Meeting children’s emotional needs, 1969

This paper was read to a large Home Office group during a course at Nottingham University in 1969.  It brings together a lot of learning experience in a way which led me to further realisation.  I remember my pleasure and surprise when I met so much sympathy and understanding in my audience (which included senior staff from approved schools).  The discussion which followed was of value to me, and the next paper, ‘Syndrome’, presented during the same course also led to useful communication.
Barbara Dockar-Drysdale

This paper was read to a large Home Office group during a course at Nottingham University in 1969.  It brings together a lot of learning experience in a way which led me to further realisation.  I remember my pleasure and surprise when I met so much sympathy and understanding in my audience (which included senior staff from approved schools).  The discussion which followed was of value to me, and the next paper, ‘Syndrome’, presented during the same course also led to useful communication.

Barbara Dockar-Drysdale

My point of view differs in many ways from that of other disciplines: for example, from that of a teacher.   Much of that I shall be suggesting may seem irrelevant in the present context of work in residential places: we are in a transitional phase between the publication of the new Act and its implementation.  Clearly, there must be development and change – must there also be actual breaks in thought and practice?  Are there some ideas or points of view which must be discarded, or can they be adapted to fit a new task?

There is a tendency, because of the close connection between physical and mental health, to think of psychotherapy of any kind as a treatment intended to lead to a cure.  Accordingly (for example) the disappearance of specific symptoms in emotional disorder is taken as a sign of recovery; when in fact, the symptom may merely have shifted its ground.  Sometimes a behaviour disorder may be replaced by physical symptoms, which will then be treated in the field of physical medicine: this is not a cure.  I really wish to jettison the concept of ‘cure’ at once, and replace this by ‘evolvement’. I believe that most people can evolve to some extent, however deeply disturbed they may be, and that in helping our clients to develop emotionally, we ourselves also evolve.  There is for me no clear line of demarcation between psychotherapist and patient, teacher and pupil, child care worker and child; we are all individual people.  Therapy, then, from my own particular viewpoint, involves a relationship between two or more people (individual or group therapy), used in a special and professional way, leading those concerned to further evolvement as unique human beings (Winnicott has pointed out that well people are unique, it is the ill ones who area stereotyped).  This realisation is essential, especially to those working with deprived and delinquent children.  For example, therapeutic work will lead a delinquent to a special kind of depression: it is only too easy to mistake such a manifestation as evidence of deterioration rather than to welcome the onset of a depression as an indication of evolvement without which the delinquent’s emotional life must remain static.

I have said that I do not see a clear boundary between workers and clients.  Perhaps I should also make clear at this point the fact that I fail to see such boundary between grownups and children.  As I have said before, I regard the word ‘adult’ as a defence against the realisation that we professional people are all children who have grown up.  There are many parents who tell their children little or nothing about their own childhood: they need to deny the evolvement of the child into the grown-up, and cannot bear their children to think of them in such a way.

It will be realised that I am trying to set up a clear field of communication in which to work.  I want my own personal outlook to be understood: it seems important that I should make my position clear.  So, I am saying that grown-ups trying to help disturbed children to evolve willthemselves evolve, provided they can allow relationships to come into existence between grown-ups and children, of which therapeutic use can be made.  Just as I am not prepared to think of grown-ups as being other than children grown up, so I am also unwilling to ignore the fact that a sixteen-year-old can have the same needs as the six-months-old, although these needs may be communicated in a distorted, broken down way (we call this ‘acting out’).  If these needs are not met at six months, or six years or sixteen years or twenty-six years, they will not change.  The approved schools are having to compensate for the failure of the residential nurseries.  One could say of the ‘outside’ child whom we meet in the approved school, that the shell is made up of defences (to hide the real self) and of broken down communication, taking the form of deviant behaviour.  We have to try to understand the nature of the defences, and the communication implicit in the behaviour.

