Arbours Association communities

1. Introduction

Version followed: the Arbours Crisis Centre model as described in its later years (team of team leader, resident therapist and sometimes a trainee; individual sessions three times a week; house meetings), set against the early-1970s Arbours network (households, crisis team, home visits) as described in a contemporary Self & Society report. Where the two differ, both are given and labelled.

What it is. The Arbours Association is not a single therapy but a London charity and community network, set up in 1970 by former colleagues of R. D. Laing at Kingsley Hall, including Joseph Berke and Morton Schatzman (other founding members named in an early report: Roberta Elzey Berke, Vivien Millett, Richard Goldberg) [source: Self & Society report; jhberke.co.uk/life; Wellcome archive record]. It ran (a) residential households where people in distress lived with therapists, (b) the Arbours Crisis Centre, opened in 1973, a short-to-medium-stay therapeutic community where up to six (later accounts) or eight (Wellcome record) "guests" lived with resident therapists, (c) psychotherapy services, and (d) a training programme [source: Metapsychology review of Beyond Madness; Community Care; Wellcome]. It ran three residential communities until 2020, then stopped running communities; it now offers psychotherapy only, and the training programme no longer runs [source: Wellcome]. Wikipedia gives the Crisis Centre's dates as 1973–2010; this conflicts with the Wellcome record [uncertain].

Core idea of change. Psychotic and other extreme states are treated as meaningful communication, "a cry for help and an attempt to be understood" (Berke), not symptoms to suppress. Change comes when a person has a sanctuary, in time (days to months) and in space (a calm, caring household), in which extreme distress can be lived through, tolerated and understood within relationships, so the person can, in Berke's words, "break down in order to break through" [source: jhberke.co.uk/psychotherapy; JKP description of Beyond Madness]. By the 1990s–2000s the Centre described its method as intensive psychoanalytic psychotherapy within a therapeutic-community frame, rather than the original anti-psychiatric alternative to hospital [source: Metapsychology review].

2. Framework

This is a setting-based model, not a session-by-session protocol. The phases below are assembled from the sources; the Centre's own "five stages of stay" are named in Beyond Madness but their content is not described here [uncertain].

Phase A: Contact and assessment.

Early version: a caller (often the most distressed family member) phones the crisis centre; the resident couple decide whether to intervene; if so a team (a therapist, one of the resident couple, one or more helpers) visits the home and meets everyone involved [source: Self & Society].
Later version: people must be assessed before a bed is offered; some self-refer, most are referred by health or social care professionals; funding (NHS, social services, private, sometimes benefits) must be agreed [source: Community Care].
Goal: understand the crisis in its family and social context; decide between home-based work, a stay, or another service.
Move on when: the person (and where relevant family) wants a stay, the team judges the household can hold them, and funding is in place [source: Community Care; criteria beyond this are not given in sources: synthesis].

Phase B: Home or family crisis work (early model). Some crises were handled by home visits alone; in others family members stayed at the centre for days or weeks, with family-and-friends meetings to sort things out [source: Self & Society].

Phase C: Residential stay.

Format: the guest lives with (in later years) three resident therapists; each guest has a team of two or three (an external team leader who is a psychotherapist or psychoanalyst, a resident therapist, sometimes a trainee); individual sessions with the team three times a week; group therapy; house meetings three times a week; art and movement groups; shared cooking, shopping and household tasks [source: Community Care; Wellcome].
Length: a few weeks, several months, or longer [source: Community Care]; early crisis stays "days or weeks" [source: Self & Society].
Goal: tolerate, understand and ease extreme distress in a lived relationship; rebuild autonomy and shared responsibility [source: JKP; Wellcome].

Phase D: Longer-stay household (where available). Early households ran as extended families, with the resident founders as parent or aunt/uncle figures; some residents came in acute distress and others to learn the approach [source: Self & Society]. Criteria for moving from crisis stay to a long-stay household are not described [uncertain].

Phase E: Ending and follow-on. Not described in the sources used. Likely sequence by analogy with therapeutic communities: planned leaving date, work in house and team meetings on the ending, continued outpatient psychotherapy through Arbours psychotherapy services [synthesis].

