A family story

You and I met because we both work at Exeter University in various clinical training programmes. How did you get started in your professional career? 

I come from a family of therapists. My early 'training' as a family therapist started there, perhaps like many of us: that sense of social utility and commitment to working within the public sector, it has always been around in my family context. I trained originally as a mental health nurse, and depending on the context I introduce myself as a family therapist, but also talk about my nursing background. It has been integral in my clinical practice. I worked in Brighton for a few years, in acute adult mental health… earned my stripes, I suppose, as lots of mental health nurses do, on an inpatient ward. It was an old Nightingale Ward with flimsy curtain separating the bays. It was a disturbing environment for the patients and the staff a lot of the time. 

I then sidestepped and started doing some work in sex and relationships education. That took me into the realms of research, and then I got a job in CAMHS, and I worked for quite a long time here in Devon before I retrained as a family therapist and starting teaching at the University. I've been doing that ever since. 

So that mental health nursing background has always been important to you?

It's interwoven, really, with my work now, as a trainer, thinking about the provision of care for those with mental health difficulties… and thinking about whole team training, how we work with services, not just with individual trainees in our mutual roles.

I trained as a family therapist at the University of Exeter, and I've just never left. I was invited to join a couples clinic that I was running with Professor Janet Reibstein, and then was appointed to teach on the qualifying course for family therapy training at the university. Things have spring boarded from there. Mark Rivett and I are co-directors, we started with just a small cohort of MSc trainees and we're now putting approximately 220 trainees through our systemic portfolio, which is amazing. 

I deliver some teaching on the clinical psychology training, and that's where you and I have come together, around ethics, diversity, power, organisational issues. Family therapy and systemic thinking has got a lot to say about all of those ideas.

And you're interested in sharing those ideas in different contexts.

Yes, I try not to be a family therapy evangelical, but a couple of years ago I was invited by a team from BBC Three, to be part of a short documentary. It's not actually about family therapy, it's a 20-minute piece of family therapy. I work with a mother and daughter, Dammy and Arinola, and it's an edited version of a three-hour session of family therapy that I did with them. It was broadcast January 2019 and is still on BBC iPlayer – I Blame My Parents. 

It was an incredible experience. I was connected to these amazing women, and I'm still in contact with them. I also got the BBC to agree to pay for me to continue doing family therapy with them, so once the cameras had stopped I carried on working with them for a couple of months. And it has been an incredibly useful resource for training – a lot of trainees, our clients and the mental health population, people don't know what family therapy really looks like. It's been helpful to be able to show that. 

Obviously I had concerns about confidentiality, ethics, informed consent. I spoke quite a lot to the UKCP and to my professional body about whether it was the right thing to do, and on balance I feel it was. I'm really pleased I did it. 

And now, are there areas of practice you're expanding into?

So many! Last year, I finished my own research, which was looking at notions of home within an adolescent inpatient unit. It was a qualitative piece of research that explored the clinical implications for young people coming and spending periods of time, essentially living in in a psychiatric hospital. It felt like a blindspot. I became very aware that clinically, there was almost no research being conducted into inpatient work generally, and certainly the curative elements of an inpatient admission. This question of home and the implications of young people often travelling many miles away from their family to come and live in a unit felt fascinating. I noticed there was a kind of ambivalence with staff and the young people and parents about whether the unit should or should not be treated like a home. It really accorded with this notion of the secure base. 

That has led on to lots of exciting things. I was already doing some whole team training for adolescent inpatient psychiatry, and that's flourished. And I've now got a wonderful research grant to bring a team from Drexel University and colleagues in Belgium to pilot an attachment-based care milieu training in adolescent psychiatry, in the South West. That's a huge project which should link to lots of different ideas in the future. I've got my fingers in quite a few pies!

That must run in the family! Your Dad, John Schlapobersky, is a group analyst but also an author. Tell me about his new book: When They Came For Me: The Hidden Diary of an Apartheid Prisoner. 

My father has been considering writing this book for a long time. 52 years ago, he was arrested in South Africa, and detained and then tortured through sleep deprivation. He was detained for 55 days, and was then deported from South Africa, straight to Israel for a while and then he came to the UK. This book is a memoir of that experience, but it's also a lot more than that. It provides historical context to what was happening at the time, and it also speaks to what became part of his life's work, with victims of torture. Along with Helen Bamber he was a founder member of the Medical Foundation for the Care of Victims of Torture, which went on to become Freedom From Torture. He used his own horrific experiences, to go on and develop what became a kind of Centre of Excellence in the UK for the support and treatment of those who've been tortured elsewhere. He's been exploring how he might share part of his story for many years.

