Tavistock and Portman NHS Foundation Trust

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The Tavistock Clinic – Tavistock and Portman NHS Foundation Trust
Formation1920
HeadquartersLondon, United Kingdom
Coordinates 51°32′48″N0°10′29″W / 51.5466°N 0.1748°W / 51.5466; -0.1748
Chair
 Paul Burstow
Website tavistockandportman.nhs.uk OOjs UI icon edit-ltr-progressive.svg

The Tavistock and Portman NHS Foundation Trust is a specialist mental health trust based in north London. The Trust specialises in talking therapies. The education and training department caters for 2,000 students a year from the United Kingdom and abroad. The Trust is based at the Tavistock Centre in Swiss Cottage. The founding organisation was the Tavistock Institute of Medical Psychology founded in 1920 by Hugh Crichton-Miller. [1]

Contents

The Tavistock and Portman NHS Trust was formed in 1994, when the Tavistock Clinic merged with the neighbouring Portman Clinic in Fitzjohns Avenue. [2] [3] The Portman specialises in areas of forensic psychiatry, including the treatment of addictive, sociopathic and criminal behaviours and tendencies. [4]

It has developed as a centre for psychoanalysis within the NHS since being included at its founding in 1948. [5]

The Trust and predecessor organisations have been influential beyond medicine, including in the British Army, management consultancy, prison and probation services. [6] [7]

Early history

Tavistock Square in Bloomsbury, London, birthplace in 1920 of the Tavistock Clinic TavistockSquare.jpg
Tavistock Square in Bloomsbury, London, birthplace in 1920 of the Tavistock Clinic

It owes its name to the fact that its original location was in Tavistock Square in central London. When it moved later to larger premises, it took its name with it. Although Hugh Crichton-Miller was a psychiatrist who developed psychological treatments for shell-shocked soldiers during and after the First World War, clinical services were always destined for both children and adults. [8] [9] The clinic's first patient was a child. From its foundation it was also clear that to offer free treatment to all who need it meant that the Tavistock Clinic needed to generate income by providing training to clinical professionals who could eventually help people across the UK and beyond. The clinical staff were also researchers. These principles remain influential to this day. [10]

Carl Gustav Jung Carl Gustav Jung.jpg
Carl Gustav Jung

Following its foundation the Tavistock Clinic developed a focus on preventive psychiatry, expertise in group relations – including army officer selection – social psychiatry, and action research. There was an openness to different streams of research and thought as, for instance, the famous series of lectures given by the Swiss psychiatrist and one time collaborator of Sigmund Freud, Carl Jung, which were attended by doctors, churchmen and members of the public, including H. G. Wells and Samuel Beckett. [11]

Its staff, who were still mainly unpaid honorary psychiatrists, psychologists and social workers, were interested in researching and consulting to leadership within the armed forces. The staff also offered treatment to members of the civilian population who might be traumatised by the prospect of a further world war, which could bring bombing of cities, evacuation of children and the shocks of loss and bereavement.

Post-war history

After the Second World War, the Tavistock Clinic benefited from the Northfield Hospital experience and from the arrival of talented professionals from Europe, many fleeing Nazi persecution. [12] In 1948 it became a leading clinic within the newly created National Health Service. At this point its education and training services were managed separately by the Tavistock Institute for Medical Psychology, which was also the umbrella for the Tavistock Institute, involved in social action research and thinking about group relations and organisational dynamics, and for work with marital couples. The clinic was managed on a democratic model by a professional committee and developed further its distinct focus on multi-disciplinary and community-centred work. At the Clinic's centenary in 2020 many post-war Tavistock staff contributed personal chapters in "The Tavistock Century" (edited by Margot Waddell and Sebastian Kraemer, Phoenix Publishing House https://firingthemind.com/product/9781912691715/)

