History

Our origins: the ‘new psychology’ and forensic psychotherapy

After the First World War the ‘New Psychology’ emerged as an alternative to traditional asylum psychiatry. Dr Hugh Crichton-Miller founded the Tavistock Clinic in 1920, applying what he had learned treating shell shock victims during the Great War to provide treatment to civilians with nervous disorders. Though influenced by Freud and Jung, he also used his own medical experience and his faith to guide his approach.

The Portman Clinic was founded in 1931. It offered clinical services for people who suffered from problems arising from delinquent, criminal, or violent behavior, or from damaging sexual behavior or experiences. The Clinic also offered training and consultation for professionals working in forensic mental health. The clinic attracted distinguished figures of the day – its early honorary vice-presidents included Sigmund Freud, Carl Jung, Havelock Ellis and HG Wells.

Driven by a strong commitment to the public health goals of the NHS, and by the ambition to influence mental health practice across Britain, the Tavistock Clinic became part of the NHS in 1948. The Portman and Tavistock Clinics joined forces in 1994 to become the Tavistock and Portman NHS Trust.

‘Learning from experience’ – understanding groups and organisations

Among the most influential figures in the history of the Tavistock Clinic was Dr Wilfred Bion. With fellow army psychiatrist and psychoanalyst Dr John Rickman, Bion pioneered a therapeutic community for soldiers, and a method of group selection of officers which became the War Office Selection Board. Taken up by Tavistock colleagues and others, these innovations led to experiential methods of learning and leadership that changed the way the Clinic was organised. It adopted a democratic model in which all senior posts, were elected by staff. This continued until it became an NHS Trust in 1994. Multidisciplinary teams – including psychiatrists, clinical and educational psychologists, social workers, and child psychotherapists – shared clinical responsibility rather than deferring to psychiatrists. In postgraduate training, learning became mainly an exploration in face-to-face discussion of clinical or theoretical material presented to the seminar.

Infant observation and child psychotherapy

Another leading figure, Dr John Bowlby, established the first British training in child psychotherapy, led by Esther Bick it included a novel naturalistic infant observation method which is now an essential part of child psychotherapy and most adult psychoanalytical psychotherapy trainings. The Trust has grown to become the largest trainer of child psychotherapists in the UK, taking a leading role in addressing the national shortage of trained professionals through collaborations across the UK. The highly successful psychoanalytic observational courses originally established by Martha Harris continue to attract students from all over the world, and have been replicated in centres internationally.

Family systems therapy

In 1949 Bowlby started doing family therapy, a method almost unheard of anywhere else. In the 1970s he went on to support the training set up by Dr John Byng Hall and Rosemary Whiffen. Embracing ideas of Gregory Bateson, Salvador Minuchin, Mara Selvini Palazzoli and others, systemic therapy at the Tavistock has become internationally respected, both for its training and as a source of writing and research. Our family therapy qualifying course, the first in the UK, has run annually since 1975.

Interweaving clinical, research and education and training functions

The delivery of training alongside clinical work became much more explicit from the mid-1980s. This led to the academic accreditation for our training courses with a range of academic partners, starting with Brunel, then the University of East London, Middlesex and Essex universities, the latter now our main academic partner.

Integrating our research, consultancy and training structures has led to the development of a number of professorships, some major research projects (including two major randomised control trials – the Tavistock Adult Depression Study and IMPACT, Improving Mood with Psychoanalytic and Cognitive Therapies) and to a large doctoral programme.

‘A secure base from which to explore’ – attachment theory

Combining psychoanalysis and ethology, Bowlby’s life’s work was the formulation of attachment theory, which describes a basic mammalian drive for security and protection, distinct from the needs for food and sex. His studies, published over five decades from the 1930s to the 1980s, are regarded as amongst the most important work in developmental psychology and have led to an enormous volume of research on attachment and loss throughout the lifecycle.

Changing hospital and medical practice

• In 1952 the social worker (and later psychoanalyst) James Robertson made a short film, A two-year-old goes to hospital, to demonstrate a child’s grief at being separated from her parents. Robertson’s report was a key influence on the 1959 Platt committee on the Welfare of Children in Hospital, promoting unrestricted visiting for parents of all children in British hospitals.
  
• Starting in the 1950s, Dr Michael Balint set up GP groups to show doctors how to notice their emotional interactions with patients, which improved their practice and changed the training of subsequent generations. Balint groups are still used in many medical and psychiatric trainings.
  
• Until the publications of Drs Stanford Bourne and Emanuel Lewis, the management of stillbirth and neonatal death was “a wellmeaning conspiracy of silence”. Their papers in leading medical journals between 1968 and 1991 helped to change midwifery practice, allowing parents to name and hold their dead child and to grieve at a proper funeral.
  
• The Adolescent Department, a unit dedicated to psychotherapy for adolescents, was opened in 1959 followed soon afterwards by the Young People’s Counselling service, based on the principle of self-referral for brief therapeutic consultations. The adolescent and young adult service at the Tavistock Centre is one of very few NHS clinics that specialises in helping young people between the ages of 14 and 25.
  
• More recently many specialist services have developed. Notable examples include the Trauma Service, the Fostering/Kinship Care/ Adoption Service, the Fitzjohn’s Unit, the Family Drug and Alcohol Court, the Family Nurse Partnership, Gloucester House (our primary school), the Gender Identity Development Service, and Thrive, a collaboration with the Anna Freud Centre to produce a new design for community child and adolescent mental health services.
  
• The Trust has also shown a longstanding commitment to make psychological ‘talking’ treatments available to previously exempt patient populations. This includes those with learning disabilities and autism (the Lifespan service) and hard to reach groups, such as those reached by our primary care based services in City & Hackney and Camden, or our Community Thinking Spaces in Haringey and Tottenham.
  

Here at the Trust we pride itself on a sustained history of innovation. We seek to link current and contemporary approaches to complex, pressing issues through our training pathways. A close relationship with Health Education England ensures that our training remains relevant and current, and that our expertise informs wider training for mental and physical health professionals.

Ongoing research in adult psychoanalytical psychotherapy

In the 1970s Dr David Malan led research into the process of brief psychotherapy with adults using video recorders. His 1976 book Individual Psychotherapy and the Science of Psychodynamics has been a global best-seller.

More recently, the Tavistock Adult Depression Study (TADS) was the first randomized controlled trial in the NHS to establish if long term psychoanalytic psychotherapy provides relief for patients suffering from chronic depression not helped by other treatments. Published in 2015, the research showed a marked and more lasting improvement for those receiving psychoanalytic psychotherapy, demonstrating the benefits of addressing the personal and psychological issues that underlie chronic depression.

Forever building a legacy

Over almost 100 years Tavistock and Portman staff and trainees have produced an enormous volume of published scholarship and research. The ‘house publisher’, Karnac Books, publishes the Tavistock Clinic Series, now numbering around 50 volumes. Our newly established Tavistock and Portman Alumni Society also helps graduates and alumni to promote their work.

Changing the way people think about mental health

The Trust treats people across their lifespan, and has expanded the understanding of mental health with its developmental approach. This has led to work with an ever-increasing range of professional groups. Health visitors, social workers, teachers, nursery workers, student counsellors, youth workers, community mental health teams, probation officers, creative therapists and many others have undertaken training courses at the Trust.

As well as our longer courses, our continuing professional development courses and conferences and events are highly multi-disciplinary and often aimed at a wide range of professionals and volunteers working in a variety of settings. These trainings support the view that we have a duty to promote mental and emotional wellbeing and resilience, something best delivered in non-specialist settings.