Date Posted: Monday, 9 July 2007

Contents

Abstract

Methodology

Chapter 1 Setting a context : an overview of the development of ‘therapeutic care for young people, drawn from a review of related literature and legislation.

Chapter 2 The group as therapy

Chapter 3 Individual needs : the ‘one-to-one’ child and adult relationship within the group setting

Chapter 4 Adolescence : the phenomenon of adolescence as an experience for the young people and the parenting figures

Conclusions

References

 

Abstract

This study examines elements of psychoanalytic theory for their potential to offer insight into, and be helpful to, the work of children’s homes. Firstly it develops a historic and contemporary context for this examination. Then it considers three themes related to the work of children’s homes : group functions and processes; the relationship between an individual child and his individual special worker in a children’s home, and the impact of the phenomenon of adolescence in such a setting. It discusses significant theories in relation to their impact on practice . Oedipal forces within the group, the efficacy of the dynamic of the group in giving an understanding of the inner world of the individual child, the emotional deprivation of the unintegrated child, the conflict between individual needs and group needs, the primitive defences of the individual and the group, the projection and transference in the relationships in a group living setting, and reflection on what is “normal” and what is “psychotic” in the process of adolescence are all considered in the light of the theoretical stances of amongst others Freud, Klein, Erikson, Winnicott, Bion, Dockar Drysdale and Menzies Lyth and of the observations of practitioners such as Bettelheim, Redl, Davies Jones, Rose and Beedell.

The study draws three principal conclusions. Firstly, the arbitrary separation of discrete themes may be a weak artifice since each theme impinges substantially on the others, yet this may illuminate the holistic and ubiquitous nature of psychoanalytic theory. Secondly, psychoanalytic theory can usefully inform work in a children’s home. While it makes no promise of finite solutions, it offers workers the opportunity to be aware of what lies behind the problems experienced by the children, and the use of this knowledge may have therapeutic value for a child. Finally, psychoanalytic theory has the possibility of finding solutions to the emotional problems of the child in a children’s homes, but this is vitiated by those primitive defences described by Bion which, aroused by the fear of loss of control, are exercised in the name of the community by all those responsible for child care from the individual worker to the prime minister.

 

Methodology

This study uses discussion informed by related literature to explore its principal aim to consider the potential of psychoanalytic theory to offer an explanation of the psychodynamic processes within a children’s home, and so examine to what extent they may be used to influence the care of children in children’s home.

Although psychoanalytic theory may be considered holistic, it has been decided that to deal with the issues of concern to this study in a general way would be too unwieldy. Consequently three themes have been isolated which in the author’s view have significance. They have been selected because they are issues which are frequently discussed directly and indirectly within children’s homes by children and staff alike. Nonetheless in whatever way this method of examination is rationalised , it does makes the study subjective. The themes selected cannot be seen as representative in theoretical or practical terms. The conclusions of the discussions on each theme, and the ultimate conclusions are not necessarily open to generalisation. They represent a consideration and not a measure.

The study deals with theoretical issues as well as practical issues, but no attempt has been made to separate or order the two. According to the development of the author’s argument, the text will transfer from the theoretical to the practical and vice versa because this seems to reflect the nature and rhythm – within a network of action, reaction and reflection – of life in a children’s home, and having reached the decision to structure the study by isolating three themes, to further structure each theme into separate discussions of theory and practice seems an artifice too far.
Little theoretical and practical psychoanalytic literature refers directly to what happens in a children’s home. Accordingly the psychoanalytic texts are sought out in those areas of theory and practice which can be sensibly transferred.
This study is further limited in that however widely researched it is, it is selective in terms of what it is considering, and it is a personal distillation of the study’s author. There are other theoretical issues which the study might have pursued purposively, such as gender, ability, culture and other matters related to difference, as well as a phalanx of other practical issues which assume a high profile in the life of a children’s home on a day to day and long term basis.

The study suffers from the shortcoming that it is expressed through the medium of a white, middle class heterosexual European male who comes from a cultural tradition which might be described as Christian. Furthermore it is written by a social worker and teacher and by a part-time student of psychoanalysis. To this extent the background of the researcher will influence the study however much conscious effort is made to guard against an emancipatory approach, the author will have views as to what extent children in children’s home and the staff who look after them are oppressed groups.

