Organic Growth and the Collective Enterprise

ORGANIC GROWTH AND THE COLLECTIVE ENTERPRISE.
Building on the work of Barbara Dockar-Drysdale to develop the new therapeutic task.
John Diamond, Director, Mulberry Bush School.

Introduction.

This paper traces some of the key themes in the evolution and development of the primary task of the Mulberry Bush School. In my view, as a result of the primacy of the model of individual therapy, complex issues of dependency and un-differentiation became embedded and unconsciously hindered the development of group based models of treatment. I look at the theoretical implications of the individual model, and explain more recent developments that re-evaluate the importance of team and group living structures, in order to build up the ‘holding environment’ for children and staff.

Organic growth.

I will talk about some of the main developments at the Mulberry Bush School which is now recognised as a unique centre for the care, treatment and education of severely emotionally troubled children, children with unintegrated personalities. Barbara Dockar-Drysdale described the growth of the Mulberry Bush School as:

The survival of the Mulberry Bush School for 55 years, and its continuing work has several sources: (1) the ability and foresight of those who were its stewards, ( 2) its capacity to adapt to the changing social and economic situations, and (3) its ability for regenerative internal growth and change. The conceptualisation of an organisation as an “open system” is borrowed from a student of biological and ecological systems (von Bertalanffy, 1950), and implies a connection between the “conditions for growth” and the structure and health of the primary task of the enterprise:

“The existence and survival of any human system depends on a continuous process of import, export and exchange with its environment, whether the intakes and outputs are, as in the biological system, food and waste matter, or, as in organisations, they are materials, money, people, information, ideas, values, fantasies and so on. Internally, the system engages in a conversion process, of transforming inputs into outputs” (Miller 1989)

The primary task of the care, treatment and education of the severely emotionally troubled children who are referred to us requires a flexible range of provision which should allow, depending on need, for both structured and safely supervised free time, as well as directive and non- directive work. The model of treatment we offer meets individual need within the context of the small group (household or class) which in turn is contained within the context of the ‘large group’ of the school’s organisation. The conscious application and use of these different mediums, allows for a child’s emotional re-education in which, through the processes of rigorous testing out, and ultimately the survival of the human and physical environment, the child begins to gain a sense of self. In this sense the integration of the different task areas of the school, contain the children, and create our therapeutic organisation.

The achievements of Barbara Dockar-Drysdale.

Barbara Dockar- Drysdale developed the treatment methodology of the “provision of primary experience” and conceptualised it in a series of papers written through the early 1950’s and 1960’s. These were published separately as Therapy and Consultation in Child Care. Dockar-Drysdale was central to the whole endeavour and to the processes of therapy. To contemporary readers this is striking. What is also noteworthy is how rarely, she writes about intense or frequent aggression from the children.
However, in its formative years Dockar-Drysdale through her directive role, and due to the small number of staff in the ‘seedling’ stage of the schools growth, was of necessity central to all aspects of the task.
During those early days the child guidance clinics would refer withdrawn and depressed children (those with neurotic disorders) to the school, as well as the high profile ‘acting out’ children. It is this second group, those children who are deemed uncontainable within their school or home environment, who are now referred.

Within the concept of “the provision of primary experience” Dockar-Drysdale carried out her most renowned work, defining the different syndromes of deprivation, and formulating treatment approaches to these syndromes. Bridgeland (1971), writes:

“Dockar-Drysdale has done her most important work in seeking to explain the nature and needs of the ‘frozen’ or psychopathic child. The emotionally deprived child is seen as ‘pre-neurotic’ since the child has to exist as an individual before neurotic defences can form. The extent to which there has been traumatic interruption of the ‘primary experience’ decides the form of the disturbance. A child separated at this primitive stage is therefore, in a perpetual state of defence against the hostile ‘outer world’ into which he has been jettisoned inadequately prepared.”

and;

“Other children requiring essentially the same treatment are those which Dockar-Drysdale calls ‘archipelago children’. These have suffered separation after the first steps of integration. They have, therefore, some ‘ego areas’ without any total personality. Their behaviour is consequently erratic and bizarre but they have some capacity for symbolization, which aids therapeutic contact. Others have become fixated at some point and have protected their ‘embryo egos’ by ‘caretaker selves’ which are set up as real. Regression is essential to allow a return to the point where the creation of the ‘false self’ became necessary.” (Bridgeland, 1971)

