Interview with Mark Freestone, Chief Education and Training Officer at Tavistock and Portman NHS Foundation Trust and a leading expert on psychopaths who helped to create the character Villanelle for the BBC’s hit series Killing Eve’s.
Mark Freestone our new Chief Education and Training Officer, and Dean of Postgraduate Studies spoke to Ben in the communications team upon joining the Trust this week. Mark talks about his own career and experiences, and how he plans to continue our innovation in clinical services, education and research as well as how best to promote our unique approach to mental health.
Ben: Thanks for being so generous with your time. I know you’ve got a lot going on. Can I kick off by asking what is your first memory or experience of the Tavistock and Portman?
Mark: That’s a really good question. I used to work for the North East London Forensic Personality Disorder Service (The Millfields Unit), which was originally a part of the Dangerous and Severe Personality Disorder (DSPD) programme. I fully appreciate that looking back these are horrible words (‘dangerous’, ‘personality disorder’), by the way, they wouldn’t be acceptable in today’s mental health landscape. At Millfields we ran a medium secure service for men with a diagnosis of personality disorder who were at a very high risk of causing harm to others, which was based around a therapeutic community model. Because of the links with the Northfields Experiments, there’s a huge influence from Tavistock thinkers – Bion, Rickman, Foulkes – in the idea of a therapeutic community. However when we set the service up around this model, which is largely democratic and focused on accountability and de-emphasising traditional hierarchies, we realised exactly how difficult it was to manage the dynamics that evolve around people with really high levels of antisocial problems; psychopathy, narcissism, sadism: things like that. The staff group tended to regularly break apart and split and become, quite antagonistic towards each other, making it difficult to build consensus around how to manage these men. I don’t think that was anything to do with the staff team ourselves; a form of ‘’malignant mirroring’’, an idea coined by Louis Zinkin, someone who himself was heavily influenced by the Tavistock. The staff seems to absorb bits of psychopathology from the patient group then doesn’t have a perspective on this or a to process it. Anyway, I’d been at Millfields for about a year, so late 2009, and the executive team appointed a guy called Steve Mackey who was a nurse consultant based at the Portman clinic to run reflective practice groups with the staff team. The reason this was so inspirational was because Steve was laser-focused not on people or problems, but helping us to think about the dynamics that were replicating what was going on in the patient group, but within the staff group. We knew some staff were doing very antisocial things; not on the same scale as the patients perhaps, but very delinquent mirroring: for example, one staff member took off their keys belt and left it inside the unit and then, for reasons we never fully understood, ended up outside of the clinic in the hospital grounds. Eventually a patient [a convicted murderer] had to call the nursing team to come and let the staff member back in: a very weird reversal of roles and hard for the rest of us to process especially as the staff member was then [rightly] placed on administrative duties. Another staff member brought a knife into work to ‘defend themselves’ and had to be sent home and then dismissed; so all sorts of strange things were going on. Amid all this, Steve was able to ask “well, what is it that you think the patients are looking for here and how does that impact what the staff want?” This was a powerful question because then we could talk about the idea of freedom as both conscious and unconscious fact, and the reality that one of our staff group had effectively broken free from the institution, gone to the outside and then successfully escaped; but there was really no escape for the patient group. So, these meetings helped to sort of cultivate a sense of shared purpose and understanding of even the most bizarre behaviours by the patients… and the staff. Steve also helped us to think about difficult behaviours in terms of – drawing on Isabel Menzies Lyth’s work at the Tavistock – social defences against anxiety: we were deliberately sabotaging therapeutic activities so we didn’t have to deal with the patients, very much as though we just couldn’t cope with the anxiety that brought. So the Tavistock and Portman approach Steve modelled helped us not just to think but to “learn how to think” about how we could cope with this very challenging work with murderers, sadists and narcissists by trying to understand a little bit better what it was that the men were doing to us and we were doing to them unconsciously, and how to bring a different perspective on it that focused on dynamics, not individuals or behaviours in isolation. Another thing we all appreciated was that Steve was a very dynamic facilitator, not like a group analyst; he always had an explanation to proffer, so we were never left feeling, “this is all on us and we’re alone with all these challenges and this anxiety”. Instead, here was someone who understood how hard this work was and how challenging it was to think at a different kind of level when you were confronted daily by difficult behaviours and transgression and that in itself was so, so helpful. I remember that reflective practice was only once every couple of weeks, but it was the only meeting in the calendar where the meeting room was absolutely packed: standing room only. Everyone always showed up to talk with Steve and I thought “wow, what a fantastic way of thinking about things; what a freeing, exciting, innovative approach!”
