What is a Therapeutic Community?

Introduction

I should start by saying that the layout of the day and the way we are doing it is very much not a therapeutic community approach. I am feeling all the anxiety right now. You are all relaxed, and in a dependent state, and really if we were to capture what a therapeutic community is about, we would be sitting in a circle, sweating over the silence and we would all be feeling that anxiety. Today I have decided not to read from a paper, so my anxiety level is even higher, because I am going to try to talk “on the hoof”. I have got various sorts of visual aids. It is a bit of a 40 minute journey, and I hope it all adds up. Those of us who run therapeutic communities are not always equipped to speak like this. I am certainly not. Put me in a group and I am fine. Put me in front of you, giving a lecture, and it is a very different experience.

I would like to start with defining a therapeutic community. I think it was Spencer Millham who said that therapeutic communities are places with long drives and the sound of tinkling glass.

David Kennard (1994) in a paper “New Frontiers for Therapeutic Communities” produced a diagram showing the main characteristics of the therapeutic community concept (See below).

Characteristics of the Therapeutic Community Concept.

In thinking about the therapeutic community in this way, it may help us to think about how far the therapeutic community concept has been or can be developed in different settings, and also to recognise that the more basic therapeutic community elements may be present in many non-therapeutic or quasi-therapeutic organisations e.g. learning institutions, small businesses (especially those run as collectives) and groups that come together for self-help.

I distributed information about the Association of Therapeutic Communities. Their annual Windsor Conference has many participants from Europe and from a wide variety of organisations that regard themselves as therapeutic communities. David Kennard’s conceptual framework allows for many different applications of therapeutic community principles. Within the Health Service there are now Day Centres based on therapeutic community principles. I have heard descriptions of a therapeutic community in the Greek Navy, which lasts for two weeks at a time. They have a continuous turnover of sailors who are suffering emotional and psychological problems which surface as a result of being on ships and submarines. Another example of the therapeutic community concept which is put into practice by the Association of Therapeutic Communities is a training event, where participants meet and live together for a weekend. Some of my staff have done this and they have found it very stimulating. It gives insight into what it feels like to be a member of the client group in a therapeutic community.

The Cotswold School

I am now going to focus on the Cotswold Community, which has an unusual history. It was not set up as a therapeutic community, and indeed had to go through some really dramatic changes to achieve that end. Those changes were immensely painful and difficult.

The history of the Costwold Community starts with the original farm becoming a Bruderhof community between 1936-1942. A group of German Christians got out of Nazi Germany because they were being persecuted and transferred their Bruderhof community to our 350 acre farm. When they arrived the farm was in a very derelict state. I believe there were over 100 refugees forming the original Bruderhof community. It was a pretty self sufficient community, with almost every trade there, and they farmed and grew their own food. Many of the buildings and the layout of the place go back to that time. There is today a Bruderhof Community at Darvell near Robertsbridge. We still have quite close links with them as they frequently visit and show the next generation of their young people where they started out in this country. As German nationals, after the outbreak of war, they faced internment, which would have destroyed their community life, so they decided to leave the country. The only country that accepted them as pacifists was Paraguay, which is where they moved. I imagine the Home Office was involved in assisting this process, because their plight must have been an embarrassment and I imagine the Home Office’s involvement led to the Cotswold Approved School starting in 1942. I have been told that as the last member of the Bruderhof was leaving down the drive, so the first members of the Approved School were arriving.

The Cotswold School was well known. It was run by C.A. Joyce, who was a regular broadcaster on the radio, “Thought for the Day” etc. In those days the Cotswold Approved School was owned, managed and run by the Rainer Foundation, (previously known as the London Police Court Mission) a relatively large charitable body. The Cotswold School probably had it’s heyday in the forties and fifties. The approved school system was crumbling in the late fifties and sixties. There were a number of scandals, eg at Court Lees. What happened then seems similar to what residential work has been going through over the last ten years, where one bit of bad news rolled on to the next and scandals were continually in the national press.

Any of the Approved Schools, including the Cotswold School, could have hit the headlines because of the nature of the abusive regimes. Probably every approved school staff team felt that they were sitting on a volcano. The lid could have blown off in a very nasty way. I will read something to you, which will give you a flavour of what I am trying to describe. It was written by Bill Douglas (1967), who was the chaplain in the latter days of the Cotswold Approved School. He blew the whistle on what was going on in the School, a very brave thing to do:

“I would liken the housemaster situation, which has been extremely difficult during my time here, to a senior/junior prefect system in an ordinary public or grammar school. They were looked upon mainly as boy minders. It was not reckoned that any work in depth as far as speaking to, thinking about or talking together about boys was of very much worth, and at one stage I was told that the only person who did any case work was the headmaster.

