Group Analysis Therapy – a therapy for our time?

Much of what we know about groups and the power of group therapy we can ascribe to the pioneering work of W.R Bion and S.H Foulkes, during and after the second world war. With this in mind, is it time again, as we did then, to consider group therapy being a therapy of our time? Today, it is not the threat of totalitarian regime from overseas that drives the distress that people feel but a pervasive culture of distilled fear of the “other” proliferate by today’s political classes which permeates the self and instills such anxiety.

Whether it be: ‘The need for austerity’, ‘The war on terror’, the fear of ‘Mass Migration’ or attacks upon the so called ‘scrounging indigenous benefit claimants’. The results are the same – that anxiety is increased, our sense of wellbeing is eroded, relationships suffer and social cohesion is attacked. The threat may not now be now from the Nazi’s, but an enemy that threatens us regardless.

Whilst this fear of the other is perpetuated, it is an uncomfortable truth that narcissistically driven gain, with its associated personality traits, is often afforded the status of being the highest of personal achievements. Conversely, collective, relational or just groups that promote sharing or creative thinking within non-hierarchical, non-financial orientations are given something far less than the status they deserve.

With this in mind, is it time to think about the group and it’s power to both inspire and hold the most intense feelings once again? But also is it time to challenge the individual to think about their personal entitlements, fears and anxieties over and around the other? Perhaps now, such as then, reconnection to group processes is required.

It was S.H Foulkes who gave the greatest trust to the power of the group to hold the most distressed, and in turn gave us the best understanding of the origins of that distress and the processes that underlie it.

For Foulkes and his acolytes, in the early days of ‘Group Analysis’, often it would be group processes rather than individual that would be relied upon most heavily to manage the most distressed. In those days in the Northfield hospital, it was the trauma of war (what we now know as post traumatic shock disorder) that was being treated and it was the group itself that was the main therapeutic medium for that treatment.

To understand how this medium was and is so therapeutically useful, we have to go further into Foulkes’ theories of the individual and the construction of the self. Whilst Foulkes was a classically trained analyst in the Freudian tradition, he had within his theoretical model of ‘Group Analysis’ a radical concept and departure from the orthodoxy of psychoanalysis. This he called ‘The Matrix’- a symbolic and hypothetical web of unconscious communication and meaning that we are all a part of, that permeates and shapes the person from their earliest moments.

The importance of this concept was that he saw individuals not as individuals per se, but as connected to a much wider net of socio-political and psychological process, whereby the individual was influenced and created by the environment and relationships around them. With this, the individual was seen not to communicate solely for themselves but as a ‘nodal point’ of communication for the wider system that included the personal.

In fact, Foulkes struggled so much with the notion of the individual that he thought that distress and neurosis emanated from its very formation. Or as Foulkes himself put it:

The deepest reason why patients………. can reinforce each other’s normal reactions and wear down and correct each other’s neurotic reactions is that collectively they constitute the very norm from which they deviate.  (S.H Foulkes 1948).

Reading Foulkes, we can begin to understand the need for the group and people’s places within it. As the socio-political influences of the day reinforce the need for greater perverse individualism and narcissistic gain, both the individual and the society at large experience greater levels of neurosis, creating a self fulfilling negative feedback loop that feeds and consumes itself equally. For Foulkes, it was only connecting and remaking contact with those larger social processes that alleviated the personal and social neurosis.

In the therapeutic world, perhaps the harshest of criticisms is, rather cruelly, that of ‘denial’. And it is this Foulkes was charged with. Foulkes’ highly positive schema of the individual within groups, reconnected to the matrix that in their individual state they had deviated from and become distressed, was considered far too utopian for some of this contemporaries and followers. It is true to say that Foulkes had no schema for the anti-group or destructive phenomena that occurs in groups. It was perhaps W.R. Bion who could describe more fully the destructive elements within group life and with it present something of a dichotomy in group thinking.