Except in particular examples, it is a convention of this study that residential child care workers are referred to as feminine and the young people who are the residents of children’s homes are referred to as masculine. This represents the national bias. The staff of children’s homes are described as residential child care workers, residential workers or workers.

Although other disciplines of psychology may use the epithet “therapeutic”, the adjectives psychoanalytic, psychodynamic, psychotherapeutic and therapeutic are used synonymously throughout the study, and they should all be interpreted as being rooted in psychoanalytic theory. Almost invariably, the children resident in children’s home are over twelve years old. However in the study the residents of children’s homes are called children, youngsters, young persons, and young people. This approach may represent a lack of precision, but avoids tedious repetition.

It is a personal view that there is a convention in psychoanalysis to differentiate clearly the theoretical and the clinical. In this study, the word clinical has not been used because it is not in the author’s view indicative of the milieu of a children’s home. The words therapeutic and practice are used to describe the work of the residential child care worker.

 

Chapter 1 : Setting a context : an overview of the development of “therapeutic” group care for young people, drawn from a review of related literature and legislation.

Most children are nurtured and reared in the social grouping which is the norm for their cultural setting. History also tells us humankind has cared for many other children who, at some time in their childhood find themselves excluded from their social and cultural norms. For these children the wider community has in some manner tended to their physical and emotional needs, and absorbed their often troubled and troubling natures. To this extent humankind has always attempted to create a “holding” environment for children in difficulty. This capacity to hold and contain troubled or troubling children with the intention of making them feel better, or to “cure” their problems, may in retrospect now be considered, disregarding what was the prevailing zeitgeist, “therapeutic” in nature and so fall into the ambit of what was later to become psychoanalytic theory. The other extreme of the “containing” spectrum – the incarceration of young people as a means of meeting the perceived needs of the wider community – is also encompassed by pyschoanalytic theory, particularly where it relates to projection and splitting. Though this kind of care consciously given – that is physical and emotional containment which provides no opportunity for personal growth – would currently be frowned upon by most of those charged with providing residential care for children and young people, it is important to acknowledge that as an unconscious process it is alive in even the most sensitive of group living settings.

These positions do represent two extreme bands of a spectrum, and a brief sojourn through the history of residential group care for children is illustrative of the variously shaded forms such care has taken and demonstrates a complexity of reasons for providing it. Children who have not been able to live with their nuclear family have been cared for in their extended natural families, in foster families, in boarding schools, in apprentices’ houses, and in large residential asylums for people of all ages, such as the workhouses. They have been provided for in juvenile penal institutions and in mental health institutions, as well as in children’s homes. At various times the reasons for providing a containing environment have included the need to respond to poverty, and neglect, the need to correct delinquent behaviour through education and training, the need to punish criminal behaviour, the need to contain or cure mental illness, the need to shield from the delicate and denying eye of the general public the often unpleasant observable symptoms of all these states of being, and, sometimes it has been provided in order to offer nurturing and healing care for children made unhappy by loss, separation, and, abuse in all its forms. (Sharpe 1985)

In a large measure caring responses to the social, behavioural and emotional problems of unfortunate children have been based on understanding children’s behaviour as a conscious reaction to their environment, and so provision has been until relatively recently, rationalised in a way which would place it within the methodological territory of what are now considered behaviourist, cognitive and social learning approaches. It follows, given its place in chronology of the art and science of human behaviour, that psychodynamic theory and practice with their focus on the unconscious processes, did not play a substantial role in the field of residential group care for children until the 1950s. There were of course some notable exceptions: Homer Lane at the Little Commonwealth during and after the First World War who based his work on Freudian principles; (Bazeley 1948) in Europe Aichorn (Aichorn 1951): the teaching of A.S. Neill, at Summerhill School from the 1930s, who used Freud and Reich as theoretical bases for the education of young people.(Neill 1962) During the 1950s in the United States of America the work of Fritz Redl at the Pioneer Project, Detroit, using “the life space interview”, and Bruno Bettelheim at the Orthogenic School creating a therapeutic milieu, Chicago, based their work on Freudian and neo-Freudian theory; (Redl 1966: Betttelheim 1974) while at the same time in England, David Wills’ Hawkspur Experiment, and Fred Lennhoff’s school for “exceptional children” at Shotton Hall also espoused Freudian principles. (Wills 1960; Lenhoff 1960) At the Mulberry Bush School and subsequently at the Caldecott Community and the Cotswold Community Barbara Dockar Drysdale began to develop her own theoretical position which was greatly influenced by D.W.Winnicott. (Dockar Drysdale 1990)

