Lothlorien Community: A Holistic Approach to Recovery from Mental Health Problems
(Published in the journal ‘therapeutic communities’ autumn 2008)
Brendan Hickey (Manager at Lothlorien, 1992-2013)
Abstract: This paper describes the work of Lothlorien Community. The natural environment is a central part of the therapy, with the daily programme primarily based on organic gardening. This has a very beneficial effect on mental wellbeing. Interacting with others in a mutually supportive atmosphere and contributing to the working life of the community helps to rebuild residents’ self-esteem and self-confidence. Relaxation groups influenced by Buddhist meditation practice help to further develop the sense of mindfulness and relaxation which is gained through gardening.
This paper will look at the work of Lothlorien Community, a therapeutic community for people with mental health problems situated in a quiet rural setting in the Galloway hills in South West Scotland.
Edward Podvoll (2003) talks about the universal impulse to create a healing environment based on our deep, intuitive understanding that mind, body and environment are enmeshed and interdependent. Lothlorien attempts to put this principle into practice. The paper (with comments from current and former residents) will look at how the different aspects of community life, such as gardening, relaxation/mindfulness groups, mutual support and staff input, combine to provide a holistic approach to recovery.
The community has 17 acres of land, which includes organic vegetable gardens, woodlands and an orchard. The main house has places for eight residents, who can stay up to two years, usually in the aftermath of a crisis or an acute hospital admission. Five voluntary co-workers live in the house in a befriending role. In 2003, a second house, Roan Lodge, was opened as a move-on house, with places for five residents, who can stay up to five years. Although there are close links between the two households, Roan Lodge has a separate structure and will not be looked at in this paper.
The four staff, known as the Core Group, have backgrounds in psychotherapy, counselling and social work. They are non-resident and are present during the working week. They come in on emergencies at other times, although in practice this rarely happens. Their main function is maintaining the structures and boundaries of the community and facilitating the therapeutic aims of Lothlorien.
Although the Core Group has certain managerial responsibilities, important day-to-day decisions are devolved as much as possible to the community.
The original Lothlorien Community was founded by the Haughton family who purchased the land in 1974 and, with the help of volunteers, built the large 13-bedroomed, two-storey house from locally-cut larch and Scots pine. Readers of Tolkien will recognise the name. In ‘Lord of the Rings’ (Tolkien 1954) the woods of Lothlorien are a place of healing, where time stood still.
The community had a broadly Christian ethos. Hospitality was a central principle, and, as well as being home for members of the Haughton family, the community welcomed vulnerable people seeking help and support. When the community ran into financial difficulties in the late 1980s, they agreed to pass on the ownership to the Rokpa Trust, who took over in 1989.
The Rokpa Trust runs Samye Ling Tibetan Buddhist Monastery in Dumfriesshire, Scotland, which was founded in 1967 by Akong Rinpoche, a Tibetan lama with an interest in healing. Over time, Samye Ling became known as a community with an atmosphere of tolerance and acceptance. Many people came looking for help in facing psychological or physical problems rather than wanting to study Buddhism or learn how to meditate. From the early 1980s, Akong Rinpoche began to develop ways to pass on his knowledge and understanding, both as a Buddhist meditation teacher and as a doctor of traditional Tibetan medicine, in a form which would be accessible to all, no matter what their beliefs. He collaborated with a small group of psychotherapists, psychologists, psychiatrists and other health care professionals in order to integrate methods from Buddhist understandings of the mind with Western psychotherapy. This led to the development of a method of psychotherapy, Tara Rokpa Therapy (Irwin & Hensey 2001), and more recently into a way of training therapists and others in health care, particularly in the field of mental health. An emphasis on developing compassion has been held at the core of Akong Rinpoche’s approach, as he identifies lack of compassion for ourselves and others as a primary cause for mental suffering (Rinpoche 1987). This is also reflected in current research into compassion-based approaches within psychology, which suggests that our ability to develop compassion for self and others helps to develop ways of living which increase wellbeing (Gilbert 2005).
In the 1980s, as the number of people with mental health problems requesting to come to Samye Ling was increasing, Akong Rinpoche saw that their needs would be better met in a smaller, secular community which offered specialist support. He had plans to develop a residential centre when the Rokpa Trust was presented with the opportunity to take over the running of Lothlorien in 1989.
