Let me begin by showing you a few slides. We shall not need a screen, projector or any other such equipment. Mental slides will be quite sufficient for us today. All of us child care workers have seen this type of slide often enough. But these slides make up the stuffí of which child care is made. I simply wish to look with you at a few of these slides to see a few familiar situations and also to explore the sorts of new problems we are having to face in our work with children.
Case 1. The Case of the Indignant
Iím not entirely sure what psychotic means, but I do understand that itís smart to say "pre". If you say "pre" you simply cannot be wrong. You do not have to commit yourself about when the psychosis is going to take place. Will you please forget about diagnosis?
Returning to our slide we see that David has got bored. Eating politely is not what he has been used to. He wants some action. One thing he has learned is that it is best to get someone else to start the action. He decides on John. After blinking at him very slowly he takes his own glass of milk and tips it just a very small amount. Only a few drops of milk spill onto the table. Johnís attention has been engaged by David and without hesitation he rises and throws his own glass of milk over the chief child care worker. John yells at the worker: "That guy is bugging me, why canít you get him off my back?" The worker, while drying himself off, begins the investigation. Quizzing John he is told finally: "David made me do it". Quizzing David he is told, "Itís nothing to do with me". David is indignant and yells: "You sons of bitches, why do you always have to get me mixed up in it?"
Now both children in our slide need treatment but treatment for what? I would hazard a guess that Davidís misbehaviour is not pathological and go on to assert that his behaviour is over-skilled for the market value of his age. If he were a little older and if he were in a different social context he would likely by doing very well indeed. Somewhere along the line David has got to learn to use this talent for instigation to positive effect. Somehow John has got to learn not to be drawn into this type of difficulty. The one child needs the other but both need the services of an acute child care worker who can deal with the situation as it arises.
Those of us who work daily with children have to be sorting out continually the situations described in Slide 1 and know that this is not usually an easy task. The child care worker is the one who is there. Behaviours such as these described in Slide 1 do not occur during the clinical hour. It means that people who are with these children have to be careful. David and John have to be watched. If they get too bored some distraction may be necessary.
Case 2. Will you take him back?
Case 3: Paranoia Under the Chestnut
And so we have our slide of the workerís frantically swiveling head picking up Bobby in the action of dunking John. So he gets Bobby to sit under the chestnut tree. Thereís no point in faulting the worker. He did warn the kids and, anyway, he is, as I said, a good fellow. So now we have Bobby under the tree. Now what you have to realize is that the tree is like a throne. From his throne Bobby sees if not everything, then a very great deal. Certainly his eyes see what our guard does not see due to lack of eyes in back of head. His greater elevation is a distinct advantage. Now he is able to start digging up his paranoid fantasies. Now he has the evidence that no one likes him anymore.
The problem which I have been discussing in this slide is a familiar one to us and it is largely a problem of timing. Any limit may be O.K. but how long does the limit last? The snag is that longer does not mean that effects are achieved faster. What about sexual insults? When we as workers receive a sexual insult from a child we are perhaps inclined to treat them about twice as hard as for oral insults. Say thirty minutes for sexual insults and 15 minutes for oral ones. Returning to Bobbyís crime we find ourselves faced with the huge problem of timing. How long can we leave him under the tree? The waterfront man has got to let him back but when? Unless the child is considered very closely we shall leave him in a situation where his own crazy fantasies will become stronger and stronger. ("Say, Ray, didnít you see Bill shoving Peter under? Why donít you pick on him like you pick on me ... "). So timing must be considered rather carefully.
Child care workers do not get enough training in the art of timing. When is it best to talk to the child, now or tomorrow? As a general rule we need to be flexible in terms of what the individual child needs. To be sure the child has to be bounced but how do I ensure that the kid will benefit from the inference not be further damaged by it? Trying to ensure that one particular child benefits when you are working with a group is sometimes very hard to arrange as the next slide clearly shows.
Case 4: Ghouls for Breakfast.
