International Journal of Therapeutic Communities, Vol. 10(1), 1989
Based on a paper given at the IX International Workshop on Therapeutic Communities, Cumberland Lodge, London. September 1987.
“The therapeutic process at the Cotswold Community has been designed and developed specifically for work with boys diagnosed as having an unintegrated personality. In such a boy, the ego boundary, which enables the mature individual to separate his internal world of drives, impulses, feelings and phantasies from the external world of relations with other people, has not yet developed; he does not yet distinguish between inside and outside, between his feelings and their causes. In this state of fusion or confusion, his experience tends to be either of having the other person or the whole world inside him – the omnipotent phantasy – or alternatively of being swallowed up by the other. He may oscillate between these positions.
The therapeutic task, therefore, is to provide the conditions within which the boy can begin to form an ego-boundary and become capable of managing his internal world in relation to his environment. At a minimum, he should acquire: the skills needed for some degree of independence; some ability to recognise choices and make decisions; and some capacity to manage transactions with other people in his environment” (Eric Miller and Richard Balbernie).
This paper is about the planned environment of the Cotswold Community which facilitates this sort of learning. The richness, strength, and quality of the healing culture as a whole is the at the heart of the matter. Our objective is to maintain a planned culture (described by Bruno Bettelheim as “the other 23 hours) which attracts trust and genuine allegiance, and is stronger than the regressive attraction of sub-culture.
The Community has approximately 50 boys living in five substantially autonomous small group living households. Most come from inner city areas throughout the country. A referral is usually made by the local authority Social Worker, but often the recognition of a need for a therapeutic community placement comes from a Psychiatrist or Psychologist. The boys” age at admission is between 9 and 14 years and they can remain with us until 18 years, although they more usually leave at 16 ½ years. The boys have been continuously in trouble with the “authorities”, i.e. the police and the school. Most boys, though by no means all, still have a family, although they have missed out on primary experiences, and in their early developmental stages have experienced repeated environmental failures and failed dependencies.
Their lack of security stems from a breakdown in the parental function of creating the child’s environment; consequently, the child has had to create his own long before he has the inner resources to do so. This leads to a surface adaptation to life which at first glance can appear adequate. However, there is no centre, no real self, no inner world, no feeing of well-being, no concern, no guilt – more a “chameleon-type” response to life.
The following statements capture something of the theory underlying our work:
“In the course of normal development the separating out of mother and baby is a long and gradual process, at the completion of which the baby exists for the first time as a separate being and an integrated individual, absolutely dependant on the mother, but no longer emotionally part of her. If integration of the personality is to take place, (usually by the end of the first year of life) the evolution of this process must not be interrupted. Interruption of this essential process, which mother and babies work through together in their own time and in their own way, is in my view the trauma which lies at the root of the various types of causes of emotional deprivation referred to us … The point at which traumatic interruption has taken place determines the nature of the survival mechanisms used by the child: the primitive nature of these mechanisms does not prevent them from being used in a highly complex manner.” (B.E. Dockar-Drysdale, “The Provision of Primary Experience in a Therapeutic School”)
“When the reciprocal relation between mother and infant goes well, the infant arrives at a stable personalisation, has a capacity for trust and confidence, and achieves a sense of comfort.” (Masud Khan)
“Before integration, the individual is unorganised, a mere collection of sensory-motor phenomena, collected by the holding environment. After integration the individual IS, that is to say, the infant human being has achieved unit status, can say I AM (except for not being able to talk). The infant has now a limiting membrane, so that what is not-he or not-she is repudiated, and is external. The he or the she has now an inside, and here can be collected memories of experiences, and can be built up the infinitely complex structure that belongs to the human being.” (D.W.Winnicott, “The Family and Individual Development”)
Before coming to the Community it is quite common for a boy to have been in a number of children’s homes or foster placements which broke down primarily because they were not able to meet the particular boy’s needs, especially the need for individual, 24 hour management – which usually puts far too much strain on a family unprepared for this. The resulting disruptive, difficult and testing behaviour becomes impossible for the family to contain, and once again the child experiences the holding environment as not “good enough”.
Their inner world is one of appalling uncontainable anxiety, and this manifests itself in uncontrollable outbursts of panic, rage, continuous disruption and environmental testing to destruction. We must provide an environment which reduces anxiety, and in which the child can begin to trust, to feel more secure, and begin to invest in freely, and learn.
