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8 MARCH 2010
NO 1551
The children
The problems with these children are
more extensive than the clinicians' internal reactions. These children
are very difficult to live with. Even clinicians who understand the
children's plight and have empathy for their predicaments find the
intensity of these children's emotional needs close to
overwhelming. The children's intense sense that the world has deeply
injured them is often manifested by a pervasive anger. They are
considered emotionally disturbed because they hate so thoroughly. Their
deep sense that they have been deprived and their profound
discouragement with themselves, with adults, with human relationships,
and with life, make them very hard to satisfy.
Because they feel so deprived, they are often at their wits' end. Lacking emotional reserves, they in effect have hair-triggers that will fire with minimal pressure or frustration. Their angry feelings rapidly convert into violent behavior, directed toward any frustrating figure, adult or child. Unless the reasons for their violence are understood and factored into program planning, these children can rapidly stress parenting figures to the point where the adults lash back. Since the child is already convinced that the world is no good, this is doubly destructive. The surrogate parents' lashing out only validates the child's distorted view that all adults are cruel and unresponsive. It also supports their view that they can never be understood, perhaps because they are monsters.
For this reason, one basic precondition in initiating treatment is that staff members have control over the frustrations the children must face, and the program have control over the frustrations the staff must face, in order to keep the level of frustration low enough to avoid painful explosions. Yet many, if not most, treatment programs operate as part of a system that leads to the children, and sometimes the staff members, becoming overly frustrated, triggering the sequence outlined above. The treatment setting must cope with a variety of external pressures that interfere with its ability to respond therapeutically to these children. Economic resources may be severely limited, leading to the children again being forced to live in a deprived and depriving environment. If a child breaks a toy, no money may be available for a replacement, and the child may soon have no toys.
The psychological resources of the staff members may also be limited, either intrinsically or because the organization's leadership and outside funding agencies institute and enforce severe financial policies that make the staff feel frustrated and deprived. The children's deprivation inadvertently may come from staff members' feelings of resentment toward them – "With all we do, how dare the children expect more? After all, they brought it on themselves."
Many institutions find it difficult to retain their focus on the children's needs. Any institution must serve staff needs as well as the needs of the children while being responsive to the outside world. In the welter of budget meetings, demands for cost-effective financing, insurance requirements, hospital, staff, university and board of trustee politics, individual ambitions, social pressures, and moral attitudes about "appropriate behavior," the concern with understanding and serving the children can easily be lost. Without persistent effort, the children's needs may be given little attention, particularly if the institution is large and the policy makers far removed from the daily clinical tasks. To make matters worse, clinicians may not acknowledge, even to themselves, how distressing this can be for their child patients. In an effort to keep the adult ranks united against the disruptive children and to provide an atmosphere of consistency, administrators may say to the children that policies made because of institutional needs are designed in the children's interest. This often is a rationalization.
As persons who are familiar with the problems of running large therapeutic institutions, we do not deny that certain policies must be made based on institutional, rather than individual, needs. But we are convinced that if the institution's mission is therapeutic, the children are better served if institutional needs are clearly labeled and dealt with as such. When decisions are made, the staff members can be more honest with themselves and with the children about why the decision was made; this helps preserve the sense of trust we want the children to develop.
ALVIN ROSENFELD AND SAUL WASSERMAN
Rosenfeld, A. and Wasserman, S. (1990). Healing the Heart. Washington D.C. Child Welfare League of America. pp. 6-8.
