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The use of strategic/systemic methods in a residential treatment home Pare, Timothy 1988

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THE USE OF STRATEGIC/SYSTEMIC METHODS IN A RESIDENTIAL TREATMENT HOME By TIMOTHY PARE B.A., Concordia U n i v e r s i t y ; Montreal, 1981  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES Department of C o u n s e l l i n g Psychology  We accept t h i s t h e s i s as conforming to the r e q u i r e d standard  THE UNIVERSITY OF BRITISH COLUMBIA A p r i l 1988 (c)  Timothy Pare , 1988  In  presenting  degree freely  at  this  the  available  copying  of  department publication  of  in  partial  fulfilment  University  of  British  Columbia,  for  this or  thesis  reference  thesis by  this  for  his thesis  and  scholarly  or for  her  Department  nF.fin/ft-n  Columbia  I  I  further  purposes  gain  the  requirements  agree  that  agree  may  be  It  is  representatives.  financial  permission.  T h e U n i v e r s i t y o f British 1956 Main Mall Vancouver, Canada V 6 T 1Y3  study.  of  shall  not  that  the  Library  an  granted  by  allowed  advanced  shall  permission  understood be  for  the that  without  for head  make  it  extensive of  my  copying  or  my  written  ABSTRACT  The systemic paradoxical with the  o r i e n t a t i o n to interventions  behavioral  has  f a m i l y therapy movement.  been experimenting with the in  residential  patient  been  treatment  settings.  interventions reluctant  may  be  clients  who  predominantly  schools,  literature  resist  associated  strategic/systemic  centers,  ideally  and the use o f  Recently p r a c t i t i o n e r s have  use o f  The  change  and h o s p i t a l i n -  suggests  suited  methods  that  these  f o r oppositional  cooperating  in  or  the treatment  process.  This t h e s i s treatment  p r o v i d e s a case study d e s c r i p t i o n of an a d o l e s c e n t home  which  has  developed  approach t o r e s i d e n t i a l c a r e . perspective  to  changes  traditional  These  to  changes  intervention  residential  a  strategic/systemic  The implementation of a systemic treatment  child  care  are  described  and  examples  are  required  substantial  p h i l o s o p h y and p r a c t i c e . discussed  and  actual  presented which help t o i l l u m i n a t e  t h i s novel approach t o r e s i d e n t i a l treatment.  iii TABLE OF CONTENTS ABSTRACT  i i  ACKNOWLEDGEMENTS CHAPTER I  i i i  - INTRODUCTION  1  NEED FOR THE STUDY  4  BACKGROUND TO THE PROBLEM 1) The I d e n t i f i e d  ,  (IP) P a t i e n t  2) The Surrogate Parent Problem  5 8 9  3) The Problem of R e s i s t a n c e  11  4) The Problem of C o n t r o l and D i s c i p l i n e  12  CHAPTER I I  - LITERATURE REVIEW  17  TRADITIONAL THEORIES OF RESIDENTIAL TREATMENT  17  PSYCHOANALYTICAL RESIDENTIAL TREATMENT  18  BEHAVIORAL RESIDENTIAL TREATMENT  32  GUIDED GROUP INTERACTION  37  THE RE-ED APPROACH  42  THE STRATEGIC/SYSTEMIC APPROACH  44  CHAPTER I I I - METHOD OF STUDY  75  THE CASE STUDY AS A METHOD OF RESEARCH  75  THE SINGLE CASE DESIGN  79  DATA COLLECTIONS  81  DATA ANALYSIS  84  LIMITATIONS  85  CHAPTER IV  - RESULTS  87  THE DEVELOPMENT OF A SYSTEMIC APPROACH  87  RELATIONSHIPS  91  RESISTANCE  98  RULES AND CONSEQUENCES  101  THE PHYSICAL SETTING  104  THE STAFF  105  iv THE RESIDENTS  108  INTERVENTIONS  I l l  FORMULATING INTERVENTIONS  1 1 5  DELIVERING INTERVENTIONS  118  CASE EXAMPLES  121  CHAPTER V REFERENCES  Case Example # 1 - Caren  121  Case Example # 2 - Sandra  125  Case Example # 3 - L i s a  132  Case Example # 4 - Shannon  135  Case Example # 5 - T i n a  138  - DISCUSSIONS AND CONCLUSIONS  142 165  V  ACKNOWLEDGEMENTS  I would like to thank a l l of the treatment home staff for their help and encouragement. Special thanks goes to Diane and Jacqueline for their valuable time.  1  THE USE OF STRATEGIC/SYSTEMIC METHODS IN A RESIDENTIAL TREATMENT HOME CHAPTER I - INTRODUCTION  Residential  settings  for  the treatment  of c h i l d h o o d and  adolescent behavior problems were f i r s t developed 1950*s.  i n the e a r l y  Buno B e t t e l h e i m , F r i t z Redl, and Moris F r i t z Mayer are  c o n s i d e r e d the founders of to treatment  the r e s i d e n t i a l  (Whittaker, 1 9 7 9 ) .  or m i l i e u approach  These t h e o r i s t s , who were a l l  members of the p s y c h o a n a l y t i c s c h o o l , were of the clinical  opinion that  treatment, where a c l i e n t i s seen i n an o f f i c e  once or twice a c h i l d and  week, p r o v i d e d  limited effectiveness  adolescent population.  potent treatment  In  setting f o r the  order t o p r o v i d e a more  approach they began t o develop community  based  t h e r a p e u t i c environments.  These t h e r a p e u t i c environments had a  common goal  on-going,  of p r o v i d i n g  s e t t i n g removed  structured  treatment  in a  from the  c h i l d or a d o l e s c e n t ' s f a m i l y ( K l e i n ,  use  therapeutic  1975) .  Today treatment  the of  of  childhood  environments  and a d o l e s c e n t problems i s r e l a t i v e l y  widespread.  There are c u r r e n t l y numerous r e s i d e n t i a l  approaches,  each  orientation.  with  With some  foundations can  f o r the  their of  own  these  particular approaches  treatment  philosophical the t h e o r e t i c a l  be t r a c e d back t o the o r i g i n a l f o r m u l a t i o n s of  the  p s y c h o a n a l y t i c t h e o r i s t s mentioned above.  have  based  ideas  their  adopted  treatment  from  behavioral theories  The  systemic  philosophy  social  on more contemporary  interactive,  (Brendtro & Ness,  family  Other approaches  therapy  educational  or  1983).  movement,  which  includes  s t r a t e g i c and p a r a d o x i c a l therapy, has r e c e n t l y taken a l e a d i n g role  in  the  behavior  introduction  change.  of  Proponents  proposed a  radically different  resolution  (Watzlawick et a l . ,  view, which the  may  traditional  is  not  of  methods this  view of 1974).  for f a c i l i t a t i n g  novel  approach have  problem formation and  This r a d i c a l l y  be c a l l e d the systemic o r i e n t a t i o n , causal-mechanistic  suggests i n s t e a d a l . , 1978).  new  a theory  Circular  determined  view  previous  challenges  phenomena  of c i r c u l a r c a u s a l i t y  c a u s a l i t y assumes by  of  different  and  ( P a l a z z o l i et  t h a t present behavior  events i n a c a u s e - a n d - e f f e c t  manner but i n s t e a d i s a product of an i n d i v i d u a l a c t i n g  on and  being i n f l u e n c e d by a system of which he i s a member.  Until quite orientation specialization  r e c e n t l y the a p p l i c a t i o n of t h i s new systemic  took of  place  almost  family  exclusively  therapy.  a s s o c i a t e s at the Mental Research I n s t i t u t e P a l a z z o l i and are  the M i l a n  within  Watzlawick (MRI)  group (1978a), and Haley  and  (1967, (1963,  the his  1974), 1976)  c o n s i d e r e d the l e a d i n g proponents of the s t r a t e g i c / s y s t e m i c  treatment  of  families.  interventions within are  as  the  primary  dysfunctional noted  as  T h e s e t h e r a p i s t s have u s e d  family  the  systems.  approach  Although  use  researchers  these  interventions  cases  have  s u c h as have  have  of  been  paradoxical Turner  &  Stanton  treated  Ascher,  The  settings  Milan  other  that  this  The  presenting  alcoholism,  innovation  delinquency, and  in  application the  and  temper  the of  on  al.,  1972;  1982).  paradoxical been u s e d  problems eating  in  included, disorders,  depression,  marital  tantrums.  field  paradoxical  clinician's  various  & Kolko,  a p p r o a c h has  anorexia  schizophrenia  than  literature  using  retention,  using  1984;  cases.  psychotherapy i s t h e  basis  Kolko, the  context,  problems,  urinary  Solyom e t  problems, anxiety,  latest  t h o u g h t s and  has  Numerous  behavioral  1979;  reported  problems, phobias,  therapy  (Ascher,  reviewed  a wide v a r i e t y of others;  1979;  interventions  circumstances.  individual  the  potential for  where s p e c i f i c  an  interventions  (1981b)  adolescent  on  of  1982).  family the  different  reported  p s y c h o t h e r a p y and  among  with the  change  interventions  feature  paradoxical  insomnia, obsessional  been  Paradoxical  investigated  under  introducing  (Weeks & L ' A b a t e ,  p r e d o m i n a n t l y been a s s o c i a t e d some  for  distinguishing  systemic/strategic  the  vehicle  paradoxical  office.  of  paradoxical techniques i n Some c r e a t i v e  4  practitioners paradoxical  have  been  experimenting  interventions  in  residential  s c h o o l s , and h o s p i t a l i n - p a t i e n t 1980;  1 9 8 0 ; Jessee  Bergman, In  1984).  response  p r a c t i t i o n e r s of dissatisfaction residential  to  with  treatment,  promising  more a  (Jessee  results  &  L'Abate,  traditional  Vancouver  r e p o r t e d by  coupled with a  based  i n t r o d u c e some s t r a t e g i c / s y s t e m i c methods philosophy.  of  et a l . , 1 9 8 2 ; W i l l i a m s & Weeks,  the  the  use  treatment c e n t e r s ,  settings  the systemic approach, for  the  growing  approaches home  decided  into their  to to  treatment  The purpose of t h i s t h e s i s i s t o d e s c r i b e the use  of these s t r a t e g i c / s y s t e m i c methods and t o  p r o v i d e examples of  interventions  effective  that  may  r e s i d e n t i a l treatment  NEED FOR  or  may  not  THE STUDY  at  radically  this  time.  different  resolution  proposed  orientation. i n order  within a  setting.  There are two primary reasons why needed  be  T h i s new  The  first  perspective by  the  of  a study of t h i s  reason has t o do with the problem  proponents  of  practical application  formation the  p e r s p e c t i v e must be i n v e s t i g a t e d  to more f u l l y develop a comprehensive  behavior and change.  sort i s  and  systemic further  theory of human  The present study i s a d e s c r i p t i o n of the of t h i s new  approach and the t h e o r e t i c a l  concerns t h a t become e v i d e n t upon i t s implementation.  5  Secondly, a study of t h i s s o r t investigating  potential  treatment f i e l d .  individuals  treatment o f f e r e d  improvements  to  as a the  means f o r residential  Front l i n e workers i n a r e s i d e n t i a l  home a r e f a c e d with treat  i s needed  treatment  the extremely d i f f i c u l t task of t r y i n g t o  who openly t o them.  r e s i s t and  actively  sabotage the  Techniques  t o i n c r e a s e the f r o n t  l i n e worker's e f f e c t i v e n e s s as a f a c i l i t a t o r of change be  developed  i n order  treatment environment.  to In  theoretical  and  practical  theoretical  standpoint,  practical  enhance the impact of the o v e r a l l summary,  need  there  i s both a  f o r the present study; from a  setting  of a p p l y i n g systemic  w i l l be d i s c u s s e d , and from a  s t a n d p o i n t , the p o t e n t i a l  a residential  then,  the consequences  methods i n a r e s i d e n t i a l  need t o  use of new i n t e r v e n t i o n s i n  s e t t i n g w i l l be i n v e s t i g a t e d .  BACKGROUND TO THE PROBLEM  The treatment home which i s the s u b j e c t of t h i s t h e s i s has a mandate t o p r o v i d e adolescent g i r l s  residential  f o r up  t o seven  between the ages of twelve and n i n e t e e n .  a d o l e s c e n t s a r e expected months, with  treatment  a maximum  to  remain  i n treatment  stay of s i x months.  The  f o r three  However these a r e  simply g u i d e l i n e s f o r suggested treatment d u r a t i o n and they a r e not r i g i d l y e n f o r c e d .  There a r e eleven f u l l  employed a t the treatment  home  (hereafter  time s t a f f members c a l l e d Vanhouse).  Six people  a r e employed  as c h i l d  men and three women), two as  care workers ( u s u a l l y t h r e e  overnight  workers,  two as f a m i l y  workers and a s u p e r v i s o r .  Prior  to  the  i n t r o d u c t i o n of s t r a t e g i c / s y s t e m i c methods  i n t o the Vanhouse treatment plan the approach was predominantly relationship-based.  This  relationship-based  approach, which  had  with  the  approach  much  in  described  common  later,  relied  on  Redl  (1952)  strong  supportive  between s t a f f and c h i l d r e n t o a c t as an a d d i t i o n the structure  s t a f f attempted  and  adolescents'  used  inappropriate  Many o f  to  i n t r o d u c t i o n of  treatment  that  set  limits  was  the p a r t  of the  At t h i s  some  the  time  was  employed  the s t r a t e g i c / s y s t e m i c methods.  r e s i s t a n c e on  strategic/systemic  Palazzoli's  c l e a r and c o n s i s t e n t on  the  behavior.  between s t a f f and r e s i d e n t s  Watzlawick's  to  In  the Vanhouse s t a f f expressed d i s s a t i s f a c t i o n with  the approach  resolution.  relationships  agent f o r change.  t o provide  confrontation  t o be  Two (1974)  of  adolescent  staff  literature sources  reportedly  on were  began  t o the  Open c o n f l i c t  quite  common and  g i r l s was the norm. to  problem of  prior  i n v e s t i g a t e the formation  specific  and  interest;  work with the Mental Research I n s t i t u t e and  (1978a) research with the M i l a n  group.  The  Vanhouse s t a f f d i s c o v e r e d  t h a t , from  a systemic  through t h e i r i n v e s t i g a t i o n  perspective,  the very  treatment to an i n d i v i d u a l removed, from countertherapeutic.  From  a  and  the f a m i l y i t s e l f where the  providing  family  unit  perspective  was an  embedded i n d y s f u n c t i o n a l  the i d e a l  ( S l i v e , 1987).  removal of  necessity.  u n i t of treatment i s  However, t h e r e are s i t u a t i o n s  the c h i l d from the f a m i l y home becomes a  For example, some f a m i l y environments become h i g h l y  d e s t r u c t i v e where can  therefore  the  systemic  i n d i v i d u a l ' s symptomatic behavior i s family patterns  idea of  violence, suicidal  severely threaten  s t a f f decided  the c h i l d ' s  t h a t to  provide  treatment they would have  well  being.  abuse  The  Vanhouse  e f f e c t i v e systemically  oriented  to work  disempowering the adolescent  behavior or sexual  i n such  a way  or her f a m i l y , and  as to  seek to  avoid  involve  them a l l i n the s o l u t i o n to the f a m i l y ' s problems.  Four  specific  attempting to adolescent's below,  to t r e a t  provide family.  essentially  theoretical  to  of  concern  treatment These  become  four i s s u e s ,  represent  adolescents  provide  in  some  which are  inherent  a residential  program i s to  apparent when  i n a s e t t i n g removed from  i n c o n s i s t e n c i e s t h a t a r i s e when an  t h a t f a c e s any and  issues  come to  the  identified  complications  or  attempt i s made  setting. g r i p s with  The  challenge  these  issues  s o l u t i o n s which are c o n s i s t e n t with the o v e r a l l  goals of the treatment philosophy.  The  i s s u e s are as  follows:  8 1)  The I d e n t i f i e d P a t i e n t  (IP) Problem  The  i s the i n d i v i d u a l i n the family  identified  patient  has  been i d e n t i f i e d ,  the  p r o b l e m a n d needs t o c h a n g e .  the  "problem"  and  therefore  one  individual  I.P.  i t i s epistemologically as t h e home  that  resolved  by  "patient".  solution  "curing"  the  Therefore  to  perspective  the  the  idea  that  unit,  i n c o r r e c t t o i d e n t i f y any  the the  adolescent  i n care,  the adolescent  staff  are i m p l i c i t l y  family  in  attempted  i . e . placing the c h i l d  strengthening  a systemic  By a c c e p t i n g  f o r treatment  the  interaction. problem,  From  a s t h e one who h a s  i s i n t e r a c t i v e , i n v o l v i n g t h e whole f a m i l y  into the  agreeing  u s u a l l y by t h e p a r e n t s ,  who  p r o b l e m s may be  isolation  solution  from  family  to the family  a d d s t o t h e p r o b l e m by  one p e r s o n  i s at the root  of the  problem.  An which  issue that has  "treatment the  cause  treatment the  staff  been  two  identified  sabotage". of staff  the  by  Now t h a t family  with  in  problem  a "cure"  somehow be  solutions that  the  Slive  the  and a s k f o r a c u r e .  succeed  t h e m s e l v e s must are  i s associated  I.P.  (1987),  I.P. has the  problem, and is  that  of  been i s o l a t e d a s  parents  turn  to the  However, p a r a d o x i c a l l y , i f  then the parents f e e l  incompetent as  that  caretakers.  t h e f a m i l y may a t t e m p t  to resolve  they There this  9 problem  of  appearing  attempt  to sabotage  With  the  incompetent.  Both  first  solution  the parents withhold staff  or  any  refuse to  accept that  have o c c u r r e d w h i l e staff  and  by  i n treatment.  refusing  to  involves great  The  loyalty  amount  of  This  t a k e on  sabotage  hangs  on  to  (Minuchin,  The  This  their  that  attempts the  status  positive By  not  treatment  b e h a v i o r a l changes  cooperating with  their  that  I.P. loyalty  I.P.,  to  likely  may  who  g e n e r a l l y has  her p a r e n t s  to t h e i r  their  a  resist  look  like  whenever  parents'  good e x a m p l e s o f how and  "good  sabotaged  includes resisting  i s similar  quo  as  be  the  positive  h e r p a r e n t s , may  a v o i d making  are  identity  treatment  The  plan  role.  the f a m i l y  shared  world  view  1974).  Surrogate  second  residential in  to  loyalty  a role  These  2)  hidden  in their  protect  way  of the  her b e h a v i o r  failures. staff  second  the  improving  an  important  acknowledge or encourage  s i g n s o f change t h e p a r e n t s parents".  involve  treatment.  i n f o r m a t i o n t h a t might h e l p the they  solutions  Parent  theoretical  c a r e has article,  Perspective".  Problem  problem  been examined w e l l "Separation  Traditional  and  approaches  which by  i s associated with  Perry  Attachment:  e t a l . (1984) A  to r e s i d e n t i a l  Shift  in  treatment  10  s t r e s s the  importance of developing strong bonds between s t a f f  and c h i l d r e n as an a c t i v e agent Jones,  Brendtro  1980;  &  f o r change  (Bettelheim, 1 9 7 4 ;  1983).  I f the goal from a  Ness,  systemic p e r s p e c t i v e i s to f a c i l i t a t e problem r e s o l u t i o n w i t h i n the f a m i l y may,  u n i t , then bonding between the s t a f f and  to some extent, be c o u n t e r t h e r a p e u t i c .  The  adolescent  rationale for  t h i s i s t h a t i f the a d o l e s c e n t t u r n s to the s t a f f to meet t h e i r intimacy needs then the s t a f f may  a c t to  block the  interaction  t h a t might have o c c u r r e d between the f a m i l y and the a d o l e s c e n t .  The  f a c t i s t h a t a c h i l d care worker i s not, and can never  be, the c h i l d ' s artificial in  care  parent.  Perry  in  are  developmentally will  t u r n , "detach"  et  al.  a  is  at  a  stage  unit.  state,  adolescent issue, that  is  it  where  adolescence  issues  turbulent  develops  However,  a simulation,  parents and  surface  given  the  an  is  environment.  beginning  the community  c o m p l i c a t i n g or postponing  at  a the This  resolve  i d e n t i t y separate precisely  families.  is and  s i t u a t i o n , given time, w i l l more than l i k e l y the a d o l e s c e n t  not  U n f o r t u n a t e l y many a d o l e s c e n t s  from t h e i r  (1984)  disturbed,  she  " a t t a c h " themselves to the s t a f f members  s e p a r a t i o n and attachment often  or  or i m i t a t i o n parent.  o p p o r t u n i t y they and,  He  this  time  As when  result i s unstable itself  as  from the f a m i l y time,  when the  to t a c k l e the developmental  identity  resources become  i n v o l v e d and  the r e s o l u t i o n of t h i s i s s u e .  risk  11 The  p o i n t t o be made here i s t h a t placement may exacerbate  the  "problem" by d i s t u r b i n g  and  attachment  the n a t u r a l  t h a t occurs during an a d o l e s c e n t ' s  For t h i s  reason r e s i d e n t i a l  look  their  at  process of s e p a r a t i o n  f a c i l i t a t e the  own  s t a f f must  behavior  and  n a t u r a l process  take a  development. long and hard  i d e n t i f y how they can best  mentioned above  and a v o i d any  a c t i o n on t h e i r p a r t t h a t may c o n t r i b u t e t o the problem.  Perry  et  a l . (1984)  give  examples  treatment i n t e r v e n t i o n s disempower creating a The  s t r u g g l e between  adolescent  the s t a f f  as  the f a m i l y , adolescent  family are e s s e n t i a l l y  As we can see t h i s "surrogate  serious theoretical  3)  family  a  u n i t by  and s t a f f .  i s s a i d t o be " t r i a n g u l a t e d " i n a process where  and the  directions.  the  of how r e s i d e n t i a l  pulling  i n opposite  parent" problem i s a  concern f o r any r e s i d e n t i a l  treatment home.  The Problem of Resistance  The  third  residential resistance.  major  setting  obstacle  has t o do  This issue,  to  with  reluctant  clients.  treatment  environment  The  a long h i s t o r y  relevant  residential  where  treatment i n a  the phenomenon  which has  mental h e a l t h f i e l d , i s e s p e c i a l l y  effective  within the  when d e a l i n g with  setting  the c l i e n t  of c l i e n t  not  is a only  unique resists  12 treatment but  o f t e n does not even acknowledge t h a t any problem  e x i s t s i n the f i r s t  place.  Recognizing t h a t people  resist  even  changing  under  their  the  best  behavior,  of circumstances  i t ' s no s u r p r i s e t o  d i s c o v e r t h a t a r e l u c t a n t c l i e n t , who i s a l s o an adolescent and is  likely  challenge  experiencing  a  t o those who a r e  treatment.  life in  crisis,  the  provides  position  an immense  of a d m i n i s t e r i n g  Much of the c h i l d care worker's energy and thought  i s taken up by t h i s task of d e a l i n g with r e s i s t a n c e .  Associated in  "reaching"  situation. conceptual  4)  with the r e s i s t a n c e  the adolescent  who l a c k s i n s i g h t i n t o her problem  T h i s i n c a p a c i t y may be due t o poor language skills,  last  i s s u e of  and D i s c i p l i n e  concern a r i s e s  from the n e c e s s i t y f o r  the s t a f f t o manage the behavior of the r e s i d e n t s . l e a s t the  staff  At the very  s t a f f must have enough a u t h o r i t y t o c o n t r o l behavior  t h a t threatens the  skills,  or r e p r e s s i o n .  The Problem o f C o n t r o l  The  problem i s the d i f f i c u l t y  the s a f e t y of the adolescents  are required  when i t comes  to  house  in  the home.  If  t o put themselves i n a one-up p o s i t i o n rules,  then  w i t h i n the home i s c l e a r l y a f f e c t e d .  their  therapeutic  role  13  According t o Dahms  (1978);  I t i s a maxim i n r e s i d e n t i a l programs t h a t e f f e c t i v e treatment  needs t o be preceded  that  treatment  no  by  i s really  disturbed, delinquent,  or  effective  possible  disorganized  control;  u n l e s s the behavior of  the c l i e n t p o p u l a t i o n can be made r e s p o n s i v e t o s t a f f (pg« 3 3 6 )  a u t h o r i t y and c o n t r o l .  The  problem  residential  here  treatment  i s that generally  r e s i d e n t behavior management. f a i l s t o cooperate to  overpower  Dreikurs  employ  In other  approaches  to  a l i n e a r approach t o words, i f a r e s i d e n t  with s t a f f r e q u e s t s , more " f o r c e " i s a p p l i e d  the adolescent  (1964)  traditional  and  gain  their  cooperation.  has shown how easy i t i s t o become i n v o l v e d i n  power s t r u g g l e s with d i f f i c u l t young people.  When s t a f f become  i n v o l v e d i n power s t r u g g l e s with r e s i d e n t s the a d u l t i s l i k e l y to  display  aggression  hostile  or  i s always  aggressive  behavior.  Such counter  c o u n t e r - p r o d u c t i v e because i t v a l i d a t e s  the a d o l e s c e n t ' s e x i s t i n g p e r c e p t i o n of t h e a d u l t as a negative person.  This question;  control how  can  issue staff  can  be  summarized i n the form of a  exercise  adequate  control  over  r e s i d e n t s without s e r i o u s l y j e o p a r d i z i n g t h e i r t h e r a p e u t i c  role  w i t h i n the home?  The  four  roadblocks  or  adolescents systemic  issues  mentioned  challenges  in  above  to  a  residential  approach  introduced  the  are  effective  presented  as  treatment  of  treatment  setting.  into  Vanhouse  the  The  new  treatment  program i s an attempt to t a c k l e these roadblocks  and  more e f f e c t i v e  to accomplish  treatment environment.  t h i s two  major  program.  The  sessions  f o r the  The  purpose  changes first  were  and  f o r t h i s change was  much as p o s s i b l e i n the process change  introduced  change i n v o l v e d  adolescents  was  the  use  of  In order into  the  a  treatment  p r o v i d i n g f a m i l y therapy  their  respective f a m i l i e s .  to i n v o l v e the whole f a m i l y of change.  The  strategic/systemic  predominant mode f o r p r o v i d i n g  provide  on-going  second major  methods  treatment  as  as  within  the the  residential setting.  This t h e s i s  is a  d e s c r i p t i v e study  s t r a t e g i c / s y s t e m i c methods The  study  i n the  of the  use  of these  Vanhouse treatment s e t t i n g .  i s a q u a l i t a t i v e , r a t h e r than q u a n t i t a t i v e , a n a l y s i s  of the i n t e r v e n t i o n s u t i l i z e d  and  issues  upon  that  become  s p e c i f i c questions  1  evident  the  associated t h e o r e t i c a l  t h e i r implementation.  addressed by t h i s t h e s i s are:  The  15 1)  How were formulated setting?  2)  B a s e d on t h e a u t h o r ' s clinical judgement as a p a r t i c i p a n t observer i n t h e home, w h i c h o f t h e various interventions u t i l i z e d appeared t o be most s u c c e s s f u l and f o r what r e a s o n s ?  3)  What are the s i g n i f i c a n t contextual variables associated with the implementation of these interventions i n the r e s i d e n t i a l setting?  4)  What a r e t h e c o m p a r a t i v e b e n e f i t s and d r a w b a c k s o f u s i n g s t r a t e g i c / s y s t e m i c methods, as opposed to traditional methods, in a residential setting?  The  the and  method o f s t u d y  strategic/systemicinterventions delivered within the r e s i d e n t i a l  chosen t o  was t h e c a s e  study  s t u d y method  i s t h e r e s e a r c h method o f c h o i c e  "why"  question  events, The  approach.  answer t h e  is  being  According  asked  case  study  attempts  to  qualitative  takes  a  illuminate statements  has  holistic the  t o Y i n (1984),  about  over which t h e i n v e s t i g a t o r  little  the case "how" o r  or  set of  no c o n t r o l .  o f a phenomenon and  significant the  when a  questions  a contemporary  view  concerning  above  variables relationship  and make between  them.  The  present  thesis  The  evidence  design. sources  of  data  time  author child  presented  collection;  information obtained The  i s an example o f a s i n g l e - c a s e r e s e a r c h  through  i s based  documentation, the p a r t i c i p a n t  o f t h e t h e s i s was employed care  worker  in  on t h r e e  the  different  interviews observation  and role.  f o r s i x months a s a p a r t -  home.  This  participant-  16  o b s e r v a t i o n r o l e p r o v i d e d the depth look  a t the  approach to  d e v e l o p i n g a t Vanhouse.  author  with  a  first-hand, i n -  r e s i d e n t i a l treatment t h a t  Chapter t h r e e  of the  was  thesis provides  more i n f o r m a t i o n on the case study as a method of r e s e a r c h .  The f o l l o w i n g  chapter p r o v i d e s  a thorough  review of the  t r a d i t i o n a l approaches t o r e s i d e n t i a l treatment as strategic/systemic resolution.  approach  to  problem  w e l l as the  formation  and  CHAPTER II - LITERATURE REVIEW  TRADITIONAL THEORIES OF RESIDENTIAL TREATMENT  In  this  section  treatment w i l l guided  be  group,  four  distinct  discussed;  and  up  residential  separately. of t h i s  the s i g n i f i c a n t  review, of is  to  the t r a d i t i o n a l understand  s y s t e m i c - s t r a t e g i c methods were  Morse, C u t l e r and workers are  Fink  the  at t h e i r  job  centres  with  t h e i r personal  stated  mind t h a t  context  that  examined  the purpose residential  into  report that  who  (Morse, C u t l e r , & Fink, a  ingredients  which  the  "many c h i l d  care  introduced.  (1964)  t h e o r i e s and  Once these f o u r  approaches to  atheoretical naturalists" personal  behavioral,  w i l l be i s o l a t e d and  I t i s important to keep i n  treatment,  t h e i r own  approaches.  treatment  residential  psychoanalytic,  re-education  t h e o r i e s have been d i s c u s s e d , make  the  t h e o r i e s of  who  base  t h e i r work on  are o f t e n q u i t e 1964).  In  successful  some treatment  o r i e n t a t i o n , the workers r e l y more on  b i a s to treatment while outwardly complying with  the o r g a n i z a t i o n ' s to f o l l o w t h e i r own  expectations.  Since c h i l d care workers tend  implicit theories,  i t becomes  an enormous  task to mold a s e r v i c e o r g a n i z a t i o n to comply with a p a r t i c u l a r p h i l o s o p h i c a l o r i e n t a t i o n (Brendtro  &  Ness,  1983).  Keeping  18  this  point  approach;  in  mind,  let  us  examine  the f i r s t  traditional  the p s y c h o a n a l y t i c .  PSYCHOANALYTICAL RESIDENTIAL TREATMENT  The p i o n e e r s who approach t o  first  treatment  for  developed  (1950,  F r i t z Redl  (1957  Fritz  Mayer  1955,  prominent t h e o r i s t s  These  1967,  with David  (1960,  1974;  attempted  p r i n c i p l e s t o the c h i l d ' s t o t a l  Bruno B e t t e l h e i m ' s  in  the  Nazi  Buchenwald (Whittaker, was  able  to  see  how  to  1959,  1966),  Blum).  apply  living  w e l l as  From h i s the  for  University  of  Chicago's  r e p o r t e d by  of  Dachau  spirit  can  himself i n  and he  be i n  environments.  the d i r e c t o r of  Sonia Shankman Orthogenic  emotionally disturbed c h i l d r e n .  school i s  experience as a  p r i s o n experiences,  During the years from 1 9 4 4 t o 1 9 7 3 , he was the  These t h r e e  being i n f l u e n c e d by  camps  human  overcoming even the most degrading of  Moris  environment.  concentration  strong  and  basic psychoanalytic  i n f l u e n c e d by h i s  1981).  i n c l u d e d Bruno  with Emmy S y l v e s t e r ) ,  1948  Arthur  work, as  p s y c h o a n a l y t i c w r i t i n g s , was prisoner  pioneers  Wineman, with  1971  r e s i d e n t i a l or M i l i e u  t r o u b l e d c h i l d r e n were a l l s t r o n g l y  i n f l u e n c e d by p s y c h o a n a l y s i s . Bettelheim  a  H i s work a t the books such  School  Orthogenic  as "Love i s Not  19  Enough" Fortress" (1981)  "Truants  (1950),  "The  (1955), (1974).  Empty  Whittaker  d e s c r i b e s B e t t e l h e i m ' s work as f o l l o w s ;  While t h e r e i s much value and sheer b r i l l i a n c e ,  i t is  a difficult  To be  approach t o  his  descriptions though i n my  clinical of  put i n t o  operation.  accounts  what  are  disturbed  judgement,  assumptions and  many  are  Although  work  treatment  i n f l u e n c e had  a great  approach t o  therapeutic  h i s recognition  workers.  This  The  into  staff/child  Another important  in  be  considered  i t s own  right,  the development  the treatment  took  treatment environment  not  a  his  of a m i l i e u  H i s work r e f l e c t s a p a s s i o n f o r d e t a i l  effect.  therapy"  activities,  impact on  treatment.  with every aspect of  "total  approached  on f a l s e  about the o r i g i n s  ( 1 9 8 2 p. 4 7 )  may  i s like,  based  of c h i l d h o o d d i s o r d e r s .  Bettelheim's  fascinating  behavior  sheer s p e c u l a t i o n  comprehensive  was  Life"  and "A Home f o r the Heart"  (1967)  sure,  its  from  environment considered f o r  development  account  interactions  (Bettelheim,  the  realization,  routines,  and a r c h i t e c t u r e of the  introduced  importance  of  rules,  1974).  contribution of  the  of what he c a l l e d  the  of  by B e t t e l h e i m the  front  line  considerable therapeutic  20  impact  imparted by workers i n t h e i r day-to-day  i n t e r a c t i o n with  c h i l d r e n , i s most e v i d e n t i n h i s l a t e r w r i t i n g s - e s p e c i a l l y "A Home f o r the Heart"  The t h e o r i s t  (1974).  