A key goal of the Sanctuary Model is to help human service organizations become true learning organizations. But that means having to unlearn established patterns and routines. Under the influence of chronic stress organizational learning of new patterns and unlearning of old patterns is negatively impacted, organizational memory is lost, organizational amnesia affects function, and service delivery becomes increasingly fragmented and ineffective. Learning to make better decisions must be a shared process of learning new patterns and routines that is integrated into the daily practice of the organization and is therefore likely to be frightening – at least at first - but also exciting and stimulating. In an effective Sanctuary environment where staff members and clients are growing and healing, the work should never be boring but instead should always be challenging for everyone, skating on the “edge of chaos” where creativity and innovation are born.
Democratic Therapeutic Community and Social Learning
The development of the Sanctuary Model has been strongly influenced by the practice of the democratic therapeutic community and that is not a coincidence. The field of traumatic stress studies was founded largely as a result of the Vietnam War and the democratic therapeutic community movement had its origins in World War II. Maxwell Jones was one of the key founders of the democratic therapeutic community in the United Kingdom and then in the United States, immediately after World War II. Jones had served in the British Army and he first developed a program during the war to treat soldiers suffering from what was then called “effort syndrome,” a psychosomatic disorder related to combat fatigue or what we now know as PTSD. As he noted:
“The lessons of war psychiatry point in the direction of immediate attention to the individual, as soon as possible after the breakdown under stress, to avoid perpetuation of symptoms..... We must try to view crisis situations in a new perspective. The rigid, formalized concepts of ‘illness’ not only prevent the situation from being seen as it really is but also predetermines all roles, role relationships, and procedures under the guise of medical treatment. It seems eminently reasonable to view the concept of the trauma itself as a potential opportunity for growth; we must seek to determine appropriate procedures as a function of the interaction between the subject, significant others in his social world, and socially skilled professional workers during the period of stress” (p.85) .
Jones’ approach was focused on education in a group setting which led to the development of what he termed a “group atmosphere”. Treatment was no longer confined to a therapeutic hour but became a continuous process operating throughout the waking life of the patient. To accomplish this, Jones had to reorder the hospital society and flatten the traditional hierarchical pyramid of authority to promote more interaction between patients, nurses, and doctors. Treatment was in part constituted by what he called “social therapy” which entailed the extensive use of dramatic reenactments as an effective technique . The patient would write, direct, and act in his or her own personal play with the help of the entire community, as part of an intensive therapeutic experience.
After the war, Jones developed a program for ex-prisoners of war and continued experimenting with the use of discussion groups, educational films, drama and discussions of community life. The results of the work impressed the government enough to ensure the development of a postwar program at Belmont Hospital to treat chronically unemployed and neurotic people. Many of them suffered from what today would be labeled personality disorders, substance us disorders, and chronic depression or in our terminology, complex post-traumatic stress disorder. Patients who were admitted were those considered unsuitable for either psychotherapy or physical methods of treatment such as electroshock, but excluded psychotic patients. Here is how he described the treatment population at the time - not the worried well, but severely dysfunctional, nonpsychotic patients very similar to the adults who are now seen as seriously problematic today in a wide variety of service delivery systems including the adult and juvenile justice systems:
" Our patients represent the 'failures' in society; they come largely from broken homes and are unemployed; inevitably they have developed antisocial attitudes in an attempt to defend themselves from what appears to them as a hostile environment; as often as not their marriages are in ruins and there is little or no attempt to keep up any of the more usual standards of behavior in their home life. They are out of work and this absence of a work role leads almost inevitably to a disruption of the man’s social relationships. To bring cases of this ‘hopeless’ kind together into one hospital must lead to chaos or worse unless there is a well-defined social structure and a well-trained staff to maintain this structure”(p.xvii) .
Jones and his colleagues performed follow-up studies and six months after leaving the hospital, two-thirds of the patients they traced had made a fair adjustment or better. Just over one-half had worked the entire time since leaving the hospital. Patients generally stayed in the hospital for two to four months, but some patients stayed up to a year, while others stayed a much shorter time than two months.
Jones believed that the main therapeutic impact that resulted in improved function was based on the idea of social learning by which he meant:
“the process of change which may result from an interpersonal interaction, when some conflict or crisis is analyzed in a group situation, using whatever psychodynamic and social skills are available to the group. In this way the therapeutic setting could become an experimental laboratory for change that the client could then exercise out in the world. “ Learning of this kind is complicated and painful: old learned patterns, adequate in previous situations, must be unlearned because they stand in the way of acquiring new and more adequate patterns of behavior" (p.69).
In Jones’ description of social learning, an internal or external stressor resulted in powerful group feelings that ideally then lead to thoughtful cognitive processes within the group resulting in changes in attitudes, beliefs and behaviors. The most profitable social learning experiences often arose as a result of some crisis that had a history and often had been evolving for months until the situation became intolerable and threatened “to become a disaster or calamity if certain organizational and psychological steps do not take place immediately”(p.74).
