I will be drawing on my 25 years experience at the Cotswold Community (Whitwell, 1989) to demonstrate the need for clear organisational boundaries as a key part of the treatment programme for the most seriously disturbed children. The Community’s primary task is to help children who are emotionally “unintegrated” (Winnicott, 1976 and Dockar-Drysdale, 1993), achieve “integration” and develop a sense of self. I hope to show that the more unintegrated the child the greater is the need for clear boundaries around the child. The unintegrated child has problems being in a group and a group of unintegrated children need to be managed in special ways. I will be linking this together to show the way the Cotswold Community has developed to meet this particular task, which includes the distinctive features of the Community’s environment. Overall I will be moving from the management issues around a disturbed child (the micro level), through to management issues at the level of the organisation as whole (the macro level).
D.W. Winnicott explained that the first twelve to eighteen months of a child’s life are crucial for his future emotional development. It is during this period that a baby moves from being completely dependent on the mother, almost of her, towards becoming a separate person, the birth of the psychological “self”, an emotionally integrated person. Erikson (1951) describes this process as achieving basic trust. This will happen quite naturally, providing the care of the infant is “good enough”. It doesn’t have to be perfect, but it should not include experiences which the baby would find traumatic, e.g. sudden, prolonged separation from the mother or withdrawal of concern. For a baby the fear would be of annihilation and psychological damage would occur. The degree of emotional damage will vary considerably, but in extreme cases will prevent basic trust being achieved. This is psychologically akin to a building without foundations. Without therapy this person will remain psychologically damaged throughout life, affecting every aspect of his life until his emotional foundations are repaired. People suffering from this early emotional deprivation are “unintegrated”, having failed to achieve emotional integration. They are psychologically fragmented with no coherent sense of self. This deep-rooted damage will not right itself. Bruno Bettelheim gave one of his early books the title Love is Not Enough (1950) to convey the fact that love by itself will not cure these severely damaged children. They need to be in an environment which is planned to be therapeutic, 24 hours a day, 7 days a week.
Adam’s birth mother visits for one and a half hours each term. She comes so that she may help him talk about his anger and confusions towards her, which he has trapped inside himself. The last visit took place a few weeks ago and was a moving experience for all concerned. After some initial banter, Adam asked his mum, “Mum, why did I have to leave you when I was young?” His mum took some time to compose herself and gather her thoughts. She seemed to be on the verge of speaking several times but paused. She then said, “I was very stupid Adam. I drank and because I drank I wasn’t able to look after you properly. Other people tried to help and get me to stop but I couldn’t. If I had my life to live over I would do it differently, but I don’t and I have to live with my mistakes.” Both Adam and his mum were on the verge of tears. Their eyes showed exactly how they were feeling. After a few moments Adam invited his mum to play with his remote controlled car. They played with the car, which went skidding round the hall for about five minutes. Adam and his mum are survivors of the same trauma. They are both victims of their past. Adam usually collects most of the sympathy, understandably, considering there is very little he could have done to change the situation of his birth. Adam’s mum also deserves some understanding, for her own life was shaped by an unstable childhood.
Diagnostically, the two main behaviours that would lead one to consider a child to be unintegrated are firstly: he becomes extremely anxious and panics when under stress and this leads to either a violent rage or despair; and secondly, he is driven to disrupt group experiences, especially if the group appears to be functioning well, in such a way that he brings about confusion and chaos. Such children often find individual psychotherapy difficult to cope with and are more likely to be helped by a living experience in a therapeutic milieu.
The least integrated (or most unintegrated) children have been described by Barbara Dockar-Drysdale as emotionally “frozen”. This is one of the most primitive forms of survival mechanism caused by the fracturing of the primary bonding process with the mother at a very early age.
