INTERNATIONAL CHILD AND YOUTH CARE NETWORK

21 SEPTEMBER 2000
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HISTORICAL

The way we are with troubled kids in residential places easily becomes “institutionalised” into our routines and practices. Some comments from mid-20th century practitioners ...

Helpful and unhelpful environments

For Fritz Redl, "an absolute sine qua non was a high standard of decent, benign, non-punitive care. In its absence there was no room for further discussion — and rationalizing, through rhetoric, theorizing and philosophizing did not impress Redl ... on this crucial issue, Redl never compromised". 

He suggested that people could use the word ’therapeutic’ too easily: something can be called ’therapeutic’ today simply if it doesn’t kill you: ’Therapeutic’ can mean "Don’t put poison in their soup"! "Regardless of the specific therapeutic needs of each child and the written plans to meet these needs, all the children are living in the unit 24 hours a day — ’and you’d better not forget it', said Redl.”  (Rabinovitch 1991: 75)

Bettelheim and Sylvester (1948: 191-l92) contrasted the anti-therapeutic qualities of many children’s programs with the benefits of a truly helpful environment. These are summarized here:

The institutionalizing experience includes: depersonalized rules to which the child makes passive adjustment; no need for independent decision-making as he is well-protected and all activities are arranged for him; compliance with stereotyped rules rather than assertive action is regarded as adjustment; reality-testing is limited to unvaried environment; external controls on behavior inhibit growth of inner controls; conflict is not therapeutically useful because it is related not to the child’s inner conflicts, but only to impersonal institution expectations; the child lives at an emotional and physical distance from adults, and even in situations of physical closeness the goal is control and compliance rather than personality growth; staff changes deprive the child of intimate relationships.

The therapeutic experience on the other hand includes: the child is expected to achieve mastery over physical and social situations; he experiences a hierarchy of meaningful and close relationships; emphasis is on spontaneity and flexibility (not to be misconstrued as licence or chaos); questions of schedule and routine are subservient to the relevance of interpersonal relationships; this system leads to internal controls and eventual integration of personality. 

Bettelheim, B. and Sylvester, E. (1948) A therapeutic milieu. American Journal of Orthopsychiatry, 18 (2): 191-206
Rabinovitch, R (1991) Fritz Redl and residential treatment at Hawthorn Center, in Morse, W. (ed.) Crisis Intervention in Residential Treatment: the clinical innovations of Fritz Redl,  New York, Haworth

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