Hilary Cottam (2018) Radical Help. London. Virago

Dr. Chris Brogan, Squiggle Trustee & Psychotherapist in Newcastle, reviews a book which promotes the identification of individual, community and professional resources to solve what have previously proven to be intractable family and social problems and finds a matrix which resonates with the spirit of the maturational processes and the facilitating environment.

“Radical Help” is a highly engaging book whose central thesis is that the welfare state was set up by Beveridge to address mid 20 century problems when social structures were so different from now that his model is no longer fit for purpose. In fact, Beveridge himself later regretted that he had not put more emphasis in his report on the relationship between the individual and the wider community. Cottam reinstates the building up of community relationships as one of the key principles guiding her action, together with recognising and capitalising on capabilities. In other words, instead of trying to ‘patch up’ the deficits of vulnerable people she finds out what they want to achieve, how they can contribute and involves them in planning. She facilitates an expansion of relationships which have often shrunk under poverty and disadvantage. She draws inspiration from Nobel Prize Economist Amartya Sen and Philosopher, Martha Nussbaum and mentions Winnicott on Transitional Phenomena and Harold Bridger who used Winnicott’s work to think about transitions in organisations.

After establishing Cottam’s position on the nature of the problems facing the U.K. welfare system, the second part of the book outlines five social experiments with teenagers, elderly lonely people, people with chronic illness, families who use services heavily and an experiment setting up an alternative jobcentre based on capabilities: Cottam is very open about the obstacles and sometimes failures which were encountered. The third part is devoted to describing the process and principles which guide her work.

These social experiments were very challenging to existing services. For instance the mother of a family who had a total of 72 people and 40 agencies involved, at a cost a quarter of a million pounds a year, was put in charge of interviewing the people she wanted to be members of a “Life Team” and was encouraged to think about her own capabilities, whilst existing agencies pulled back. Whereas the Life Teams were very successful in working with families in Swindon and Wigan in other areas they were not so successful. Success stemmed from the Leaders of Councils and Social Services recognising that existing systems were failing, being open to alternative ways of working and providing a space for transitional change.

Cottam went to live in the same estate as the families mentioned above. She and her team spent a long time listening and understanding the subjective world of these families, gaining their trust. Rather than futilely telling them how much they needed to change, she put the families in charge of driving any change. She and her team helped individuals to dream what they would like to do in life. Cottam and her team gave some of the most vulnerable and derided people, agency and helped them feel they were of value and could contribute. For me this was what was so moving.

Cottam is using many of the principles outlined by Winnicott who was writing before and around the inception of Beveridge’s Welfare state. She is trying to alter the hostile environment which traps so many families into an unhealthy infantilising dependency where the families become passive recipients of interventions which require compliance and adoption of a False Self (3). Such families regard all state interventions as very threatening, not least because evictions and removing children are a constant reality. Cottam pays very careful attention to the Facilitating Environment and this helps trust to develop. By helping families take power into their own hands, she inverts the existing order and stops the “downward spiral of defeat, anger and further defeat. The more control the families took, the more they changed and the more they dared to raise the bar and engage with the idea of building their capabilities.” Six families appointed eight professionals with a wide range of backgrounds to form the Life Team. They helped each other practically and emotionally and gradually told their stories. and rediscovered hidden talents.

I was attracted to Winnicott’s ideas because they were hopeful: he believed that infants were born with an innate creative potential which needed to flourish in a facilitating environment. Incidentally one of Cottam’s guiding principles is Aristotle’s idea that flourishing (eudaimonia) gives meaning to life. Winnicott (2) was critical of Beveridge’s Welfare State and felt there was a danger that the State could interfere too much in family units. According to Christopher Reeves (3), past Director of Squiggle who sadly died in 2012, Winnicott felt that the State should act more as a paternal function protecting the family unit, and that it too readily becomes an oppressive boundary when families are fractured, instead of supporting families’ ability to reconstitute and carry on. Reeves thinks the State is now like a single parent “omniprovider” ruled by a centralised rigid managerial system with protocols of safeguarding; a far cry from the days of a “Children’s Officer” who would know the troubled children and families in the area.

Cottam’s work also made me wonder if she had managed to help these families move away from a position of being locked into a toxic dependency on a State mother who was burnt out, fragmented, unresponsive and mis-attuned to their developmental needs and who responded punitively with threats of removal to any assertiveness, perhaps only able to perceive this as aggression. By putting the families in charge, at considerable risk, she had in effect helped these families be able to “use their objects”, whilst surviving their destructiveness and aggression. Quite movingly one of the mothers, after several weeks in the programme, realised her son’s violent outbursts were in response to being pushed away when he needed to be close to her. Perhaps for the first time she had felt close to other people in the Life Team and by no longer feeling rejected and shunned by others, but respected and even loved, she no longer pushed her son away.

Cottam is very respectful of professionals who have tried to offer help with the best of intentions but are hampered because they are operating in a system which is rigid, has a ‘silo mentality’ and was set up in a different era. At one point she brings together all the agencies involved in a family and draws a timeline from first intervention 20 years ago to the present and then asks if anyone can introduce her to a family where there has been change and is no longer on the books. Many of her audience cried. The chapters on the other social experiments are equally inspiring and riveting. This is a book that fires the reader up.

If you want a taster look up her RSA lecture up on YouTube interviewed by Gary Younge.


(1) Winnicott D.W.W. (1960) ‘Ego distortion in terms of True Self and False Self’ in The Maturational Processes and the Facilitating Environment: studies in the theory of emotional development. London. Hogarth Press and the Institute of Psycho-analysis

(2) Winnicott D.W.W. (1971), ‘The Use of an Object and Relating through Identifications’ in Playing and Reality 1971 London: Tavistock

(3) Reeves, C. (2012) ‘Can the state ever be a “good-enough parent”?’ in Broken Bounds, Contemporary Reflections on the Antisocial Tendency ed. Christopher Reeves, London. Karnac.