Tavistock Clinic Research Articles

Inkblots, Psychotherapy and the Tavistock Clinic

AbstractThe purpose of this article is to recount the early history of the Rorschach's inkblots test in Europe and the USA; its subsequent application in highlighting the ill effects on children of bombing during the Second World War; its wartime use in selecting military personnel; its post‐war use in selecting patients for psychotherapy at the Tavistock Clinic in London and subsequent decline in this use of Rorschach's inkblots in favour of focus on the psychotherapy patient's transference experience of the psychotherapist treating them. The article ends with evidence of interest, beyond psychotherapy, in Rorschach's inkblots and with the implications of this for the author's principal conclusion regarding the value of these inkblots in evoking the free association and conversation crucial to psychotherapy.

After the Cass Report; does British clinical psychology need an ethical re-boot?

This paper challenges the BPS to realign its position on transgender presentations in the light of the Cass Review. The latter highlighted the failure of a narrow ethics of recognition approach at the Gender Identity Development Service at the Tavistock Clinic, which had created an iatrogenic scandal, with clinical psychologists at its centre.

The Cass report, gender identity, and where to go next

Child and adolescent clinicians in the United States have to be paying attention to what has happened to gender medicine in the United Kingdom. The highly respected service at the Tavistock Clinic has come under intense criticism — confusing as that may be — and in April Hilary Cass released her report to the UK's National Health Service expressing concern for gender medicine, saying it is “built on shaky foundations.” Coupled with recent lawsuits against the American Academy of Pediatrics (AAP) and gender‐affirming care, the standard in the United States, clinicians are left pondering their next steps. An editorial in the British Medical Journal following the release of the Cass Report gives a balanced summation. (For the report, go to Download the Final Report). The editorial is subtitled “an opportunity to unite behind evidence informed care in gender medicine.”

The Cass report, gender identity, and where to go next

Child and adolescent clinicians in the United States have to be paying attention to what has happened to gender medicine in the United Kingdom. The highly respected service at the Tavistock Clinic has come under intense criticism — confusing as that may be — and in April Hilary Cass released her report to the UK's National Health Service expressing concern for gender medicine, saying it is “built on shaky foundations.” Coupled with recent lawsuits against the American Academy of Pediatrics (AAP) and gender‐affirming care, the standard in the United States, clinicians are left pondering their next steps. An editorial in the British Medical Journal following the release of the Cass Report gives a balanced summation. (For the report, go to Download the Final Report). The editorial is subtitled “an opportunity to unite behind evidence informed care in gender medicine.”

Clinician experiences of remotely delivering psychodynamic and intensive psychoanalytic psychotherapy within an NHS institution during the COVID-19 pandemic, and possible implications for future clinical practice

When it became clear that the COVID-19 pandemic would require significant shifts in working practice, staff in the Adult Complex Needs department at the Tavistock clinic designed a study to explore the emotional impact of remote working on clinicians and patients, and to consider related clinical implications both individually and collectively. A set of semi-structured questions were designed to tap into experiences of working remotely, and clinicians were interviewed. The material arising from these interviews has been summarised into themes. The predominant theme was clinicians’ awareness of the importance of their own emotional milieu in delivering psychoanalytic psychotherapy, especially at a time of crisis, in their initial emotional responses and as they gathered further remote experience. They raised challenges around maintaining an analytic frame amid therapeutic uncertainties, and in the context of the many physical losses of a remote frame: blurred clinical boundaries, altered emotional experiences and resonance, and important impacts on holding, patient attendance, and worsening distress and risks for patients who struggled remotely. Strategies to adapt were key, particularly remaining emotionally consistent and observant amidst uncertainty, and support was paramount to do so. These experiences assist in informing clinicians about the limitations and uses of remote clinical work.

Shining light: A case study analysis of a tutor training programme for architect-educators at the University of East London, 1996-c.2002

ABSTRACT A reappraisal of the education of future architects is now a point of focus for Schools of Architecture in the UK because professional bodies have called for a ‘sharpened focus’ on the training of students. Specific teacher training for architect-educators does not currently exist in the UK. However, between 1996 and c.2002, a tutor training programme for architect-educators was taught at the University of East London, modelled on the pedagogic approaches of the Tavistock Clinic. This article uses case study research and semi-structured interviews to show that trainee architect-educators were taught to teach using the practice of observation and reflection; methods which are unfamiliar in architectural education. This article argues that the creators of this tutor training programme adopted an atypical, transdisciplinary approach to learning and teaching, which remains unique and special, and concludes by suggesting that support for architect-educators could be an important component of any re-structured education programme.