The staff aim is to prevent the boys continuously “acting out” their difficulties, and for this to be done in such a way that they can gain insight into their own behaviour and develop controls from within. It is essential therefore that we have neither a punishment system to maintain control which would prevent inner controls from developing, nor a reward system which would simply encourage “false-self” (Winnicott) good behaviour. Staff teams become skilful at anticipating difficulties, being aware of groups which can quickly “merge” delinquently, and knowing how and when to intervene. In time a boy will become aware of these things himself and be able to keep himself “separate”. The personal authority of the individual members of the staff team and the cohesion of that team are the basis for a “safe” unit, where the boys feel secure that grown-ups can cope with their difficulties rather than need to suppress them. The continual tension between providing sufficient containment, on the one hand, and enough space (physical and emotional) for separation, on the other, is the dynamic of treatment.
Before boys come to the Community efforts have generally been made to tackle their symptoms, e.g. enuresis, truanting, stealing, wandering off – all forms of anti-social behaviour. This has had little or no effect because the cause is a root damage in that child that can only be healed in a total living setting with 24 hour, 7 days a week therapeutic management of that individual. This is what we provide at the Community. There is an unconditional acceptance of a young person, e.g. we would not place a 13 year old boy under pressure to behave as an integrated 13 year old by telling him what he “ought” to be capable of. We find this reduces anxiety considerably and, with the pressure off, a lot of the prevailing symptoms soon fall way. Everything possible is done to facilitate meaningful contact with the adults to foster the gradual change from a basic mistrust to a basic trust (Erickson). This is a long, painful process. Adults are tested to the limits but their continued concern brings enormous relief to the young people who thus gain the opportunity of integrating dispersed, detached parts of themselves, and of moving towards becoming more “whole” individuals.
“People working with unintegrated children and adolescents have to carry a much heavier load of tension and anxiety than those who are trying to help neurotic, integrated youngsters. Workers at the Cotswold are constantly exposed to the full blast of primary processes – they are in touch with what should be in the unconscious but which, without ego-development, is present at a conscious level in all its primitive violence (Winnicott used to describe this as “dreaming awake”). The danger – apart from the actual violent acting out – is that this primitive material can pick up wavelengths in the unconscious of the workers – this is what can lead to collusive pairing, which is damaging in the extreme to boy and adult. For these reasons it is essential that workers should become as conscious as possible about themselves, so that they and the boys are less at risk and more free to concentrate on the primary task.” (B.E. Docker-Drysdale, “Staff Consultation in an Evolving Care System”)
Each of the five household has its own individual character and task reflected in the names: The Cottage, Springfield, Northstead, Larkrise and the Long Barn.
These are three “primary” households that admit unintegrated boys who are new to the Community (The Cottage, Springfield and Long Barn). The work in them concentrates on the individual boy and his needs. These are met by the staff team as a whole although a special, dependant relationship with one grown-up forms as basic trust begins to grow. Within the reliability of this special relationship there can be planned, localised regression, symbolically working through the early deprivation. Being given a chance to communicate real feelings, fear and anxieties to a grown-up who is willing to listen is a vital process in reducing the boy’s need to “act out”. This is facilitated through regular communication times, two or three times a week, with the boy’s therapist together with daily “talking groups” which comprise four or five boys and one grown-up meeting for half an hour.
Winnicott describes the stages of residential treatment in the following way.
“… a collection of relatively unintegrated persons can be given covering and a group may be formed. Here the group does not come from the individuals but from the covering. The individuals go through three stages:
- They are glad to be covered and they gain confidence; (the honeymoon phase”)
- They begin to exploit the situation, become dependant, and regressing to unintegration:
- They begin, independently of each other, to achieve some integration, and at such times they use the cover offered by the group which they need because of their expectation of persecution.
Great strain is placed on the cover mechanisms. Some of these individuals do achieve personal integration, and so become ready to be moved to the other type of group in which the individuals themselves provide the group work. Others cannot be cured by cover-therapy, alone, and they continue to be managed by an agency without identification with that agency.”
(D.W. Winnicott, “The Family and Individual Development”)
The two “secondary” households (Northstead and Larkrise) mix the need of the individual with those of the group. This happens when there has been sufficient real, inner growth within the individual who has therefore some capacity to manage primitive impulses. This second stage only has meaning if the individual boy’s needs have been met in the first stage. Gradually, with support, a boy takes on more responsibility for himself and others, and will be more involved in the running of the household.
The emotional growth which takes place in these two stages normally happens in the first few years of a child’s life, initially with the baby’s relationship with mother and father and siblings.