whose name  i s most commonly a s s o c i a t e d with  the p s y c h o a n a l y t i c approach t o Redl.  Redl's  considered  book,  the  Although  his  "Controls  basic work  and  is  helps  Vanhouse  prior  to  For t h i s  approach  i s provided.  The  cornerstone  c h i l d h o o d pathology (Redl,  keeps us  uncover  1952).  i n touch  of  treatment. Redl's  elements  of  much i n common with  approach t h a t developed a t of  systemic/strategic  a thorough coverage of the Redl  the Redl  as an  c o u l d be  cut across t h e o r e t i c a l the b a s i c  introduction  reason,  (1952)  residential  H i s approach has  the  i s Fritz  psychoanalytic,  interaction  sense, experience-based  methods.  ego  on  labelled  to  r e s i d e n t i a l treatment. the common  from W i t h i n "  textbook  d e s c r i p t i o n s of s t a f f / c h i l d boundaries  r e s i d e n t i a l treatment  approach  i n d i c a t i o n of  Ego i s t h a t p a r t  is a  view  of  a poorly functioning  of the p e r s o n a l i t y which  with r e a l i t y and with which we r e g u l a t e our  impulse e x p r e s s i o n so t h a t i t i s w i t h i n the bounds which such a reality dictates. treatment t y p i c a l l y numerous  impulses  Redl  suggests t h a t  i s unable which  to  the c h i l d r e f e r r e d f o r  adequately  continually  deal  with the  c h a l l e n g e the ego. For  21  example, such c h i l d r e n are unable to insecurity  of  aggression g u i l t and  any  kind  without  (Redl & Wineman,  aggression  leads  begins  a n x i e t y , or  breakdown i n t o d i s o r g a n i z e d The  1951).  s i n c e the c h i l d ' s ego  the g u i l t , a c y c l e  handle f e a r ,  aggression  leads t o  i s weak and unable to deal  where  guilt  to g u i l t , e t c .  leads  In Redl's  to a g g r e s s i o n ,  e x t e n s i v e work with  c h i l d r e n , i t became c l e a r to him t h a t the " i n d i v i d u a l process",  seeing  a time, was provided  treatment  the c h i l d once or twice a week f o r an hour at  relatively  in  i n e f f e c t u a l compared  a treatment  home.  r e a l i z e d t h a t the treatment  to what  might  be  A l s o , and most i m p o r t a n t l y ,  he  p r o v i d e d by the home  should be  going and as such be p r i m a r i l y p r o v i d e d by the c h i l d care who  have  day-to-day  contact  with  the  r e s p e c t , as w e l l as many o t h e r s , Redl was b r i n g i n g the treatment p r o v i d i n g the  to i t s  grass  children.  in his characteristically flavorful  job we may  what geniuses  level  and  have  c h i l d ' s anxiety  performed  environment f o r change.  in  the  which i s so f u l l  treatment  n e u r o s i s i n our s e s s i o n s , how  h i s waking  and  s l e e p i n g day  of traumatic  process  be and what f l a w l e s s  get any p l a c e i f the same c h i l d spends hours of  thereby  prose;  we may  staff  w e l l before h i s time,  roots  c h i l d r e n with a powerful  on-  In t h i s  Redl d e s c r i b e s the weakness of the i n d i v i d u a l treatment  No matter  with  2 3 of  of a can  we  the 2 4  i n a framework  situations?  How  can  we  help a steps  child into  if a  world  picayunishness narrowed  by  sprinkled  soon a f t e r  of a  with  h i s meeting with us, he  regimented  suppressive  programless the  by  the compulsive  roles  and  routines  to  boredom,  exposure  over-stimulations  coming  s e l e c t i v e c o n t a g i o n - i n i t i a t o r s i n h i s group, with  the  scenes  of  sadistic  from  peppered  punishment  and  sentimental teacher pet c u l t i v a t i o n , and punctured by nothing but  wordy speeches  disinterested (1952,  representatives  of  child-  s o c i e t a l demands?  p.40)  Faced w i t h  the inadequacy  the s e v e r i t y of the so c a l l e d i n need  and l e c t u r e s from  of the i n d i v i d u a l approach  "ego  impairment"  and  of the c h i l d r e n  of treatment, Redl developed a treatment process which  i n c l u d e d the t o t a l environment environment"  provided  strengthening  of  the  strategies.  Redl  by  of the  Redl  ego  (1952)  has  youngster. as  through  its  various  basic  "total  goal the  ego-supportive  c l a s s i f i e s f o u r b a s i c modes of ego  support; 1 ) the ego support by the impact of the t o t a l environment,  This  i . e . physical  d e s i g n of the  l a y out, p o l i c i e s , r u l e s , 2 )  the ego-supportive r o l e of a c t i v i t y and  program s t r u c t u r e s , 3 )  the  b e h a v i o r , or what Redl  calls  techniques  to  handle  " s u r f a c e b e h a v i o r " , and  day-to-day 4 ) the  ego-supportive impact of  the whole s t r a t e g y of h a n d l i n g t h e i r own  l i f e experiences.  With ego  support and  g o a l , Redl began to The  formulate  actual pioneering  m i l i e u had in his  strengthening his  as  "total  a b a s i c treatment treatment  attempt to c r e a t e a r e s i d e n t i a l  been made e a r l i e r by August Aichorn  book "Wayward Youth" (Aichorn,  and  1935).  every aspect therapeutic  His  t o t a l treatment  of the design impact.  be  treatment  i s described  However, f o r  purposes, Redl's approach o f f e r s a more in-depth m i l i e u approach.  design".  account of  approach r e q u i r e s  considered  for  our the that  i t s contributory  T h i s means t h a t the p h y s i c a l layout of  the  home, the housekeeping p o l i c i e s , the r e l a t i o n s h i p between s t a f f members, and served,  way  down to the p a r t i c u l a r way  i s taken i n t o account f o r i t s t h e r a p e u t i c  A key children "fun". are  a l l the  element with  a  of  the  program  Redl that  seen  integral  part  simply of  as  the  time-filling therapeutic  communicates  through  acceptance of  the c h i l d r e n ' s  them  and  gratification. messages of  are  their  there  S t a f f are  is  providing  games  "fun a c t i v i t i e s " support  d i r e c t e d at  them  The and  in  an  staff  complete  t h a t they  a l l costs  When i n t e r f e r e n c e must be used, i t i s the conveyed.  and c r a f t s  process.  h o s t i l i t y towards the c h i l d r e n ' s "fun  a t t i t u d e t h a t must be  the  programming but as  encouragement  to  influence.  s a t i s f i e s t h e i r needs to have  In other words s t r u c t u r e d a c t i v i t i e s ,  not  about  approach  meals are  care  t h e i r need to a v o i d  any  activities".  "reality limitations"  24 It i s  important  t h a t Redl developed between the  to  note a t  this point  h i s treatment  ages o f  philosophy  i s tailor-made  However, t h i s  i n any  does not  cannot  be  f o r were boys  9 and 12 and t h e r e f o r e the s t r u c t u r e s and  programming of the home  techniques  t h a t the c l i e n t s  modified  f o r that  population.  way mean t h a t Redl's ideas and so  as  to  be  effective  with  another p o p u l a t i o n of c h i l d r e n .  This  brings  philosophy; as  the  us  or  controversial  most  between  family issue,  treatment  context.  treatment  and  crucial  so  area  and  setting  the  is a  literature  i s remarkably  t h i s i s s u e i s t o the  Brendtro  & Ness, 1983), but  r e l a t i o n s h i p or effect.  offer a  Just  i n the  l i v e l y and  on r e s i d e n t i a l  scarce  when  overall  treatment  the l i t e r a t u r e from the d i f f e r e n t  i n g r e d i e n t of t h e r a p e u t i c success  1980;  children.  therapist  seems t o suggest t h a t a n u r t u r i n g , s u p p o r t i v e key  of treatment  i t should be w i t h i n the r e s i d e n t i a l  relationship  Most o f  client  counselling  However  c o n s i d e r how important design.  a  the r e l a t i o n s h i p between s t a f f and  relationship  individual  to  T h i s i s s u e w i l l be  described  approaches  relationship i sa  (Bettelheim, 1974; Jones,  few go  r a t i o n a l e to  you  on t o  describe that  explain i t s therapeutic in  detail  at  a later  time, f o r now l e t us r e t u r n t o Redl and h i s thoughts on s t a f f child relationship.  25 Redl  emphasizes  relationship  that  between  an  staff  accepting,  and  children  affectionate  is  e s s e n t i a l , but  s t r e s s e s t h a t the s t a f f must a l s o p l a y the r o l e of The  adult  areas; from  plays  role  of  protector i n four  p r o t e c t i n g the c h i l d from other outside  situations.  interference  behavior  and  reaches  c h i l d r e n are conflict.  with the which w i l l  and  only  from  i n those  a potentially  l e f t to This  systemic  in  potentially  harmful l e v e l .  himself, dangerous  h i s peers i s  s i t u a t i o n s where  aggressive  Otherwise  themselves to s e t t l e i n t e r - g r o u p non-interference  strategy  the  tension  i s i n agreement  approach to i n t e r a c t i o n a l problem r e s o l u t i o n  be d i s c u s s e d  in a later section.  P r o t e c t i n g the c h i l d r e n from issue  significant  c h i l d r e n , from  I n t e r f e r e n c e to p r o t e c t a c h i l d from  used s p a r i n g l y  and  the  "protector".  treatment  that,  as  themselves we  is  s h a l l see  an  important  l a t e r , becomes a  c e n t r a l concern i n the Vanhouse treatment philosophy.  Children  in  weak-ego  treatment,  even  those  with  development, are a c u t e l y aware  what  of when  Redl  t h e i r behavior  the boundary i n t o the i n a p p r o p r i a t e r e g i o n . i f the s t a f f , f o r curb t h i s  whatever reason,  extreme behavior  fail  calls  Redl b e l i e v e s t h a t  to  the c h i l d w i l l  provide  f o r more  c o n t r o l by the s t a f f  other words, the c h i l d i n seeking  l i m i t s to  r e a c t i n a somewhat  p a r a d o x i c a l manner by e s c a l a t i n g the i n a p p r o p r i a t e an i n v i t a t i o n  crosses  to f i n d the  behavior  as  (Redl, 1952).  In  limits  of h i s or  26 her  power  will  effective  progressively  limits  are  sometimes r e f e r r e d the new  placed  to as  upon  manner  confident  by  the  that  " t e s t e d " i n a methodical  and  children.  particular  inappropriate  behavior, subside and  and  more c o n f l i c t - f r e e b e h a v i o r .  only  protective  does  limits  negatively  protective  the are  child not  limits,  child  member  will  the  the c h i l d  become  Once the  staff  provide  t h a t not  probes,  appears to Redl  more  e s t a b l i s h e d but  Some  of  these  via relax  (1952) notes  aggressive  when  he/she w i l l  afterwards to that p a r t i c u l a r s t a f f who  f u n c t i o n of p r o t e c t i v e  dynamic i s and  consistently  displays  This  c h i l d care workers  probing  a  t h e i r behavior u n t i l  them.  " t e s t i n g " by  s t a f f member i s c o n s t a n t l y  persistent feels  escalate  react  missed t h e i r  interference.  "protective  functions" described  by  (1952) are what most people commonly r e f e r to as d i s c i p l i n e they  take  a  central  Whenever Redl's s t a f f are  cautious  caring,  as  to  in  interferes  frame  opposed  disapproval.  role  to  the  (1952) b e l i e v e s  approach  from  commonly  reward  positive  behavior  which  is  educational  seen  with a  treatment  which  as is  associated  clearly distinguishes  behavior as  approach.  protective  towards i n a p p r o p r i a t e  programs.  with  h i s treatment  restrict  inappropriate  and  behavior i s  Educational and  and  c h i l d ' s behavior they  interference  punishing  This a t t i t u d e  what Redl  Redl's  Redl  or  programs or  punish  undesirable  27  (Brendtro  &  Ness,  symptoms are  In  1983).  Redl's  t o l e r a t e d with an a t t i t u d e of acceptance,  with an e x p e c t a t i o n f o r eventual Redl suggests  1952,  p.  change.  The  coupled  message which  should i d e a l l y be t r a n s m i t t e d t o the c h i l d r e n  be summarized: of course  approach u n d e s i r a b l e  "We  i n the  l i k e you, we take you the way long run  we'd  like  you  can  are, but  you to change".  (Redl,  59)  There i s a f i n e l i n e between hand and  "symptom t o l e r a n c e "  "permissiveness" on  on the  other.  t o l e r a n c e a l l o w s the symptoms t o come  out i n  exposed, so t h a t they can be manipulated attitude,  on  the  one  The a t t i t u d e of the open,  t o be  and used f o r treatment  purposes.  A permissive  the  other  hand, lends  i t s e l f to  m i s i n t e r p r e t a t i o n as the c h i l d might assume t h a t the  s t a f f has taken a p o s i t i o n of i n d i f f e r e n c e t o the i n a p p r o p r i a t e behavior or  i s a c t u a l l y encouraging  c r e a t i o n of an a p p r o p r i a t e l y strategic  issue,  d i s c u s s i o n i n any  We calls  one  which  creates  setting,  i n t e r f e r e n c e " , as  occurs between interaction,  t o l e r a n t atmosphere  r e s i d e n t i a l treatment  can view l i m i t  "limit  s t a f f and of  the c h i l d to a c t out.  a  a f f e c t i o n and warmth.  more  or  much  i s a serious  controversy  what  one type  Redl  (1952,  p.  57)  of i n t e r a c t i o n which treatment.  positive  is  kind,  believes  and  setting.  c h i l d r e n during  Redl  The  that  a  the  Another  d i s p l a y of  heavy  dose of  28  a f f e c t i o n i s required  to c a r r y out  e f f e c t i v e treatment and  t h i s a f f e c t i o n should be d i s t r i b u t e d evenly I t appears  t h a t the  that Redl e n v i s i o n s  is  very  similar  to  Carl  and  stresses  relationship  element of  the  client  (Redl,  Redl's p o s i t i o n on the  The  children  The  p.61).  1952,  whether they deserve i t or not; the  basic  which Rogers c a l l s term " t a x - f r e e "  following  p l e n t y of  quota  of  and  love and  they must  gratifying  life  parts  of  the  well  situations,  bargaining tools m o t i v a t i o n , but  as  must  be  kept  antiseptic  short  granting  of  made  the  be  tax-free  as minimum  youngster's d i e t , i r r e s p e c t i v e of  descriptions  problem b e h a v i o r .  In  or even t h e r a p e u t i c  (Redl, 1 9 5 2 ,  of the most v a l u a b l e c o n t r i b u t i o n s  his detailed  assured  experiences  the  cannot  of e d u c a t i o n a l  problems of deservedness.  One  as  children;  affection be  happy r e c r e a t i o n a l  affection,  Redl  manipulation  of  the  p.61)  p r o v i d e d by Redl i s  s p e c i f i c techniques f o r h a n d l i n g  refers of  love  quote summarizes  whether they seem to have i t coming or not. love  Redl  1961).  r e l a t i o n s h i p between s t a f f and  must get  child  Rogers' i d e a l  (Rogers,  " u n c o n d i t i o n a l p o s i t i v e regard", u s i n g the instead  group.  i d e a l r e l a t i o n s h i p between s t a f f and  r e l a t i o n s h i p between t h e r a p i s t that  amongst the  that  to  surface  these  techniques  behavior"  (Redl,  as  "the 1952,  29  p.153).  Many of the 17 techniques d e s c r i b e d  by c h i l d  a r e used  care workers, as w e l l as p a r e n t s , on a "common sense"  or "common knowledge" b a s i s . provides  theoretical  " a n t i s e p t i c " that  f o r these  step f u r t h e r and  interventions  and The  effectively  apply  Redl r e f e r s  t o suggests  t h a t , whatever the  be concerned  therapeutic.  goes one  most  of the i n t e r v e n t i o n ,  must f i r s t  Redl  support  suggests when and how t o  goal  by Redl  In other  the c l i n i c i a n  or f r o n t  them.  l i n e worker  t h a t the i n t e r v e n t i o n i s not c o u n t e r words,  although  there  i s a definite  requirement f o r the s t a f f t o p r o v i d e l i m i t s i t must be c a r r i e d out made  i n such a manner than any t h e r a p e u t i c thus  rapport  f a r are  not  destroyed.  gains t h a t  The l o s s of e s t a b l i s h e d  between s t a f f and c h i l d and the c r e a t i o n of a traumatic  episode a r e two examples of the p o t e n t i a l l y e f f e c t s of s t a f f  Redl's v a r i o u s  counter-therapeutic  interventions.  Due t o the c o n s t r a i n t s of  space  interventions w i l l  s i n c e Redl's work o f f e r s the only to-day i n t e r a c t i o n s interventions are  interventions  a  thorough  coverage o f  not be undertaken.  However  in-depth a n a l y s i s of the day-  between s t a f f and c h i l d r e n and s i n c e these o f t e n considered  r e s i d e n t i a l treatment key  have been  approach, a  follows.  the core  component o f any  d e s c r i p t i o n of  some of the  30  I n t e r v e n t i o n s are not simply techniques to  provide a safe  and manageable environment, they are a l s o important i n g r e d i e n t s i n the t h e r a p e u t i c p r o c e s s . deceivingly  simple  One  techniques  (Redl, 1 9 5 2 , p. 1 5 8 ) .  Planned  of the is  most i n t e r e s t i n g  called  "planned i g n o r i n g "  ignoring essentially  means t h a t  the s t a f f member avoids i n t e r f e r i n g i n behavior t h a t may surface  appear  considerable  inappropriate.  experience  become  s i t u a t i o n q u i c k l y and d e c i d i n g to  solve  Child very  interfere.  A  typical  f r u s t r a t e d teenager comes  stomping  h i s / h e r path. the  child  developed to  sizing  up a  at  inteference w i l l it.  The  l e t something  the  who  house  else  the behavior  glaring  is  in  or, on  becoming p a r t  ignoring  resolution  has  proposed  "Change" (Watzlawick,  a by  difficult  go and when  the  f a c t o r s , such house  Watzlawick  Weakland  &  Fisch,  as;  who  may  decide  behavior  may the  T h i s technique of  rationale et  crosses  hand, the s t a f f  of the problem.  and  and the rapport  By i g n o r i n g the  similar  school  at anyone who  the other  decide t o i n t e r v e n e immediately. s t a f f avoids  help  example might be the case where a  Depending on a number of  is,  with  r e t u r n s from a d i f f i c u l t day at  in  on the  workers  between s t a f f and c h i l d , the s t a f f member  ignore  planned  adept  the s i t u a t i o n or simply exacerbate  p a r t , of course, i s t o know when t o to  care  i f their  and  al.  to  the  in  their  1974).  problem book,  Watzlawick  r e f e r s to f a u l t y i n t e r f e r e n c e as "when the s o l u t i o n becomes the problem" (Watzlawick  et a l . , 1 9 7 4 , p. 3 1 ) .  31 Another i n t e r v e n t i o n of s i g n i f i c a n t refers  to  p.178).  as  "interpretation  Redl d e s c r i b e s  understand  the  misinterpreted, hand.  approach  requires  occurs.  meaning  the  the  h i s own  help  member  whenever  s i x types  to  and strengthen  interviewing  styles  professionals  considerable  are  experience  through  significant  incident  of  interviews  under the  "guilt-squeeze "interpretation  interview"  and  the "group function to  t h e r a p e u t i c a l l y a c t as a means  the c h i l d ' s weak ego. familiar  to  with  Each  of these  c h i l d care workers and  children  who  have  of the Redl approach i s the use o f  viewed as  b e h a v i o r a l change.  a shaping  had  i n the f i e l d .  In summary, we can see t h a t one of the most unique  to i n f l u e n c e  i n an  a  interview",  working  has  by the Redl  intervene  rub-in interview",  and  he  motivation  (Redl, 1952, p. 254). These i n t e r v i e w s behavior  a child  which  treatment provided  staff  "the  to  situation  "counter-distortional  defuse d i s r u p t i v e to support  attempt  a  "expressional  interview", interview"  of  child  categories;  interview",  the  The on-going  Redl c l a s s i f i e s  following  other  i t as  i n t e r f e r e n c e " (Redl, 1952,  or t o help him grasp  issue at  "interviewing"  as  i n t e r e s t i s what Redl  t o o l which  the t o t a l  treatment  aspects design  The treatment environment i s can be  manipulated e i t h e r t o  " s o f t e n or l u r e out symptomatic behavior"  (Redl, 1952, p. 307).  Treatment takes p l a c e i n an on-going  f a s h i o n with  the d i s p l a y  of p a t h o l o g i c a l  behavior seen  to  appropriate  provide  an  as an o p p o r t u n i t y f o r the s t a f f treatment  intervention.  Redl's  "techniques f o r the m a n i p u l a t i o n of s u r f a c e behavior" p r o v i d e s us with a  good  interventions  description which  psychoanalytic  child  tradition  approaches.  Redl's  between s t a f f  and c h i l d  and  rationale  care  workers  and  many  of  micro-analysis suggests the  f o r many use  the  both  other  of t h e d a i l y  o f the i n the  treatment interaction  paramount importance of  the r e l a t i o n s h i p between these two p a r t i e s .  It  is  important  to  note  psychoanalytic label associated somewhat o f  a misnomer.  sense  he  that  uses  maladaptive behavior  at  with  this  point  Redl's  work  that  the  i s perhaps  Redl's work i s p s y c h o a n a l y t i c i n the  psychoanalytic d i s p l a y e d by  terms  to  children i n  d e s c r i b e the care.  However  h i s i n t e r v e n t i o n s a r e not " t r a d i t i o n a l l y p s y c h o a n a l y t i c " and as such  they  stand  on  their  own,  independent  of any l a b e l o r  school of psychology.  BEHAVIORAL RESIDENTIAL TREATMENT  The  i n t r o d u c t i o n o f b e h a v i o r a l concepts and  techniques t o  the m i l i e u approach came a t a much l a t e r date than those o f the psychoanalytic t r a d i t i o n . that to  L i k e Redl the  behaviorists believed  have a s i g n i f i c a n t treatment impact the therapy should  33  be p r o v i d e d i n an on-going manner, not i s both  p h y s i c a l l y and  natural group  l i f e milieu of  analysis in the  e x p e r i e n t i a l l y removed from the  (Whittaker, 1979).  psychologists  Washington f i r s t  behavior  of  in  and  educators  setting.  behavior  teacher  attention  children.  In  a  series  crawling  (Harris  ( A l l e n et a l . ,  such  et  1964),  a l . , 1964), and  e a r l y 1960's a  studies  examined  maintaining  problem  of  experiments,  excessive  behaviors  1966)  were d i r e c t l y c o n t r o l l e d by t h e i r  crying  excessive scratching  and  experimenters were Encouraged  by  treatment  centers,  modification  this  dispensing  successful  programs.  a  were  (Allen & Harris,  s o c i a l reinforcement  on  of  homes  Whittaker  founded  (1979)  school  By the  adopted  behavior  points  out  d i f f e r e d i n s t y l e and the  following  programs,  that  emphasis  agreed-upon  principles: 1)  a  immediate consequences  number  group  although i n d i v i d u a l b e h a v i o r i s t s efforts  as  at a l t e r i n g the above b e h a v i o r s .  success, and  the  whining  environment - i n t h i s case the a t t e n t i o n of a d u l t s .  s e l e c t i v e l y w i t h h o l d i n g and  of  1964), s o c i a l l y i s o l a t e  et  their  child's  the U n i v e r s i t y  diverse  al.,  who  p r i n c i p l e s of behavior  in  (Hart  i n the  at  These i n i t i a l  i n v e s t i g a t o r s demonstrated t h a t regressed  In the  attempted to apply the  a natural  effects  by a p s y c h o t h e r a p i s t  A c h i l d ' s p s y c h o l o g i c a l nature i s h i s behavior; directly observable and measurable actions c o n s t i t u t e the sum and substance of p e r s o n a l i t y . The behaviorist r e j e c t s the notion of inner  34  personality ego.  s t a t e s such  as i d , ego and super  2)  Behavior is largely controlled by the environment and, i n the case of operant or active behavior, is either strengthened, maintained, or diminished by i t s immediate e f f e c t s on the environment. Therefore i f the reinforcers for any given behavior can be identified and brought under c o n t r o l , the behavior i t s e l f can be s i m i l a r l y c o n t r o l l e d .  3)  The symptom of the t r o u b l e d c h i l d i s the e n t i r e problem; it is not simply an e x t e r n a l manifestation of some underlying disease p r o c e s s , psychoneuurosis or c h a r a c t e r d i s o r d e r . If the a c t i n g • out of the d e l i n q u e n t , or the bizarre behavior of the p s y c h o t i c c h i l d , i s stopped, then the b a s i c problem of delinquency or p s y c h o s i s has been solved (taken from Whittaker, 1 9 7 9 , p. 5 7 - 5 8 ) .  From a p r a c t i c a l  standpoint behavior treatment  i n t h a t t h e r e i s no need t o analyze the s o - c a l l e d contributors to  takes  the  problem  behaviors  as they  looks f o r c l u e s t o how these behaviors are e l i c i t e d -  and maintained (1979)  "deep seated"  an i n d i v i d u a l ' s c u r r e n t p a t h o l o g i c a l b e h a v i o r .  The b e h a v i o r i s t simply stand and  i s inviting  points  w i t h i n the  c h i l d ' s environment.  out, treatment  As Whittaker  u s u a l l y i n v o l v e s f o u r stages;  1 )  i d e n t i f y i n g and s p e c i f y i n g the problem behavior, 2 ) determining the c o n t r o l l i n g c o n d i t i o n s ; p a t t e r n s o f reinforcement, h i s t o r y , environmental behavioral  goals,  3)  factors,  4)  techniques, e i t h e r s i n g l y  applying or  p r e c i s e e v a l u a t i o n of p r o g r e s s .  in  specifying any  number  combination,  learning  the p r o - s o c i a l of  behavioral  followed  by a  35  A  typical  example  of  behavior  modification  r e s i d e n t i a l s e t t i n g i n v o l v e s the use of a "point i s monitored  daily.  or  e s t a b l i s h e d contingent  end of the day,  system" which  the accumulated  undesirable on these  and  a reward  behaviors.  p o i n t s are  At the  t a b u l a t e d and some  reward such as money or e x t r a p r i v i l e g e s i s g i v e n to the In some programs t h e r e i s the and  negative  a  A number of behaviors are i d e n t i f i e d which  are c o n s i d e r e d e i t h e r d e s i r a b l e system i s  in  reinforces  c o n t i n g e n t use  of both  child.  positive  to simultaneously a c c e l e r a t e d e s i r e d  behaviors and d e c e l e r a t e u n d e s i r a b l e ones.  One  of the  programs f o r  most  ( P h i l l i p s et  called  and  Achievement  the  law.  was  al.,  1973a). was  interacted  t h e i r progress treatment progressed  environment.  g r a d u a l l y allowed improved. to  this  with  school,  through  a  their  families,  on  home  The series  "teaching p a r e n t s " ,  youth of  visits, in  and  monitored w i t h i n the  Achievement  behavioral  programs  them more p r i v i l e g e s and freedom as  is  of the  to teach youths the  the youth and c l o s e l y  An i n t e r e s t i n g f i n d i n g which thesis  goal  The youths s e l e c t e d f o r the program  closely in  by P h i l l i p s i n  The  problems with  l i v e d with a p r o f e s s i o n a l l y t r a i n e d couple, who  m i l i e u treatment  described  Place,  b a s i c s k i l l s to h e l p them a v o i d teachers  behavioral  disturbed children  the e a r l y 70's program,  noteworthy  that  Place which  behavior  i s especially relevant  an attempt to r e p l i c a t e Achievement  36  P l a c e i n another home proved t o be a f a i l u r e . offered for  this failure  the second home.  The e x p l a n a t i o n  i s a l a c k of s o c i a l reinforcement i n  S o c i a l reinforcement  an i n t i m a t e  r e l a t i o n s h i p develops  the process  of  dispensing  points  development  of  this  of  kind  a p p a r e n t l y occurs when  between s t a f f as  and youth i n  reward.  Without the  r e l a t i o n s h i p the reward system  f a i l s t o encourage p r o g r e s s i v e change i n the youth. reports that  t h e p o i n t system c o u l d work a t peak e f f e c t i v e n e s s  only i n t h e context "Many  clinical  of a  warm, open  colleagues  have  ' r e l a t i o n s h i p ' i s an e s s e n t i a l are  now  Phillips  convinced  that  and g i v i n g  told  us  component of  they  are  interaction;  a l l along any therapy.  right."  that We  ( P h i l l i p s et a l . ,  1973a, p. 107).  This question  of r e l a t i o n s h i p  change i s a c e n t r a l  "relationship"  i t contributes to  concern i n t h i s t h e s i s .  c l e a r l y i m p o s s i b l e t o determine of  and how  the r e l a t i v e  between s t a f f  and c h i l d  Although treatment  that  effect. focus  these  two  variables  likely  effects  as compared t o the  c o n t r i b u t i o n p r o v i d e d by techniques, i t i s important mind  i t is  have  t o keep i n  an i n t e r a c t i v e  As mentioned above, even the b e h a v i o r i s t s , who u s u a l l y on  techniques,  reinforcement  schedules  concede  without  that  r e l a t i o n s h i p , s u c c e s s f u l treatment  and a  other  close  i s unlikely.  behavioral  interpersonal  The  behavioral  standardized The  goals  approach t o  and systematic  r e s i d e n t i a l treatment i s more  than most other  and techniques  f o r treatment are o f t e n c l e a r l y  out and as a r e s u l t the approach lends to  comprehensive  evaluation.  encountered i n c l u d e reactions  program  (Browning  difficulties stressing  arise  &  equally  design  one  the  attitudes (Whittaker,  staff  appears  balance  been  that  a program  behavior, and a t the to e l i c i t  S t a f f o f t e n r e p o r t t h a t they  the  well  a t t i t u d e s and  It  to  have  laid  a c c e l e r a t i o n of d e s i r a b l e behavior and  techniques  toward  that  1971).  p o s i t i v e reinforcement  complex b e h a v i o r s . modification  and  attempts  the d e c e l e r a t i o n of u n d e s i r a b l e o f f e r continuous  itself particularly  Problems  Stover,  when  treatment programs.  "unnatural" program  as  undermines  Browning  1979).  and  and  same time  increasingly find  a  behavior  result their  i t s effectiveness  Stover  (1971)  found  l i m i t a t i o n s t o the g e n e r a l i z a t i o n of e f f e c t s and i n p r o v i d i n g a treatment setting.  environment Their  conclusion  g e n e r a l i z a t i o n but, learned  that  gradually was  that  r a t h e r , should  i n one s e t t i n g i s e l i c i t e d  approximated one  should  the home not assume  work t o ensure t h a t what i s and maintained i n another.  GUIDED GROUP INTERACTION  The  third  approach t o  d i s c u s s i s Guided  approach s t r e s s e s  the importance o f  major treatment  Group I n t e r a c t i o n .  This  38  viewing the treatment  child  as  part  institution.  b e h a v i o r a l approaches argue t h a t  of  As  a  social  group  treatment e f f e c t i v e n e s s  i n d i v i d u a l s who  life  space.  interaction  proponents  i n f l u e n c e of  the c h i l d ' s  peer c u l t u r e  Rose,  significant  treatment  (G.G.I.), u t i l i z e s acknowledging  gains,  the powerful  (1962)  institutional  institution.  the  Polsky's  therapy,  which  To  encourage  group  approach  1981).  the  guided  i n f l u e n c e of  the peer  group,  stated  processes treatment  sociologist,  raised  the d e s c r i p t i o n of were  often  o b j e c t i v e s of  Howard Polsky, a l s o  serious  concerns  about  the  study, he acted as a p a r t i c i p a n t observer i n  institution  depended with  and  l i f e acted  i n s t i t u t i o n a l treatment f o r d e l i n q u e n t youth.  (1962)  cottage  treatment  on h i s or her b e h a v i o r  approach with  structure  Another  study  e f f e c t i v e n e s s of In  the overwhelming  c l a s s i c study of i n s t i t u t i o n a l  c o n t r a d i c t o r y t o the f o r m a l l y  published a  stress  Strain,  1972;  as a c a t a l y s t f o r the G.G.I.  the  Most i m p o r t a n t l y , the  i t as an i n t e g r a l p a r t of the treatment p r o c e s s .  Goffman's  how  proponents  i n t e r a c t i o n s the c h i l d has with those  share h i s  1969;  interaction  i s h i g h l y dependent on the  guided group  (Glasser,  w i t h i n the  with both the p s y c h o a n a l y t i c and  the guided  q u a l i t y of the day-to-day  system  of  primarily  psychiatrically  Hollymeade. on  This i n s t i t u t i o n ' s  almost  trained  daily  individual  p e r s o n n e l , which took  p l a c e i n an o f f i c e s e t t i n g p h y s i c a l l y removed from  the c u l t u r e  39  of  the  cottage.  p a r e n t s " who from the  The  were  cottages  minimally  clinical  the  trained  decision-making  Polsky's r e s u l t s suggested adolescent's  were s u p e r v i s e d by and  behavior  was  e f f e c t i v e l y removed  process of the  t h a t the most not  "cottage  powerful  institution. i n f l u e n c e on  the i n d i v i d u a l  treatment  s e s s i o n s or the i n t e r a c t i o n with the c o t t a g e parents but was f a c t the d e l i n q u e n t s u b c u l t u r e t h r i v i n g w i t h i n the He d i s c o v e r e d seekers",  that  the  "con-artists",  "scapegoats",  and  that  i n t i m i d a t i o n through silence.  