Lothlorien was then run as a supportive community by volunteers for three years until grant funding allowed the appointment of a manager and staff in 1992. Over the next two years, the structures, roles and procedures were modified to give Lothlorien a defined purpose as a therapeutic rather than a supportive community. An important part of this process involved having a number of feedback consultations with community members, using an external facilitator. A Management Advisory Group, which included key people involved in the development of Tara Rokpa Therapy, was formed in order to assist with the development of the therapeutic community model. The members of this group had a wide range of experience in mental health work, psychotherapy and in therapeutic communities such as the Philadelphia Association in London, Soteria House and Burch House in the United States.
The philosophy of Lothlorien
Between 1992 and 1994, Lothlorien’s approach was developed and articulated.
It was strongly influenced by the Buddhist model of psychology, which in common with some western models such as the Systemic and Constructivist approaches, takes an optimistic view of human nature. Buddhist Psychology is based on the premise that basic health and sanity are intrinsic in our deeper nature, manifesting as openness, clarity and compassion (Trungpa 2005). This is always present, even in the midst of pain and distress. All human beings have within them the resources to heal themselves at a deep level when they are able to reconnect with this ground of basic sanity. This can be fostered in an environment of emotional warmth and acceptance, which helps people in recovery from serious mental health problems to find a more gentle and accepting attitude towards themselves and to move away from painful self-preoccupation (Podvoll 2003).
Over the years, the approach at Lothlorien has been influenced by the fact that most members of the Core Group, as well as a significant number of co-workers, have come with a background of individual meditation practice. In the area of mental health, our expectations in our engagement with others have a powerful effect on outcome (Mosher & Burti 1989). The deeper one goes in one’s meditation practice, the more confident one becomes in the presence of basic health and sanity in oneself (Trungpa 2005). This leads to an optimistic and respectful view of others. When one comes to see that everyone has a similar potential to reconnect with basic sanity, one sees that, ultimately, people need not be imprisoned by their past nor by what they are experiencing in the present. It becomes natural to focus on strengths rather than on deficits. This can also help in the breaking down of the tendency to distinguish those who are ‘well’ from those who are ‘unwell’.
In recent years, research has shown the benefits of a mindfulness-based approach as a means to helping people who experience mental distress (Kabat-Zinn 1996). From the point of view of Buddhist Psychology, basic sanity can be fostered through relating mindfully to the here and now, especially in the process of bringing mind and body together when relating to the external world (Podvoll 2003). When people in emotional distress came to stay at Samye Ling, Akong Rinpoche usually recommended that they do gardening or physical work within the community as a means to regaining a sense of balance. As this was seen to be very effective, it was decided to make the therapeutic use of horticulture the central feature of the programme at Lothlorien and to apply methods from Tara Rokpa Therapy as a means of further developing the sense of mindfulness and relaxation.
Lothlorien has also been influenced by the phenomenological approach of R.D. Laing (1960) and Loren Mosher (Mosher & Burti 1989), which focuses on the development of non-intrusive, non-controlling but actively empathetic relationships with those experiencing psychosis. Through unconditional acceptance of the experience of others as valid, the aim of this approach is to develop, over time, a shared understanding of the meaningfulness of the individual’s experience without having to do anything explicitly therapeutic.
Selection of new members
The approach at Lothlorien has been designed in particular to help people who are in the early stages of recovery from psychosis. However, it has also benefited people with a wide range of mental health problems. In considering applications, we look at whether the person is motivated to change, wishes to take responsibility for themselves and is able to live with others with an attitude of respect and cooperation. Due to the low level of staffing, we cannot consider those with a history of violence or those who are likely to seriously self-harm. It is important that people apply at a stage in their recovery when they are motivated to join in the daily programme, although naturally we understand that those who come after a long spell in hospital or a period of inactivity will need to ease their way into the programme.
Residents come to Lothlorien from all over Britain. Most are funded through their local Social Services, but some are able to self-fund as charges are relatively low in comparison with most therapeutic communities. If the applicant fits the criteria for being at Lothlorien, they are invited for a two-week trial stay. The community, who are normally very astute in assessing who could benefit from being at Lothlorien, then decide whether to invite the person to join on a long-term basis. A minimum commitment of six months is required and the maximum stay is two years. There is a relatively low dropout rate. Over the last seven years, about 10% of residents have dropped out before the end of the first six months, with each of these staying for periods of between 10 to 16 weeks.
It has been important to develop a collaborative working relationship with the local statutory mental health services, as none of the Core Group is medically trained. Most residents have had a long involvement with psychiatric services and would not be able to sustain being at Lothlorien without medication. They are required to register with a local doctor and to receive input from the Community Mental Health Team.