A typical “frozen” child in a therapeutic milieu presents a curiously contradictory picture. He has charm, he is apparently extremely friendly and seems to make good contacts very quickly. He is neither shy nor anxious in an interview and in his everyday existence he is usually healthy, clean, tidy and orderly. He is frequently generous and kind to younger children, especially one particular child, whom he protects from all attacks. In contrast he may become suddenly savagely hostile, especially towards a grown-up with whom he has been friendly. He will fly into sudden panic rages for no apparent reason, in which he smashes and destroys anything in his vicinity. He is a disturbing element in class – a storm centre – and frequently has acute learning difficulties. Sometimes he seems to build a high wall between himself and other people, which is impossible to scale or break through. He steals, lies and destroys relentlessly and without remorse. He is either cruel or over-indulgent to animals, which appear afraid of him. It is repeatedly reported that he is improving and hopes are raised; it is claimed that he is making a relationship at last, but each time disaster follows until finally he becomes intolerable. The longer the period of supposed improvement, the more drastic is the breakdown; experience teaches us to think in terms of lull and storm, rather than maturation and regression or recovery and deterioration.
The “frozen” child is, of necessity, delinquent; he may easily become a “delinquent hero” who gives permission to the other members of the group to break in, steal or destroy. His own lack of remorse, the fact that he can do these things without emotional discomfort, has a disastrous effect in a group.
We know that he cannot risk being left short of satisfaction for a moment because when the level of his pleasure drops, pain will flow in. Having withdrawn from frustration he must use any means in his power to maintain the pleasure level and this tends to be delinquent. If this form of excitement is blocked because say, a door is locked or a pocket is empty, he will panic and in the effort to keep himself from self-destruction he will attempt to destroy his environment, which is felt to be an extension of himself.
The “frozen” child ignores the inevitable consequences because he has achieved what Fritz Redl (Redl and Wineman, 1951) termed “reality blindness”. He does not merely deny that he has done some delinquent or aggressive act, he does not know that he has done it. In addition he has no concept of time. There can be no past to regret and no future to consider. He lives in the present.
It is very difficult to treat “frozen” children. From a state where nothing is felt and no-one is important, you begin to see some internal conflict and dependence on grown-ups, with evidence of depression and anxiety, which to us are real signs that emotional recovery is occurring.
Permissiveness is completely inappropriate when working with a “frozen” child. The behaviour pattern is carefully observed by the therapist until patterns emerge. Next, interruption is introduced; this involves breaking into a behaviour pattern at a critical point in order to make the child aware of what he has done, is doing and plans to do. A next stage is reached when the first signs of a pattern can be recognised. Each child has a sort of signature tune, which becomes familiar. Interruption now takes place at so early a stage that we can speak of anticipation.
When interruption or anticipation is used correctly, acute disturbance is felt by the child and he needs a great deal of support and reassurance. He will do anything to try and close the gap that has been made in his defences. His response to early interruption is panic and rage. If however, the gap can be kept open by steady interruption and anticipation used in the context of his everyday life, then the next stage may be reached. Here we meet the first phase of depression which affects every aspect of the child’s life; during it he re-experiences the loss of the unity (mother and baby) and faces the fact that this cannot be restored.
It is at this stage that a bond begins to be achieved with the therapist, the child becoming babylike, dependent and trusting, vulnerable and helpless. A far cry from the arrogant, delinquent defence. It is from this point that he can slowly become loving and loved as a complete person. An example of reality confrontation:
At the end of session we spent time with Stephen, who we knew had stolen a large quantity of Lego. In may ways it was an arduous process, with one step forward and one back. After three quarters of an hour he acknowledged that he may have taken one piece by mistake. After one and a half hours he acknowledged that maybe it was a few more and we could go to his room and after three hours a pile of Lego was able to be returned. This piece of work was only possible through three of us working together. It enabled different aspects, feelings, thoughts to be voiced and held by different people at different times, i.e. someone holding the empathy, someone the depression, someone the anger etc., and created something which was eventually sufficiently containing and challenging to enable Stephen to be able to put something right in a context where there was no blame or devastating consequences. It was a moving experience and something significant had taken place for Stephen and our relationship with him.
I have already said that unintegrated children do not need permissiveness. Their lack of personal boundaries requires an emphasis on clear external boundaries. However, control, sanctions, punishment are not words that sit easily in a therapeutic environment. At the Cotswold Community we do not have a system of punishment and reward to control children because having children “under control” is not our primary task. As therapists we are more interested in the meaning of their behaviour than simply controlling it. If a child is behaving in an anti-social way we want to know why and ultimately we want the child to understand why because a gain in insight by the child will lead to a change in behaviour. If one understands why one is driven to steal it is no longer possible to steal with impunity. We are not interested in children behaving well while they are residing in the Community and then falling apart when they leave.
