Quote of the Day

	… most treatments, as currently conceived, can take place only through human agency. Indeed, most of them depend on the establishment of a positive therapeutic relationship between the treatment agent and the ‘client’ child. ‘Therapeutic relationships’ have been generally regarded by everyone as being crucial prerequisites of all treatment, particularly in relation to adults (for example, Truax and Carkhuff, 1967). In the phrase ‘therapeutic relationship’ the word ‘therapeutic’ is intended to connote the intention of the treatment agent in relating to the client as well as the outcome (optimistically) of the interaction. The word ‘relationship’ is, however, more complex. Apart from denoting straightforwardly that a treatment agent and his client are related through their respective positions as seeker and giver of help, the word connotes a cluster of positive feelings, views and expectations by one towards the other and preferably shared. In this sense, the word ‘relationship’ has come to take on substantial extra meanings which impose their weight by implication rather than explicit statement. Indeed, because of its positive connotation, it has been elevated to the position of a therapeutic method or technique (the writings are too ambiguous to allow the distinction to be made) without in any way either identifying the theoretical basis or producing the evidence for such elevation. More importantly, the word ‘relationship’ has come to act as an excusatory umbrella in many forms of intervention with problem children, where, instead of being one element of treatment, it has become an end in itself, based on the dubious and unsubstantiated premise that most children are disturbed or delinquent due to ‘difficulties in relationships’. This is not to deny that positive relationships are desirable in all treatments, but they are not indispensable. It would be nice for the child with a hole in the heart to think well of the surgeon, but so far as is known, such a positive view is not a necessary precursor for a successful surgical operation. Nor has the same sort of relationship been shown to be essential in many forms of behaviour modification, remedial teaching, psychotherapy, group therapy or environmental treatments (Mitchell et al., 1977; Kolvin et al., 1981). To establish a therapeutic relationship, both the treatment agent and the child must have the basic personal qualities and interpersonal skills which enable such a relationship to be established. These qualities and skills include mutual liking, interest, caring, trust, consistency, resilience and the ability to withstand set-back and disappointment. Such a relationship, if established, is likely to act as an important bridge and lifeline during those lean times when treatment seems to be proceeding slowly and both the therapist and the child and his family have hit a low mark and are beginning to question the validity and the efficacy of the treatment. The relationship will allow the motivation to be maintained at a high enough level to ensure an upturn. Therapeutic relationships are established in a variety of settings, such as a foster home, a hospital, a secure unit or a child guidance clinic, though both the form of the relationship and its content are largely determined by the form of treatment that is likely to be undertaken in these settings. An important corollary of such forms of treatment is the length of time the therapist and the child are engaged in them. A visit to the surgery or out-patient clinic demands hardly any relationship, whereas long-term stay in an ESN school or in a psychiatric adolescent unit makes the development of relationships of some kind inevitable. Other elements relate to the gender of the therapist and his position, whether the treatment is taking place individually or in groups and whether the therapist is acting alone or in partnership with other treatment agents. Whilst we strive after positive relationships with children who are subjected to treatment, we ought to be aware that often only negative relationships are engendered, particularly where a coercive element is allowed to prevail. The major exception to this occurs in such settings as a foster home. In such cases, positive, supportive and dependent relationships are not only the norm but the prerequisite without which neither the contact nor the treatment could be sustained (see also Herbert, 1981a). In general terms, the less urgent the child’s problems (truancy compared with physical violence) and the more voluntary the child’s participation in treatment (a foster home as against an adolescent unit), the more such a negotiated, ‘therapeutic relationship’ seems to be necessary for the maintenance of the treatment programme. The professional writing on relationships is too diffuse and full of special pleading for us to be any less tentative in our conclusion.
	MASUD HOGHUGHI Hoghughi, M. et al. (1988) Treating problem children: Issues, methods and practice. London: SAGE Publications. pp.37-38