I am advocating a therapy based on needs rather than symptoms, bearing in mind that many of our clients have been traumatised in one way or another: we are often trying to treat emotionally damaged people who need corrective experience (‘corrective’ in this sense has no punitive implications).  Just what experience may be needed depends on the stage of integration reached by each individual: we need to classify children according to needs based on degree of integration reached.  Such classification can be carried out within any kind of residential unit by the people working in the place.  If the treatment of the kind I am considering is to become available to the thousands in need of help, then residential units must shoulder the responsibility of providing therapy themselves, rather than looking to outside agencies.  This applies equally to residential nurseries and to community homes.  Anybody doing residential work with children and young people must learn to make use of therapeutic skills.  We have an enormous emotional refugee problem on our hands: thousands of emotionally starved children who are all, in the deepest sense of the word, displaced people.  There is nobody beyond us to whom we can hand over this responsibility.  Furthermore, a therapy of provision leading to evolvement is not available in a child guidance clinic: such treatment can only be appropriately given in a residential setting, relating as it does to the entire life of the child in need.

It is important that this work should be seen as active, skilled and economic.  I am not talking about a permissive environment with minimal controls and structure.  There will certainly be no place for corporal punishment or other archaic punitive practices in the new community homes, but it is no use forbidding one kind of management unless it be replaced by another – certainly nothing can evolve in a vacuum.  I am, of course, well aware that therapeutic work, such as I have described is being carried out already and I want this to become more conscious and more communicated.

I have spoken of the necessity for classification within a residential unit, based on need and on stage of integration.  I must clarify my use of the term ‘integration’, which is based on Winnicott’s concept of integration as an individual.  I am sure that many of you are accustomed to thinking of integrated or unintegrated children; but, so far, it does not seem usual for residential staff to classify the children in a unit on this basis.  When I speak of integration, I am thinking on the lines which Winnicott has postulated.

The population of residential nurseries, children’s homes, and schools for the maladjusted and (up to the present) approved schools, are made up in nearly all cases of a mixture of integrated and unintegrated children.  It is essential that the needs of all deprived children should be met: and it must be clearly understood that the nature of these needs depends on degree of integration.  So far, it is usual for the behaviour of unintegrated children to be recognised as ‘different’ from that of others, and to attach labels to them such as behaviour disorders, character disorders, psychopathic personalities, and so on.  These labels – technical or otherwise – emphasise the difference between these children and others, while totally failing to suggest that (although they cannot benefit from what is available in the way of management) they are in need of special treatment: this need is so much less easy to recognise, for many reasons, in unintegrated children than in integrated, functioning children, especially because of the breakdown of communication into acting out.

The therapist working with integrated children depends on transference phenomena and on verbal interpretation within the strict limits of the therapeutic hour.  The therapist working with unintegrated children must depend on personal involvement, on symbolic actions (adaptations) and on re-establishing communication in place of acting out.

I have worked in two units as a consultant; one catering for five- to twelve-year-olds and specialising in the treatment of severely emotionally deprived unintegrated children who are selected on this basis, and the other an approved school which is still in the difficult phase of change from approved school to therapeutic community.  In the first unit (the Mulberry Bush), the only integrated children are those who have evolved to a point at which they are nearly ready to leave the school.  In the second (the Cotswold Community) there is at all times a mixture of barely integrated and unintegrated adolescents.  It has been possible to classify the approved school children by assessment of integration in the four house groups.  This kind of assessment is not usually available in referral reports, but I have found that residential staff are quite able to carry out this sort of in-living diagnosis themselves, in consultation with me.  We have used two factors only, in assessing degree of integration: these have been panic and disruption.  Where both these factors are present we assume unintegration.  Both phenomena are easy to recognise, once their nature is understood.  Panic is often described as temper tantrum: disruption as antisocial behaviour.  Panic, rarely mentioned in psychiatric reports, is the hallmark of unintegration, and represents traumatic – unthinkable – experience at an early age.  It produces claustrophobia, states of disorientation and a total loss of any sense of identity: the victim falls to pieces in a state beyond terror.  He may be totally immobilised; or, more frequently, he may hit out, scream, destroy things or attack other people.  Disruption, described by Erikson as play disruption, can be seen in action very easily.  The child comes into a situation where others are functioning, either in work or play, and at once compulsively breaks into the group and breaks up the activity.  Panic and disruption are familiar to any experienced worker, but may not have been seen as signals of distress.

