As a doctor, psychiatrist, psychotherapist and author, Robin Skynner, who has died aged 78, was a 20th century mental health pioneer. He contributed to major changes in clinical practice and professional training, and leaves a legacy in the practice of family, marital and group therapy, and through books like Families And How To Survive Them, which made psychology accessible to lay readers, and put analytic insights on to high street bookshop shelves.
Skynner's mother, he recalled, worried whether he would end up a genius or a lunatic. With hindsight he realised that, lacking the resources for the first option, he spent much of his life trying to avoid the second. He ultimately compromised by entering a mental hospital through the staff entrance.
The oldest of five sons born in Charlestown in Cornwall, Skynner's father had a family business mining and shipping china clay and his mother was a local fisherman's daughter. Educated at St Austell County School and Blundells School in Tiverton, in 1939, he volunteered for the Royal Air Force. He was commissioned and qualified as a pilot and a navigator. He spent 30 months training pilots in Britain and Canada and then flew Mosquito fighter-bombers on low-level raids.
Post-war, he qualified in medicine at University College Hospital, London, and in psychiatry at the Maudsley Hospital. There he specialised in child psychiatry. He became a consultant at Woodberry Down Child Guidance Unit and the Queen Elizabeth Hospital for Children, serving north-east London and the East End, and had a major influence introducing family therapy to Britain. He was made a member of the Royal College of Psychiatrists on its formation and was later elected a fellow.
He left child guidance in 1970 to become senior tutor in psychotherapy at the Institute of Psychiatry and the Bethlem Royal and Maudsley hospitals. There he remained until he retired from university and National Health Service teaching in 1982.
While at the Maudsley he met SH Foulkes, a psychoanalyst who had come from Germany in the 1930s and who had developed "group analysis", a group approach to the treatment of war neuroses. Skynner was an early member of the Group Analytic Society and, with Foulkes and others went on to establish the Group Analytic Practice which provided him with a professional home for the next 30 years. Here they developed individual, group, family and marital therapies. The practice continues to flourish.
In the 1960s they were in demand as trainers and the introductory course Skynner established led to the formation of the Institute of Group Analysis, which offers clinical training and a qualification in psychotherapy and is the main training centre for group therapy in Britain. The approach has had a major influence on psychotherapy in Europe and beyond.
In the 1970s Skynner brought together at the practice another network to staff a training programme which grew into the Institute of Family Therapy. The approach, based on systemic and structural principles, informs most psychiatric services for children and adolescents in Britain, and many adult services. Skynner was its first chairman, contributed to the later development of the Association for Family Therapy and became a regular contributor to its Journal Of Family Therapy.
Until her death in 1987 he had a highly constructive working relationship with his late wife Prudence in a partnership that linked group analysis and family therapy. They provided the early leadership of the courses for the Institute of Family Therapy; helped establish credibility for co-therapy with couples and families; and pioneered the development of therapy groups for couples that included groups for bishops of the Church of England and their wives. In 1978 the American Association of Marriage and Family Therapy awarded them distinguished affiliate membership and 12 years later St George's Hospital's family therapy unit was named in honour of Prudence.
His first two books, One Flesh, Separate Persons: Principles Of Family and Marital Psychotherapy (1976) and Families And How To Survive Them (1983) have been continuously in print. The latter, co-written with John Cleese, has sold some 353,000 copies in English editions and has been translated into 10 other languages. The clinical work on which it is based is available in two edited collections, Explorations With Families: Group Analysis And Family Therapy (1986) and Institutes And How To Survive Them: Mental Health Training And Consultation (Methuen 1989).
In the group analytic approach, as he describes it, the therapist exposes himself to the dynamics of those he is treating, remains closely attentive to his own responses and emotions and passes this back as information about himself in a careful and considered way. Skynner had a rare capacity to compose himself in the presence of others' emotions and to master the terms of their predicament in ways that were often very practical. He belonged in the tradition of the Cornish miners who designed and built London's underground, but this capacity for dealing with things below the ground was applied to human dilemmas.
His inquiry was focused by his struggle to deal with the confusion and distress of his own upbringing and he remained profoundly interested in the life of the family. "It has enormous creative potential including that of life itself," he observed, "and it is not surprising that, when it becomes disordered, it possesses an equal potential for terrible destruction."
These destructive forces, he believed, led to and derived from a fragmentation of consciousness complicated by the need to deny the underlying divisions. Denied problems were then transmitted across generations. He believed that his creativity as a clinician arose out of these fundamental concepts, but also derived from his native sense of curiosity; his commitment to work under pressure with needy people; and his consistent interest in health as well as illness.
He was a spiritual man, enriched by a long association with the Gurdjieff Society, and his experience of meditation lent a special quality to his attentiveness with people. He had bearing of authority and a strong, containing physical presence. During his early training he had been influenced by a group of philosophers, including Bertrand Russell, whose ideas influenced his own conceptual clarity and his publications introduce many original concepts to the field.
His co-author John Cleese wrote after Skynner's death that he had never met a man who knew so much about people. "He had a wonderfully unorthodox yet systematic mind: what was so special about him was that he never allowed himself to get stuck in theory as he was continually questioning it in the light of his own experience."
Some of the things Skynner said about Foulkes when he celebrated his colleague's life could well be said of Skynner himself. Foulkes, he had said, had an open, curious questioning attitude, always stepping back to examine the ground that he himself had just been standing on, and by that example aroused others to do the same. Foulkes and Skynner took everything seriously, yet took nothing too seriously.
For his last 12 years Skynner enjoyed a relationship with Welsh landscape painter Josh Partridge, who provided inspired care after he suffered a serious stroke in 1993 following the publication of his last book, Life And How To Survive It (1993), also written with John Cleese.
He struggled courageously against residual paralysis and his first speaking engagement after the stroke was the Jonathan Swift Founder's Day Lecture at St Patrick's Hospital Dublin in 1994. Skynner was a big man with an imposing presence. With his gait impaired by the stroke, and his long walking stick, he cut a remarkable figure. He travelled by himself and returned, elated, to report that his host, Anthony Clare, thanked him not only for the content of his lecture but for demonstrating to the audience by his spirit and bearing that there was no reason to fear old age.
This was only the beginning. He went on to travel and lecture in many parts of the world over the next few years. With advancing infirmity he required increasing levels of care, but despite the indignities of his condition he never lost this spirit and he continued to inspire extraordinary devotion among all who looked after him - carers, friends and family. "Simply by his presence, he taught us something about enjoyment of life, of learning," he had said of Foulkes, "of learning with each other." It was just as true of Robin Skynner.
He is survived by his son David, daughter Rosie, and four grandchildren.
Augustus Charles Robin Skynner, psychiatrist, born August 16 1922; died September 24 2000