Bridgeland captures the quintessential aspects of Dockar-Drysdale’s treatment approach. This could be defined as; firstly categorisation, ( identifying the syndrome), and then applying the therapeutic intervention. Holding this process were adults who provided close and unsentimental management through which the ‘authentic’ chaotic child emerged. Within this containment of behaviour, a deep attachment to an adult was supported, in which a localised regression to the point of the failure was therapeutically managed. Very often a regular and reliable symbolic adaptation, the ‘special thing,’ was introduced. This allowed the child a real (and illusory) experience of primary adaptation to need, and an experience of the regularity of close bonding and nursing with a primary carer. Most often this symbolic adaptation would take the form of the child’s ‘focal therapist’ providing a food chosen by the child, such as a boiled egg or a rusk with warm milk. The child’s choice was often exacting in its primary connotation. The task of the school is still to provide care, treatment and education for severely emotionally troubled children referred to us by local authorities. How we carry out that task is currently being re-evaluated and reformulated. As I mentioned earlier, the literature on the history of the school shows the working model to be of Barbara Dockar-Drysdale, and her colleagues engaged in close one to one therapeutic relationships with the children, the lived experience was literally of ‘continuous therapy’.

“the unending demands on the physical and emotional energies of the staff, particularly as it was the principle of the school never to close, produced new problems in the management of the school, now brought into closer contact with the expectations of the outside world”. (Bridgeland, 1971)

I note here, as in Bridgeland’s earlier explanation of the unintegrated child’s inability to cope with the hostile outer world, that the concept of ‘sanctuary’ or ‘asylum’ from external reality is a central tenet to the Bush’s therapeutic methodology. Reeves (2002) defines the theme of ‘Impact and Impingement’, as one such issue for the school; the child, and the therapeutic relationship, is protected by the boundary of the organisation from the unhelpful impingements and the over stimulating forces of the ‘outside world’.

The modern school is in a social situation where the work of the regulation of the boundary is generally busier;- more staff, therefore more cars, more visitors, more inspectorial bodies, and a culture more preoccupied with the safety and welfare of children.(For example, our visitors book records 12 visitors each day on Tues.3rd and Wed.4th June 2003, and this is fairly typical of most days). This number is probably more on a daily basis than the school would have seen in a month during those formative years. But the more important issue is that the ‘impingement ‘ or intrusion of the ‘outside’ world is now a daily reality. Accordingly, it has to be re-thought and managed as a daily part of the culture. Within our current thinking external reality can be seen as a ‘pulling force‘ to a more inclusive model of community living, and as an experience of ‘reality testing’, within the treatment process. Although the ‘ semi-permeable boundary’ remains, it is of necessity far more permeable. The school has had to open up to the outside world, and become less insular. Paradoxically, the concentration of grossly acting out children has also increased.

Paradoxically too, within this history, little is mentioned of Stephen Dockar- Drysdale who actively fulfilled this role of gatekeeping against impingement, and managed the boundary of the enterprise in order to protect the therapeutic task. Barbara Dockar-Drysdale herself used the phrase ‘there can be no therapy without management’. Within the new formulation we currently emphasise the importance of the internal interfaces between the different task areas, and the authority and accountability of staff at these different levels. Instead of the model of continuous therapy, bounded space and time are becoming more relevant as structures for providing the appropriate containment for the therapeutic work.

This is not the only way we have modified the task to fit the modern circumstances, I quote from Bridgeland:

“The therapists task in all cases is to give the child ‘complete experience’ so they can first find unity then individuality. For the most difficult ‘frozen’ child the treatment begins by a process of ‘interruption’ in which he is made conscious of the reality of himself as a unit in the world. His behaviour is carefully observed and anticipated …..If the child fails to close the gap in his defences he is likely to panic since he has to forge a new unity in the world. At this point he may begin a severe ‘unfocused depression’ interpreted as a ‘state of mourning for the loss of unity’….The next stage depends on a deep attachment to an available adult…so that the eventual separation of the ‘self’ can be achieved” (Bridgeland, 1971)

