Hospitality, not hospital

Commitment goes hand in hand with professionalism, but for some
observers the level of commitment shown by staff at the Arbours
Crisis Centre in north London might seem somewhat daunting. Here,
three therapists share their home with up to six people who might
otherwise be on a psychiatric ward.

The resident therapists invite individuals, many of whom have a
borderline personality disorder, to stay as house guests for a few
weeks, months or even longer. Throughout their stay they are
referred to as guests rather than patients or clients. This is to
promote the idea of hospitality and move away from the notion of
treatment.

During their stay, guests receive intensive therapy. Unusually,
individual psychotherapy is carried out with a team of
professionals, with two or three therapists working with one
guest.

Three times a week guests meet their team, consisting of a team
leader, who is a psychotherapist or psychoanalyst based outside the
house, a resident therapist and perhaps a trainee.

As well as their individual therapy, the guests take part in group
therapy. This includes house meetings three times a week when the
resident therapists and guests discuss progress and take part in
art and movement groups.

The resident therapists play an integral role in the life of the
therapeutic community. They provide consistency and can offer a
bridge between the day-to-day goings-on in the house and the more
formal therapy sessions. However, being a resident therapist places
an enormous strain on the professional and consequently the post
can be held for only three years.

Lizzi Payne was a resident therapist for three years during the
1990s and is now a team leader. A nurse by training, Payne says she
was bored of being a community psychiatric nurse and wanted to live
in the “hothouse” of a therapeutic community. But whereas nurses
have a clear-cut role, this is not the case for resident
therapists.

“One of the challenges of being a resident therapist is how to
manage the ambiguity of living with people, cooking, shopping,
watching television and playing games and then being in a more
professional role in terms of therapy sessions.”

Being a resident therapist obviously has an impact on family and
social life, but partners are allowed to stay at the centre and in
fact the first resident therapists were a married couple.

“We want to normalise ordinary healthy relationships including
sexual relationships so it’s important for them to see that,” says
Payne.

Due to the intensity of the environment, resident therapists are
required to have their own psychoanalytic psychotherapy three times
a week outside the house.

Payne likens being a resident therapist to being in a
laboratory.

“You learn so much about yourself, your reactions and responses,
and you get lots of supervision and personal therapy. It’s a unique
opportunity to learn professionally and personally,” she
says.

It is not just hard work for the therapists. It can also be
difficult for the guests, says team leader Tamar Schonfield.

“You may think they are pampered, are fed and have their house
cleaned but it is actually hard work. In a relatively short period
they have to take a risk and look at the parts of themselves that
they have worked damned hard not to know about,” she
explains.

Often the centre is viewed as a last resort for people who have
been in the mental health system for years.

“A lot of time has been wasted,” she adds. “People have learned the
role of being a mental patient so we have to help them believe
there is more to life and more to them than being a mental
patient.”

It can be difficult to get funding. Generally, guests are funded by
social services or health or a combination of both, but sometimes
they pay privately. They have to be assessed in order to qualify
for a bed, but lack of funding often means that even those deemed
suitable have to be turned away.

Some people self-refer but most referrals come from professionals
within health and social care. Yet there remains a strong degree of
scepticism among some medical personnel who view mental illness
predominantly as a chemical malfunction. Schonfield, however,
believes this does not reflect the true picture.

“People come with a life story. That can’t be answered with
medication,” she says. “If you can begin to make sense of a
terrifying and bizarre emotional experience, then you can begin to
live with it.”

There is no denying that the crisis centre is different from
conventional therapeutic settings, and it is likely to provoke some
degree of scepticism for a long time to come.

But for those not helped by more traditional forms of treatment,
surely anything is worth a try.

Therapists’ pay and conditions

Resident therapists in their first year receive £316 a
week, plus their food, accommodation, and telephone bills are paid.
Their psychotherapy training fees are covered and they can take six
weeks’ paid annual leave, although not over Christmas or Easter.
They get an extra £10 a week in their second and third years.
www.arbourscentre.org.uk/index.htm

How do guests rate the centre?

Staying at the centre comes at a price – £1,750 a week for
guests funded by health authorities or social services and
£1,850 for private funders. So what do the guests think? 

“You’ve always got somebody you can go to and say ‘can I talk
about a problem’ or ‘I can’t sleep – can I sit and talk to someone’
or ‘I feel like self-harming but can I talk instead and then I
won’t do it’,” says Dawn Mallott, who has been a guest at the
centre since June last year. 

Mallott had been in hospital eight times over five years before
moving to Arbours and wanted to talk about her problems in more
depth. 

“The back-up support basically didn’t work. If I was suicidal in
the community there were no outreach services available other than
the local hospital. My social worker said I was making no progress
and I agreed. I wanted to come off all my medication and talk about
the issues in a safe environment where I was being contained,” she
says. 

At home she was “drugged up to the hilt” and slept all day, but
after being in the centre for three months she came off her
medication. 

Before moving into the centre, Mallott’s funding fell through
three times. Most of her fees are paid by the NHS and social
services, but she has to use her benefits to make up the shortfall,
leaving her little to live on. But she insists it is “worth every
penny twice over”. 

This is Kitt Murphy’s second stay at the centre. She says
although it is strange living with your therapists, it can help to
have someone around who can think more clearly. 

The therapists pick up on things, she says, like the fact that
she often goes out in the night to the 24-hour shop. “They can say
‘why are you going out at this time of the morning? Is it because
you fancy chocolate, or is it because there’s something going on
and you don’t want to be in the house?’ You get to think about why
you are doing things,” she says.