In the United Kingdom a powerful, legislative impetus was given to the provision of therapeutic child care by the implementation of the 1969 Children Act, following the abolishment of the Approved School Order. On their closure, Approved Schools, institutions which had been juvenile penal establishments approved by the Home Office became designated, virtually overnight, Community Homes with Education under the auspices of the new local authority social services departments. This legislation was borne out of an era now often criticised as having been to excess, politically, educationally and socially permissive. (Sharpe 1986) It was a time for instance when in the field of therapeutic care for adults with mental health problems, inclusive and more democratic methods of patient care as promulgated by R.D. Laing became influential. (Laing 1961)

In the field of child care, the new children’s community homes were to be places where the care and nurturing were based on the building up of trusting relationships between the young people and staff, and places where within safe socially determined boundaries the young people would have choice and freedom to express themselves. It was not surprising therefore that new personnel with a background in therapy based on psychodynamic theory were attracted to leading these new residential child care establishments. (Milham et al 1975) A substantial number of people with therapeutic leanings were appointed to set up the new homes. However, the majority of the staff in these new homes were those who had worked in the establishments when they were Approved Schools. Their working ethos and such training as they had received reflected this. This staffing combination was destructive. Richard Balbirnie and Melvyn Rose who were eventually successful in establishing therapeutic children’s homes in what had been approved schools offer intense descriptions of the prolonged and often dramatic struggle they faced to achieve their goal. (Balbirnie 1971; Rose 1990) The vast majority of the new managers of these establishments did not prevail and by the mid 1980s most of these community homes had been closed down. Fuelled by media campaigns, the wider community projected the blame for failure in the residential child care sector on to the therapeutic movement. Therapeutic care was perceived as unclear and permissive in its approach, while disregarded was the probability that the lack of clarity was a consequence of creating establishments where different professional philosophies struggled in an inevitably destructive war of attrition, and where the young people were caught in the middle, confused and frightened in the cross fire. (Milham et al 1975) By the late 1970s, as one of a number of consequences of the closures which followed the criticisms, a process began – a process not identified until the mid- 1980s – of children ”drifting” without direction while in the public care, as the purpose of children’s placements in residential care became lost in the sense that their “care careers” became rudderless, as they were moved from a children’s home which had been closed down to another which was soon to be closed down! (Milham et al 1986)

Equally significantly, by being placed in large isolated institutions which received little supervision from their managing organizations, and in which staff groups were intent on internecine battles, the children lost touch with their parents, their extended family and their community, and so became estranged from their cultural identity. The geographic isolation of these establishments, the informal power structures within the staff groups, together with infrequent external management, and its concomitant lack of accountability, too often fomented an environment where institutionalized emotional, physical and sexual abuse of the young people could take place without check. These child abuse scandals, suspicions of which were already influencing child care policy in the 1980s, were not openly confronted until the 1990s (DoH/Utting 1991:DoH/ Warner 1992).

The issues concerning the isolation of these establishments, and the depersonalizing effects of their size, as well as the tendency of the young people to drift in care with no overall plan for their future began to be addressed in the mid 1980s, when there was a movement in public policy which aimed to reduce further the numbers of children placed in residential care, and sought to make children’s homes smaller and less forbidding while situating them in the locality of the children’s community. As a consequence of this, most children’s homes now have fewer than ten residents and are situated within an hour’s journey from the children’s natural family home. (Berridge and Brodie 1997) At the same time the results of a series of research projects led to further refined policy on decision making and child care planning and to the 1989 Children Act, in an attempt to prevent ‘drifting’ in child care. (DHSS 1986)

Rehearsing these developments in residential child care since the Children Act 1969, demonstrates the ambivalence towards therapeutic child care of those charged with determining the form residential child care should take in the 21st century. Simultaneously there is an attraction to the uniformity and consciousness of the more specifically expressed and rigid treatment and outcome programmes of the behaviourist and social learning schools of thought, and an espousing, with an almost religious fervour, of the legislative texts which emphasize the need to recognize and value the uniqueness of each individual child in the public care. (DoH 1991) These texts continued to emphasise the need for residential child care workers to base their work on building a healthy trusting relationship with the young people. Indeed this relationship came to be termed a “therapeutic alliance”. (Kahan 1994, p211) A question which recurs in any examination of the work of children’s homes is, why is there a resistance to a psychoanalytic approach in the work of children’s homes when the basic tenets of psychoanalytic practice are so sympathetic to what is legislatively expected?