Bion, in his theory of groups, was able to differentiate when groups were working and when they were not. When processes were creative and when they were stuck. Bion described this as the theory of “Basic Assumption Groups”. Using his theory to think about groups, we are able to differentiate when a group is working – engaged in its primary task of overcoming and understanding neurosis – and when it is not – that is, has become a “basic assumption group”. Bion, essentially an analyst trained in the Kleinian school, was able to identify when anxieties were high and the group had fallen into an unconscious defensive position. In such a position, the group relies heavily from within its number on dependency figures, in the unconscious hope that the individual or pair will rescue it from its neurosis. Differently to Foulkes, it was the personal unconscious stimulated by the presence of the group, and the imponderables therein, that inspired the group to amalgamate into a split position and defend against its primary work task.

While personally I find the theory of groups fascinating and could spend far more time exploring than this piece allows, I want to return to the central point that groups are both able to inspire and hold the a strongest of feelings. I asked the question, ”is group therapy a therapy for our time?” And whilst there is obviously no definitive answer to this question, what is important is that therapy in our time should have a way of reflecting on the type of processes that inspire the kind of anxieties that people suffer with and illustrate that their origins are not always from within. Our therapeutic understandings need to be able to place a person in the socio-political context that permeates the individual, and both give an understanding of what inspires anxieties and make conscious how those anxieties come to reside there in the first place.

In addition to this, therapy needs locate us within our own personal potential to split and inspire in us a greater understanding of what influences our splitting. There resides within us an understandable desire for a charismatic leader(s) to rescue us from our most primitive fears, a desire which drives us to project not just the worst of ourselves, but also the best of ourselves into the other – depleting our own internal resources. It is group analysis and group therapy that can most usefully offer this in my understanding.

Lastly, there is a brief point referred to earlier regarding narcissism. I made the point that in our time often what can be described as serious narcissism and self entitlement is celebrated and defended within our society – the banking crisis and the defence of those that maintain it, whilst scapegoating the poor, being the most obvious of the current examples of this. However, in groups it is my experience that narcissistic processes either within a group’s membership or within the therapist themselves remain unchallenged. Actually, group analysis has a unique unfathomable way of both inspiring a person’s narcissistic traits to be present and challenging them when they do. However, that is another paper altogether. But needless to say, the benefits of challenging the cult of narcissism would have far reaching positive outcomes.

I started with a point that what we know about groups was inspired by the need to treat the sufferers of the worst conflicts the world has known. Today, conflict – whist not as explicit as the wars of the 20th century – is waged in ideology and economics as much as conflict with weapons. As such, I believe the group is required to illustrate the processes that underpin the split positions that allows for such sadism, and at the same time acknowledges that, like then, there are many distressed people traumatised by those same processes. Groups are ideal to support and hold the most serious of traumas.

Michael Caton

Replacing mental health diagnosis with understanding real people and the difficulties of everyday life

Eric Maisel writes:

And who isn’t in the middle of calamity? Forget about world wars. What is it like for the quarter million women diagnosed with breast cancer each year and the one in eight women threatened by it? What is it like for a gay youth in a fundamentalist town? What is it like for a workingman or workingwoman living in a tract home in Amarillo, Queens, or Dayton? What is it like for a writer with no publisher, a painter with no gallery, a musician with no gigs? What is it like for an obese man or an obese woman with no sex life? What is it like for the millions who hate their jobs, the millions with no job, the millions who cringe when their mate enters the room, or the millions who have aged into invisibility?

Against this backdrop of mental stress, distress, and misery, we are supposed to stand “mentally healthy,” as if life were a lark and as if sweet smiles were not only our birthright, but also an obligation. Why should we be smiling? Why should we be “mentally healthy,” whatever that phrase is supposed to mean? For the whole history of our species, until very recently, your drinking water could kill you. In our age of good drinking water—which is only a reality for some percentage of our species—we have only had world wars and nuclear weapons to contend with. And what is life like for someone living under a dictator, where you can vanish for speaking? And how pleasant is your boring, taxing job? How pleasant, for that matter, is your own seething mind, packed with worries, regrets, resentments, and to-do lists?