cottage  a  had  its  "isolates", power  institution.  "leaders", "status "bush  structure  boys"  existed  based on  the  weakness  of  the  institutional  experience;  f a m i l y , the  child  i s not exposed to a f a t h e r  and a mother, but to t h e i r i n t e r a c t i o n , t h e i r " f a m i l y culture".  In  the  barred from e x t e n s i v e staff  culture,  l a t t e r ' s goals. parents are  yet  institution, interaction he  is  the  youngster  outnumbered by  is  with p r o f e s s i o n a l  expected  to achieve  In the c o t t a g e , hard-pressed  boys improve i n s p i t e of the others f a i l  and  p h y s i c a l c o e r c i o n , toughness and a code of  Polsky e x p l a i n s  In the  in  cottage  d e l i n q u e n t youths. negative peer  the  Many  pressure;  because of i t . (Polsky, 1 9 6 2 , 1 4 9 )  40  The  guided  group proponents  recognized  t h i s overwhelming  s u b c u l t u r a l i n f l u e n c e and decided t o s t r u c t u r e using  the  endeavor.  peer group Pilnick  Guided  as an  defines  (1971)  Group  i n t e g r a l part  Interaction  t h e i r treatment  o f the t h e r a p e u t i c  the approach as f o l l o w s ;  is a  process  of  group  treatment which d i r e c t s the dynamics and s t r e n g t h s o f the peer  group  toward  constructively  a l t e r i n g and  d e v e l o p i n g the behavior of the group members.  Empey and of  G.G.I.  are  Lumbeck to  s t a t e t h a t the b a s i c  (1972)  question  the  delinquency, t o p r o v i d e b e h a v i o r a l recognition f o r a  youth's  w i l l i n g n e s s t o help reform  The  guided  utility  objectives  of  persistent  a l t e r n a t i v e s , and t o p r o v i d e  personal  reformation  and  for his  others.  group approach  attempts t o use the peer group  to develop p o s i t i v e p r o - s o c i a l v a l u e s and r e i n f o r c e s conformity by  strongly  sanctioning  (Whittaker,  1979).  making power  behavior  The group i t s e l f  to  attend  of the p a r t i c i p a n t s situation"  v i o l a t e s group norms  i s often  given  decision-  t o determine what p r i v i l e g e s and r e s p o n s i b i l i t i e s  each of the members deserve. required  that  and  Members of the group  are u s u a l l y  h i g h l y s t r u c t u r e d group s e s s i o n s reports  receives  on  how  feedback  they from  are the  where each  "handling the  other  members.  41  Intense group dynamics are  generated  that  must  be monitored  c l o s e l y by a s t a f f who a c t s as a group l e a d e r .  Typically i s s u e s ; low problem,  the  group  members  self-esteem,  misleads  with  inconsiderate  others,  easily  e a s i l y angered, s t e a l i n g , a l c o h o l fronting  deal  of  the  following  others,  authority  m i s l e d , aggravates o t h e r s , or drug  problems, l y i n g and  ( t r y i n g t o be something you are not; clown, tough guy,  dumb-bell)  (Vorrath & B r e n d t r o , 1 9 7 4 ) .  Honesty,  of course, i s  h i g h l y valued and c o n f r o n t a t i o n i s i m p l i c i t l y encouraged by the group l e a d e r . leader's  V o r r a t h and Brendtro  primary  verbal  behavior  s t i m u l a t i n g the group toward the sessions follow  a strict  (1974)  described  as  solution  "questioning" of  problems.  l e a d e r summary.  p o t e n t i a l l y explosive  that  atmosphere  group i n t e r a c t s a t an i n t e n s e l e v e l , and  and The  agenda; r e p o r t i n g problems, awarding  the meeting, p r o b l e m - s o l v i n g and  skillful  the group  knowledgeable of  of the group or misreading an  can be  Due  t o the  expected when a  the group  l e a d e r must be  group dynamics.  Losing c o n t r o l  i n d i v i d u a l ' s responses  can have  s e r i o u s d e t r i m e n t a l e f f e c t s on group members.  The q u e s t i o n of the r e l a t i v e e f f e c t i v e n e s s of guided group approaches as compared t o Stephenson and  Scarpitti  and community based guided  other (1974)  programs  remains u n r e s o l v e d .  reviewed s e v e r a l  group programs  institutions  and found  t h a t the  42  guided  group  traditional parole.  graduates  fared  somewhat  reformatory graduates,  A common  c r i t i c i s m of  t h a t t o a l a r g e extent i t r a t h e r than  seems  method (Whittaker,  better  than  the  but not as w e l l as youths on the guided to  be  1979).  group approach i s  based  on p e r s o n a l i t y  In other words, programs  with a c h a r i s m a t i c l e a d e r may be s u c c e s s f u l simply  because the  strong p e r s o n a l i t y  f o r change.  Whittaker  of the  l e a d e r a c t s as an agent  suggests, however, t h a t  d e l i n q u e n t behavior group, Guided  for older  o r i g i n a t e s and  a d o l e s c e n t s whose  i s maintained  i n the peer  Group I n t e r a c t i o n p r e s e n t s a p o t e n t i a l l y  powerful  technique f o r going t o the heart of the d e l i n q u e n t ' s s u b c u l t u r e and o r i e n t a t i n g i t i n a p o s i t i v e  THE  RE-ED APPROACH  The the  direction.  f o u r t h , and l a s t treatment  Re-ed  concept  introduced  by  approach t o be Hobbs  examined i s  (1967).  program i s an American a d a p t a t i o n of the "educateur" was  common  living  i n Western Europe.  and  programs.  special The  education  acquisition  enhancement of the c h i l d ' s for  this  approach.  Re-ed i s a combination i n small, of  new  life  usually  have  role that of group  community skills  learning a b i l i t i e s  Staff  The Re-ed  based  and the  a r e b a s i c goals a  background  in  classroom t e a c h i n g and a r e t r a i n e d i n l i f e - s p a c e i n t e r v e n t i o n s . Re-ed's focus  on education  aims t o s t i m u l a t e the c h i l d  in his  43  environment and new  s k i l l s and  to r e - a c t i v a t e  knowledge (Brendtro  e x p l a i n s t h a t the on an  needs to l e a r n how  the c h i l d  to l e a r n .  process  are,  middle  developing knowing  class  community  Re-  trust,  cognitive control,  p h y s i c a l experience,  and  joy.  natural  strengths  of  s c e n a r i o , they f a i l with  be  l e v e l l e d against  main stay  behavior  The  of t h i s  are  children  to provide  problem  disturbed c h i l d .  strong  and  present  concrete and  how  joy".  (Hobbs, 1 9 6 4 , p. 1 5 ) .  that  exposure  their to  "decent"  significantly children process i s  in  staff  alter care?  likely a  meet adults  the  accenting an  to "reach" who  described  as  the  optimistic  information  teacher-counsellor,  approach, i s  the Re-ed program on  educated, w e l l t r a i n e d , ... a person of hope,  hope  of the  c o n t r o l l i n g symptoms,  attaining  i s t h a t although i t s proponents  and  problems  t o Hobbs; developing  t i e s , providing  (1964)  approach i s based  i s experiencing  feelings,  values,  acquire  Hobbs  1983).  core components  according  A c r i t i c i s m t h a t may  deal  who  The  g a i n i n g competence, n u r t u r i n g learning  & Ness,  a b i l i t y to  l e a r n i n g b i a s of the Re-ed  assumption t h a t  education  his natural  on  the  how  to  severely  appears to be  the  "a decent a d u l t ; q u i e t competence  Every treatment program would  this a  description, potent  entrenched  Furthermore, p o s i t i v e agent  enough  behavior  although  but  i s the  force  to  problems  of  the Re-education  f o r change,  does one  not  44  r e q u i r e the c o o p e r a t i o n in educational  and  w i l l i n g n e s s of the c h i l d to partake  experiences?  In the development of the Re-ed program, the Re-ed have  gravitated  towards  behavioral  schools  approaches to treatment.  However, Hobbs i n reviewing  the f i r s t 20 years of p r o j e c t Re-ed  states that  component of the program should  the b e h a v i o r a l  be over-emphasized. "...  pays  He  states  insufficient  attention  i d e n t i f i c a t i o n with an admired of  expectancy  fulfillment cited  in  behavioral  stated  &  techniques,  motivate and  l i m i t the  r e s p e c t s , one  questions  treatment approach education contributed  and  the  to  the e v o c a t i v e  problem  behavior of whether  power of  the r i g o r o u s demands  in situations,  exercise  1983).  modification  of  and  to  the  competency"  (as  With the de-emphasis of still  remains  of  t r o u b l e d youth.  Re-ed can  Nevertheless,  the general  s t i m u l a t i n g d i s c u s s i o n and  f i e l d of  how  Hobbs'  as a  special  philosophy  residential  to  In many  be c l a s s i f i e d  as i t appears to belong more to the  field. to  the  Ness,  behavioral  a d u l t , to  implicit  t h a t comes from Brendtro  that  not  treatment  has by  drawing a t t e n t i o n to community based  treatment p o s s i b i l i t i e s .  That completes the review of the t r a d i t i o n a l residential  treatment.  view of human nature and  Each of the above t h e o r i e s change.  approaches to has  T h i s view i f r e f l e c t e d  its  own"  i n the  45  s t r a t e g i e s and s t r u c t u r e s t h a t i n an  e f f o r t to  section,  the  movement  with  each treatment  enhance t h e r a p e u t i c  strategies their  change.  suggested  by  corresponding  change w i l l be reviewed  and  approach adopts In the f o l l o w i n g  the  view  contrasted  family  therapy  of human nature and with  the t r a d i t i o n a l  approaches o u t l i n e d above.  THE  STRATEGIC/SYSTEMIC APPROACH  In t h i s s e c t i o n , some of the s t r a t e g i e s and theory to the s t r a t e g i c / s y s t e m i c approach* w i l l be by a review of the l i t e r a t u r e which deals use  reviewed,  related followed  s p e c i f i c a l l y with the  o f s t r a t e g i c / s y s t e m i c methods i n treatment s e t t i n g s .  As  was  mentioned  earlier,  much  of  the  l i t e r a t u r e on  paradoxical  psychotherapy o r i g i n a t e d and was used predominantly  by  therapists  family  Working with  the f a m i l y  working  with  part  behavior.  of  a  larger  Some  system  paradoxical  school  or h o s p i t a l s e t t i n g s .  three  levels  viewing each  which therapy  i n d i v i d u a l s , both i n a c l i n i c a l  of  family  as  a unit.  as a u n i t r e q u i r e s t h a t the t h e r a p i s t  adopt an i n t e r a c t i o n a l p e r s p e c t i v e ; as  the  influences has  i n t e r a c t i o n a l and t r a n s a c t i o n a l  intervention; or  systemic.  h i s or her  been  s e t t i n g and w i t h i n  Weeks and L ' A b a t e  paradoxical  f a m i l y member  used  with  residential,  (1982)  r e f e r to  the i n d i v i d u a l , In  the f i r s t  46  l e v e l , the p a r a d o x i c a l person or one member interactional  of  level  provides  Weeks  and  the  family.  of the  system, but  interlocking  L'Abate  interactions.  second  l e v e l or  (1982)  The  i n an  as i n d i v i d u a l s .  paradoxical point  third  messages,  out,  level  of  t r a n s a c t i o n a l , where the p a r a d o x i c a l e n t i r e system  The  i n v o l v e s the d i r e c t i o n of the i n t e r v e n t i o n  at a l l the members level  i n t e r v e n t i o n i s d i r e c t e d toward only one  focus  This  which as on  intervention  dyadic i s the  message i s d i r e c t e d a t the  attempt t o capture the dilemma t h a t  faces  the f a m i l y or group.  This  thesis  i s primarily  individual  paradoxical  residential  setting  the f i r s t  concerned  interventions  and t h e r e f o r e  with  with  the  use of  adolescents  emphasis w i l l  be p l a c e d on  category i d e n t i f i e d by Weeks and L'Abate (1982).  i s important t o note t h a t p a r a d o x i c a l  ina  It  interventions directed at  i n d i v i d u a l s may i n v o l v e and r e f e r t o other people, but they a r e d i r e c t e d a t only one person a t paradoxical is  message  essential  taking  into  that  time.  When  formulating a  that i s t o be d i r e c t e d a t an i n d i v i d u a l i t one  adopt  consideration  c o n t r i b u t i n g t o the  a  other  maintenance  (Watzlawick et a l . , 1974).  an  of  interactional perspective, individuals the  that  problematic  may  be  behavior  47  The  distinction  provides change  and  problem  two  (Ashby,  order change.  quantity.  change  In some  to new problems.  elements  If a  on  et a l . (1974),  the  work  of  a  coined the f i r s t and secondrefers  to  change  within a  l e v e l of change, the system within  F i r s t - o r d e r change  solved i n  based  1956), who  this  second-order change  Watzlawick  F i r s t - o r d e r change  system.  i n t a c t while  of  and  s t r a t e g i c / s y s t e m i c view of  resolution.  levels  cyberneticist  again.  first  a good i n t r o d u c t i o n to the  discuss  given  between  it  undergo  a  remains  change i n  involves applying o l d solutions  problem becomes  evident  that  has  been  the past with some s o l u t i o n , the s o l u t i o n i s a p p l i e d  I f the problem f a i l s  solution" i s  to be  r e s o l v e d then  "more of the  a p p l i e d i n a l i n e a r or step-wise f a s h i o n  L'Abate, 1982).  A  r e l e v a n t example  would be  (Weeks &  the p r o g r e s s i v e  withdrawal of p r i v i l e g e s f o r a r e s i d e n t i n a treatment home who continues  to misbehave.  punishment,  More  of  the  same,  in  the  form of  i s used i n an attempt t o s o l v e the problem.  Second-order change i s a change of the system i t s e l f . system i s s a i d t o move t o a higher  l e v e l of f u n c t i o n i n g and the  body of r u l e s which governs the group i s a l t e r e d to f i t the structure. unexpected  Second-order or  change  uncommon-sensical  often and  appears  there  element t o the process of change (Watzlawick et r e f e r e n c e to  the f i r s t  example, \  The  new  unusual,  i s a paradoxical a l . , 1974). In  a second order change s o l u t i o n  48  might be t o suggest t o the misbehaving a d o l e s c e n t time being  he/she seems  because she/he can't established. different From a  less structure  to  with  seem  This  from  t o need  the  comply  attempted first-order  f i r s t - o r d e r change  solution solution  t h a t f o r the (rules, etc.)  the  ones a l r e a d y  is  qualitatively  mentioned  earlier.  p e r s p e c t i v e t h i s attempted  solution  seems e n t i r e l y i l l o g i c a l ; how c o u l d l e s s  punishment  ever begin  to s o l v e a problem of c o n t i n u i n g misbehavior?  Second-order  change  attempted s o l u t i o n . i s the  solutions  As Watzlawick e t a l .  attempted s o l u t i o n  problem.  In  c h i l d care  many  focus  which i s  situations  with  on  the p r e v i o u s l y  often at  unsuccessful.  the r o o t of the  adolescents,  attempted s o l u t i o n  p a r e n t s and  proves t o be  A f t e r a w h i l e i t i s t h i s attempted s o l u t i o n , the  a p p l i c a t i o n o f f o r c e , which becomes the problem. (1974)  it  workers attempt t o s o l v e a problem by a p p l y i n g more  and more f o r c e even when t h i s  al.  p o i n t s out,  (1974)  describe  three  ways  in  which  Watzlawick e t  problems  can be  mishandled: a)  A solution i s attempted by denying t h a t a problem e x i s t s . In other words, an a c t i o n i s necessary but i t i s not taken.  b)  A change i s attempted regarding a difficulty which i s really unchangeable or n o n - e x i s t e n t . For example, trying to stop somebody from f e e l i n g sad when they have a l e g i t i m a t e reason to f e e l t h a t way - action i s taken when i t should not be.  49  c)  First-order change solution i s repeatedly attempted when a second-order change s o l u t i o n i s required. T h i s k i n d of attempted s o l u t i o n i s the same as the one mentioned above where more force is added when an e n t i r e l y different s t r a t e g y would be more e f f e c t i v e . This kind of error can a l s o take p l a c e when a second-order change i s attempted when a f i r s t - o r d e r change would be a p p r o p r i a t e . For example when a parent i n s i s t s t h a t a c h i l d "want" t o study i n s t e a d o f s e t t l i n g f o r an i n c r e a s e i n the amount of time a c h i l d spends studying (Watzlawick, 1 9 7 4 p. 3 9 ) .  When problems treatment  home,  established  are a  that  long-standing, is  interventions are  mishandled  difficult  either  in  cyclical to  the  f a m i l y or  pattern  alter.  can  be  Paradoxical  i n t r o d u c e d t o f o r c e the i n d i v i d u a l or system  to adopt a second order s o l u t i o n t o the problem.  Weeks and L'Abate  (1982)  have  described  three  types of  paradox: antimony, semantic antimony and the pragmatic paradox. It i s t h i s a basis  t h i r d type, the pragmatic paradox, t h a t  f o r paradoxical  psychotherapy.  pragmatic paradox i s the can see  this sort  Palo A l t o group paradox i n  d i r e c t i v e "be  of request  i s credited  a research  1 9 5 6 was  (Bateson  entitled  et a l . ,  1956).  example of a  spontaneous".  As you  i s impossible t o c a r r y out. for first  using  s e t t i n g and f o r attempting  t h e o r e t i c a l explanation f o r i t . Their in  A good  i s used as  "Toward  a  The  the pragmatic t o uncover a  c l a s s i c paper p u b l i s h e d  Theory  of  Schizophrenia"  50  The Palo A l t o group suggested t h a t produced  through  they c a l l e d , for  this  repeated exposure  s c h i z o p h r e n i a c o u l d be  to a c e r t a i n k i n d o f , what  p a t h o l o g i c a l communication.  communication was  The  the double-bind.  term they used For double-bind  communication to take p l a c e , a number of c o n d i t i o n s must be over  a  period  of  time.  First  of  a l l , there  must  met be  communication, v e r b a l or nonverbal, between two or more persons who  are  c l o s e l y connected  requirement parties.  i s a recurrent  "If  The  second  communication between the  Thirdly,  a  primary  negative  i n j u n c t i o n must  T h i s r e f e r s to a c o n d i t i o n a l type of communication  like  you don't do so and so, I w i l l punish you" or " I f you do so  and so, or  theme of  members).  In other words, a s i n g l e experience i s not c o n s i d e r e d  significant. occur.  (e.g. f a m i l y  I w i l l punish you".  Most o f t e n the withdrawal  a t t e n t i o n i s threatened as punishment  l a c k of  it.  f o r some  of l o v e  behavior or  The f o u r t h c o n d i t i o n c a r r i e s the double-bind  c o n s i s t s of a secondary message which c o n f l i c t s with the As Weeks and L'Abate (1982) d e s c r i b e i t , t h i s secondary i s g e n e r a l l y more d i f f i c u l t to i d e n t i f y conveyed  at  a  i n c o n s i s t e n t with communication i n  nonverbal the  level.  first  a no-win  and  because i t  The  first. message  i s usually  secondary message i s  puts  situation.  and  the  receiver  A common  of the  example of a  secondary message i s c r o s s i n g the arms and backing away w h i l e a primary  message  communicated.  like The  "I last  love  you"  condition  i s s i m u l t a n e o u s l y being is  called  a  "tertiary  negative i n j u n c t i o n "  which d i s a l l o w s  the v i c t i m t o comment on  the c o n f u s i n g message or to leave the f i e l d . victim  of  this  kind  of  " f r o z e n " , not knowing how messages.  pathological  The  r e c e i v e r or  communication i s l e f t  best to respond  to  the c o n t r a d i c t o r y  A l s o , as i s most o f t e n the case, the s u b t l e t y of the  secondary  nonverbal communication leaves the v i c t i m  unaware of  the c o n f u s i n g double-binding s i t u a t i o n they f i n d themselves  in.  To " r e l e a s e " the v i c t i m from h i s no-win s i t u a t i o n the Palo A l t o group developed to  the  pathogenic  the t h e r a p e u t i c double-bind.  In c o n t r a s t  double-bind which p l a c e s the person  win s i t u a t i o n , the t h e r a p e u t i c double-bind f o r c e s the i n t o a no-lose s i t u a t i o n . bind i s  A commonly used  the " p r e s c r i p t i o n  g e n e r a l l y encouraged accept one of two which  implies  not t o  options, control  change. either over  a  Watzlawick complies, he as we  et  d i r e c t i v e and al.  (1967)  client  In t h i s case, the  h i s symptoms  and i s  T h i s binds the c l i e n t t o a)  continue  supposedly  behavior, or b) d i s c o n t i n u e the symptom, the t h e r a p i s t ' s  the symptom,  uncontrollable  thereby going a g a i n s t  i n the process " c u r i n g " h i m s e l f .  explain  the  situation,  "if  no longer 'can't h e l p i t ' ; he does ' i t ' and  have t r i e d to show, makes ' i t '  purpose of therapy.  no-  t h e r a p e u t i c double-  of the symptom".  c l i e n t i s d i r e c t e d to continue d i s p l a y i n g  in a  i m p o s s i b l e , which  he  this, i s the  I f he r e s i s t s the i n j u n c t i o n , he can do  so  52 only by not behaving therapy"  It  symptomatica1ly,  which  i s the  purpose  of  (p. 241).  appears  t h a t p a r t of what makes a pragmatic paradox or  t h e r a p e u t i c double-bind work i s the message w i t h i n the message. If a  client  is  t o l d to  secondary message i s "You Once  the  client  continue behaving  symptomatically the  are  of  in  implicitly  the  pragmatic  paradox,  u s i n g and w r i t i n g about to Mozdzierz,  group were  Alfred  of  the f i r s t  Adler  i s c r e d i t e d with  clients.  problem  By  behavior,  the  paradoxical  encouraging  2) P r e d i c t i o n  therapist.  strategies  According  the  c l i e n t to  Mozdzierz d e s c r i b e s  employed  - p r e d i c t i n g the c l i e n t ' s  by  A d l e r ; 1)  the symptom;  symptoms would r e t u r n ;  P r o p o r t i o n a l i t y - g e t t i n g the c l i e n t  t o exaggerate  or have the t h e r a p i s t take them more s e r i o u s l y than the 4) P r o - s o c i a l r e d e f i n i t i o n -  reframing  symptomatic  positive  directing  first  A d l e r side-stepped the i s s u e of  P e r m i s s i o n - g i v i n g the c l i e n t p e r m i s s i o n t o have  3)  to research  i t (Mozdzierz et a l . , 1976).  r e s i s t a n c e between c l i e n t and some  behavior.  A d l e r used p a r a d o x i c a l techniques to a v o i d power  s t r u g g l e s with h i s d i s p l a y the  your b e h a v i o r " .  r e c e i v e s the message i t makes i t  d i f f i c u l t to d i s p l a y the problem  Although the Palo A l t o  control  behavior the  client  in to  a  behave  in  or way; a  symptoms client;  r e i n t e r p r e t i n g the 5)  Prescription-  symptomatic  way;  6)  53 Practice  -  asking  the  client  to  refine  or  improve  his  symptomatic b e h a v i o r .  Behavior  therapists  paradoxical i n  nature.  also  use  a  technique  which  is  Implosive therapy uses the process of  e x t i n c t i o n t o e l i m i n a t e avoidance  behavior.  Phobic r e a c t i o n s  and problems l i k e f e a r or r e j e c t i o n , sexual d e v i a t i o n s , l o s s of impulse  control  and  i m p l o s i v e techniques  aggression  (Stampfl, 1967).  c l i e n t t o use guided imagery, behavior  from  provoking. phobic  The  behavior  have  treated  anxiety  client  never  instead  using  The therapy r e q u i r e s the  imagining scenes of  least  but  been  provoking actually  imagines  some avoided  to  most  anxiety  participates in  detail  i n the  the  most  t h r e a t e n i n g of s i t u a t i o n s .  Another it  is  t h e o r i s t whose work  Victor  powerful  Frankl.  technique  has a  p a r a d o x i c a l element t o  F r a n k l ' s logo therapy makes use of a  which  he  calls  A c c o r d i n g to F r a n k l (1975), he was  paradoxical  u s i n g t h i s technique i n  and documented i t s use i n a paper p u b l i s h e d in  Weeks  &  L'Abate,  1982).  i n 1939  occur.  Frankl  encourages  a t t i t u d e towards the symptom and  1925  (as c i t e d  When u s i n g t h i s technique, the  t h e r a p i s t d i r e c t s the c l i e n t t o i n t e n t i o n a l l y to  intention.  the hopes  w i l l the symptom  adoption that  take a more detached, o b j e c t i v e view of t h e i r  of the  a humorous client  situation.  will  54 The  goal  of  paradoxical  intention  i s t o i n t e r r u p t the  v i c i o u s c y c l e of a n t i c i p a t o r y a n x i e t y which at the  root of a n x i e t y  occurs  when  the  neurosis  patient  symptom t o appear  the  and phobic r e a c t i o n s .  imagines  l e a d i n g t o an avoidance r e a c t i o n . patient  Frankl b e l i e v e s i s  a  feared  Anxiety  stimulus,  thus  By i n t e n t i o n a l l y w i l l i n g the i s freed  from  the  c y c l e of  a n x i e t y and avoidance.  Rosen aspect  (1953)  of  procedure,  used  a  procedure  psychosis"  to  which  similar  is  treat  called  psychotic to  had e x h i b i t e d .  Rosen  behavior.  prescribing  i n v o l v e d d i r e c t i n g the p a t i e n t t o re-enact t h a t they  " r e - e n a c t i n g an  the  This symptom,  any b i z a r r e behavior  provides  a r a t i o n a l e f o r the  procedure;  Whenever your hunch t e l l s you they repeating  some  such i r r a t i o n a l i t y ,  are i n  you beat them t o  the draw by demanding t h a t they re-enact the p i e c e may f a l l to the  of p s y c h o t i c i n t o again.  behavior t h a t  just exactly you f e a r they  Perhaps your boldness i n d i c a t e s  p a t i e n t t h a t you a r e w i l l i n g to take a chance  of making him a c t t h a t he  danger of  no longer  crazy can.  because  you  a r e convinced  Perhaps i t has something t o  do with the p a t i e n t ' s sense of shame when you ask him to do  something f o o l i s h  and remind him that he used  55  to do t h i s makes an out  foolish  thing.  feebly,  obviously  sometimes he w i l l say  has reason p.  his  spontaneous,  and When  l o s t h i s touch, the t h e r a p i s t  to r e j o i c e .  (cited  i n Weeks & L'Abate,  11)  use  patients,  Rosen  success.  One  of  paradoxical  (1953)  claims  his  studies  of  schizophrenics emotional  not  'he d i d i t to humor you'.  the p a t i e n t has c l e a r l y  In  the p a t i e n t  attempt to re-enact the symptom which comes  very  1982,  Sometimes  recovered  to  s t a b i l i t y of normal  highly creative psychotherapy  techniques to  have  reports  the  with  psychotic  achieved  remarkable  36  that  extent  of  individuals.  achieving Rosen's  and p r o v i d e s a good example of how  can  be  used  with  even  of 3 7  out  the  the  work i s  paradoxical most  severe  p s y c h o l o g i c a l problems.  Gestalt  therapy  element to i t . based on  clearly  Beisser  a paradoxical  "change occurs when one to  become  (1970)  what  "exaggeration"  he  to  suggests  theory of  have  not"  change.  the  (p. client  a  paradoxical  t h a t G e s t a l t therapy i s According to  becomes what he i s ,  is  requires  seems  77). to  not when  him,  he t r i e s  A technique known as repeat  behavior  in  a m p l i f i e d movements or g e s t u r e s , with the goal being to uncover the hidden meaning of the behavior.  T h i s emphasis on a c h i e v i n g  56 awareness of  where one  " i s " before  change behavior i s a l s o therapy.  similar  being able t o move on and  to  c l i e n t - c e n t e r e d Rogerian  In c l i e n t - c e n t e r e d therapy, t h e c l i e n t  to accept h i m s e l f  i n the present  so as  t o move  process of s e l f - a c t u a l i z a t i o n (Rogers, 1961). therapist  and  paradoxical  the  client-centered  i n f l u e n c e on the  was i n s p i r e d  therapist  adoption of  by  Watzlawick focuses  (1967)  t h a t occur w i t h i n the f a m i l y  group, a l l  p e r m i t t e d and  by to  unit.  i n the  a systemic  According to  These r u l e s ,  maintain the  many of  l i m i t s t o what i s  r e l a t i o n s h i p s amongst the  behavior w i t h i n the f a m i l y i s a l s o  "meta-rules"  and  the  system's s t a t u s  "Paradox and Counterparadox" t h a t when  unit.  u n a r t i c u l a t e d , provide  Pathological  these  on  the communication and b e h a v i o r a l  of the  not p e r m i t t e d  group members.  techniques a t  groups, i n c l u d i n g the f a m i l y , have r u l e s  t h a t govern the behavior hidden or  on  i s based  transactions  enforced  the  T h e i r work which, i n t u r n ,  and  governed  assume  paradoxical  orientation  which a r e  Both the G e s t a l t  group ( P a l a z z o l i et a l . , 1978) had a  the Vancouver House treatment home.  the M i l a n  forward i n a  r o l e of not being a changer.  Research by the M i l a n direct  i s encouraged  (1978),  they a r e able t o d i s c o v e r  r u l e , p a t h o l o g i c a l behavior q u i c k l y  rules  are r i g i d l y  quo.  In t h e i r book  the M i l a n  group s t a t e s  and change one fundamental disappears.  57  In order to f u l l y comprehend the work of one  must  be  able  to  b e h a v i o r a l change. psychoanalysis of  of  the  theories  The  causal-mechanistic  i s determined  a n d - e f f e c t manner.  Palazzoli  importance of viewing  must  suggests  et  al.,  (1978)  abandon the c a u s a l - m e c h a n i s t i c has  dominated  members  of  the  c i r c u i t of i n t e r a c t i o n .  the  that  i n a cause-  explained  the  view of  sciences u n t i l  orientation.  inevitably  family  None of  influences  others.  T h i s i s because every  others,  but  is  in  turn  as  With  influenced  from i t .  by  the  the  behavior  of the of the  member i n f l u e n c e s the  influenced  by them. i s at  The  the same  communications he r e c e i v e s  (p.5)  W i t h i n the f a m i l y u n i t , being i n f l u e n c e d whose behavior  elements i n a  the members  i n d i v i d u a l a c t s upon the system, but time  view  view  o r i e n t a t i o n , the t h e r a p i s t should be a b l e to  the  family  human nature,  by previous events  recent times, and adopt a systemic  see  of  the f a m i l y s y s t e m i c a l l y ;  phenomena, which  t h i s new  o r i e n t a t i o n to  i n c l u d e d , are based on a c a u s a l - m e c h a n i s t i c  present behavior  we  a p p r e c i a t e the systemic  Many  phenomena.  ...  the M i l a n group,  with each  member i n f l u e n c i n g and  by the whole, s u r f a c e s the i d e n t i f i e d p a t i e n t  t h r e a t e n s the  homeostatic tendency of the group.  58  The  identified  patient in  acting in  a b i z a r r e , d i s r u p t i v e or  withdrawn manner i s r e a c t i n g , i n the best way the  conflicting  rest  of  the  double-binding  family  unit.  how,  to  messages he r e c e i v e s from  the  Paradoxically,  behavior of the i d e n t i f i e d p a t i e n t which has i n t o therapy, threatens  the  same time  s t a t u s quo  said  to  permits the be  desperately  in to  the  identified  s t a b i l i t y and  family  the M i l a n  called  Facing  and  functions  group devised  "positive  The  e f f e c t i v e strategy  underline  To  provide  and  producing, i n  a  rationale  the  1978).  the  status  strategy  Milan  general  (Palazzoli  group  et a l . ,  the  family.  the f a m i l y ' s for  b e l i e v e t h a t "someone decided  By  t h e i r most behavior  doing  so they  (1978,  p.  homeostatic  supporting  1978).  system where each  would be to p o s i t i v e l y connote the  confirm  on  change i n  to p r o t e c t  b e l i e v e they "gain access to the systemic model" and  family i s  most s i g n i f i c a n t  the  every member of  the  family's  connotation"  change",  at  s t r a t e g i e s to counter the  of the members c o v e r t l y r e s i s t change and e l s e needs to  family  hanging  to p r o t e c t  the problem of attempting to change a  of each and  The  cohesion of the group ( P a l a z z o l i et a l . ,  homeostatic maneuvers. is  and  p r o h i b i t any  Recognizing t h i s powerful tendency quo,  the u n i t  members, who  disturbing  brought the  transaction",  r u l e s which  patient  the  to continue.  "schizophrenic  the r e l a t i o n s h i p s amongst turn,  s t a b i l i t y of  the f a m i l y  he knows  56),  tendencies.  the f a m i l y members'  59 b e h a v i o r s the t h e r a p i s t suggests t h a t t h e i r best to provide  Positively p a t i e n t and  each  connoting  the  symptoms  the f a m i l y should  of  states  p o s i t i v e connotation  in a  "...  paradox; why  For  as  that  l i t e r a t u r e has examine  a  general  does such  strategic/systemic  s p e c i f i c a l l y r e l a t e to the order  to  the use  review  been presented,  do t h i s ,  reviewed,  followed  a  paradoxical by Jessee authors  paper  that  puts  t h i n g as  w i l l be and  the  narrowed to  ideas  residential  review  of  the  r e l a t e s to  as  they  context.  