It is easier to pick out children who are not integrated, rather than to describe those who are whole, functioning people.  My own experience leads me to suppose that in a group of twelve children in residential care – let us say in a children’s home – probably two or three will be unintegrated.  These children will have an obvious and harmful influence on the lives of the integrated members of the group; while the integrated, functioning children will have very little counter-influence on those who are unintegrated.  The mixture of integrated and unintegrated seems to be disastrous for both groups, unless we can find ways of meeting very different needs in the same environment (see chapter 3).  I believe this to be possible: whether economic is questionable.  On the whole, I fell that there is something to be said for classification to take place as early as possible within the unit, so that living groups can be constituted from similar ingredients, rather than from an explosive mixture of elements.

Within the Cotswold Community there is now a cottage which contains the least integrated group in the community.  I think from what I have seen so far that the cottage group remains therapeutically viable, despite inevitable changes of staff and inmates.  On the other hand, each of the eight or nine children in the cottage would cause havoc in other groups: from time to time an unintegrated boy arrives into the community who cannot be placed in the cottage, and one can then see only too clearly how disruptive his presence can be in another group, and how easily he can become either a delinquent hero or a scapegoat.  In the same way, any one of the thirty younger children in the Mulberry Bush School would be ‘the impossible one’ in any normal class, but each becomes manageable in an environment which meets his needs.

I have suggested that a classification of needs can be made, based on two factors – the presence of panic and disruption.  Obviously this is a rough-and-ready way to work, and there will always be some borderline cases where it will be difficult to decide the degree of integration.  The later the stage of evolvement reached, the less obvious will be the lack of integration.  However, nothing can be absolute, and assessment must always be tentative and experimental.

What follows is a scheme or chart, which lists assumptions, aims and techniques, in regard to integrated and unintegrated people of any age, from the standpoint of a psychotherapist.  One would say that there must always, in any case, be a contract between therapist and patient; a process, whatever needs to happen between them – involvement of the patient and the therapist.

  INTEGRATED UNINTEGRATED
Assumptions Good enough start Not good enough start
  Identity Projective Identification
  Possibility of transference No transference, involvement
  Capacity for guilt No capacity for guilt
  Defences, eg, repression Primitive defences, splitting
  Boundary between conscious and unconscious No barrier between conscious and unconscious
  Symbolisation No symbolisation
  Capacity to contain experience  
Aims Sorting out the past Filling gaps in experience
  To resolve conflict through transference To achieve integration as a person
  Break down crippling defences enable patient to make full use of potential Through adaptation to reach regression, containment, with build-up of defences to reach personal guilt, repression, and so on
Techniques Use of transference interpretation Involvement with realisation symbolic communication adaptation
  Surfacing of repressed material  
Therapeutic management Not needed Needed in some or all areas

Very special and long training, including personal analysis, is required to treat integrated patients: in residential work, much that we can achieve for such children depends on our ability to be suitable people with whom children can identify.

We assume that integrated children can identify, having reached secondary experience; but that in the past parental figures have been in some way inadequate: we have to compensate for such inadequacies.  The parents will hate and envy us because we are able to help their children in a way which they cannot achieve.  We cannot assume that unintegrated children can identify, because they have not reached secondary experience.  Here we have to supply missing primary experience, which their deprived parents (or staff in institutions) have been unable to supply.  We can expect these parents also to hate us, but they will envy their children rather than ourselves, because such parents will know that they themselves have these primary needs (see chapter 2).

Therapeutic work with integrated children in residential treatment is more complex, but less exacting, than work with unintegrated children.  Once integrated, children can transfer the deep confused feelings they have for their parents to us, giving us an opportunity to understand these feelings, and to help them to do so, thereby freeing them to identify with us in a new way.  We have to ask ourselves whether we as people can offer them a better chance to evolve in relation to us and our way of life.  It is not painful to reach understanding of their difficulties, but it can be very painful to be understood by them – sometimes better than we understand ourselves.

