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10 OCTOBER 2008
NO 1358
Therapeutic management
We have long been aware that certain children require the type of total care, management, and treatment that can only be provided in a residential institution. Yet, only recently have we begun to do something about the great gulf that exists between institutionalizing a child and establishing a truly therapeutic treatment program for him. While most of the formerly custodial institutions have become at least nominally "treatment oriented" through the addition of a few mental health professionals, there has usually been very little change in the procedures that are carried out by "on-line" staff in the living situation. Child-care workers have often been provided with only minimal training and have received sporadic supervision by professionally trained personnel who experience difficulty in communicating their theories to workers in the action setting (Carducci, 1962). In the final analysis, child-care workers have generally been sent out into the milieu with little more than their own intuitive knowledge; it is little wonder that their well-meant efforts have sometimes fallen short of providing for the many and complex needs of maladjusted youth.
Numerous pressures influence the interactions between child-care workers and the children with whom they work. Some of these pressures emanate from the cottage subculture (Mayer, 1958; Polsky, 1962) 1962) or from the organizational structure of the institution; others are the result of the personality of the worker or of those with whom he must deal. Even the most conscientious worker finds it difficult at times to cope with these pressures without interfering with the therapeutic treatment of children. The best interests of the children are sometimes forgotten as the worker strives to satisfy his own superiors, his co-workers, or the institutional policy. Even such seemingly innocent concerns as striving to control children, gaining their acceptance, and achieving success are not without their pitfalls. In this chapter we shall consider seven major issues that should be carefully considered by the child-care worker who is committed to maintaining "the therapeutic stance."
Those professionals oriented primarily toward individual psychotherapy will perhaps interpret these issues as examples of subtle or obvious "counter-transference phenomena." However, it would be a mistake to consider them only in the light of individual personality dynamics. To say of a worker that he should "get some therapy" or that "his counter-phobic stance toward danger makes children unsafe" functions mainly as a rationale for avoiding an honest look at the pressures and pitfalls of child-care work. In our experience seven issues are encountered in most institutions by most child-care workers. Often we have found that being made aware of the issues themselves enables the worker to function more effectively. Awareness and discussion of these pressures and pitfalls in child-care work is surely more helpful to most individuals than instant diagnosis and on-the-spot interpretation therapy.
LARRY BRENDTRO
Brendtro, L.K. (1969). Avoiding some of the roadblocks
to therapeutic management. In Trieschman, A.E.; Whittaker, J.K. and
Brendtro, L.K. (Eds.). The Other 23 Hours: Childcare with
emotionally disturbed children in a therapeutic milieu. pp.
219-220.
REFERENCES
Carducci, Dewey J. (1962). A possible solution to the training and orienting of child-care workers. Child Welfare, 41, 5. pp. 212-216.
Mayer, Morris F. (1958). A Guide for Child-care Workers. New York. Child Welfare League of America.
Polsky, Howard J. (1962). Cottage Six: The social system of delinquent boys in residential treatment. New York, Russell Sage Foundation.