Within the treatment process described above, the original theory the ‘provision of primary experience’ enabled the deprived child to have the ‘gaps’ in their early life experience ‘filled up’ via relationship building and the one to one symbolic adaptation to need. Rather than ‘gap filling’ we are currently translating and thinking about how this process can allow the child to accept, come to terms with and mourn these losses of primary experience (‘experience-realisation-conceptualisation’- Dockar- Drysdale [Bridgeland, 1971] ). This is being carried out by using the specialisations (differentiation) of the task areas to enable each part of the school to provide for aspects of the work which were previously provided by the individual ‘focal’ therapist. The aim of this new approach is to provide an economy of emotional energy being directed to the child, rather than facing the situation of ‘vertical dependency’ (Diamond 2003) with the associated destructive ‘burnout’, lack of differentiation, alienation, and the resulting feelings of workers qualities being reduced to ‘sameness’ across their different professional disciplines.

This is not an avoidance of individual work. Children still have keyworkers, and many have access to sessional work with the schools art and child psychotherapist. Our new approach relies on a new honesty and accountability from staff. It requires the members of the organisation individually and collectively to be in touch with and manage their own individual and team ‘depressive position,’ and to develop a capacity for ‘negative capability’ or ‘staying with not knowing’ in the face of extreme behaviours. In this sense, dependency on the individual worker, leader or consultant as the ‘authority that knows’ is actively removed.

“Unfortunately this requires us to be able to face both external and psychic reality, which means being able to tolerate uncertainty. We all know that this requires work, whereas the more infantile state of mind that we call the paranoid/schizoid position enables us to avoid this work by believing in certainties. Consequently there is a tendency in all of us to remain with what we know rather than having to face uncertainty.” (Stokoe 2003)

Within the new formulation, all the component parts of the school (group living, education, family team, art and psychotherapy, ancillary and maintenance staff ) work interactively to create the totality of the ‘organisation as therapist’ rather than the dependency on the individualised relationship. In this way the therapeutic school can adopt the model of the therapeutic community for children. Consequently the school’s theoretical basis and practice are increasingly systemic as well as psychodynamic.

Developing distance regulation within one to one work.

We inherited aspects of the original therapeutic methodology of ‘continuous therapy’. We have, over the last few years started to become aware that historically we may unconsciously have offered too much of a ‘promise of something special (cure?)’ to the referred child. This unconscious ‘promise’ has, we feel, often been interpreted by the child as something like ‘unconditional sympathy’, in which, due to their manipulative abilities the children have often set about to exploit.

In an environment such as the school where the regressive behaviours of children are often the primary emotional currency, we believe that the role of observation, and the collective use of group structures will help clarify and define how this material is managed and worked with. In one sense the transference material which children project onto staff is too readily available. However, we also need to think about how the unconscious infantile needs of staff are reactivated within this work, and try to reduce these being acted out in the workplace.

Example 1

Several years ago ‘Ronnie’ aged five was referred to the school. On his arrival staff talked about their positive feelings of working with such a little boy. Some staff were drawn into this way of relating, and Ronnie played into these relationships which focussed on a positive transference. When Ronnie started to act out his abusive past through aggression towards these staff, they realised that they had become involved in a complex unbounded relationship with him.

Whereas, before, workers engaged in the day to day work with the children, would at times unconsciously align themselves to the demands of the child, we are trying to create the conditions within group living, whereby the child will reach out to the adult. This requires the child to work on a conditional acceptance of care and respect from adults. Unconditional provision for the most unintegrated children is targeted within the assessment process, and aligned to the child’s age and stage ability. The anxiety of adults may influence how close they feel they should be to the children. We try to reformulate how we work so that children have as much responsibility as they can bear as they learn that their anxieties will be increased by the distances created through negative and anti-social behaviour.

In recent discussions we have redefined the task of care workers at the school. Although it may sound paradoxical, our current view is that we do not want staff to make deep relationships with children. We do, however, want them to observe the child and engage in the tasks of childcare, and to use their colleagues within team meetings to help them think and develop ideas about the child’s care and treatment. We require staff to be observant, creative, sensitive and thoughtful in their interactions with children and to use the team as a reference point for their work. We feel that when the child is referred we should adopt a view of the child as a blank sheet –not anticipating behaviours.