Charlie does make it. In view of the contract the staff have to go through with their side of the bargain. He watches the T.V. show. At breakfast Charlie has his moment. Half of the children become so agitated they wet themselves. But after a few days all the children want to watch the Ghoul Show. This they have decided is what they need not candies. You can, I think, imagine the child care workerís predicament at this point and there is no need to elaborate the situation further. In pointing to a behavior modification programme as being instrumental in creating this difficulty, it should be realized that I am by no means being critical of this approach. What I am critical of is over-simplification. All I am trying to do is warn against taking too surface a view of these childrenís difficulties and also to point out that great care is needed in the design of any group-treatment programme.
Perhaps now we can put slides behind us and try to address ourselves to some problems in the treating of adolescents. While it is certainly true that we have learned a good deal during the last fifteen years it seems to me that our problems have become not easier but more difficult. It may be that these issues are not as evident here in Canada as in the U.S.A. but it seems to me that changes in our society during the past fifteen or twenty years create new challenges for the child care worker. Let me give you a few examples:
1. The Adolescent has Depersonalization
and Role Freeze Against the Adult.
2. The Adolescent has an Inability to
3. There has been an increase in the
Suction Power of Rituals.
Of course we have to make children aware of the consequences of their behaviour. But sometimes we as workers lose sight of these consequences. We resort to threats we could not possibly want to carry out (if we were in our right mind at the time). But to return to our John who is now getting bored after five minutes have passed. He puts his foot into the corridor. The worker ignores it. He does it again putting it out a little further this time. Again the worker more or less ignores it. Now he puts it out even further still. The counsellor is now worried about his own prestige. He says to John: "If you do that again youíll have to go to the quiet room". (Where you can make as much noise as you like and even try to wreck the place). Now if only the worker had not said this. He has thrown down the gauntlet. We might as well be looking at two four years olds or we might well be working ourselves up to fight a duel in 19th century Germany. One man makes the slightest suggestion that the other has erred in his manner. The other replies suggesting that the other, not he, was in the wrong. Finally, it escalates into one saying to the other: "You are lying". Now they have to choose weapons and shoot. Now they are puppets on a string, nothing can be done to prevent the duel for honour is at stake. Too bad it happened that way but...
Our therapist has succumbed to the suction power of the ritual. Now he will get into trouble from the chief counsellor. It was not necessary. Under what conditions is a threat reasonable? Under some circumstances it has to be a help but not under those outlined above. We should remember that the adolescentís need for ritual is great. The power of the reference group is strong. Which kids have high vulnerability to suction? Most of the data we get on the children may be very helpful for combatting disease but they are of limited value compared to a knowledge about a particular childís suction power of rituals maintained by the peer goup.
4. There Exists a Group Code Cassette.
Not uncommonly a youngster will make a violent attack on me. He is in a rage and he lashes out. It is as though the "group-code system" has suddenly been switched on. Many youngsters do not actually want to hit anyone but they have to face the question. "What will happen to me if I donít?" The code does not permit a youngster to "take it" from an adult. Even children who have a reasonably settled superego are likely to have trouble. The child care worker has to know what the dueling code is. Kids are dependent on the group code and the worker has to know about the groupís values.
From the child care counsellorís perspective it is important to remember that it is not so much that the adolescent rejects you or your rules but that the child has now come under a new code. Has the child "blown" or is it that the "Group Code Cassette" has come into play. This phenomenon of group code cassette would appear to be different from the breakdown of controls.
Let me close by commenting briefly on something we need and on where we are as child care workers today. One thing we need and often donít have is data on a given child. Is this particular child allergic to the usual calming techniques or not? If I put my hand on his shoulder will it work or will it make matters worse? Everyone who had the child before me had to figure this out and many people know the answer. But now when I need the information there is no one who will give it to me. We have got to learn how to generate our data and how to transmit it to colleagues.
Where are we today? The role of
child-care worker is emerging out of a sort of poorly-paid baby sitting
job into a new profession. It is not just a composite of nursing, social
work, psychology and so on. It has started to emerge. We are beginning
to be able to offer thoughtful suggestions to the people who count but
who often think the issues surrounding disturbed children are simple.
Can we help people get over the idea that it is not a matter of
either/or, for example, either all these children should be locked up,
or they should be on the street. What this means is that we should have
a variety of programmes. We have more children in need than ever
before. And all too often only one or two of their needs are met in a
programme. Often there are a dozen or so needs left over. We as child
care workers must become experts in creating life spaces for children.