Community life: making and sustaining relationships
Lothlorien, in common with all therapeutic communities, sees the community itself not just as the backdrop, but the primary therapeutic factor. Most residents have experienced social isolation and lack of support prior to coming to Lothlorien, with little opportunity to contribute meaningfully to society. The normal process of daily community life encourages a sense of interrelatedness and acting in a manner which takes into account others’ needs and feelings, as well as one’s own. Positive qualities which can serve the interests of the community are seen as inherent in each individual and are respected and reinforced when they emerge. This helps to counteract the low self-esteem, lack of confidence and demoralisation which affects many people who experience serious mental health problems (Mosher & Burti 1989).
Lothlorien is characterised by a non-intrusive approach. In order to benefit from being at the community, it is not essential for residents to significantly self-disclose their personal history, either in one-to-one support sessions with the members of the Core Group or in the community meeting. Many residents have said that living in an atmosphere of acceptance and non-judgmentalism is in itself the crucial aspect.
The most valuable thing about being here is the unspoken camaraderie, being part of something where people are accepted and having a sense of belonging. You don’t necessarily have to talk about your problems. People empathise with you, especially when you are having a hard time.
Others find that the mutual support among residents to be the main therapeutic factor. Sharing experiences of mental distress with fellow residents results in relief and validation and the sense of having something to offer each other. Choice in self-disclosure is highly valued and the following sentiment was echoed strongly by a number of other residents.
There is a lot of personal disclosure with specific people you form friendships with. There is always someone with a listening ear, but it’s important to me that I feel in control of who to share with, what to share and when to share it. There are some things I want to talk about with the Core Group and other things I share with people I’ve become friendly with here in the community.
We believe that alleviating mental distress is not just the domain of experts but is a human problem that can be addressed with a human response. Drawing on the example of the Soteria House project (Mosher, Hendrix & Fort 2004), non-professionals play a key role at Lothlorien in creating a homelike, non-authoritarian environment. Co-workers come to live at Lothlorien on a voluntary basis for a period of between six months and two years. This reinforces the notion of community, because co-workers are choosing to make Lothlorien their home, rather than being paid to ‘look after’ residents. As community members, they have an acknowledged right to have their individual needs and limitations taken into account rather than being continuously expected to be in the caring role.
Although distinctions between co-workers and residents are minimised, the co-workers have a key role to play by helping to provide support and encouragement and by sustaining the daily routines. They aim to take an approach of ‘doing with’ rather than ‘doing for’ so that everyone is encouraged to participate to the best of their ability. In this way, unnecessary dependency is avoided and residents can develop their sense of autonomy and independence.
Forming and sustaining meaningful social and personal relationships is a major part of recovery. The co-worker’s role is, as much as anything else, a befriending role which eases the residents’ transition into the social world from which many people with mental health problems are excluded. In this regard, the leisure time of the community is as important as the work routine, whether it’s relaxing together after a day’s work or sharing the simple pleasures of rural life, like going for a walk in the surrounding countryside or a swim in the river during the summer. Community members have built links with the wider community. They feel well accepted when they go to the village pub for a drink or a game of pool and often attend social events in the local area, where people have been very supportive of Lothlorien over the years.
Before coming here, I had difficulty in socialising. Here I have been able to do things, especially with the co-workers, whether I have felt well or unwell. I feel that sometimes I am regressing in a fun way, having a deep sense of enjoyment in doing things with other people here, without the fear I felt in my childhood.
Community life: work routines
There is a structured daily programme between Monday and Friday. After breakfast, there is communal chore time, followed by the community meeting. There are work periods of two hours each in the morning and in the afternoon. Participation in the work programme helps residents to feel valued through making a positive contribution. It also allows residents to re-learn patterns of healthy, everyday living.
The routine is very important for me, from doing chores in the morning to working in the garden or cooking. Before I came here I was living on my own and my life was very chaotic. The structure and the routine here has helped me to be much more stable.
The organically-cultivated vegetable garden is the main focus of daily life and gives a sense of purpose to the community. The work is productive and with a growing area of about 1,500 square metres, we are self-sufficient in vegetables for about four months of the year. Two polytunnels extend the growing season and, by storing surplus fruit and vegetables, we have the option of using some of our produce throughout the year.
The Horticultural Support Worker provides the necessary expertise in planning and overseeing the work and in offering practical instruction. Every day there is a wide variety of tasks on offer and people can gravitate towards the type of work that they most enjoy, whether it is hard, energetic work like digging or lighter work, such as weeding. Some people like to work on their own. Others benefit from working as part of a group, which helps them to feel connected, even when they are struggling with their mental health or finding it hard to engage at a verbal level: ‘I value the companionship. An ease develops when you are working alongside people.’