An emotionally unintegrated child has very few inner controls. His behaviour is impulsive. Emotionally he is a baby or toddler and we wouldn’t expect babies and toddlers to be able to control themselves. We know that they need almost constant support and supervision from their parents. This is our task at the Cotswold Community when children first come to us. We call it therapeutic management. It is bringing together the emotionally disturbed child’s need for therapy and management. It is not possible for one to succeed without the other. Punishment is irrelevant to this task. These aren’t children who can respond rationally to the “carrot and stick” approach. These children steal in such a way that they ask to be caught. The task of the residential therapist is to make a judgement about what the child can manage. This takes a good deal of skill and knowledge of the child. Over a period of time we want the child to become emotionally stronger so that he can take over some of this responsibility for himself, i.e. to move from a position of having few inner controls and needing to be managed, to having self-control and needing minimal management.
Babies who have not had enough primary experience from their mothers experience helpless rage. I believe that panic violence – which sweeps the person involved off his feet – is just this helpless rage and the acting out of this omnipotent violence. A person in a state of violence is therefore both omnipotent and helpless, but the omnipotence is a denial of the helplessness. It follows that if, through verbal and non-verbal communication, we can reach the helpless baby, we can establish a wavelength which may reach the original source of the violence (Dockar-Drysdale, 1990).
The following is an example of a boy who was in a panicky and distressed state and who, for a while, needed to be physically managed by his focal therapist, Susan.
I walked into his bedroom to do his bedtime visit and Trevor was frantically putting on several layers of clothing, including five pairs of socks. I told him that I would not just let him run off in such a state.He went to the window. I explained it was cold, dark and wet outside and that I would take hold of his hand if he started to climb out the window. Knowing this boy very well, I predicted openly what may follow. I said that if he went to scratch me I would take hold of him so that he couldn’t scratch. I went further to explain that if he then went to kick I would then have to take hold of him fully. I re-stated that I really did not want him to run off.
The holding felt inevitable, but at each stage I was able to clearly state what would happen next and explain that I would be with him until it was over.
There came a point during the holding when he became so desperate to go outside for some fresh air. I felt I had to respect this. Before I let go I explained that as before I did not want him running off and would stay with him. He went through the French doors and walked a short distance with me closely behind. He then looked up in astonishment, saying “my feet are wet”. I explained that socks are not waterproof, so it did not matter how many layers you had on. He said his feet were cold, so I asked if he wanted me to pick him up, he nodded. I held him across my hip, as you would a toddler.
It is worth noting that when I let go he called me by his natural mother’s name and did not want me even holding his hand. At this next stage we carried on in the same direction, as if we were mother and infant. I turned round and he anxiously said that he did not want to go back inside. I replied, “You don’t feel ready”, but explained we would have to go back in as it was getting late, but not yet.
Trevor looked up at the moon and started asking questions about the universe, God, spirits and witches. We discussed all these things with me carrying him back and forth, the length of the house. We were getting very wet but neither of us noticed. He then spoke about being held. He said he felt safe when he was held, but not when I held him, as I was his carer. He explained that he did not fee safe because he scratched and bit me. I said he did not want to hurt me. He stroked my scratches on my hand as he said this. I went over why I had held him and how it had come about.
We chatted some more about this and that and I suggested it was time to go back in, he agreed and got changed for bed. I tucked him in with a hot water bottle. He held my hand affectionately and we said goodnight.”
This vignette conveys both the omnipotence and helplessness referred to earlier.
Communication and play
Time and again we come back to the importance of communication. Emotionally disturbed children need to be helped to communicate how they are feeling. Failure to do this will inevitably lead to the acting out of these feelings in anti-social and violent behaviour. It is important that these children are offered non-verbal models of communication because their ability to put feelings into words is inhibited and some of the unconscious feelings belong to a pre-verbal era in their lives.