Reflecting on this dichotomy, Roger Bullock and his colleagues, reviewing recent research, pointed out what on the face of it had been obvious since the closure of the Approved Schools : the trouble with children’s homes was not whether they were run on psychodynamic lines, or indeed run using cognitive or behaviourist methods, but that most had no clear working ethos at all. They offered a mélange of approaches determined by the make up of largely untrained staff groups, recruited to poorly remunerated posts which were generally conceded to be wearing and stressful. (Bullock et al 1993) The prevailing ethos of a home did not reflect any philosophical or psychological stance of the managing organization, but was represented by the views and practice of those subgroups of the staff, informal as well as formal, who at any one time held power within the home.
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In an attempt to confront this problem, the regulations related to the Children Act 1989 required all children’s homes to have a statement of purpose, what Bullock defined as a guiding philosophy which though not rigidly exclusive, would be sufficiently coherent to shape staff perspectives on the children’s problems, and enable them to relate to the causes of the children’s problems and to justify their approach to practice. (Bullock et al 1993)

This development influenced professional and public expectations of the role of a children’s home. Barbara Kahan, summarising the work of a child care task group meeting in 1993 which included senior practitioners, social work academics, and policy officers from local authorities and ministerial departments, mandated by the government to point towards a positive way ahead for residential child care, proposed that each child in a children’s home must be helped to sustain their development as far as it was possible, without a level of emotional stress which would disable them, impinge unreasonably on the others who lived with them, and that the level of development which could be achieved and the emotional damage which could be undone would be uniquely different for each child. (Kahan 1994) These aspirations, couched in terms which may seem sympathetic to a psychodynamic approach, also raise the issue of the tension between group needs and individual needs which is a constant concern for those working in children’s homes.

When specifically considering psychotherapeutically based residential child care, Kahan defines it as the provision of “integrated, residential and educational environments….” where, “ ……psychotherapeutic treatment for exceptionally emotionally damaged children” is given. She continues by suggesting that such homes are seldom of the same model, but they aim to have to some extent, a physical environment which emphasizes care and self-worth; an environment which is actively maintained to a level where children are enabled to make good use of the experience of life in a group setting. She maintains that in a therapeutic children’s home both staff and children should share the experience of living in the environment in order to forge a “therapeutic alliance” which would assist the children to achieve the changes needed to help them overcome their problems. In a setting of this kind, staff share and identify with the ethos of the home. Kahan had the expectation that these homes would have high levels of staff support including supervision and external consultancy, focused on the particular therapeutic theoretical stance of the home. Here Kahan and her colleagues are considering those Community Homes, which base their work on psychodynamic theory, like the Cotswold Community and Caldecott Community, which survived the aftermath of the closure of the Approved Schools. (Kahan 1994 p218)

Beedell in his study of nine of children’s homes which specifically pursued an approach to the problems of the children in their care informed by a psychodynamic understanding of the individual, found them to share a number of common principles and features. Principal amongst these, according to Beedell, is that the homes all purport to be therapeutic communities in the classic mould, where the young people and staff live and work together in what is often called a “total environment”. (Beedell 1993) The theories which underpin the work of these homes are a matter for discussion throughout this study, because their guiding theoretical stances can be usefully transferred in a consideration of the dynamics of all children’s homes.

Nonetheless these establishments represent a very small minority of children’s homes in the United Kingdom. They are not representative of the vast majority of children’s homes in the United Kingdom and neither are they representative of the many children’s homes situated in urban communities, which to some extent make use of psychodynamic principles in order to understand and to meet the needs of emotionally upset children, while claiming to maintain the children’s right to remain members of the wider community in which the home is situated.