The task in Northstead and Larkrise deals quite specifically with the problems facing boys emerging at adolescence from deep dependencies, and moving towards an understanding of responsibility. In this it must look both ways: back towards the dependency, with its provision and support, and forwards into maturity with its demands of responsibility and self-control. It is particularly important that staff members in these units become skilled in dealing with the defence mechanisms that are predominant at this stage, and which provide for the boy a way of reconciling the tension between these two impulses. Slowly, with the support of one or two adults, a boy will develop a firmer sense of identity and greater control over himself and his future.
Moving to Northstead and Larkrise is a decision reached with each individual boy when it seems the right time for him to take on two particular aspects of living that have previously lain more in the background. An increasing share in decisions and personal responsibility in living with other people, and the development of his own inner world, must now be balanced against the demands of the external world. Boys move to Northstead and Larkrise at various ages; this depends on the individual’s growth, not on how old or big he has become.
At this stage boys have reached a certain level of emotional maturity and have some control over their own behaviour, and it is important that they have the shared experience of managing their environments. Cooking all the meals, responsibility for personal laundry, growing vegetables, keeping a cow and goats for milk and cheese, are all part of the way of life in Larkrise. Such activities require a high level of individual and group responsibility and co-operation between boys and grown-ups. We try and get as many “self-help” projects off the ground as we can, rather than rely on outside contractors; so boys and adults together can be involved in, for instance, the conversion of a building into a household within which they will be living. This will enable their new-found individuality a chance to expand and provide a “model” for changing their environment constructively. Larkrise has converted a part of an old building into two bedsits for boys who are going out to work and are able to live a little more independently from the household.
The experience of work is a big step for each person. Thus seeking firms and craftspersons who can help a boy out into the working world, particularly at this time, is a major part of the Community’s task of facilitating the transition from total care and dependence to supported independence. At the same time it builds towards the point when, with the youngsters parents and social worker, the next stage beyond the Community must be planned and begun.
Each household has its own large garden, clearly defined as its territory and usually well tended, with much work going into vegetable plots both for the household and individual boys. During the past few years many individuals have contributed to a growth of the households as “alive” places for both boys and grown-ups to live and work in. This is reflected in such features as: the pictures on the walls; the homeliness of the furniture; the attention paid to mealtimes and the way the tables are set; bedrooms that engender a feeling of comfort, calmness, security and individuality; the centrality of the kitchen to the unit’s way of life; a good workshop and play area.
The strengthening of the “culture” within the households is most clearly seen in relation to food. We have moved away from food centrally cooked and eaten to meals which are cooked in households, where the boys are able to help and eaten in a more convivial atmosphere. Food also has a very important place in an individual boy’s treatment; the rediscovery of an excitement about foods in general and favourite foods in particular provides for the conversion of delinquent excitement into oral greed. The process of “decentralisation” has continued as we recognised the value of laundry, sewing and cooking being located within households, rather than organised as more “efficient” institutional services which deprive people of the opportunity of learning such basic living skills.
The Cotswold Community admits only boys but the six full-time group living workers, in each staff team include both men and women. The boys are too emotionally damaged to cope with living alongside girls especially with the advent of puberty and the surge of adolescent sexuality occurring at a time when “inner controls” are underdeveloped. They first have a good deal to “work through” about women in general (stemming, basically, from the lack of “good enough mothering” during babyhood) and this needs to be undertaken consciously by women mature enough to cope with the complexities of this task.
The staff team are supported in their learning by our consultants: Mrs Dockar-Drysdale (Psychotherapist), Dr. Faith Spicer (Medical Adviser), Dr Colin Morison (Child Psychiatrist), Mr Ron Dare (Educational Psychologist), Mrs Sandy Panniceard (Educational Psychologist) and Dr. Eric Miller (Tavistock Institute). We also have a system of training groups which meet weekly and enable people from different households, at a similar stage of learning, to share experiences and to work together on the inter-relation of theory to practice.
Regular sessions with our Consultant Psychotherapist enable staff teams to learn to meet the emotional needs of the boys, as and when they arise. A great deal of emphasis is placed on open, direct communication within a staff team, and the Community as a whole. There are regular meetings within households and the Community. The main tools for monitoring the treatment process within a planned environment are:
- the “need assessment”, i.e. a staff group who live with the boy sitting down together and sharing the different parts of the boy they see, so that a realistic assessment of the boy’s needs can be achieved. This way of working also facilitates staff communication.
- The “context profile”, this is of equal importance; a specific period of time is taken, e.g. a week, and during that time everyone who has contact with a particular individual writes down the content of that contact. This is then pulled together, and the result is a document which really gives a very full picture of that individual young person, with very little being missed.
