Chapter Nine – Fraser House Transitionary
Processes
INTRODUCTION
This chapter
looks at Fraser House small group process and the many other change processes
evolved at Fraser House. Margaret Mead’s visit is discussed and Neville’s
adaptation of Keyline to Cultural Keyline is analysed.
SOCIAL
CATEGORY BASED SMALL GROUP THERAPY
Just like Big Group, Small Groups
were run like meetings. Typically, one staff person ran the Small Group and
another staff person was a process observer, on-sider and trainee. Small Groups
were mainly conducted by the nurses, with some groups being lead by medical
officers, the social worker, and the chaplain. The chaplain ran some spiritual
groups at Fraser House. The Fraser House Handbook specifies the nurse therapist
role in Small Groups (refer Appendices 7 & 8):
The role
of the Small Group therapist and observer has always been the province of the
nurse in Fraser House, and represents part of the rise in therapeutic status.
Nurses have become therapists in their own right.
The first
essential in taking a group is to see it as a meeting, and like all meetings,
there is a need for a chairman to conduct affairs and keep issues to the point.
The
initial function of the therapist is to see that the group functions as a group
(Yeomans,
N. 1965a, Vol. 4, p. 18).
The Handbook then gives detailed
specifying of group process. Sections of the Handbook on the Nurses Roles and
Big Group process are shown in Appendices 7 and 8.
Small groups were held from 11 AM
to 12 Noon after a half hour refreshment break following big group. They were
preceded by the staff discussion over morning tea. After evening Big Group and
a similar thirty-minute staff discussion period, Small Groups were run from 8
PM to 9 PM. During the staff discussion, patients and visitors had an informal
morning tea together separate from the staff. All groups and the refreshment
break ran strictly to time. Another staff discussion meeting took place after
Small Groups to ensure all staff was well briefed on unfolding contexts.
In an April 2003 email Phil Chilmaid wrote:
There were several ways to follow
up progress and issues: inter-staff verbal exchange at shift change, ward
report books, patients’ progress notes, and at various times, small group
report books, and a large sheet of butchers paper ruled up with boxes for all
the weeks programs and events so staff could come in after a gap or next shift
and follow themes and developments.
Generally,
nearly all the outpatients (typically, friends, workmates and relatives of
patients) attending Big Group stayed and were allocated to the various Small
Groups in both the morning and evening sessions. It was expected that
outpatients attend both Big and Small Groups. There were ten or more concurrent
Small Groups typically made up of between 8 to 12 people, or more per group.
Drawing 1 A Sketch of a Fraser House Small Group by Harry
Campbell
The above illustration by "Sun" artist
Harry Campbell of patients at Fraser House was published in The Sun Newspaper,
17 July 1963, p.28 [Also included in Neville’s News clippings (Various
Newspaper Journalists 1959-1974, p. 33-34)].
Recall that upon Tikopia there was constant linking
within and between people of differing generations, gender, clan, village,
locality, status (chief/non-chief families) and occupation, that is, between
differing sociological categories. Similarly, Neville cleaved Fraser House
family-friendship networks and inter-patient factions by sociological category.
Neville’s aim was to create self-organizing communal
living, which may impact upon and create shifts away from isolation and
destructive cleavage, or make functional cleavage in entangled pathological
networks.
In
supporting mad and bad people with their dysfunctional family-friendship
networks live well with each other, Neville’s view was that one of the primary
healing processes that was both structured into and continually and pervasively
at work within Fraser House, was the day-to-day lived-life dynamic healing
interplay of social cleaving and unifying processes – the same processes that
have been discussed in talking about Tikopia. Neville would set up scope for
micro-experiences creating very strong forces cleaving pathological
entanglements, as well as forces forging functional bonds within and between
people. Typically, patients arrived with a very small family-friendship
network.
Both the sociological category and the composition of
small groups varied daily. All the small groups at any one time were based on
the same category.
The social categories were:
(i)
age
(ii)
married/single status
(iii)
locality
(iv)
kinship
(v)
social order (manual, clerical, or
semi-professional/professional) and
(vi)
age and sex.