For me, it was a very powerful and moving book. What a wonderful man. The revelations about his own practice, the context it provided, together with the details about his actual experience… but it was all so humane, even for these perpetrators. And the personal notes…

I think for anybody who's had their family story written about in a particular way, there's something interesting about that process. It is a family story, with repeated references to my whole family, how they were impacted, how they rallied round. And it is also the story of how we came to this country. At the time my parents left South Africa, my father in particular had no idea if and when he'd be able to go back. In fact, he rather naively thought he'd be going back quite soon, and of course that wasn't the case – apartheid carried on for many years after he left. 

The atmosphere at the time – people were being picked up by the police and security services, and friends were being picked up just because they were mentioned, and your Dad didn't understand why he was being detained and thought he could probably be out in a few days. You feel as though you were there because of the way he describes it:  how it became more obvious that he wasn't going to get out quickly, the experience of isolation…

Albie Sachs, an acclaimed activist and former judge in the Constitutional Court in new South Africa, wrote the foreword to the book and talks about the innocence… my father was 21 when he was arrested. In contrast to Albie and others who were known activists, my father wasn't in that category, he was just trying to live an ethical life. 

Most of us in this country, we can't begin to imagine what it must be like to live in a police state. Albie describes whiteness as being both a mitigating and an aggravating factor in terms of how the police approached my father as a detainee. The fact that he was a white man meant that he survived – he probably wouldn't have if he had been a black man – but also, there was a kind of aggravation from the special police force. They were embittered by the fact that he was engaged in something… they felt a betrayal, I think.

And do you recall mixed feelings towards you as a family in that way?

Oh yes. As a child, in the 70s and 80s in the UK, I remember feeling quite confused about other people's attitudes towards my South African family. There was such a sense of hostility towards white South Africa: it was the time where sanctions were being brought in. There was a hostility towards white South Africans… shame, almost. And I think of the wider context now, the level of scrutiny, and our thoughts about social injustice and Black Lives Matter. This is a story from 52 years ago, but the ideas, sadly, are as pertinent as ever.

Absolutely. I was around back in the day, and involved in anti-apartheid demonstrations. But even though I was on the road to being a psychologist, I hadn't realised how much psychologists had been involved in the establishment of apartheid. Saths Cooper was an anti-apartheid activist and has been president of South African Psychological Association. He has said that when he was imprisoned in Robben Island, he was surprised at the number of psychologists who were there – but none of them were imprisoned. They were leading figures. Hendrik Verwoerd was a professor of psychology and is often described as the architect of apartheid. 

It's a very disturbing part of our history, to reconcile and to think about the psychological processes associated with a regime such as apartheid. And of course, the form of torture used against my father was essentially a psychological process. He was deprived of human contact. He spent 55 days in solitary confinement, he was sleep deprived and made to stand on a brick for five days. He was tortured in such a way that the harm wouldn't be evident on his body, but it was evident in his spirit, his mind and his psyche. To be denied human contact…

The other side of that, though, was your father's description of his relationship with that brick…

He was able to have interesting conversations with the brick, which actually appeared to talk back to him and give him comfort and resilience.

It's such a great example, isn't it, of the incredible lengths that our human psyche will go to, to protect us. We'll find comfort and companionship in anything that we can. 

You've said a bit about lessons from the book, but I particularly wanted to ask you about appendix three: the principles for the political application of psychotherapy [see below].

These were eight guiding principles that were developed over years of practice at the Medical Foundation, through the guiding inspiration of Helen Bamber. They speak to the question of our responsibility, as therapists, psychologists and psychotherapists, and therapy as a politicised act. They invite us to think about where we place our own ethical positions of power, particularly in relation to those who've experienced oppression. 

My father describes some of these principles. They include the Human Rights commitment, and organisational commitment. He talks about the reclamation of space and time, survival as a process of bearing witness… those of us who work with anybody within the mental health service who has experienced abuses of any kind can connect with that. Often in our psychotherapeutic work, what we're doing is bearing witness to and supporting somebody's testimony in their experience of injustice. 

