The Psychological therapies team offers individual and group psychotherapies of varying modalities as well as systemic family therapy and psychodrama. Achievements include the development of the Therapeutic Eating Charter, co-written as between staff and patients.
What We Did
The Psychological therapies team (Psychology and Psychotherapy, known as ‘P&P’ for short) offers individual and group psychotherapies of varying modalities as well as systemic family therapy and psychodrama. However, this application is not concerned with that general work that is expected of us, although we believe we can evidence that this is carried out innovatively and to a high standard. Where we want to describe making a difference for present purposes is in the domain of collaborative working with patients and the transformation of the therapeutic milieu that we have led and mobilised and developed over the last four years. We have done this by establishing a countercultural ‘practice of equality’ in working alongside and engaging with very stricken and distressed and in some particular ways disabled sufferers in order to restore or for the first time develop experiences of self-esteem and affirmation and validation consequent upon feeling listened to and taken seriously in ways that not merely pay lip-service to the ethos and discourses of ‘co-production’ and ‘service user involvement’ but genuinely engage in an adult to adult way with their functional inner selves.
Examples of both process and production that we wish to present are: - developing the practices associated with the daily community meetings, in which P&P staff take the lead within the staff team
– the development of the Therapeutic Eating Charter, co-written as between staff and patients, a process led by P&P staff - co-authoring research and conference presentations on an equal footing as between experts by experience and experts by training and involving experts by experience on this equal footing in research meetings and in developing research ideas and research design (if this process allows, we would like opportunity to submit pdf attachments in evidence)
– mobilising and providing outlets for tapping into a deep wellspring of creativity among sufferers who are often denigrated and dismissed for their seeming destructiveness in other areas of their lives and practices (particularly as to practices around food and eating)
Wider Active Support
– We are closely linked to the Eating Disorders Research Committee of St George’s University of London, chaired by Professor John Morgan and via this committee, with researchers and clinicians across the field - via the Association for Psychosocial Studies, of which I am a founder member, we disseminate findings across a wide range of interdisciplinary fora and make links with like-minded colleagues across many different fields, for example, in critique of the discourse of ‘co-production’
– we have particularly strong links with the Essex Autonomy Project led by Professor Wayne Martin, University of Essex. EAP staff have attended community meetings, ward rounds and academic meetings on the ward and patients have contributed to the design of research proposals generated by the EAP
– in this context our main partners are of course the patients and ex-patients of the ward and our colleagues in eating disorder services both on and off the ward, with whom we work closely in taking forward projects and disseminating findings
This initiative within Avalon Ward goes beyond – and indeed critiques – discourses of service user involvement and co-production that have been ‘colonised’ by mainstream psychiatry. There is widespread resistance within the system of care to asking the sufferers about their experience – they are felt to be ‘not well enough’ to answer clearly. We have as a field, started to ask ex-sufferers what their experience WAS like… but this project has begun from the principle that staff and patients are equal in their humanity and intellect and that a conversation on equal terms can usefully and creatively and productively be had. This is not to suppose there is no power differential or to gloss over existing hierarchies – but it is to have a level playing field for the simple encounter. Our initiatives have not directly involved carers in such things as the therapeutic eating charter or conference presentations but the ethos does spill over into the clinical domain, as for example in our soliciting of carer reports which are filed alongside staff comments on such matters as how a period of home leave has gone or what structures need to be in place for discharge planning. Staff feedback has been intrinsic to the processes in question via the community meetings and the discussions they generate. The P+P team also survey staff attitudes, eg to data collection and the therapeutic eating charter was developed using focus groups in which nursing staff in particular could respond to patient comments on drafts of the Charter.
Looking Back/ Challenges Faced
We have been taken aback by the strength of feelings sometimes stirred in opposition to the simple idea of asking the sufferers for their views in the way that we have practised and promoted. In retrospect we would have begun our auditing and surveying of staff attitudes earlier in the sequence.
Certain kinds of collaborative and collective work-sharing depend on different time frames coming uneasily together. ‘Let’s make a time to meet’ is a complicated suggestion when experts by training are working to one time frame and experts by experience to another. We have had to negotiate and be very flexible and appreciative of the difference in the experiences in question. Co-writing is a complex process at the best of times and we have had to improvise arrangements as to eg confidentiality of contributors. The sufferers themselves are very much unused to being taken seriously in this kind of way and it has often taken a while for them to develop confidence that their contributions are being treated as of genuinely equal merit.
Via the community meetings, the evidence of joint work across the ward environment (pictures on walls, noticeboard displays, patient information booklets co-authored by experts by experience), via the ethos and practice of the SGUL ED research committee and the dissemination of publications across the field and via the culture carriers in the patient population
We have conducted various audits and evaluations of our own interventions with the help of our sequence of assistant psychologists and one of our conference presentations consisted of a group of staff and patients reflecting on their experience of the process of working together to produce the previous conference presentation and the published paper that came out of it
We publish widely in the field, present at conferences alongside experts by experience, promote our initiative widely within our Trust and the results of our efforts are displayed throughout the ward environment
Is there any other information you would like to add ?
Here follows a list of ‘productions’ of various kinds that have emerged out of this initiative to date:
Publications, co-productions and other outputs arising out of collaborative work on Avalon Ward 2012-2016
- “Keywork Resource File -“written by patients for patients” (2015) – document generated by the patients
- Food for Thought – “A Glimpse into the World of Eating Disorders: An Avalon Patient Guide for Those who work with them’ (2015) – document generated by the patients
- Principles of Therapeutic Eating – (2015) “renegotiation of ward boundaries’ around food provision, co-created by patients and staff, process facilitated by Caroline Plumb and John Adlam
- The Avalon Ward Charter for Therapeutic Eating – (2014) – co-created by patients and staff, process facilitated by Caroline Plumb and John Adlam
- A Rough Guide to Avalon Ward – (2012) – generated by a working party of current staff and former service users, chaired by John Adlam with expert-by- experience consultation from Kati Turner, Survivor Researcher
Journal special issues
Adlam, J. & Turner, K. (Eds) (forthcoming) Special Issue of Journal of Psycho-social Studies: ‘Offering food’ ‘refusing food’
Adlam, J. (2015) ‘Refusal and coercion in the treatment of severe Anorexia Nervosa: the Antigone paradigm’, Psychodynamic Practice, 21 (1), 19-35. http://dx.doi.org/ 10.1080/14753634.2014.989714. Adlam, J. (2014) ‘Meeting together; eating together’, Journal of Psychosocial Studies, 8 (1).