More recently Chris Hume and his colleagues, when considering a broad range of children’s homes have expanded on Kahan’s and Beedell’s analysis of what is required to enhance the positive potential of therapeutic work in a children’s home, by suggesting that not only staff leaders but all the workers should have a strong grasp of psychodynamic theory. Such an understanding, they claim, can be used to enable workers to provide containment and reassurance, to set appropriately safe boundaries, to find ways of meeting the child’s primary needs, and to facilitate a child’s emotional development, while retaining empathy and understanding in the face of attack, manipulation, seduction and other alienating and hostile behaviours. By emphasising the possibilities of psychodynamic theory in underpinning the work of children’s homes, Hume et al propose a widening of the expectations of the role which therapeutic group child care might play. They argue that psychodynamic theory rooted as it is in child development, and specifically emotional development, offers an opportunity for the better understanding of families and their functioning, by providing a greater awareness of unconscious forces in children, parents, staff and institutions. (Hume et al 2000) This suggests there is potential for residential child care workers to extend their practice into family work, a field in which therapeutic group child care, in its “total environment” form, has in recent times been negatively viewed, in that it is seen as tending to deal with the child’s problems in isolation from his family. (Little 1995) If as Hume et al suggest, residential child care staff professing a psychodynamic approach can only be effective when they have a thorough grasp of relevant theory, then this has implications for the training of workers. Yet the training of staff, and the defences and resistance of managing organizations remain a major obstruction to purposeful therapeutic work with children and young people. A search by the author found that only two teaching institutions in the United Kingdom provide residential child care training based on psychodynamic theory. (Sharpe 2001) The current government has based its training strategy ( whether this strategy has a philosophical ethos is probably worthy of discussion, but is not a concern for this study ), on the NVQ competency system which focuses on practical skills and does not deal with relationships and unconscious processes which lie behind them. (DoH2001)

In setting a contemporary context for therapeutic child care it is surprisingly difficult to find specific parameters which might help identify those young people who are in need of it. Adverse research, which emphasised how leading a life where the resident, slept, ate, worked, and was educated in one place only led to depersonalisation and stifled the development of the individual, (Goffman 1961) and the subsequent shift towards placing children who are not able to live with their own families into substitute families, has rightly reduced the number of children placed in children’s homes. In a positive sense this has meant that those children who are placed in children’s homes are those who are unable, unwilling, or not ready to make themselves available for substitute family care, or are those whose placement in substitute families have repeatedly failed. Dockar Drysdale has developed theoretical positions which offer an explanation of the problems experienced by those young people who may need care in a therapeutic residential setting based around her concept of the “frozen child”. Such a child has suffered an interruption of primary experience at the point where the child and his mother would have commenced the separating out process, rather than in the case with the frozen child, a breaking off. The frozen child survives by “perpetuating a pseudosymbiotic state”. He has no boundaries to personality, and, merged with his environment, he is unable to make real object relationships or feel the need for them (Dockar Drysdale 1973 pp 60-61) Beedell, in his study of the nine therapeutic children’s homes makes observations on some common characteristics and experiences of children who are assessed as in need of therapeutic group care. He found they have an accumulation of adverse childhood experience which is demonstrated by emotional pain, bewilderment and lack of trust and hope. He suggests they also carry an emotional load which may only dealt with by adults ready, trained and committed to share the burden and to survive it with realism and determination.(Beedell 1993) Recent evidence from social research suggests that the reasons for the placement of young people in any children’s home tends to be based on the particular bias of the placing social worker, the immediacy of the availability of a residential place and the financial considerations of the placing local authority, as much as it is on the assessment of the young person’s individual needs or on an evaluation of the commitment, training and skills of the residential workers in particular children’s homes.(Bullock 2000)

This brief survey of the history of residential child care and some of the issues which currently concern it is an epitome of a service which, because it is charged with caring for those who are split off from the wider community, is projected as being in crisis by the same community. In denying its own guilt, and to justify its own failures it seems the wider community struggles to allow those who seek to help children excluded from the mainstream of life to succeed. This is not an inverted attempt to idealise residential child care. It is a service which has areas of shameful history, and it is a service which despite its altruism is not as focused or as informed as it should be. Examining how psychoanalytic theory may explain these phenomena, and at the same time as considering how residential child care practice might be informed and developed by psychoanalytic theory would be an unwieldy, if not impossible task. To bring this study within manageable bounds three issues of concern to residential child care have been isolated.