In  setting  will  on be  strategic/systemic significant  concepts  context.  describing  L'Abate (1980).  believe  group  strategic/systemic  the  strategic  procedures on an i n - p a t i e n t c h i l d and  Milan  s t u d i e s t h a t have been r e p o r t e d  w i t h i n the r e s i d e n t i a l treatment  first  the  implicitly  'patient'?"  r e s i d e n t i a l treatment  l i t e r a t u r e as i t s p e c i f i c a l l y  The  identified  implicitly  a good  the focus  methods i n  by  of  methods  the few  of p a r a d o x i c a l  the  the  cohesion of the group r e q u i r e the presence of a  Now  cohesion.  remain the same and  change.  (1978, p. 61);  i s doing  f a m i l y members e x p l i c i t l y  suggests t h a t they should  the f a m i l y  them  the f a m i l y with s t a b i l i t y and  the behavior of the other  suggests t h a t  of  As was  paradoxical  u n i t was  use  written  mentioned e a r l i e r ,  procedures  can  of  be  these very  60  effective  with  children  because  l i m i t e d v e r b a l a b i l i t y and can i n c l u d e  the  insight,  an i n t e r a c t i o n a l  work w e l l with o p p o s i t i o n a l  interventions  are  normally  p e r s p e c t i v e , and individuals.  require  short-term,  have proved t o  The authors  present  us with t h r e e case examples and c o n t r a i n d i c a t i o n s f o r t h i s of i n t e r v e n t i o n are d i s c u s s e d . an  11  year  o l d boy  stealing toys.  The  had  In the f i r s t  been  example p r o v i d e d ,  hospitalized  boy's mother  type  f o r repeatedly  reported a  long h i s t o r y of  d e p r e s s i o n and s a i d t h a t she handled a l l matters concerning the boy except f o r s t e a l i n g which was d e a l t with by both the mother and  the  little  father.  contact  discipline.  The with  The  father,  the  staff  who worked odd hours and had  boy,  would  noticed  then  dole  along e a s i l y  with females-.  how d i f f i c u l t  i t was  i n the h o s p i t a l  The i n t e r v e n t i o n used was  as f o l l o w s : the s t a f f got together and t o l d now understood  the boy  He  was then  whenever he wanted t o spend some enjoyable time with  the male s t a f f he was magazine from  to  "take"  the counter.  ( h i s word  The  together  and  talk  congratulated f o r creating  about an  f o r stealing) a  s t a f f a l s o t o l d the boy t h a t  when he "took" the magazine, the s t a f f , male get  t h a t they  f o r him t o l e t them know  that he wanted t o spend more time with the s t a f f . t o l d that  some  t h a t the boy had d i f f i c u l t y  e s t a b l i s h i n g r e l a t i o n s h i p s with the male s t a f f but got  out  the  situation.  opportunity  t o g e t h e r and share some i n f o r m a t i o n .  and female,  would  The boy was  for staff  t o get  61 The  boy's  confusion,  reaction to  followed  the d i r e c t i v e was astonishment and  by anger  and r e f u s a l  t o do  the task even  though he had p r e v i o u s l y agreed t o i t . The authors r e p o r t the boy never f o l l o w e d again  either.  In  through  analyzing  on  the  task  and  that  never s t o l e  the i n t e r v e n t i o n , we can see t h a t  the symptom, s t e a l i n g , was p o s i t i v e l y connoted and given a p r o social  rationale  - getting  the s t a f f  see that the d i r e c t i v e p r e s c r i b e s the explanation  f o r i t s function  the  afternoon  following together,  a d d i t i o n , the  week  A l s o , we can  symptom and  p r o v i d e s an  which p a r a l l e l s the hypothesized  f u n c t i o n i t has w i t h i n the f a m i l y that  together.  the  system.  father  and  something they had not  mother reported  weeks and e x h i b i t e d a  much  The authors the  brighter  years.  In  than she had i n  affect.  These  would suggest t h a t the i n t e r v e n t i o n had systemic changing e s t a b l i s h e d p a t t e r n s  boy spent an  done i n  f e e l i n g better  report  reports  repercussions,  o f i n t e r a c t i o n s and u p s e t t i n g the  f a m i l y homeostasis.  In the  second case study, a boy who had a long h i s t o r y of  argumentative,  oppositional  problems p r e s c r i b e d .  It  behavior  his  difficulties  arguing  helped  her  with a come  to  distract  with each other.  female nurse out  of  these  presenting  was hypothesized t h a t the d i s r u p t i v e  behavior of the boy f u n c t i o n e d t h e i r own  had  her  was a  the  parents from  The boy was t o l d good t h i n g  depression.  He  that  because i t was t o l d t o  62  misbehave i n f r o n t of her whenever he f e l t The  authors r e p o r t t h a t t h i s p r e s c r i p t i o n was  of e n a b l i n g  the boy  function  of  example,  the  his  In the  behavior  in  refused  the f a m i l y .  to  follow  study, an 11 year o l d boy  Apparently the  d e s t r u c t i v e p l a y and the boy  boy was  had  l e a r n to  days the boy  the  should  have two  c o n t r o l them.  stopped having any  child  with  death of  very a c c i d e n t prone.  with  was  the  admitted  h i s younger  The  accidents  authors  a day,  happen, then  using  he might  They r e p o r t t h a t w i t h i n  three  accidents.  Another i n t e r v e n t i o n reported provides  first  a long h i s t o r y of dangerous  the r a t i o n a l e that i f they are going to as w e l l  As with the  by Jessee and  an e x p l a n a t i o n  L'Abate (1980)  f o r h i s behavior  p o s i t i v e l y connotes i t . They r e p o r t that t h i s procedure can used i n a general  the  responded with b l a t a n t anger to the d i r e c t i v e .  t h i r d case  prescribed that  used i n the hopes  through  to h o s p i t a l a f t e r the a c c i d e n t a l shooting brother.  depressed.  to get an e x p e r i e n t i a l understanding of  boy  p r e s c r i p t i o n and  and  she was  way  and  has  been found e f f e c t i v e with  For  i n s t a n c e , the c h i l d who  and be  various  behavioral  difficulties.  difficulty  s e t t l i n g at night can be t o l d that h i s s t a y i n g up i s  an  i n d i c a t i o n t h a t he  parents would  be proud  convincingly.  He  loves  his  of him  parents  very  much  i s having  and  f o r demonstrating h i s c a r i n g  i s then encouraged to stay up u n t i l  his so  he f e e l s  63  l i k e he has shown enough c a r i n g f o r h i s p a r e n t s .  The behavior,  then, becomes framed i n such a  way t h a t  the  f o r by h i s parents,  child  that  he  i s cared  d i s t r e s s as a p o s i t i v e  expression,  and  s t a y i n g up reassures l a b e l s the  p r e s c r i b e s the symptom  i n a way t h a t removes the need f o r i t .  I t i s i n t e r e s t i n g t o note t h a t i n the above case examples the symptomatic behavior t h a t was p r e s e n t i n g f a m i l y environment  was a l s o d i s p l a y e d  Jessee and L'Abate's (1980) interactional  dynamics  i t s e l f w i t h i n the  i n the h o s p i t a l s e t t i n g .  i n t e r v e n t i o n s seek  that  are occurring  t o capture the i n the h o s p i t a l  s e t t i n g which p a r a l l e l the dynamics which a r e happening home  setting.  setting to  Although  the other,  the i n t e r v e n t i o n  symptomatic behavior. the case  w i l l be so  displaying  the  One  same  and  interventions  be  They a l s o  compliance-based effective.  i s aimed  a t the same  the  identified  patient  i n the h o s p i t a l s e t t i n g as he  parents.  (1980)  most  e s p e c i a l l y those who r e s i s t way.  a r e d i f f e r e n t from one  wonder, however, how o f t e n  c u t with  symptom  L'Abate  may  has t o  clear  d i s p l a y s a t home with h i s  Jessee  the a c t o r s  i n the  suggest  that  paradoxical  s u c c e s s f u l with d e f i a n t c h i l d r e n , being  supported  or helped  i n any  suggest t h a t  with h i g h l y compliant c h i l d r e n ,  paradoxical  interventions  With compliance-based p a r a d o x i c a l  can  be  quite  p r e s c r i p t i o n s the  64  assumption attempts  i s t h a t the  to  symptom  w i l l f u l l y bring  p r e s c r i p t i o n s seem  to  be  will  cease  when  on the symptom. especially  the p a t i e n t  Compliance-based  effective  with  somatic  complaints, depressions and phobias.  Jessee  and  L'Abate's  (1980)  i n t e r v e n t i o n s should not be used when crisis,  report  that  paradoxical  c h i l d r e n are  i n intense  a r e e x p e r i e n c i n g d i s o r g a n i z e d t h i n k i n g or a r e r e t a r d e d .  F i n a l l y , the i n t e r v e n t i o n s should reality  of  the  child,  using  always be  framed w i t h i n the  concepts and language t h a t a r e  comprehensive t o him/her.  In Clinical present  "Positive  Reframing  Considerations"" us  with  the  With  (Jessee  theoretical with  Children:  Conceptual  &  a t a l . , 1982), the authors and  hospitalized  pragmatic  aspects of  positive  reframing  middle-school  aged  children.  The authors of t h i s a r t i c l e c r e d i t Watzlawick e t a l .  (1974) f o r i n t r o d u c i n g p o s i t i v e reframing as an a c t i v e agent of change.  According  to  Watzlawick  et  a l . (1974) reframing  alters;  ... the  conceptual and/or  emotional  s e t t i n g or view  p o i n t i n r e l a t i o n t o which a s i t u a t i o n i s experienced and p l a c e s i t i n another of the same  concrete  frame which f i t s the ' f a c t s '  situation  especially  w e l l or  65  even b e t t e r ,  and t h e r e b y  changes i t s meaning.  (p.  95)  Jessee  a l .  et  report  (1982)  that  positive  reframing,  amongst o t h e r t h i n g s , s e r v e s t o c o u n t e r a c t t h e n e g a t i v e of p s y c h i a t r i c positively negative can  and  Once t h e  child's  behavior  has been  r e f r a m e d , h e / s h e c a n no l o n g e r be s e e n i n a  light.  affect  behavior  labelling.  effects  A new more p o s i t i v e  the  pattern  group as w e l l  encouraging  maturational  processes  view o f t h e c h i l d  and a l t e r  as b o o s t i n g  progress  in  development.  As  strictly  the  established family  the c h i l d ' s  his  or  behavior  her  authors  self-esteem  intrapersonal state,  positive  reframing  ... may  s e r v e as  developing the  The case  ability  desirable  particular  type  positive  examples.  reframing In  encouraging  him  The  realizing  two,  to  decided  the  simultaneously  undesirable  attributes  (p.  article first  interact  to  presents  and  with peers  "resistance"  focus  both of  a  315)  case,  behavior,  that  stimulus to the c h i l d ' s  consider  of behavior,  isolative  least  to  and  displaying  authors,  a positive  two  interesting  a 1 2 year  o l d boy was  a  direct  approach  proved u n s u c c e s s f u l . required  an N  of at  on t h e p o s i t i v e a s p e c t s o f t h e  boy's stubborn i s o l a t i v e b e h a v i o r . after thinking  about  behavior and thought  it,  know  himself  interact  well  with  he  good attempt  wouldn't  message  d r a m a t i c a l l y changed  the  boy t h a t ,  t o "get i n touch  They a l s o s t a t e d t h a t u n t i l  others.  i n i t i a l l y by the  told  they had changed t h e i r mind about h i s  i t was a  with h i s sad f e e l i n g s " .  They  be  able  to  he got t o  satisfactorily  The  boy was understandably  confused  and  within  days, he  h i s behavior.  a  couple  of  The authors r e p o r t t h a t he  began t o spend v i r t u a l l y a l l of h i s f r e e time with peers and he f e l t better  about h i m s e l f and more i n c o n t r o l of h i s b e h a v i o r .  N o t i c e t h a t t h i s p o s i t i v e reframe was on the it  does  not  mention  hospital  system.  The  second  i n t e r v e n t i o n that  other  significant  members  case  u n i t , the  an e x p r e s s i o n "you don't & L'Abate,  example  i s a paradoxical level.  of i n t e n s e peer c o n f l i c t on  authors came  d i r e c t e d a t the whole group.  level;  the boy's f a m i l y or  belongs t o the t h i r d or t r a n s a c t i o n a l  Faced with the ever present problem a hospital  of  individual  up with a reframe t h a t was  They r e l a b e l l e d  peer c o n f l i c t as  of a f f e c t i o n and c a r i n g u s i n g the r a t i o n a l e t h a t  f i g h t with people t h a t you don't care about" 1980 p.  (Jessee  316).  The c h i l d r e n  adamantly denied the  v a l i d i t y of the r e l a b e l l i n g  but c o n f l i c t  such as scapegoating  r e p o r t e d l y dropped  off significantly.  67  In  each  of  the  above  cases,  the  reframing c r e a t e d a  c o n f l i c t f o r the c h i l d ; behavior t h a t was p r e v i o u s l y c o n s i d e r e d undesirable  took  on  a  positive  meaning  a c t u a l l y encouraged t o d i s p l a y i t . the  purpose  or  intention  the  disqualified  by  the  new  the c h i l d was  I t may be hypothesized t h a t child  behavior i n the f i r s t p l a c e , whether is  and  had f o r d i s p l a y i n g the  conscious or unconscious,  meaning  a t t r i b u t e d t o i t , thus  l e a v i n g the c h i l d i n a s t a t e of c o n f u s i o n about whether to  continue  the  behavior.  In  dilemma f a c i n g the i n d i v i d u a l p a r a d o x i c a l message  dissonance  (belief  about  i s created oneself,  c o n f l i c t s with  l e a s t one  oneself.  The the  Festinger's whenever  one's  one  behavior  or  another c o g n i t i v e element.  t h a t at  tolerate  been presented  of F e s t i n g e r ' s  theory of c o g n i t i v e dissonance. that  many ways, t h i s view of the  who has  reminds one  o f these  assumption  discomfort  caused  that by  with a classic  (1957)  theory  suggests  c o g n i t i v e element the environment)  The theory  c o g n i t i v e elements being  or not  suggests  must r e f e r t o  the i n d i v i d u a l  these  two  cannot  conflicting  c o g n i t i v e elements and so he a c t s i n a manner so as to make the two  elements consonant.  positively  reframed,  For the c h i l d whose he  can  either  d e f i n i t i o n and continue d i s p l a y i n g  a)  behavior has been disregard  the behavior,  the  new  or b) accept  the new d e f i n i t i o n and a l t e r h i s behavior so as t o be consonant with the new meaning a t t r i b u t e d t o i t .  68  Jessee  and  L'Abate  report  (1980)  that  their  most  s u c c e s s f u l reframes  on an i n - p a t i e n t u n i t addressed the e n t i r e  problem  In  system.  transactional,  other  involving  words,  a l l the  reframes  members  provided  the most impact and d r a m a t i c a l l y  of  group  the  reframing not  members.  the  be e f f e c t i v e  concrete  (1980)  describes  i n t e r v e n t i o n s t o change the resistants  retarded.  with c h i l d r e n  of  who  are  behavioral  considered used  approaches  Bergman assumes that symptoms function for  them and  stage 7  of  who have cognitive  8  (Inhelder &  of  paradoxical  or  He  use  behaviors  of community  c h r o n i c a l l y d i s t u r b e d or  were had  initiated proved  a f t e r more unsuccessful.  d i s p l a y e d by r e s i d e n t s serve some  are maintained  w i t h i n the community home. replication",  the  resistant  The i n t e r v e n t i o n s  traditional  "context  system,  1964).  Bergman  home  the  a l t e r e d the behavior  operation  development which emerges a t the age Piaget,  of  were  These authors c a u t i o n t h a t p o s i t i v e  i s u n l i k e l y to  reached  which  by the emotional system  also introduces  suggesting  that  the r e s i d e n t d i s p l a y s i n the community  the concept of  the same symptoms home may  that  have served a  s i m i l a r f u n c t i o n when the r e s i d e n t was l i v i n g i n an i n s t i t u t i o n or, p r i o r t o t h a t , when the r e s i d e n t was l i v i n g with h i s f a m i l y of  origin.  69 Bergman  assumes  that  " h e l p l e s s " with respect they a r e  displaying.  it.  much  o f t e n used  r e c e i v i n g some  the  the  in a  manipulative  (Bergman, 1 9 8 0 , p. 6 8 ) . 20 year  been doted on and i n f a n t i l i z e d during a  him  f o r the r e t a r d e d .  and  behavioral  treat  approaches  s t a f f decided  The  him  Much of h i s behavior  delicately.  to  change  t o use a p a r a d o x i c a l  paradoxical  way, with  i n a case study  of s u b t l e and not so s u b t l e i n v i t a t i o n s t o others of  are not  symptomatic behavior  A good example of t h i s dynamic i s provided  s t a t e school  home  "secondary g a i n " when d i s p l a y i n g  of a 30 year o l d man named B r i a n had  of  of  He suggests t h a t symptomatic behavior i n  a r e s i d e n t i a l home i s the r e s i d e n t s  to  residents  to  Brian  stay a t a consisted take  care  A f t e r t r y i n g more d i r e c t  h i s dependent  behavior the  intervention.  approach c o n s i s t e d of f i r s t  apologizing to  B r i a n f o r t r y i n g t o make him a c t l i k e an a d u l t when, a f t e r a l l , he  "was  (p.68).  3  a  year  old child  trapped i n the body of a man"  For the next three days the s t a f f t r e a t e d B r i a n l i k e a  3 year o l d ; p u t t i n g him t o bed at 7 pm, making him take naps i n the a f t e r n o o n , After a  and c u t t i n g  while Brian  up h i s meat and  responded a n g r i l y to the treatment he was  r e c e i v i n g and complained t o h i s f r i e n d s . author  reports  adulthood. groomed  He  and  mashing h i s food.  that became  refrained  Brian more from  Within  three days the  "metamorphosized"  assertive, looking  into  organized, to  others  full  and w e l l -  f o r help and  70  support.  Bergman  i n t e r v e n t i o n was  states  (1980)  introduced  that  B r i a n was  two  months  a f t e r the  l i v i n g i n an apartment i n  the community i n a f u l l y grown s t a t e .  One case i s  a d d i t i o n a l s t r a t e g y which the author used i n the above predicting a  relapse.  s i g n i f i c a n t behavioral  A f t e r B r i a n began to show some  changes they  s t a r t l e d by these changes and  with  a  move  away  him  that  they were  d i d n ' t expect them to l a s t .  s t r a t e g y f u r t h e r heightens the wrong  told  challenge  to  prove  from dependency and  a  the  This staff  "flight-into-  health".  Bergman  (1980)  effectiveness  of  o f f e r s an his  paradoxical  t h a t by p r e s c r i b i n g a behavior it,  the  s t a f f are  house h i e r a r c h y . r e s i s t a n t to the  power  reframing  are  of  thus  the  assume  adult/child  focuses  continue  within  r e s i s t a n t behavior  r e g a i n c o n t r o l and  staff  the  a c t i n g out  and  are h i g h l y  o u t s i d e i n t e r f e r e n c e f u n c t i o n a l l y take c o n t r o l of  the  explanation  suggests  able to assume a one-up p o s i t i o n w i t h i n who  reframing  He  for  Children  and  interventions.  f o r the  the m o t i v a t i o n  hierarchy  hierarchy  i n t e r e s t i n g explanation  to  therapeutic and  system.  By  p r e s c r i b i n g i t , the  staff  their  transactions  normal  status  (Madanes,  1980).  i n the This  on the r e s i s t a n c e w i t h i n the system; i f the push  change, the s t a f f appear  for  change and  powerless.  the c h i l d r e f u s e s to  However,  if  the  staff  71 encourages  the  resistance  and,  troublesome behavior, they disarm of c o n t r o l .  This explanation  be the treatment  of  choice  in  a  sense, a u t h o r i z e s the  the c h i l d r e n  of t h e i r means  would suggest t h a t reframing when  a  power  may  s t r u g g l e develops  between s t a f f and c h i l d r e n .  Williams  and Weeks (1984) demonstrate some of the p o s s i b l e  uses of p a r a d o x i c a l adolescent  and adolescent  straightforward resistance i s be  methods  school  therapy  Symptom  be  predicts  that  tried  first  and  paradoxical  student w i l l  l i k e l y continue t o  individuals  behavior j u s t t o prove others  reported  four  articles  t o date that  methods i n  The author  t h i s s o r t of i n t e r v e n t i o n works w e l l with h i g h l y  r e s i s t a n t and o p p o s i t i o n a l  The  paradoxical  p r e d i c t i o n the  d i s p l a y the problem behavior f o r some time t o come. suggests t h a t  and, i f  very u s e f u l i n t e r v e n t i o n s with  With the  with p r e -  i n t e r v e n t i o n may then  prescription  as being  population.  setting  The authors suggest t h a t a  encountered, a p a r a d o x i c a l  p r e d i c t i o n a r e reported  therapist  a  children.  approach t o  appropriate.  an adolescent  in  a setting  alter  examine  above a r e the only  the  than  use  their  examples  of s t r a t e g i c - s y s t e m i c  the c l i n i c i a n ' s o f f i c e .  case examples presented r e v e a l the i n g e n u i t y the authors i n adapting  will  wrong.  reviewed  other  who  The  and c r e a t i v i t y of  s t r a t e g i c / s y s t e m i c methods t o f i t a new  72 t h e r a p e u t i c context. address i s plays i n plays the  One  issue  the d i s t i n c t i v e l y conventional  in  the  review  which  these  studies  child  of  to  d i f f e r e n t r o l e that r e l a t i o n s h i p care as  compared to  s t r a t e g i c / s y s t e m i c approach.  section  fail  this  thesis,  the r o l e i t  Before  let  us  concluding  examine  this  important i s s u e f u r t h e r .  As  was  mentioned  representing  the  earlier,  established  most  of  the  approaches  to  treatment suggest  that a nurturing, supportive  a key  of  ingredient  Jones, 1 9 8 0 ;  therapeutic  Brendtro & Ness, 1 9 8 3 ) .  the development of a r e l a t i o n s h i p bonds v i a  t r u s t , empathy and  to s t a t e t h a t " r e l a t i o n s h i p " agent of  change; with  behavior  success  change.  residential  the  treatment  residential  relationship is  (Bettelheim,  Brendtro ( 1 9 6 9 )  as  the  formation  Ness,  Parry,  1983;  the a c t i v e  great  care i s  of bonds to  majority  seems  to  of  1980;  facilitate  literature  be agreement t h a t  P i e r c e , 1982;  on the  (Brendtro  Trieschman,  1969;  1984).  When theory  of human  within c h i l d  there  Kruger,  describes  He goes on  s t a f f - c h i l d r e l a t i o n s h i p i s the essence of c h i l d care &  1974;  communication s k i l l s .  the development  In  literature  we  therapeutic  we  look  find role  to  that as  the  literature  "relationship" an  agent  for  on  strategic/systemic  does not take a c e n t r a l change.  In  fact,  the  73 strategic/systemic literature relationship  between  description  of  client  the  has very l i t t l e to say about the and  systemic  therapist.  position  r e l a t i o n s h i p i s s u e i s put forward by They  suggest  that  to  in  The  regards  P a l a z z o l i et  to  work s y s t e m i c a l l y the t h e r a p i s t  family.  should not  According  p e r s o n a l i t y does al.,  to  not a c t  take s i d e s the  with any  Milan  as an agent  group  the  a l . (1980).  behave i n a manner so as to be p e r c e i v e d as a n e u t r a l The t h e r a p i s t  best  should  figure.  members of the the  therapist's  f o r change ( P a l a z z o l i et  1978a).  Many r e s i d e n t i a l treatment  programs a c t u a l l y encourage and  f o s t e r the dependent behavior of t h e i r r e s i d e n t s .  Maier  (1981)  s t a t e s "Group care programs have to be s t r u c t u r e d i n such a that  child  care  workers  have time, know-how, and above  immediate support f o r dependency  nurturance"  (p.  31).  "dependency nurturance" takes the form of encouragement new  b e h a v i o r s ) , empathy, a d v i c e  T h i s approach  giving  contrasts sharply  and  takes  f a c i l i t a t o r of  therapist  often  encouraging  the s t a t u s quo and a v o i d i n g  that  occur  may  Unlike  c o n v e n t i o n a l c h i l d care workers, who  and accept the r o l e of a  an  (Watzlawick  all, This  (to t r y comfort.  with the "no-change" p o s i t i o n  o f t e n taken by the s t r a t e g i c t h e r a p i s t s . taken by  physical  way  equal  et  and  the p o s i t i o n  encourage change  change, the  strategic  opposite  position,  credit for  a l . , 1974).  any  change  This  major  74  d i f f e r e n c e of o p i n i o n over the r o l e of r e l a t i o n s h i p as an agent of change w i l l  be d i s c u s s e d f u r t h e r i n a l a t e r s e c t i o n .  As  we  can  see  from  written  on  the  use  of  residential  setting.  the  above review, l i t t l e has been  strategic/systemic  Of  the  few  methods  articles  i n the  t h a t have been  r e p o r t e d , there i s no mention of how s t r a t e g i c / s y s t e m i c methods can be  i n c o r p o r a t e d i n t o the general philosophy  treatment.  The adoption  treatment  inevitably  Following  the  interventions complications  case used  will  of these  new methods  into r e s i d e n t i a l  produces some t h e o r e t i c a l study at  presentation  Vanhouse  be d e s c r i b e d .  some  of of  of r e s i d e n t i a l  complications.  a  these  selection  of  theoretical  75  CHAPTER 3 - METHOD OF STUDY  THE CASE STUDY AS A METHOD OF RESEARCH  The  case  study  i s a f a i r l y common r e s e a r c h s t r a t e g y i n  psychology, s o c i o l o g y , p o l i t i c a l case  study  approach  was  science  characteristics  of  r e t a i n the  the  o c c u r r e d a t the Vanhouse Treatment  real-life  The  the r e s e a r c h  h o l i s t i c and events  that  Home.  The type of q u e s t i o n s asked i n t h i s t h e s i s s e l e c t i o n of  planning.  s p e c i f i c a l l y chosen f o r the present  r e s e a r c h endeavour f o r i t s a b i l i t y t o meaningful  and  method.  determined the  The purpose of t h i s  thesis  i s t o d e s c r i b e the use of s t r a t e g i c / s y s t e m i c methods i n a novel s e t t i n g ; the  r e s i d e n t i a l treatment  home.  on t h i s t o p i c i s r e l a t i v e l y n o n - e x i s t e n t . of the  present study  i s to  p e r t a i n t o the implementation These q u e s t i o n s ,  which were  address the of a  with "why" q u e s t i o n s theory.  that  "Why" q u e s t i o n s  the aim  "how" q u e s t i o n s t h a t approach.  s t a t e d i n the i n t r o d u c t i o n ,  the r e s i d e n t i a l context i n f l u e n c e d t h a t  t o "how"  Therefore,  unique treatment  to how t h e s t r a t e g i c / s y s t e m i c methods were  In a d d i t i o n  Previous l i t e r a t u r e  refer  implemented and how  implementation.  q u e s t i o n s , t h i s t h e s i s i s concerned contribute  to  the  development of  a r e e x p l a n a t o r y i n t h a t they  attempt  to connect the r e s u l t s t o the see, the  q u e s t i o n s posed  from the  stated  As  we  can  by the t h e s i s , which f o l l o w d i r e c t l y  goals,  determine  Yin ( 1 9 8 4 ) ,  According to  e s t a b l i s h e d theory.  its  structure  and  focus.  the case study i s the r e s e a r c h method  of c h o i c e when a "how"  or "why"  q u e s t i o n i s being asked about a  contemporary  events,  over which the i n v e s t i g a t o r  little  or no  set  of  control.  (1984),  Y i n , i n h i s book "Case Study Research" excellent  has  discussion  of  the  case  p r o v i d e s an  study method and h e l p s to  d i s t i n g u i s h i t from other r e s e a r c h s t r a t e g i e s .  Y i n d e f i n e s the  case study as;  ...an  empirical  enquiry  that  investigates  contemporary phenomenon w i t h i n i t s r e a l - l i f e when are  the  boundaries  not  clearly  between phenomenon and  evident;  in  which  sources of evidence are used.  (pg.  Unlike  research  an  experimental  d e l i b e r a t e l y d i v o r c e s a phenomenon study  and  attempts  setting. isolate a i n order  to  capture  The experimental few  significant  that quantitative  the  a  context; context multiple  23)  from i t s phenomenon  strategy,  which  c o n t e x t , the in  its  case  natural  s i t u a t i o n r e q u i r e s the r e s e a r c h e r t o v a r i a b l e s and statements  " c o n t r o l " the context  may  be made concerning  77  the r e l a t i o n s h i p between those s i g n i f i c a n t v a r i a b l e s . study,  by  view  of the  phenomenon and attempts t o i l l u m i n a t e the s i g n i f i c a n t  variables  and make  contrast,  takes  qualitative  a  more  statements  holistic  The case  concerning  the r e l a t i o n s h i p  between them.  Yin  (1984)  states  that  traditionally  m u l t i p l e - c a s e study has been viewed  the  s i n g l e - and  as a l e s s d e s i r a b l e form of  enquiry as compared t o e i t h e r experiments  or surveys.  t h r e e common complaints t h a t  levelled  case study  method.  r i g o r t h a t has  The f i r s t  been  acknowledges t h a t  have  been  findings  associated  with  the  into  and  the  case  study.  Yin  many case s t u d i e s have been g u i l t y of sloppy  conclusions.  c r i t i c i s m i s not unique enter  a g a i n s t the  complaint focuses on the l a c k of  r e s e a r c h methods and that b i a s e d views the  He c i t e s  t o the  conduct  of  have p r e v i o u s l y  tainted  However, he notes t h a t case study,  experiments  as b i a s and  this  can a l s o  other r e s e a r c h  strategies.  The  second  generalizability  common of  complaint  the  r e f e r s t o the r e s e a r c h  concerns  case study method.  study's e x t e r n a l  the  scientific  Generalizability  validity.  Typically,  c r i t i c s who q u e s t i o n the g e n e r a l i z a b i l i t y of the case study a r e i m p l i c i t l y c o n t r a s t i n g the s i t u a t i o n t o survey r e s e a r c h .  If a  sample i s s e l e c t e d c o r r e c t l y i n survey r e s e a r c h then i t should  78  readily generalize to a however,  that  this  larger universe.  analogy  to  Yin  samples  i n c o r r e c t when d e a l i n g with case s t u d i e s . survey r e s e a r c h case  studies  r e l i e s on s t a t i s t i c a l (as with  generalizations. researcher's  goal  and He  states,  universes  is  p o i n t s out t h a t  g e n e r a l i z a t i o n s , whereas  experiments)  With  (1984)  analytical  rely  on  analytical  generalizations  the  i s t o g e n e r a l i z e a p a r t i c u l a r s e t of r e s u l t s  to some broader theory.  Case s t u d i e s , then, do not r e p r e s e n t a  "sample", and t h e i r r e s u l t s  are  p r o p o s i t i o n s , not t o p o p u l a t i o n s  generalizable  to theoretical  or u n i v e r s e s .  R e l a t i n g the above d i s c u s s i o n s t o the case a t hand, namely the  Vanhouse  treatment  approach,  Vanhouse a r e not intended of a l a r g e r  population  Instead  r e s u l t s are  and  the  generalizing  concerned with  documents.  residential  intended  theories;  obtained  at  sample  treatment approaches.  f o r the purpose of expanding  specifically  those  which  are  r e s i d e n t i a l treatment and the s t r a t e g i c / s y s t e m i c  t h i r d frequent  case s t u d i e s  results  t o be used as a r e p r e s e n t a t i v e of  o r i e n t a t i o n to behavioral  The  the  take too With  change.  complaint  that Yin  long and  r e s u l t i n massive, unreadable  reference  to  participant-observation strategy time investment was c o n s i d e r a b l e .  the  (1984)  present  notes i s t h a t  case,  where the  was used t o c o l l e c t data, the However, as Y i n p o i n t s out,  79  a good case study does not r e q u i r e the i n v e s t i g a t o r to spend an i n o r d i n a t e amount of time s u f f i c i e n t data. Yin  As f o r the  suggests t h a t  (1984)  i n the  "field"  in  order  to  collect  " u n r e a d a b i l i t y " of the case study,  the  prospective  investigator  should  read h i s book to s o l v e t h i s problem.  THE  SINGLE-CASE DESIGN  There  are  both  s i n g l e - and m u l t i p l e - c a s e  the case study method.  Yin  states  (1984)  designs w i t h i n  that  there  are a  number of circumstances t h a t d i c t a t e the use  of the  design,  extreme  or unique  study i s c l e a r l y an example of the  revelatory  i n c l u d i n g ; the c r i t i c a l  case, and  The case.  case,  the  single-case  the r e v e l a t o r y case.  present The  observation  revelatory and  case  analysis  study of  may a  be  described  phenomenon  i n a c c e s s i b l e to s c i e n t i f i c o b s e r v a t i o n .  An  as  an  previously  i n v e s t i g a t i o n of  the Vanhouse treatment method i s r e v e l a t o r y i n t h a t an approach of t h i s type has The  purpose  phenomenon  of and  never p r e v i o u s l y been attempted the to  study test  is  to  theoretical  reveal  or  the nature of  propositions  p r e v i o u s l y been suggested i n the a s s o c i a t e d  described. the  t h a t have  literature.  