But you are supposed to keep smiling. You are supposed to stay positive. No matter that every human right is a fight that must continually be fought for. No matter that in this modern age of plenty, which advertising tells us comes with beautiful homes, beautiful cars, and beautiful bodies, insomnia is an epidemic, obesity is epidemic, sadness is an epidemic, and meaninglessness is an epidemic. You must not notice the machinations of the powerful: none of that should affect your mental health. You must not notice your aging, your illnesses, or your mortality: none of that should affect your mental health. You may not even look in the mirror and announce that you might strive to be a better person: none of that!

Read the full article here

Where in the world does poetry belong? Rogan Wolf

By roganwolf April 7th, 2014 @ 3:38 pm

I run a project called “Poems for…” It  offers poem-posters free of charge for public display. Many of the poems are bilingual, with over fifty different languages represented so far.  The poems go far and wide – to schools and libraries and healthcare waiting rooms.

I have just remembered a piece I wrote as the introduction to my very first report on the project. It contains some general thoughts on the role of poetry in a society where, once their schooldays are past, most people barely ever read a poem – yet often look for one when a funeral has to be organised or during a love affair. I think the piece still holds good, even though it was written ages ago.

For the project has been running since before the Millenium. During that time, it has had many funders and much support, the earliest from the UK Poetry Society when Chris Meade was its Director. It was thus the Poetry Society who received this first report, written in 1999. Here is the introduction, very slightly revised.

“This project [then called “Poems for the Waiting Room”] takes place against a background in which poetry as an art form appears to have regained a popularity and acceptance it has lacked since Edwardian times.

Obviously this cannot be said without qualification. Publishers continue to find poetry books hard to sell. The Oxford University Press caused a stir a few years ago by closing down its poetry list.

And yet some poetry sells enormously. Ted Hughes’s poetry is neither easy nor comfortable. But his last publications before he died were bestsellers.

Here are some other random indicators for poetry’s renewed place in people’s lives : the evident popularity of the BBC programme “Poetry Please” ; the success and huge influence of “Poems on the Underground,” which has spread to bus services and even to telephone booths, and in different versions has been developed in cities across the world ; that astonishing issue of ‘The Guardian’ in the the middle of the First Gulf War, when a photograph of a lorry driver burnt to death in the desert appeared in the news pages, with a long new poem by Tony Harrison underneath ;  the research industry which recently seemed to gather round poetry in more than one university, evaluating its “therapeutic” benefits, and from time to time attracting a flood of correspondence from social workers, counsellors and similar care workers, many of them already using poetry extensively in their work, unsung and on their own account ; the wide range of organisations that now take people on as Poet in Residence and – more subjectively – the impression one has that an interest in reading and writing poetry no longer requires one to take cover in some “arty” coterie or secret isolated self, so that in more and more places and situations, there seems a new openness to poetry, perhaps even a hunger for what it can offer. Only a few years ago, the very subject caused embarrassment almost everywhere outside the class-room. Not now. No longer does poetry need be mumbled. For some reason it has re-joined the language of the main-street.

It seems reasonable to conclude, then, that even though the public appears largely unwilling to buy it in book form, in other media poetry has begun to live and flourish again. Perhaps it is looking for a new home, a new form of delivery.

The reasons for this resurgence of poetry as an art of the mainstream can only be guessed at.

I should like to present some of my own ideas here, since I think they are relevant to the “Poems for the Waiting Room” project. Inevitably the ideas overlap, but I shall try to set them out as distinct items.

First, poetry is a way of making sense of our surroundings, our emotions and how we live. Not from the detached point of view of the laboratory technician. But from the perspective of the ordinary person in the human feeling middle of it all, struggling through. Our ability to comprehend and find sufficiently meaningful our lives and environment is essential for health and well-being. But this has surely never been harder to achieve. For human beings everywhere the familiar is dissolving around us at faster and faster rate, and traditional frameworks and explanations no longer satisfy the vast majority. So, at some level, all of us are left detached and groping. And perhaps as a symptom of that lostness, people have turned again to poetry.

But this puts poetry in an impossible position. It cannot offer explanations as such. It cannot be a philosophy or religion. Nor, in my opinion, can it “heal” in the way a treatment heals a particular condition.