Rebecca Adams spent some time at the Cotswold Community researching material for her book The Playful Self (1977). She wrote the following piece on the healing power of play.
“The profound benefits of play can be seen most clearly in the lives of those whose capacity to play has been suppressed or distorted as a result of trauma or deprivation. In such cases, play itself can be an extremely effective method of healing, for “Play, like dreams, serves the function of self-revelation, and of communication at a deep level” (Winnicott, 1942). This is the central premise behind play therapy. Using play as both the vehicle and the cure for psychological distress, play therapists aim to break the destructive circularity of that distress. At the Cotswold Community, a therapeutic centre for severely disturbed boys, play is highly valued. One of the central tenets is that play is a vital ingredient in well-being. Playing is an essential part of the emotional “work” that the boys must do, and this is reflected in the daily time-table, which gives as much to play as to school-work.
However, many of the boys are unable to play or rather their play is as disturbed as they are. Mock-fighting often escalates into real fighting; competitive games can quickly become unbearably stressful; even relatively gentle fantasy play with toys can feel quite threatening to these children whose own lives have provided so little of the safety and stability that are the necessary pre-conditions for play. They invariably come from broken homes, many will have been in several children’s homes and foster families, and the majority will have a history of delinquency. The Cotswold Community is often a last ditch attempt to stop them sliding into juvenile crime.
In the centre’s highly supportive environment the boys are given the opportunity to discover a way of playing that is not destructive either to themselves or others. This process of self-discovery through play is extremely powerful. The boys are able to regress to the age at which they “lost themselves” and, as it were, start again. A thirteen year old may retreat to the age of three or four year old in which he clings to his teddy bear and uses it to communicate to the world. There is nothing unusual in asking a toddler “what teddy would like for tea”, but addressing a thirteen year old in this way is a poignant reminder of the necessity of childhood play, as necessary to our future well-being as learning to walk or talk.
“Peter” came to the Community when he was ten. He seldom spoke and seemed locked away inside his head from where he viewed the world with unconcealed mistrust and fear. The only clue he gave to his inner state were the pictures that he was constantly drawing. There were several striking features about these pictures: they were always of a town encircled by high, thick walls, drawn in heavy grey or black crayon; inside the town there were a few buildings dotted about but there were no streets or paths to connect them. On the outside of the wall a few wiggley roads led to the perimeter of the town but no further, for there were never any gates in Peter’s drawings either into or out of the town.
For a long time, Peter’s pictures, or “maps” as he called them, remained unchanged. But very gradually they began to acquire new features. More streets and pathways appeared inside the town, connecting up the different buildings; more roads appeared outside the town too, so that there were now several approach routes; a small gateway appeared on the south side of the town, although no roads as yet led directly to or from it.
The therapist working with Peter let him discuss the design and detail of his maps without making an attempt to “connect” them to his psychological state. The turning point came one evening when the therapist came across a bundle of papers tied up in a plastic bag and dumped in the outside dustbin. The bundle turned out to be Peter’s latest maps, hurriedly rejected for what they might reveal. And indeed they were revealing. He had drawn a town that resembled the maps of medieval London, bustling and beaming with life and laced with a thick network of roads. And, most startling of all, at the four compass points, there were now four gateways permitting access to and from the town. Peter himself recognised this as a turning point, hence his frightened reaction to this brave new role he’d discovered. Nevertheless, it signalled the start of his recovery from his psychic wounds and his gradual return to the world.” (Adams, 1977)
Symbolic communication is extremely important in therapeutic work with emotionally unintegrated children. It is often associated with a child being in a regressed state, i.e. being younger than his actual years. The following is an example of symbolic communication between a boy and his focal therapist, Steve.
I first met Joe in 1989, he was a small slight boy approximately ten years of age, full of fun, very lively and could be experienced by people as a much younger child. He used to spend a good deal of time walking around holding my hand or being carried on my back.
