audience, there’s no point in arguing with someone whose ideas are set.
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 people.
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.
St Charles, my experiences
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 group of professionals from Teaching, nursing and residential social work, all of whom were at ‘charge nurse’ level.
You can find the story of my experiences here:
Achievements & Innovations
1988 to 1991 Assessment Services Royal Borough of Kensington & Chelsea
1994 to 2012 Adult Department Tavistock & Portman NHS Trust
Bibliography
Further developments
Coming Soon
What happened next
Featured Book
The Curiosity Drive: Our Need for Inquisitive Thinking
Nominated for the Gradiva Award 2021
Author: Philip Stokoe