But what it can do is offer words from an ordinary human place that give shape and meaning to a common human experience. In this sense it can make sense of things, serving both to validate and to bridge, both to affirm and articulate a private emotional human experience and to create a link between people who can identify with that experience. Thus, not a cure as such, but an antidote. Not a prescription, but a tapping into an essential human process, holding us together in the human community.

Secondly, at the end of the second millennium, the average individual’s experience of self is radically different from that of any previous time. In our age as never before, we have to be continuously conscious of ourselves as members of the limitless multitude, the whole of fragile Earth’s population, the vast TV audience, the rush-hour hordes, the “Market,” the Electorate. Even while the adverts cajole us to “get away”, treat ourselves, celebrate and pamper our particularity and uniqueness, we live much of our lives and are addressed on all sides as objects en masse, recipients of one manipulative “spin” after another, customers, passengers, blank figures in the crowd. The human race has never loomed larger or more potent ; at the same time and even despite the Internet, the human individual has perhaps never felt smaller or more meaningless.

Again, this is surely relevant to poetry and its resurgence. For, of all the arts, poetry is perhaps the most purely individual, and in finding and marshalling public words and resonant meaning for inner and private experience, it reminds us of, and can sometimes perhaps restore us to, the largeness and centrality of the individual human self. Furthermore, if the poem’s any good, it talks direct and open-hearted, whole person to whole person, I to Thou. It’s not a slick sales-patter, some overhanging cloud you have to peer behind or defend yourself against. It talks a true language. It is naked and searching for you.

Which leads to the third and final suggestion. For the last few years politicians and philosophers have been talking much about Community, the need for mutual belonging, for the feeling and experience that there is a circle you belong to wider than your own. It can perhaps be said that the present Labour Government owes some of the strength of its position to the widespread yearning for a greater sense of social cohesiveness, in contrast to the furious materialism and anarchic self-interest of the previous two decades.

In some strange way I believe that here too poetry has found a role. For not only does a good poem add to a sense of individual significance, it adds to a sense of connection between people, and not just between writer and reader but between everyone ; in the very act of getting through and speaking to people, it affirms our commonality at the deepest emotional level. In this sense poetry renews community every time it is recited, breaking down our separateness and desolation. So here too the present renewed interest in poetry perhaps reflects a wider yearning, in this case for connectedness.

Other suggestions and explanations can be made and have been. What is common to the three offered here is that, assuming we are right that poetry is experiencing a renewed importance in our cultural and social life, it is doing so as a symptom of human neediness in times of enormous change and strain. It is tempting to think of poetry as some sort of cure. But this I think would be presumptuous. While I personally believe poetry actually can make things happen (pace WH Auden), at least in the sphere of the inner person, and certainly I think it can act helpfully and healingly, I hesitate to lay claims for poetry it cannot meet. Poetry can make waiting rooms more human. But it won’t turn them into treatment rooms or rescue us from the predicaments of our time.

I would like to pass on and offer a few brief reflections on the waiting room.

It is a truism that the pace of modern life is frantic. The waiting room is one place in the world where all of us at some point are going to have to pause for a while, like it or not. Whatever use we find for our normal franticness, it will not help us here.

Another feature of the waiting room is that for many of us it is a place which reinforces our sense of essential powerlessness. It is the antechamber of a system we have resorted to, in whose hands we will be helpless, but whose powers we need. Our normal routines and defences have proved insufficient. We are here to some degree as supplicants.

Furthermore, it is an impersonal place. Not just a room full of strangers, it is a room representing an organisation and a discipline whose approach to the individual is likely to take little account of him/her as a whole person, with  a familiar name and a unique history. The average health waiting room leads to a surgery where you are likely to be addressed and treated in terms of immediate presenting symptoms, of groupings, of categories.

So the waiting room is a profoundly democratic place. Like aging and death, it levels us. It is a place of tension and anxiety but also of human potential, in which people have a chance to reflect and be enriched. And it’s a place that could do with the human touch.