Friday’s
Small Groups were made up according to both age and sex for both staff and
patients. This was the one exception to the non-segregation policy. Often
inter-generational issues, including sexual abuse issues, were the focus of
these Friday groups.
People in pathological social networks would be all
together with everyone else in Big Group. However, because of the
continual changing composition in small groups, the members of these
pathological networks were regularly split up (cleavered) for the small group
sessions. Age grading was deemed very important, as it is one of the basic
divisions in society. Neville told me (July 1998) that the thinking was that
age grading sets a context for the production of personality changes to prepare
the client for life outside Fraser House. Age grading also allowed space for
sorting out inter-generation pathology that was very prevalent. For example,
Appendix 13 contains a note that at one time the Canteen was staffed only by
people under twenty years of age. This would have created scope for sustained
inter-generational relating with suppliers and customers.
Because of the number of
categories, any visitor coming regularly on certain days of the week would find
that they would be attending groups based on differing categories. For the
small groups based on locality,
After a time at Fraser House these
individual patient family/friendship networks would expand to have members with
cross-links to other patient’s networks, and with a continual changing Unit
population with overlap in stays, these nested patient-networks became very
extensive. As well, all these people had Fraser House experience in common, and
a common set of mutual support skills. The critical role of locality and
Neville’s use of locality in this increase in the size and functionality of
patient’s social networks is entirely resonant with Indigenous links to place,
and the significance of place and placeform in Keyline.
CHILD-PARENT PLAYGROUPS
Webb and Bruen (1968) wrote up
research relating to the first 13 weeks of Multiple Child-Parent Therapy in
Fraser House – called by some, ‘the mad hour’. Median attendance was 15 parents
and sixteen children (aged 14 and under). This therapy was held in the same
room as Big Group. All chairs were removed and ‘free play’ items were provided
- including saucepans, games, balls, clothes as well as chalk and a blackboard.
Attendance for parents and their children under 14 was compulsory and doors
were looked to prevent people leaving; although parents with unproblematic
relations with young infants were not required to bring them. Outpatients
visiting Fraser House with children under 14 also attended the parent-child
groups. As with other groups at Fraser House, there was a spread of diagnostic
categories[1]
among the people attending, as well as a spread of under-actives/over-actives
and the under-controlled/over-controlled (Bruen Dec, 2005).
The first half hour was a free period. Parents asked
what they were supposed to do. The only instruction was ‘parents are free to
play with or discipline their children as they see fit’. Staff were told that
during the free period they were to observe but not intervene unless physical
damage seemed imminent. Staff could move around and talk to parents or play
with children; however, staff were not to organize anything.
In the first few weeks these groups were extremely
noisy, rowdy and stressful for parents, staff and children alike, especially
the free period where staff were almost as overwhelmed as the parents.
The second half hour was usually structured with
finger painting or routine group therapy. The third half hour was a reporting
session. After that session the attendees were divided into three groups run by
staff - parents (one hour session), children 8-14 (one hour session) and
younger children (half hour session). The half hour with the younger children
was described as ‘utter chaos’. There was then a final reporting session for
staff for a half hour.
Initially, nearly all parents expressed considerable
hostility towards the group and towards the staff who set up the group. During
subsequent groups, parents grudging acknowledged that children enjoyed it. In
an email exchange Bruen stated (December 2005) that:
Even
having parents become hostile towards us succeeded in bringing them closer to
their children.
The free period was originally an arena for staff to
watch interactions that emerged. Initially parents were unable and unwilling to
go near or engage with their children – they were emotional strangers. ‘Getting
together’ as a family was a rare event in these people’s lives.
For six weeks the group was a provoking agent. After
six weeks parents grudgingly admitted that the children enjoyed the sessions
(Webb & Bruen, 1968, p. 52). After 9 weeks, successful whole family
discussions were starting. Parents began playing with each other and play was
being organised by parents with and between whole family groups. Whole families
began to get together and enjoy each other’s company. A major therapeutic role
of the groups was having parents showing pleasure and amazement in having for
the first time their children approaching them to play with them, and if
parents did this, that it would not have disastrous consequences.