3. Guiding principles

Distress is communication. Treat strange beliefs and behaviour as attempts to be understood; ask what is being said before what should be stopped [source: jhberke.co.uk/psychotherapy].
Sanctuary in time and space. Give enough time (days to months) and a calm, homely place; do not rush resolution [source: jhberke.co.uk/psychotherapy].
Hospitality, not hospital. Residents are "guests" of the therapists, not patients; use the language and arrangements of a home [source: Community Care; Metapsychology].
Living alongside. Therapists live in the house; no locked doors; therapeutic work happens in everyday life as well as in sessions [source: Wellcome; Community Care].
Tolerate extremes. The household's task is to let extreme distress be tolerated, understood and eased rather than contained by force [source: JKP description].
Context, not just individual. Crises are understood in the family and social network; families and partners can be seen and even accommodated [source: Self & Society; Wellcome].
Shared responsibility and autonomy. Guests share household tasks and attend group meetings; behaviour labelled illness may be a bid for autonomy [source: Wellcome; Self & Society].
Scepticism about the medical model. Early Arbours rejected the medical model where no physical cause is found and described mental illness as more "a career" than an illness; the later Centre framed itself as an alternative to physical psychiatric treatment [source: Self & Society; JKP]. Practical meaning today: hold psychological understanding central without stopping anyone's medication outside prescriber oversight [synthesis].
Psychoanalytic understanding. Later work is intensive psychoanalytic psychotherapy; resident therapists are in their own three-times-weekly psychoanalytic therapy [source: Metapsychology; Community Care].
Teams, not lone heroes. Each guest has a team; residents are backed by an external team leader and a resource group of psychiatrists, psychologists, nurses, social workers and others [source: Community Care; Metapsychology].
Limit the strain on carers. Resident posts are capped at about three years because of the strain [source: Community Care].
Power, authority and money are clinical material. The Centre's own book gives these a section; fees and funding shape who can stay [source: JKP; Metapsychology; Community Care].

4. Intervention inventory

The sources describe structures and routines rather than scripted techniques. Below are all procedures described in the sources used; the step detail inside each is partly synthesis where marked. The fuller manual-like accounts (Berke 1979; Sanctuary, 1995; Beyond Madness, 2001, including its "five stages of stay" and self-harm strategies) were not available to open [uncertain].

4.1 Crisis call and triage

Purpose: decide quickly whether and how to respond to a crisis reported by a person or family [source: Self & Society].
Steps: (1) take the call, noting that the caller is often the most distressed member, not necessarily the identified patient; (2) the experienced resident couple (early model) decide whether to intervene; (3) if so, assemble a team and arrange a home visit [source: Self & Society]. (4) Today, add a standard risk screen (suicide, violence, physical health, safeguarding) before deciding [synthesis].
Example language (illustrative): "Who is most worried right now, and who else is in the house with you?"
Watch for: urgent medical or safety needs that a non-medical household cannot meet; route these to emergency services first [synthesis].

4.2 Home visit with the whole family

Purpose: understand the crisis in its family context and sometimes resolve it at home [source: Self & Society].
Steps: (1) the team (a therapist, a resident, one or more helpers) visits; (2) meet all family members involved together; (3) listen for how the crisis is shared and who carries which part; (4) agree either further home visits or a stay for the person and possibly relatives [source: Self & Society; steps 3–4 partly synthesis].
Example language (illustrative): "We'd like to hear from each of you what the last few days have been like."
Watch for: family members scapegoating one person; it is working when the family can talk about the crisis as shared [synthesis].

4.3 Assessment and referral for a stay

Purpose: decide whether the household can offer a bed and whether funding can be arranged [source: Community Care].
Steps: (1) accept self-referrals or professional referrals; (2) assess; (3) agree funding with NHS, social services or private payers; (4) agree a start date and a team [source: Community Care]. Assessment content is not described [uncertain]; at minimum include psychiatric history, current risk, physical health, medication and prescriber, and a crisis plan for hospital admission if needed [synthesis].
Watch for: suitable people turned away for funding reasons; guests whose funding falls through mid-stay (one guest's funding failed three times) [source: Community Care].