I would now like to make a point or two about the Health services I work with and where this project has been piloted and where it mostly belongs. (On the other hand, what about railway and airport waiting rooms ? What about sitting rooms in old people’s homes ? What about private sitting rooms ?). In my experience health services of all kinds are profoundly under stress, as a result not just of the demands on them – the quantity of those demands and often the intractable and scarcely bearable quality of those demands ; not just the inadequate resources, low pay, low morale, the “culture of blame” increasingly referred to by cautious politicians ; not just the unsure ethic of care which has not yet recovered from Thatcherism and remains shaky and uncertain ground from which to work. All of these things and maybe more combine to make centres of social and health care often rather difficult to approach and difficult to work with on a new idea. This is not in any way an accusatory statement, not is it an attempt to create an alibi to explain the delays there have unquestionably been in this project. It is simply to record the fact that workers of all kinds dealing on a day to day basis with much distress, inundated at the same time with continuous changes of policy in a climate of top-down management directives, waiting for disaster and to be pounced on by disaster-hungry reporters, tend increasingly to look out on the world outside their walls with dread and suspicion. Defences are up and responses are slow. A project to do with putting poetry up and about may well come as a delightful relief and opportunity for generous action and a human touch, but it is unlikely to be put on the top of an overcrowded action priority list. And, just possibly, in touching on emotions that people – to get by – cannot allow themselves to feel, it may actually be unwelcome.

I would conclude this piece with a brief personal statement. I believe my enthusiasm for the “Poems for the Waiting Room” project is two-fold – that it truly democratises poetry, bringing it to a place where at some point every man, woman and child has to pause ; and that it can help to humanise an impersonal space in which people can feel particularly lost and at sea.

My chief concern for the project is that there’s a danger we shall expect too much of it, that the yearning its initial success surely represents is for something greater than poetry can possibly satisfy. It is essential that we continue to choose the poems with great care for their accessibility and applicability. But even if we do, and manage to resist the temptation to put poetry up on every blank public wall, or use it to fill every possible moment of communal quiet, it is possible that the spiritual yearning from which poetry is presently benefiting, will soon move on. There is an opportunity here to make warm and honest human language count, perhaps as never before. But it is an opportunity not to be grabbed. We must grasp it, yes – but carefully, feelingly, sparingly.”

 

More from Rogan and ‘Poems for….” here:  www.roganwolf.com and www.poemsfor.org  and  a ten-minute film made of Rogan performing in the Large Meeting Hall of the Friend’s House last year.https://vimeo.com/76307847  
 

 

The sorry state of NHS provision of psychological therapy.

Healthcare Today carried the following headline at the end of January – “Figures from the Health and Social Care Information Centre (HSCIC) show fewer than 6% of referrals made under the Improving Access to Psychological Therapies (IAPT) programme in 2012-13 resulted in ‘reliable recovery’”. Shocking surely? If this were physical health, wouldn’t there be an outcry about wasted money and human resources? Wouldn’t NICE’s confidence in CBT be a little disturbed?

But according to the HSCIC report itself, this is a story of success. “43% of patients completing a course of treatment under IAPT achieved recovery”. In its foreword, Lord Layard writes, “the dataset … supports … the Department of Health’s continuing commitment to parity of care between Mental Health and other Health services”.

So, what is going on? Is it 6% or 43%? The answer lies in the opacity and manipulation of IAPT’s evidence base, and the politics of mental health.

According to the reported statistics, 43% “of those referrals that had completed treatment and were at ‘caseness’ at their first assessment (127,060 referrals)” achieved recovery. However, this group of 127,060 represent only 14% of 883,968 new referrals during the year. 51,900 patients were deemed to have recovered  – 6% of the total number of referrals.

The four-year vision for the IAPT programme published in Feb 2011, and repeated with every quarterly progress report, is for a total of 3.2m referrals, 2.6m completed courses of treatment (81% of referrals) and 1.3m ‘recoveries’ (40% of referrals) between 2011 and 2015. Compare this with the actual figures for 2012-13 – 14% of referrals completed treatment and 6% of referrals recover.

Put another way, then, 94% of referrals to IAPT failed to receive a successful course of therapy, and 86% failed to complete any course of therapy at all. What happened to 757,000 referrals who never completed a course of therapy?