Unintegrated children present quite other problems.  We have to provide experience which is actually missing from their lives.  They will, in time, accept us with a devastating degree of trust and dependence.  There will be no transference in the ordinary sense – they cannot transfer what they have not got.  They will be involved with us and we with them in a very simple and primitive way: our reliability will become our most valuable therapeutic tool.

Here, then, are the two main groups to be found in all residential work.  How much therapy can be carried out in any residential unit by the people in the place?  What is the nature of such therapy?  How can we actually help children to evolve?

Our first task is to produce a suitable emotional climate in the place, for therapy to be possible.  We need to remember that a therapist, basically, is not a person doing, but a person being: for example, people can stop actually punishing but remain punitive.  The right words are no use if they are only a cover for the wrong feelings. Since child care workers cannot have a personal analysis and a distinct training as therapists, we need to evolve a mainly ‘do-it-yourself’ approach, which may help them to gain insight and free them to become professionally involved with children in this special way.

People tend to think of therapeutic work as being carried out in a clinic or consulting room in the course of formal sessions, over a considerable period or time.  Therapy in child care is concerned with the content of the total life situation in the place, including waking and sleeping, eating and drinking, working and playing and so on.

To produce the essential emotional climate, if it is not already present, we need to ‘clear the decks’.  We can most easily make a start in the field of communication, which can become a desert in residential work.  There is a tendency to use stereotyped phrases in talking to children or about them.  Workers hide behind these phrases, and the children do likewise: as a result, real feelings are not communicated unless they burst through under stress in the broken-down form which we call ‘acting out’ (punishment is often acting out).  There are various ways of establishing real communication in residential work.  You will all be familiar with the writings of David Willis:1 the concepts of self-government, democratic participation and shared responsibility all involve open and free communication between grown-ups and children; in the course of which, feelings and ideas can be expressed, and respected and used by all.  I feel that this sort of approach is ideal for integrated children who have had a good enough start in emotional life, and who are able therefore to experience, realise and conceptualise adequately, in a way which unintegrated children cannot do.  Children are encouraged by such work to accept responsibility for being themselves.

At the same time, we must provide them with objects for identification – ourselves.  This means in practice a great deal of self-awareness.   The worker functioning as a therapist must do so as himself, but with concern, so that he speaks and acts in a responsible and sensitive way in the place.  The avoidance of direct and real communication between workers and children aims at preventing the formation of deep personal relationships – which are essential for therapeutic purposes.  Therefore, once such communication is established, we can expect these relationships to come spontaneously into existence.  When children are integrated, they will transfer to us their conflicts in regard to their parents, and we are then in a position to understand something of their difficulties; and by communicating our understanding, to help them to evolve from long static positions in regard to others.

Institutionalisation is a defence against emotional processes: de-institutionalise, and we produce a climate in which these processes can developthrough which people can evolve. Lack of real communication has a depersonalising effect, and the establishment – or re-establishment – of communication is an essential first measure to make therapeutic work possible.

It is a much easier task to establish communication with integrated children than with unintegrated ones.  The latter group must be considered carefully because this is the source of most problems in any residential work.  I have already mentioned the tendency of unintegrated children to panic and to disrupt the functioning of others.  I have found that small groups of four children and one grown-up, meeting each morning for about half an hour, can eventually reach intercommunication.  Such a group can be mixed in degree of integration (a ratio of one unintegrated to three integrated), but ideally not mixed, so that the functioning of the integrated does not threaten the unintegrated.  The beginning of such work will probably be extremely discouraging, but communication will come with patience and empathy.

In order to understand the therapeutic value of invariable response to all communication from children of any age, it is important to grasp the concept of ‘the spontaneous gesture’ (Winnicott).  The baby smiles at the mother and reaches out to her: the mother’s response is an essential to the baby’s emotional wellbeing.  If the mother does not or cannot (because of her own defences) respond to the spontaneous gesture, then the baby is reaching out as though for ever into infinity.  Eventually in such a case the baby ceases to attempt those gestures, having reached despair.  Our response to what a deprived child tries to communicate may re-establish his belief in the possibility of response to his reaching out.  Recently a child aged ten called Timothy drew for me a picture of himself in his cot as a baby: the picture showed him lying flat in the cot with one hand showing between the bars.  He said, ‘That’s me trying to reach my mum – it’s a bit like a cage, the cot, isn’t it?’  I replied that this was so but perhaps the bars of the cage also kept his mother away from him – were also the bars of her cage: in other words, her defences, protecting him from her violence, but also isolating him.

