After I became Principal of the Cotswold Community in 1985 I regularly attended the residential Windsor Conference (organised by the Association of Therapeutic Communities) at Cumberland Lodge in early September each year. In the spirit of therapeutic communities everyone was encouraged to participate. It was where I gained some confidence, still fragile I have to say, in writing and speaking to a group. It was possible to take a paper, still in draft form, present it at the conference and from the ensuing discussion complete it and submit it for publication in the journal. An excellent process I think.
One of the many pleasures at the Windsor Conference was the opportunity to renew friendships among the substantial contingent who attended from the Netherlands. Hany Eykman was held in high regard. As a result of ill health he had missed several conferences but he returned to deliver this paper which was well received. As a leader of a therapeutic community myself, I could relate very well to this paper.
THE LONELINESS OF THE LEADER
Reflections on Psychotherapeutic Leadership. Hans Eykman. Psychotherpeutic Centre “De Viersprong” De Beeklaan 2 4661 EP HALSTEREN
Paper presented at the XIIIth Windsor Conference, 17 – 20 September 1990.
What happiness? Who can enjoy alone,
Or all enjoying what contentment find?’
J Milton, Paradise Lost
A 59-year old Dutch man suddenly falls seriously ill at the start of his holiday in a car sleeper train in the midst of France: repeated collapses, vomiting, diarrhoea. He is acutely admitted into a local hospital. Elaborate, internal, cardiological and neurological examinations, with the whole scale of modern laboratory tests, tell more about the sophisticated standing of French provincial medicine than about the illness: only a minor disturbance in the heart rhythm (ventricular extrasystoles) is found – which could not be held responsible for the complaints of the patient. The illness is diagnosed as “malaise vaso-vagale”, and three days later the patient is transferred by ambulance to a hospital in his home town. There again he is overwhelmed with the blessings of modern science, but even the latest isotopes fail to bring more light in the case, which is finally concluded to be a “vegetative disturbance”. Maybe the patient is overloaded with work, as he suggested himself already. Couldn’t he slow down a little bit? Well, that is not so easy, since the patient has a function that requires full time work. And he dislikes the idea of quitting the job very much.
The patient in this case is a medical director of a psychotherapeutic centre. He has been in this function for 7 years, with pleasure; previously he had been working as a psychotherapist and as head of the adolescent department in the same centre. Until a year ago he took part in a three-headed board of directors, in which he had been working closely together with a colleague, who was at the same time a very good friend for a very long time. This colleague had departed as director a year ago, after gradually having turned over his tasks to the patient. The patient, who experienced the leaving of his friend and colleague as difficult, did not, however, have the feeling of being burdened, because there has been a reshuffling of tasks in the board of directors as well as in the management teams. But he remembers now that he has experienced the feeling of “standing alone for the job” quite often, in spite of the broad support he got from his administrative colleague. Responsibility simply pressed harder on him. He often felt much more tired than before, but blamed this on his age. After being dismissed from the hospital, the patient treated his illness himself by appointing a colleague psychotherapist as a new third man in the board of directors. So far follow up data are encouraging.
What can be learned from this quite interesting case report? Leadership is not everybody’s job? The leader has to be able to cope with loneliness, or even has to take a certain amount of pleasure in solitude? The management of a psychotherapeutic centre is a moreheaded job? Let us try and find some answers to theses questions.
The Willy-nilly Leader
Much distress in leaders is caused by the so-called “Peter’s Principle”: promotion continues till one reaches the level of his incompetence. One is doing well in the health service, is being promoted to leader of a team, of a department, to manager and at last to director. This is the way to go, and if you are not participating in this race, you have an abominable lack of ambition.
For myself, I am inclined to believe that leaders are born, not made – in spite of the vast market of training courses in management and leadership. The born leader will not suffer under his leadership, but the obvious successor (typical example of the willy-nilly leader) on the contrary, is easily drifting into a situation from which he can not withdraw. He is balancing on the edge of competence and incompetence – and no one will discourage the rope-walker from doing his smart and courageous performance. The predecessor of our patient in the case history was a born leader. The patient was an inevitable successor, but – according to himself – more a typical “second man”. But you cannot get a permanent appointment as “second man”, even if you want to.