The ‘evidence base’ obscures rather than clarifies the picture. We learn that of the 449,000 referrals who do not enter clinical treatment of any kind, 37% were still on a waiting-list at the end of the year and a half of this group (84,000) had been waiting for more than 90 days. The other 283,000 non-starter referrals disappear from the data. Who are they? Where do they go?

From a different starting point, we are told that 60% of new referrals ‘ended’ during the year. This figure includes referrals who completed treatment and those who either never started or failed to complete. A quarter of this 60% dropped out of the process ‘unexpectedly’ and another quarter ‘declined the treatment offered’. Why? What happened to these people?

These are not new questions being asked of the IAPT statistical light show.

In Nov 2013, The We Need to Talk Coalition report on access to talking therapies proposes from the results of its survey that 10% of IAPT referrals have been on a waiting list for over a year, and that 50% have been waiting for 90 days or more.

Tellingly, an article in Pulse Today in November 2013 reports an analysis of IAPT data for the previous year, 2011-12, by researchers from the University of Chester’s Centre for Psychological Therapies in Primary Care (CPTPC), published in two papers in the Journal of Psychological Therapies in Primary Care.

“ In the first paper, an analysis of IAPT data from the NHS Information Centre for 2011-2012, the team reported that the official figure for patients moving to recovery was 44%, based on those patients who were ‘at caseness’ to begin with and were considered to have completed treatment.However, when the researchers considered all patients entering treatment – completing at least one session – the figure fell to just 22%. If the full quota of patients referred for IAPT was considered, the proportion of patients moving to recovery fell even further, to just 12%.”

So, it seems one year later the proportion of patients moving to recovery has fallen even further, to just 6%.

Apart from the raw numbers, the report is full of obscure terminology and statistical caveats which are surely incomprehensible to the uninitiated and intended to hide as much as they reveal. For example, what a course of treatment consisting of two sessions means; what reliable recovery or reliable improvement really mean; how to read the complex flow chart illustrating the relationship between the two; and, even more, the perplexing diagrams of the various types and stages of threshold to recovery – all are beyond me at least.

Nor can I get my mind around this caveat concerning which case may or may not be counted to measure an outcome of ‘recovery’:

Not all referrals that have ended are eligible to be assessed on outcome measures such as recovery. It is possible for patients to exit the service, or be referred elsewhere, before entering treatment, or without having the required number of appointments to determine the impact of IAPT services. As a result of this, in order to be eligible for assessment a referral must end with at least two treatment appointments, allowing any changes between those two (or more) appointments to be calculated. This is known as “completed treatment”, but may not be the same figure as the number of referrals with an end reason of completed treatment, as the method allows all referrals with the requisite amount of treatment appointments to be assessed (even if the end reason is that the patient dropped out or declined treatment).

It does not help my understanding to hear that Professor David Clark, a key proponent of the IAPT programme, criticised the Chester researches by pointing out that it was inappropriate to consider all people referred to the service as many would not end up being treated, while those who did not complete treatment were people who had one session of treatment and advice, ‘in many cases entirely appropriately’.

By comparison, I know where I am when the Department of Health academics who made the economic case for the IAPT programme reject the researchers’ claims as based on ‘flawed analyses’, ‘inappropriate’ calculations and ‘dubious assumptions’. This is what the political game of evidence-base is all about. It makes no differences what the numbers actually say. Statistics are essential to the political lie. In this case, in the pursuit of the familiar policy – contempt for mental health.

The truth revealed by the 2012-13 IAPT annual report is that the IAPT programme is failing –  a failure obscured by the smoke and mirrors of its statistical evidence.

Paul Atkinson

March 2014

Sage Community Arts Gallery

Thanks to Sage Community Arts for sharing with us a gallery of their work to help bring the website to life. The gallery can be accessed in the right-hand column of any post.

Sage Community describes itself as a  “free space for marginalised artists”. You can learn more about the Community, the artists and their work at their website  www.sagearts.co.uk  (email sagearts@hotmail.co.uk).

Sage Community Arts is an incorporated registered charity, limited by guarantee. Charity Number 1155276, company number 8738832.
 