This requires staff to maintain a neutral ‘boundary position’ in which they both interact and observe in order to develop a hypothesis about what aspects of the child’s functioning (or lack of functioning) needs to be treated. This distance regulation does not mean the worker withdrawing from the child, rather it means creating an appropriately bounded distance, in order to develop a thinking space, and an emotional economy of relating.

Example 2

“I have been doing an individual time with my key-child for just over a year now. This was put in place after discussion with the team and our consultant. The reason for this individual time was because the child was expressing difficult feelings about how he felt his relationship with me was threatened. This ‘threat’ was my new role in the team as deputy team leader, which meant more meetings, less child contact time, and therefore in his mind, less space to think about him. The time is in many ways a symbolic representation of the availability of this mental space, as well as a physical time and space to be together. We use the playroom in the new therapy suite for the time, an area that he will not use for anything else, and the resources available there are not used by him for any other activity. The time is also protected by myself not arranging meetings or other activities that will clash, and by communicating to other members of staff that neither the child nor myself should be expected to be involved in other things during this time. During the time the child will generally play undirected and watched by myself, whom he sometimes asks to help or join in. Although the play can often be seen to relate to themes which are known to me, the playtime is not therapy, and I need to hold on to these interpretations, allow the child to play, and consciously or unconsciously work them out for himself.” (Goodspeed 2003)

The idea of ‘deep relationships’ has too often implied enmeshment with the child leading to feelings of alienation and demoralisation for the worker. I have previously described this state of mind as ‘vertical dependency’. Deep relating can be interpreted by the child as an ‘open season’ on unbounded and pathological forms of relating. There are two risks in this way of working. First, it gives the child little responsibility for starting to think about how and why they relate in inappropriate ways, secondly adults own unresolved issues are made available for the child to exploit or are projected onto the child. Ultimately, staff are there to meet the child’s needs, not to have their needs met via the relationship.

“The business of setting up the therapeutic system is, therefore, the business of setting up structures to reduce the effect of the staff unconscious on the staff/child relationship and to maximise the chance of detecting the effect of the child’s inner world on the system” (Stokoe 2003)

Through this process of observation and discussion, the child’s strengths and regressive tendencies can be identified. The team can then create a treatment plan which should give the message that ‘we will support your strengths’ e.g. via schooling, ‘we will not nurture your regressive behaviours, we will manage them for you’ (the unintegrated child) ‘or help you manage them’ (the recovering or fragilely integrated child). Within this framework ‘efficiency’ is the worker knowing when to intervene, and intervening thoughtfully and decisively, rather than getting lost or merged in the child’s disturbance.

As the child arrives with a sense of some form of family, we will require a commitment from the family to work with us (along with the referring agency, they are ‘the stable third’). Staff are required to keep the family alive and in mind for the child. For some children this work will include helping them modify their disturbed or distorted sense of family, for others it will mean helping them engage with the concept of what a family might be like.

In response to this important aspect of the work we have developed a ‘Family Team ‘comprising two full time and one part time social workers. This team has become essential in supporting and maintaining close links between the families and their children at the school. They also act as a ‘buffer zone’ in potential disputes between the family and the work of the care and treatment teams. The team can offer counselling and family therapy in order that there is a ‘match,’ at the point of re-integration, between the emotional maturation of the child and those adults at the home base.

Teams, groups and structures.

To my knowledge to date there has been no coherent attempt to apply theories of group based forms of treatment which include Planned environment therapy, (Franklin), Group Analytic Psychotherapy (Foulkes) or Psychoanalytic Group Psychotherapy ( Bion), to the work of the Mulberry Bush School. This seems ironic as the very nature of the work has been about using the group as a forum for the containment and nurture of emotionally distressed children. Even in the earliest organisation of the school:

“The children were arranged into four official group and many unofficial groups, graded in their degree of structure but with a strong bond with a single teacher” (Bridgeland 1971)

However, apart from her 1961 paper ‘ The problem of making adaptation to the needs of the individual child in a group,’ which largely focusses on individual work, Dockar–Drysdale makes no conscious reference to the work of groups, not even to the group living model that the school adopted being that of ‘planned environment therapy.’