80  When u s i n g the case study method i t i s important the s p e c i f i c u n i t of a n a l y s i s . the  parameters  of  the  focus  i s on  residential treatment  the  setting.  study takes.  In  the present  a n a l y s i s had  study  use of s t r a t e g i c / s y s t e m i c methods i n a The  unit  of  analysis  i n c l u d e s the  home as the context, but the "case" cannot  as the "treatment  refers to  phenomenon under i n v e s t i g a t i o n or the  p a r t i c u l a r focus t h a t the the  The u n i t of a n a l y s i s  to define  home" i t s e l f .  be d e f i n e d  I f , f o r example, the  u n i t of  been the "home" i n g e n e r a l , then the d e s c r i p t i o n s  would have focused on a l l aspects of the behavior t h a t o c c u r r e d at Vanhouse.  However, not a l l of the behavior t h a t o c c u r r e d a t  Vanhouse i s of equal importance behavior  which  implementation residential  is  and use  setting.  t o the focus of the study.  of  particular  of  s t r a t e g i c / s y s t e m i c methods  In  order  approach i s adequately understood must  be  described.  p r e v i o u s treatment other  concerns  are  i n the  c e r t a i n c o n t e x t u a l elements  explains  which  the  t h a t the s t r a t e g i c / s y s t e m i c  the  d e s c r i p t i o n of the  approach a t Vanhouse as w e l l as  descriptions  strategic/systemic  This  interest  The  less  central  some of the to  the  approach.  As was s t a t e d e a r l i e r , the present study i s a s i n g l e - c a s e design.  Using  Yin's  (1984)  terminology,  "embedded" r a t h e r than a " h o l i s t i c " d e s i g n . would d e s c r i b e  and analyze  the A  study i s an  holistic  design  the g l o b a l nature of the treatment  81 approach at Vanhouse,  while  certain  "subunits",  aspects,  subunits  are  or  described  subunit  "Interventions", examples.  which  of  the  focuses  approach.  under  receives  the  most  The  i n t e r v e n t i o n s are  should  the  larger  a c t u a l case  presented as a  unit  of  case examples, with  only  a  the approach.  brief  A multiple-case  For  i n t e r v e n t i o n s are provided  approach  A  detailed  in  operation  r e s i d e n t i a l approaches formulate some general  description  the present i n order  description helps and  of  to  the  intervention of  the  the  other design  study more  strategic/systemic  distinguish  provides  the  design,  single-case  to make  the  propositions  i n c o n t r a s t , would focus almost e x c l u s i v e l y on the  robust.  "case  "multiple-  focus,  for extrapolating  to broaden the t h e o r e t i c a l framework.  the  etc.  a t t e n t i o n i s the  not be confused with  s t r a t e g i c / s y s t e m i c approach, and  aspects of  such as;  i n t e r v e n t i o n examples are presented f o r  illuminating  on  These  headings  which i n c l u d e s the d e s c r i p t i o n of  examples", the design  purpose  of  design  Consequences, I n t e r v e n t i o n s ,  Although the  case d e s i g n " .  embedded  separately  R e l a t i o n s h i p s , Rules and The  the  it  data t h a t  from  other  can be used to  theoretical propositions.  DATA COLLECTION  According different  to Yin  sources  (1984) case s t u d i e s of  data  may  collection;  be  based on s i x documentation,  82  interviews,  participant-observation,  a r c h i v a l records, makes use  The  and  of the f i r s t  physical three  artifacts.  The  analyzed  reports  was  used to record the s t r a t e g i c / s y s t e m i c v e r b a l from  weekly  history/demographic recorded  The of the  staff  information  log r e p o r t s  each r e s i d e n t .  to monitor process.  the progress  determine how  The was  the  strategic/systemic  previously  and been  c o n s i s t e d of a w r i t t e n d e s c r i p t i o n recorded  i n the house  of the r e s i d e n t through the  indications  of  the case  purpose verbal  of  logs  change, and  i n the  book  interventions to these  treatment  to  i s s u e s t h a t emerged.  the t h e s i s  this  and  study the  behavioral  an i n n o v a t i o n  author of  r e a c t i o n s of the r e s i d e n t s  i n separate note  "events" o c c u r r i n g  s t a f f handled s p e c i f i c  by the The  had  reports,  These logs were used to ensure t h a t  "message book" was  initiated  observer.  for  daily  interventions,  progress  that  As a source of evidence f o r  analyzed  the  residents.  the s t a f f were aware of the  were  meetings,  r e s i d e n t s ' behavior, which was  books f o r  study  of the r e s i d e n t s , a "message" book which  f o r each of the  daily  present  included;  log  minutes  observation,  sources of evidence.  documentation t h a t was f o r each  direct  was  approach t h a t  as a p a r t i c i p a n t to and  record the  interventions.  the  initial The  case  83  examples t h a t are p r o v i d e d i n the r e s u l t s chapter were s e l e c t e d from the  numerous  message book.  interventions  The  that  message book  were  recorded  i s described  i n the  f u r t h e r i n the  r e s u l t s chapter.  Minutes from the weekly source of  evidence of  Vanhouse.  These meetings,  a staff the  Adjustments  and  to  meetings.  provided  a good  treatment p h i l o s o p h y a t  which were attended by the author as as an arena f o r open d i s c u s s i o n of  weaknesses  the  strategic/systemic  meetings  the d e v e l o p i n g  member, f u n c t i o n e d  strengths  staff  of  the  approach  and  interventions  also  treatment the  approach.  f o r m u l a t i o n of  occurred  d u r i n g these  For these reasons, the weekly s t a f f meetings  proved  to be an i n v a l u a b l e source f o r g a t h e r i n g case study evidence.  The i n t e r v i e w s t h a t were of an family  open-ended nature. worker  were  used t o  gather i n f o r m a t i o n were  The c o o r d i n a t o r of the program and a  interviewed  informally  regarding  their  p e r s p e c t i v e s on the d e v e l o p i n g approach.  The source o f evidence which p r o v i d e d the most i n f o r m a t i o n was  the  ongoing  observations  participant-observer.  Much  of  the  author  had  as  a  The author was employed as a c h i l d c a r e  worker i n the home, two months.  that  the  days  a  week,  f o r approximately s i x  i n f o r m a t i o n that was used i n the case  84  study came from observing and p a r t i c i p a t i n g meetings.  The  author  formulate and d e l i v e r quality  and  also  had  the  opportunity  strategic/systemic  accuracy  of  i n the weekly  staff  to  help  interventions.  The  the i n v e s t i g a t i o n was s i g n i f i c a n t l y  enhanced as a r e s u l t o f t h i s " i n s i d e r ' s " view of the phenomenon under  study.  Of  course,  participant-observation role biases.  as  Yin  may  reminds  (1984)  potentially  us, the  produce c e r t a i n  Due t o the f a c t t h a t the present study i s d e s c r i p t i v e  i n nature, as opposed t o e v a l u a t i v e , these b i a s e s a r e h o p e f u l l y kept to a minimum.  I f , f o r i n s t a n c e , the study i n v o l v e d making  comparisons between two  different  the  "objectivity"  author's  relative  treatment  approaches,  then  would be a more s e r i o u s  concern.  DATA ANALYSIS  According to Yin  (1984),  a n a l y s i s i t i s important The a n a l y s i s i n the framework,  which  i . e . , "The  helps  a  case  study  t o have a general a n a l y t i c s t r a t e g y .  to  i s based  organize  various  elements  Residents",  "The  e t c . , and each of these elements initial  conducting  present t h e s i s  framework covers the case;  when  the or  case  study.  "subunits"  This of the  Staff", "Interventions",  i s examined  q u e s t i o n s posed by the t h e s i s .  on a d e s c r i p t i v e  in light  of the  85  In  addition  to  the d e s c r i p t i v e a n a l y t i c framework, t h i s  t h e s i s a l s o r e l i e s on some general guide the a n a l y s i s of the data.  t h e o r e t i c a l p r o p o s i t i o n s to  These p r o p o s i t i o n s were s t a t e d  i n problem form i n the i n t r o d u c t o r y chapter headings;  "The  Identified  Patient  under the f o l l o w i n g  Problem",  Parent Problem", "The Problem of R e s i s t a n c e " , of  Control  and  Discipline". from o b s e r v a t i o n s  tested  the  of the Vanhouse approach a r e  The u l t i m a t e goal i n the  i s to accurately  a n a l y s i s of the  d e s c r i b e the phenomenon under study and  formulate  hypotheses  theory.  The d e s c r i p t i v e  by the i n i t i a l  chapter the  t h e o r e t i c a l p r o p o s i t i o n s d e r i v e d from the  existing literature. data  and "The Problem  In the c o n c l u d i n g  r e s u l t s obtained against  "The Surrogate  that  contribute  the  development of  framework and the s t r u c t u r e  theoretical  a n a l y s i s and p r o v i d e s  to  propositions  helps  to  provided focus the  o r g a n i z a t i o n f o r the e n t i r e case study.  LIMITATIONS  As  was  analytic  stated  earlier  generalization  generalization.  In  conclusions  of  theory  of  residential  study  were  comparative,  the  based  as  essence  study  on  the present  are  opposed  to  statistical  t h i s means t h a t the r e s u l t s and generalizable  treatment  to  the broader  and systems theory.  statistical  quantitative  case study r e l i e s on  statement  generalization could  then  I f the some  be made about the  86  r e l a t i v e success of the approach. study  was  not  understand with the  and  to  evaluate  identify  residential  the  the  implementation  the  of  a novel  theory  suggested  i n t e r p r e t a t i o n of a potential  approach,  but to  variables associated  treatment  approach i n the  study r e p r e s e n t s  by  the  literature.  a "test  The  l i m i t a t i o n of the study. of  the  Vanhouse  If  their  theory  is  r e p r e s e n t a t i o n , then the study f a i l s as a v a l i d  and  staff's represents  interpretation an  inaccurate  " t e s t case" of  theory.  Finally a  note about how  the r e s u l t s can be used by other  i n v e s t i g a t o r s and p r a c t i t i o n e r s .  The present  to  i n the r e s i d e n t i a l  focus  field  and,  future  investigations  hopefully,  p r a c t i t i o n e r who  will  wishes to  provide implement a  study w i l l  help  to determine  p r o p o s i t i o n s are  help  treatment  guidelines  for  the  s i m i l a r approach.  In  r e f e r e n c e to f u t u r e i n v e s t i g a t o r s , a r e p l i c a t i o n of the will  case"  r e s i d e n t i a l treatment  the s t r a t e g i c / s y s t e m i c l i t e r a t u r e  implementation  that  purpose of the  context.  strategic/systemic  and  Vanhouse  significant  In a very r e a l sense, the for  However, the  results  whether the s t r a t e g i c / s y s t e m i c theory's  c o r r e c t , or  whether some  e x p l a n a t i o n s might be more r e l e v a n t .  a l t e r n a t i v e set of  87  CHAPTER 4 - RESULTS  The  purpose of t h i s chapter i s t w o f o l d .  i s concerned with the aspects  of  the  r e s i d e n t i a l context;  approach  which  section  h i g h l i g h t i n g those  d i s t i n g u i s h i t as a systemic  o r i e n t a t i o n t o r e s i d e n t i a l treatment. d e a l s with  The f i r s t  the s t r a t e g i c / s y s t e m i c  The second major s e c t i o n  i n t e r v e n t i o n s themselves and  t h e i r p l a c e w i t h i n the o v e r a l l treatment  plan.  THE DEVELOPMENT OF A SYSTEMIC APPROACH  As was s t a t e d that  existed  methods  prior  was  placed  on  earlier,  primarily  the  residents  the e x p e c t a t i o n s  inappropriate  with  with  an emphasis  clear,  underlying  consistent  assumption of  was that r e s i d e n t s would  behavior  as a  response t o staff.  t o have an impact on the r e s i d e n t s ' behavior the s t a f f  the a d o l e s c e n t s .  are  based  and d i s c i p l i n e a p p l i e d by the treatment  made an e f f o r t t o develop s t r o n g ,  based  An  e s t a b l i s h e d approach  begin t o a l t e r t h e i r  In order  relationship  f o r t h e i r behavior.  this previously  treatment approach  t o the i n t r o d u c t i o n of s t r a t e g i c / s y s t e m i c  providing  expectations  the Vanhouse  on  the  inherently  The  supportive  development of  r e l a t i o n s h i p s with  these r e l a t i o n s h i p s was  premise that c l o s e , i n t e r p e r s o n a l r e l a t i o n s h i p s therapeutic.  88  The  p r e v i o u s l y e s t a b l i s h e d approach  l i n e a r , or  using systems  language, one  may  in quantity, the same  to change  not q u a l i t y .  problem-solving  First-order  theory of  f i r s t - o r d e r change.  Typical disciplinary  d i s p l a y e d by an adolescent  consequence to behavior severe  act  occurs  For  again  which i s  a  then  the  with the  action i s  If  same  conventional, f i r s t - o r d e r , of  direct intervention  adolescents  who  are s t i l l  the may  based on a  s t a f f were  of the  s e t t i n g these  i n t e r v e n t i o n s were  is  inappropriate,  the  inappropriate  consequence or a more  i n a step-wise  fashion.  and f r u s t r a t e d  d i s c i p l i n a r y responses to residents.  Although  be r e l a t i v e l y  this  s u c c e s s f u l with  r e s i d i n g with t h e i r f a m i l y of  the Vanhouse  (Weeks  or s t a f f i s to apply a  s t a f f at Vanhouse became d i s i l l u s i o n e d  the i n a p p r o p r i a t e behavior k i n d of  over again  considered  deterrent.  consequence, i s administered  The  change i n v o l v e s using  example, some behavior  response by parents as  first-  First-order  1974).  s t r a t e g i e s over and  1982).  the c o n v e n t i o n a l  as  w i t h i n a given system; i t i s a change  & L'Abate,  and  described  t h a t encourages  order change s o l u t i o n s (Watzlawick, et a l . , change r e f e r s  be  origin,  opinion that i n a r e s i d e n t i a l inadequate and  i n some cases  countertherapeutic.  One  of  the  reasons  s o l u t i o n s were thought to  why  direct  be inadequate  or may  f i r s t - o r d e r change be  a t t r i b u t e d to  89  the profound  resistance exhibited  example, an o p p o s i t i o n a l  by the  residents.  adolescent repeatedly  If, for  f a i l e d to  return  on time f o r curfew then p r o g r e s s i v e l y d i s c i p l i n a r y consequences would simply heighten the  adolescent's  rebellious  d i s t u r b the treatment r e l a t i o n s h i p by c r e a t i n g an struggle.  The  disciplinary change  in  staff  measures the  questioned  produced any  adolescent's  countertherapeutic significant,  also  and  l o n g - l a s t i n g change the  itself  (Weeks  trying  to  promote is  the  interaction occurs.  includes  the  staff.  the  residential  change  by  the  s t a f f focused  In  change  In other  altering  the  change  from  w i t h the  s t a f f wishes then there i.e.  on  second-  system  the  resident.  the  has  of  system,  the  structure  and  members of a system a context  the  residents  and  attempted i n  r e l a t i o n s h i p between r e s i d e n t  demands  behavior,  avoid  words, i n s t e a d  residential  where the s t a f f the  to  i n the  When f i r s t - o r d e r change s o l u t i o n s are s e t t i n g the  direct,  difficulties.  r e l a t i o n s h i p between the  as one  the  a  between the  s t a f f i s defined  in  order  s t a y i n g w i t h i n the By  power  to a c t as a c a t a l y s t f o r  to  1982).  altered.  qualitative shift "system"  refers  & L'Abate,  system i t s e l f meaning of  change  whether  In  order s o l u t i o n s to the r e s i d e n t s ' b e h a v i o r a l  Second-order  intense  and  long-lasting, internalized  behavior.  power s t r u g g l e s  nature  and  encourages, d i r e c t s or I f the r e s i d e n t  complies  been a q u a n t i t a t i v e change  behavior  is  displayed  less  90  frequently, the two  however the s t r u c t u r e  p a r t i e s remains  of  constant.  the  i n t e r a c t i o n between  In order f o r second-order  change t o occur there must be a change i n the  s t r u c t u r e of the  i n t e r a c t i o n , i . e . a change i n the system i t s e l f . the  Vanhouse  paradoxical conventional  system  role  occurred  of not  when  being a  the  The change i n  staff  "changer".  assumed  the  That i s , u n l i k e  c h i l d care workers, the Vanhouse s t a f f assumed the  paradoxical  position  p o s i t i v e l y connoting,  of  encouraging  predicting  or  the  status  prescribing  quo  by  the problem  behavior.  To be s p e c i f i c , a s h i f t occurred  when the r e l a t i o n s h i p  q u a l i t a t i v e l y changed. a system also  i n the Vanhouse system's  changes the  changes.  As  between s t a f f  Vanhouse  meaning a t t r i b u t e d we  shall  see  following sections describe staff  to  alter  c o n s i s t e n t with a systemic These  descriptions  strategic/systemic  and r e s i d e n t was  When the r e l a t i o n s h i p s t r u c t u r e  are  their  i n the f o l l o w i n g  section,  together.  the attempts  made by the  approach so t h a t i t would be  orientation followed  within  to that r e l a t i o n s h i p  s t r u c t u r e and meaning a r e i n e x t r i c a b l y t i e d  The  structure  to  behavioral  change.  by s p e c i f i c examples of the  i n t e r v e n t i o n s employed a t Vanhouse.  91 RELATIONSHIPS  L'Abate ( 1 9 8 2 ) d i s c u s s the p r o p e r t i e s  Weeks and system.  These  r e l a t i o n s h i p and that a  a  equifinality.  defined  as  Wholeness r e f e r s to the  a system, r e l a t i o n s h i p ,  system can  only be understood i n terms  among  its  parts.  d e f i n e d by each o t h e r . makes  sense  or  their  concept  other  example, the meaning  r e l a t i o n s h i p was  or  r e l a t i o n s h i p with would assume  defined  system. behavior  the  concept  that  relationship  care g i v e r ' s the  are  r o l e only  context of i t s  this  profound importance of r e l a t i v e to  If, for  a  then the  is  staff  the by  substitute-parent residents,  r e l a t i o n s h i p with  concept  each of  example, the  cultivated  residents  a child-parent  language  second  words, the p a r t s  within  s t a f f at Vanhouse r e a l i z e d the  actions  systems  In  of the  The  It i s  i n d i v i d u a l being cared f o r .  other members of the their  For  acquires  r e l a t i o n s h i p to the  The  r e f e r s to the  open  wholeness,  set of interdependent p a r t s o p e r a t i n g as a u n i t .  existing  how  are  system i s more than j u s t a c o l l e c t i o n of p a r t s .  p r o p e r t y of the  properties  of an  called  the  in  turn,  staff.  In  "complementarity"  (Watzlawick et a l , 1 9 7 2 ) .  The  staff  at  complementarity and  Vanhouse  examined  r e l a t i o n s h i p from the  this  c r u c i a l issue  of  l a r g e r p e r s p e c t i v e of  92 treatment g o a l s . the  Vanhouse  residents  relationship staff  between  examined  concluded  The primary treatment goal f o r almost a l l of  relationships reparative  the  their  that  process  adolescent  and  concerned  that  likely  development the  the  interfere  words, ties  natural  they  interpersonal  eventually  of  When the  children  close,  or  other  systemic p e r s p e c t i v e ,  Vanhouse s t a f f might be d e s c r i b e d solution  standpoint the  of  would In  functional  with  occur the  process  between  staff  between  the  were  s t a f f and  of s e p a r a t i o n  attachment t h a t occurs between parent and c h i l d .  From a  the  with  disrupt  that  a  and her f a m i l y .  development  r e s i d e n t s would j e o p a r d i z e and  re-establish  resident  parent. the  to  relationship  the  would  was  becomes  the  the dilemma  by Watzlawick (1974) as "when  problem".  the "attempted t h e r a p e u t i c  residents  with  meaningful,  a c t i v e agent f o r change; interpersonal  the  relationships  t h a t faced the  From  conventional  s o l u t i o n " i s t o provide  caring  relationships  understanding are  a  being  inherently  as an  that  close  therapeutic.  However the "attempted s o l u t i o n " becomes the "problem" when the development  of  these  relationships  serves  t o j e o p a r d i z e the  "meta-goal" of r e - e s t a b l i s h i n g a f u n c t i o n a l f a m i l y u n i t .  In order undermine  to a v o i d  or  block  being p l a c e d any  in a  beneficial  p o s i t i o n that might interaction  between  adolescent  and parent, the  r e l a t i o n s h i p to  the r e s i d e n t s .  meant t h a t the s t a f f personal  lives  "surrogate still  of  did the  parent" kinds  pleasant  avoided being  staff  in  a  to  re-define  their  Essentially this re-definition  not  become  residents  too  and  of b e h a v i o r .  and g e n e r a l l y put  decided  involved  steered  with the  c l e a r of any  Although the  s t a f f were  a c c e s s i b l e t o the r e s i d e n t s they  position  the  r e s i d e n t s might  become dependent or o v e r l y i n v o l v e d with them.  In doing so the  s t a f f hoped t h a t the adolescents  where  would  turn to  to meet t h e i r needs f o r belongingness and the  their families  intimacy  and  not t o  staff.  To  r e d e f i n e t h e i r r e l a t i o n s h i p t o the r e s i d e n t s , the s t a f f  primarily Instead  changed  the  level  of always empathizing  of  communication  or encouraging  t a l k about t h e i r problems or w o r r i e s ,  i n the home.  the r e s i d e n t s t o  the s t a f f r e d i r e c t e d them  to b r i n g up t h e i r concerns i n a f a m i l y therapy s e s s i o n t h e i r parents  directly.  the r e s i d e n t s personal their social  It  is  The s t a f f a l s o r e f r a i n e d from  questions  or becoming  or with asking  too i n v o l v e d with  lives.  impossible  to  report  on the consequences of the  change i n s t a f f / r e s i d e n t r e l a t i o n s h i p s some b e h a v i o r a l  with any  c e r t a i n t y but  consequences may be hypothesized.  a few of the r e s i d e n t s were known t o  complain that  F i r s t of a l l "the s t a f f  94  didn't  really  care  about  them,  they  were only a t the home  because they were being p a i d to be t h e r e " .  A number  of the  r e s i d e n t s were a l s o , on o c c a s i o n , g e n e r a l l y h o s t i l e towards the s t a f f without any apparent that  a  few  of  reason.  And  finally  i t was  observed  the r e s i d e n t s behaved a g g r e s s i v e l y when s t a f f  were a s k i n g f o r minimal  compliance  with the house e x p e c t a t i o n s .  During a s t a f f r e t r e a t t h a t took p l a c e approximately months from  the date  when the s y s t e m i c / s t r a t e g i c approach  i n s t i t u t e d , the s t a f f The  general  attempt  addressed  consensus  of  in  treatment  goal of  hostility  attachment  and  parents may  have  disengaging  may  directed  the  issue  staff  directed  avoiding  was  separation  the  between  have  been  this  t h a t perhaps t h e i r  staff. with  the  The  in this initial  process of  the a d o l e s c e n t s and  observed  was  of r e l a t i o n s h i p .  been s u c c e s s f u l , however, a by-product  their of the  increase i n s t a f f -  hostility.  present a more engaging the  staff  adolescents treatment  at  interfering  To remedy the s i t u a t i o n  time,  this  at disengaging from the r e s i d e n t s had r e s u l t e d  increase  seven  to  were the  approach.  should e x i s t  i t was  presence quite  extent I t was  decided t h a t  s t a f f would  to the r e s i d e n t s .  At the same  determined^ that  they  not  to  engage the  had with the p r e v i o u s  decided t h a t the  relationship that  between the s t a f f and r e s i d e n t would be one where  95  the s t a f f  were  generally  r e s i d e n t s while  at the  supportive  and  interested  i n the  same time a v o i d i n g t a k i n g on, or being  put i n , the p o s i t i o n of surrogate parent.  As the reader might imagine, living  day  to  day  extent t h a t the interest  with  is  becoming  overly  without  to  each  one  the  t o engage them t o the of  caring  involved  Of course, the way of  d i f f i c u l t t a s k , when  adolescents,  relationship  dependent behavior. relate  i t is a  in  adolescents  and  and  genuine  encouraging  which s t a f f members  is  dependent  on  the  i n d i v i d u a l r e s i d e n t ' s r e l a t i v e engagement or disengagement with the s t a f f . staff  In  some cases, with o v e r l y i n v o l v e d r e s i d e n t s the  consciously  backed-off  in  order  that  the a d o l e s c e n t  might become motivated t o engage with more " s i g n i f i c a n t o t h e r s " in their  lives.  This relationship systemic/strategic  issue  approach  t h a t the s t a f f encountered the  one  neutral,  hand,  systemic  disengaged  a d o l e s c e n t s are f a m i l i e s , and perspective,  a  to  the  an  theory  other  element  r e s i d e n t i a l care.  in a  I t appears  i n treatment  g o a l s ; on  would seem t o suggest t h a t a  relationship  disengaged  important  a conflict  not "drawn on  is  is  away" from hand,  required  so  i n t e r a c t i o n with  from  a  residential  r e l a t i o n s h i p leads to  and h o s t i l e behavior on the p a r t of the  that  residents.  the their care  unresponsive The  staff  96  adopted a  compromise between  present  more engaging  "room  a to  move"  so  these two  p o s i t i o n s and  began to  l e a v i n g the  residents  presence while  that  they  might r e - e s t a b l i s h f u n c t i o n a l  r e l a t i o n s h i p s with t h e i r f a m i l i e s .  It  may  be  "complementary" was  said  that  relationship  substituted  for  a  the r o l e  of those  was  one  and  the  than  r e f r a i n e d from  the  vulnerable,  draw on  parties  f r e e to  t h e i r own  support.  The was  assume a  one.  In  A more  e x i s t e d when  i n the n u r t u r i n g  symmetrical r e l a t i o n s h i p between the two r e s i d e n t s to  and  two  always being  supported  one.  while the r e s i d e n t s assumed  of n u r t u r i n g  r e s i d e n t s , i n t u r n , were  residents  where the s t a f f ' s r o l e  symmetrical r e l a t i o n s h i p between the the s t a f f  established  the s t a f f and  "symmetrical"  supportive  i n need  previously  between  more  complementary r e l a t i o n s h i p d e f i n e d as n u r t u r i n g and  the  role  essence,  role, other a more  p a r t i e s encouraged  strengths  and- the  strengths  the of  their families.  Another important from a  systemic p e r s p e c t i v e  the s t a f f and Durrant  their  was  the  the r e s i d e n t ' s f a m i l y .  (1987)  r e s i d e n t i a l care and  relationship  argues  that  ignore the  most  context  that one  the  s t a f f examined  t h a t e x i s t e d between  An a r t i c l e by  Menses  and  "traditional"  models  of  within  adolescents  f a m i l i e s make sense of placement.  which  They suggest t h a t  97  the meaning of placement i s o f t e n one t h a t exacerbates f e e l i n g s of  failure  and  removes  responsibility  from the f a m i l y .  To  remedy the s i t u a t i o n these authors suggest t h a t the r e s i d e n t i a l staff  "frame" the placement as a " r i t e of passage", which marks  the change of context  t o one  stand up t o the problem  The aspect  i n which  together.  of placement and  avoided t r i a n g u l a t i n g  t a k i n g over  that  adolescent. whenever  unit.  develop  the  family's  the  p o s i t i o n of  the  s t a f f , f a m i l y and  the s t a f f  made sure t h a t  integrity  and  resources.  communicate a simple message of r e s p e c t ,  with  the  residents'  parents Clothing  m i n i s t r y was a l s o passed on t o the parents assume r e s p o n s i b i l i t y messages to  for their  communicated maintain  t o the  f a m i l y members they acknowledged  bedtime f o r the a d o l e s c e n t s .  functioned  in  Triangulation refers  between  with  put  f o r " c u r i n g " the adolescent i n  To avoid t h i s s t r u g g l e ,  respected  consulted  can  communicating  example, t o  being  the r e s p o n s i b i l i t y  i s o l a t i o n from the f a m i l y struggle  themselves with  What i s meant here by " t r i a n g u l a t i n g " i s t h a t  the s t a f f avoided assuming or  other  i s able t o  s t a f f a t Vanhouse were a l s o aware of the disempowering  f a m i l y members.  and  the f a m i l y  about  the s t a f f  an a p p r o p r i a t e  money s u p p l i e d by the so t h a t  they would  c h i l d ' s purchases.  from  staff  For  to  family  These and members  the f a m i l y ' s i n t e g r i t y and encouraged  t h e i r p a r t i c i p a t i o n i n the s o l u t i o n t o the f a m i l y problem.  98  Another providing  relationship  treatment  which  from  a  systemic  r e l a t i o n s h i p of the s t a f f t o the the  community  resources  and  by workers  c l o s e l y monitored both the the o u t s i d e  examination  perspective  l a r g e r system  ministry  goals and i n t e r v e n t i o n s w i t h i n those planned  required  the  home  may  the  included Treatment  c o n t r a d i c t with  i n the f i e l d .  The s t a f f at Vanhouse  response t o  t h e i r i n t e r v e n t i o n s by  system and the independent a c t i o n s taken by workers  i n the  f i e l d that  from a  systemic p e r s p e c t i v e ,  might a f f e c t  the r e s i d e n t s .  the s t a f f  resident's  system;  family,  When working  must be aware o f , and  not underestimate, the p o t e n t i a l impact of the  was  which  personnel.  when  peers,  a l l the staff  members of  and community  resources.  RESISTANCE  As " r e l u c t a n t  clients",  challenge  to  For  adolescent,  the  expectations  adolescents  provide  an immense  those i n the p o s i t i o n of a d m i n i s t e r i n g  may  change  or  be i n t e r p r e t e d  compliance  with  as d i s l o y a l t y  treatment. treatment  t o her f a m i l y .  The r e s i d e n t , by a l t e r i n g her i n a p p r o p r i a t e  behavior, may  that  the s t a f f are more  she  is  implicitly  s u c c e s s f u l at " p a r e n t i n g " a d d i t i o n , the family's  suggesting her  resident l i k e l y  s t a t u s quo by  that  than her  own parents  feels obligated  continuing  to  play  were.  feel  In  t o p r o t e c t the  her  part  i n the  f a m i l y "drama" extreme  (Hoffman, 1981).  resistance  interventions. described to  the  factor.  In  residents  addition  which  way  later  to  the  adopted a helped  to  or  the  i t clear  who  to the adolescent  c o u l d decide what was  d i d not  in  the  section  on  interventions  position in relationship minimize  the  resistance  s t a f f r e f r a i n e d from  residents  When i n t e r v e n i n g with a  s t a f f made  the s t a f f  directing  of d e a l i n g with t h i s  specific  In p r a c t i c e , t h i s meant t h a t the  c e r t a i n way.  the  described  l a t e r , the s t a f f  "overpowering"  only one  is  One  to  behave  in a  r e s i d e n t ' s behavior  the  t h a t she was  really  the  this  way  best f o r her.  In  remove the r e s p o n s i b i l i t y f o r behavior from  adolescent.  Another type of provided  by  resistance  the a d o l e s c e n t ' s  I n t e r a c t i o n approach d e s c r i b e d influence  of  this  peer  encountered  at  Vanhouse  peer c u l t u r e .  The  Guided Group  e a r l i e r focuses  on  the powerful  c u l t u r e and  attempts to u t i l i z e  f o r c e to a l t e r the behavior of the r e s i d e n t s . s t a f f were  aware of  the r e s i d e n t s  how  difficult  "banded t o g e t h e r "  and  was  this  At Vanhouse, the  treatment c o u l d become when viewed the home  as an  "us"  ( r e s i d e n t s ) versus "them" ( s t a f f ) s i t u a t i o n .  I t may perceive cohesive,  be hypothesized  the s t a f f as the  t h a t adolescents  i n care tend to  "enemy" because i t helps  group f e e l i n g amongst the r e s i d e n t s .  to develop a  To minimize  the  100 detrimental staff  at  e f f e c t s of t h i s s t a f f vs. r e s i d e n t s phenomenon, the Vanhouse  were  p r o c e s s of developing  careful  group  to  "togetherness"  time, avoided encouraging any  perception  an a d v e r s a r i a l r o l e to the r e s i d e n t s . avoided  this  perception  inappropriate  has  behavior.  