Children and young people

New developments in child and adolescent mental health were particularly fruitful in the immediate post-war period. In 1948 the creation of the children's department supported the development of training in child and adolescent psychotherapy. Dr John Bowlby supported this new training and naturalistic infant observation. He also developed Attachment Theory. Husband and wife clinicians James Robertson and Joyce Robertson showed in their film work the impact of separation in temporary substitute care on young children for example, when their parent was admitted to hospital. The Australian Hazel Harrison was teacher-in-charge from 1954 to 1956 where she worked with Bowlby. They looked in detail at English pre-school education. [13]

The Tavistock Clinic opened its Adolescent Department in 1959, recognising the distinctive developmental needs and difficulties of younger and older adolescents. In 1967 it absorbed the London Child Guidance Clinic, founded in 1929. [14]

In 1989 the Tavistock established the Gender Identity Development Service (GIDS), a highly specialised clinic for young people presenting with difficulties with their gender identity. [15] In July 2022, following a critical independent review from Hilary Cass, it was announced that this service would be discontinued and replaced with regional clinics providing a more "holistic" approach. [16]

Training in education

By the 1960s The Tavistock Clinic was also providing both 1-year and 4-year professional training courses in educational psychology, the latter embracing a teacher training element through Leicester University School of Education. For a number of years the senior tutor and principal psychologist for these courses was Irene Caspari who did much to promote the concept and practice of Educational therapy. In the 1970s systemic psychotherapy became the Tavistock Clinic's newest professional training. Applications of the clinical ideas and skills of its multidisciplinary clinicians are at the heart of its education and training, with academically validated programmes developing from the early 1990s with the University of East London, and later with the University of Essex and Middlesex University.

Reflecting on the workplace

Work discussion, supervised clinical practice and experiential group relations work are central to many trainings all of which aim to equip mental health workers with the emotional, organisational, and relational capacities to operate confidently in front line settings. A BBC TV series 'Talking Cure: Jan' brought the work of the Clinic to a wider audience in 1999 and remains relevant today. [17] Organisational consultancy by former CEO Anton Obholzer, featured in the TV series, and their edited collection, with Vega Roberts, 'The Unconscious at Work: Individual and Organizational Stress in the Human Services', remains one of the classic texts to emerge from the Tavistock Clinic. [18]

Public sphere

The Tavistock's tradition of social and political engagement has been renewed in recent years through its programme of Policy Seminars which model a dialogic, exploratory approach to policy analysis and debate with the social epidemiologist, Richard G. Wilkinson, the psychologist, Oliver James and the columnist, Polly Toynbee, among recent contributors. The series of Thinking Space events follows a similar model of participatory engagement around themes of diversity, racism, and sexual orientation.

The Tavistock Institute, which had been part of the Tavistock family, moved to its own premises in 1994. The Tavistock Centre for Couples Relationships, TCCR, formerly the Tavistock Institute of Marital Studies, was always a separate, charitably-funded organisation which left the Tavistock Centre for new premises in 2009.

NHS Trust

In 1994, the Tavistock Clinic joined with the Portman Clinic to become the Tavistock and Portman NHS Trust. [4] In 2006 the Trust acquired NHS Foundation Trust status and become the Tavistock and Portman NHS Foundation Trust. [19] It is an active member of UCL Partners, the Academic Health Service Centre located in North London.

Paul Burstow, a former Minister of State for Care and Support in the Cameron-Clegg coalition government, became Chair of the Trust in November 2015. [20]

Services

The Trust provides clinical services for children and families, young people and adults. It also provides multi-disciplinary training and education. These programmes include core professional training, for example in psychiatry, psychology, social work and advanced psychotherapy training, as well as applied programmes for anyone working in the mental health or social care workforce.

Since 2010, the clinical work of the Trust has diversified, with new services, such as the Family Drug and Alcohol Court in Milton Keynes, [21] and the City and Hackney community psychotherapy service.