By the way: there seems to be hardly any attention for the “second man issue”.
The Capacity to be Alone
In a paper on “The capacity to be alone”, Winnicott (1958) wrote:
“It is probably true to say that in psycho-analytical literature more has been written on the fear of being alone or the wish to be alone than on the ability to be alone; also a considerable amount of work has been done on the withdrawn state, a defensive organisation implying an expectation of persecution. It would seem to me that a discussion on the positive aspects of the capacity to be alone is overdue”.
Further on he states:
“..that the capacity to be alone is based on the experience of being alone in the presence of someone (ie, the mother), and that without a sufficiency of this experience the capacity to be alone cannot develop”.
The description of Winnicott’s ideas – here only quoted briefly – forms so to say the core of an interesting book by Anthony Storr (1988), titled, “The School of Genius” (in the paperback edition more precisely renamed as “Solitude”). In this book, Storr opposes, in a pretty and convincing way, the shift of our attention from individuals to relations, from intrapsychic to interacational, from resistance to transference, from work to marriage. In his opinion a happy marriage has become the main criterion for a successful life, and solitude has come into a bad odour. Indeed: being alone is often associated with a pitiful or even pathological state, and withdrawal usually is considered more suspicious than sane.
It is a pity that Storr makes an overshoot here from a plea for, to a glorification of solitude. Only in solitude creativity would flourish well, and he supports this statement with a string of examples of lonely geniuses, who were not only successful in their work but also very healthy and happy. But I agree very much with the essence of his – or was it Winnitcott’s? – argumentation: besides the capacity of the individual to develop mature relationships on equal terms, the capacity to be alone is equally an essential condition for emotional maturity.
The Loneliness of the Psychotherapist
If the capacity to be alone is in general already a condition for real maturity, it is even more a prerequisite for the psychotherapist. The therapist not only must be capable to be alone, but he also has to endure the loneliness and the abandonment into which his work brings him every day. The patient may feel deserted after therapy – at least that is what he is supposed to feel -, but the end of a psychotherapy or even a therapy hour, loaded with intimacy and warmth as it often is, can also be a painful experience for the therapist. While the therapist, in contrast with his patient, does not have the opportunity to share his feelings with others – unless he finds a solution for this problem, which I shall discuss later.
Sometimes after a group session I catch myself feeling a kind of envy, when I see the patients – arms around one another or chatting happily away – leave the therapy room and me. (And I think: “At least they have each other”). Of course, we can prohibit contact between group members outside the group sessions (Is this the reason of the prohibition?), but this is impossible in therapeutic communities, and it is right here, that these feelings are experienced most clearly.
I wonder if this aspect of psychotherapy is given sufficient attention, eg, in training. I wonder also if this loneliness of the psychotherapist, if it remains unconscious and untreated, could be a main cause for the modern plague of derailment of colleagues, who get entangled in incestuous relationships with patients or so called ex-patients.
However, rather quickly after the invention of psychotherapy, therapists have found a solution for their problem of loneliness: The Team! There, the psychotherapist can give air to his feelings, share them with others – and get rid of his loneliness, which afflicted him a moment ago. Many meetings are designed for this purpose only. The therapeutic community goes quite far in providing opportunities in such a way that no one needs to be alone at any time, and this holds for both patients and staff.
By the way: do patients in therapeutic communities have sufficient opportunities to learn to be alone?
The Loneliness of the Leader
When one of the humble and happy psychotherapists becomes the leader of his department or community, history repeats itself. What is said about the psychotherapist, is even more valid for the leader! He should be able to take a position above and in a way also outside his staff, and he should be capable to endure the loneliness of his position. This not only means that he has to stand all the reproaches of abandonment from his staff, but also that he himself can not share his feelings of being abandoned with his staff. Sometimes the leader finds a solution for this problem: he forms a sort of club with other lonely leaders, who may comfort him by in their sharing that they all have suffered likewise. However the loneliness still remains, more or less. And the higher he is climbing – eg, by becoming director – the more lonely he will be, however beautiful the view from the top of the mountain may be.