p r i v i l e g e such  as the  use  positively  to  and,  at  the  the same  t h a t the s t a f f were i n  One  do  connote  example of  with  how  they  consequences  In  residential  settings  of  the stereo i s being  for  when  a  abused by a  number of r e s i d e n t s , a t y p i c a l consequence might be to withdraw the use  of t h a t p r i v i l e g e f o r the e n t i r e house. 1)  i n f l u e n c e to discourage any  f u r t h e r misuse of the s t e r e o , or  the r e s i d e n t s band together  and  The  f u r t h e r misuse  and  residents  direct  t h e i r peer  their hostility  disregard  s t a f f at Vanhouse were c a r e f u l  use  outcome of  t h i s i n t e r v e n t i o n might be  s t a f f by  the  The  of house  not  to  use  at  2) the  expectations. this  kind  of  i n t e r v e n t i o n when they suspected the r e s i d e n t s might respond i n t h i s l a t t e r manner. and  knowledgeable  I t was of  important t h a t s t a f f were  group  dynamics  i n order  assess what type of i n t e r v e n t i o n would be most  From a general dealt  with  altogether. p o i n t out not  by  essentially  As was that  standpoint,  reported  resistance  trying earlier,  to  aware of  to adequately  appropriate.  in  the  sidestep Jessee  et  home the  issue  a l . (1982)  " r e s i s t a n c e r e q u i r e s an N of at l e a s t two".  showing up f o r the  was  " b a t t l e of w i l l s " the s t a f f were able  By to  101 minimize the  "us and  them" phenomenon  t y p i c a l of r e s i d e n t i a l  care.  RULES AND CONSEQUENCES  In order t o a v o i d i n s t i t u t i o n a l i z i n g the were concerned  about keeping  the r u l e s  To a v o i d any power s t r u g g l e s a s s o c i a t e d s t a f f presented  them i n  the n e c e s s i t y f o r having r e s i d e n t s were the r u l e s  at  changed i f the need  The  behavior  as  rules i n  were  to  a  and  on  applied  for  a  closely  linked  stayed earlier  occasion,  as  house o v e r n i g h t , next  night.  r u l e s were  t o meet house  to  inappropriate  the  For example the consequence f o r abusing  removal  next  The  failure  of  that  night.  they were  f a c i l i t i e s , etc.  privilege.  out past curfew, they were expected t o the  setting.  arose.  possible.  temporary  r u l e s , the  d i s c u s s and q u e s t i o n  house p r i v i l e g e s such as T.V., s t e r e o , cooking was  and p r a c t i c a l .  with house  a residential  opportunity  meetings,  consequences  expectations  simple  a m a t t e r - o f - f a c t manner and e x p l a i n e d  given the group  house, the s t a f f  I f a resident  r e t u r n t h a t much  When a r e s i d e n t was away from the expected to  stay i n  the house the  102 A general r u l e of thumb a t Vanhouse was t o a v o i d o v e r u s i n g a form of d i s c i p l i n e . r e t u r n home  for a  s t r i c t consequence resident  r a t h e r than the  few days,  ifa  to  break  possibility  resident f a i l e d to  then the s t a f f would not apply a  such as grounding  continued  i n v e s t i g a t e d the  In other words  an  for  three  days.  established  of  using  a  If a  r u l e the s t a f f  novel i n t e r v e n t i o n  p r o g r e s s i v e l y i n c r e a s i n g the consequences t o match  infraction.  T h i s approach t o d i s c i p l i n e theoretical  position  proposed by Watzlawick mechanically applying staff  avoided  becomes remove  the  the  controlling  problem  et  a l . (1974).  accordance  formation  and  By  with the resolution  refraining  from  an a p p a r e n t l y u n s u c c e s s f u l s a n c t i o n , the situation  the  If  where the  residents'  inappropriate  the  "attempted  privileges  to  or i n c o r r i g i b l e  solution  s t a f f were t o p r o g r e s s i v e l y  behavior,  s o l u t i o n " might very w e l l lead r e p e t i t i v e AWOL'ing  in  on  problem".  a l l of  was  a  as  then  a  this  larger  means  of  "attempted  problem  such as  damage t o the t h e r a p e u t i c  r e l a t i o n s h i p between s t a f f and r e s i d e n t .  Whenever a s i t u a t i o n arose where the problem  resolution  application  of  a  appeared standard  p r o b l e m a t i c behavior,  " d i r e c t " approach t o  inadequate, consequence  then the  that did  s t a f f would  i s , when the not  alter  the  use an " i n d i r e c t "  103 method.  An  order  indirect  change  solution  strategic/systemic i n Vanhouse general  method was or,  intervention.  one  that  what  may  u t i l i z e d a secondbe  called,  These i n t e r v e n t i o n s were used  both to deal with management kinds of problems  treatment i s s u e s .  management and  general  a  Of course i n a  treatment  and  residential setting,  i s s u e s or  goals may  overlap  considerably.  The  strategic/systemic  next s e c t i o n .  Before  i n t e r v e n t i o n s are  moving on,  approach f o r r e s o l v i n g i n t e r - g r o u p residential  settings,  there  r e s i d e n t s about t h i n g s the establishment  Frequently,  in  i s a l o t of i n f i g h t i n g amongst  the  deal with t h i s k i n d of c o n f l i c t by  interfering  leads to  r e s i d e n t s themselves.  Redl  of  (1952,  pg.  i g n o r i n g the  a resolution  the phone  He c a l l s 158).  which  Inter-group c o n f l i c t inevitable. to  day  likely  really  of the c o n f l i c t by  the  unchangeable  amongst r e s i d e n t s  or  out  that  regarding  non-existent.  i n a treatment home i s  I f s t a f f were to r e g u l a r l y i n t e r f e r e  conflicts  The and  Watzlawick et a l . (1974) p o i n t  is  this  conflict  problems can be mishandled when a change i s attempted a difficulty  and  (1952) chooses to  ignoring i t .  ignoring"  r a t i o n a l e for t h i s decision i s that not  conflict.  l i k e s t e a l i n g , the use  "planned  i n the  l e t us examine the Vanhouse  of a "pecking order".  non-intervention  discussed  with the  day  between r e s i d e n t s , t h e i r i n t e r f e r e n c e would  "become the problem".  The  staff  s t r a t e g y to  at  deal with  the r e s i d e n t s . the  "space"  conflicts become  Vanhouse roost  By not  they  part  to  the  circumstances, such as found  it  over the  necessary  present  out  their  faulty  the  own  Of  between  residents  interpersonal  interference  problem.  to  course  that in  safety  was  involved,  intervene  and  set  could  certain the  limits  staff  on  the  conflict.  coordinator  c o n t r a c t to  c o n t r a c t was  and  of  run the  negotiated  Social Services  and  house i n  The nothing  house  i s situated  at Vanhouse took  March of  1980.  (MSSH). is  Included  owned  and  i n the  contract  maintained  by  considerable comfortably on  home.  The  effort  over  i n a r e s i d e n t i a l area and  a limited  the f u r n i s h i n g s was  one  coordinator the  years  budget.  of r e s p e c t ,  the  (BCBC).  there i s  about i t s outward appearance t h a t might i d e n t i f y  treatment  This  renewed y e a r l y with the M i n i s t r y of  Housing  the house i t s e l f , which  the program  B r i t i s h Columbia B u i l d i n g C o r p o r a t i o n  a  non-interference  PHYSICAL SETTING  The  was  work  when  residents' inter-group  THE  a  of the day-to-day c o n f l i c t  avoided  of  adopted  i n t e r f e r i n g , they allowed  required  and  also  of the home has to  furnish  the  i t as put  in  house  The  s t a f f a t t i t u d e towards  and  damaged  furniture  was  105 attended t o  immediately.  By d i s p l a y i n g a r e s p e c t f u l  towards the surroundings,  the s t a f f were  their  residents.  respect  f o r the  r e s p e c t f o r surroundings  was  an  indirectly  attitude  expressing  I t i s a l s o thought  important  attitude  a d o l e s c e n t s t o adopt before moving on t o independent  that  f o r the  living.  Residents were given f r e e access t o a l l areas of the house except  f o r the s t a f f o f f i c e .  d i n i n g room.  Smoking was only p e r m i t t e d i n the  The smoking r u l e was e s t a b l i s h e d both f o r s a f e t y  and t o p r o v i d e the g i r l s with other and  with the s t a f f .  an area  to s o c i a l i z e  The designated smoking area c r e a t e d  a c e n t e r f o r a c t i v i t y and i n t e r a c t i o n and p r o v i d e d to  the a d o l e s c e n t s when an i n t e r v e n t i o n was  In  summary,  then,  underestimated  as  an  environment.  By  modeling  physical  surroundings,  the  important and  part  easy  access  planned.  physical  setting  of  the  encouraging  was  not  therapeutic  respect f o r the  the s t a f f helped to e s t a b l i s h a p o s i t i v e  a t t i t u d e towards the home and the r e s i d e n t s  THE  with each  themselves.  STAFF  As was  stated i n  the i n t r o d u c t i o n t h e r e were eleven  time employees at Vanhouse.  Six  full  time  full  c h i l d care workers  ( u s u a l l y t h r e e men and t h r e e women), two o v e r n i g h t workers, two  106 f a m i l y workers and a c o o r d i n a t o r . employed as r e l i e f  The  child  There were  a l s o two people  staff.  care workers  a t the home had between f i v e and  ten years experience w i t h i n the f i e l d of r e s i d e n t i a l Most of  the s t a f f had undergraduate u n i v e r s i t y degrees and one  of the f a m i l y workers had previous strategic/systemic  influence  s o c i a l work e x p e r i e n c e .  can  be  largely  f a m i l y worker who spent some time studying in  The  attributed to a  with the M i l a n  Group  Italy.  When  the  strategic/systemic  developed and i n t r o d u c e d  ideas  were  first  ' 8 6 the c h i l d care  i n April  by and l a r g e u n f a m i l i a r with the s t r a t e g i c / s y s t e m i c The  treatment.  s t a f f reported  about having with. using  that  t o adopt  at this  o f them  and  discussing  methods i n t h e i r  the  next  the  the c h i l d  a t Vanhouse f o l l o w e d  care workers  a shift  working from  p.m. or 3 : 0 0 p.m. t o 1 1 : 0 0 p.m.  changes t o  chapter the importance of s t a f f  a t t i t u d e s towards the approach w i l l be d i s c u s s e d  Staffing  were wary  treatment approach, the s t a f f  and e x c i t e d about the new  In  literature.  the p o t e n t i a l f o r  were g e n e r a l l y s u p p o r t i v e program.  s t a f f were  an approach that they had no experience  After investigating systemic  time some  being  further.  work schedule with  e i t h e r 7 : 0 0 a.m. t o 3 : 0 0  The 1 1 : 0 0  p.m. t o  7 : 0 0 a.m.  10 7  shift  was  covered  by  an  overnight  worker  who  was not  r e s p o n s i b l e f o r any of the c h i l d care worker d u t i e s .  During the weekdays, one of either  the  supervisor 7 : 0 0 a.m.  house from  or  the  family  to 3 : 0 0  child  care  workers and  worker were present  p.m.  In the  a t the  evenings, and on  weekend days, two c h i l d care workers assumed r e s p o n s i b i l i t y f o r the house.  Child  care  f o l l o w i n g : keeping  worker  d a i l y logs  responsibilities on the  behavior  i n c l u d e d the of each of the  r e s i d e n t s , w r i t i n g s y n o p t i c r e p o r t s a t r e g u l a r i n t e r v a l s during the r e s i d e n t ' s  stay and  at discharge,  monitoring  of the r e s i d e n t s and i n t e r v e n i n g a t a p p r o p r i a t e the upkeep  of the  the behavior  times,  house i n c l u d i n g shopping and p r e p a r a t i o n o f  meals, i n i t i a t i o n and p a r t i c i p a t i o n  formulating  and d e l i v e r i n g treatment i n t e r v e n t i o n s .  two f a m i l y workers  t h e i r work  at Vanhouse.  i n v o l v e d i n doing some  weekly  had d i f f e r e n t  staff  r e s i d e n t group  participating  and  in  i n weekly  meetings,  The  meetings,  One o f the f a m i l y workers was mainly  f a m i l y therapy with the r e s i d e n t s of the home  Outreach c l i e n t s .  addition,  was  coordinate  the home.  treatment  and  responsibilities in  The  other f a m i l y worker a l s o d i d  f a m i l y therapy with the r e s i d e n t s and Outreach c l i e n t s  in  ensuring  responsible  f o r helping  However both  decisions  concerning  to  and, i n  administer  and  f a m i l y workers p a r t i c i p a t e d the  residents  and  both  108 attended t h e weekly s t a f f meetings. home  was  responsible  administration  The  f o r , among other  and  participating  THE  RESIDENTS  of the  t h i n g s , the f i n a n c i a l  of the home, t a k i n g r e f e r r a l s  l i a i s o n person with community resources  The  coordinator  and a c t i n g  and m i n i s t r y  as  a  personnel,  i n the weekly s t a f f meetings.  following information  i s provided  so  t h a t the reader  may have an understanding of the background or h i s t o r i e s o f the c l i e n t s being period  treated at  i n which  October  1986  to  residents placed at  Vanhouse.  During  the  author  was  May  1987,  there  a t the  home.  the  e i g h t month  employed at Vanhouse, from were  a  total  of twelve  No more than s i x g i r l s  resided  the home at any one time and over the e i g h t month p e r i o d the  average was approximately four g i r l s at a time.  The  age  average being the  girls  of the  girls  ranged between 12 and  c l o s e t o 15 years.  were  having  twelve g i r l s , presenting time  of  attempted  I t i s safe t o say t h a t a l l of  serious  r e l a t i o n s h i p s p r i o r t o being  difficulties  placed  i n care.  f a m i l y c o n f l i c t was reported  problem. referral suicide,  Other p r e s e n t i n g included: three  come  in their  For e i g h t as the most  problems  three  had  18, with the  reported  of the g i r l s from  family of the serious a t the  r e c e n t l y had  families  where  109 neglectful situations parents abusing  had occurred  alcohol  or  ( u s u a l l y as a r e s u l t of the  drugs),  two  of  the  g i r l s were  c o n s i d e r e d t o have drug or a l c o h o l problems themselves, and one of  the g i r l s had a h i s t o r y of d i f f i c u l t i e s  with the law.  Background i n f o r m a t i o n on the r e s i d e n t s r e v e a l e d t h a t of  the  twelve  adolescents  were  f a m i l i e s at the time they were r e s i d e n t s had  come from  these being a blended  members  placed i n  two parent  family.  of  single  care.  five  parent  Seven of the  f a m i l i e s , with only one of  Of the twelve  r e s i d e n t s only one  had been adopted.  Before being  r e f e r r e d on t o Vanhouse s i x of the g i r l s had  spent a b r i e f amount of resource.  Two of  the g i r l s  p r i o r to t h e i r a r r i v a l spent  some  time  in  an  emergency  had been  a t Vanhouse.  time i n another  treatment  or assessment  p l a c e d i n f o s t e r homes Three  of the  g i r l s had  center p r i o r t o coming t o  Vanhouse and one had been i n two f o s t e r  homes and  a  treatment  center.  Upon a r r i v i n g a t Vanhouse and throughout t h e i r stay t h e r e , most of the g i r l s attended did  not  a t t e n d school  look f o r work.  school s p o r a d i c a l l y . A few  of them  a t a l l and as a r e s u l t were expected t o  One of the g i r l s was known  p r o s t i t u t e i n the Vancouver a r e a .  t o be  working as a  110 Seven of  the twelve g i r l s  d i s c h a r g e from Vanhouse. within  the community  returned t o t h e i r f a m i l i e s upon  Three  and  moved  on  to  other r e s o u r c e s  two were d i s c h a r g e d t o independent  1iving.  One of the most common behavior problems e x h i b i t e d girls  during  their  stay  a t Vanhouse was AWOL'ing  away from the house without p e r m i s s i o n .  by the  or s t a y i n g  Many of the g i r l s were  s o c i a l l y i n v o l v e d with f r i e n d s and acquaintances who spent much of  t h e i r time l i v i n g  were q u i t e  on the s t r e e t s .  a l i e n a t e d from  Since most  their families,  of the g i r l s  they seemed t o get  t h e i r need f o r belongingness met on the s t r e e t s where a c l o s e l y k n i t , s u p p o r t i v e group was e a s i l y  For an  a number of reasons, AWOL'ing presented the s t a f f with  especially  difficult  i n t e r v e n t i o n s used large  were  problem.  to alter  unsuccessful.  residents  very  t h a t AWOL'ing  Secondly difficult  was i n f e c t i o u s ;  r e s i d e n t s were l i k e l y  to follow.  i f the r e s i d e n t s  First  stayed  i t was  found  to  engage  And  finally  once one  on  the other  all,  the  that  i n any  AWOL'ing sort  of  i t was observed  r e s i d e n t AWOL'd other  The s t a f f were o f the o p i n i o n a t the home long enough f o r a  group cohesiveness t o develop then AWOL'ing If,  of  t h i s behavior proved t o be by and  s i g n i f i c a n t treatment p r o c e s s .  that  accessible.  was l e s s f r e q u e n t .  hand, the r e s i d e n t s f r e q u e n t l y AWOL'd then  Ill  t h e r e were fewer of them present and  a  group  cohesiveness  i n the  was  group cohesion the r e s i d e n t s  house a t  any one time  u n l i k e l y t o develop.  turned  to  the  Without  streets  t o meet  t h e i r need f o r belongingness.  INTERVENTIONS  Interventions,  in  a  residential  r e f e r t o those a c t i o n s taken on were designed  residents  formulated is  on  part  t o c o n t r i b u t e to t h e r a p e u t i c  d e f i n i t i o n i n c l u d e d the and  the  and  day-to-day  the  formal  formal  of  specifically  the  staff  change.  interaction  that  T h i s broad  between s t a f f  treatment messages t h a t were  i n weekly s t a f f meetings.  the  context,  The focus  strategic/systemic  of t h i s t h e s i s  interventions  used at  Vanhouse.  As  was  stated  development of work  of  provided  the by  earlier,  a  major  Milan  researcher/therapist  Group  and  and  the  theoretical  h i s associates  groups both r e l y  heavily  language as a means of promoting t h e r a p e u t i c  the s e s s i o n  on the  the systemic approach at Vanhouse came from the  Watzlawick  Group presents  influence  the f a m i l y with a formal  i n an  attempt to "capture"  reframe i t i n a p o s i t i v e l i g h t  formulations  at  MRI.  on  the  change.  message  These use of  The M i l a n  a t the  end of  the f a m i l y dilemma and  ( P a l a z z o l i et  a l . 1978a).  The  112 MRI  Group  use  prescribing  the  impotence, t o their  number  symptom, alter  approach  residents'  a  t h e meaning o f t h e  also  behaviour  in  utilized  and  messages, relapse  to  the  formal  redefine  such  or  as  declaring  symptoms o r t o r e d e f i n e  relation  o f t h e most commonly u s e d  Vanhouse was  reframing  in  According  to  conceptual  and/or emotional  which a  situation  is  the  client.  The  messages t o  reframe  relationship  between  the  or  meaning"  (1974, pg.  95).  involved  examining  a  difficult  to f i n d  even  the  in a positive  Palazzoli  setting  of  better  of p o s i t i v e "...means  or viewpoint and  the and  resident's  with  In  the  in relation  to  i t in  positive and  another  situation  connotation  "picking  served  most c a s e s  something about the  t o change  changes i t s e n t i r e  behavior likely  connotations.  concrete  thereby  that  resident.  to place same  Reframing  of the behavior  for  form  reframing  'facts'  well  function  paradoxical i n t e r v e n t i o n s at  experienced  equally  aspects  the  Watzlawick,  frame w h i c h f i t s  put  strategic  and r e s i d e n t s .  One  those  of  predicting  therapeutic position  Vanhouse  staff  a  behavior  a  out"  positive  i t was  not  very  which  could  be  light.  (1978a)  positive  connotation  In o t h e r  words, t h e  states  that  i s to gain access M i l a n G r o u p use  the  primary  to the positive  f u n c t i o n of  systemic  model.  c o n n o t a t i o n as  a  113 means  of  joining  i n t r o d u c e some residential  with  the  family  systemic change.  so  that  Positive  was given  of an a d v e r s a r i a l  were  then  "freed  position  Presumably when  the message t h a t others understood and  accepted the p o s i t i v e elements of t h e i r they  then  j o i n i n g with the  i n r e l a t i o n to t h e i r behavioral d i f f i c u l t i e s . the r e s i d e n t  may  c o n n o t a t i o n i n the  s e t t i n g a l s o acted as a means f o r  r e s i d e n t s and avoided the assumption  they  up"  i n a p p r o p r i a t e behavior  to re-examine t h e i r behavior and  alter i t accordingly.  It  would  appear  i n a p p r o p r i a t e behavior response  that  many  simply as  or  prescribing  removed themselves  as  the  targets  display  a r e b e l l i o u s or o p p o s i t i o n a l  to adult a u t h o r i t y f i g u r e s .  predicting  adolescents  By p o s i t i v e l y  problem for  behavior  the  rebellious  connoting, the  staff  behavior.  Those a d o l e s c e n t s who were e s p e c i a l l y r e a c t i v e and o p p o s i t i o n a l with a u t h o r i t y f i g u r e s were found paradoxical predictions. an e s p e c i a l l y poor predicted that few days. two  of  In  record  be  good  school  attendance,  staff  l e t themselves  be  The  resident i n  f o l l o w i n g manner:  overheard  d i s c u s s i o n concerning a bet t h a t had been made school attendance.  the s t a f f  be able t o a t t e n d f o r more than a  T h i s p r e d i c t i o n was s e t up i n the the  candidates f o r  one case with a r e s i d e n t who had  for  she wouldn't  to  having  a  over the g i r l ' s  q u e s t i o n asked the s t a f f  what they were b e t t i n g about and they t o l d her t h a t one of them  114 thought she other was  about  r e s i d e n t was  her  and  school.  The  very s u r p r i s e d t h a t  declared  Over  the  immediately  next  few  the  They t o l d  had made a bet between themselves about who  The  improved  able to attend school a l l year while  sure she would drop out w i t h i n a week.  t h a t they right.  would be  her  would be  they were b e t t i n g  t h a t she would not q u i t  months  her  attendance r e c o r d  considerably.  above  i n t e r v e n t i o n was  the o p p o s i t i o n a l i t y of the the r e s i d e n t  overheard  an attempt by the s t a f f to  resident in  that  a positive  a s t a f f member was  way.  of the  use When  opinion  t h a t she would be unable to attend school c o n s i s t e n t l y , she presumably  motivated  to  prove  the  staff  theoretical  standpoint  i t i s not e n t i r e l y  wrong.  From  c l e a r why  because  improving  her school performance f o r anyone  motivated  adolescent  may  her  Perhaps,  was  the  about  to change her behavior.  as a c h a l l e n g e to an adolescent wrong, e s p e c i a l l y  when i t  who  came to  have  school felt  a  this sort  of i n d i r e c t method i s more e f f e c t i v e than simply p r e s e n t i n g r e s i d e n t d i r e c t l y with concerns  was  the  attendance. she was  not  in particular,  she  T h i s i n t e r v e n t i o n acted  thrived  on p r o v i n g  what she c o u l d or  others  couldn't  do.  T h i s k i n d of i n t e r v e n t i o n was fashion in  what may  be c a l l e d  also  a "split  used i n  a more s u b t l e  team" message.  With a  115 " s p l i t team" message the r e s i d e n t staff  have  behavior  a  while  instance, a she  particular other  meet  the  opinion  staff  r e s i d e n t may  i s r e a l l y not house  i s told  have  a  expectations,  some  of the  the r e s i d e n t ' s  different  opinion.  For  t h a t some of the s t a f f  s e t t l e down  and won't  life  and i s  feel  be able t o  while the remaining s t a f f  t h a t she has had enough of s t r e e t down a b i t .  concerning  be t o l d  ready t o  that  feel  ready t o s e t t l e  The message h o p e f u l l y m i r r o r s the dilemma faced by  the r e s i d e n t h e r s e l f and helps her t o make a c h o i c e between the two  options.  Notice  how the  first  option,  framed as a p l a c e where people go when s e t t l e down".  By  framing  "street  they a r e  life", is  "not ready t o  i t t h i s way i t i m p l i c i t l y  suggests  that sooner or l a t e r she w i l l be ready t o s e t t l e down.  FORMULATING INTERVENTIONS  A  four  Vanhouse.  hour  staff  During these  meeting  the  would f i r s t  residents  "problems"  was  discussed  t h e r a p i s t s , which a r e problems to by t h e  handled  once  were attended  other  week a t by a l l  community workers,  business  and then each of  individually. by  a  family  Unlike or  the  individual  i d e n t i f i e d by the c l i e n t or c l i e n t s , the  be addressed  staff.  some  cover house  typically  held  meetings, which  s t a f f members and o c c a s i o n a l l y the agenda  was  i n the treatment home a r e i d e n t i f i e d  Those problems  which were  most p r e s s i n g were  116 addressed f i r s t  and more minor i s s u e s were t a b l e d f o r the next  meeting.  Some of the t y p i c a l problems or  symptoms t h a t  were d e a l t  with a t  Vanhouse i n c l u d e :  drug or a l c o h o l problems,  general  oppositional  obnoxious  o u t b u r s t s of anger.  or  behavior,  anxiety  and  The standard procedure d u r i n g the meetings  was t o d i s c u s s each o f the a d o l e s c e n t s and, as a whether an i n t e r v e n t i o n would be b e n e f i c i a l . t h a t the problem was  AWOL'ing,  a  serious  one  and  group, decide  I f the s t a f f  felt  the a d o l e s c e n t was  "ready" t o r e c e i v e a message, then the s t a f f , as a group, would work on the wording of the message.  A t y p i c a l example might be the use of c o n n o t a t i o n message girl  a standard p o s i t i v e  t h a t was used i n more than one case.  had r e c e n t l y moved i n t o the group home  Ifa  and was d i s p l a y i n g  argumentative, o p p o s i t i o n a l behavior, then the message might go as f o l l o w s : "We can see by your a r g u i n g and anger a t us that you are r e a l l y q u i t e l o y a l t o your p a r e n t s . We j u s t want t o say t h a t we agree that no one c o u l d ever r e p l a c e your parents". T h i s message p o s i t i v e l y connotes the "problem" behavior by a s s o c i a t i n g i t with an admirable, p r o - s o c i a l i n t e n t i o n ; t h a t of loyalty.  By framing the behavior  p o s i t i v e l y and acknowledging  117 the bond feel  between parent and c h i l d , the r e s i d e n t w i l l h o p e f u l l y  l e s s compelled  staff.  In  the  i n t e r v e n t i o n such  t o r e s i s t and words as  systemic model.  of  this  r e j e c t any  the M i l a n  allows  Theoretically  i n t e r a c t i o n with  group  the s t a f f  (1978a), access  be undermined  t o the  once t h e r e s i d e n t f e e l s  t h a t the r e l a t i o n s h i p between her parents and h e r s e l f or s u b s t i t u t e d , she w i l l  feel  an  secure  w i l l not  l e s s threatened as  a r e l a t i o n s h i p develops between h e r s e l f and t h e s t a f f .  The  s t a f f would work on t h e above message during a meeting  and each word would be chosen c a r e f u l l y t o " f i t " to  whom  the message  considerations  would  taken  be  delivered.  into  account  i n t e r v e n t i o n s were: 1) does the "language" the  adolescent  t o whom  the i n d i v i d u a l  i t will  Some when  of t h e  formulating  o f t h e message match  be d e l i v e r e d ?  2) Could t h e  message be i n t e r p r e t e d i n a way so as t o make i t i n e f f e c t i v e or countertherapeutic? was  3) Is the behavior  also displayed at  home, and  i n q u e s t i o n one t h a t  i f so, can we  formulate t h e  message i n a way so as t o "capture" the home behavior? should d e l i v e r t h e message t o get the most impact  When a "problem" was i d e n t i f i e d c o n s c i o u s attempt  t o view  the s t a f f  from i t ?  would  account  make a  i t from a systemic p e r s p e c t i v e . To  view a p r e s e n t i n g problem from a systemic p e r s p e c t i v e take i n t o  4) Who  the following:  one must  1) What purpose or f u n c t i o n  118 might the  contributing  to  the maintenance of the problem?  focuses on other i n d i v i d u a l s f a m i l y members, 3)  far?  It  is  This  be  question  a d o l e s c e n t ' s system, i . e .  been attempted  to r e s o l v e  problem.  the  problem  e s s e n t i a l when examining a problem from a  systemic p e r s p e c t i v e s o l u t i o n s may  i n the  e l s e may  peers, or s t a f f , that are p a r t of the  What s o l u t i o n s have  thus  2 ) Who  symptom have f o r the adolescent?  to  investigate  be c o n t r i b u t i n g  how  previously  attempted  to the maintenance of the  problem  behavior.  Once the problem staff  had  worked  had  out  message ( i n t e r v e n t i o n ) book i n c l u d e d of the  a  the was  had  decision  to the was  and  the  p r e c i s e wording of a message,  the  initial  about  impact from  formulated, the  reaction  intervention.  made  identified,  recorded i n a "Message Book".  the  o p p o r t u n i t y to d e l i v e r the the most  clearly  the date the message was  i n t e r v e n t i o n and  resident  been  any)  F i n a l l y , during  which  staff  intervention.  a message,  (if  would  This purpose  that  the  meeting  have  In some cases, to  a specific  the  s t a f f member  the get was  chosen to d e l i v e r the message.  DELIVERING INTERVENTIONS  Once an the  i n t e r v e n t i o n had  "Message Book" then  the  been formulated and  staff  were ready  recorded i n  to " d e l i v e r  the  119 message".  The  delivered The  manner  was an i m p o r t a n t  impact  factors  specific  of the  such a s :  delivered? formally)  message  1) Who  3)  part  How  may  in  which  the  of  the  be  influenced  therapeutic  i t delivered?  4) I s t h e message d e l i v e r e d  was  process.  by a number o f  d e l i v e r s t h e message?  is  message  2) When  ( i . e . formally  privately  is i t o r non-  or are others  present?  The the  impact  specific the  staff  two  relative  a  impact  experienced would  the event.  the  resident.  to was  have  more  be  seemed t o  when a  important that  i f  event with  impact also  f a c t o r when  a resident  had  her f a m i l y ,  then  i f i t were d e l i v e r e d  soon  delivered  at the p r e c i s e  the inappropriate  Closely a  to influence the  delivered.  an  displayed  elicit  seemed  thought  M e s s a g e s were  concern.  increased  cases  as t h e gender o f t h e s t a f f ,  that  a significant  the resident  w h i c h had become a behavior  factors  It  be  in certain  i t . The r e l a t i o n s h i p between  as w e l l  appeared  messages.  moment when  the  of  that  could  o f t h e message b e i n g  also  message  after  member d e l i v e r e d  examples  delivering  the opinion  message  and t h e s t a f f ,  Timing  recently  were o f  of a therapeutic  resident  are  staff  linking  strong  behavior  t h e message and  initial  reaction  from  120 In  certain  cases  the  interventions  were  delivered i n -  p a s s i n g , n o n c h a l a n t l y , while at other times the s t a f f assumed a f o r m a l , more s e r i o u s manner.  To  s e r i o u s manner  was u s u a l l y  the adolescent  present  the  message  ina  asked t o meet with  the s t a f f p r i v a t e l y f o r a few minutes.  Unlike  the  messages  a s s o c i a t e s , who t e l l  delivered  by  Palazzoli  and her  t h e i r c l i e n t s t h a t they have a message f o r  them and o f t e n d e l i v e r i t i n w r i t t e n  form,  Vanhouse were  u s u a l l y presented  l e s s formal manner.  o c c a s i o n , the  staff  message  would  discussing message.  her  tell  member the  in a  who  was  resident  situation  and  chosen  that  had  the  come  to  the  messages a t  d e l i v e r the  staff  up  On  with  More o f t e n the message was d e l i v e r e d i n a  had been a certain f a s h i o n so  as t o make i t appear spontaneous.  The  l a s t f a c t o r t o mention which  r e l a t i v e impact  i n f l u e n c e the  of a message was whether or not the message was  delivered privately. presenting  seemed t o  problem  In  c e r t a i n circumstances,  involved  the  l i k e when the  r e s i d e n t ' s peers, the s t a f f  would d e l i v e r the message with s i g n i f i c a n t others p r e s e n t . the message  reframed  If  a r e s i d e n t ' s behavior then her peers were  a l s o i n t r o d u c e d t o t h i s new  outlook  on  the  problem behavior  and, presumably, t h e i r behavior would a l t e r a c c o r d i n g l y .  121 CASE EXAMPLES  In t h i s Vanhouse  section a  will  be  number of a c t u a l i n t e r v e n t i o n s used a t  described  and  analyzed.  