The “Learning Relationship”
Therapeutic education focuses on the needs of the individual, from his inner world outwards, rather that a curriculum or blueprint inwards.
Education is provided for boys in the Community in our own education area, which we call the “Poly”. Here, each of the five household groups has its own separate area and works with its own teacher. Boys come to the Community with varying experiences of schools and teachers but in general have found their previous school life difficult. Within the Poly they are given the opportunity to begin to learn again, in a small group setting and with a lot of individual support and attention.
The work within each of the five groups naturally varies, sometimes considerably, depending on the individual needs and abilities of each boy and of the group as a whole. However, the common aim of all of the areas is to facilitate the learning process in boys where this has become inhibited. The fears which disturbed young people have of finding out new things, in case more frightening facts are discovered, can be paralysing intellectually as well as emotionally and socially.
In the areas working particularly with boys from the primary households an emphasis is initially placed on learning through play. There is also much opportunity for expression through simple art and craft work. We find that for many boys the internal world is so impoverished that they need to begin with very primary sorts of learning experience, exploring their world through the basic senses. With the onset of some emotional growth, there is often a corresponding growth in the desire to learn; at this point a boy is usually more ready to develop his basic literacy and numeracy skills. The importance of reading and the development of language skills are continually highlighted through the availability of a wide and ever changing range of books, through boys being read to and through constant communication with them.
At the secondary stage we aim to extend the boys’ basic skills and to encourage both an interest in the world around them and the ability to express and communicate something of what they themselves feel and think. The learning of practical skills such as carpentry, painting, modelling or gardening is also encouraged. With these particular boys who have shown some signs of recovery and who are able to take some responsibility for their own development, they are also able to consider their own educational needs and are motivated towards achieving realistic goals. This process is more noticeable, perhaps, as a boy begins to think about the sort of work he might go in to, say sometime in his sixteenth year.
The learning process only really becomes alive and meaningful when the individual needs of boys can be met consistently over a period of time by someone who knows them well. To facilitate this and to reduce the division between the group living and the education areas, the person who runs the education group also works with boys during some evenings and for part of each weekend. This broader involvement in the boys’ lives helps to build up that basic trust on which real learning depends. Similarly, people working with boys in households are encouraged to be involved where possible in the education area, both to help and support boys in particular activities and to experience at first hand some of the learning difficulties and educational problems that these boys have. Such involvement makes for a more therapeutic environment. (Millar).
During a boy’s first stages with the Community our experience has been that it is better for a group of individuals not to keep partially dispersing for weekends at home, but to stay together for 6-8 weeks and then take a break of about one week to ten days. Grown-ups also take their holidays during these periods; this allows for more continuity when boys are in the household. However, the Community never closes and there are always some boys who have to be provided for within our household, or, more commonly, through small camps and expeditions. It is important that a boy lives away from the Community for short periods in order to remain in touch with the world at large and his family in particular.
His focal therapist will maintain contact during these periods with letters, telephone calls, and visits. It is also very often a time when group living workers visit the boy’s family to enable them to continue to feel involved with what we are trying to do, as we need their backing to do it. Contact with the family and the Community is established before a boy is admitted. This occurs at the time of the interview when the parents and the social worker are involved, and in fact we rarely admit a boy without the full support of his parents.
Some Structural Characteristics
The Cotswold Community is managed by Wiltshire County Council. We have a farm of approximately 350 acres. The farm gives us the space we need to work with these very damaged boys, without being too constrained by neighbours – a cordon sanitaire. There is a growing importance of the farm in the way of life of the Community, which is particularly noticeable when the hay is cut and at harvest time when everyone “mucks in”. Very few boys have any idea about the seasons and the corresponding farming activities, although this changes after being here for 2 or 3 years.
Some of the Cotswold stone buildings within the Community are very old and reflect its beginnings as a farm. A large number of buildings were erected during the period when it was a Bruderhof Community in the late 1930s and early 1940s. After being a more traditional “warehousing-type” establishment for adolescent boys, in 1967, there was a fundamental change which resulted in it becoming a “therapeutic community”.
It is essential that the people who work at the Cotswold Community also live in it so that, more than a commitment to a job, there is also an investment in a way of life. It is also essential that everyone who lives and works in the Community, whatever their specific role, is conscious of the “primary task” (that is, the task that an enterprise, or part of an enterprise, must perform in order to survive) and can identify with it. This level of consciousness and identification has to be worked for constantly through regular group meetings.