 

Hidden History: Free Clinics

“…the conscience of society will awake and remind it that the poorest man should have just as much right to assistance for his mind as he now has to the life saving help offered by surgery” (Freud, 1918 quoted in Danto: 1999).

Until very recently, psychoanalytic psychotherapy was available in England and Wales through the NHS, and not, as it is almost exclusively now, by paying to see a psychotherapist privately. This meant that people could be referred by their GP if they were unable to afford to pay for therapy, or if they did not want to see a psychotherapist privately.

The division that developed between public and private psychotherapy led to free psychotherapy becoming largely associated with the public sector. However, early on in the history of psychoanalysis, Freud encouraged all analysts to see people for free. In 1918, in a speech to the 5th Psychoanalytic Congress, he urged those present to make psychoanalysis publically available by setting up “institutions or outpatient clinics (where) treatment will be free” (Danto: 1998,1999). This speech was made at a time of considerable and progressive social and political change in the aftermath of World War 1 and it reflects Freud’s agreement with the social democratic politics of the day.

Inspired by Freud’s speech, two free psychoanalytic clinics were founded. In 1920, Max Eitinglen set up the Berlin Poliklinick and, in 1922, the Ambulatorium in Vienna was opened by Eduard Hitschmann, amidst concerted opposition from physicians who were both sceptical of the developing field of psychoanalysis and mindful of the possibility they could lose paying patients (Danto:1998).

These two outpatient clinics enabled men, women and children between the ages of five to 70 to access psychoanalysis to address their difficulties. The psychoanalysts expected people to pay what they could afford; which was very often nothing. Therapy was offered based on the person’s presenting problem, and free and fee-paying patients were seen alongside each other and offered the same length of session and length of treatment (Danto: 1998, 1999).

The records from both of these clinics, kept over a period of 10 years, include details of the age and gender of patients, why people sought psychotherapy and the length and outcome of their analysis. The records illustrate just how diverse a group of people attended the clinics, as well how wide a range of emotional and physiological problems people sought help for. Domestic servants, tradespeople, academics, farmers, unemployed people, factory workers, students and civil servants were amongst the occupations listed for people attending the clinic. The consistently largest group of people seeking psychoanalysis were young adults between the ages of 21 and 30. Many men attended the clinic, and in the 21-30 age group men and women were seen in equal numbers (Danto: 1998, 1999).

The free clinics give us an alternative perspective on the widely held view that psychoanalysis was largely consumed by Viennese bourgeois women. It provides evidence that historically psychoanalysts did not consider working class people to be unable to make use of psychoanalysis. On the contrary, some of the early psychoanalytic theory and practice developed out of the work of these clinics. Karl Abraham, Karen Horney, Erich Fromm, Helen Deutsch, Anna Freud, Sigmund Freud, Wilhelm Reich and Annie Reich were just some of the analysts working in the two clinics (Danto: 1998, 1999). The free clinics also clearly demonstrate that, historically, psychoanalysis was interested in and informed by the material and social context of people’s lives, as important contributory factors to our mental health.

 
 
References:
Danto, E.A. (1998). The Ambulatorium: Freud’s Free Clinic in Vienna. Int. J. Psycho-Anal., 79:287-300
Danto, E.A. (1999). The Berlin Poliklinik. J. Amer. Psychoanal. Assn., 47:1269-1292
See also:
Hitschmann, E. (1932). A Ten Years’ Report of the Vienna Psycho-Analytical Clinic. Int. J. Psycho-Anal., 13:245-255
Danto, E.A. (2005) Freud’s Free Clinics: Psychoanalysis and Social Justice, 1918–1938 (New York: Columbia University Press)
 
 
 

The Free Psychotherapy Network

We are a group of psychotherapists offering free psychotherapy to people on low incomes. Since 2014, we have been developing our own ways of doing no-fee work and we are supporting each other in the experience. We would like other qualified psychotherapists and counsellors to join us in building the network.

We envisage a loose, mutually supportive, network of practitioners offering their time, experience and energy to their local communities in whatever settings work for them. This might be through individual or group sessions, through facilitating peer-support groups or by working with existing community groups.