4.4 The guest team

Purpose: give each guest a small, stable team linking formal therapy and daily life [source: Community Care].
Steps: (1) appoint a team leader, an experienced psychotherapist or psychoanalyst who lives outside; (2) add a resident therapist; (3) sometimes add a trainee; (4) the team meets the guest for individual sessions three times a week; (5) the resident brings observations from house life into sessions [source: Community Care].
Example language (illustrative): "Yesterday at supper you went quiet when your mother rang; can we think about that here?"
Watch for: splitting between the outside leader and the resident; regular team discussion is the obvious remedy [synthesis]. Working signs: guests report that the therapists' observations help them understand their behaviour [source: Community Care].

4.5 Residential hospitality ("guest" stay)

Purpose: provide sanctuary, an alternative to a psychiatric ward, where extreme states can be tolerated [source: Community Care; JKP].
Steps: (1) the guest moves into the therapists' home (up to six guests in later accounts); (2) no locked doors; (3) therapists live there permanently; (4) the guest joins daily life and the timetable of sessions and meetings [source: Wellcome; Community Care].
Watch for (risk): an open, unlocked, non-medical setting cannot provide the observation or physical-health care of a ward; agree in advance when hospital is needed [synthesis]. See Harm account.

4.6 Individual psychoanalytic psychotherapy

Purpose: understand the meaning of the crisis and of the guest's experiences [source: Community Care; Metapsychology].
Steps: three sessions a week with the team; psychoanalytic in orientation; links drawn to life in the house [source: Community Care]. Session technique is not specified in the sources used [uncertain].
Example language (illustrative): "When you say the voices are warning you, I wonder what they are warning you about."
Watch for: rapid exposure to painful material; the stay is described as demanding because guests face painful parts of themselves quickly [source: Community Care]. Pace interpretations to the guest's capacity [synthesis].

4.7 House meetings

Purpose: run community life together and work with tensions between members [source: Community Care; Wellcome].
Steps: (1) three house meetings a week; (2) attendance required for residents and guests; (3) agenda includes household business and relationships [source: Community Care; Wellcome; item 3 synthesis].
Example language (illustrative): "The kitchen has been left again; what is going on between us that nobody is clearing up?"
Watch for: one guest's crisis taking over every meeting; scapegoating [synthesis].

4.8 Group therapy

Purpose: work with relationships and feelings among guests in a therapy frame distinct from house business [source: Community Care].
Steps: guests take part in group therapy in addition to house meetings [source: Community Care]. Frequency and method are not specified [uncertain].
Watch for: guests too disorganised to tolerate a group; allow shorter attendance and follow up individually [synthesis].

4.9 Art, movement and social activities

Purpose: non-verbal expression and ordinary shared living [source: Community Care; Wellcome].
Steps: art groups and movement groups are offered; residents are encouraged to take part in art therapy and social events [source: Community Care; Wellcome].
Example language (illustrative): "You don't have to explain the picture; we can just look at it together."
Watch for: participation is encouraged, not required (unlike group meetings) [source: Wellcome].

4.10 Shared domestic life

Purpose: build autonomy and shared responsibility; give residents material from everyday life for therapy [source: Wellcome; Community Care].
Steps: (1) guests and resident therapists shop and cook together; (2) household and community tasks are shared; (3) frictions are brought to house meetings or team sessions [source: Community Care; Wellcome; step 3 synthesis].
Watch for: the ambiguity of being both housemate and therapist, which a resident named as a central challenge [source: Community Care]. Keep boundaries explicit [synthesis].

4.11 Family and partner involvement

Purpose: keep relationships alive during a stay and work on them directly [source: Wellcome; Self & Society].
Steps: (1) families and partners could receive therapy and, in some cases, accommodation [source: Wellcome]; (2) family-and-friends meetings during a crisis stay [source: Self & Society].
Example language (illustrative): "Your partner is coming on Thursday; what would you want us to talk about together?"
Watch for: family contact that repeatedly precipitates crises; agree visiting arrangements with the guest [synthesis].