It is the largest provider of transgender services in England, but funding for the service has not kept pace with demand. In August 2019, 5,717 people were on the waiting list for a first appointment, and average waiting time was about two years. [22] The Gender Identity Development Service (GIDS) at the Tavistock Centre has come under scrutiny due to reports that concerns over children's welfare were "shut down". [23] The Tavistock and Portman NHS Trust have defended their practices. [23] In July 2022, following criticism in the interim report by Hilary Cass, it was announced that this service would be discontinued, and replaced with regional clinics providing a more "holistic" approach. [16] It was set to close at the end of March 2024. [24] [25] [26]

In February 2023, BBC journalist Hannah Barnes' book, Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children was published. [27] Barnes describes the premise of the book by saying, "I wanted to write a definitive record of what happened [at GIDS] because there needs to be one." [28]

Performance

The Tavistock was named by the Health Service Journal as one of the top hundred NHS trusts to work for in 2015. At that time, it had 449 full-time equivalent staff, and a sickness absence rate of 0.92%. 84% of staff recommend it as a place for treatment and 73% recommended it as a place to work. [29]

The Trust borrowed £58 million in 2016, which it intends to repay by selling its current sites. [30]

Discrimination claim

The Tavistock has been accused of forcing racist ideology on students, with lectures such as "Whiteness - A Problem of Our Time", and in 2022 a claim against the Trust for discrimination on the basis of race and religion was commenced. [31]

Notable contributors to the clinic

Over the years many hundreds of staff members, at all levels, have contributed to the work of this institution. This list is merely representative of some of the lasting contributors to the different fields encompassed by the Clinic.

Medical directors, chief executives and Chair of Trust

The Scottish Institute of Human Relations

In line with Hugh Crichton-Miller's original vision for clinics to be set up in communities across the country, his dream was not realised in his 'native' Scotland for another 50 years. [68] However, with Jock Sutherland's return to Edinburgh in 1968, he became the catalyst for the formation of an organisation modelled on the London centre, albeit on a smaller scale. The Scottish Institute of Human Relations (SIHR), now defunct, was constituted as a charitable educational institution in Edinburgh in the early 1970s. Eventually a branch was opened in Glasgow. The 'MacTavi', as it was sometimes fondly called, worked closely with the National Health Service in Scotland and provided psychoanalytic training and courses for professionals in the health and educational systems and beyond. [69] It also guided adults and children into treatment for the forty years of its operation. [70] SIHR was finally dissolved in 2013 and its centres closed down. Some of its functions were taken over by a number of other organisations, specifically psychoanalytic training has become the remit of the Scottish Association for Psychoanalytic Psychotherapy (SAPP).

See also

Related Research Articles

Psychoanalysis is a set of theories and therapeutic techniques that deal in part with the unconscious mind, and which together form a method of treatment for mental disorders. The discipline was established in the early 1890s by Sigmund Freud, whose work stemmed partly from the clinical work of Josef Breuer and others. Freud developed and refined the theory and practice of psychoanalysis until his death in 1939. In an encyclopedic article, he identified the cornerstones of psychoanalysis as "the assumption that there are unconscious mental processes, the recognition of the theory of repression and resistance, the appreciation of the importance of sexuality and of the Oedipus complex." Freud's colleagues Alfred Adler and Carl Gustav Jung developed offshoots of psychoanalysis which they called individual psychology (Adler) and analytical psychology (Jung), although Freud himself wrote a number of criticisms of them and emphatically denied that they were forms of psychoanalysis. Psychoanalysis was later developed in different directions by neo-Freudian thinkers, such as Erich Fromm, Karen Horney, and Harry Stack Sullivan.

<span class="mw-page-title-main">Melanie Klein</span> Austrian-British psychoanalyst (1882–1960)

Melanie Klein was an Austrian-British author and psychoanalyst known for her work in child analysis. She was the primary figure in the development of object relations theory. Klein suggested that pre-verbal existential anxiety in infancy catalyzed the formation of the unconscious, which resulted in the unconscious splitting of the world into good and bad idealizations. In her theory, how the child resolves that split depends on the constitution of the child and the character of nurturing the child experiences. The quality of resolution can inform the presence, absence, and/or type of distresses a person experiences later in life.