Firstly group living is discussed because every children’s home whatever its ethos must to some extent or another use a group as the arena for its work with its residents. The provision and utilisation of the group setting must be fundamental to the caring process. Secondly the predicament of the individual in the group setting will be examined because an abiding issue for young people and residential staff alike is the tension between the needs of the group and the needs of each unique individual within the group. Finally although the young people in children’s home are exceptional because of where they live and because of their unhappy childhood experience, less exceptionally they are living through the period of adolescence with all its universal elements. Given the nature of the problems experienced by the young people for whom they care, it may be understandable for inexperienced or untrained residential child care staff to mistakenly identify the behaviour of an agitated group of youngsters, not as displaying the normal anxieties of teenagers but rather as being the menacing and merged representations of a group of deeply troubled youngsters. The impact of adolescence on the lives of young people and staff in children’s homes, will be critically examined in the light of related psychoanalytic theory, with the object of considering the potential of the adolescent experience being used as a therapeutic tool.

 

Chapter 2: The Group as Therapy

The idea that a group setting is a fertile arena for therapeutic work has many advocates. One of its most insistent proponents, S.H. Foulkes suggests that group members can modify their extreme ways of coping by learning from and articulating their underlying feelings in the “network of relationships” . Foulkes suggests that the process which achieves this is a “working towards an ever more articulate form of communication” which “is identical to the therapeutic process itself” (Foulkes 1975 p11) This optimistic view of groups offers a positive starting ideal for a young person and of course a member of staff newly arrived at a children’s home.

The previously mentioned adverse criticism which residential group care has received in recent decades, and the emphasis which the social work profession has placed on “normalising” the experience of troubled children by identifying an over-riding need for them to remain in a family setting – whatever their individual predicament – either in their own natural family or in a substitute family, seemed to challenge the notion that residential group care could have any therapeutic value for emotionally troubled youngsters. Subsequent events have confirmed that many children were placed in residential care in the 1970s, should have remained in their own families or have been placed in substitute families. (Milham et al 1986) The decline in the numbers of children placed in residential care brought about by social policies designed to support children in their own community, was influenced by what Haydn Davies Jones refers to, with some ambivalence, as the “rediscovery of the importance of family and community in the growth of the child” as a response to “the Bowlby credo”. He also suggests that the subsequent numbers of children who have suffered multiple failures when placed in one substitute family after another indicates that the swing towards family placement has at times been indiscriminate. To counter this, he attempts to identify those children for whom group living may offer a helpful alternative nurturing environment. There are children he argues who, experiencing family breakdown in adolescence, are developmentally unable to take on a new family and find residential care with its opportunities for peer relationships, more congenial to their current needs. There are also those children who continually fail to respond to both family and substitute family care. They are the children who are the casualties of repeated family and foster family failure, and for whom the family has ceased to be the appropriate background for nurture. For Davies Jones these are children who are unable to respond to the intensity of relationships in families. In this latter group he includes those children, the victims of systematic physical, emotional and sexual abuse within a family setting, for whom family life has become too threatening, and indeed those children, who, notwithstanding the abuse they have experienced, retain emotional loyalties to the families from which they must nevertheless be protected. Davies Jones proposes that residential group care can provide these children with a nurturing experience which offers consistent primary caring, and what he calls the “exploiting” of the group living experience for positive therapeutic purposes. (Davies Jones 1981 p228)

David Challender places stress on the similarities of living in a family and living in a children’s home. Reflecting on his work with groups and dealing with their unconscious processes he observes that most children are brought up in a group setting, whether it be in the family, extended family, substitute family or in residential care. From the moment of birth most will experience close interaction with other human beings and will be progressively socialized by exposure to groups of other people, from family to friends and neighbours and then in playgroups and in schools. It is a lifelong process and adults rearing their own children will re-enact their own process of socialisation with the children entrusted to their care. (Challender 1999) Certainly psychoanalytic theory from Freud’s Oedipal propositions, through to Bowlby’s attachment theory emphasised the child’s primary need for attachment to another and socialisation. (Freud 1931; Bowlby 1976)

Young people in children’s homes are for the most part victims of a failure of this primary caring and socialisation process and life in a children’s home attempts to rekindle the process by providing a special primary carer, a role which will be considered in the next chapter, and by providing positive group experiences. (H. Davies Jones 1981)

