How to Coach Yourself and Others Coaching and Counseling in Difficult Circumstances | Page 57

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his own residential treatment centre in Kingsley Hall, in the East End of London. Laing’s writings drew upon
these philosophical sources coupled with many ideas from psychoanalytic psychotherapy, in particular those of
defence mechanisms in order to explicate the experience of psychotic breakdown (Laing 1965). While such
accounts might, if true, help us to understand what a person suffering a psychotic breakdown experiences, they
do not lead to clear recommendations on how to communicate or treat them, other than conveying that
understanding. The main account of treatment at Kingsley Hall supports the idea that communicating such
understandings was the treatment, in addition to allowing and facilitating the psychotic process to take its
course. Laing’s stance never received wide acceptance in psychiatry, let alone by psychiatric nurses, although it
does have some supporters. The concepts and the language in which these ideas are conveyed are not easy to
understand, nor do they have ready, easy or certain applicability to dealing with the acutely psychotic person.
However the idea of being with the psychotic person and trying to grasp or understand their experience was well
received by psychiatric nurses, although difficult to put into operation and not well described in the psychiatric
nursing literature.
One of Laing’s co-workers, Berke, went on to found the Arbours Centre, a charitable institution which still
offers treatment in this form today. Treatment at the centre has been described in a number of papers and books,
and consists of tolerating the extreme emotions of the patient in an accepting manner, being with them, and
expressing understanding of them in psychoanalytic terms (Berke 1987). Some elements of therapeutic
community practice are also present, with regular community meetings being held. Therapy is seen in terms of a
working through of psychic pain, and the therapists live and eat together with the ‘patients’. The Arbours Centre
does offer that rare thing, a fully explicated model of how to interact with acutely psychotic people. However it
is not one that can readily be followed in an acute psychiatric ward where the backbone of treatment is through
medication, stays are short and often compulsory, nurses and their superiors are not in psychoanalytic therapy,
and the psychotic experience is not viewed as one of personal growth and development but rather something
that prevents and disables such growth. In addition, the Arbours literature does not seem to explain how they
deal with violent incidents, inter-patient bullying, serious self harm and other disturbed behaviours that tax the
abilities of psychiatric nurses. However the kindness, respect, warmth and egalitarianism shown by Arbours
staff to their residents are very clearly transferable. While there does not exist a clear historical link to
psychiatric nursing practice, these human values are very much a part of psychiatric nursing as they are of the
Arbours approach.
In the US, dually inspired by phenomenological philosophy and by contact with Laing and Kingsley Hall,
Mosher created Soteria method. This was remarkably similar to the Arbours centre, but without the
psychoanalytic orientation (Mosher 1999). Thus the focus is on being with the ill person and building a nonintrusive empathic relationship, without the use of neuroleptic drugs. However there was still a longer term
attempt to develop a meaningful understanding of the psychotic experience based upon the person’s
interpersonal circumstances and history. Soteria House itself only operated for a few years, although it has more
recently been replicated in Berne, Switzerland, and does have some evidence for its efficacy (Calton et al.
2008). The model cannot really be claimed to have influenced psychiatric nursing practice in the UK, and is not
completely distinct from that of B