Dockar-Drysdale developed her work in an era when Group Psychotherapy was still in its formative stages, the ‘Northfield Experiment’ and the associated 1946 papers that launched the TC movement, were still recent innovations. She had met Marjorie Franklin and David Wills who, via the ‘Q camp’ experiments of 1936 to1940, had already defined ‘planned environmental therapy’. By 1945 Marjorie Franklin had written and publishedthe manuscript ‘the use and misuse of planned environmental therapy’, butDockar-Drysdale did not refer to this work in her writings of the early 1950’s. It seemsthat planned environment therapy crept into the garden almost unnoticed.

Planned Environment Therapy.

The roots of PET reach back to 1928, when before the planning of the ‘Q camps’, Marjorie Franklin had set up the ‘psychological and psychotherapeutic discussion group ‘at her consulting rooms in Harley Street. Meetings of this group included analysts of the time such as Dr. Kate Friedlander, Dr. Melitta Schmideberg, Dr. Adrian Stephen, and later Dr. Denis Carroll (Portland Institute for Scientific Treatment of Delinquency) who later worked as an army psychiatrist at Northfield. By 1963 Franklin had set up a planned environment therapy discussion group, which led in 1966 to the formation of the Planned environment Therapy Trust (PETT) to promote ‘the serious clinical study of the use of the environment as a means of correcting asocial and other related character deficiencies’. Franklin claimed that ‘PET has long reached the stage of a serious branch of psychotherapy’ and Arthur Barron describes it as ‘the only method that provides available method and approach to the residential care and treatment of the maladjusted’( Bridgeland 1971).

That the Mulberry Bush should have adopted this group based form of treatment is entirely understandable. Nevertheless, questions remain: how was it consciously developed, and why did no one ever attempt to document or define this important development? As a treatment model it must have made sense to Dockar-Drysdale, because it allowed for the integration of her own clinical and theoretical ideas with theability of the care staff to provide the practical and thoughtful daily routines of life in the group. Franklin writes:

“In partnership, the environmental therapist, by his closer contact with the children, can be considered to be much more of an observor, and the psychotherapist , owing to his theoretical and clinical studies, to be more in a position to interpret and explain. But this is not a fixed relationship and there will be overlapping. There can be no rigid separation of the attitudes and spheres of activity between workers with the same people and of a similar school of thought.” (Franklin 1968)

We translate Franklins ideas by using the different levels and structures of the task, in particular our own internal case conferenceing meeting to provide observation, hypothesis, and then care and treatment planning to meet the needs of the child in the placement. For this reason the school needs to be multi functional and to offer a diversity of experiences, including different levels and types of relationships (replacing quantity with quality). We must develop our collective and experiential knowledge to determine the stage a child is at, and to be able to construct detailed programmes to help him take his next maturational step. Therefore it is essential for all members of staff to share their perceptions of the child and to co-operate in his treatment.

Why are group based models of treatment important for the current therapeutic culture? We have used the term ‘vertical dependency’ to describe the one to one model and highlighted the potential isolation and risks of this position. We are developing the use of teams as the ‘horizontal axis’ increasingly to support and manage children. Planning for the child who needs a very dependent relationship/ attachment in order to evolve emotionally, is discussed in the internal case conference and organised by the team who support an individual worker to meet these needs via localised work (see example 2). Art therapy and child psychotherapy are also used with some children in order to resolve deep attachment issues and confusions. We hope that through the observation and assessment process all children will have their needs met by the full range of structures and daily routines (group living experience, education , family work etc.). In this sense we are creating the conditions whereby the child can feel that the organisation, and the adults who are significant to him, form his attachment to the ‘secure base’ of the school.

