Dr Rex Haigh ~ TCTC: born 22/10/12, Windsor, England

The following post is written by Dr Rex Haigh, blogger for Struggling to Be Human: what we’re up against, originally posted on 24 October 2012.

‘The Windsor Conference’ started in the 1970s, set in the right royal setting of Cumberland Lodge, in the gated community of extreme privilege of Windsor Great Park. Every autumn, the grand old founding fathers of the British TC movement all came to play here, every year, until 2010. With friends and colleagues from overseas, mostly the Netherlands at first; later Italians and currently Greek therapists, together with a smattering of like-minded clinicians, researchers and TC leaders from Switzerland, Germany, New Zealand, Australia, USA, India and Africa, they came along to an unbroken sequence of annual community meetings, and much besides, until last year.

Cumberland Lodge (rear)

Cumberland Lodge (rear)

What happened last year? Well, the organisation of ATC decided that it was time for a change – the most prominent reasons were that the 3-night conference, for up to 100 people in its heyday, had become too expensive for many, inaccessible to new delegates, and somewhat anachronistic and unrealistic in its expectation that all delegates must stay throughout the four leisurely days. There was a general feeling of it having become somewhat repetitive and perhaps ‘stuck’. It was therefore moved to a large and pleasant Quaker Meeting House in Birmingham in September 2011, but the membership soon made it clear that they wanted Windsor back!

So, for the 2012 event, a new three day/two night format was introduced, which had a theme of INTEGRITY – with a different sub-theme each day and various guest speakers. Delegates were able to come for one, two or three days – and were made welcome with goody bags, a very professionally produced programme, and daily large and small discussion groups.

 
 
INTRODUCING INTEGRITY
The first day was called ‘Introducing Integrity’ and it was built around the ending of two longstanding TC organisations, The Association of Therapeutic Communities (ATC – for adult TCs) and Charterhouse Group (CHG – for children’s TCs), and the merger to form a single new body ‘The Consortium of Therapeutic Communities’ (TCTC – for all types of TC).
On the shoulders of giants:
Nick Manning and Colwyn Trevarthan (front)
Rex Haigh and Gary Winship (rear)

Gary Winship – a longstanding champion of the movement – gave a spirited and funny précis of ATC’s forty years which he called ‘a cross between a love letter and a eulogy’. He peppered his talk with lively character vignettes of some of the main characters over the years, and criticised ATC for not having enough managerial ‘savvy’, and for being rather patriarchal in its choice of leaders; he acknowledged the organisation’s adaptability and relentless adherence to a radical political position, through the thick and thin of social psychiatry, Thatcherism, regulation and governance, to neoliberal economics. Richard Rollinson, with many years of CHG history, told of missed opportunities to come together sooner – and the different but oh-so parallel history of personalities and conflict, trials and tribulations in the history of the childrens’ TC organisation.

After saying goodbye to the old organisations, and a typically wonderful Cumberland Lodge lunch, the main topic for decision about the new organisation was introduced: what sort of organisation do we want TCTC to be? (TCTC2B??) Was it to have ‘more of the same’ (called the narrow focus), or was it to look to expand and cover new territory – particularly including the wider use of TC principles in different ways and settings? Almost a reprise of David Clarke’s ‘TC Proper v TC Approach’, or the more recent ‘Community of Communities’ and ‘Enabling Environments’ projects. The eight small groups, variously scattered throughout the lodge, thought about it and described a clear consensus: think wide. After having done most of the thinking, the inaugural AGM was mostly a formality; perhaps most interesting for electing six new board members, several of whom are ex-TC members.

The hour-long large group at the end of the day – now called a ‘community meeting’ – was reflective and open, if a little constipated. As its conductor, I was determined not to make any plunging interpretations and to positively nurture it as a warm and welcoming space. Indeed, nobody tried intimidating tactics of ‘Nobel Prize thinking’ (as originally described by Lionel Kreeger) – and  the Greek delegates seemed particularly appreciative of the simple opportunity to be together. When somebody thoughtfully asked them if they wanted any space at the conference to be in a Greek-speaking small group, they said that they could do that at home!  It’s widely acknowledged that being in a large group (this one was between 60 and 75) can be a weird emotional experience; I would add that it is even weirder to be conducting one.

PROMOTING INTEGRITY

The second day had three seriously impressive external speakers. The first was Professor Colwyn Trevarthan, from Edinburgh: the distinguished academic who introduced the concept of ‘primary intersubectivity’ (which impressed me first when I heard of it in my Cambridge social psychology days, and still does). With a title of ‘The Social Brain: The Healing Power of Emotions’, he put on a dazzling performance to demonstrate experimentally what we all feel and know clinically: that there is a lot more to relationships, and how important they are, than  transmitter neurochemistry, or detailed scans (even though discoveries such as mirror neurones support this), or indeed the multitude of clinical questionnaires and ‘instruments’ that we routinely use could ever meaningfully measure.