<span class="mw-page-title-main">John Bowlby</span> British psychiatrist and psychoanalyst (1907–1990)

Edward John Mostyn Bowlby, CBE, FBA, FRCP, FRCPsych was a British psychiatrist, and psychoanalyst, notable for his interest in child development and for his pioneering work in attachment theory. A Review of General Psychology survey, published in 2002, ranked Bowlby as the 49th most cited psychologist of the 20th century.

Hugh Crichton-Miller was a Scottish physician and psychiatrist. He founded the Bowden House nursing home for nervous diseases at Harrow-on-the-Hill in 1912 and the Tavistock Clinic in London in 1920.

Donald Meltzer (1922–2004) was a Kleinian psychoanalyst whose teaching made him influential in many countries. He became known for making clinical headway with difficult childhood conditions such as autism, and also for his theoretical innovations and developments. His focus on the role of emotionality and aesthetics in promoting mental health has led to his being considered a key figure in the "post-Kleinian" movement associated with the psychoanalytic theory of thinking created by Wilfred Bion.

Neville Symington was a member of the Middle Group of British Psychoanalysts which argues that the primary motivation of the child is object-seeking rather than drive gratification. He published a number of books on psychoanalytic topics, and was President of the Australian Psychoanalytical Society from 1999 to 2002.

Martha Harris, née Dunlop was a British Kleinian psychoanalyst of children and adults. From 1960 to 1980 she was head of the Child Psychotherapy service at the Tavistock Clinic, taking over from Esther Bick, who had established a foundational method of disciplined infant observation. Harris was responsible for the subsequent expansion in the number of English and international trainees at the Tavistock, and for laterally developing the training into what became known as the Tavi Model. This model, in which infant observation continues to play a pre-eminent role, has been adopted, with modifications, in other European countries and in South America: such as the GERPEN in France, the six Martha Harris Study Centres in Italy, and the São Paulo Mother-Baby Study Centre in Brazil.

Psychoanalytic infant observation is a distinct empirical case study method in psychoanalytic and psychotherapy training which was developed at the Tavistock Clinic in London by child psychoanalyst Esther Bick. In 1948 she collaborated with John Bowlby to develop the approach as part of psychotherapy training. It has since become an essential feature of pre-clinical training in child and adult psychotherapy, psychoanalysis and related fields throughout the Western world.

John Derg Sutherland, also known as Jock Sutherland, was a Scottish physician, psychoanalyst and theorist, notable also for his role as Medical Director of the Tavistock Clinic.

Thomas Ogden is an American psychoanalyst and writer, of both psychoanalytic and fiction books, who lives and works in San Francisco, California.

Esther Bick, (1902–1983), born in Przemyśl, Galicia, Poland, was a psychologist and child and adult psychoanalyst who, with Dr. John Bowlby, established the child and adolescent psychotherapy training program at the Tavistock Clinic, London, in 1948.

Psychodynamic Therapy with Infants and Parents aims to relieve emotional disturbances within the parent(s), the baby, and/or their interaction, for example, postnatal depression and anxiety, infant distress with breastfeeding and sleep, and attachment disorders. It rests on attachment theory and psychoanalysis. Sigmund Freud suggested that a modification of his method could be applied to children, and child analysis was introduced in the 1920s by [Anna Freud].., [Melanie Klein], and Hermine Hug von Hellmuth. Klein speculated on infantile experiences to understand her patients' disorders but she did not practice PTIP. Donald Winnicott, a pediatrician and analyst, focused on the mother-baby interplay in his theorizing and his brief parent-child consultations, but he did not work with PTIP.

David Howell Morgan is a psychoanalyst and consultant psychotherapist who has worked at the Portman Clinic London and Tavistock and Portman NHS Trust for 25 years.