Many kinds of group experiences take place in a children’s home. In some children’s homes therapeutic treatment groups, facilitated and led by specifically qualified therapists, are set up to achieve specific therapeutic goals, but in the ebb and flow of life in a children’s home there are always other groups forming, operating and breaking up. These are not specifically therapeutic groups, and though they can be formal as well as informal in nature, they are widely acknowledged as having therapeutic possibilities. (Aveline and Dryden 1988) These groupings represent the greater part of group life in a children’s home, and in a large measure define the context of all the group work in the vast majority of children’s homes. Since most of those who work in children’s home are not formally qualified to facilitate “group therapy” or indeed individual therapy, these non-specific therapeutic groups are a principal focus of this study. In addition to staff meetings, most children’s homes have regular formal meetings in which both children and staff participate. These have the function of organising living arrangements and responsibilities, reviewing recent events, sharing information and dealing with consequences of failed expectations and boundary breaking. In short, these meetings serve the purpose of achieving the institutional aims. There are also other formal meetings such as eating together at meal times, and, as in some children’s homes, attending class in the school room. There are groups formed in which only a small number of children and staff participate which may also involve others from outside the children’s home such as parents and social workers. Less formal sub- groups are continually assembling, dispersing and re-establishing for impromptu activity such as discussion or recreation.

It is this complex of groups which meets the child who enters a children’s home. Rose offers the reminder that the basic anxiety each child resident in a children’s home carries with him is triggered by the normal process that exists within any group. People leave, people arrive, and for all groups new problems are continuously being thrown up. (Rose 1990) However Dockar Drysdale suggests that children placed in children’s homes have not developed the repertoire of psychic responses that normal life experiences require. For them new arrivals are experienced as though they are actually displacing siblings, while familiar residents and staff leaving throw them back into their past traumas of loss and rejection. Consequently their reactions to these processes can be extreme. (Dockar Drysdale 1961) Nevertheless, as Rose points out, the milieu of a children’s homes is created in order to allow this to occur. (Rose 1990)

If one of the primary tasks of staff in a children’s home is to sustain the meaning and purpose of what seems such a potentially volatile group, can psychodynamic theory offer insight into how this might be achieved ? Freud, who did not differentiate between individual and group psychology, held that being a member of a group is a consequence of the group we are born into, or, have an attraction to, or an unconscious desire to be like the leader of the group. (Freud 1921) Fairbairn, in considering the development of social groups, suggests that such groups are sustained by libido and that the cohesion of a group is dependent on the extent to which libido is bound within the group, and the extent to which the group can exclude aggression from relationships within the group. For Fairbairn the roots of the social disintegration of a group lie in aggression. (Fairbairn 1935) Children resident in a children’s home are not living in their natural family setting and are rarely placed there because they are attracted by, or identify with the notion of living there. They are placed in a group care setting because their parenting figures have failed them, and consequently other adults have decided that they will stay there. These are pained, anxious, fearful, and at times, angry children. As Fairbairn suggests, these are elements which may not be conducive to a cohesive group and yet, as has been indicated, a primary function of a children’s home is to use the group setting to facilitate a child’s development from a state of emotionally painful anomie towards a position of identification with the home and the parenting it provides.

However, as Rose contends, while these overtly threatening elements can create a chaotic regressed infantile group, such a group is regarded as normal in a children’s home. Coping with this abnormal “normality” is the very essence of the therapeutic group task. Nevertheless, he suggests, even by those standards life becomes intolerably difficult, and that necessary solutions have to be developed, by clarifying so far unexpressed relationships, and attempting to begin to resolve the problems which arise from them. (Rose 1990)

Of course developing solutions in such an apparently chaotic environment is a problem for incoming staff, while a problem for established staff is to communicate a sense of purpose to new children as well as new staff. A great deal has been written about the efforts of those charged with developing a therapeutic group care setting to create an internal culture which facilitates personal growth and change among the members of such a group. (Balbirnie 1966; Bettelheim 1974) For the inexperienced residential child care worker, this helpfully speaks in practical language grounded in psychotherapeutic theory. Yet however well prepared a newcomer to residential group work with children may be at a conscious and rational level, the actual experience of the variance between the culture of the therapeutic group care setting and that of the wider community, is less easy to prepare for and to contain emotionally. Rose points out that a group of human beings rarely, and then only fleetingly, achieves perfection. The community of staff and residents in a children’s home is also subject to the rivalries which split families. He argues that the survival of a children’s home depends, just as the survival of a family would, on how it manages itself in the wider social context; how it responds to departures, separations, failures, betrayals, and human inadequacy. (Rose 1990)