David Willis explains the importance of shared living in the following ways:
“Planned Environment Therapy, as I see it, is a form of treatment, preferably residential, aimed at helping people who have hitherto, for whatever reason, found themselves unable to adjust happily in society. It seems to provide experience of loving social relationships in an egalitarian setting, through also sharing in the responsibility for the administration of day-to-day affairs. Where the personalities of the residents are impoverished by the absence of warm effective ties in childhood, Planned Environment Therapy seeks to provide what has been lacking; where the personality of the resident is warped or distorted by unhappy or traumatic experiences, Planning Environmental Therapy seeks to provide an atmosphere conducive to therapy, and aims, through a study of the person’s history and with psychiatric advice, to provide the kind of specific experiences that are calculated to correct the distortions brought about by earlier experiences.
The attitude of the staff is non-moralistic and non-punitive, because they believe that the experience of seeking to build a satisfactory way of living together will gradually bring about the development of moral and ethical ideas. This is not to say, however, that they are themselves amoral in their attitude. On the contrary, they should be stable and well-integrated people with firm moral convictions which they are not afraid to express, but which they should always express in a non-condemnatory manner. Their function in the community is to provide stability and direction, to provide security not only by the authority of their personalities, but through affection and tolerance; to provide love and identification objects for the residents and to set standards of courteous and considerate social relationships. It is believed that such people, behaving in such a way, can do much to help the residents with whom they live in close communion and also that the residents in this setting will, often unconsciously, be a help to each other; in fact, that the whole life of the place is one large exercise in group therapy.”
The five group living households and the education area are responsible for the management of their own situations, each person who works in the Community having delegated areas of responsibility. In each staff team there is a person responsible for seeing that each boy’s treatment needs are being met; for the domestic organisation of the household; for the establishment and growth of “culture”, relevant to the boys, e.g. books, records, pictures, games and play materials. This tends to create a situation where boys are living with adults who do not have to go up a hierarchy for the answer to every question (though they may have to move horizontally to the person whose particular responsibility it might be). Boys are consequently provided with “models” of responsible adult behaviour rather than an institutional “pecking order”. The management of the Community as a whole is carefully co-ordinated through a daily meeting of the people responsible for the different sections, which facilitates a flow of communication throughout the Community.
“… a basis for organisation of the treatment milieu must be to provide a model that is structured in such a way that the “ego functions” of the whole institution and of all its parts are mature and sophisticated. It must provide well-defined boundaries and adequate and firm controls over transactions across them. Members (staff and children) must be clear about their different roles they take. Thus the therapy must be the “order” of the institution and the “ego functioning” and behaviour of the staff. The milieu must reinforce and support this, for if it contradicts it, it will disastrously re-enact and echo earliest environmental failure and breakdown”. (R. Balbernie, “Unintegration, Integration and Level of Ego Functioning as the Determinants of Planned “cover Therapy”, of Unit Task, and of Placement.” 1973).
For boys who have been living in chaotic environments, characterized by little or no communication between home, school, social worker, friends, etc., and reflecting and reinforcing their inner chaos, it is a relief to come to a situation where all aspects of living are integrated, and which provides the basis for their own personal inner integration which, in turn, can enable them to move towards a capacity for mastering their environment rather than being swamped by it.
BALBERNIE, R AND MILLER, E. (1984) The Cotswold Community: Management Implications of the Therapeutic Task. Unpublished paper.
TRIESCHMAN, A.E., WHITTAKER, J. AND BRENDTRO, L.K. Published by Aldine, Atherton. The Other 23 Hours.
DOCKAR-DRYSDALE, B.E. (1968) The Provision of Primary Experience in a Therapeutic School in Therapy and Child Care. Longman.
KAHN M.M.R. (1974) The Privacy of the Self. Published by Hogarth Press and the Institute of Psych-Analysis.
WINNICOTT D.W. (1965) Group Influences and the Maladjusted Child: The School Aspect in The Family and Individual Development. Tavistock publication.
DOCKAR-DRYSDALE B.E. (1973) Staff Consultation in an Evolving Care System in Residential Establishments; The Evolving of Caring Systems by Arthur Hay, Richard Belbernie, Barbar Docker-Drysdale, Ben Morris, Joan Hunter and Frank Ainsworth. University of Dundee.
WILLS, D.W. (1968) What do we mean by Planned Environment Therapy? Studies in Environment Therapy, Vol. 1. edited by Arthur T. Barron, Planned Environmental Therapy Trust.