Ben: What year was this?
Mark: So this would have been 2009 to 2013. These sessions took place for quite a while.
Ben: So what made our model of reflective practice a pioneering approach? What made it different? Was it more interactive, a less passive approach?
Mark: I’m sure this isn’t the technical term, but I thought that what Steve did was like a kind of relational jiu jitsu, like the martial art where one uses the energy of one’s opponent against them. So we came in with all of this negative energy, despondency and low motivation, and Steve was never passive in the face of that. He always acknowledged what we saying and what was going on, but he was able to use his experience and understanding of dynamics to shape it and give it back to us, digested. He could say “well, maybe the reason that you feel demotivated is because you don’t trust the rest of the team around you. But what’s the evidence that you have that you can’t trust them? You all show up for work; you haven’t had a serious incident with a patient for a long time… so why is there a lack of trust here? And to what extent do you think that’s an expression of the trust that you want but never experience from the men that you’re working with?” For me that exemplified this really graceful, active hearing, reflecting and interpreting approach that was so much what we needed at the time.
Ben: That’s great example of how our reflective practice model helped another organisation’s practice. I’ve read up on you and you’re a bit of a pioneer yourself. You’re bringing your pioneering approach to our pioneering organisation if you like. What’s something that you’re excited about that you could bring to the Tavistock and Portman? A research piece?
Mark: Research falls under my brief as CETO, so let’s start with that. The Tavistock and Portman has all these connections and legacies that run through the NHS and internationally; but that legacy is constantly under threat because of the perception of what we do as exclusive, expensive and over-complex. For example, the WHO recently published a draft of their recommendations for the of psychological interventions, and there’s been a sort of a rippling, turning into a wave of outrage saying “why hasn’t the psychodynamic approach been involved or mentioned in these recommendations”. So a petition has been launched by the Psychotherapy Action Network and all the lead psychoanalytic and psychodynamic thinkers internationally have signed it. Of course, I also signed it – because I was so horrified to see that this had happened – but it underlined the scale of the problem to me. I think if you are a modern commissioner, when you see the words “psychodynamic and psychoanalytic” describing an intervention, they evoke something that is, perhaps, over-complicated, expensive and out-of-date. Even people who try to rehabilitate or provide a different narrative about these approaches agree, that level of implicit understanding and appreciation of the approaches has largely gone from the level of people who fund, commission or – in the main – research mental health services. The German psychotherapy researcher Falk Leichsenring, who describes the psychodynamic approach as “transference focused psychotherapy” has attempted to rehabilitate psychodynamic practice by changing the name, but it hasn’t really worked because terms like ‘transference focused’ don’t mean anything to – for example – NHS commissioners. They think “well, I know what CBT is and understand what it does, because of the Layard report”, and it’s perhaps the same with behavioural therapy or solution-focused therapy, so that’s the much easier option for them than to think about the role of the unconscious in depressive symptoms, for example. So, for me the challenge is that we have to try and think about what’s at the core of our work: why is psychodynamic practice so effective in the long term with people with conditions, when they don’t respond to treatment elsewhere? What are the key elements of the Tavistock’s approach that we can sell to commissioners? My answer is that that a huge part of that answer is that relationships drive everything and that essentially a kind of relational care, or a relational practice, is what’s key. And it is fantastic to hear those words being spoken by local authorities, by NHS Trust, hesitantly still, hesitantly still, but with increasing frequency and commitment. So going back to my first example, like with Steve Mackey’s work with the Millfiends staff, the idea is that the relationships between us, between us and the patients, between us as staff members are the absolutely core thing to resolve here if we are going to have safe and effective services. Almost to the point where perhaps we need to stop thinking about how we reduce depressive symptoms in our patients, how do we prevent relapse, how do we improve the outcomes of our clinical practice, and instead what is the first step here? Perhaps it’s “how do we fix our relationships with our patients and each other?”, because if you don’t have good relationships with your patients, years and years of psychotherapy research show that they are much less likely to have good outcomes. So it’s almost like a sort of an epistemic shift that needs to happen and the Tavistock and Portman understands this prioritisation. Reflecting on that, I think it’s the way these ideas are presented to the outside world that we need to emphasise differently. Our understanding of the relational aspects of what we do, the dynamics of relationships, if you want to call it that. Perhaps we’ll call it ‘dynamics’ internally, but don’t tell the commissioners! In any case, needs to be understood much more and emphasized a lot more. Coming from a background in therapeutic communities, I know the risks of not moving with the times. The problem has been that the therapeutic community, particularly in the NHS, carries very negative connotations despite the fact that almost if not all the research and clinical practice has shown how successful the approach is with people with the most complex emotional and relational needs. Yet the public and commissioners only focus on places such as Penetanguishene or the Paddington Day hospital because there are more convincing stories about why those places went adrift. It reassures me that somebody was crazy enough to try LSD psychotherapy in naked encounter groups with psychopathic prisoners. So hey what if we just dosed everyone with psychedelics? Well no, because it makes them worse. We now have the research evidence to prove that.