Which of those principles stood out for you, Tony, how relevant are they amongst our clinical trainings?

I thought that bearing witness and so on is part of a strand of psychological work usually thought of in post-genocide situations and so on, but it has very general relevance. We have so many ways in which the world has become politicised… having some framework for thinking about how psychological psychotherapeutic work needs to think of itself within a more political frame is very helpful.

I totally agree. We were confronted with it last year when we saw responses from organisations around the Black Lives Matter movement. Many organisations became quite self-searching and rather perturbed by the invitation to step forward and to take a particular position around Black Lives Matter. That's highlighted the need to have some guiding principles, and for us to be thinking about how we do confidently step forward into that political arena. It hasn't always felt safe or appropriate to do so.

With the British Psychological Society's Human Rights steering group, we're thinking about human rights based approaches in practice, generally. 

I'm working with family therapists in a similar way to think about our roles and responsibilities. But many clinical staff feel very disenfranchised, and don't feel like they have a sense of agency within the wider mental health system. So there's something about helping us all to be thinking about how we politicise ourselves (with a small 'p'), to be working with a shared endeavour to support those who are most at risk and most vulnerable.

I remember a paper that you sent me about your work with families, where they have very different perspective. I think it was primarily religious families you were working with. 

Yes, families where a kind of fundamentalist mindset around their religious beliefs seemed to be predominant. It forced me to think about our position as family therapists. We pride ourselves on thinking about power and diversity, race and religion. But I was finding a sense of trepidation around engaging in conversations with people who had very different ideas about power and abuse, or women's rights or children's rights, for example, than our own. The situation invited me to start exploring that – what are the limits of family therapy, of psychology, any form of psychotherapy, when the very notion of inviting a family or an individual to take an alternative position threatens the family's epistemological worldview? The idea that there might be an alternative view to the prevailing one was so threatening that we had to understand that as a real risk to the very fabric of that family.

These feel like taboo areas that we don't always get into. As therapists we might assume that it's always going to be possible to work with people… that there's always work to be done. But we sometimes get into situations, working with any kind of fundamentalist mindset – and that might be a kind of secular mindset that becomes fundamentalising for us, so that we become very polarised around a set of ideas, you know, views on the medical model or psychotherapeutic model – and that can be unhelpful.

So very relevant to many areas?

I think so. It was in some ways quite a provocative paper that I wrote. But I wanted to write it from a position of curiosity, collaboration and inquiry. I'm inviting us to engage in those tricky conversations that aren't clear, where we end up in murky waters trying to make sense of how to manoeuvre ourselves ethically and professionally.

Yes. Because the Truth and Reconciliation Commission, in some ways, coming back to the book, in some ways, is an example of trying to get away from the polarisation and give people an opportunity to think where they stood.

Absolutely. And it's so pertinent… here's a story, my father's story, where there is an element of rage, still… about the injustice that was done not just to him, but to thousands of people. It continues, you know, the situation in South Africa is incredibly complex and desperately sad in many ways. How do we support people to befriend and forgive, but also in validating and providing their testimony – to be heard? And we somehow have to do those things simultaneously.

- Note: This originally appeared online 25 May 2021.

Principles for the Political Application of Psychotherapy [appendix from 'When They Came For Me…'

These eight guiding principles were developed over years of practice at the Medical Foundation through the guiding inspiration of Helen Bamber, some of whose expressions will be found in this text. I drafted these principles in policy documents to guide our choice of personnel and our delivery of services, and saw to their publication. Today they are carried forward by Freedom from Torture (the agency's new name), the Helen Bamber Foundation, the Traumatic Stress Clinic and other agencies in the field. They were originally given by Helen Bamber and me, in a joint presentation under the title, 'Torture as the Perversion of a Healing Relationship', to the Annual Meeting of the American Association for the Advancement of Science, Boston, Massachusetts, 14 February 1988, in a panel convened for the AAAS Committee on Scientific Freedom and Responsibility by Dr (now Professor) Richard Mollica. The document was published by Diana Miserez in Refugees, the Trauma of Exile (Martinus Nijhoff Publishers, 1988) and then in Trauma and Uprooting (Matador, 2020), pp. 92–106.

Schlapobersky, John R. When They Came for Me (p. 301). Berghahn Books. Kindle Edition.