During the thirteen weeks covered in the Web-Bruen
research, the attendees were also attending Big and Small Groups, and
discussion about the Child-Parent Groups was often raised in both of those
forums.
Terry O’Neill used to facilitate
this upstairs child-play segment as a volunteer psychologist after Warrick
Bruen left. (I received my counselling skills training from Terry in the late
Seventies.) Terry told me (Oct 1998) that on his first evening alone with the
children (8-14), so much emotional energy had been generated during the first
segment, ‘playing’ with their parents, that the nature of the frenzied play
upstairs was scary. Some of the older children were kicking a soccer ball round
like a deadly missile. Everyone had to be super alert not to get his or her
head knocked off. Terry said (Oct 1998) that having a number of disturbed
children in play therapy in these evening sessions stretched his skills to their
limit.
The substantial change towards good parent-child
relations during free play in these child-parent groups is another example of
‘provoking’ or ‘perturbing’ the families and tapping into functional self-organizing
aspects in the context of all of the other Fraser House changework.
INDIVIDUAL THERAPY
When deemed appropriate,
face-to-face therapy between two patients, a patient and a nurse, or a patient
and a doctor was held. Even in this individual therapy, the central focus was
inter-patient relationships. Encouragement was continually given to ‘bring it
up in the group’.
While it was recognized that
during some crisis times a patient may need support by a doctor or nurse, most
face-to-face therapy was informally between patient and patient as they went
about everyday life, with the wider community always a background.
RESEARCH AS THERAPY
Neville
commenced his postgraduate diploma in sociology shortly after Fraser House
started and completed it in 1963. Neville spoke (July 1998) of Fraser House
being an informal Post Graduate Research Institute, and of the Unit being the
most advanced Social Research Institute in Australia.
Neville had pointed out to me that Franz Alexander
had observed the potential for healing of the caring relationship between
Freudian analysts and patients (Alexander
1961).
Similarly, Elton Mayo (Trahair
1984)
had found in the Hawthorne experiments amongst workers in the early part of
this century, that the change component was not so much the various
‘treatments’ of the research - rather that it was that the researchers were
acknowledging the workers’ dignity and worth and showing an interest in them.
Change was linked to the emotional experience of being research subjects.
Similarly to Mayo’s work, Fraser House patients and staff were the focus of
continual research by Fraser House researchers and the outside research team headed
up by Alfred Clark. Patients were being continually asked to reflect on
themselves, other patients, other staff, Big Groups, Small Groups and on every
aspect of Fraser House and aspects of wider society. Through all of the
research, patients learned about the difference between quantitative and
qualitative research as well as about the notions ‘validity’, ‘reliability
testing’ and ‘trustworthiness’, and how these are very useful notions as part
of living in a modern community, especially one with extensive pathology.
Patients also became involved in both qualitative and quantitative research
data gathering as well as discussing the results and implications of the
research.
During 1963-1966, research by nurses in Fraser House
was supervised by Neville (Yeomans,
N. 1965a, Vol. 12, p. 69). Neville
gave preliminary training to nurses in research methods and also trained the
social worker in research methods. At one time Neville arranged a Fraser House
Research workshop with 25 associated projects (Yeomans,
N. 1965a, Vol. 12, p. 86-99). As an
example, Fraser House residents were involved in rating patient participation
and improvement (refer Appendix 16). In answering, patients were not only being
encouraged to notice healing micro-experiences (experience of little bits of
behaviour that may contribute to healing), they were receiving the strong
positive emotional experience that what they thought and felt about things
mattered and was of value. Having come from conflicted family environments
where contradictory communication (Laing and
Esterson 1964) was the norm, doing reality
testing and checking the practical usefulness, validity and relevance of their
observations was valuable. Patients and outpatients would start discussing a
very diverse range of topics and in the processes evolve their capacities in
forming, expressing and evaluating opinions and making insightful and useful
observations about human interaction.
VALUES RESEARCH
Another example of treating
patients with respect, dignity and worth was asking them to explore and give
answers to questions about their value systems. Neville carried out extensive
values research (1965a) based on
the concepts of Florence Kluckhohn (1953, p.
342-357).