Consequently the tasks of the four daily operational teams for working with the children are:

1. The task of the Group Living Teams is first to provide an assessment of the child’s needs via distance regulation and boundary setting. The task for the established group is to provide a continuity of containment and nurture (planned environment therapy). Through these processes the child can internalise an experience of close management, being cared for, role modelling, and a re-education in social/emotional awareness.
2. The three different tiers of education (nurture, national curriculum, becoming an independent learner ) provide the child with a ‘pulling force’ towards ego functioning, self esteem and hope for previously ‘ineducable’ children.
3. The ‘Shifford’ Team, is a behavioural support team which operates in the transitional space between group living and education, supporting issues of behaviour management, and acting as another tier of containment to these task areas. It also organises and runs positive experiences e.g. the current ‘Shifford club’ as well as ‘outgroups’ so as not to become only associated with crisis management.
4. The individual therapies team currently consists of one part time child psychotherapist, and a full time art therapist. (The appointment of a Grade B consultant psychotherapist ‘team leader’ role has been agreed but has been put on hold). These therapists are engaged in one to one work with individual children. The need for individual therapy is identified and discussed by the care and treatment teams, and in consultation with the schools consultant psychotherapist, referrals are then made to the therapists.

The integration of the different task areas across time and space gives the child a sense that the whole school and its structures provide for their developmental needs. No longer is the experience of care and treatment highly individualised. Typically now, many children, although they are in constant denial of the value of the school to themselves, regard it as a safe and meaningful haven, a real alternative to some of the extremes of their chaotic home situations. Recognition of this process is very important: the holding task of ‘organisation as therapist’ may create the conditions in which emotionally deprived children can start incrementally to define their fantasies, desires and needs, and through this process begin to conceptualise what they have lost. Through this process of experiencing differentiation, children begin to develop their abilities for thinking. i.e. emotional holding facilitates cognitive development.

The matrix and the introduction of group therapeutic interventions.

Foulkes defined his concept of ‘the matrix’ as:

“The hypothetical web of communications and relationships in a given group…It is the common shared ground which ultimately determines the meaning and significance of all events and upon which all communications and interpretations, verbal and non-verbal, rest. This concept links with that of communication.” (Foulkes, 1990)

The matrix provides a mental framework for thinking about all issues of the life of groups and teams within the school. These groupings range from the small or median groups of the households and classrooms, to the large group of the community of the school. Small and median groups work together regularly during the week e.g. ’circle time’ in class, or staff team meetings. On lesser occasions the whole school or a ‘large group’ of professional or ancillary staff come together for the purpose of discussion e.g. whole school study days. For the children the weekly assembly, is an adult managed version of the large ‘community meeting’.

The idea of the matrix as a framework for understanding the complex interactions and communications in both small ‘task’ groups and within the totality of the whole school community is of value to ourselves as a therapeutic organisation. The proper conduct and understanding of groups is helped by this framework, and by Bion’s theory of the defensive, regressive tug of the basic assumption group undermining the focussed and task led work group. This theoretical underpinning can be taken further. Staff meetings should be constructed within the notion of the ‘work group’ where team members are being helped to take responsibility for understanding the unconscious processes of such meetings. Similarly, focussed therapeutic groups for children can be used as interventions within the treatment task. I wish to emphasise here that such groups do not provide an alternative to ‘opportunity led work’ (Ward 2002) within the daily lived experience of residential treatment.

Example 3

The following example is from Soren Dahm a senior practitioner at the school, and is taken from a work discussion group presentation from his postgraduate diploma training course ‘working with groups in the public and private sector’ at the Tavistock Clinic. The group presented is one of two independent weekly groups each facilitated by two group facilitators. This is the 15th session, and the first after a three week Easter break. The material presented may sound disturbing in its description of sexualised and aggressive behaviours, but I believe it is an accurate reflection of the severity of disturbance, and the lack of boundaries within the child population we work with.

This is Soren’s narrative:

“Katey, Colin and Janie then arrived. Katey came in looking distressed. I said that she looked sad. She said in a dramatic way that she was, but that she could not talk about it. I said that it was OK and asked her to sit down. Colin seemed in a good mood and walked calmly into the room and sat down. Janey appeared rather manic. . She was constantly in motion and found it hard to sit down and twice tried to run out of the room …….

A drawing activity begins:

Katey got up, and as she passed Janey , she pushed her back in her chair. Janey shouted “I’m going to kill all you fuckers!” and started aggressively to cross out her drawing. She then started shouting sexualised abuse at Colin and started to rub her genitals aggressively making loud sexualised sounds. Colin laughed excitedly and started throwing pencils at Janey shouting that she was disgusting.