<span class="mw-page-title-main">Joyce Robertson</span> British psychiatric social worker (1919–2013)

Joyce Robertson was a British psychiatric social worker, child behavioural researcher, childcare pioneer and pacifist, who was most notable for changing attitudes to the societally acceptable, institutionalised care and hospitalisation of young children, that was prevalent. In the late 1940s Robertson worked with Anna Freud first at the Well Baby Clinic and later in the Hampstead Child Therapy Clinic. She was later joined by her husband James Robertson. In 1965, both of them moved to the Tavistock Institute of Human Relations to work with John Bowlby on the Young Children in Brief Separation project and the development of attachment theory. This was to research the mental state and psychological development of children who underwent brief separation from their parents. Later in her career, Robertson worked with her husband to produce a series of celebrated documentary films that highlighted the reaction of small children who were separated from their parents. These were shown in hospitals, foster care and state run hospitals. Later she was known for promoting the idea of foster care instead of residential nurseries.

Child Guidance was both an evolving 20th-century social construct, sometimes called the Child Guidance Movement, and an influential network of multidisciplinary clinics set up to address the problems of childhood and adolescence. It began in the United States and after World War I spread rapidly to Europe, especially to Austria and England, though not to Scotland. It was the first child-centred institutional response to meet perceived child and youth behavioural and mental disorders. It therefore predated the advent of child psychiatry as a medical specialism and of distinct child psychiatric departments as part of modern hospital settings.

The Gender Identity Development Service (GIDS) was a nationally operated health clinic in the United Kingdom that specialised in working with children with gender identity issues, including gender dysphoria. The service closed on 28 March 2024 after serious concerns were repeatedly raised over a number of years by several independent NHS whistleblowers.

The Society of Analytical Psychology, known also as the SAP, incorporated in London, England, in 1945 is the oldest training organisation for Jungian analysts in the United Kingdom. Its first Honorary President in 1946 was Carl Jung. The society was established to professionalise and develop Analytical psychology in the UK by providing training to candidates, offering psychotherapy to the public through the C.G. Jung Clinic and conducting research. By the mid 1970s the society had established a child-focused service and training. The SAP is a member society of the International Association for Analytical Psychology and is regulated by the British Psychoanalytic Council.

<i>Bell v Tavistock</i> 2021 UK case regarding puberty blockers

Bell v Tavistock was a case before the Court of Appeal on the question of whether puberty blockers could be prescribed to under-16s with gender dysphoria. The Court of Appeal said that "it was for clinicians rather than the court to decide on competence" to consent to receive puberty blockers.

Irma Brenman Pick was a South African-born British psychologist and psychoanalyst known for her work on countertransference. She served as the president of the British Psychoanalytical Society from 1997 to 2000.

<i>Time to Think</i> (book) 2023 book by Hannah Barnes

Time to Think: The Inside Story of the Collapse of the Tavistock's Gender Service for Children is a 2023 nonfiction book by BBC Newsnight investigative journalist Hannah Barnes. The book is about the NHS Gender Identity Development Service (GIDS) based at the Tavistock and Portman NHS Foundation Trust. Barnes said, "I wanted to write a definitive record of what happened [at GIDS] because there needs to be one."