A leader may stumble easily if he does not use his capacity to be alone well. This may be the case if he is missing a certain need to be alone. Such a need, however, will too often be looked at with suspicion and will be confused with an urge to withdraw from society. This is a pity, for a sound need to be alone can be a nice impulse for a good leader and does not necessarily lead to evil autarchy.
The Soloist and the Ensemble
Some musicians, I imagine, perform best as soloist, while others prefer to play together in an ensemble. There may also be artists with equal preference to both settings. In reality, not much can be done with these preferences, simply because the soloist gets much more respect than the ensemble player, but I intend to use this idea only as a metaphor for our psychotherapeutic practice.
As a trainer in psychotherapy I often have the feeling that prospective young colleagues are to be distinguished as typical individual versus typical group psychotherapists. The former is an obvious soloist, feeling himself comfortable in the dyad of a one-to-one relationship, and the latter is much more at ease in the setting of the group, with a clear preference for co-therapy and working in a team. Of course these preferences have to be interpreted properly, but it also makes sense to recognise, admit and allow the difference between the more soloistic therapist and his more “groupy” colleague. An important output of participation in a learning therapy group is the awareness of the participant of his “disposition” as a psychotherapist: soloistic, groupy or both.
One could think that the typical solotherapist is more apt to be a successful leader than his “groupy” colleague. He will be more accustomed to the situation of being alone and he will languish less to company. But luckily there usually are enough therapists of the mixed type to meet our need for leaders.
Leading a Psychotherapeutic Community: a paradox?
Group psychotherapy is the core of the treatment programme in a psychotherapeutic community, so all psychotherapists involved in the programme will be more or less of the “groupy” kind. When such a psychotherapist is called to leadership, the problem, which I mentioned before, will arise: he has the capacity to be alone (otherwise he would not be called to this position). But he does not want to be alone. Creating a group on the highest level could be a way out and the patient in the case report has sought the solution in that direction: enlargement of the board of directors to a triad, the smallest possible group. Tres faciunt collegium. But there are also dangers in such a solution: The members of the board can be prone to occupy themselves too much with themselves and less with the organisation, and the enlarged chance on discord within the board can be a serious menace to the strength of the management.
Management is a problematic matter anyhow in a psychotherapeutic community. One of our beloved principles is democratisation: every member of the community is very seriously held responsible for his own behaviour and his own role in the community. This starts with the patient being in charge of the leadership of the expedition of his therapy, while the therapist, as Jongerius put it much to the point, is no more than the native guide, who knows the landscape with all his surprises and treacherousness thoroughly, who is very skilful in dealing with the problems of the expedition, but who does not determine the destination.
In the same way a big amount of responsibility and autonomy is credited to psychotherapists, teams and staff within a therapeutic community. The director acts as a guide, waiting for instructions from members of the expedition and handing them the tools they need. This is what we call facilitating management, and a team of directors fits very well in this view on leadership.
Such leadership evokes much resistance, however. As the classical psychoanalyst keeps on getting reproaches from his patient for not giving him useful advice, not having him do proper homework, leaning back lazily and letting him suffocate, the board of directors is constantly confronted with a call for action, strong action and solutions for every problem. Such a call presents itself frequently as a fantasy in which big power is attributed to the director: “we want something (a nail, a room, a therapist), but the director will probably, no, surely, oppose against this strongly!”
In those cases it is important for the leader not to lose his head, but keep on patiently pricking the fantasies, enduring the reproaches and keep on being present, as a good enough therapist.
Enough with the complaints!
The Three Questions, I started with, are answered:
- Leadership is not every man’s job.
- The leader has to have fully available his capacity to be alone.
- The management of a psychotherapeutic centre can well be carried out by a team of directors.
A fourth question is added in the meantime: is it possible to perform leadership in a psychotherapeutic way? I am inclined to answer this question positively, but I would like to hear your opinion about this.
Thank you for listening.
Jongerius, P J: Personal communication
Storr, Anthony (1988) The School of Genius. Deutsch, London (1989)
Solitude. Fontana Paperbacks, London.
Winnicott, D W (1969) The maturational processes and the facilitating environment. The Hogarth Press, London.