We have to be careful that children find us when they reach out, and that they do not again find defences instead of people.  A boy at the Cotswold Community said to me: ‘It’s different here from the other place.’  I asked what was the greatest difference, to which he answered: ‘People really listen to you – they don’t just hear you – they listen – nobody has ever listened to me like that before.’

Sometimes people are afraid of what children will say, of the dreadful unanswerable questions they may ask: this is a valid fear, but it is also valid to say that just listening is therapy.  At first much that our clients will say will be paranoid accusations and complaints against all who are in authority of any kind, complaints without logical reasoning.  We can listen to such complaints, accepting the reality of the feelings expressed and leaving the objective reality alone for the present.  Gradually the child will start to communicate his dread and his helplessness.

We are, I assume, considering the whole range of residential displacement, residential nurseries, children’s homes, schools for maladjusted children, and approved schools.  In all these institutions I suspect that there is a larger proportion of unintegrated children than is realised – this is not a policy, but a relatively unconsidered fact.

Let us now take a look at the needs of these unintegrated children.  With integrated neurotic children, we can assume the presence of an identity, a functioning ego, a capacity for concern (personal guilt), and anxiety (repressed guilt).  None of these assumptions hold good when we come to consider those who have not achieved the establishment of identity.  We are now considering the terribly deprived ones – those whose needs have not been met during the first year of life.  I have elsewhere described2 the syndromes which develop in terms of the nature of the traumatic interruption of emotional development and the point at which this has taken place.  Here I must quote my descriptions of these syndromes of deprivation.

‘The most primitive of these categories, that is to say the least integrated, is made up of those whom I have described elsewhere as the ‘frozen’ children who have suffered interruption of primary experience at the point where they and their mothers would be commencing the separating out process, having been as it were broken off rather than separated out from their mothers.  They have survived by perpetuating a pseudo symbiotic state; without boundaries to personality, merged with their environment, and unable to make any real object relationships or to feel the need for them.

Such a child must be provided with the actual emotional experiences of progression to separating out; thereby establishing identity, accepting boundaries, and finally reaching a state of dependence on the therapist.  This kind of child cannot symbolise what he has never experienced or realised. (A ‘frozen’ child, on referral, will steal food from the larder because he wants food at that moment and for no other reason.  The same child in the course of recovery may steal again from the larder, because his therapist is absent; this stealing will now be symbolic.)

The next category consists of those who have achieved the first steps towards integration; so that one could describe them as made up of ego-islets which have never fused into a continent – a total person.  For this reason we call them ‘archipelago’ children.  These children give the impression of being quite mad whenever they are not being quite sane.  They are either wildly aggressive, destructive, and out of touch in states of panic-rage or terror; or they are gentle, dependent, and concerned.  They present a bewildering picture till one comes to know them and to understand the meaning of their behaviour.  They too need to progress through the process of integration.  However, these stormy children are not so difficult to help as are ‘frozen’ children; because the presence of ego-islets amid the chaos of unassimilated experience makes life more difficult for them.  They are, from time to time, very unhappy and aware that they need help.  The fact that some primary experiences have been contained and realised results in their having a limited capacity for symbolisation, which facilitates communication of a symbolic kind which is not available to ‘frozen’ ones.  Where ‘frozen’ and ‘archipelago’ children are concerned, treatment must involve the breakdown of pathological defences, containment of the total child, and the achievement of dependence on the therapist as a separate person.  These two groups, in which integration has not been sufficient to establish a position from which to regress, are very different from those in the next category.

Classifying the ‘false-self’ organisations, Winnicott (1960, pp. 142-3) writes:

‘At one extreme: the false-self sets up as real and it is this that observers tend to think is the real person.  In living relationships, work relationships, and friendships, however, the false-self begins to fail.  In situations in which what is expected is a whole person the false-self has some essential lacking.  At this extreme the true-self is hidden.’