These s p e c i f i c  examples were chosen t o show the range of i n t e r v e n t i o n s used at Vanhouse. success  Since or  there  failure  of  was  no  these  control  group  the r e l a t i v e  i n t e r v e n t i o n s was d i f f i c u l t t o  measure. - However, from a t h e o r e t i c a l p e r s p e c t i v e and author's  clinical  judgement  and  c o n c l u s i o n s can be made concerning of each  of the  interventions.  observations,  from the tentative  the s t r e n g t h s and weaknesses  The p e r s o n a l  information  given  below i s f i c t i t i o u s .  Case Example #1 - Caren  H i s t o r y and P r e s e n t i n g  Problem  Caren, age 1 6 , was p l a c e d at at  an  assessment  home.  h i g h l y d i s r u p t i v e at home sporadically. all  Vanhouse a f t e r  According and  t o her parents  recently  was  stay  Caren was  attending  school  Caren had one s i b l i n g , an o l d e r s i s t e r , who from  r e p o r t s was w e l l behaved and  "problem-free".  When Caren's parents met with the t o l d us  a brief  t h a t Caren  would l i k e l y  staff at  Vanhouse they  have a "honeymoon p e r i o d " of  about t h r e e weeks, a f t e r which she r e p o r t from was  her p r e v i o u s  displaying  become  would begin  placement a l s o  Prior  to  A  would  eventually  the  following  formulating  i n t e r v e n t i o n , Caren's behavior c o u l d be d e s c r i b e d c o o p e r a t i v e and a l i t t l e  up.  suggested t h a t Caren  "honeymoon" behavior there and  disruptive.  to act  as p l e a s a n t ,  shy.  Intervention  Upon the  discussing  staff felt  t h a t she was  p r e v i o u s placement the to  Caren's  t o begin  s i t u a t i o n i n the weekly meeting  set  up  by  the  a c t i n g out.  parents  Both her parents and  p r e v i o u s placement had suggested to the Vanhouse Caren  t h a t her p o s i t i v e behavior was  should t h e r e f o r e get no c r e d i t f o r i t . acting  out  then  everyone's  Vanhouse  staff  prophecy  of  i n t e r v e n e with  were  this  concerned  "honeymoon"  I f Caren  and  were to begin  would come t r u e and  would be  about  the  prediction  a s t r a t e g i c message.  staff  only temporary and she  predictions  Caren's l a b e l as a d i s r u p t i v e teenage  and the  verified.  The  self-fulfilling and  decided  The message was  as f o l l o w s : W e understand t h a t you have a r e p u t a t i o n of having a honeymoon p e r i o d of three weeks. We feel t h a t i t ' s b e t t e r to get these things over with q u i c k l y , 'so whenever you're ready i t might be a good t h i n g to get over the honeymoon." 1>n  2,  3  to  delivered  123 Caren's i n i t i a l  r e a c t i o n to the message was,  "No!  I'm  not  staff  are  going to do that here, I l i k e i t here".  Analysis  ^ ' T h i s p a r t of the message e s t a b l i s h e s that the aware of  the honeymoon p r e d i c t i o n and r e a l i z e t h a t others have  pinned t h i s l a b e l on suggests  that  l i m i t e d and, and  the 3  her.  'The second  positive  'the last  implicitly  2  p a r t of  behavior being d i s p l a y e d  part prescribes  suggests  the message  that  Caren  i s time  the problem behavior  is  in  behavior  as  control  of her  behavior.  Discussion  By  framing  the  positive  temporary  p r e s c r i b i n g the problem behavior the s t a f f placed the  paradoxical  display that  the  would  symptomatic be  countered with presenting she  can  position  expected  complying "honeymoon"  with  encouraging  behavior. form  an  The  the  to the  Caren  oppositional  i s presented  display  or  in  resident  to  teenager  was  by encouraging  the  with two  options:  the symptomatic behavior;  staff's  prediction,  themselves  r e s i s t a n c e to change  a request f o r the s t a t u s quo  problem. begin  of  requests 2)  she  can  and  and  1)  thereby  fulfilling  the  continue d i s p l a y i n g  124 appropriate well  as  initial  behavior and  refusing  to  disprove comply  r e a c t i o n i t would  her  with  parents'  p r e d i c t i o n as  s t a f f requests.  appear t h a t  Caren chose  From her the  second  option.  We  can  see  from  t h i s example  how  the r e s i d e n t i s u t i l i z e d f o r t h e r a p e u t i c r e s i d e n t oppose display  of  the s t a f f  the  appropriately,  behavior? its  own  r e s i d e n t prove the s t a f f wrong.  On  gives  resident. can  has  responsibility  be  The turned  for  implicit on  or  purposes.  How  can  when the s t a f f make a request  problem which  the o p p o s i t i o n a l i t y of  control suggestion  Only inherent  by  the  for a  behaving  rewards, can  the  another  l e v e l the message  of  behavior  that  the  to  the  the problem behavior  o f f g i v e s the behavior new  meaning  and  suggests that i t i s p u r p o s e f u l .  T h i s . k i n d of message, p r e s c r i b i n g the symptom, seems to most e f f e c t i v e  with o p p o s i t i o n a l r e s i d e n t s .  s t a f f makes  a request  plays  the  and,  into  not  rebellious  i n e f f e c t , removes  i m p l i c i t message  for a  the  d i s p l a y of  f a c t that  wind  from  the  the problem behavior  nature of the developing her  sails.  teenager Another  w i t h i n the i n t e r v e n t i o n i s t h a t the s t a f f  " a f r a i d " of the symptom and  express i t .  The  be  accept the r e s i d e n t ' s  are  "need" to  125 T h r o u g h o u t C a r e n ' s s t a y a t Vanhhouse h e r within staff than  acceptable and  she  limits.  Once she  house r o u t i n e s she had  extreme  initially.  and  she  expectations. extent the  Of  became f a m i l i a r  usually  message may  behavior  responded  well  i t i s impossible to have a f f e c t e d  was  remained with  d i s p l a y e d more d i s r u p t i v e  However h e r  course  behavior  behavior  never to  i n the  the  determine  Caren's behavior  the  house t o what  while  at  Vanhouse.  One  final  reflects parents their  the  o b s e r v a t i o n about t h i s role  that  Caren  seemed t o g i v e c r e d i t  other  daughter,  and  message c h a l l e n g e s C a r e n  her  b l a c k sheep s t a t u s .  S a n d r a was Prior  depressed.  16  attempted  when she  unit She  the  Caren  message  family.  positive  Her  behavior  i n the b l a c k sheep  to  role.  to take  on a new  role  and  disprove  first  came t o  live  a t Vanhouse.  - Sandra  to placement  psychiatric  i s how  p l a y s i n her  f o r a l l the  put  The  C a s e Example #2  likely  case  had  had  and a  she  been had  history  s u i c i d e before being  hospitalized been of  in  diagnosed suicidal  admitted  to the  an as  adolescent clinically  ideation hospital.  and  had  126  Sandra was and had  one of t h r e e c h i l d r e n of d i v o r c e d parents  l i v e d with her mother  coming i n t o  care.  and mother's  b o y f r i e n d p r i o r to  She had a twin brother who  her f a t h e r i n e a s t e r n Canada  and  an  older  still  l i v e d with  brother  who  also  l i v e d with her mother.  The p r e s e n t i n g problem at time of r e f e r r a l was home with her mother and d e s c r i b e d as couple of and  depressed,  weeks at  mother's suicidal  boyfriend.  She  and a l c o h o l i c .  Vanhouse, Sandra  appeared  her  time  was  spent  s o c i a l i z i n g with both s t a f f and  Intervention  The most  observed presented attempted  in  s i t u a t i o n was  much of a  how  she  avoided  the p o t e n t i a l l y d e t r i m e n t a l  l a b e l of d e p r e s s i o n .  her s o - c a l l e d  dramatic  her to  accepted the l a b e l of others  and  l o o k i n g sad.  peers.  manner.  s o l u t i o n s to the problem were  and encourage  room  first  s e r i o u s concern t h a t the Vanhouse s t a f f had when  the p s y c h i a t r i c  that  her  In her  also  #1  d i s c u s s i n g Sandra's e f f e c t s of  in  was  quite lethargic  spent a c o n s i d e r a b l e amount of time c r y i n g and  Most of  c o n f l i c t at  "sick"  feel  less  was.  Her  staff  had  behavior  was  parents' p r e v i o u s l y  to empathize  depressed.  d e p r e s s i o n and she  "depressed"  The  was  with her  Sandra a p p a r e n t l y  eager  to e x p l a i n to  She had been p r e s c r i b e d a n t i -  127 depressants and  during  her  first  few  weeks i n  the house she  took them r e g u l a r l y .  The  f i r s t therapeutic  involved  reframing  Whenever  the  the  goal  so-called  opportunity  arose  Sandra's behavior as sadness never discouraged did  not  manner.  engage  addressed by the Vanhouse s t a f f  the  empathically  as  sadness.  would  describe  depression.  She was  staff  i n s t e a d of  from d i s p l a y i n g her  "depression"  her "sadness" and the s t a f f when  she  behaved  in this  Three messages were used t o reframe and p r e s c r i b e the  problem behavior.  The  f i r s t message  was d e l i v e r e d  w h i l e she  was c r y i n g i n her room and went as f o l l o w s : *"When you a r e t i r e d of c r y i n g you w i l l stop, ' b u t some people can c r y f o r y e a r s . "  1  2  Sandra's response was, " I t ' s exhausting c r y i n g ! " immediately stopped the  and had  r e s t of the r e s i d e n t s  a nap.  After sleeping  f o r dinner and  displayed  and she  she j o i n e d a positive  affect.  Analysis  ^•'The f i r s t  part  i s under her c o n t r o l limited.  of and  the message suggests t h a t her c r y i n g predicts  that  the  crying  There i s a l s o the i m p l i c i t message that  i s under her c o n t r o l then i t must serve  i s time  i f the c r y i n g  some f u n c t i o n .  2  'The  128 second  part  position  of  the  message  places  the  staff in a neutral  i n r e l a t i o n to the symptom by suggesting  continue  crying  indefinitely.  Essentially  message g i v e s Sandra p e r m i s s i o n to continue  t h a t she  may  t h i s p a r t of the  crying.  Discussion  I f one h y p o t h e s i z e s t h a t the "purpose" to communicate  crying  and  and  ineffectual  makes  the  them  display  T h i s f i r s t message p l a c e s  The  re-evaluate of  empathized  the  to t h i s  expression.  group.  and  encouragement  their  affect  confuses behavior.  become  the The  socially  i n a s u p p o r t i v e manner. for control  over  behavior s q u a r e l y on Sandra's s h o u l d e r s .  response  join  sad  likely  the r e s p o n s i b i l i t y  f i r s t message was  acknowledged t h a t c r y i n g was and  a  when others f a i l to respond  the "depressed"  symptom i s  to others a need f o r nurturance, then a c c e p t i n g  the c r y i n g and a v o i d i n g the " s a v i o u r " r o l e "patient"  of the  If,  nurtured of  the  t i r i n g and  immediate; Sandra have a  nap  on the other hand, the s t a f f  had  Sandra  depressive  the  decided to  result  behavior  by  may  be  an  rewarding i t s  129 Intervention  #2  The second message was a l s o d e l i v e r e d t o Sandra was c r y i n g .  The message was as f o l l o w s :  "Do you f i n d i t more or your sadness t o c r y ? " Sandra appeared confused when and  while she  less helpful for  the  message  was d e l i v e r e d  f a i l e d t o respond t o the q u e s t i o n .  Analysis  Again,  this  question  behavior as p u r p o s e f u l suggests that and  helps  to  frame  the  problematic  and under Sandra's c o n t r o l .  The message  there may be other ways t o deal with her sadness  that perhaps c r y i n g may not be h e l p f u l .  Since the q u e s t i o n  i s an open one, the s t a f f i s able t o remain n e u t r a l i n r e l a t i o n to the symptom. hearing  the  effective.  The  message As  other  confusion may  be  a  clinicians  that  Sandra  sign  that  have  e x h i b i t e d when the  message was  reported  (Weeks and  L'Abate, 1982; Watzlawick et a l . 1974), a confused response may be evidence t h a t the c l i e n t i s from a new  perspective.  beginning to  view the symptoms  130 I n t e r v e n t i o n #3  The t h i r d message was d e l i v e r e d as f o l l o w s : "It's really helpful f o r you t o get i n touch with your sadness. By c r y i n g and spending time i n your room you a r e a b l e t o get i n touch with your f e e l i n g s . " Analysis  T h i s message i s a good example of p o s i t i v e l y connoting the symptom  to  reframe  h e a l t h y response In  this  i t s meaning.  i n the  example  the  The c r y i n g i s framed as a  context of staff  growth and r e h a b i l i t a t i o n .  move  from a n e u t r a l p o s i t i o n t o  a c t u a l l y encouraging the p r e s e n t i n g problem.  The  presenting  c r y i n g and i s o l a t i n g  problems  Sandra,  in  and  room  Sandra much  a  a concern,  were  year  i n control  a lot  less  time  c r y i n g episodes decreased c o n s i d e r a b l y delivered.  after  these  s t a t e d t h a t a f t e r coming t o more  become  indeed, began t o spend  her  a f t e r these messages approximately  have  i n her room, a r e s p e c i f i c a l l y mentioned i n  t h i s message. her  which  of  her  When messages  talking  were d e l i v e r e d ,  Vanhouse she  own b e h a v i o r .  r e a l i z e d that I was the best person to h e l p me".  t o her  began t o f e e l She s t a t e d , "I  131 Discussion  These  three  consolidate behavior. behavior  a The  as  goal  the f u n c t i o n  was  However  become more  "permission"  up to t r y some new  T h i s case  of a  behavior  used  at  depressive  factor  positive  that  may  her  one  her  depressive  of the  Vanhouse.  adolescent.  was  and  listened  thoughtfully.  behavior  her  was  likely  an  to  the  and  freed  successful  her a f f e c t  the  By  problems.  most c l e a r l y  stay  and  behavior  changed remained  at the house. success  of  i n t r o s p e c t i v e and  i n t e r e s t e d i n what the s t a f f had to  may  crying  Sandra's behavior  contributed  t h a t Sandra  her  life  a solution.  as a s o l u t i o n t o her  intervention i s She  the " s i c k "  excessive  problem than  throughout  have  to  symptomatic  reframe  d r a m a t i c a l l y w i t h i n a short time p e r i o d and relatively  the  to d i s p l a y i t , Sandra was  represents  interventions  to  case the  r e f r a i n i n g from empathizing with g i v i n g her  of  succession  of drawing a t t e n t i o n to her need f o r  guidance.  i s o l a t i o n had  in  response to l e g i t i m a t e l y d i f f i c u l t  In Sandra's  and  used  perspective  therapeutic  a healthy  have served  were  different  circumstances.  support  messages  One this  curious  to say  to  d e l i v e r e d messages a t t e n t i v e l y and  132 Case Example #3 - L i s a  H i s t o r y and P r e s e n t i n g Problem  L i s a was only 12 years o l d treatment  home.  Prior  when she  t o placement  her mother whose own behavior may unreliable.  Her  father  was  came to  she had been l i v i n g  be d e s c r i b e d  were scheduled  f a i l e d to a t t e n d them. stating  he  would  Lisa's  have  little  with  as e r r a t i c and  l i v i n g i n the U.S. with L i s a ' s  o l d e r s i s t e r , where he had r e c e n t l y remarried. therapy s e s s i o n s  l i v e at the  Although f a m i l y  a number of times the parents father  was  strict  t o do with her u n t i l  with her, she "got  better".  L i s a was a very d i f f i c u l t person to engage. from  the  home  regularly  with s t a f f f o r no little  She  ran away  and would behave q u i t e a g g r e s s i v e l y  apparent  reason.  She  seemed to  have very  t r u s t f o r a d u l t s and was e a s i l y i n f l u e n c e d by her p e e r s .  Intervention  The s t a f f a c t i n g out  were of  behavior was  the o p i nion  l i k e l y being f u e l l e d by the c o n f u s i n g  messages she was g e t t i n g from he r of  view,  that Lisa's unpredictable  parents.  From L i s a ' s p o i n t  i t was u n c l e a r whether she would ever be r e t u r n i n g to  133 l i v e with one of her p a r e n t s . about  Lisa's  behavior  future  became.  the The  The more vague  her parents were  more desperate and d i s o r g a n i z e d her staff  formulated  and  delivered  the  f o l l o w i n g message: W e understand from your behavior l a t e l y t h a t you are f e e l i n g very confused about your f a m i l y . ' I n our experience c o n f u s i o n u s u a l l y leads to growth. 'So we expect i n the near f u t u r e you w i l l s t a r t t o f e e l l e s s confused." 1>n  2  3  Lisa's  response  because they again  was,  screw up  on Monday and  my  "I'm life  going and  r e s t up and eat  I'm  to  stop  doing drugs  going to s t a r t school  right".  Analysis  ^-'This p a r t of the message made an a s s o c i a t i o n between her behavior and  the hypothesized c o n f u s i o n .  to l e g i t i m i z e the d i s t u r b e d behavior and concrete connoted come from  precipitating  factor.  2  3  'The l a s t  t h a t the c o n f u s i o n was  attribute i t  'The second  the c o n f u s i o n by suggesting t h a t it.  The purpose here  sentence  in  was  to some  part p o s i t i v e l y  something good would the message  suggested  temporary and t h a t she c o u l d expect some  change i n the near f u t u r e .  134 Discussion  The  basic  goal of t h i s i n t e r v e n t i o n was t o help L i s a make  some sense of the c h a o t i c s i t u a t i o n she was  experiencing.  The  message  intervention  that  was  essentially  acknowledged the situation. her  confusion  an and  empathic  a n x i e t y present  i n her f a m i l y  The s t a f f were hoping t h a t i f L i s a could a t t r i b u t e  erratic,  irresponsible  precipitating factor  then she  behavior  to  a  legitimate  might f e e l a l i t t l e  l e s s out of  control.  From L i s a ' s i n i t i a l message was However  p e r f e c t l y targeted  Lisa's  throughout  her  improvement.  stay  Vanhouse  at  to  mention  be  any  specific  i n the message  impact  of  showed  behaviors  confusion. states,  u s u a l l y leads to growth".  the  impact.  i n a p p r o p r i a t e and  for the f a i l u r e  little of t h i s  this  type  but i n s t e a d  In a d d i t i o n the  "In our experience  a 12  year o l d .  To  o f a message i t might be  h e l p f u l t o s i m p l i f y i t and s p e c i f i c a l l y mention those which a r e t a r g e t e d f o r change.  The  A concept such as t h i s may  be t o o s o p h i s t i c a t e d t o make an impact on increase  t h a t the  to the vagueness of the message.  the r e s i d e n t ' s general  second sentence  assume  her behavior  One p o s s i b l e e x p l a n a t i o n  message d i d not  might  and made a s i g n i f i c a n t  continued  be due  confusion  one  behavior  i n t e r v e n t i o n may  referred to  response  behaviors  135 Weeks  and  L'Abate  (1982)  have  observed  t h a t the most  e f f e c t i v e p a r a d o x i c a l i n t e r v e n t i o n s are o f t e n met with a may  look of  c o n f u s i o n or anger.  be evidence t h a t the message  was  by the  L i s a ' s compliant not  client  response  "powerful" enough to  a l t e r her p e r c e p t i o n of the s i t u a t i o n she was  experiencing.  Case Example # 4 - Shannon  H i s t o r y and P r e s e n t i n g Problem  Shannon, at home  and  had  behavior.  18 years a  great  of age, amount  of  the e l d e s t g i r l  influence  P r i o r to coming to Vanhouse she had  a year i n another treatment quite  was  controlling  and  s e t t i n g h e r s e l f up i n  facility.  manipulative opposition to  Her and  on  i n the  her peers'  spent more than  behavior was  often  she had a knack f o r  the s t a f f ' s  requests  and  expectations.  In the weekly d i s c u s s i o n s the s t a f f came to the c o n c l u s i o n that Shannon was  quite proficient  " f a i l u r e " she can be.  She  Information  t h a t Shannon This role  played a  i s often  proving  seemed determined  t h a t would get her i n t r o u b l e the same.  at  and encouraged  from f a m i l y similar role  how  much  of a  t o choose behavior her peers  to do  therapy s e s s i o n s r e v e a l e d i n her  f a m i l y of o r i g i n .  c a l l e d the "black sheep", and  i n Shannon's  136 f a m i l y her behavior c o n t r a s t e d s h a r p l y with t h a t of  her o l d e r ,  more r e s p o n s i b l e s i s t e r .  Intervention  In f o r m u l a t i n g be h e l p f u l t o draw w i t h i n her  an i n t e r v e n t i o n the s t a f f thought a t t e n t i o n to  f a m i l y and  a t the  the r o l e  treatment  i t might  t h a t Shannon played home.  The f o l l o w i n g  message was d e l i v e r e d : "Why do you spend so much time and work so hard at t r y i n g to convince us what a f u c k up you a r e ? " Shannon's i n i t i a l  response was,  "I'm not  as fucked-up as  I used to be i "  Analysis  There  are  intervention. that  the  problematic  hoped t h a t  things  a l l the behavior  worth  noting  about  message i m p l i c i t l y was  purposeful  and  under  By framing the behavior i n t h i s way, i t was  She might even begin t o put the p i e c e s  behavior.  this  suggested  Shannon would begin t o q u e s t i o n the motives  achieve some her  few  F i r s t of  Shannon's c o n t r o l .  behavior.  a  f o r her  t o g e t h e r and  awareness of how the f a m i l y system has i n f l u e n c e d  137 Secondly the message reframes l a b e l of  the  process  by  "fuck-up" has been a t t r i b u t e d to Shannon.  which the Presumably  from Shannon's p o i n t of view i t i s o t h e r s , s p e c i f i c a l l y who  have  labelled  her  as  the  "black sheep".  however, suggests t h a t the process around, with failure.  Shannon t r y i n g  has  to prove  A d d i t i o n a l l y , the use of  worked  adults,  The message, the  other way  to o t h e r s t h a t she i s a  the word  "convince" i n the  message suggests t h a t the s t a f f do not c o n s i d e r Shannon to be a failure.  An important p o i n t should be made here i n r e f e r e n c e to the language used i n t h i s message.  When f o r m u l a t i n g messages i t i s  e s s e n t i a l t h a t the language chosen makes sense to the r e s i d e n t . The  term  describe  "fuck-up" someone  wording of  was  who  language  that  consistently  the message  i s crucial  Shannon would use to  misbehaved.  Since  the  i n determining i t s e v e n t u a l  impact on the r e s i d e n t , language t h a t matches the world view of the r e c i p i e n t stated;  "why  behavior  should be used.  I f , f o r example,  do you t r y so hard to  problem  you  are?",  i n t e r p r e t the message  as  authority  Palazzoli  L'Abate  figures.  (1982) a l s o s t r e s s  then  simply  the  convince us  much  rejection  of a likely  by a d u l t  a l . (1978), and Weeks and  importance  t h a t matches the c l i e n t ' s world view.  how  Shannon would most  another et  the message had  of  using  language  138 Again the most important in  which  it  refrained  p u r p o s e f u l with was  aspect of t h i s message i s the  Shannon's  her working  behavior  as  to "convince"  way  v o l u n t a r y and  the s t a f f t h a t she  a failure.  Case Example #5 - T i n a  H i s t o r y and P r e s e n t i n g Problem  T i n a was P r i o r to  f i r s t p l a c e d at  her a r r i v a l  assessment described  and as  with T i n a was intervals  "highly  before as  for  coming  facilities.  old  December  to  Tina's  self-destructive  frustration.  She On  was  relationship for brief  Tina's behavior  and  she  displayed  was  often  a couple  p h y s i c a l l y a g g r e s s i v e with s t a f f .  when f i r s t  1986.  mother  r e t u r n i n g home  Vanhouse.  of  time i n a number of  v o l a t i l e " woman and her  v e r b a l l y a g g r e s s i v e with s t a f f . had become  in  spent some  up and down, with T i n a  characterized tolerance  she had  treatment a  Vanhouse  a  was low  demanding  and  of occasions  she  She was  14  years  p l a c e d at Vanhouse.  Intervention  When d i s c u s s i n g T i n a ' s behavior the  "tough  exterior"  that  the s t a f f  she d i s p l a y e d .  were s t r u c k by  In f a m i l y therapy  139 sessions  i t was d i s c o v e r e d  d i s p l a y e d a tough e x t e r i o r . "toughness" vulnerable  served and  exposing.  a  that Tina's  e x p l o s i v e mother a l s o  The s t a f f hypothesized t h a t  self-protective  sensitive  side  function,  which  The f o l l o w i n g i n t e r v e n t i o n was  she  had  Tina's  masking a difficulty  d e l i v e r e d t o reframe  her behavior i n a p o s i t i v e l i g h t : "We have noticed that you a c t tough sometimes and we can understand i t because i t i s probably your way o f d e a l i n g with the sadness that you have." Tina's  initial  response was one of c o n f u s i o n  and she asked  f o r the message t o be repeated.  Analysis  The  basic  goal of t h i s message i s t o reframe the behavior  so t h a t T i n a might achieve some "tough" b e h a v i o r .  message  the  staff,  observation  behavior i s put on t o achieve some e f f e c t .  was made "have  her c o n s t r i c t i n g  The choice of the word " a c t " i n the message  suggests t h a t Tina's The  insight into  more powerful by t e l l i n g Tina that  noticed",  instead  was made by one person.  of  stating  that  "we", the  140 Discussion  The  message communicated to T i n a t h a t the s t a f f understood  her need to p r o t e c t h e r s e l f from the p a i n i n her q u i t e common f o r adolescents resource their  to another and parents  to  who  present  out  some new,  a  observed  more rewarding  that Tina  tough  exterior  and  T i n a up to t r y  behaviors.  the d e l i v e r y of t h i s message i t  seemed more  at ease exposing her more  On  act  c a s u a l l y mention her need to  staff  h e r s e l f t h a t way aggressive  would  and  this  those occasions  seemed  of the i n some  f u n c t i o n of  a l t e r i n g the  cases p r e s c r i b e d .  behavioral  change w i l l  has  altered  defuse  follow.  then  determined  to  Reframing  serves  meaning of the symptom i n order  it  Once the meaning of the no  p r e v i o u s l y e s t a b l i s h e d context. is  effectively  present her  above examples the symptomatic behavior i s  reframed and  who  to  when Tina would  behavior.  In a l l  been  avoid  P o s i t i v e l y connoting  s e n s i t i v e s i d e to o t h e r s . tough,  one  r e l a t i o n s h i p s with  hopefully free  In the weeks that followed was  stormy  with o t h e r s .  f u n c t i o n would  It i s  have spent time going from  have had  establishing relationships this protective  who  life.  oppose  and  example, rebel  the  against  that  symptom  longer makes sense w i t h i n For  the  the  adolescent those  in  141 authority positions i s f i g u r e s accept and  On  another  r e s i d e n t that behave i n  able  rewarding  An was  level  do  so  staff  respects  develop  important element of  the use  family  the  "need" to  I f the r e s i d e n t i s  "are", then h o p e f u l l y they w i l l and  experiment  with new,  more  the i n t e r v e n t i o n s used at Vanhouse  By  having acce ss  therapy  sessions,  residents'  environments. improve  residential  behavior.  of messages which re f l e e t the behavior e x h i b i t e d  adequately equipped  to  authority  behaviors.  f a m i l y system.  the  the  resident's  they are behaving.  they p r e s e n t l y  further  the  the r e s i d e n t s both w i t h i n the t r eatment  from  if  these i n t e r v e n t i o n s communicate to  whatever way  to  to  even p r e s c r i b e the o p p o s i t i o n a l  the  accepted f o r who be  unlikely  to  the  to the the  within  information  staff  were  formulat e i n t e r v e n t i o n s that  behavior In the  home and  within  the  family  and  their  provided  more  of  systemic  treatment environmen t w i l l be  work  provided.  than  "captured" treatment  c o n c l u d i ng chapter some thoughts on  effectiveness  by  within  how the  142  CHAPTER 5 - DISCUSSION AND CONCLUSIONS  i  The  purpose  of  this  statements of c o n c l u s i o n was  introduced  at  chapter  concerning  the  residential  make some general  the treatment approach t h a t  Vanhouse r e s i d e n c e .  f u n c t i o n t o broaden the theory to  i s to  treatment  These statements  of a s t r a t e g i c / s y s t e m i c  and  hopefully  will  approach  guide  future  i n v e s t i g a t o r s and p r a c t i t i o n e r s i n t h e i r work.  The  f o u r i s s u e s , or "roadblocks"  treatment, which  were i d e n t i f i e d  to  effective residential  i n the i n t r o d u c t i o n ,  us with an e x c e l l e n t t h e o r e t i c a l backdrop  on which  the  treatment  relative  success  of  the  Vanhouse  provide  t o examine approach.  Success, here, i s measured a g a i n s t  the t h e o r e t i c a l p r o p o s i t i o n s  suggested  literature,  by  the  corresponding  q u a n t i t a t i v e a n a l y s i s of b e h a v i o r a l  change  in  and  not  by  a  the r e s i d e n t s .  Some suggestions f o r s p e c i f i c improvements and adjustments t o a s t r a t e g i c / s y s t e m i c approach t o r e s i d e n t i a l be p r o v i d e d  The  in this  first  introductory  also  chapter.  t h e o r e t i c a l problem, which was i d e n t i f i e d chapter,  concerns  concept.  When the adolescent  i s placed  i n care, there  problems can  treatment w i l l  be r e s o l v e d  the  "Identified  i n the  Patient"  i s s i n g l e d out as the problem and  i s an i m p l i c i t message t h a t the f a m i l y by c u r i n g the I.P. i n i s o l a t i o n from  143 the f a m i l y u n i t . perspective,  As  the  stated  problem i s  whole f a m i l y u n i t . isolation is  was  Any  from  an i n t e r a c t i v e one,  attempt  l i k e l y to  earlier,  to  treat  the  be i n e f f e c t i v e and  may  a systemic  i n v o l v i n g the individual in  even exacerbate  the s i t u a t i o n .  To  address  included family purpose of  these  this  I.P.  therapy s e s s i o n s sessions  " f a m i l y system" l e v e l .  i d e n t i f i e d adolescent  for  their  was  the  to the  to  focus  introduce  of  the  f a m i l y as  change  problem  The  at  the  parents from  a dysfunctional  Of course, view and  of her  In some cases the  with  s a t i s f i e d t h a t t h e i r daughter had  consolidated  approach  as p a r t of the program.  meetings.  parents r e f u s e d to cooperate  resident's  Vanhouse  the  unit.  many of the r e s i d e n t s ' f a m i l i e s f a i l e d to show up  scheduled  behaviour.  the  By e n l i s t i n g the support of the  the s t a f f hoped to move  Unfortunately  problem  treatment  as  behavior  they were  shown some improvement i n her  without the  herself  until  resident's  family's  the is  involvement,  the  cause of the problem i s likely  to  continue  to  deteriorate.  One  possible  s t r a t e g y to i n c r e a s e the f a m i l y ' s  r e c o r d f o r therapy s e s s i o n s would be of s p e c i f i e d  s e s s i o n s at  s t r e s s i n g the  importance of  the time  to c o n t r a c t of i n i t i a l  the f a m i l y ' s  attendance  f o r a number placement.  By  p a r t i c i p a t i o n i n the  144 treatment  process  cooperative  and  agreeing  relationship  f a m i l y and the treatment  In an  would  on, perhaps, be  ten s e s s i o n s , a  established  between  the  team.  e f f o r t to counter the I.P. problem and to encourage  the p a r t i c i p a t i o n of s t r e s s the  the  importance  i n the f a m i l y ' s residential  family,  of  and  Durrant  (1987)  framing placement as a p o s i t i v e step  treatment  staff  Menses  process.  frame  the  They  suggest  t h a t the  placement as a r i t e of passage,  which marks the change of context to one  i n which the f a m i l y i s  a b l e t o stand up to the problem t o g e t h e r .  The  i n c o r p o r a t i o n of  treatment  may  have c o n t r i b u t e d  to a  s t r a t e g i e s , such as  more p o s i t i v e  the above,  working r e l a t i o n s h i p between the s t a f f  the r e s i d e n t s ' f a m i l i e s at Vanhouse. involvement  in  the treatment  As i t  process was  The  the f a m i l y ' s  l a c k i n g somewhat  as a r e s u l t , the p e r c e p t i o n of the r e s i d e n t p a t i e n t " was  was,  as the  and,  "identified  strengthened.  second  "test"  of  the treatment  i d e n t i f i e d i n the i n t r o d u c t i o n , parent i s s u e .  As was  and attachment  has to  approach,  do with  the n a t u r a l  which  was  the s u r r o g a t e  s t a t e d e a r l i e r , placement may  the "problem" by d i s t u r b i n g  exacerbate  process of s e p a r a t i o n  t h a t occurs d u r i n g an a d o l e s c e n t ' s development.  