A few gems – often of linguistic precision as much as empirical fact – which caught my attention, amidst the array of sparkling jewellery:

  • “a project made propositional by their collaboration” (musical analysis of infant movements)
  • secondary intersubjectivity – from about 9 months – includes understanding the intention of the other; “sense of shared dynamic intentionality” (catch up, mentalisation!)
  • primary complex emotions = PRIDE and SHAME
  • elemental need for playfulness / fun / imagination / creativity
  • ‘Empathy’ is philologically the wrong word: sympathy is better, and mirror neurones would be more accurately described as ‘sympathy neurones’
  • ‘being human’ is more limbic and subcortical than it is cerebral…

Mark Johnson was next with a powerful service user account, ‘Reclaiming Integrity after a Destructive Childhood’. Mark is a Guardian columnist and author of the very successful book ‘Wasted’, who founded the charity and social enterprise ‘User Voice’.

After lunch, we had Leonie Cowen giving us a refreshingly clear and radical view of how commissioning should be done. If only it was!

A panel discussion to explore the detail of the issues, followed by small groups, gave ample time and space to give the ideas due reflection and digestion. ‘Fringe sessions’ followed – and Fiona and I took about a dozen delegates for a walk to the copper horse, after explaining what greencare is  and showing some pictures of our project, yurt and all, at Iver Environment Centre. Unfortunately the gate was locked just shy of the copper horse itself, because it’s rutting season for the deer – but there’s greencare for you. And of course, in the leisurely old days of the Windsor conference, a whole afternoon would be set aside for walks in the park; later to be timetabled as ‘professional networking’ to avert the gaze of sharp-eyed study leave funders. No such luxury any more – unless we repackage it as ‘greencare’!

Large group, and a splendid dinner – hijacked as a magnificent birthday party by the Bard of East Anglia. Then there was drinking, and dancing, and more. I was long in bed by then.

DEMONSTRATING INTEGRITY

We all now know so well that is does not matter a jot what good work we do, if we cannot suitably demonstrate what we do, and justify it with the sort of evidence required by the prevailing demands of the superordinate system. So – enter the TCTC research group, ably chaired by Susan Williams and presided over by Nick Manning.

They presented two streams of thought about outcomes: individual questionnaires so we can all be measuring what matters, and doing it in a way that facilitates comparison; and environment questionnaires to measure that elusive ‘atmosphere’ which is so easy to smell, but so hard to define.

The two questionnaires which came top of their Delphi exercise were:

  • CORE (34 items for well-being, symptoms, relations and risk)
  • Euroqol EQ-5D (5 items for quality of life are almost meaningless taken individually, but are very significant to health economists and QALY calculations)

So these are now going to be recommended to Community of Communities to be included in the basic service standards. Others also mentioned included the Recovery Star, HoNOS, GHQ and its derivatives, and the social functioning questionnaire.

None of the environment questionnaires examined were quite up to scratch – too old and whiskery; too long; too complicated; or not particularly relevant for TCs. The committee is therefore going to design a new one, with help by piloting it in volunteer communities. Watch this space…

Equally significant, in that ‘deep and thick’ way that only rigorous ethnography or phenomenology can do, were some of the research presentations about PhD work under way. In fact, there are currently three qualitative studies under way at Nottingham’s Institute of Mental Health – which can only serve to enrich and expand the academic base for the field.

After lunch, the demonstration of integrity took a different turn – and we all assembled in the elegant drawing room for we knew not quite what. We first heard the story of Simon Clarke, told by himself – from a hopeless and chaotic existence, through Christ Church Deal TC (CCD), to a productive high-level academic career. The next was Jonathan Walker, from an equally troubled background through CCD to a very successful career as a Liverpool campaigner and street musician: we enjoyed two lyrical and moving songs. Finally, Matthew Shipton told us of his own similar trajectory from squalor and disarray to rediscovering his own musical aptitude. Then he lifted the lid on the grand piano and simply blew everybody’s socks off (as they say) with a twenty minute rendition of an exquisitely complex Chopin rendition. Being about conflict and its resolution, he prefaced it – but so much more besides.

Bedazzled, we collected tea and wandered into our final small group sessions, before the final presentation: a presentation from a modern-day progressive catholic foundation school in Leamington Spa, called MAL-HER-JUS-TED. It was led by a passionate and forceful teacher from Chicago (echoes of the Boys Republic?), and described how they gathered information from ex-residents of young people’s TCs as part of the Lottery-funded ‘looking after other people’s children’ project run by Craig Fees at the Planned Environment Therapy Trust (PETT) in Gloucestershire.

With just half an hour’s quiet and reflective large group to finish, most seemed appreciative of being with each other – and their various contributions.

The logo of the new combined organisation

The logo of the new combined organisation

Back next year, dates booked already. By then we’ll see if this new organisation is on the tracks we hope – to say and do something really significant…

Posted by:
Dr Rex Haigh FRCPsych
www.greenshrink.blogspot.com

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