Having described other types of false-selves advancing towards health, he continues:

‘Still further towards health: the false-self is built on identifications (as for example that of the patient mentioned whose childhood environment and whose actual nanny gave much colour to the false-self organisation).’

The latter organisation he has described as the ‘caretaker-self’ (Winnicott, 1960). This elaborate defence takes various forms, and is often difficult to recognise, especially because the ‘little self’ part of the child is carefully concealed by the caretaker (for example there may be a delinquent ‘caretaker’ which steals without conflict, on behalf of the ‘little-self’).’

Therapeutic work with these deeply deprived children involves one in making adaptations to their needs, much as the ‘ordinary devoted mother’ (Winnicott) makes adaptations to the needs of her babies.  It is important to realise at once that there is nothing impossible about this task, which is being carried out constantly in therapeutic institutions.  The easiest approach is to introduce certain adaptations oneself, which become ‘part of life’.  As I have said before, all children should have hot water bottles, a special drink, and the chance to communicate when they are in bed, before they go to sleep.  Such provision will soon become highly individual.  A child will choose a bottle of this colour, will write his name on it, will need it filled so full and so hot, and for the bottle to be placed in his bed, or given to him, or whatever.  You can see how depersonalisation can be tackled by such means.  Provision like this can be made either based on an individual relationship established between child and grown-up, or between the child and the house team.  In any event there must be constant communication between child and grown-up, or between the child and the house team, so that everybody becomes aware of the individual needs of each child.  While it is always difficult to embark on provision, the rewards are so instant that the work becomes easier as staff gain confidence.

Food is an area of provision which is all too often utterly institutionalised.  Delinquent excitement is frequently a displacement from frustrated infantile greed.  Food available when needed can often help to bring this excitement back into the oral zone where it belongs.  There must be plenty of milk and snacks available on request (as Derek Miller found):3 but the food, in my view, should always be given by somebody, rather than be collected by the child from the larder.

Society tends to be punitive in regard to food in institutions: not enough money is assigned to food in the budget; cooking is impersonal, in bulk, and frequently unappetising.  Ideally each group should be eating in the unit or cottage, rather than with the whole population in one large dining hall.  It is interesting to note that meals eaten in small groups take much longer than those en masse, because the children talk and enjoy themselves personally over a meal in their own group, whereas they eat their food and go as soon as possible when eating in a dining hall.

Children in rigid institutions are constantly exposed to further frustration and deprivation, which lead, of course, to subcultures and depravity – for which they are punished, thus creating a vicious circle.

Many people in child care would spontaneously work in the way I have described: they often only need permission, encouragement and support to become therapists.  Very often in a rigid institution such workers may be criticised, discouraged and undermined: this is true in every field – in hospitals, schools, and children’s homes.  Leadership roles in a therapeutic community must be distinct and reliable.  The ‘director’ (or whatever he may be termed), the head of group living, the head of each unit, or the housemother, must be linked by principles and free communication on a basis of mutual support.  Women need to be able to work professionally and in role, not confining their activities to mending and housework.  A group of men and women working together as therapists, helping each other to understand the problems of the children in their care, can achieve a high standard of therapeutic skill.  They will need to read, and to talk over and apply what they read to their experience, in order to learn how to add therapeutic attitudes to their various skills and to accept roles within their specific functions as teachers, craftsmen or houseparents.

I was involved in a very interesting and valuable experience which took place between a carpentry instructor and a deprived delinquent boy.  Tommy had become interested in chess and the history of the game.  He could play very well, and he decided that he wished to make his own chess set.  He was interested in an eighteenth century chess set which I had been given, and I brought a piece to show

him.  He was fascinated by the survival of the set, and wondered about the craftsmen who had carved the pieces with such skill, so long ago.  He suggested that if he now made a chess set, this might also survive into some future century, and in any case he could hand the set down to his son.  This was the first time I had heard Tommy talking about any distant future or past (like most delinquents, he lived in the present exclusively).  I explained about Tommy’s wish to the carpentry instructor, who gave him the considerable amount of help and support that he needed to carve the queen, which he brought to show me on my next visit.  Subsequently he carved the king, and then a remarkably fat pawn (he is a solid little person himself).  Tommy was delighted by his achievement, and we all eagerly awaited further developments…..  There was none.  Tommy was satisfied by what to him was a complete experience.  He had symbolised a family – a father, a mother and one child, which was what he would have wished his family to be.  A chess set became irrelevant in terms of his symbolisation.  Nobody urged him to continue a task which, however incomplete for us, was finished for him: he values his three pieces highly, and so do we all.  Here is an example of therapeutic work action within the normal structure of a residential place.