We take into account that many residents have been inactive for a long time before coming here. The pace of work is gentle and there is a tea break half-way through each work period. The dissociative effect of medication may also slow down energy levels and motivation, but most residents generally manage to participate in the programme every day. Peer pressure and mutual encouragement are the main motivating factors and those who are less keen on gardening can spend some of their time on other practical tasks which benefit the community.
All the community members get involved to a greater or lesser extent in cooking the communal meals, with frequent sharing of ideas and recipes. There is also regular bread-making and baking. Cooking wholesome food, especially when it is harvested from the garden, reinforces the sense of being in a nourishing environment and also leads to the satisfaction of making a positive contribution to the community’s welfare.
The therapeutic benefits of gardening
There is a growing recognition of the therapeutic benefits of gardening (Grut & Linden 2002). Community members report improvements in their physical health and a sense of fulfilment though carrying out a meaningful activity which benefits the community. Learning to care about the natural world through the process of planting seeds, nourishing them and watching them grow before finally harvesting the vegetables can help to re-activate a sense of caring for oneself and others.
Working along people who really enjoy gardening has opened up how to appreciate the joy of the natural world. It’s taught me to respect the natural world and to respect ourselves in the process
Laing (1960) says that there is often a split or dissociation between mind and body as a result of psychosis, with mind experienced as ‘self’ and body as ‘other’. This tendency can be counteracted by physical activities such as gardening, which promote mindfulness in a very natural, gentle manner by bringing body and mind together, leading to a sense of relaxation.
Gardening helps me to feel grounded and helps to take away the negative thoughts I might be having. It helps to stop me from becoming too preoccupied.
When I was most unwell gardening was difficult, but over time I built up a strong relationship with it. It was about me and the natural world. I liked working on my own in the garden. It helped to calm my mind and allowed my emotions to settle.
Residents often find metaphorical links between the garden and their own journey, with the garden offering readily available metaphors which reflect their inner process. One person found that there was a parallel between being part of the cycle of nature and her own life.
Relating to the four seasons has helped me to relate to the cycle of change and growth. It is a metaphor for growth and change in myself.
In therapeutic communities with an action-based programme, it is important that residents are supported in bringing the gains made to conscious recognition by verbalising them (Blake, Millard & Roberts 1984). The Core Group facilitates this process through offering regular one-to-one support. Although the members of the Core Group are trained in psychotherapy, individual psychotherapy is not offered as it would detract from the community as the locus of therapy and could also create preferential relationships. We respect that people may not want to explore past distressing events or indeed to use the one-to-one support to any significant extent. However, to varying degrees, residents may wish to explore the context in which their mental health problems emerged. This can help them to find new ways of understanding their experiences and to look at how they can use Lothlorien to create a better quality of life in the future.
If a resident experiences a relapse in his/her mental health while at Lothlorien, there is generally felt to be a great deal of tolerance and support among the community members at these times. However, with low staffing levels, we are not set up to work intensively with those in a crisis for any length of time, as was the case in communities like Soteria House (Mosher, Hendrix & Fort 2004). Sometimes the individual’s distress can be contained through more intensive one-to-one support from the Core Group, and through support from the statutory services. Occasionally, a short hospitalisation may be required if the person is so distressed that they feel unsafe, or when the situation is resulting in exhaustion and stress for the rest of the community.
The community meeting
In keeping with the therapeutic community ethos of democratisation and empowerment, a daily community meeting is held, which usually lasts between 20 and 30 minutes. It is chaired in turn by members of the group and primarily focuses on information sharing, planning, negotiating and decision making with regard to work tasks and practical day-to-day issues in the community. It promotes the idea that community life is a shared responsibility.
The community meeting serves as a reminder every day that you are part of a group of people who are trying to help each other.
The meeting does not function as a psychotherapy group and we do not attempt to explore deeper unconscious or transference issues or to foster regressive processes, as we feel that this is not beneficial for those in recovery from psychosis. The vast majority of residents freely acknowledge that they would have not come to Lothlorien if it was based on intensive group psychotherapy with an expectation of a high level of self-disclosure. Therefore, rather than breaking down defences, we see the purpose of the meeting as building up self-confidence, developing interpersonal skills and fostering mutual support and understanding.
It was important that the meeting was non-threatening when I felt most fragile. It provided a safe holding space, with a sense of acceptance, patience and tolerance.