Ben: I didn’t know that. I read Timothy Leary’s book. I’m glad we’ve dismissed it as an idea.
Mark: Timothy Leary and Terence McKenna were very venerable back in the day. But can LSD psychotherapy in naked encounter groups help psychopaths? The answer is quite definitely no. They actually make them worse. They may yet provide hope for the rest of us – like the current research into MDMA and PTSD – but that’s a different question!
The current situation is that all the years of success and positive stories about therapeutic communities has sort of leached away over time because of the negativity associated with dramatic failures of services that would never have been accredited as therapeutic communities today, if ever. Whereas I think relational care, relational practice likes at the core of the therapeutic community approach and is something that the Tavistock has years and years of established clinical expertise, research evidence and critical consideration of the ontology of a therapeutic relationship: that powerful ability to deconstruct a failing relationship, put it back together differently and make something meaningful and productive out of it. For me this means that Tavistock and Portman have this opportunity to present ourselves as experts in training, education, clinical practice and research to the rest of the NHS and say “look, this is what we’ve always done” , it just needs to be presented in terms that emphasis what healthcare providers want and need rather than emphasising our intellectual heritage. So I’m hugely optimistic that this is exactly the right time for that kind of narrative. And it doesn’t mean rethinking what the Tavistock does, it means thinking what is it that commissions want from us and how we can present that in the most effective way.
Ben: So you definitely see a future for Tavistock and Portman as an organisation in the changing commissioning landscape?
Mark: I wouldn’t be here if I didn’t. I think that’s the power of the Tavistock and Portman. The thinking, the practice, the research, the education and the training are all aligned together. If you break that up, you lose something, a sort of the magic which is exactly what makes the Tavistock and Portman so potent. I think the whole executive team, the whole organisation in fact will fight as hard as we can to ensure the Tavistock and Portman continues as pioneers in our field.
Ben: Mark that was excellent. I’m quite new to the organisation myself, so that was absolutely fascinating. Thank you for finding the time to talk.
Interview with Denise Van Outen for the Sydney Star Observer
Ladies and Gentlemen…
DENISE GET’S THEM OUTEN!
I enter the pristine retro foyer of the Quay Grand to the sounds of publicists gushing about how excited Denise Van Outen is to meet me. Apparently the host of the British TV show Something for the Weekend has insisted that the guy from the “gay paper” interviews her last so she can fart out loud, whack out her tits and indulge in some smutty dialogue without having to worry about being unfairly stereotyped. A fair enough assumption I think to myself, that is, assuming all gay men can be relied on to appreciate gratuitous flatulence and genital innuendo. Fortunately Van Outen’s trademark filth is not wasted on me.
After reading several magazine articles on Denise Van Outen and catching a quick glimpse of her sex and relationship game show, Something for the Weekend, I was ready to meet a brazen blonde with a mouth like a sewer. To my surprise, however, as she gabbed my hand and shook it firmly, her hair was pink. Everything else thankfully was in check. At once her mouth was foul and her attitude suitably audacious. We launched immediately into casual banter like old friends who’d been clubbing and popping ecstasy together since the mid-eighties. It was that sort of straight girl/gay boy instant bonding we all know so well. Trust in place, Denise began discussing her vagina. Now was as good a time as any to press play on my Dictaphone and begin the interview.
The British are masters of sexual innuendo, you know like Carry On films, Benny Hill and Are You Being Served? Something for the Weekend throws sexual innuendo out the window and gets straight to the point doesn’t it? It’s not like “wink, wink, nudge nudge”.
It’s more like “wank, wank, nudge nudge”.
Is this a first for British TV?