To his way of thinking and working, every social interaction or crisis presented a “living-learning situation” which provided the grist for the therapeutic mill and the opportunity for changing and learning how to change. It was clear to Jones and other founders of the therapeutic community movement, however, that for such a living-learning environment to exist, certain preconditions were necessary such as egalitarianism, permissiveness, openness, honesty and trust [3-5]. It was also clear that the role of leadership in creating such an environment was no less important than it is now. “We have found that the greatest stumbling block to such an approach is the threat this approach holds for authority figures. ...The approach advocated here demands that the professional be willing to become the subject when appropriate, and that his performance in crisis situations be subject to scrutiny” (p.86).
So, if Maxwell Jones were still around today, he would recognize in the Sanctuary documentation some basic structures for creating what he called a “living-learning environment” where people are learning to change problematic feelings, thoughts, attitudes, beliefs, and behaviors in a group environment. The basic values are to be curious and question everything, including authority.
Each person that comes for help is an entire complex world onto himself or herself and each part of that person – physical, emotional, social, moral, spiritual - interacts with every other part. Memory then connects each person to their past and can be altered by their present, and imagination connects them to the future so that the future may determine the present. Additionally, exposure to traumatic experience, particularly repetitive adversity beginning in childhood, has such a profound effect on development and current behavior, that without a full understanding of these effects, a person’s behavior just does not make sense to the average person or the professional. It is easy to overlook key aspects of the person because the secrets to understanding their actions lie buried in the past.
We argue, therefore, that every environment that delivers services to troubled human beings must struggle relentlessly to see the whole, not just the parts. The Commitment to Social Learning isn’t just an individual endeavor. It has to be a group achievement because no one human being will be able to encompass the whole of any other human being. But because we have to depend on each other to keep us from being blinded by the part, we have to have methods that allow us to hold onto our individual perception of the part while still seeing the whole – and that turns out to be no easy feat, never fully achieved, but with any luck, always in the process of attainment.
The goal of this commitment for the organization is creating an on-going learning organization that identifies errors and self-corrects those errors as a routine and exciting part of doing the work involved in helping people to recover from whatever injuries they have sustained. For there to be an environment of creativity, innovation and learning, there needs to be a diversity of opinions and ideas and that means having a diverse group of people – the greater the diversity the greater the number of possible options for combinations or recombination of ideas and actions.
Some of the most useful explorations of organizations as collective and living organisms derive from the study of organizational culture. Organizational culture is “the sum total of all the shared, taken-for-granted assumptions that a group has learned throughout its history (p.29) or “How we do things around here”. Organizational culture matters because cultural elements determine strategy, goals, and modes of operating .
This new paradigm for what constitutes a healthy organization – defined by more than financial profitability but consistent with that profitability – reflects a growing recognition that businesses are indeed alive and that corporate responsibility entails recognizing and responding to issues of ecological sustainability . Definitions about the way organizations learn, self-regulate, and remain healthy go back over thirty years . Much discussed in the business world, a “learning organization” is an organization skilled at creating, acquiring and transferring knowledge and modifying its behavior to reflect new knowledge and insights . To be a learning organization, systems must be able to: 1) sense, monitor, and scan significant aspects of their environments; 2) relate this information to the operating norms that guide system behavior; 3) detect significant deviations from these norms; and 4) initiate corrective action when discrepancies are detected (p.77) . Although not always practiced, it is well-established in the world of business that healthy learning organizations provide measurable business advantages. It is also established that there is a strong relationship between the culture and people practices of organizations and the productivity and health of their people, a relationship so strong that investing in people is seen as a wise strategy for achieving and maintaining high levels of bottom-line business success .
Little has been done to apply insights about the learning organization to the mental health system or the social service system despite the fact that helping people to change – through learning – would seem to be the essential mission of all organizations concerned with the well-being of individuals and families. Discussion of many of the characteristics of a learning organization can be found in the pages ahead but for now let us just look at an abbreviated list of the common characteristics of the learning organization: 1) the presence of tension; 2) the presence of systems thinking; 3) a culture which facilitates learning . These characteristics mirror longstanding insights of how to create healthy environments that derive from the therapeutic community literature, perhaps best described by one of its originators, Maxwell Jones when he discussed the concept of “social learning” as “the little understood process of change which may result from the interpersonal interaction, when some conflict or crisis is analyzed in a group situation, using whatever psychodynamic skills are available”(p.70) .
Dissociation and Organizational Amnesia
Organizational Learning Disabilities
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- Jones, M., The Therapeutic Community: A New Treatment Method in Psychiatry. 1953, New York: Basic Books.
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- Leeman, C., The therapeutic milieu and its role in clinical management., in Inpatient Psychiatry: Diagnosis and Treatment, Second Edition., L. Sederer, Editor. 1986, Williams and Wilkins: New York.
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- Ray, M., What is the New Paradigm in Business?, in The New Paradigm in Business: Emerging Strategies for Leadership and Organizational Change, M. Ray and A. Rinzler, Editors. 1993, G. P. Putnam's Sons: New York.
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- Luthans, F., M.J. Rubach, and P. Marsnik, Going beyond total quality: the characteristics, techniques, and measures of learning organizations. International Journal of Organizational Analysis, 1995. 3(1): p. 24.
- Morgan, G., Images of Organizations: The Executive Edition. 1998, San Francisco: Berrett-Koehler.
- Levey, J.a.L., M. Corporate culture and organizational health: A critical analysis of the reasons why investing in people is a wise business investment. 2005 [cited 2005 September 17]; http://www.wisdomatwork.com/BUSINESS/center/report.html].