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4 MARCH 2009
NO 1408
Management or therapy?
I want to address the chasm between authoritarian behavior management and effective treatment, and show how effective treatment cannot and does not happen when the goal is to manage behavior only for the sake of demonstrating worker competence. I will look back to our theoretical foundations which remind us that behavior management can and should be part of effective treatment, and not counter to it. I would like to pose some alternative ways of looking at authority, and would suggest that we can use our authority therapeutically, not just as a means of control.
Redl and Wineman (1957), in their classic volume on residential treatment for children, The Aggressive Child, never envisioned behavior management as anything but treatment. In the chapter "Techniques for the antiseptic manipulation of surface behavior" they listed numerous techniques in which workers seek to rebuild and support the damaged egos of their children, and manage their difficult behaviors at the same time. In fact, it is through management of the day-to-day behaviors of such children that workers are allowed the opportunity for treatment. Using the daily routine as the place for treatment has become known as milieu therapy. In this model all parts of daily experience – the physical characteristics of the setting, the furniture, the routines, the people, the food, and so on – become tools for therapy. Clearly these are also an integral part of behavior management. In the therapeutic milieu, at least in theory, therapy and management are intertwined and inseparable.
Trieschman, Whittaker and Brendtro (1969) expanded the concept of the therapeutic milieu in their well-known book The Other 23 Hours. They included informative and detailed guidelines for the creation of therapeutic routines such as waking up, meal times, and bed time. As well, they added the notion of the therapeutic relationship. They described the relationship between the worker and the child as another area in which treatment occurs. In fact, the uniqueness of residential child care is the opportunity to develop a relationship with the client unlike any other helping relationship. Nowhere else does the worker become such a large part of the client's daily life. Through the therapeutic relationship, the worker is better able to manage difficult behavior, and engage ineffective treatment. Here again, we see how behavior management and treatment are connected.
Modelling as treatment
One of the key ways in which workers can use relationship is in
modelling, through which a worker has an excellent opportunity to
effectively manage children's behavior. Consider, for instance, the
child care worker who demonstrates composure and does not blame others
or make accusations when angry at a colleague. A child with whom this
worker has a relationship may be more likely to adopt a similar way of
handling angry feelings. This is behavior management, in that the
child's destructiveness when angry is curbed, but also treatment, in
that the child learns positive skills in handling anger. Swanson and
Richard noted that". . . the aggressive child has learned that
aggression pays .... Aggressive children need to learn that adults whom
they admire are capable of getting their needs met without acting
aggressively" (1988, p. 987).
When we fail to recognize the importance of modelling, we stop being therapeutic, and become only managers of behavior. This becomes especially true when what we say is incongruent with what we do. The danger is in being unaware of what we are modelling to the children. As Bertcher commented, "Adults who work with children are continually modelling particular attitudes and behaviors, whether they intend to or not" (1973, p. 179).
JIM VANDERWOERD
Vanderwoerd, J. (1991). Divisions between behavior
management and therapy: Towards new directions of authority in Child and Youth Care. Journal of Child and Youth Care, 5, 1. pp. 33-41.
REFERENCES
Bertcher, H. J. (Fall, 1973). The child care worker as a role model. Child Care Quarterly, 2, 3. pp.178-191.
Redl, F. and Wineman D. (1957). The aggressive child. Glencoe, Illinois: Free Press.
Swanson, A.J. and Richard, B.A. (1988). Discipline and child behavior management in group care. In C.E. Schaefer and A.J. Swanson (Eds.), Children in residential care: Critical issues in treatment, pp. 77-88. New York: Van Nostrand Reinhold.
Trieschman, A.E.; Whittaker, J.K. and Brendtro, L. K. (1969). The other 23 hours: Child care work with emotionally disturbed children in a therapeutic milieu. Chicago: Aldine Publishing.