References

  1. ↑ Crichton-Miller, Hugh (1922). The New Psychology and the Parent. Jarrolds. Retrieved 16 November 2016.
  2. ↑ "Tavistock Centre". Lost Hospitals of London. Retrieved 2 May 2022.
  3. ↑ Huffington, Clare; Halton, William; Armstrong, David; Pooley, Jane (2019). Working Below the Surface: The Emotional Life of Contemporary Organizations. Abingdon: Routledge. p. 19. ISBN   978-0-429-92423-1.
  4. 1 2 "Portman Clinic". Cindex, Council for London Borough of Camden.
  5. ↑ Elliott, Anthony; Prager, Jeffrey (2016). The Routledge Handbook of Psychoanalysis in the Social Sciences and Humanities. Abingdon: Routledge. p. 237. ISBN   978-1-317-30820-1.
  6. ↑ Gossling, Glenn (March 2021). "Celebrating 100 Years of the Tavistock and Portman" (PDF). New Associations. British Psychoanalytic Council. p. 7. ISSN   2042-9096.
  7. ↑ Dicks, H. V. (1970). Fifty Years of the Tavistock Clinic (Psychology Revivals). London: Routledge. doi:10.4324/9781315743028. ISBN   978-1-315-74302-8.
  8. ↑ Bourke, Joanna. (1996). Dismembering the Male: Men's Bodies, Britain and the Great War, Reaktion Press and University of Chicago Press. ISBN   978 1861 89035 1
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  10. ↑ "History". Tavistock and Portman nhs trust. Retrieved 11 September 2016.
  11. 1 2 Jung, C.G. (1935). Tavistock Lectures, in The Symbolic Life. Collected Works, vol.18. London: Routledge. pp. 1–182. ISBN   0-7100-8291-6.
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  15. ↑ "About us | GIDS". gids.nhs.uk. Retrieved 5 December 2017.
  16. 1 2 Hayward, Eleanor (28 July 2022). "Tavistock gender clinic forced to shut over safety fears". The Times . Retrieved 29 July 2022.
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  22. ↑ "'Unprecedented' demand leaves thousands waiting two years for specialist service". Health Service Journal. 23 August 2019. Retrieved 1 October 2019.
  23. 1 2 Barnes, Hannah; Cohen, Deborah (19 June 2020). "NHS child gender clinic: Staff concerns 'shut down'". BBC Newsnight . BBC News. Retrieved 19 June 2020.
  24. ↑ Stavrou, Athena (12 March 2024). "NHS says children to no longer receive puberty blockers at gender identity clinics". The Independent . Retrieved 15 March 2024.
  25. ↑ "Children to no longer be prescribed puberty blockers, NHS England confirms". Sky News . 12 March 2024. Retrieved 15 March 2024.
  26. ↑ Boal, Daniel (12 March 2024). "Children will not be prescribed puberty blockers at gender identity clinics, NHS says". ITV News . Retrieved 15 March 2024.
  27. ↑ Rayner, Gordon (14 February 2023). "Tavistock clinic 'ignored' link between autism and transgender children". The Daily Telegraph . Archived from the original on 14 February 2023.
  28. ↑ Freeman, Hadley (11 February 2023). "How the Tavistock gender clinic ran out of control". The Times . Archived from the original on 11 February 2023.
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  59. ↑ Corrigan, E. 'J.D.Sutherland in Memoriam', http://www.tandfonline.com/doi/abs/10.1080/10481889209538932?journalCode=hpsd20&
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  63. ↑ Trotter, Wilfred. Instincts of the herd in peace and war 1916–1919, London, Keynes Press, 1985." Medical History 31(1): 113–4.Jordan, E. (1909). "Herd Instinct and its Bearing on the Psychology of Civilized Man". Psychological Bulletin. 6 (12): 420–421. doi:10.1037/h0066945.
  64. ↑ 'Preface: Pierre Maurice Turquet, MA, MRCS, LRCP, FRCPsych.', in W. Gordon Lawrence, ed., Exploring Individual and Organizational Boundaries: A Tavistock Open Systems Approach, Karnac Books, 1979 ISBN   1 85575 232 8
  65. ↑ Spensley, Sheila (17 December 1994). "Obituary: Frances Tustin" . The Independent . Archived from the original on 26 May 2022.
  66. ↑ Waddell, Margot. Inside Lives: Psychoanalysis and the Growth of the Personality, London: Karnac Books. 2002. ISBN   9781849403665
  67. ↑ Williams Paul (2009). "Obituary:Arthur Hyatt Williams" . The Independent. Archived from the original on 26 May 2022. Retrieved 11 September 2016.
  68. ↑ Crichton-Miller was actually born in Italy of Scottish parents and educated mainly in Edinburgh.
  69. ↑ Hugh Moreton's witness statement at the Witness Seminar (2009) about the History of Child and Adolescent Psychiatry 1960–1990 at Yorkhill Glasgow: Archived 4 July 2013 at the Wayback Machine p. 7. Retrieved 26 December 2016
  70. ↑ Mental Health Strategy for Scotland 2011– 2015 (PDF), The Scottish Institute of Human Relations, 2012 Retrieved 14 November 2016
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