From somewhere he developed an interest in dolphins and whales and in particular the killer whale. At Christmas I gave Joe a cuddly killer whale, he quickly began to take the whale everywhere with him and it took on a position of great importance for him. This “teddy” was called “Whale” and at times of greatest stress for Joe I was able to talk to Whale who would tell me how Joe was feeling, (Joe would use a special voice for Whale when he was talking to me). Whale started to fall ill as my time off approached and on my return would be at “death’s door” and it would take a good deal of care and time to enable whale to recover. This pattern would repeat itself every time I had time off.
In discussion with Mrs Drysdale, our consultant at that time, we devised a way of enabling Whale and hence Joe to bridge the space of my time away.
When I was away Whale stopped eating, so I suggested to Joe that I left a “sugar shrimp” (a candy in the shape of a shrimp), so that Whale would not go hungry when I was away. This seemed to make the space more bearable and Whale thrived.
One day Joe told me that Whale’s name was Winnie, not only had he named Whale but had also sexed it. Whale or rather Winnie was a female. The routine with the shrimp continued and Winnie used to swim happily in the sea while I was away.
One night when I was putting Joe to bed he told me that Winnie was not feeling very well, this confused me as my time off was not due. I asked Joe what was wrong with Winnie and he told me that he could not tell me but that Winnie would whisper it to me. Winnie whispered that she was pregnant. Joe told me that Winnie would need a lot of looking after and that she would let us know when the baby was due.
In discussion with Mrs. Drysdale we decided that the lead of Joe and Winnie would need to be followed and that if the outcome was that the pregnancy ran its full term then I would need to produce a baby whale. The pregnancy lasted a number of weeks and as fortune would have it, I found a baby killer whale one day while out shopping. I had to have the baby whale close at hand at all times in readiness for the birth. Winnie had similar stresses and pains to those that most pregnant woman have, morning sickness being particularly evident.
The day of the birth arrived. Joe sent me for hot water and towels as Winnie went into labour. As I returned Joe told me that Winnie needed covering with a towel, which I did, and that her brow needed mopping. When the baby cries started that was my cue to bring the baby whale from beneath the towel. Mother and baby were fine and went for a swim in the sea.
Father was never on the scene and was always away swimming in a far off sea. Joe told me that Winnie was only going to have one baby, which was of great significance as Joe was a twin.
Through this birth we were able to do a great deal of work around the issues of mothers, fathers and Joe’s twinship as well as the difficulties involved in looking after a baby.
Groups and structure
Most of the discussion so far has taken place at the level of the individual child but one of the most difficult phenomena to work with in group living with the very disturbed children are group mergers. Emotionally unintegrated children with very undeveloped personal boundaries are especially prone to merger. These children have not had the experience of being emotionally merged with their mother as babies and then gradually separating out (emotionally) during the first 12-18 months. For a variety of reasons that early merged state was interrupted, which makes them especially prone to seek merger, in the here and now, at every opportunity. With the boys we work with it is used as a defence against experiencing painful feelings. The mergers we see are often very wild, driven by the search for delinquent excitement. A merged group contains no individuals one can relate to. It is a blob, a mini-mob, capable of doing extreme things which the individuals by themselves probably wouldn’t do. A merged group is a frightening phenomenon, capable of physically attacking someone or doing considerable damage. The only way that, at the Cotswold Community, we know of preventing a merged group from spiralling out of control, is to have enough adults to take individual children away from the group until they can calm down and find their own sense of separateness. The alternative strategy is to stand back and allow the merger to burn itself out. This is a risky strategy because mergers have considerable energy, can last a long time and be very destructive towards people and property around them. It is interesting that the government’s guidance on permissible forms of control in childrens homes (DoH, 1993) avoids the issue of groups becoming out of control. Their advice is based on an assumption that problems of control occur only in one-to-one situations. This is astounding considering that residential workers are more often going to behave inappropriately, when a group is out of control, because they are frightened.