Work Discussion for community mental health

ABSTRACT This paper aims to emphasize the pertinence of psychoanalytic work in the context of communitary mental health. The theoretical orientations for this are based on the concept of Social Defence Systems, as introduced by Jaques and developed by Menzies, and the intervention method used is Work Discussion, an original and applicable approach designed and consolidated at the Tavistock Clinic. With this contributions, we are able to consider the ways in which Institution´s malfunctioning relates to ways in which it´s work implies a defensive activity with which its participants, workers and patients, can be unconsciously colluded. After describing this method and the mentality behind it, this work describes in detail its application in the context of a Communitary Mental Health Centre in Santiago, Chile. Some clinical examples are included, together with some thoughts about the value that this intervention has for the community.

The emotional and relational impact of starting kindergarten for non-native speaking children: a case study of a three- year-old child

This paper presents a case study and some results of a longitudinal study conducted from 2013 to 2018 in preschools in Hungary and Switzerland. This study has been prepared as part of the author’s PhD research at the University of Geneva (Toth, 2018). The objective of this research was to reveal the relational and emotional experience of entering kindergarten/ school for non-native speaking children, i.e., children who do not speak and understand the language spoken at kindergarten or school. (In this case study, the chosen child did not speak Hungarian when she started kindergarten). To capture the complexity of the emotional experience, a special observation form has been chosen called the Esther Bick method (Bick, 1964; Franchi & Toth, 2014), which has been developed in the training of child psychotherapists in the Tavistock Clinic in London. Through the unconscious, projective, and transferential movements captured by the observations and completed by other mainly qualitative tools, I could reveal the internal movements that go through the children and approach their fears and their anxieties.

Edward Glover, John Bowlby, psychiatry, Bion, and the War Office Selection Boards—towards a context for the emergence of group analysis

This paper is a reflection on the context from which group analysis emerged in Britain during the Second World War. Edward Glover’s objections to the work of army psychiatry in a radio broadcast in November 1943, and the difficult collaboration between the War Office and psychiatrists as they sought to develop officer selection and training procedures, influenced developments in psychoanalysis, including the emergence of group analysis. It considers the response of the British Psychoanalytical Society whose members were engaged in army psychiatry work alongside colleagues from the Tavistock Clinic. Bion’s and Rickman’s collaboration and the experiments at Northfield were an outcome. The abrupt ending of the first Northfield experiment, and the development of psychiatry more broadly, prompted serious questioning within the Society about its isolationalist policies. The Society’s move to develop its training role, and to participate in post war health, mental health and welfare services was a result. Not only did it ensure the Society’s survival, but enhanced the emergence of group analysis as a discipline within the psychoanalytic project.

Shapes of gender identity: three stories with impact

The paper describes three stories of children and adolescents with atypical gender identity development followed in psychotherapy. These cases have already been published, but are revisited here to show how these experiences contributed to the creation of the therapeutic intervention model of the Gender Identity Development Service originally established in 1989 at St George’s Hospital, London. The service transferred to the Tavistock Centre in 1996. The first case shows the gradual recognition of dealing with the development of an atypical gender identity rather than a psychiatric condition. Reflection on this case led to the definition of possible therapeutic goals. The second case illustrates the difference between solid and fluid identities, an important distinction in the decision to consider the possibility of physical intervention. The third case shows the network management model and addresses issues concerning autonomy.

A quality improvement project to increase patient feedback in the psychotherapy department, Tavistock Clinic

AimsA rigorous and systematic patient feedback system is important for identifying gaps, improving the quality of care and encouraging patient involvement in service delivery. In the Adult Complex Needs Service of the Tavistock Clinic, a tertiary psychotherapy centre, only 5% of patients have provided feedback when requested. This Quality Improvement (QI) project aimed at improving the return rates of the Experience of Service Questionnaire (ESQ) and the CORE Outcome Measure by 10% within a year.MethodThe QI methodology was used to help identify factors contributing to the low response rate, including views amongst stuff about how such feedback, and the method of its delivery, might affect a psychoanalytically-informed treatment. Previously these forms were posted or handed out in person. In the first Plan-Do-Study-Act (PDSA) cycle, the method of distribution was changed by sending out the questionnaires to patients electronically, using an online survey platform. In the second PDSA cycle, the CORE-34 questionnaire was replaced with a shorter version, the CORE-10. This was in order to test our hypothesis that a shorter questionnaire would result in an increase in the response rates.ResultIn the first cycle of change, 197 patients were emailed for both the CORE-34 and ESQ and a total return rate of 31% was achieved. This signified an increase of 26% in the response rate. Overall more ESQ forms were completed (35% uptake) compared to CORE-34 forms (28% uptake). In the second cycle 199 patients were emailed with the CORE-10 and ESQ forms. The response rate was 21% and 18% respectively. Although the response rates decreased slightly in the second PDSA cycle the results indicated that this method of distribution was capturing a greater range of patients who had not previously provided the service with this sort of feedback.ConclusionSending out the outcome measures electronically and adopting shorter versions of the CORE questionnaire increased the feedback response rate significantly, and provided the service with useful data as to patients' experience of their treatment journey here.