The picture of one of the unending activity for staff and boys, beneath them, hierarchically, came the boys, who in fact were looked after in large groups. They were looked upon as being required to be totally active, and thus there was little time for inter-personal relationships, there was virtually no time for case work whatsoever.”

Also in this paper he gives very vivid and sickening descriptions of bullying, and the power of the sub-culture:

“The actual forms of bullying were thus. Firstly, sheer physical force, using fists. Secondly, physical force using boots, usually when the boy was on the ground. Thirdly, the twisting of arms or fingers. Fourthly, the gripping of genitals and twisting them. Fifthly, the strapping of the hand to a hot water pipe, where it comes out of a boiler, and left there until such time as the boy agreed that he would do what the gang wanted him to do. Sixthly, the requirement of other boys to take servant type roles, making beds, cleaning shoes, running errands of all kinds. The form of bullying which took place in drying rooms operated in this fashion. The gang would assemble, and would get hold of a duffel coat. One of the gang hangers-on would then call the boy who was to come before the court. As he came into the room, the duffel coat, with a hood, would be deftly thrown over his head, and the punishment, which was decided, probably with fists or boots, in this case was meted out. Immediately it had been meted out, the gang would take off very quickly so that by the time the boy had become disentangled from the duffel coat, he would have no actual proof as to who it was who’d been beating him up.”

That was an everyday event in approved schools. I would suggest that actually these problems have not gone away and that a lot of the abuse we are hearing about in the media, in different kinds of residential institutions, is not so terribly different.

In 1967, when the headship of the Cotswold School became vacant, Richard Balbernie was appointed by the Rainer Foundation. This was just before the l969 Act, which abolished the Approved School System. He was appointed because he was a significant person in the residential child care/education sector. He had written a book called “Residential Work with Children” (1966). He had already set up one therapeutic community and he was a research fellow at Bristol University. He worked with Chris Beedell on running the Advanced Residential Social Work Course, so he was a well known and significant figure to appoint.

The Rainer Foundation must have realised they had appointed a person who would lead a revolution.¹

The Impact of Richard Balbernie and the birth of the Cotswold Community

I think that it took a good five years to change the institution from an approved school to something that would resemble a therapeutic community. It was an extremely difficult and daunting process. Richard Balbernie did not have the luxury of closing the place down and opening it with new children and new staff. He had to sweat it out with the same people who were there. And just to give you an example of the kind of chaos that could reign, think of what happened in Eastern Europe quite recently when the communist regime collapsed. First there was a great feeling of goodwill, and then came the chaos with many people probably wishing they could turn the clock back. Something very similar went on at the Cotswold Community. Spare the Child, which David Wills (1971) wrote in the early ´70’s, is about the change process and is still a good, graphic read of what it is like to go through that revolutionary process. It is not surprising, on reading this, that so few places went through this change process. Peper Harow was one approved school which did, but sadly is now closed. It went through a similar kind of tough process. I think it took someone like Richard Balbernie or Melvyn Rose (1990) at Peper Harow to lead that change. They were remarkable people, extremely courageous and ruthless, single minded, with a clear vision of where they were going to go. Obviously those qualities also had their shadow side, and they could be extremely difficult people to work with at times. The charismatic leaders who are often the best people to create a place, or to change a place radically, are not always the best people to carry it on beyond a certain stage. The ruthless single-mindedness, the enjoyment of the fight with authorities, cannot find an obvious outlet when the community moves from the revolutionary stage to a more evolutionary process of change and development.

One of the first things that Richard Balbernie had to do was to reduce the number of boys. There were 120 boys in the approved school, living in very large groups. He sent half the boys home very early on, those he regarded as petty criminals, who did not seem particularly disturbed. The follow up study that was done showed that they did much better than if they had stayed in the approved school. He retained the boys who, on the face of it, were the more vulnerable ones, and who seemed to be more emotionally disturbed. The other problem of course was to do with the staff. Many who resisted the change left immediately, but some stayed on thinking, “Well, this lunatic’s going to give up soon; it will revert to how it used to be”. There were a few who identified with that change process, and they really formed the core of the staff, but it was not something that happened overnight. It took several years, and certainly when I came to work at the Cotswold Community, which was five years into the change process, there were still quite a lot of staff there who had had links back with the approved school, and with some very mixed attitudes still about the therapeutic community approach.