“In practice, the collectively low level of ego functioning in the group meant that I and other staff members spent many days (and nights) attempting to bring boys down from the roof, where they had retreated from “unthinkable anxiety” (Winnicott, 1976) in a state of raucous delinquent merger. So I suppose my first hard-won lesson was that you cannot “do therapy” until you have management, boundaries and containment.” (Mikardo, 1996)
A disturbed, chaotic child needs to be in an ordered integrated environment to hold all the various bits of him together. In the Cotswold Community it is possible for a child to be looked after, to play, to go to school all in one environment. If there is a problem in one part of his life everyone knows straight away, e.g. if he has a difficult afternoon in our school, the adults who work with him in the evening will know about this and they can continue to work with him on the problem.This is not usually the case in our society where it is possible for a child to have a problem at school for weeks before the parents get to hear about it and vice versa. Disturbed children do not find this containing enough and they exploit it, creating “splits” between the different groups of adults in their lives. A boy at the Cotswold Community cannot get away with working those splits for long and this is difficult for him, confronting him with his problem.
If a person has not developed the capacity to distinguish properly what is “inside” himself and what is “outside” and to control the boundary between them, then he needs to be somewhere where there are clearly defined and simple boundaries in the external environment. The less developed are the former, then the stronger, more clearly defined and less complex must be the latter. In the residential community everyone must be clear who is inside and outside what, otherwise chaos and breakdown ensue. In working with disturbed people there has always to be clear definition with regard to individuals, groups and systems and their boundaries.
In some respects the therapy is the “order” of the community and the ego-functioning and behaviour of the staff. The milieu, the whole management structure must reinforce and support this; if contradicted it will re-enact and echo earliest environmental failure and breakdowns.
Unintegrated children need: a basic sense of well-being, which they have never had; an order that they can identify with and internalise; the symbolic equivalent reliably provided, of missed earliest experience. This external order or holding environment is for the unintegrated very like the earliest mother and baby experience.
The organisation as therapist
In order to explain the importance of organisational issues at the Cotswold Community I need to say a little about its history and what had to change for it to become a therapeutic community.
The Cotswold Community was formerly an approved school from 1942-67. Only two approved schools managed to transform themselves into a therapeutic community, Peper Harow (Rose, 1990) and the Cotswold Community (Wills, 1971). Richard Balbernie was appointed in 1967 to lead this transformation.
Richard Balbernie realised from the beginning that a therapeutic community couldn’t be created by simply adding a dose of psychotherapy to the existing approved school organisation and structure.1 The whole of the Cotswold Community had to be restructured and reorganised to support the therapy and be a part of the therapy. It had to be much less hierarchical, top-down and centralised. Power had to be shifted towards the staff working directly with the boys.
Richard Balbernie turned to the Tavistock Institute in 1968 for consultant advice to help with this process and we have had ongoing consultancy from the Institute. For the first two years this was from Ken Rice, then Isabel Menzies Lyth for ten years or so and since then Dr Eric Miller. Ken Rice explained the importance of the organisational model in the following way:
The organisation of the Cotswold Community should provide a model that is structured in such a way that the “ego-function” of the whole institution and of all its parts are mature and sophisticated. The organisation model for this institution must provide well defined boundaries and adequate control over transactions across them.
To put this another way: the members of the Community must be clear about and committed to the task of the whole and the different tasks of its different parts, they must be clear about their structure and accept the different responsibilities and authorities of the different roles they take. They must be aware of change in situation and role and change in response called for.
In this way the Community can provide models of an institution and of institutional behaviour, and the staff of appropriate adults, authorities with which the boys can identify themselves. Moreover, the models should be transferable to the external world, i.e. they must be of use to the boys when they leave.
………….. Even for the very disturbed, psychiatric or psychological therapy, as direct treatment, cannot take up more than a comparatively small proportion of waking life. The milieu in which it takes place should therefore reinforce and support specific treatment. Certainly if it does not support it, then any results of therapy will almost certainly be jeopardised. Without specific treatment, the institution and staff behaviour provide the only therapy available. (Rice, 1968).
It took several years before a genuine therapeutic culture was established at the Community. Some things, like the abolition of formal punishments, changed rapidly whereas other things evolved more slowly, e.g. incorporating psychodynamic thinking into daily life. Eric Miller (1989) has identified four distinct features of the therapeutic process of the Cotswold Community.
- There are separate systems for daily living and for education. Even though education is tailored to the individual’s treatment needs, he experiences change of role, which is reinforced by physical movement between one building and another for the different activities.
