We left our last Blog, with the whole concept of trying to understand why on earth a group of teams would have a chance to stop sabotaging their joint effort to work together and to, instead, productively concentrate on their joint Primary Task?
Nobody consciously would do this e.g. no-one in those teams would say, 'let's sabotage this plan to work together' and yet that is exactly what they did.
Well, this model's understanding of these processes goes back to the 1950s and this aspect of this model was first elucidated in the 1950s in the Cassel Hospital, Richmond-on Thames.
I won't here have time to give a biographically accurate history here but basically, Tom Main was a Psychiatrist/Psychotherapist associated with the Northfield Army Hospital for War Neuroses in World War 11, which was widely regarded as a progenitor of the UK Therapeutic Communities Movement which gained traction in the 1960s.
He became Medical Director of the Cassel Hospital in 1946 and in differing capacities, he was associated with the Cassel for the next 30 years. At some point in the 1950s he decided to the to export the lessons leaned at the Northfield Hospital to the Cassel which was of course, at that time, a traditional psychiatric asylum i.e. an hierarchical institution.
Here we might characterise the Institutional Model as being, a model which (implicitly of course) says that all individuals are potentially mad and dangerous to themselves and to society: When/if this madness erupts, they need to be locked away (in asylums)and can only be re-integrated into society when the institution pronounces that this aberration to have been quelled.
Inside the Psychiatric Hospital there was a strict hierarchical structure from top to bottom and with Main himself, of course, being very much a part of that system
Main proposed that this hierarchical structure be flattened - the patients if they are re re-join society cannot be cut off from it completely and then discharged, having in the meantime, had no outside contact at all.
So, he organised groups of nurses and doctors (although they were, in the event. the least interested) and who, having got together over months of meetings, initiated some changes in this rigid system.
The main (!) one which concerns us here, is that the system concerning patient leave from the hospital was changed: Hitherto this had been the absolute exception - weekend leave had implied that patients were 'fit' to mingle with society - how could this be so when they were patients? This had, in fact, been a contradiction in terms.
The Tom Main led nurse-working-groups, had decided that from now, on the default position was that patients would, after a sensible amount of in-patient life, be allowed and even encouraged, to have weekend leave. I am not sure how much resistance this policy met - a great deal I imagine - but it was instituted, became accepted policy and indeed, part of the culture.
Again, I am not sure of the details here but at some point Tom Main left that post and worked abroad (?) but in any event, some time later, he returned to the Cassel Hospital in perhaps a slightly different role.
So, as with the earlier example of the NHS Mental Health Teams, positive change, after much thought and conscious consultation, had been instituted and all seemed well but remember, in the NHS Teams this change had been unconsciously sabotaged and the old ways re-instituted.
So, if the Tom Main example above is our earliest exemplar - what happened there and from this, what lessons did he/we learn that become such an important part of this model?
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