The Therapeutic Community at Austen Riggs: The Italian Lectures

Published on 
December 2016

Donna Elmendorf, PhD
Edward R. Shapiro, MD

These three lectures were given by videotape and presented at a conference on therapeutic communities sponsored in 2016 by Il Porto in Italy. The first, by Dr. Elmendorf, gives the history of the therapeutic community at Riggs. Beginning with Austen Fox Riggs' effort to engage people in shared tasks in order to open up their life stories, Dr. Elmendorf traces the increasing influence of psychoanalysis at Riggs, outlining the early recognition of the impact of patient freedom on learning. She traces the movement at Riggs from the study of the therapeutic community to the interpretive study of the total organization (staff and patients, with their role-related interaction).


In his first lecture, Dr. Shapiro opens up an interpretive model for collective irrationality, moving from the individual to the couple to the family to the organization. Focusing on the primary task for each social system, he notes that 'role' (which is a function of that primary task) is the place where person and context meet. Interpreting experience in role and linking it to the experience of others in related roles opens the possibility of making sense of the underlying dynamics of the system. He ends with the study of psychoanalytic institutes as an example of this approach.


In his second lecture, Dr. Shapiro suggests that changes in the outside world (in family structure, gender roles, and social institutions) have contributed to a change in presenting psychopathology over the past century, from neurosis to personality disorder. These changes have gone along with changes in psychoanalytic models of treatment (from the silent analyst studying the patient, to the recognition of a two-person system, to the necessary recognition of the influence of the context). With an extended family example, Dr. Shapiro illustrates how individual psychopathology is a product of a family system, inevitably engaging the therapist in irrational ways. The case illustrates the interpretive model presented in the first lecture and its applicability to the therapeutic community.