4.12 Long-stay households

Purpose: longer-term communal living for people in distress and for those learning the approach [source: Self & Society].
Steps: residents live as an extended family with experienced members in parental or aunt/uncle roles; the first was in Schatzman and Millett's own home [source: Self & Society]. Rules, length of stay and leaving are not described [uncertain].
Watch for (risk): quasi-parental roles in a home setting blur therapist boundaries; see Harm account.

4.13 Network meetings

Purpose: hold the wider community of residents and about 40 outside members together [source: Self & Society].
Steps: the whole network meets monthly at one of the houses, as a combined therapeutic and social encounter [source: Self & Society].

4.14 Resident therapist role and support

Purpose: sustain the people who live with guests [source: Community Care].
Steps: (1) appoint resident therapists for up to three years; (2) require their own psychoanalytic psychotherapy three times weekly; (3) back them with team leaders and a resource group of psychiatrists, psychotherapists, psychologists, nurses, social workers and others [source: Community Care; Metapsychology]. Partners may live in the house [source: Community Care].
Watch for: burnout, the stated reason for the three-year cap [source: Community Care].

4.15 Training programme (historical)

Purpose: train therapists in the Arbours approach [source: Self & Society; Wellcome].
Steps (early version): seminars across child psychology, psychoanalysis, sociology, anthropology, communications theory and philosophy; personal therapy; at least six months living in a community; work at the crisis centre [source: Self & Society]. The training no longer runs [source: Wellcome].

4.16 Approach to medication

Purpose: the Centre presented itself as an alternative to physical psychiatric treatment; Berke is described as a pioneer of treating psychosis without medication [source: JKP; jhberke.co.uk/psychotherapy].
What sources show: a formal medication policy is not described; one guest reported coming off heavy medication after about three months at the Centre [source: Community Care].
Watch for (risk): reducing antipsychotics or other drugs without prescriber oversight risks relapse and withdrawal effects. Any reduction should be planned with the prescriber, monitored, and reversible [synthesis]. See Harm account.

4.17 Five stages of stay; self-harm interventions

Beyond Madness describes five stages of stay that guests typically pass through and specific strategies for people who self-harm [source: JKP]. Their content is not drawn on here; they are named here so they are not omitted, not described [uncertain].

5. Handling problems

The sources used name a few difficulties (resident strain, role ambiguity, funding, demanding pace). Everything else here is synthesis.

Resident therapist strain and role ambiguity [source: Community Care]. Cap tenure (the Centre used three years); require personal therapy and regular team supervision; name when a remark is said as housemate and when as therapist.
Funding breakdown mid-stay [source: Community Care]. Agree a funding contingency and a step-down plan before admission; tell the guest early if funding is at risk [synthesis].
Overwhelm from fast exposure to painful material [source: Community Care: guests confront painful parts of themselves quickly]. Slow interpretation; shift sessions toward stabilising daily routine; use art or movement groups rather than verbal work for a while [synthesis].
Stuck guest / stay drifting on [synthesis]. Review in the team what the stay is for; set a review date; involve family and the referrer; consider a planned move to outpatient therapy.
Non-attendance at required meetings [synthesis; attendance requirement from Wellcome]. Explore it in the team session as communication before treating it as rule-breaking; agree a minimum the guest can manage.
Rupture with the team leader or resident [synthesis]. Bring it into a joint team session; acknowledge the therapist's part; watch for splitting between the inside resident and the outside leader.
Escalating risk: suicide, self-harm, violence, self-neglect [synthesis; Arbours' own self-harm strategies, uncertain]. Use current structured risk assessment and collaborative safety planning; agree in advance the thresholds for calling the psychiatrist, GP, crisis team or ambulance and for hospital admission; for suicide risk, include lethal-means counselling (safe storage and removal). An unlocked therapeutic household is not a substitute for medical care when physical health is at risk (not eating or drinking, intoxication, withdrawal).
Medication change during a stay [synthesis]. Do not encourage stopping medication; any change is the prescriber's decision, done gradually with monitoring and a relapse plan. Flag: 4.16.
Boundary blurring in shared living [synthesis]. Explicit rules on touch, gifts, money, sexual contact (none), and on physical play; record and supervise any departure. Flag: 4.10, 4.12.
Families who undermine the stay [synthesis]. Offer family sessions (4.11); agree visiting arrangements with the guest; be alert to safeguarding concerns.