I have written a paper on the subject of therapeutic play in residential work: 4 I find it difficult to condense such a large subject into any sort of summary.  I have suggested that – in common with other therapeutic measures – therapeutic play comes from inside the children themselves, many of whom have never played in this symbolic way.  There is, however, no need to interpret this sort of play – to tease out the meaning of the children’s use of play material: interpretation of play belongs to play therapy, whereas opportunities for therapeutic play can be provided by workers in residential places of all kinds, and for children of all ages.

You will realise from what I have said that here again, the play groups need to be classified into integrated and unintegrated, with never more than eight children in a group, with one therapist-worker.

There will always be occasional children who need more intensive treatment – psychotherapy or even hospitalisation.  Such decisions can only be reached on the advice of a consultant psychiatrist.  It would seem that there will be intensive care units for very ill children who need to be insulated and contained for treatment to be possible.  Most children, however, could be treated within the proposed framework of a community home, where (presumably) a child guidance team will be available to the whole community.  I would hope that some of the work of such a team would be available for use in the further training of staff, through lectures, films and discussion groups.

At first any consultant will be felt as a threat to the people in the place; then, probably, in the next phase as some sort of magical messiah ‘who knows all the answers’.  Eventually, however, there is a good chance that the consultant will be reasonably in role, working in a structured and carefully planned way, known to all and used economically and to further primary tasks (ie, not regarded as a resource for the gown ups, to the exclusion of the children).

As a consultant psychotherapist I work in the two units already mentioned on much these lines.   Most of my work takes the form of group discussions: at the Mulberry Bush I also meet the child care staff as a group, and I have an individual session which each member of the team every week.  I see children ‘on demand’ for short or long sessions, and I meet the headmaster weekly.  All these meetings are based on whatever people wish to discuss with me, with the exception of one weekly meeting with the whole team (about fifteen people), when we consider a context profile which has been build up by everyone, including myself.  This kind of reporting in depth seems to have special values in residential work.  In order to make a context profile, the team choose a child for special consideration, and then report on all their experiences (not observations) with this child in the course of a week.  At the end of a week, during which I have a session with the child, we meet to pool experiences, and discuss the implications in terms of the child’s own needs, and how these can be met at this point.  This is an oversimplified description; ‘Context profiles’ is a paper in Therapy in child care.

Summary

I must apologise for the fact that I have as it were painted a picture, instead of producing a blue-print for therapy in residential work.  I hope, however, that I have succeeded in showing you, what many of you must already know, that therapy belongs within the context of everyday life in a place.  There can be no therapeutic work without the foundation of relationships between grown-ups and children: you cannot do therapy in an emotional vacuum, however precise the dosage.

There must be communication – real, uncensored communication, which means that grown-ups at all levels have to listen in a very special way to anything which children say, however apparently rude or irrelevant.  There must also be this real communication between the grown-ups themselves, who can then pool their resources.  There will be adaptation to individual needs in groups – provision of primary and transitional experience among unintegrated children, and opportunities and support for functioning among integrated children.  For this to be possible there must be classification according to integration reached.  There is a need for consultation to be available to grown-ups and children, individually and in groups.

But above all, therapy needs to be seen as a recognition of needs – deep, urgent needs – which must be met with concern.

References

1.  See David Wills, Throw Away the Rod, Gollancz 1960

2 . Therapy in Child Care, ch. 9, ‘The provision of primary experience in a therapeutic school’. And Ibid., p. 99

3.  See Derek Miller, Growth to Freedom, Tavistock 1964, pp. 109 and 178

4.  See ‘Play as therapy in child care’ Therapy in Child Care, ch. 11

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