1. A Human Rights Commitment:

Torture is a social, political and moral problem that arises on co-ordinates of time and geography that are frequently planned as a political strategy at local and global levels. Whenever it is applied on a systematic basis, torture has historical precedents and well-designed social consequences. In these cases it is usually associated with other major features of political instability, and the individual sequelae of torture are therefore often difficult to disentangle from trauma associated with other man-made calamities like warfare; political conquest and dispossession; concentration camps; solitary confinement and other forms of imprisonment; exile, deportation and refugee status in a foreign land. Meaningful progress in rehabilitative work with survivors requires an understanding, by all concerned, that such work is part of a broader human rights commitment, addressed to these issues. In the face of these injustices, therapeutic neutrality is meaningless. Clients do better in therapy when they know that their therapist is aware of these human rights issues and when it is possible to share with clients the fact that therapeutic help is part of the organization's broader commitment to social justice.

2. The Principle of Positive Intervention: 

A Commitment to Rehabilitation with Individuals and Families Many of those we see have suffered extensive physical trauma. In these and in all other cases of torture there is massive psychic trauma, which, if unattended, will almost certainly be compounded rather than alleviated over time. We work to the principle of positive intervention through medical attention and through sustained and structured emotional support in all those cases where people express a need that allows us to engage with them in constructive terms. Where physical trauma is implicated, the principle of positive intervention begins from a medical consultation. We find that this plays a part in legitimizing help-seeking behaviour across a wide range of cultures. As a specialist in physical disorder, the physician has a direct and practical role to play, as well as an indirect symbolic one in helping to restore to individuals the privacy and integrity of their own bodily processes. The separation of body from mind is nowhere less appropriate than in the treatment of torture, where the body has been abused to gain access to the mind. An integrated physical and psychosocial approach is developed from this basic principle of positive intervention involving the combined endeavours of a multi-professional team. The concept of cure is in many cases inappropriate. Such post-traumatic sequelae are not the conditions of an illness so much as a form of bondage through which the torturer ensures that his interventions will last over time. The rehabilitative aim is centred on the purpose of freeing victims rather than 'curing' them. Damage is in many cases profound and extensive, but with almost everyone that comes to our attention there is something constructive that can be done. There are always questions to be asked as to what constitutes a resolution to the ultimate violation of someone's personal world: What does it mean for someone to get better, when wilful cruelty has caused lasting damage? And what counts as healing?

3. An Organizational Commitment

Separate individual treatments and discrete, unrelated resources are less useful than the resources of a team. Survivors' feelings of grief, rage and helplessness need a containing environment where staff can accept and work with them. A young man spoke of the process of 'decompensation' – the abreaction of profound trauma – not long after arriving in London from his home in Central America where he had been tortured and had seen others suffer. Until he was seen at the Medical Foundation some months later, there was no one who could encompass the terms of his anguish. And so, he told us, 'the forest was my doctor'. He would visit a nearby patch of beech forest where he would run about, cry and shout in great distress, relieving pent-up emotions. The Medical Foundation, he said later, 'took over from the forest'. Survivors need a relationship with a community rather than with a specific treatment, and it is only in a therapeutically structured community that staff can feel sufficiently supported by one another to endure their repeated exposure to extreme experience. There are always questions to be asked here about what this experience does to the staff who undergo this work, what they get out of it and how are they best supported.

4. Survival as a Creative Act

People's responses to stress are influenced by their own appraisal of the situation and their capacities to process the experience, to attach meaning to it and to incorporate it in their belief systems. Resilience in adversity is not only a strategy for coping but also a creative challenge. People's developmental histories, cognitive set, attachment and affectional base, their relationship network and prior experience of mastery and self-confidence through challenge and adaptation, are all determining factors in their reactions to massive trauma. In the range of therapies offered, we have found it essential to make contact with a person's prior forms of adjustment, and to reactivate internal and adaptive strategies for further recovery We have been profoundly impressed by the dignity of those who survive torture and by the importance they attach to transcending the victim identity and to reacquiring a sense of agency and creative endeavour in their lives. We have come to regard the services we offer as aids for the remarkable powers of self-renewal that our clients bring to us. Ordinary social relationships contain those agencies for change that can, when tapped, release profound self-healing, regenerative resources. We see our professional skills as a means towards this end. Mustafa, the teacher mentioned in the Epilogue, described how by teaching others he had found himself able to survive. Group therapy played an important role in his subsequent rehabilitation, for it helped him to rediscover strengths and resources in himself that the needs of others drew from him. He had lost most of what he loved and valued, and a sense of inconsolable loss pervaded the clinical picture. He was startled by the growing recognition in the group that he had not lost the capacity to be of use to others, and after this discovery he was able to rebuild his life. There are intriguing questions to be raised here as to how many other cases of psychotherapy show progress when survival, self-renewal and personal transformation arise through similar dynamics of self-creation.

