Winnicott and the therapeutic community

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Sanity and Bonding

Analogous to Winnicott’s (1965b) notion of the “ordinary good home”, the therapeutic community has been defined as “a structure of belonging within which might exist the possibility of the individual’s finding his or her own way” (Cooper, 1991). When a psychotic patient who had been transferred to a closed hospital during an acute regression was speaking at the Community Meeting about his possible re-admission, he responded to a patient’s question about what he hoped to gain from his return by saying “sanity and bonding.” Given the quality of the group’s discussion with him, what he meant seemed clear. Indeed a patient spoke of her walks with him and how she could tell during her conversations that when she understood him, he got anxious. “It can be scary getting close to people,” she said, and he agreed. This exchange is precisely sanity and bonding. The fact that it came so naturally and was joined so movingly in this patient-to-patient interaction speaks to one aspect of the texture of the “ordinary good” community.

Winnicott’s concept of “potential space” (1971e; Fromm, 2009) is relevant to this work. The, one might say, “ordinary good” interpretation at the Community Meeting of the prospective patient’s anxiety about closeness was made by another patient. New patients, new staff and professional visitors at the Community Meetings regularly have the experience of asking themselves, “Was that a staff member or a patient who said that?” This is a powerfully and helpfully de-centering moment, in which patients become in their daily participation what others think of as staff. They can then sometimes come to appreciate, with whatever mixture of exhilaration and chagrin, that patienthood is a role, not an intrinsic aspect of person – a realization basic to the process of taking authority.
Conversely, as part of the therapeutic community program, staff take the daring step of attempting to make freely available for interpretation their unconscious organizational enactments. They too belong in this deep sense. They take part in the conscious give-and-take of the community’s democratic process, helping patients achieve the kind of capacities for living Winnicott was so attentive to, while they also surrender themselves to an “interpretive democracy” in which anyone - patient or staff - can facilitate the community’s development by contributing toward making sense of it. They thus attempt to free themselves from rigid and “hidden antisocial” role attributes, recognize in vivo the “psychological equality” (Kennard, 1998, p.27) of all human beings, and add their weight to the critical mass of maturity necessary for a truly democratic, therapeutic process.
A holding environment both enriches the developmental process and contains its various elements toward their eventual integration. “The operation of setting factors” (Winnicott, 1954, p.293) can be considered as an effort to understand the systemic dynamics of the holding environment. Winnicott argued that a reliable setting invites patient regression to early failures of the environment, which must be accounted for as part of making sense of the patient’s experience. The data of this chapter suggests that this accounting may go beyond the understanding of the enactments within the psychotherapeutic dyad and include an understanding of the particular organizational dynamic with which a given patient has become psychologically implicated. This is another aspect of the essential “examined living” practice of any successful therapeutic community.

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