Shortly after Janey was led out of the group to be with a support worker waiting outside.

Soren comments:
I said to Nicky (female co-facilitator, in a voice audible to the children) that I felt quite left out and that I was wondering if it had anything to do with the long Easter holiday without a group. Nicky said that perhaps the children wanted us to feel left out because they were angry with us for not having the group for so long. I then said that I had noticed that none of the children had asked us about our holiday. At this point the children were listening and started asking questions about our holidays. We briefly said a few things. We then went on to reminding the children that the next group would be cancelled because of the school trip to Wales. The children all made disapproving sounds like ‘Oh no’. Janey then entered the group again and sat down next to Nicky. I said I was glad she could be part of the last bit of the group. Nicky said that we needed to finish soon and that it was time for biscuits.”

Commentary.

This example gives a flavour of the ‘lived experience’ of working closely with very disturbed children. In this case Soren and Nicky had to struggle both to manage the children’s behaviour and at the same time to maintain an ability to think about the situation. Soren writes in his commentary:

“The rage, the fear, the loss, the pain and in lack of a better word, madness in the group made thinking about this session unpleasant. Such counter-transference feelings and their importance for understanding behaviour is described by Heimann as “the analysts emotional response to his patient within the analytical situation remains one of the most important tools for his work.” (Heimann, 1950). My problem is however, that using these tools i.e. thinking about my emotional responses, as indicators of what is going on in the group, is an unpleasant process that I would rather avoid. Heimann points out that “violent emotions of any kind, of love or hate, helplessness or anger, impel towards action rather than towards contemplation”(ibid). The group acted by violently attacking and rejecting each other and the facilitators. In choosing to present this session I want to try to keep on thinking about the group and not just act by rejecting it or as Heimann says “..to sustain the feelings which are stirred in him,(the therapist) as opposed to discharging them as do the patient.”(ibid)

The fantasy of Nicky and I as a parental couple was discussed in the Work Discussion Seminars. This helped me to understand the importance of the unconscious fantasies the group might have about Nicky and me, in the absence of the group, producing a new baby that ultimately would replace the group. It also seems likely that the increased sexual acting out in the group is connected to such fantasies.”( Dahm 2000 )

This example shows the increasing emphasis on groupwork. More specifically, in thinking about the group as providing the appropriate containment and nurture for our work, Soren and Nicky were able to reflect on and stay with the chaos projected by the group. This was ‘reflective practice’ or ‘negative capability’ informed by an explicit theoretical base. The children obtained a sense that their chaotic behaviours would not frighten off the adult workers. I believe that this holding function allowed the group to come together and experience a sense of completion and resolution of the conflict, through which they achieved some collective concern for each other and the adults. Hinshelwood (1996) writes of ‘reflective practice’.

“ the therapeutic community is one level of a versatile form of practice. That form of practice has come to be called reflective. My own work has convinced me that the specific characteristics of a reflective space is that it is for establishing and maintaining bridges that will prevent, or heal splits” (Hinshelwood 1996).

Conclusion

I have tried to provide you with some of the key elements in which the task of the Mulberry Bush School is changing and being re-formulated, in order to continue working with some of the most disturbed and chaotic children referred to us from a wide geographical range of local authorities. These elements are:

• We believe that the organisation, and the structures of staff teams provide safe, nurturing, and containing experiences routines and boundaries for the very chaotic behaviours of children. These help the child evolve emotionally.
• We require that staff maintain an appropriate emotional distance in order to identify need. Individual work is then planned and provided from the context of the group.
• We are committed to supporting the development of the teams working with the children, in order that authority, responsibility, and accountability are properly delegated and shared.
• We value the thinking of all staff in helping to identify the needs of children. This process is supported by professional supervision and consultation.
• We believe that working in partnership with both the referring authority and the parents/carers of children is essential for a successful outcome.

Notes on ‘Organic growth and the collective enterprise’

Meeting with John Whitwell at MB3 on May 16th 2022

This was written as a working document for staff in 2003, and later that year presented at the ATC Windsor conference, and published in ‘the International Journal of Therapeutic Communities’. I became Director in 2001, so this paper followed on from Richard Rollinson’s tenure as Director, in which the School site was redeveloped to create a clear sense of a community, four independent households built and the School itself converted with the aim of developing better differentiation between education and group living. The paper explores how we went about creating a more group based therapeutic model which was necessary for ‘inhabiting’ the new site to create a therapeutic community environment.