Harm account

Few harms specific to the Arbours communities are documented in the sources used: no deaths, injuries, inquiries or regulatory findings are recorded. This is an absence in the sources used, not proof none occurred; the Arbours archive at the Wellcome Collection is uncatalogued and not expected to be accessible before 2027 [source: Wellcome; uncertain]. What is documented is (a) strain and pressure in the Arbours model itself and (b) the Kingsley Hall precursor practice in which Berke took part.

What was actually done

Kingsley Hall, London, from 1965 (Philadelphia Association, R. D. Laing). Mary Barnes, a nurse in her forties diagnosed with schizophrenia, was the first resident. Berke was assigned to her. She regressed, spending much time on the floor curled up in a box-like enclosure; she often refused to eat, drink or wash and sometimes smeared herself with excrement. Berke bathed her, fed her from a bottle like an infant, encouraged her to scribble on the walls, and their relationship included play-fighting and occasional physical violence [source: jhberke.co.uk/marybarnes, Berke's own site; account not independently verified here]. Kingsley Hall was not an Arbours project, but Arbours founders came from it [source: Wellcome; Self & Society].
Arbours (from 1970; Crisis Centre from 1973). Guests lived unlocked in therapists' homes; early staff said they might "go to extreme lengths" to give residents time and space; early households cast founders as parent figures; the model was offered as an alternative to physical psychiatric treatment [source: Self & Society; JKP]. In later years a guest stopped heavy medication after about three months; she reported benefit [source: Community Care].

How it caused harm

Documented at Arbours: heavy strain on resident therapists (posts capped at three years), role ambiguity, funding failures interrupting stays, and a demanding pace for guests [source: Community Care]. No documented injuries or deaths found.
Kingsley Hall: refusal of food, drink and washing during deliberate regression carries risks of dehydration, malnutrition and infection; physical play and violence between therapist and patient carries risk of injury and boundary violation. Whether harm resulted to Mary Barnes is not documented in the source opened; she is described as recovering [source: jhberke.co.uk/marybarnes; mechanisms synthesis]. A reviewer of Beyond Madness cites Laing's own view that Kingsley Hall did not yield a workable model others could use [source: Metapsychology].
Risk mechanisms by inference [synthesis]: unsupervised medication withdrawal (relapse, withdrawal effects); unlocked setting with acutely suicidal guests; quasi-parental living arrangements enabling dependency or exploitation. Most at risk: people with high suicide risk, physical-health compromise, or no outside relationships or advocate.

Recognising it today

Phrases: "break down to break through", "let the psychosis run its course", "medication just shuts people up", encouragement to regress (bottle-feeding, infant care of adults) [source of phrases: jhberke.co.uk; risk reading synthesis].
Red flags in a colleague or group [synthesis]: pressure to stop medication without the prescriber; no agreed thresholds for medical or hospital care; one charismatic therapist with no team or supervision; physical play, holding or feeding of adult clients; therapists living with clients without tenure limits, personal therapy or outside oversight; families excluded or blamed.
How legitimate versions differ [synthesis, drawing on later Arbours structure]: team-based care with external leaders and a multidisciplinary resource group; therapists in their own therapy; time-limited resident posts; formal assessment and referral; voluntary, informed stays; medication decisions left to prescribers.

What to do instead and how to help those harmed

Safer alternatives [synthesis]: NHS crisis resolution and home treatment teams, crisis houses, peer-run respite, Open Dialogue-style network meetings, and psychological therapies for psychosis offered alongside, not instead of, medical care.
Affected clients [synthesis]: ask openly about past residential or communal therapy; assess for trauma, shame and boundary violations; review medication history and any abrupt withdrawal; respect positive accounts as well (some guests valued the Centre highly [source: Community Care]).
Duties [synthesis; UK framing]: raise adult-safeguarding concerns with the local authority where abuse or neglect is suspected; report boundary violations or unsafe practice to the practitioner's registering or professional body; keep records; seek supervision and legal or professional-body advice before disclosure without consent.

Sources

Sources: