I'm going to talk about the issues of scale whilst considering how we work at the Arbours Crisis Centre. At the Centre we have three groups of people, three resident therapists, six guests (the name we give to our patients at the Centre) and 10 team leaders.

The guests who come to the Centre are extremely damaged people. They live on a precipice, their identities uncertain, unsure whether they want to live - or not. Many of our guests over recent years have inhabited the borderline state of mind, neither in relationships nor out of them, 'stable in their instability' neither choosing life nor death but often finding frightening behaviours that keep them compromised at death's door. Many of the guests at the Centre 'do' something destructive like bingeing, or cutting. Usually they are people who in their history have experienced someone 'doing' something to them - they have been intruded upon by others. Their 'no', perhaps in a situation of abuse, has not been heard. Consequently as part of their way of communicating they 'do' things to themselves... and to others, usually through the launching of violent projections - that is forcing their anxieties into other people. For people in this borderline state of mind nothing is right, and, often, despite having used considerable energy to get to the Crisis Centre, when they get there, everything is wrong. The food is wrong, the rooms are too big, or too small, the resident therapists are either always too busy when you want them, or they are knocking on your door just when you wanted to be alone. Rooms are too hot or too cold, team leaders are either too removed, or too demanding on the guest - and so' on. This is the borderline world where the world of intimate relations between subject and object, mother and child, has been profoundly damaged. And there is the longing for the transformational object - the person or place that will make everything right.

Often, guests at the Centre experience a crisis on arriving they feel they are going to be trapped in a cruel setting where everything is wrong. They worry that no one will like them, and that no one would voluntarily want to be with them. For these people every attempt must then be made to control others, through projective processes - that is making other people feel as they feel. We are all familiar with the feelings of being very special to them one moment (achieved through our taking in their projection of their desire to merge), that we are an exclusive source of help, only to feel that what we offer is making them worse, the next. This shifting transference, often full of aggression, is the hallmark of work with people in borderline states as they desperately try and protect themselves from the dangers that close relationships have caused in the past. Obviously, in a setting as small as the Crisis Centre, these dynamics are intensified but the possibilities for creative resolution are also increased.

The three resident therapists who live at the Centre are its backbone, the people the guests spend most time with and usually become most attached to. Because the resident therapists live at the Centre, this means that the Centre can be staffed 24 hours a day without shifts. 1 think this is a cornerstone to the success of the Centre. Because we don't have to rely on a shift system, we can work intensively with very disturbed and distressed guests, but without needing a large team of people - the guests need to relate to a team of three, not a team of 9 as there would be in a shift system. This simple fact makes a huge difference to people who are very disturbed and overwhelmed. It provides a level of consistency which is unrivalled and sustains an environment in which ordinary acts of human concern and kindness can be shared. Obviously this concern and kindness is found in most psychiatric settings, but there the comings and goings of staff and patients alike means that it is sometimes harder to hold onto these interactions within the context of a deepening human relationship. The psychoanalyst Donald Winnicott wrote that 'psychotherapy is not about making clever and apt interpretations; by and large it is a long-term giving the patient back what the patient brings'. It seems to me that this 'giving back' is easier in a smaller setting where there are frequent opportunities for a fine tuned responsiveness and that this responsiveness is such an important part of any attachment.

However, at the Crisis Centre we get it wrong as often as anyone else. I don't think that we are any better at getting it right as such, than anywhere else. But because of the scale of the Centre, what is wrong or distressing between the guest, the resident therapist or the team leader can be addressed more quickly. And this seems to be especially important when working with people who live on the borderline of sanity, for whom time is never a healer, and who are often unconsciously trying to recreate chaotic relationships which are 'aggressively charged'.

Most of the guests who come to stay at the Centre cannot tolerate experiences of separation or breaks. For them, at this point, psychotherapy is only possible within a residential setting. Often, continuity in their personal relations has been broken. Also most of the guests at the Centre have experienced such a failure in their early containment that, as adults, they need a large container to work through their emotional problems. This is why we work in a team at the Centre - that is the three' or four weekly therapy sessions are held between the guest, the resident therapist and the team leader who is an experienced psychoanalytic psychotherapist. It is our experience that building a bridge in this way between the house (the milieu) and the psychotherapy means that splits - divisions between people - can be better held within people. Furthermore the team leader can 'gather' the negative feelings, the negative transference, aimed at the resident therapist, or to the house, towards themselves. This makes it possible for the resident therapist to remain close and kind towards their guests rather than at their wits end, full of hostile feelings which have been projected from the guest. In this way the resident therapist helps the guest to think about situations too difficult for them to handle alone. On the other hand the team leader also functions as an ego-support to the resident therapist who is often carrying a very considerable burden of anxiety.

The team structure also allows us to keep relationships as our focus. We can put together a psychodynamic approach which is based on a psychoanalytic understanding of the guest's distress, with something more practical and day-to-day, the here and now. This focus on the experience of everyday living in the house, and in the therapy, is very important. This is especially true for this group of people who have great difficulty with closeness, and may be very suspicious and intolerant of it. Perhaps because they didn't meet with maternal responsiveness in their early childhoods, they may not have adequate ways of dealing with intense emotion. They lack adequate internal 'representation of their own or others' states of mind' (Holmes 1993). This representation is what Peter Fonagy calls 'mentalising capacity' the ability to imagine that the self will be responded to and understood and that a' reciprocal process can take place. That is, that one can understand another person and take another's point of view. Those people who lack this experience of containment or soothing, have to deal with intense emotion through projection. For them need and anger sit very closely together and inevitably the transference is filled with aggression.

Another crucial aspect of the team is the opportunity it provides for a coherent approach, with both the team leader and the resident therapist having a similarity of response. This is especially helpful to those guests who maintain their precarious equilibrium by splitting, that is creating conflict between people. It also avoids the unhelpful situation where a guest could be extremely engaged in exploring major issues in their therapy whilst being profoundly unsettled in the house, or vice versa. For the resident therapists issues of identification and coherence are also important. All the resident therapists have their own intensive psychoanalytic psychotherapy or analysis and all follow the training programme of the Arbours. I would also suggest that their presence in the team meetings also allows them a necessary identification with the team leader, a benign way of making the distinction between themselves and the guests. This is an identification with the therapist part of their role, rather than the resident.

The team approach has, I think, been part of the innovative and coherent approach taken at the Arbours Crisis Centre. It enables the resident therapists to live closely with very disturbed people. And over the years the resident therapists have provided substantial help to their guests. This is the history that we're celebrating this evening - the history which began when the Arbours was founded by Drs Joe Berke and Morton Schatzman. The first Arbours Community started in 1970 when Morton Schatzman and Vivian Millet began to share their home with several people diagnosed, or diagnosable, as schizophrenic. This was followed by a more structured venture, which became the Arbours Crisis Centre, with Tom Ryan and Sally Berry as the first resident therapists. And by now there have been 25 resident therapists - each making a remarkable contribution to the Crisis Centre.

I want to say too something about our director Joe Berke who has brought, and continues to bring, to the Centre a powerfully consistent and coherent vision, an overview of the work, held with remarkable stamina and energy. Joe has been director of the Centre for 25 years. Although the Centre is small. in scale, it has always been big in ideas. Through his teaching and writing Joe has extended the influence of the Centre far and wide. I'd like to acknowledge the contribution Joe makes to the work and the inspiration he has given, and continues to give his colleagues.