The Role of Consultants

We have already referred to the importance of external consultancy, and there is no doubt that Richard Balbernie in a managerial, leadership role, could not have brought about all the change by himself. He was having to deal with so many different things at one and the same time. As well as attending to what was going on inside the place, he was having to deal with external agencies and the parent body of which we were a part. He appointed two key consultants – I think it was a stroke of genius to choose the consultants who were going to help the place change in those early days. One of them was Barbara Dockar-Drysdale, who was the founder of the Mulberry Bush School. She was brought in really to work at changing the attitude of the staff. It was no good just putting a flag up one day and saying, “We’re a therapeutic community”. There is an immense amount of work to be done about helping people develop and learn a therapeutic approach, and already she was a well known figure from her work at the Mulberry Bush. Her book Therapy in Child Care was published at this time, followed by Consultation in Child Care (Dockar-Drysdale, 1993).

The other consultancy, which was vital, was provided by the Tavistock Institute, which had the task of advising on the re-organisation of the Community. The approved school had a very steep hierarchy, with all the power vested in the headmaster. Clearly this was not an organisation that was sympathetic to therapy. Richard Balbernie couldn’t just bring in “therapy” if the organisational structure was not there to support it. The approved school structure would actively undermine therapy unless it also was transformed. We have had some very high calibre consultants from the Tavistock Institute. From 1968-69 the consultant was Ken Rice, until his sudden death. That was then followed by Isabel Menzies-Lyth for the next ten years, and from then onwards we have had Dr Eric Miller. They have provided a continuity of consultancy which has been of crucial importance to us. The kind of thing they helped to change was the top down hierarchical organisation into a decentralised structure, giving power and authority to the staff who were at the coal face with the children.

Under the approved school regime the care staff had very little power. They were at the bottom of the pecking order in the staff group and were certainly below the teachers. They had to get permission for everything. The Tavistock Institute quickly pointed out the inadequacy of this as a role model. We had a large institution with a central laundry and a central kitchen, and a central everything, which had to be broken up and de-centralised, so that each of the four house units had all those facilities in a much more homely atmosphere. I know it does not sound very much now, because this is now accepted practice, but at that time, within the Cotswold Community this was very important and very difficult to achieve. There were all kinds of resistances to that change. The people who worked in the central laundry were terrified of the idea of doing their laundry work close to disturbed children. Persuasion was needed for them to try it out step by step, and to survive. They not only survived, they got to like it. From all points of view it was a good thing that their work involved the boys having direct discussions about their clothes and what needed mending and what they were going to eat today, and then participating in it and getting them to help and so on.

Change took place in stages. It did not occur overnight by any stretch of the imagination. I cannot stress strongly enough the importance of external consultants, because I think time and again, we see in every residential place, the collusion to make bad practice seem like good practice, and defining it in our own terms in a rather inward looking way. If you have the right consultants they should be a continuous irritant, forever prodding, poking and reassessing what is happening. It should not be a nice cosy relationship and to achieve this the consultants should be external to the organisation.

The Structure of the Cotswold Community

A brief description of the therapeutic structure at the Cotswold Community.

“The Cotswold Community is a therapeutic community for boys who are seriously disturbed emotionally. It exists specifically to provide an environment for treatment. It recognises that the boys will initially be prone to extreme anxiety and uncertainty, and will be compulsively disruptive. To enable personality to develop, it will work with a boy at whatever stage of emotional development he has reached, regardless of his chronological age. Boys live first in three primary households. Long Barn, Springfield, and the Cottage, and later, when ready, in the secondary household, Larkrise. Adult staff are allocated long term to specific households and boys. Five consultants support the staff team. The community has educational facilities, geared to the capacities of individual boys. It is surrounded by countryside, including its own farm, and everything is integrated into a total environment in which the boys’ physical, emotional and psychological needs can be met. There is no system of punishment or reward”.²

The Influence of Barbara Dockar-Drysdale

I will turn now to the work of Barbara Dockar-Drysdale at the Cotswold Community, in her role as Consultant Psychotherapist.

Principles In Which We Try To Live In The Households Of The Cotswold Community.

An example of Mrs Drysdale’s work is the following “Principles in which we try to live in the households of the Cotswold Community”. This came out of regular discussion with the Therapeutic Resource Group, who she met weekly. Each household staff team had several key roles and one of them was the Therapeutic Resource, whose responsibility was to monitor each boy’s individual treatment plan and provide support and supervision to other members of the team. I think the principles speak for themselves. They are worked on directly with children who seem to pick up their importance and take them seriously.

