NUMBER 230• 19 MARCH 2003 • FAMILY TREATMENT
INDEX OF QUOTES
For treatment to be successful, attention must be paid to the child’s context. In effect, the entire family has become the client, in a very concrete way. The unit is now often filled, on a daily basis, with parents and siblings. We believe that we must focus on both the overall family system and each "self" in the system. Every family member’s beliefs, motivations, dreams, and aspirations are relevant to the treatment process.
When a family presents for milieu treatment, it is assumed that their present situation represents the culmination of a widely diverse number of factors that have melded together in a unique manner. Therefore, it is imperative to fully explore the family’s history, including the family’s reaction to life events. Every family is encouraged to share their unique story.
Parents are seen, not as "bad" or "inadequate," but as individuals who have tried their best to deal with difficult situations. Parents are seen as doing the best they can with the personal resources that they currently have. There is no "good guy" and "bad guy." Instead, there are individuals who can be helped to develop the resources they need to be responsible for themselves and their role in their family (Ainsworth, 1991).
We assume that family-of-origin issues influence present parenting styles. It is further assumed that parents require a highly nurturing, supportive, and skill-building approach, at the same time that they need to become aware of family-of-origin influences on current behaviour. Every individual in the family needs to take responsibility for their behaviour and their effect on the family. It is assumed that all families can change, given the needed intervention.
In all of our work and especially on the milieu unit, a positive programming approach is utilized, focusing on building skills and self-esteem. All family members need to develop a sense of efficacy, the sense that "I can do it," "I do have the ability" (Bandura, 1977). All staff are seen as coaches, who help families rehearse effective behaviours, first in protected situations, and then in the natural environment.
In sum, it is believed that attention must be paid to each individual, and also to the family system. At the same time, attention must be paid, in an organized fashion, to both process issues and content issues. For every member of the family, as well as the family as a whole, intervention occurs simultaneously on three levels.
First is the educational level: where parents and children learn about themselves, family roles, and family behaviours (e.g., "why can’t my kid sit still in a restaurant?" or "why won’t my parents live together again?").
Second is the skill-building level, where families practise new behaviours (e.g., child management techniques or relaxation techniques). Skills must be practised both in the protected setting and in the natural environment.
Third are the process issues, such as belief systems and automatic reactions, that may stop families from behaving in more adaptive ways (e.g., "if I’m firm, my kid won’t like me anymore").
Therefore, numerous treatment strategies are constantly in use, and must be coordinated and melded. It is in the balancing of these strategies, overlapping of process and content, that a unique, wrap-around service for each family is created. Developing this service requires the coordinated work of various disciplines (i.e., child and youth work (CYW), social work, psychology, education, etc.) coming together to encourage the family’s development of efficacy, competencies, and family responsibility. The integration of therapies is crucial, and is aided by the elaboration of common themes—themes of competency and success.
ALAN GOYETTE et al
Goyette, Alan; Marr, Karen & Lewicki, Jo-Anne (1994). The Family and community in Milieu Treatment: challenging the Parameters of Residential Treatment. Journal of Child and Youth Care.
Vol. 9 No. 4. pp 41-42
Ainsworth, F. (1991) A "no blame" approach to work with families of children and adolescents in residential care. Child and Youth Care Forum, 20(5): 301-311
Bandura, A. (1977). Self-efficiency: Toward a unifying theory of behavioural change. Psychological Review, 84, 191-215.