We are not talking about charity, nor are we interested in this government’s bogus vision of ‘the big society’. We see ourselves as contributing to a broad movement of activism, pressing for social justice and community values in response to the social injustice and cynical market values that seem to have a tightening grip on our society.

We support the provision of psychological therapies by the NHS. But, for the moment, we see little hope of a turnaround in the recent cuts to NHS services – in particular, cuts to the open-ended talking therapies.

We believe that the state of our emotional and psychological lives is as fundamental as our material standard of living – our incomes, our physical health, our working conditions, our education and housing. They are clearly inseparable, though not necessarily in a simple way. We know that money doesn’t buy happiness any more than poverty destroys the possibility of love and a creative life. But we do live in a society whose dominant political and cultural messages seem to us to overvalue money, profit, property and consumption, while at the same time undervaluing the quality of our emotional lives and relationships with our families, friends, co-workers, neighbours and wider communities.

Inequality of wealth, income and power are growing in the UK. In some respects, they are becoming more deeply and subtly entrenched in the way we think about ourselves and the meaning of our lives. We believe that it is as essential to a decent life to feel that we have the power to influence the way we live and can find the courage to live well with ourselves and each other, as it is to have basic material security. Gross inequalities of social, economic and political power corrode mental as well as physical health for everyone.

The intersection of class and racial inequality is a powerful dimension in patterns of social injustice and mental ill-health in the UK. We recognise the disparities of income and basic social resources experienced by BAME communities, alongside the pain and trauma of institutionalised racism, overt racist aggression and the encouragement by our governments of a hostile environment towards people of colour. The racial violence of our criminal justice system and the UK’s immigration and asylum policies have been highlighted recently by the Black Lives Matter movement and other anti-racist campaigners. The FPN supports anti-racist campaigns and recognises the critical role of racial hatred and discrimination in the mental ill-health of our society. 

We also support the need for more therapists from minority ethnic communities, and the development of better intercultural and race awareness in the training of counsellors and psychotherapists.

In general, we believe most people find the rapport and understanding they need to live well in their everyday network of friends, family, colleagues and community. A significant minority, however, find themselves struggling in relative isolation with painful and debilitating experiences of anxiety, fear, depression or self-doubt. Usually, the sources of such psychological difficulties are environmental – poverty, early trauma or abuse, family breakdown. All too often the people struggling with psychological insecurity are also struggling with financial and social insecurity.

We want to work with local communities by supporting people who would benefit from the experience of practitioners, who cannot get the kind of support they need from their GPs or from voluntary services, and who do not have the money to pay for psychotherapy. We want to work, as far as possible, from local bases in communities we are connected to. We want to encourage people to collaborate, support each other and share experience and understanding of psychological difficulties. We will work with people as psychotherapists, but also as equals in the common experience of wanting to understand ourselves and others better, and to live our lives with more freedom, more creativity and more responsibility toward the common good.

How you can get involved with the network:

*  If you are already involved in free and/or low-fee work as a qualified practitioner and you support the ethos of the network, you could join us by sending a short statement about what you are doing, its setting and the social/political perspective you hold about the work. With your permission, we could add your statement to the website and connect you with other therapists interested in developing support for each other.

*  If you are interested in starting a project or you want some support for an existing project, get in touch with us and we will think about how we might be able to help.

*  If you want to support the network in some way – by getting involved in existing work, offering ideas for community projects, thinking about the clinical implications of working for free, setting up support groups for no-fee practitioners, or simply by endorsing the philosophy of the network – get in touch with us.

Email us at  freepsynetwork@gmail.com

Please include your email address in the body of your message. Thanks.

Find free psychotherapy near you through the Free Psychotherapy Network

If you are looking for an FPN therapist, go to the Find a Therapist page here.

The directory is organised by geographical areas. Choose a therapist and use the contact details to get in touch. Many of the therapists have a short profile available about themselves and their work. We offer no guarantee that therapists have free or low fee places available at any particular time. You will have to find out for yourself. All arrangements for therapy will be made between yourself and the therapist. Individual therapists work under the codes of ethics and practice of their registration organisations.

For  a list of other organisations offering free and low-fee counselling and psychotherapy nationwide, click here.