The first principle is in contrast to a description such as “This is a house run by adults and there happen to be children in it”. This is our house and when anything goes wrong in our house it affects all of us. When you damage our house you do damage to all of us.

Mrs Drysdale continually stressed the importance of open communication and listening. If a team turned to Mrs Drysdale with a problem, say a child who was being especially difficult, maybe involved in some acting out, she wouldn’t simply sympathise with the team, saying, “what a dreadful child”. She would be exploring where the breakdown of communication around the child has occurred. The staff team would probably have to face up to the fact that important cues coming from the child were missed, and opportunities for prevention were missed.

There must always be food if someone is hungry. Food plays a very important part in the therapeutic progress. Bettelheim (1950) was probably the first to write about the importance of food being available at all times. This was a key part of the Peper Harow way of working. Mrs Drysdale developed the idea of an adaptation, of a special thing, with a child being able to feel and experience greed about something in particular, something specially provided for him or her.

You cannot like other people if you do not like yourself. This is a reminder to all of us that often the source of anger and difficulty with others is the view we have of ourselves.

Everyone needs to be able to trust. This is of course particularly difficult for children who have had such awful life experiences leading to basic mistrust.

If you give orders, grownups or children, then these must have a reason. I think this links in with a common principle within therapeutic communities, that things are explained. You just do not expect to be given respect as an adult because you’re an adult. Respect has to be earned. I think the Children’s Act and the permissible forms of control within childrens homes really rocked the boat in more traditional establishments with repressive regimes. Therapeutic communities had less to fear apart, perhaps, from the threat of false allegations of abuse.

Some people cannot be taught, but they can learn. That is a very important principle and a challenge to the National Curriculum way of thinking. A lot of the children we are working with, if given the time, space and emotional support, can learn. They may not be able to sit down in one situation, in desks, and be taught. Hopefully these principles convey a flavour of the values that Mrs Drysdale was working to establish at the Cotswold Community.

Group Meetings

The large group community meeting is a key feature in some therapeutic communities, e.g. the Henderson Hospital and Peper Harow. The Cotswold Community doesn’t have whole community meetings. We have four separate group living households. Probably only one of those households would come close to the model of the therapeutic community envisaged by Maxwell Jones. Larkrise household works with those boys who have been in therapy at the Community for some time, and have consequently matured emotionally, have the capacity to work and live in a group, to be more democratic, to take decisions together, to be mindful of the whole group. At this stage the boys have achieved some emotional integration.

The three other households are working with children who are emotionally unintegrated (Winnicott, 1976, l984; Dockar-Drysdale, 1990). They are particularly characterised by panic and disruption, and find being in a group immensely difficult, needing a lot of one-to-one attention. Even in these primary households there will be group meetings where the day is discussed, and just occasionally these groups function like therapeutic groups. But this is a bonus, not the norm. Most of the therapeutic work going on at this stage is on an individual basis. We are encouraging the child to form a close attachment to a particular grown up and within the context of this relationship to be able to be younger than they are, to regress.

There was a period a few years ago, when “regression” was a “dirty word”. Frank Beck used so-called regression therapy as a cover for sexually abusing children and for a time we were all tarred with the same brush. What we now know is that Frank Beck contaminated the idea of regression. He made a kind of anti-therapy out of it, and force fed children with regression. That is very, very different from having an environment where if a child wishes to be, feels the need to be, younger than his years, that is all right. But neither is it going to be pushed his way.

It is the same problem I have with physical holding and holding therapies. It is a reality of our work, with the very aggressive and angry children we work with, that a child will from time to time have to be physically held. We do not make a therapy out of it. It is a last resort. It can be therapeutic if it is done in a caring way, and if a child comes out the other side feeling. “I was really looked after through my panic and rage.” It can be positive, but again, we would not make a therapy out of that.

