Turning the Tide: The Psychoanalytic Approach of the Fitzjohn's Unit to Patients with Complex Needs

Editor : Rael Meyerowitz, Editor : David Bell

Turning the Tide: The Psychoanalytic Approach of the Fitzjohn's Unit to Patients with Complex Needs

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Since it was founded in 1920, the Tavistock Clinic has developed a wide range of developmental approaches to mental health which have been strongly influenced by the ideas of psychoanalysis. It has also adopted systemic family therapy as a theoretical model and a clinical approach to family problems. The Clinic is now the largest training institution in Britain for mental health, providing postgraduate and qualifying courses in social work, psychology, psychiatry, and child, adolescent, and adult psychotherapy, as well as in nursing and primary care. It trains about 1,700 students each year in over 60 courses.

This important volume traces an impressive range of descriptions, all clinically based, of the work of the remarkable Fitzjohn’s Unit, which has about 60 patients under its care at any one time. The book also evokes a clear sense of collective commitment, one that has lasted over seventeen years, since its beginnings as an experimental project that was set up by David Taylor in 2000. David Bell subsequently took over as Consultant in charge of the unit in 2002. The commitment is to a model of working therapeutically with extremely complex cases.

Such a great range of complex disorders requires an equivalently strong and shared commitment on the part of the staff to offering and receiving a firm model of management and containment of the kind that, whatever the often immense stresses, the Fitzjohn’s Unit can provide. This book expresses the courage, and also the hope, that such a unit can instil in all its participants.

Reviews and Endorsements

‘This book documents the remarkable achievement of David Bell and his team at the Tavistock Clinic. They have been able to continue, to extend, and to protect the tradition at the clinic of using psychoanalysis to treat severely ill patients in the NHS, which is now under threat. Through their excellent individual papers the team demonstrate how a psychoanalytic attitude can provide a humane and effective treatment environment which also provides a stimulating learning experience for the staff. It is a book that should be read by everyone working in the mental health field.’
- John Steiner, FRCPsych, author of Psychic Retreats, and recipient of the Sigourney Award

‘This book arises from and celebrates an innovative psychotherapeutic unit within the Tavistock Clinic that has undertaken to treat particularly difficult, distressed and disturbed patients. This group of patients is hard to classify and impossible to treat by conventional psychiatric methods based on a medical model of classification. As this book shows, it needs a psychoanalytically-informed, persevering approach that can be sustained for an adequate period of time. It also needs mutual support and shared experience amongst the staff engaged in the work. It is to the credit of this unit that they have sustained this in an overall therapeutic environment impatient of clinical difficulty and unfriendly to longer-term work. The book itself should inspire similar efforts and innovations that can demonstrate that sometimes the longer road is the shortest route and the most rewarding.’

- Ronald Britton, FRCPsych, Distinguished Fellow and Past President of the British Psychoanalytical Society, and recipient of the Sigourney Award

‘This modification of the model for psychological management of personality disorder is innovative, inspiring, and likely to be of enormous practical significance. It represents a highly coherent, effective response to the most complex and painful mental disorder there is.’
- Peter Fonagy, Professor and Head of Research Department Clinical, Educational and Health Psychology, UCL, and Chief Executive of the Anna Freud National Centre for Children and Families

While reading this enjoyable and useful book, my thought right from the beginning was that its title is entirely appropriate. It is about inverting a tendency we have today when trying to use our psychoanalytical instruments in difficult working conditions, such as in the case of the Fitzjohn’s unit. The tendency is to objectify, an objectification deriving from the institutions, from society and from the culture in which we live but, also, as David Bell convincingly illustrates in his Preface, sometimes from our patients themselves. It is this defensive self-objectification that treats 'the illness as if it really could be alienated from the rest of the personality.' Paradoxically therefore, the institution, volens nolens, as well as the policy of progressively reducing the funds destined to mental health and of relying only on short-term treatments, contributes to reinforcing this objectification rather than contesting it. I think that on many occasions psychoanalysts are guilty of seconding this tendency by refusing institutional work, while the authors of this book, by insisting on a multi-level approach to life and mental health in institutions, are heading in the right direction with courage and dedication.'
- Prof. Dr. Jorge Canestri, EPF President

About the Editor(s)

Rael Meyerowitz was born in South Africa. He is an adult psychotherapist and psychoanalyst (member of the British Psychoanalytical Society since 2004), having embarked on clinical training in mid-life, after an earlier career as an academic in a range of humanities disciplines and on several continents. In addition to working clinically at the Tavistock and in private practice, he teaches a variety of psychoanalytic subjects on the Tavistock’s adult psychotherapy training, at University College London, the British Psychoanalytic Foundation, and elsewhere.

David Bell is a Consultant Psychiatrist at the Tavistock Clinic in London, where he directs the Fitzjohn’s Unit, a specialist service for serious/complex psychological disorders. He is visiting Professorial Fellow, Birkbeck College, London and past President of the British Psychoanalytical Society. Throughout his career he has been deeply involved in the relation between psychoanalysis and literature, philosophy and politics, and has made numerous contributions in these areas. He is one of the UK’s leading psychiatric experts in asylum/human rights. He is contributing editor of Reason and Passion and Psychoanalysis and Culture: A Kleinian Perspective.

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