5. Survival as a Process of Bearing Witness

Disaster imposes a sense of isolation on each survivor. The reduction of this isolation must be a central part of the process of recovery if people are to make genuine adjustments. The sustained and structured emotional support available at the Foundation has the aim of sharing with survivors an acceptance that they have each witnessed disaster of incomprehensible magnitude. Many come to see that the testimony they provide in the process of bearing witness carries a responsibility towards the past that is one of the keys towards adjustment in the future. This can become one of the most powerful antidotes to the guilt of survival. The telling of stories and the recounting of narrative has become an integral and engaging aspect of the Foundation's life. The question to be asked here is, in how many other such cases of psychotherapy should we regard the evidential content of the patient's narrative as something like testimony that can be built upon as it is written up? In this case, the therapist's role is akin to that of the oral historian. 6. Torture as a Perverted Form of Intimacy Torture frequently involves an intimate and intense relationship between an individual and one or several others. The body and mind of the victim are a focus for concentrated attention, either in the form of an onslaught or assault, or in a process that is sustained over time and repeatedly applied. Injury thus arises in a direct and personal relationship whose purpose is the deliberate destruction of bodily and psychic integrity. Where the body is the primary site of attack, it is the torturer's point of access to the victim's identity and mind, and every physical scar leaves an emotional scar.

7. Torture as a Secular Inquisition

Torture has always been an instrument of war. It is today once again the means for maintaining a particular kind of 'peace', and to achieve social control through coercion or terror the state has established itself as a secular inquisition in many countries. The suffering of the individual is thus the torturer's access to the community. The victims of torture are always individuals, but never individuals alone. For every person detained, there are mothers and fathers, brothers and sisters, wives and children who wait. Torturers deprive the community of its individuals. Just as significantly, they deprive the individual of community by attacking the trust and coherence that make the fabric of any society. As a personal and intimate violation, the torture process 'borrows' from the prototype of a healing relationship between a person and their doctor, confessor or counsellor. But in doing so it perverts the benign intentions of the healing relationship to induce the very state from which the healer is committed to free their patient. This can leave the victim maimed, incapacitated, disabled, cowed, and dispossessed of information; or the victim can be forced to witness or participate in such action against others.

8. The Reclamation of Space and Time

The majority of those tortured do not survive. The testimony of those who do, seen in agencies like ours, casts a shadow upon us all. Koestler's account of his time in detention awaiting execution during the Spanish Civil War is given in the Epilogue. He described himself and his fellow inmates as 'men without shadows'. We see our responsibility, partly, in reclaiming time and space for those who have suffered the loss of both. We attempt to help those who have lived 'without shadows' to discover a voice with which to speak of themselves. A young man, consumed by intensely injured emotions that followed torture and exile said, 'I've lost my life, I've lost my plan. When you have a plan for life and the base is broken, nothing is left. I wanted to build my future and have an education, but now everything is lost.' Another person talked about becoming 'zero.' First, he had been a student; and he would have become an economist, he said, or perhaps even a lawyer. But now, he said, 'I have become a zero.' Sometimes, he said, he did not want to live: 'If you aren't happy, if you aren't glad in the world then you might [as well] die.' Then he laughed and said that he still had his youth and his freedom, and he wanted to make a new beginning. We find that as people begin to speak for themselves, they can reclaim time and space. Like the people described above, they recover from the consequences of torture and rediscover an entitlement to a lifespan that the process was intended to destroy. When people who have endured a nightmare begin to talk about survival, it behoves us all to take account of what they have to say. The poet Anna Akhmatova writes that if you listen to her, "You will hear thunder".

And so it is with the perversion of human relationships. The damage done in hours, days or months remains in the bodies and minds of those who survive. Torment is internalized, and profound injuries are either disavowed at great personal expense, or are lived out through biological and psychological processes, until such time as an audience is found that can bear to pay attention. To listen, however, one must be ready to 'hear thunder'.