- Daily living is provided in four separate houses, each in its own territory. There are ten boys per household with a complement of staff. The number is small enough to provide security and family-type intimacy, but large enough to offer a range of potential relationships, and also to give an “open system” experience of boys (and staff) joining and leaving, while maintaining a group identity. Each boy has his own room, with his own possessions, which affirms his identity as an individual. The household, like a family home, is self-contained for catering, cooking, cleaning, laundry etc., and operates within a budget, which is part of the Community’s financial culture and which helps the boys develop a sense of economy. In the primary households, to which the unintegrated boys are initially admitted, the therapeutic approach is to reproduce the positive experience of parenting that they have commonly lacked in infancy. There is opportunity for individual regression – soft toys, special foods, bedtime stories. Through such experiences, positive interjections of caring and loving parental figures lay the foundations of an ego function. Each boy has a “special relationship” with one adult. When the boy moves to the secondary household, after two or three years, his ego boundary is still fragile, and the therapeutic task is then to reinforce it and to begin to prepare him for a more autonomous life outside the Community.
- The Cotswold Community includes a farm which serves several important functions. It is an example of productive work – another type of adult role-model. Boys benefit from helping with farm activities, including looking after animals. Awareness of the cycle of seasons, and of animal’s life-cycles, is symbolically very valuable for their own development. Through the existence of the farm the territory of the Community is greatly enlarged, providing a safe space, an alternative to a fence or wall.
- Staff and their families live on the campus. For the boys it is reassuring that staff are not far away, and also beneficial to observe, and sometimes be in contact with, off-duty staff in their family roles. The Cotswold Community is a therapeutic village which is the setting for a therapeutic organisation.
The concept of boundary is central to the work of the Community. The therapeutic task consists of two (on the surface) contradictory tasks; to contain and to provide separation. As the unintegrated boy’s ego-boundary is inadequate or unstable, the organisation has to provide an outer boundary on his behalf. At the same time the boundary has to allow enough space for the boy to experience being separate and to begin to acquire a personal identity.
The concept of “negotiated space” describes the space within which varying degrees of containment and separation can occur. The more unintegrated the boy the more containing the space needs to be and as he grows emotionally the space needs to allow for more separation. Testing the limits is necessary for development so limits have to be clear enough to be tested and resilient enough to survive the test. The dynamic of treatment is the management of the continual tension between containment and separation. Each boy’s experience of using this space within the Community will equip him with the skills to use a corresponding negotiating space between himself and others in his external environment: his family, his friends, his social workers, etc. This is tried out during regular periods away from the Community.
The organisational boundaries may be viewed as a series of membranes. This membrane around the individual boy – his ego boundary, which is wafer thin or incomplete. Face-to face staff provide a second membrane, which defines the boy’s negotiating space. When this is tested the manager of the household provides another membrane and beyond that, the fourth membrane is the management of the organisation as a whole. These layers of membranes act as “shock absorbers” for disturbances exploding outwards from the boy or group, and therefore need to be flexibly firm.
Occasionally the outer boundary is breached when, for example, a boy absconds and the police have to find him. Fig.1 also shows how the membranes work to absorb the shock of external environment impingements.
An external environment impingement can come from a boy’s family, especially when the parents themselves are emotionally deprived, and over the years their needs have been unmet. It is not surprising, therefore, that they will have complex feelings about their son having such special treatment.
David frequently phones his parents when he is in a distressed state and claims he is in on the receiving end of maltreatment from other boys and/or the staff team. His mother, Mrs. F., in particular reacts very strongly to this and she phones to complain and accuse. There is no way that reason can prevail. She “knows” that her son has been wronged and abused. On one occasion, when David was aware that his mother was on the phone to a staff member, he let out the most awful screams knowing that his mother would assume his intense distress and indeed he got the reaction from her that he was looking for. Previously David and his parents, between them, have destroyed several placements. We have identified a senior staff member, outside the household, to take the “good object” role as a means of facilitating communication. So far this has enabled his placement at the Cotswold Community to keep going despite enormous disruption. Occasionally there are periods when the parents are working co-operatively with us. This coincides with periods when David has been at home for a holiday and has been a management problem. For a while they feel more sympathy towards our staff, but it doesn’t last. When Mr. and Mrs. F are at war with their neighbours, and the negative/paranoid feelings are going elsewhere, we can temporarily bask in their positive feelings. At times when the hatred from Mr. and Mrs. F. is at its most intense, to relieve the stress, we have fantasised about bribing the neighbours to start another dispute to take the pressure off us!