Implementation of balint group for a team who care patients with head and neck cancer in a service in Brazil: A proposal post qualitative research

IntroductionThe Balint group emerged at the Tavistock Clinic in London in the early 1950s. Its creator was a doctor and psychoanalyst Michael Balint. It consisted of a group process, with meetings among general practitioners, in which non-conscious aspects of the professional-patient relationship were approached. We present how a proposal for implementation of a Balint Group has emerged, specifically for physicians and nurses who care for cancer patients. Is is a consequence of results obtained from a qualitative study conducted by a student of the professional master’s degree linked to a Clinical Oncology.ObjectivesTo present a technical product, as required in a Brazilian professional master’s degree, as a result of research that studied reports of doctors and nurses who deal with usual difficulties of handling patients with HNC.MethodsThe group work is triggered by the report of a case brought by a participant, presenting a problem-situation in the management of his patient. The meeting leader seeks to understand the reactions reported by the presenter in the light of a psychodynamic approach.ResultsExpected results: the holding of a Balint group, perhaps monthly, in charge of a colleague who has knowledge in applied psychoanalysis, will allow insights to the participants who will bring them conditions to perceive “neurotic elements” in the relationship with their patient.ConclusionsFinal consideration: having accumulated decades of positive experience, Balint Groups must remain as an updated proposal for the work on emotional issues of professional teams, with emphasis on clinical services with the management of so-called “difficult patients”.DisclosureNo significant relationships.

Looking out whilst considering what lies within: engaging in further thought about one’s own relationship with diversity and difference

ABSTRACT This paper consists of a collection of individual learning and developmental experiences in the area of diversity and difference, based on the author’s participation in the ‘difference; identity; diversity’ workshop, as part of the Tavistock Clinic’s child psychotherapy training. There is a discussion here of how this learning took place, through a consideration of relevant theory, historical context, and clinical examples within the workshop’s individual seminars. In the seminars, the exploration of all these components was further enhanced by individual and group reflective processes, which formed part of the workshop. The paper highlights how the facilitating environment that was created through the containing net of all these components within the workshop allowed for my individual exploration of and learning about both internal and external diversity. This kind of learning is not commonplace in child psychotherapy trainings, which is to the detriment of child psychotherapists’ individual development, the training process itself, and the profession as a whole.

Bourdieu’s contribution to psychoanalytic thinking in the context of research

ABSTRACT This article explores the added value that the application of the conceptual tools of French sociologist, Pierre Bourdieu (1930–2002), has the potential to bring to psychoanalytic thinking. Drawing on evidence derived from our individual studies, we aim to demonstrate how Bourdieu’s theories can contribute to our understanding of workers’ occupational choices and add to our knowledge of the way organisational cultures combine with personal attributes to either sustain people in their jobs or drive them out. Given we have practice backgrounds informed by psychoanalytic and psychosocial theory and undertook our Professional Doctorates in Social Work at the Tavistock Centre in London, which strongly promotes psychoanalytic ideas, it may seem surprising that we chose to utilise sociological concepts with which we were largely unfamiliar. However, upon studying Bourdieu’s key concepts of habitus, field, capital and practice we recognised their relevance and ability to bring fresh insights to our research findings.

‘When the eye begins to see and the ear begins to hear’: Teaching infant observation at university level

ABSTRACT This paper presents the author’s work in introducing a modified version of infant observation as a requirement of a university course in Early Childhood Education, a qualification course for Nursery Teachers in a Norwegian University. The author explores her psychoanalytic ideas about how learning takes place after tracing the paradigm shift in Early Years Education in a north European country in the late 20th and early 21st centuries. The author herself learnt a great deal about the Tavistock model of observation and in later work at the Tavistock Clinic. She emphasises the emotional component in learning, the nature of learning from a psychoanalytic perspective and on the countertransference (what is felt) along with what is seen and heard in observing young children. The expansion of nursery places in the author’s country for three to six-year-old children led to an expansion in nursery teaching courses at universities and the opportunity to include ‘learning form experience’, along with other forms of learning, was taken. The paper also includes responses from questionnaires given to former students who had undertaken observations and their thoughts on its impact on their approach to their teaching work.