It kind of is in the sense that it has a female presenter hosting the show. It’s very new. Nobody’s ever done that. We have a lot of stand up comedians who can get away with that sort of humor, who are guys. But you get a female doing it and its really rare. But then also we have kind of in-your-face kind of shows that actually go much further than what this show does. You know in the UK at the moment we’ve got those real doco-soap shows, you know where we follow people around, kind of like the Shipwrecked thing but with groups of teenagers who are on holiday at Ibetha or the Caribbean or Greece and you see everything. This is kind of like that but it’s done in such a cheeky way.
It’s a clever show in parts. It’s not just obvious humour all the way through.
Are the concepts in the show all your ideas?
Well this whole show came about because I’ve now got my own production company in London called Whack ‘em Out productions because I say, “If in doubt whack em out.”
(Laughing)
You like that don’t you?
I have a gender specific equivalent, “flop it out.”
That’ll be yours then “If in doubt, flop it out.” Every time I see you now I’ll say “flop it out boy!”
I don’t know whether it’ll be a “flop” sound.
[Pretending to be embarrassed] So anyway back to the interview. So I teamed up with this team in London and this is what we came up with. You see this show is not so much about me it’s more about the people on the show. They give us the stories that give us the ideas for the games.
So when you were a little girl did you sit around with your brothers and sisters thinking up game concepts about sex? Do you have that history?
I don’t know about that. You see in England I’m known for doing shows like The Big Breakfast and everyone said to me it won’t work [Something for the Weekend] because then I was all about seaside humour and innuendo and I could get away with it because it was on at 7 o’clock in the morning when people are getting ready for school and work and it was really quite shocking. So when I said I wanted to take it a little bit further people said it wouldn’t work, it would be too rude, people would find it offensive, but they don’t. People now laugh and joke about these sort of things, it’s a way of life really.
What about Jerry Lewis’s comments about female comedians recently. Did you hear what he said?
No, what did he say?
He said he imagined women as the bearer of children not up on stage making fart jokes.
Fuck him!
Thank you.
Tell him Denise Van Outen said “fuck him” and then she farted.
[Laughter]
Moving on. So in the show I watched, you made everyone in the audience picture their parents having sex and then one poor guys parents appeared on stage in bed together and then you tested his knowledge on how much he knew about his parents sex life. He won money for the right answers. Is that a regular thing?
The thing is about this show is it’s not really formatted. Sometimes we play the same game but with a twist, like that game you just mentioned, Honey Lets Embarrass The Kids. In the UK we had this gay couple with one of the guys son’s and we played the game with them.
How did that go?
It went really well. It was so funny because they were so up for it and he [the son] was so shocked, he couldn’t believe that his Dad and his partner were suddenly in bed together on stage. But it was great and they were so funny, they really hammed the whole thing up.
Are you going to do that in the Australian version?
Well I don’t know. I can’t give too much away because I want people to watch the show but that is the kind of thing you can expect. Expect the unexpected.
From here the interview degenerated into a giggly conversation about Denise’s tits. Frustrated trying to search for the appropriate superlatives to describe them, she eventually gave up and just showed me. And that was that.
The Australian version of Something for the Weekend called How Much Do You Love Me is currently being filmed in Melbourne naturally with that naughty vixen Denise Van Outen at the helm. The show hits our TV screens sometime in July. Watch my column for details.
Thursday, October 17, 2002
The “Gay & Lesbian Mardi Gras” will live on
South Sydney City Council yesterday met with the President, Julie Regan, and Secretary Jennifer Wilson, of Sydney Gay & Lesbian Mardi Gras Ltd to discuss the future of the organisation and the annual gay & lesbian parade.
Arising from these discussions, Council expressed an interest in purchasing, in trust for the gay & lesbian community, all rights to the names “Sydney Gay & Lesbian Mardi Gras” and “Sleaze Ball” and all the logos, trade marks and intellectual property associated with the Mardi Gras branding.
“The Sydney Gay & Lesbian Mardi Gras deserves the support of the broad community” said Mayor John W. Fowler.
“Some mistakes have been made. However, the Sydney Gay & Lesbian Mardi Gras is not a company listed on the stock exchange. It is a celebration of our tolerance”
“Mardi Gras should not be allowed to disappear or be sold to commercial interests”
“The Mardi Gras is important on so many levels for the queer community and for this city and its economy. It is also important for the international image of Australia as a tolerant and diverse society,” he said
“Given this, I believe the way the State Government has responded is shameful and extremely disappointing”
“I hope, out of these dark times, with the support of Sydney’s gay & lesbian community, a new organisation can arise to organise this annual celebration,” he said.
___________________________________________________________________
Media contact:
Ben Tunstall
9288 5005
0414 616 986