Mr. B. has a reputation within his local Social Services Department for sabotaging his son’s placements and threatening violence to staff. When Billy was admitted his father was prohibited, by the court, from any contact with Billy. A senior staff member took the role of befriending Mr. B. and gradually won his trust and confidence. This helped considerably, although he would occasionally phone at midnight, the worse the wear for drink, threatening to come and beat us up. At least the membranes were working in the sense that Billy was not being urged by his father, as in previous placements, to be as disruptive as possible in order to sabotage the placement. Over a period of about nine months we have moved towards Billy having direct contact with his father and going to stay with him. Just recently Mr. B., his wife (not Billy’s mother), his brother and sister came to stay in a house we have specially prepared for families. By “looking after” the parents we have established a trusting relationship which should enable Billy to feel safe, in the sense that he will be less able to create splits between the adults in his life.
Another sort of external impingement is when the local authority, who have purchased our service, decide to end the placement on financial grounds. For young people trying to overcome their own basic inner insecurity, this can feel traumatic. Fortunately there are not many occasions where we have failed to get a reprieve or a reversal of the decision but the process itself can be so destructive. The exception is when a boy has sufficient ego strength to be in touch with reality to know about the financial problems of local authorities. He knows he will have to mount a campaign, to issue a formal complaint against the local authority and with luck he can experience it as empowering, especially when he succeeds. It can also help him value his placement at the Cotswold Community and the purpose of the therapy.
The membrane analogy denies the fact that these are human beings struggling to cope in immensely demanding roles constantly having to make difficult judgements about when to contain and when to promote separation. The vicissitudes of the unintegrated boy can threaten the sense of self of the staff, who may find themselves swinging between the poles of authoritarianism and permissiveness, of either loving or hating, without being able to hold on to a realistic ambivalence. The hatred may be repressed. As the boys have experienced emotional deprivation, physical and sexual abuse, this can inhibit staff from acknowledging their own anger towards the boys. Sometimes staff wish a violent boy to leave because they feel unable to cope with his increasingly murderous attacks on them. Maybe, on the other hand, the staff feel unable to contain their murderous impulses towards the boy.
The therapeutic process is a long, slow process with many setbacks. It is important to keep the dynamic of the institution at all levels under constant review. What are boys projecting onto staff and vice versa? How far is the violence displayed by one individual a product of the group? Inter-household dynamics need to be kept under scrutiny. A culture of continuous self examination is necessary and is supported by external consultants.
It is our experience that there is a clear link between the needs of an emotionally unintegrated child for a “holding environment” within which therapy can take place and the organisation structure of a residential treatment centre. If the organisational structure of the residential treatment centre does not mirror the need for clarity of boundaries, needed by an unintegrated child, then the therapeutic process itself will be in jeopardy.
The Cotswold Community has been through a transition from one parent organisation to another in which there was a loss of clarity of boundaries between the Community and the new managing organisation; almost inevitable, I imagine, in such a transfer. However, it did not end with administrative inconvenience. The membranes (shock absorbers) in the above model were affected and consequently we witnessed a higher level of acting out in the boy group.
I think we have also seen a loss of clarity in boundaries through some of the procedures following the 1989 Children Act. These procedures are designed to prevent malpractice and abuse in residential centres, an aim which we all support. However, the consequence has been a breaching of the external boundary of residential centres e.g. through unannounced visits and inspections. The paradox is that in order to achieve one kind of safety in relation to child protection matters, we have seen a loss of another kind of safety which is achieved through a residential until being able to manage transactions across its boundary.
In the past therapeutic communities had the reputation for being little kingdoms accountable to on-one. However, we are now in danger of creating a situation where it is very difficult to manage the boundary of the organisation and this creates a less containing environment for very disturbed children.