At the beginning and end of the week, the meeting offers the opportunity for personal sharing. This fosters an atmosphere of mutual support and a sense of being connected to the group, which spreads to informal interactions within the community. The focus on the here and now and the community members is not encouraged or expected to explore links with past events. When conflict or differences emerge in the meeting, the Core Group take a facilitative role. However, it is not necessary to deal with all conflict within the whole group and there is the option to use a member of the Core Group as a mediator in a private meeting when two people have interpersonal issues to resolve.
Relaxation and mindfulness
According to Podvoll (2003), Western approaches pay more attention to the content of the mind, rather than to the process of mind. They rarely show a person in recovery from psychosis how to care for their mind. In a mindfulness-based approach, the key task is to bring the mind back to its focus in a gentle way whenever it gets caught up or distracted by discursive thoughts or emotions. At Lothlorien, this can be fostered in a natural way in activities such as gardening, which increase mindfulness and sensory awareness of the environment. It can be further developed through participating in sessions which use methods based on Tara Rokpa Therapy. These are held after the work period three times per week and are led by the Deputy Manager, who is a trained Tara Rokpa Therapist. Attendance is optional, but the majority of people come regularly.
The sessions consist of relaxation exercises which develop mindfulness through gentle breathing exercises and the cultivation of awareness of body sensations (Irwin 1999). These are usually done lying down rather than sitting. Self-healing visualisations are also presented. The exercises are based on the premise that all human beings have within them the resources to heal themselves at a deep level by connecting with the healing quality of the mind, which is intrinsic. One learns to be present in the here and now and to develop a relaxed openness to whatever is encountered. This helps in identifying less strongly with thoughts and emotions and can counteract the tendency to self-absorption.
Sometimes the sessions are followed by massage, which is presented at a beginner’s level with the emphasis on friendly exchange. Art materials are also used in the sessions as a means of playful exploration and self-expression.
Participants in the group report a variety of benefits in these methods. For some, it is initially very difficult to relax and to sustain the exercises. It may take months before they can feel comfortable enough to stay until the end of the session. However, over time the exercises help them to reconnect with emotions in a safe way. Some participants may find that they fall asleep and achieve a deeper sense of rest than they do at night. Others find that there is a positive effect on their mood.
The exercises relax me and settle me. It’s become part of my routine. It gives me a focus to clear myself. It puts me in a more positive mood and sets me up for the rest of the day.
The process of mindfulness and relaxation is further augmented by Qigong, a system of gentle exercises closely related to Tai Chi, which are designed to promote health and vitality. We do a 20-minute session of Qigong three mornings a week. Again this is optional, but well attended.
We have not been in a position to undertake specific research on Lothlorien, although we have participated with about 20 other communities in the ATC/ NLCB research (Lees et al. 2004). The evidence as to the effectiveness of our approach is based on feedback from current and former community members. This seems to be in line with research which shows that adopting the therapeutic community ideology, actively participating and forming close relationships leads to improvement (Smith, Wood & Smale 1980).
The moving on process from the community can be challenging for many residents, due to Lothlorien’s geographical isolation. For those moving to the local area, it is possible to have a gradual transition and follow-up support, which includes having the opportunity of visiting the community on a weekly basis to work in the garden. However, for those who return to their home area outside the region, it is more difficult to offer a similar level of support. Although residents are encouraged during their time at Lothlorien to keep in touch with networks of support in their area of origin, moving from a highly-supportive structured setting to living independently can present some initial difficulties. One ex-resident said that leaving was ‘like landing with a bump.’
The opening of Roan Lodge as a move-on house has addressed this issue for some residents. At Roan Lodge the benefits gained from participating in the structured lifestyle at Lothlorien can be consolidated and residents can achieve a gradual transition back to independence by undertaking some activities locally, such as voluntary work or training courses, in addition to working within the community garden
From the point of view of social and psychological recovery processes (May 2004), most former community members say that Lothlorien has made a significant difference to their quality of life, in spite of some people having initial difficulties with the transition back to independence. Residents feel that Lothlorien gives them a greater confidence at the interpersonal level which they carry on to new situations. It has created a supportive social network which continues long after people leave, with most community members keeping in contact with their peer group for years after leaving and also visiting the community on occasion.
Most residents experience a higher level of social inclusion as a result of their stay. Almost everyone moves on to live independently after being at Lothlorien. Those who have been able to achieve a more active lifestyle say that the structured daily programme at Lothlorien has helped them to re-discover internal discipline and healthy daily rhythms. Rather than singling out a particular part of the programme, it seems that it is the totality of all the different aspects of community life, the work, the interpersonal and the relaxation, which helps to lay the foundation for recovery.
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