A list of the questions that were asked in Neville’s Values Research is in
Appendix 17. This Fraser House values research was followed up by
questionnaires being completed by over 2,000 people in Sydney, Melbourne and
Brisbane - the three largest cities in
In Neville’s view (Dec 1993), substantially shifting
core values amounts to shifting culture. Neville also stated that at the time,
this values research was, in all probability, the most extensive research on
values that had been done anywhere (Clark and
Yeomans 1969, p. 20-26).
Appendix 18 and 19 lists inventories developed and
used at Fraser House (Yeomans,
N. 1965a, Vol. 4, p. 43, Vol. 11). These
inventories enabled the putting together of a holistic psycho-social emotional
mindbody portrait of each patient and outpatient’s whole life, covering
presenting matters, recent past, post-school period, childhood, as well as work
history and recreational activity. This is consistent with the holistic
socio-emotional focus of change at Fraser House. Reflecting these stories back
to patients engaged in reconstituting their unfolding story had functional
value.
Despite being extremely busy with
every aspect of Fraser House and its links into the community, Neville was very
active in research and writing up papers. He was an active presenter at
conferences and other professional meetings. Appendix 20 contains three Tables
(A, B, and C) listing fifty seven of the extensive body of Neville’s research
papers and monographs mentioned in his collected papers in the Mitchell
Library. Many are undated though come from the 1959-1965 period.
Group and crowd behaviour during big groups was a
constant research theme. For example, in a filenote called ‘Colindivism’ (1965a) Neville
describes the interactive nature of collective and individual behaviour in
Fraser House.
Patients knew that all manner of
data was being collected about them relating to demographic and socio-economic
data, length of stay, participation by their friends and relatives and the
like. Research outcomes were discussed with patients.
Within
a connexity based Cultural Keyline frame it made absolute sense to connect
patients to the interconnection and inter-dependence of aspects of society at
large. Psychiatric patients and ex-prisoners were asked their attitudes towards
overseas trade with SE Asia, or about landscape planning and urban renewal in
Neville
told me (Dec 1993, July 1998) that a process he used to protect Fraser House
was that a number of research workers from
Bruen told me (Aug, 1999) that
Margaret Cockett made sociograms of networks within Fraser House using the
concepts of ‘power’, ‘opinion leaders’, ‘leaders’ and ‘influence’. The conducting
of this research was later confirmed by Margaret Cockett (April 1999).
Regrettably, this research was among the materials discarded by
Sociogram based research in Fraser
House recognised that P.A.’s three primary landforms (main ridge, primary ridge
and primary valley) embody horizontal unity in the context of vertical cleavage
though no reference to Keyline is made. Neville and other researchers at Fraser
House used the above notions of horizontal unity in the face of
vertical cleavage in doing sociogram research into the friendship patterns
among staff and patients in Fraser house (Clark and
Yeomans 1969, p. 131). A
‘glimpse’ of Neville’s use of Tikopia’s cleavered unities is in Clark and
Yeomans’ book, ‘Fraser House’ under the subheading ‘Cleavages’ relating to the
sociogram research (Clark and
Yeomans 1969, p. 131). Not
surprising, this sociogram based research showed that Neville was only staff
member:
with a
link, by means of a mutual tie, into the genotypical informal social
structure…. (Clark and
Yeomans 1969, p. 131).
Sociogram 1 Sociogram Showing the Friend Network in
Fraser House.
This finding is fully in keeping
with Neville’s notion of devolving responsibility and reversing the status quo.
It was also in keeping with Neville’s hands-off though being profoundly and
sensitively linked that he was enabler on the edge of the informal social
structure.
Apart from research as therapy,
Fraser House research served at least two other functions. Firstly, the results
were fed back in to modify the structure, process and action research in the
Unit. For example, the critical and destructive role of extremely dysfunctional
families and friends in holding back patient improvement became clearer to
staff and patients alike from both experience and research over the first three
years. Greater efforts were then made to involve these networks. Secondly, the
research was used to protect the Unit and ensure its survival, at least for a
time.
PSYCHIATRIC RESEARCH STUDY GROUP
Neville
set up the Psychiatric Research Study Group on the grounds of the