NUMBER 156 • 20 NOVEMBER 2002 • A POSITIVE CONTEXT FOR RESIDENTIAL PLACEMENTS
INDEX OF QUOTESReferences
In the situation of residential treatment, the context is the overall framework (or set of interlocking frameworks) that gives meaning to the placement and against which particular experiences and events will be interpreted. This context will be shaped by the structure of the program, the expectations clients, staff, and the wider society (public and professional) have of it, and the beliefs about themselves, each other, and their purpose that all parties bring to the encounter.
My concern about some residential programs is that many individually skillful and apparently successful activities and interventions occur but often within a context that mitigates against their ongoing success. That is, as long as residential placement occurs within a context built upon ideas of parental failure and/or child pathology, then even successful treatment will be made sense of in a way that will tend to reinforce those pre-existing beliefs. The context of placement involves the way the child or adolescent and the other family members make sense of themselves in this situation ("We have failed"; "He/she is disturbed"; "I am bad"; etc.) and the way residential staff make sense of themselves and their roles. These beliefs or constructs provide the template against which apparent success or failure will be interpreted.
Given that residential placement is often a "last resort," families have usually been well-schooled in notions of their own failure, incompetence, or pathology. Having been caught on a slide (or a rollercoaster, with its ups and downs) of attempts to deal with their situation, seeking help, perhaps feeling hopeful and then having these hopes dashed, it is not surprising that families approach a residential placement as being yet more of the same. In desperation, they will try anything, although they may suspect that this, too, will not really work. When the agency does what they (or someone else) asks, and admits their child, this is confirmation of all they have believed about themselves and/or their child. The context is inevitably one of incompetence, and what is surprising is that residential treatment sometimes works, given that we might expect ideas of incompetence to permeate everything that happens.
The problem, of course, with the beliefs and ideas that contribute to the residential contest — the residential "reality," if you like — is that the participants believe them. They gain the status of reality. The more I, as a parent, "know" that I am a failure, the more I will see evidence that confirms this, the more I will interpret the helpful suggestions of residential staff as revealing that they consider me a failure, and so on. I will have no conceptual means for interpreting things in any other way. Similarly, the more I, as a residential worker, "know" that particular parents are unmotivated, the more I will see evidence that confirms this and the more I will respond to them in an adversarial manner.
In reconsidering residential treatment, then, our task is not primarily one of tinkering with the mechanics of residential programs. In fact, we can tinker all we like but, as long as the context or meaning-frame for family and staff remains the same, we are doing little more than window-dressing. What we need to reconsider is the overall context. How do we make sense of the phenomenon of residential placement? How do our clients make sense of it? Is there a way of "reframing" — not just reframing this particular presenting problem, but placing the whole experience of residential treatment within a different frame — one that will maximize the possibility of clients experiencing themselves as competent and successful? Of course, any such change in the way we think about residential placement will have implications for the day-to-day details of any program and for the interrelations between the different people involved (who is the expert at what?), and the day-to-day details will contribute to the extent to which any frame persists. However, my major concern is with formulating ways of thinking about residential admissions which may provide a coherent template for considering every aspect of the program.
Durrant, M. (1993). Residential Treatment: A co-operative competency-based approach to therapy and program design. New York: W.W. Norton
Allport, G. (1961). Pattern and growth in personality. New York: Holt, Rinehart and Winston