I f the s t a f f take on a surrogate parent r o l e , then they may to block  and  the i n t e r a c t i o n  t h a t would  act  e v e n t u a l l y occur between  145 the f a m i l y and the a d o l e s c e n t . p r o v i d e the  In other  words, i f  the s t a f f  a d o l e s c e n t ' s need f o r intimacy, then there i s l e s s  l i k e l i h o o d t h a t the adolescent w i l l put i n the  required e f f o r t  to r e s o l v e the f a m i l y d i s t u r b a n c e .  As was attempted  d e s c r i b e d i n the R e s u l t s chapter, the s t a f f ' s f i r s t  solution for resolving  proved t o  be u n s u c c e s s f u l .  "backing  off"  relationships  from  the  the surrogate  This  solution  development  this  i n v o l v e d the s t a f f  of  close,  dependent  with the r e s i d e n t s and d i s c r e t e l y encouraging  r e s i d e n t s ' i n t e r a c t i o n with t h e i r f a m i l y . that  parent problem  strategic  policy  resulted  I t was  hypothesized  i n a "backlash e f f e c t " ,  where the r e s i d e n t s r e a c t e d i n an angry manner to the distant  the  now  more  staff.  To  counter  this  "backlash  r e l a t i o n s h i p which they f e l t was previous  positions.  relationship  which  while l e a v i n g  standpoint  this  advantageous way issue. t h e i r own  was  the  compromise resolve  supportive  the necessary  both  a  and  engaging,  "space" to i n t e r a c t  practical  position this  two  s t a f f hoped t o p r o v i d e a  relatively  From  to  a compromise between t h e i r  Ideally,  the r e s i d e n t s  with t h e i r f a m i l y .  e f f e c t " the s t a f f p r o v i d e d a  seems  and to  staff-resident  theoretical be  the most  relationship  However, i t should be noted t h a t each s t a f f member has i n d i v i d u a l way  of i n t e r a c t i n g with r e s i d e n t s  and,  as  146  a result,  i t can  to s t a f f - r e s i d e n t the  be  d i f f i c u l t to e s t a b l i s h a uniform approach  relationships.  supervisor  monitor  i n t e r v e n e whenever he or behaving i n resident. between  an o v e r l y It  is  staff  she  favoritism  scapegoating.  that  can  to  between  adolescent's family. and  residential  on  the  the  fall  avoid  the  relationships a  staff  member i s  d i s t a n t manner with a manner  within  problems  of  c e r t a i n agreed-upon such  as c o a l i t i o n s ,  problems of  adolescent,  interaction  the  triangulation  staff,  attachment  issues  situation.  that  can  and  the  of  the  they suggest the  the  E s s e n t i a l l y , t h e i r primary  disempowering e f f e c t that integrity  complicate  family  r e s i d e n t i a l placement unit.  To minimize  c o u n t e r - t h e r a p e u t i c aspects of treatment i n i s o l a t i o n family,  and  In t h e i r paper they i d e n t i f y a number of  treatment  concern i s the has  that  a l . (1984) d i s c u s s the  occur  separation  that  resident  order  Perry et  feels  engaging or o v e r l y  parameters i n and  recommendation i s to have  staff-resident  important  and  One  from  following:  1)  the program should serve only as a c a t a l y s t to e n e r g i z e the r e l a t i o n s h i p between the f a m i l y and the r e s i d e n t .  2)  the program should best non-attached nurturance and empowerment.  3)  no matter what s t a t e the f a m i l y in, the resident should be  r e f l e c t a q u a l i t y of unconditional family relationship is unconditionally  the the  147  supported f o r having as much p o s s i b l e and support from f a m i l y .  connection  4)  s t a f f ' s r o l e should be to u n r e l e n t i n g l y c o n f r o n t the f a m i l y with t h e i r r e s p o n s i b i l i t y and value to the r e s i d e n t ' s w e l l - b e i n g .  5)  the f a m i l y should be i n v o l v e d i n the treatment plan and should be i n v i t e d to p a r t i c i p a t e i n activities i n the house, as well as attend r e g u l a r f a m i l y therapy s e s s i o n s . (pps. 2 3 - 2 4 )  These suggestions with  the  are, to  strategic/systemic  Vanhouse.  a great  extent,  approach  that  However, i n regards to supporting  i n accordance developed  at  residents i n t h e i r  i n t e r a c t i o n with f a m i l y members, the Vanhouse s t a f f took a more n e u t r a l p o s i t i o n than the one At Vanhouse the p o l i c y was family contact.  It  was  suggested by Perry et a l .  to n e i t h e r encourage  nor  (1984).  discourage  thought that by remaining n e u t r a l  the  r e s i d e n t s were best able to decide f o r themselves i f , and when, they were ready f o r f a m i l y  contact.  In regards to f a m i l y involvement i n the treatment the  residents'  i n v o l v e d as  families  Perry et  parents were c o n s u l t e d times  and  clothing  al.  at  Vanhouse  (1984)  were  recommended.  expenses,  but,  on  i n v o l v e d i n the on-going process.  p o i n t of  view, as  likely  On  as.actively occasion  the  about minor treatment i s s u e s l i k e curfew  minimally  cooperative  not  process,  the whole, they were From  the  author's  a p a r t i c i p a n t observer, a more engaging  and  r e l a t i o n s h i p with the r e s i d e n t s ' parents would have  increased  the  overall  e f f e c t i v e n e s s of the  approach.  148 The  neutral, passive  have been  i n t e r p r e t e d by  participation  The  not  issue  the  treatment.  or  was  third  involved  was  As  was  highly  between t h e  of  and  strategic/systemic  the  a message t h a t  the  staff  to  to  may  their  chapter,  assumption  o f an  and  residents  interventions  to  the  them" o r as  as  address  change  Results  relation "us  had  resistance  i n the  in  assumed  desired.  client  a s s u m p t i o n o f an staff  as  Vanhouse  avoiding role  Vanhouse s t a f f  parents  the  described  directive the  the  that  1)  the  expected or  problem  d e a l t w i t h by  avoiding  role that  or  resistance overpowering  residents,  adversarial  a  g r o u p , and  the  predominant  3)  2)  role using  treatment  method.  In  reference  resistance,  the  and  communicated  the  only  doing  so  to  staff  adolescent position empowering  feels of  taking  decide  on  p o w e r l e s s and  strategy  was  or  what was  self-imposed  behaviour.  a  such  with  best  the  for  were  them.  By  s i t u a t i o n where  the  p r o c e e d s t o oppose anyone i n a  belief  begin to develop  dealing  they, themselves,  guardianship.  the  study  for  a highly directive role  that  were h o p i n g t o a v o i d  authority  In  method  residents  could  staff  first  avoided  to the  o n e s who the  the  that  limits as  d e t e r m i n e c o n c l u s i v e l y whether t h i s  on this  the  Underlying  this  adolescents  would  their  inappropriate  i t i s impossible  dynamic a c t u a l l y  to  occurred.  149 From Redl's in detail  (1952) t h e o r e t i c a l  i n the Review  adolescents necessary  from "ego  inappropriate  s t a n d p o i n t , which i s d e s c r i b e d  chapter,  it  dysfunctional  strength" impulses.  residents' unpredictable,  is  q u e s t i o n a b l e whether  families  to  self-impose  It  is  would limits  possible  out-of-^control  that  have on  their  some of the  behavior  c o u l d have  been b e t t e r managed, both i n a p r a c t i c a l and t h e r a p e u t i c by a p p l y i n g more d i r e c t i v e  The  author's  the  sense,  force.  opinion  on  the  above  issue  is  t h a t an  empowering s t r a t e g y can be a very e f f e c t i v e t h e r a p e u t i c t o o l i f used with a d o l e s c e n t s who responsibility for  are developmentally  t h e i r behavior.  On the other hand, i f the  s t a f f g i v e up too much p e r c e i v e d c o n t r o l to not  ready  to  receive  i t , then they may  a d o l e s c e n t ' s o u t - o f - c o n t r o l behavior. analogous to  the "omnipotent  ready to assume  The  a resident  who  is  act to i n c r e a s e the situation  c h i l d " dynamics, where the  may  be  child  presumably a c t s out as a means f o r probing the l i m i t s of h i s or her  personal  a d o l e s c e n t s may  power.  be too immature to  they, themselves, f o r them.  In the r e s i d e n t i a l s e t t i n g , then, some b e n e f i t from  are the only ones who  can decide what i s best  For these a d o l e s c e n t s the i m p o s i t i o n  the " o u t s i d e " are p o s s i b l e .  may  be  necessary  messages t h a t  before any  of l i m i t s from  self-imposed  limits  150 To make the above specific  examples  example  involves  complaints of abuse.  She was actively  from a  Vanhouse  16  year  may  old  d e p r e s s i o n and  Initially  the s t a f f  d i s c u s s i o n more  couple of  be h e l p f u l .  The  first  presented  with  girl  who  problems a s s o c i a t e d with a l c o h o l  she d i s p l a y e d h i g h l y  and tended  concrete, a  to dramatize  dependent behavior with  her " d e p r e s s i v e " b e h a v i o r .  keen on r e l a t i n g her many, v a r i e d problems to s t a f f sought  others'  advice.  In  response,  c o n s i s t e n t l y framed her " d e p r e s s i o n " as sadness connoted  its  expression.  conveyed the message initiate  any  she  was  in  her  behavior.  communicated to her t h a t she was to  l i m i t and a l t e r her own  Over the  and  the  only  and  empowerment appeared  the only one who  had the power  observed  to be imposing  erratic  to be  behavior.  successful in  beginning to take r e s p o n s i b i l i t y f o r her own  The  second  example  could  E s s e n t i a l l y i t was  of months, i t was  seemed  l i m i t s on her p r e v i o u s l y  who  behavior.  next couple  "depressed"  positively  one  above r e s i d e n t ' s behavior improved s i g n i f i c a n t l y . less  staff  In a d d i t i o n , the s t a f f r e p e a t e d l y  that  changes  the  and  involves  a  She  t h a t the appeared  more a p p r o p r i a t e The  as much  message of as she  was  behavior.  thirteen  year  o l d whose  p r e s e n t i n g problems i n c l u d e d an e x p l o s i v e r e l a t i o n s h i p with her mother  and  numerous  "acting-out"  incidents  that  may  be  151 categorized  as  r e b e l l i o u s and  Vanhouse s t r a t e g y of d e a l i n g  immature. with  In keeping with  resistance  and  the  avoiding  a  power s t r u g g l e , the s t a f f communicated to the r e s i d e n t t h a t  she  was  her  own  r e a l l y the only one behavior.  The  consequences to her the  resident  case the  make  staff  her  "empowering"  her placement.  refrained  own  a  p o i n t where she was  number  the  who  seemed  of  applying and  to  and  insisted  tended  the to  empowering message and  the  appropriate  She  function.  guidance and  limits  contributed  to  look l a c k of  imposed  her  reported  example, others strict  this  as  the  throughout verbally  e s c a l a t e d to  respective  to  that  In  was  out at the  examples  first  was  she  her outbursts  residents' In  strict  backfire,  occasions  physically striking  developmental stage. adolescent  l i m i t s on  "responsible" decisions.  d i f f e r e n c e i n the two to  from  behavior  strategy  s t a f f members  attributed  put  became i n c r e a s i n g l y problematic  On  abusive with  could e f f e c t i v e l y  inappropriate  r e s i d e n t ' s behavior  The  who  the  staff.  above  may  maturity with  or  the  older  f o r guidance,  controls  be  the  served  an  at the developmental stage where from  dependent,  the  "outside"  would have  "irresponsible"  behavior.  However, i n the second example the message of "empowerment" and the a s s e r t i o n  t h a t the  any  change, l i k e l y  behavioral  feeling  of  being  s t a f f were  r e a l l y powerless to  exacerbated  "out-of-control"  and  the  13  contributed  effect  year  old's  to her  need  152 to  display  effective,  reckless  behavior.  It  on  "ready" to  her  behavior  impose her  own  until  limits.  s t r a t e g y and  messages communicated  matched  the  to  setting  specific  A "blanket is  not  are at v a r i o u s  she In  was  been  recommended  to each  r e s i s t a n c e and  when working  with adolescents  second method  as  potential  problem.  opportunity  a  to  r e s i s t a n c e , the be d i s c u s s e d  The  s t a f f manage that  Group  for dealing  use  and  of  defuse The  together there i s  also any  address  provided  growing  a  the this good  f e e l i n g s of  t h i r d method of d e a l i n g with interventions,  will  shortly.  is  or  here  roadblock,  concerned  the i n a p p r o p r i a t e arises  adequately  strategic/systemic  problem,  treatment  to  who  with c l i e n t  the r e s i d e n t s band  meetings  the s t a f f .  in detail  last  residential  seemed  discuss  h o s t i l i t y towards  limit  S t r a t e g i e s t h a t avoided s a n c t i o n i n g  group  be  maturity.  view the home as a s t a f f vs. r e s i d e n t s s i t u a t i o n ,  residents  the  stage that they have  to deal with  encountered when  l i t t l e more to r e p o r t .  then,  r e s i d e n t should  stages i n t h e i r developmental  resistance, that  issue  more  developmentally  conclusion,  developmental  policy"  In regards to the  and  have  with the more immature r e s i d e n t , f o r s t a f f to impose  firm limits  reached.  might  is  that  behavior of the r e s i d e n t s .  The  what  the  with  necessity  to  with  associated  extent  the  staff's  153 therapeutic  role  is  jeopardized  when  they  are r e q u i r e d t o  assume a p o s i t i o n of a u t h o r i t y and  control i n  s o l u t i o n t o t h i s i s s u e can be found  i n the p r e v i o u s d i s c u s s i o n .  For those a d o l e s c e n t s who are developmentally they  are  ready  to  impose  to  back-off  from  a d o l e s c e n t s who where they  the  have not  can assume  authoritative  yet reached  the s t a f f ' s t h e r a p e u t i c r o l e  developmentally staff's  the  immature  strategy i s  to  role  The  most  unique,  functioned various  to  behavior,  assuming an  the  the  to  s e l f - c o n t r o l , the  j e o p a r d i z e d by assuming an i t is  staff's  resident  and  in  with  suggested  that  most t h e r a p e u t i c a  firm,  approach  many ways the most were  clearly  important,  the s t r a t e g i c / s y s t e m i c  These messages were " t a r g e t e d " at  of  the  residents  reframe  the  maladaptive  interventions  c o n n o t a t i o n and  not  the c o n t r a r y ,  messages.  behaviors  t h e i r own  stage  relationship.  element of the Vanhouse  specific  is  On  provide  i n t e r v e n t i o n s or  the developmental  i t comes  adolescent,  defined authoritative  For those  In other words, f o r a d o l e s c e n t s who are  a u t h o r i t a t i v e stance. for  stance.  necessarily involves  immature when  therapeutic  stage where  advantageous t h e r a p e u t i c r o l e  responsibility for  a u t h o r i t a t i v e stance.  at a  The  t h e i r own l i m i t s and take on more  r e s p o n s i b i l i t y , the s t a f f ' s most is  the home.  utilized  p r e s c r i b i n g the  at  and,  in  most  cases,  behavior.  From the  Vanhouse,  positive  symptom seemed t o be the most  154 effective.  T h i s c o n c l u s i o n i s based  responses of  the r e s i d e n t s  simply  on  the observed  and the o p i n i o n s h e l d by the s t a f f  members.  P o s i t i v e connotation  appeared t o  " j o i n i n g " with the r e s i d e n t . behavior served s t a f f were  f u n c t i o n f o r the r e s i d e n t , the  assume a r o l e t h a t d i s t i n g u i s h e d them from  the t y p i c a l a u t h o r i t y f i g u r e . residents  continued  the s t a f f ,  and  e f f e c t i v e way of  By a c c e p t i n g t h a t the p r o b l e m a t i c  some p o s i t i v e  able to  be an  to  In  some  cases,  however, the  be a n t a g o n i s t i c and o p p o s i t i o n a l with  escalated  their  provocative  behavior  as an  invitation for control.  One c o n t r o v e r s i a l  issue that  p o s i t i v e c o n n o t a t i o n , c e n t e r s on type of  message can  the  r e l a t i o n to  staff  in  the q u e s t i o n  be m i s i n t e r p r e t e d .  a c t s both t o ; 1) reframe the place  arose concerning the use o f  a  meaning of  neutral,  the symptomatic  or  behavior.  of whether t h i s  P o s i t i v e connotation the behavior,  and 2)  "positive" position, i n Although  the e x p l i c i t  message of the i n t e r v e n t i o n p o s i t i v e l y reframes the symptomatic behavior, the o v e r a l l goal to l i m i t  the e x p r e s s i o n  of the of t h a t  r e s i d e n t can e a s i l y p e r c e i v e a s p e c t s of tell  an i d e n t i f i e d  intervention i s , obviously, behavior.  both  behavior.  the  In some cases the  positive  and negative  For example, i f the s t a f f  a r e s i d e n t t h a t c r y i n g alone i n her room i s a good t h i n g ,  155 then the  negative aspects  of the p o s i t i v e l y connoted  would most l i k e l y be evident t o the r e s i d e n t . although  she  may  begin  to  In  behavior  other words,  see t h a t the behavior may have a  p o s i t i v e f u n c t i o n , she a l s o must f e e l t h a t she does not want t o c r y f o r too much  longer.  In other cases the negative aspects  of some i d e n t i f i e d p r e s e n t i n g problem may not be the r e s i d e n t .  For  past her curfew  r e p e a t e d l y , she may not p e r c e i v e  as e v i d e n t t o  example, i f a r e s i d e n t i s s t a y i n g out l a t e  to t h i s behavior when i t i s p o s i t i v e l y connoted. p o s i t i v e c o n n o t a t i o n would not f u n c t i o n to  any drawbacks In t h i s  case,  reframe the meaning  of the b e h a v i o r .  I f the  behavior i n q u e s t i o n has not been reframed  r e s i d e n t , due t o the f a c t t h a t the r e s i d e n t cannot aspects  exacerbate  the problem by a c t u a l l y i n c r e a s i n g the e x p r e s s i o n of  symptom.  To  c o n n o t a t i o n can be  avoid  i t , then  positive  p e r c e i v e any  negative  the  to  f o r the  connotation  may  t h i s problem, a message of p o s i t i v e  formulated i n such a way t h a t  the n e g a t i v e  consequences of the behavior a r e a l s o s p e l l e d out by the s t a f f . For example, the message might go as f o l l o w s : "The s t a f f have n o t i c e d how d i f f i c u l t i t i s for you l a t e l y t o r e t u r n on time f o r curfew. We understand t h a t you a r e making friends out there and we t h i n k t h a t ' s great. However you are having t r o u b l e g e t t i n g up i n the morning and your school work i s probably suffering from l a c k of s l e e p . Do you t h i n k you can s t i l l see your f r i e n d s and make i t i n f o r curfew?"  156 T h i s type of message p o s i t i v e l y connotes the behavior, negative  making f r i e n d s ,  c e r t a i n behaviors,  behavior are not should the  while pointing  consequences of s t a y i n g out too  then, f o r  both the  identified  behavior.  Another promising was  at  some  behavior  which  Some  examples  of  late.  the  some of  In  negative  aspects of  the message  appeared q u i t e  When a symptom  encouraged by the s t a f f  frustration,  that  were  anxiety,  undesirable.  prescribed anger  and  include; sleeping  difficulties.  T h e o r e t i c a l l y , once the behavior  the  resident  should  it.  P r e s c r i b i n g the symptom suggests t h a t , to some extent,  have d i f f i c u l t y  behavior i s under v o l u n t a r y  One Vanhouse  of was  explanation  the common to for  i s prescribed,  spontaneously  expressing the  control.  reasons f o r p r e s c r i b i n g the symptom at  provide their  was  to d i s p l a y  would u s u a l l y be considered  behaviors  the  consequences of  which  symptom".  the  conclusion,  resident,  Vanhouse  " p r e s c r i b i n g the  p r e s c r i b e d the r e s i d e n t was  depression,  to  p o s i t i v e and  intervention  out  where the negative  self-evident  contain  the i n t e n t i o n of  the  residents  dysfunctional  with  behavior.  an The  acceptable Vanhouse  s t a f f were of the o p i n i o n that although the r e s i d e n t s r e g u l a r l y defended  and  denied  that  concern, they were inwardly  their  behavior  confused and  was  a  cause f o r  d i s t u r b e d by t h e i r  own  157 actions.  The  staff  hoped t h a t by a t t r i b u t i n g a benign motive  to the i n a p p r o p r i a t e behavior, the r e s i d e n t would begin to f e e l more at  ease and  less g u i l t - r i d d e n .  For example, a r e s i d e n t  might be d i r e c t e d to continue arguing would  help  unresolved  to  relieve  family  a t t r i b u t e d to  some  As  we  can  benign motive,  the behavior  the r e s i d e n t w i l l  the motive a n x i e t y , and  The  g o a l , of  feel  has been  attributed a  l e s s compelled  to d i s p l a y  behavior.  A s i d e from the q u e s t i o n used  it.  her  t h a t once the r e s i d e n t has been given p e r m i s s i o n to  d i s p l a y the behavior, and  that  see,  i s an a c c e p t a b l e one;  the r e s i d e n t i s given p e r m i s s i o n to express course, i s  because t h i s  of the t e n s i o n s coming from  situation.  the behavior  with s t a f f  at  Vanhouse  messages appeared those  cases  effect,  i t may  were to have  where  the  of how  or why  effective,  more  a positive messages  the i n t e r v e n t i o n s o f t e n than not, the  t h e r a p e u t i c impact.  seemed to have l i t t l e  In or no  be hypothesized t h a t the f o l l o w i n g elements were  lacking; 1)  the message was not matched developmental l e v e l of the r e s i d e n t .  with  the  2)  the way i n which the message was d e l i v e r e d underscored i t s impact, i . e . a more "formal" p r e s e n t a t i o n may have been more e f f e c t i v e .  3)  the language used i n the message d i d not "match" the r e s i d e n t to whom i t was being d e l i v e r e d , i . e . the s p e c i f i c words chosen were not s u i t e d to the a d o l e s c e n t ' s world view.  158 4)  and, f i n a l l y , the s p e c i f i c s t r a t e g y chosen was o f f " t a r g e t " , i . e . the message f a i l e d to capture the s i g n i f i c a n t dynamics of the s i t u a t i o n .  Another  important  i n t e r v e n t i o n s has suggests  that  "context  symptoms  displayed  displays  by  are maintained  community home.  in  origin.  the  the  treatment  the r e s i d e n t i a l present  author,  are  It  goal  treatment  dysfunction.  h i s or  i n order  her  originated in  form or another, i n  suggested  further,  by  the  be  the  interventions.  behavior of  t h a t the  a  support  critical  to do with the fundamental treatment g o a l .  a unit,  the  have served  these "reenacted" behaviors are of  r e t u r n to that f a m i l y . the  may  that  that these "reenacted" behaviors should  i s to a l t e r the d y s f u n c t i o n a l  f a m i l y as  symptoms  behaviors which  is  some  the concept of  l i v i n g with  "reenacted", i n one  setting.  reason why  importance has  serve  emotional system  home  primary " t a r g e t " f o r s t r a t e g i c / s y s t e m i c  The  Bergman  Observations at Vanhouse d e f i n i t e l y  the h y p o t h e s i s that symptomatic the f a m i l y context,  residents  He a l s o i n t r o d u c e s that  formulating  (1980).  by the  s i m i l a r f u n c t i o n when the r e s i d e n t was f a m i l y of  to  by Bergman  r e p l i c a t i o n " , suggesting  resident  related  been d e s c r i b e d  f u n c t i o n f o r them and w i t h i n the  concept  This  the  resident's  r e s i d e n t may  eventually  Those behaviors which are r e p l i c a t e d i n  context By f o c u s i n g  are  manifestations  on these  behaviors,  of the  the  family  resident's  r e t u r n , and  ultimate  s u c c e s s f u l f u n c t i o n i n g , w i t h i n the f a m i l y  unit i s f a c i l i t a t e d . i  In order target  t o formulate s u c c e s s f u l i n t e r v e n t i o n s ; those t h a t  "reenacted"  behaviors,  i t i s essential  that the s t a f f  have a good knowledge of the f a m i l y h i s t o r y and dynamics. knowledge  comes  f a m i l i e s and For t h i s and  from  the  previous  the i n f o r m a t i o n  r e s t of  suggested  that  workers should sessions:  gathered by  the treatment to  be  enhance  the f a m i l y workers.  staff i s  It i s  involved,  somehow,  in  the  overlapping  of  the  would  residents  a more  dynamics  will  attained,  s u c c e s s f u l i n t e r v e n t i o n s should  Finally, strengths  some  and  residential  general  weaknesses  treatment approaches  approach  child  care  complete p i c t u r e be  can  day  workers  In  t o day By  and the  of the i n d i v i d u a l and  and,  consequently, more  follow.  s tatements of  the  be  made.  described  squarely  from  i n the treatment c o n t e x t .  the f u n c t i o n s of the  f a m i l y workers  benefit  care  f a m i l y therapy  p r e f e r a b l y as observers behind a one-way m i r r o r .  observations  treatment  a necessity.  t h i s communication the c h i l d  a d d i t i o n , the f a m i l y workers  Vanhouse  w r i t t e n h i s t o r i e s on the  reason, good communication between the f a m i l y workers  the  family  This  in  about  Vanhouse  the  Unlike Review  the  relative  approach many  of  to the  chapter, the  ad dresses the problems a s s o c i a t e d  160 with t r e a t i n g an i n d i v i d u a l i n i s o l a t i o n from the Both the  r e l a t i o n s h i p of  interventions  utilized,  family unit.  Also,  c o n t r o l l i n g and staff  apply  to  by a v o i d i n g  the  behavior.  "learnt"  her own the  The  under  Vanhouse  of  the  been  adolescents as  a  By  hoped  Immature  c o n t r o l and  lack  adolescents,  in  of  the  developmental  h i g h l y d i r e c t i v e and the  residents  questioned whether  provide  are  they are  more l o n g -  in  using  setting  has  behavior, presumably,  control not  and  ready  discipline. to  assume  r e q u i r e more pronounced ready to  receive  less.  encountered at Vanhouse i n v o l v e d  members' a t t i t u d e toward  own  problem arose when immature  staff  who  resident  room to make her  inherent  provocative of  the  residential  t h e i r behavior, may  t h a t was  the  change.  This  d i s c i p l i n e before  Another problem staff  methods  a  responsibility for  to  contraindications  identified.  of  overly  residents  "empowering"  g i v i n g her  staff  escalated t h e i r  result  of an  the  these circumstances i s t r a n s f e r r a b l e  d e c i s i o n s , and  strategic/systemic already  process  Vanhouse s t a f f  l a s t i n g , t r a n s f e r r a b l e behavioral  One  with the  programs are  the  disempowering  the assumption  once the r e s i d e n t r e t u r n s home.  mistakes,  r e s i d e n t s and  consequences as a means of teaching  "appropriate"  to make  avoid  natural  Some r e s i d e n t i a l  severe  behavior  sought  to the  directive relationship  facilitated  maturity.  the s t a f f  family u n i t .  the  approach.  Some  of  the the  161 workers q u e s t i o n e d whether be e f f e c t i v e and, Needless  to  as  say,  a  the new changes to the program result,  without  their  full  support  support  was  would  lacking.  from the s t a f f , the  treatment approach s u f f e r e d and the r e s i d e n t s became aware of a l a c k of best  enthusiasm on the s t a f f ' s p a r t .  dealt  with  by  holding  T h i s kind of i s s u e i s  meetings  and  resolving  any  d i f f e r e n c e s between the s t a f f members.  In  reference  to  treatment d e s c r i b e d comparisons  and  the t r a d i t i o n a l t h e o r i e s of r e s i d e n t i a l  in  the  Literature  contrasting  issues  and b e h a v i o r a l  approach  the  environment".  The  chapter, some  are noteworthy.  both the p s y c h o a n a l y t i c acknowledged  Review  As w i t h  approaches, the Vanhouse  importance of the " t o t a l treatment  rules,  routines,  activities,  staff/child  i n t e r a c t i o n s and a r c h i t e c t u r e of the treatment environment were all  taken  into  account  treatment approach. approach emphasized child  care  worker,  traditional  as  I t may  important  of  the  be s a i d t h a t the Vanhouse treatment  the importance of the f r o n t l i n e worker, or to  approaches  a  greater to  strategic/systemic  to day c o n t a c t  with  residents  extent  residential  incorporating  behavioral  ingredients  the  than  any  of the  treatment.  interventions into their staff  hoped  By day  to encourage  change at the s t a f f / r e s i d e n t i n t e r a c t i o n a l l e v e l .  162 Behavioral level a  by p r o v i d i n g  separation  care  change was a l s o e n c o u r a g e d a t t h e f a m i l y  meetings.  earlier, using  has  suggest  that a  treatment  of a b e h a v i o r a l in  the  between s t a f f staff  the  i n the treatment and t h e  i n the on-going  Vanhouse a p p r o a c h traditional  been s t a t e d p r e v i o u s l y , most  1980; B r e n d t r o  residential  work  importance o f  therapy,  sessions  the  described  sessions  of family  of  i t from  key i n g r e d i e n t  Jones,  only  aspects  t h e weekly  residential  from f a m i l y t h e r a p y  two  the  therapy  of  in  child  which  residential  approaches.  philosophies a  family  to avoid  approaches  underlined  delivery  distinguish  treatment  As  are  order  participated  The i n c o r p o r a t i o n  of information  clearly  from  In  and t h e o n - g o i n g  the t r a d i t i o n a l  approach  and  interventions.  the  Unlike  information  formulation  is  therapists  t h e Vanhouse  treatment,  sessions.  between t h e f a m i l y t h e r a p y  work, t h e f a m i l y  staff  use  f a m i l y therapy  system  of therapeutic  concluded,  of  and r e s i d e n t s  provided  residents.  behavioral  their  a  system  a warm, open a n d g i v i n g (Phillips  et  that their  a relatively  However,  ( B e t t e l h e i m , 1974;  upon a t t e m p t i n g  home, t h a t  a t Vanhouse a l s o c o n c l u d e d i f they  A  al.,  approach t o replication could  only  interaction  1973a).  The  a p p r o a c h was v i a b l e  engaging  t h e Vanhouse  treatment  supportive r e l a t i o n s h i p  success  & Ness, 1983).  treatment context  nurturing,  residential  r e l a t i o n s h i p with  approach  suggests  that  163 t h i s c r u c i a l r e l a t i o n s h i p should than  the  relationship  that  be  less  may  develop  t r a d i t i o n a l approaches to r e s i d e n t i a l  The  in  tolerance"  traditional  also  residents displayed  symptom  it  the  two  expression;  1)  able to  from many of  symptoms  significant by  them  i.e.,  d i s p l a y e d the prescribe  s t a f f are i n a p o s i t i o n to  it.  behavior  by  behavior  and  purposes;  Some  applying by  treatment strict  providing  approaches  attempt to to  residents  encourage any  long-lasting behavioral  i s s u e of symptom  expression.  excessive  limitations f a i l  change.  approach was  alter  with a s t r u c t u r a l  s t a f f induced c o n s t r a i n t s and  strategic  been  inappropriate  "artificial",  tolerant,  the  p o s i t i v e l y connote or  Vanhouse s t a f f were of the o p i n i o n that  more  assess  to manipulate  program. • The  a  a tolerant  once a symptom has  consequences the  reasons f o r  2) with the symptoms out  better position  treatment  the  allowed to  more a c c u r a t e l y  of the r e s i d e n t s , and  to the  that  presenting  i n the open the s t a f f were i n a for  the  relation  were t o l e r a t e d and  There were  atmosphere the s t a f f were " t r u e " behavior  of  at Vanhouse  i n the open.  tolerating  Many  of  treatment.  distinguishes  approaches.  involved  some  p o l i c y that the Vanhouse approach h e l d i n  "symptom  come out  i n t i m a t e and  For t h i s  to  reason,  used to address  the  164 In c o n c l u s i o n , methods  into  innovative  the  the  approach  experiment  adolescents.  implementation  in  at  Vanhouse  the  of s t r a t e g i c / s y s t e m i c was an e x c i t i n g and  residential  The r e s u l t s presented  treatment  of  i n t h i s t h e s i s suggest t h a t  these methods may c o n t r i b u t e s i g n i f i c a n t l y t o  a general  of s t r a t e g i c / s y s t e m i c  In many ways the  work at Vanhouse should uncovering  the  r e s i d e n t i a l treatment. be c o n s i d e r e d  inherent  complications  p r o v i d i n g r e s i d e n t i a l treatment Hopefully  this  thesis will  wish t o pursue a residential  more  treatment.  a pioneering  from  a c t as  complete  a  and  theory  attempt at  advantages  systemic  a catalyst  theory  of  perspective.  f o r others  who  of s t r a t e g i c / s y s t e m i c  165 REFERENCES Allen,  K. 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