Psychoanalysis, social science and the Tavistock tradition

This article is about the connections between the fields of sociology and psychoanalysis, as they have been present in the traditions of the Tavistock Clinic and Institute of Human Relations from their origins to the present day. It describes a ‘double dissonance’ in this relationship, in that the Tavistock’s commitment was never to psychoanalysis or to sociology, narrowly conceived. Its interest was in a broad conception of the social sciences, involving socio-psychological, socio-technical and ecological perspectives, and it developed a broader social engagement of psychoanalytic perspectives than that of a conventional psychoanalytic institute. Nevertheless, the Tavistock synthesis has been an original and valuable one. The Tavistock Institute’s model of research has been closely linked, through its consultancy practice, to social action, and it has investigated and initiated democratic forms of organisation. The Tavistock Clinic developed a model of mental health care and professional education within the National Health Service, which provided support to individuals, families and communities at each stage of the human life cycle. Although both of these models have been placed under pressure in the individualist and market-oriented climate of recent decades, both traditions survive and retain a potential for the future.

An RCGP plaque for Michael and Enid Balint: from the archivist's perspective.

Neither Michael Balint nor his second wife Enid were GPs and yet it is entirely appropriate that the names of these two psychoanalysts grace the most recent RCGP blue plaque to be unveiled.1 Michael and Enid met at the Tavistock Clinic, following his emigration from Hungary shortly before the Second World War. By the time of their marriage in 1953, she was already supporting social workers to consider in groups their working relationships with the families they were supporting, a clear precursor to Michael’s approach with doctors. Their contribution to the development of the profession was helping GPs to reflect on their doctor– patient relationships, to improve therapeutic practice. The Balint Society, now in its 50th year, has extended their philosophy and approach to more recent generations around the world. In …

Finding meaning, making links, creating space: an early intervention with children on the autistic spectrum and their families

ABSTRACTA novel psychoanalytic intervention with young children on the autistic spectrum is presented, addressing the family as a whole and focusing on the relationships between the family members. The intervention is based on the philosophy of the Tavistock Clinic’s ‘Under Fives Counselling Service’, taking into account the principles of psychoanalytic observation as introduced by Esther Bick, and the tenets which Didier Houzel put forward regarding the work with parents of autistic children. In the paper, the therapeutic journey of young Jason and his family is depicted. The therapists’ primary objective was to establish a cohesive narrative of the story of the family as a whole, and of each member separately. This effort implied, first of all, that their story would become an object of thought. Based on the clinical material presented, it is argued that this type of psychoanalytic intervention offered the family the necessary psychic space to process their fragmented story, to contain life-threatening anxieties and to gradually change their way of functioning and relating to one another.

‘The Drug Doctor’: Michael Balint and the Revival of General Practice in Postwar Britain

In the early 1950s, the psychoanalysts Michael and Enid Balint established in the Tavistock Clinic, an innovative peer group for general practitioners (GPs). The goal was to create a forum of family doctors to discuss case studies of a psychosocial nature and to provide then with psychotherapeutic tools to better help their patients. What started as a small peer group of GPs in the London became, by the 1960s, a worldwide medical movement which still exists today. This article traces the cultural and social origins of the Balint Groups movement, and aims to contextualize it within the ‘psychosocial turn’ of interwar and postwar Britain; the need of general practice to renew itself as a profession after WWII and the introduction of the then NHS; and the flourishing of a new welfarist ideology in the postwar years. The article argues that the Balintian approach is emblematic of the ‘pastoral’ role – ‘patronizing’ and ‘caring’ at the same time – played by the British welfare state in the early years of its citizens’ everyday lives.

Evaluating the impact of Work Discussion techniques on the formation of psychoanalytic skills and attitudes: research designs and first results

ABSTRACTWork Discussion, developed at the Tavistock Clinic in London, is a specific psychoanalytical method which is used in order to stimulate, encourage and support the development of a wide range of psychoanalytic skills and attitudes of relevance for psychotherapy and related fields of psychosocial work. For this aim Work Discussion is an element of several psychoanalytically based Master’s degree programmes. In the paper, it is discussed how the use of Work Discussion can be evaluated and the impact of Work Discussion on the development of psychoanalytic skills and attitudes can be investigated. With special respect to two Master’s degree programmes offered in Vienna, it is shown that teachers ranked Work Discussion as the most important element of a psychagogic Master’s programme and how Work Discussion seminar papers have been analysed in order to evaluate the professional developments of psychotherapeutic candidates of two psychoanalytic training institutes.