The model of therapy we inherited in 1991 was of the previous Principal Robin Reeves offering individual psychotherapy to all referred children, thus the leader of the School had an intimate relationshIp with all children. The new management had moved to a situation where the Director was working ‘at the boundary to promote the work’ rather than being central to the dependency needs of the children, and we had worked hard to ensure that authority and accountability were handed down to front line care workers. Despite this the remains of the model of 1 – 1 therapy seemed to be still embedded, hence the need to move to a group based model.

The paper also attempts to look back at the work of Barbara Dockar- Drysdale and apply a current analysis to some of her ideas for example ‘Impact and impingement.’ The reality for us was that the MBS was no longer an insular institution it had opened up to the world, and there was far more activity across its boundary than in the past. We regarded this opening up to the outside world as a healthy situation. In the paper I mention the role of the family team which had actively contributed to this new ‘more fluid’ situation through its work to improve our engagement with the children’s families, after it was established with National Lottery funding in 1999.

Looking back it is also influenced by the ideas of our therapeutic consultant at the time Dr Alejandro Reyes, who brought a more Kleinian critique to the Dockar- Drysdale /Winnicottian theory base/culture. This meant challenging ourselves and developing a better understanding of conditional and unconditional regard within therapeutic relationships.

From his regular work with the staff teams, Alejandro would speak of the transference and regressed behaviours as being ‘too available’ through the regularity of the childrens ‘acting out.’ He interpreted that the staff had an unconscious need for these behaviours to keep them busy and to ‘organise’ the work, and at the time we called this dynamic our need for reactive ‘contingency’. We were by then moving away from a time when the children’s behaviours would invade all aspects of the adult meeting space, hence we needed to develop a more containing adult lead culture, and ensure that we were able to develop a greater ‘reflective capacity’ to observe and understand the meaning of those behaviours. So the paper was written at a time of change in both the physical school environment, and to develop the relational therapeutic culture.

Looking back at the paper I think the central ideas of developing stronger team structures and ’emotional distance regulation’ still hold true, and it was a ‘working document’ to support further staff discussion. As mentioned in the paper ‘emotional distance regulation’ did not mean withdrawing from the child, it meant using the observation and the creative relating of the whole team and sharing these perspectives, to better understand the child so that a treatment plan could be developed which better met the child’s authentic needs.

Coming from the Cotswold Community with Barbara Dockar- Drysdale as consultant it feels a bit like heresy in parts especially when I write ‘we are not looking to make close relationships with children’ ! but the issue was about helping staff think, observe and reflect on the qualities of the relationships and to develop a greater tolerance for staying with difficult feelings and deepening their reflective capacity. The case study of working with Ronnie the 5 year old child aims to explain this dynamic. I also think we were working through the remains of a 1 to1 culture in which some staff were enmeshed in those relationships, hence I write ‘staff are there to meet the children’s needs, not to have their needs met via the relationship’. In terms of further evolution the establishment of our reflective space model and the Foundation Degree in 2007 and over successive years these have radically modified the culture, and it has enabled all staff to have an appropriate reflective structures and a level 5 training that brings together theory and practice, and it has helped address exactly those staff dynamics through the delivery of experiential work based learning.

The case study material at the end of the paper by Soren Dahm (who was a senior practitioner), is about a children’s therapeutic group as it forms again after the Easter break, and it was a timely reminder of how our practice was developing and being influenced by new ideas, in this case it was a MA in group work from the Tavistock Clinic. The development of this reflective capacity is one way of developing and improving the counter – transferential abilities of staff, and this theory from a Kleinian perspective is picked up in Soren’s commentary about the work of Paula Heimann who was also a Kleinian.

I think the paper is interesting as both the concepts of ‘organic growth’ and ‘collective enterprise’ have been central concepts to our ongoing development. Most of our organisational development since then has been organic growth via opportunity led work, and as multi – disciplinary collective work, or as we now say in our 3 core principles ‘collaborative work.’

John Diamond