The Discipline of Self Inquiry

Another aspect to the way the Cotswold Community functions as a therapeutic community is the continuous process of examining and thinking about the whole place, and how the different parts inter-relate. Whenever we have a problem, we ask ourselves the question, “what is going on in the dynamic of the community that might be causing the problem?” It might be an individual child who becomes the violent one, the violent one that we cannot tolerate, and who all of us feel the need to exclude. What is that particular child expressing on behalf of all the children, of all the adults? The problem could be a staff member in a collapsed state, who is depressed, who cannot turn up for work, having changed within a few weeks from being a person who is seen as a pretty good worker, to someone we just want to flush away. Why is that? What is going on for that individual, and what are we as a staff group projecting into that person? Is that person carrying for us the feelings of hopelessness and helplessness arising from the work? The discipline of asking ourselves about the dynamic is a crucial part of therapeutic community work. We have a structure of small groups, so the dynamic could be the interplay that goes on between the groups. We have the household that is seen as the “marvellous” household, it is doing brilliant work, and the boys look happy. There is the other household, an utter nightmare! Chaos! Constant phone calls. “We’ve got five kids on the gym roof, and they’ve all just jumped in the swimming pool fully clothed,” night after night. What is that about? The offers of help from the staff in the quiet and calm household can be counter productive in that they confirm the projections. Our consultant may say that the most helpful thing you can do is to take back your negative projections. Instead of basking in your own glory look for your own problems.

Therapeutic Culture

When I arrived at the Cotswold Community, I thought I was quite experienced in residential work. I had done all of three years in a probation hostel, which was not at all psychodynamic, although I had been on a few courses at the Tavistock Clinic. I was confronted by the culture of a treatment environment, which I gradually embraced, but which initially threw me. For example: Depression can be a good thing. We are working with children who live in a permanent state of excitement, fending off painful, difficult thoughts. It is going to be helpful for them to begin to feel sad and depressed. That was new to me, and I think it is common currency in our society that if anybody is depressed they’ve got to be jollied out of it.

Another example, fairness is not about everybody having the same thing, but each according to his need. In our group of children, when they each have special things or adaptations, we may hear John’s getting so-and-so, I want that. We aim to develop a culture where it is possible to say “Well, that is right for Johnny at this point in time, and you’ll get to something that is right for you”.

The importance of being the bad object, or carrying the negative transference. I had come from a hostel where, in the staff group, if anybody was working a shift and had had a bad time from the clients, the other staff would say, “I do not know what he’s doing wrong, it is all right when we work”. Or “I do not have a problem with this child, I can manage him perfectly, he smiles OK for me. What’s your problem, you cannot handle him?” The staff team needs to understand that children will relate to staff members differently, and that coping with the hatred that a child invests in you at a particular time is important. In a sense the team ought to celebrate that you are doing it on their behalf, and support you, rather than being in any way critical, implying that you may not know what you are doing, and that is why you are getting a bad time.

Stealing is a sign of hope. The hope stems from the need in the young person to look for something through the process of stealing, and it is a good sign that he wants to take something from the environment rather than feeling hopeless. He has identified a need. It is hopeful. Much more worrying is someone who has completely given up and is passive. It is something to work with, and I think Winnicott helped us see “delinquency is a sign of hope”.

Greed is important and should be respected. Particularly for very deprived and disturbed children, to experience feeling greed for a special food, can be a stage in getting well. Finding excitement about something that is legitimate, rather than antisocial behaviour, delinquent excitement.

The concept of delinquent contract. “I will scratch your back if you scratch mine”. One of the delinquent contracts I first faced when I arrived at the Cotswold Community – it was still pretty primitive in those days – was in the house unit we lived and worked in. I suddenly realised that the way the chairs were arranged to watch television was quite extraordinary. It was not a particularly big room, and the television was in the corner, and there were these concentric circles of chairs. But the front chairs were never filled until certain people came in the room. Or if someone else was in them and a particular person came in the room, the other person would get off the chair. I immediately felt in my gut, “Hold on, this is not OK.” But then as soon as I had that thought, I also had the fear that went, “How on earth do I tackle this?” The boys who were getting the others to get out of the chairs, had considerable power in the group. Confronting this in the group situation and bringing it out into the open created an enormous rumpus with considerable fury. However, I knew that I had interrupted something important. I had broken a delinquent contract. I still find this a useful concept. I still find many examples of the delinquent contract and not just with children. This links to the important factor in psychodynamic work of using one’s own feelings as a barometer, not only of how one is feeling, but also what is going on for others – what you are picking up from others.

Conclusion

It seems to me that, although therapeutic communities are regarded as rather specialised settings, they have something to say which is of relevance to society in general and social services and education in particular. I have tried to cover what I regard as significant features of the Cotswold Community, its unusual history and journey of transformation, in the hope that it resonates with people in other settings.

1. A video entitled “A Healing Culture” was made in 1987 about the Cotswold Community’s work. It includes a short history of the Approved School era.
2. This is a quotation from the video “The Recovery of Childhood”.