It is not therefore surprising that for staff in children’s homes, the acting out behaviour which these issues engender in the resident group, seems to expend an inordinate amount of time and emotional energy. It can feel as if the children’s demands are endless and progress can seem non-existent. It may appear to be a child’s fervent wish to frustrate those who are most committed to his care, and to hurt those who persist in sustaining a caring relationship with him. In this state of conflict staff may experience what Shohet, in expanding upon the Kleinian concept, describes as “group projective identification” which may lead to “scapegoating”. In attempting to discard its frightening bad or unacceptable parts the staff group puts them into someone else. (Shohet 1999) Inevitably the question arises, “Can we sacrifice the needs of all the other children for the sake of one?” Clearly a negative response represents a failure of the holding environment.

If, as related literature suggests, the challenge for those striving to create and provide all that the children’s home should offer, is to create for children who have been emotionally deprived, a group living culture which they experience as emotionally dynamic and in which individual growth is encouraged to the extent that when on leaving the children’s home a young person is substantially able to cope with the vicissitudes of family or adult life, how will those entrusted to carry out the group care task be prepared and sustained in carrying it out?

As noted, Freud claimed that people are drawn into, and remain in groups because of emotional ties between members and that one of the principal processes effecting such an attraction is identification – the process by which a person seeks to be like his parents. Freud suggested that an individual introjects a preferred person or the qualities they like in that person, while at the same time projecting some of the bad or painful qualities of themselves on to others. Accordingly when each member of a group internalises the same qualities as the leader, they can identify with each other. (Freud 1921) Menzies Lyth, discussing the development of the self in children residing in institutions, suggests that it is through introjective identification that the development of the self takes place. In language which has a faint resonance of Social Learning Theory she contends that healthy development depends on the availability of appropriate models of individuals, relationships and situations for such identifications. While acknowledging that these models may be available to the children in the adults who care for them, importantly she stresses that the individual adult’s relationship with the children, together with the adults’ relationships with each other and the ambiance of the setting for care, are all also models for introjective identification. She recognizes too that a child’s healthy development may require the management of the child’s identification with inappropriate models, for example other children within the institution. She argues that children in the group living setting of an institution are likely to find the most significant models for identification within the institution as a whole, and in its sub-systems and in the individual children and staff. Like Bettelheim (1974), she sees this process as the basis of the concept of the institution as a therapeutic milieu whose primary task may be described as providing conditions for healthy development and providing therapy for emotionally damaged children. It follows then that all the child’s experiences in the institution contribute positively or negatively to the child’s development, not only through education, individual or group therapy or child care, but also by the more general features of the institution. Such an aggregate she argues, points to a need to take a wide view of an institution in assessing its effectiveness in carrying out its primary task. This assessment would include the whole way the institution functioned, its management structure, including its division into sub-systems and how these related to each other, the nature of authority and how that is operated, the social defence system built into the institution, and its culture and traditions. These then have to be considered in the context of how far they facilitate the provision of healthy models for identification, or alternatively inhibit the provision of such models. Although it is possible to regard the whole institution as the model, Menzies Lyth suggests that for the child the impact of the institution is in large measure mediated through its staff who are the individual models for identification. While individual staff have their own personalities with their differing strengths and weaknesses within the institution, she maintains that the extent to which individual staff are able to deploy their personalities, their different qualities, their strengths and weaknesses within the group care setting will depend on characteristics inherent in the institution. She maintains that due attention should therefore be given to the maximizing of the opportunities available for staff to deploy their capacities, and for it to be seen that children respond to them.
( Menzies Lyth 1985)

For Dockar Drysdale this symbiosis between the children and the staff can only be achieved by the staff having an awareness of the dynamics of the inner world of each of the children. (Dockar Drysdale 1959) A problem posed for the worker in a children’s home is how this awareness of the individual’s inner world can be separated out in a group setting.

Hinshelwood in his search to find out what happens in groups begins to explore this. He suggests that the group is “concerned with the transportation of stressful experiences between people”. This clause encapsulates life in a children’s home. He suggests that it represents a dynamic which can be understood as a “container” in the sense that projective identification, “the transportation of stressful experiences” towards another person is the phantasy that a part of one’s self has been removed to another who now contains it. Acknowledging this notion as Kleinian at source, but further elaborated by Winnicott and Bion he describes the construct as similar to the baby whose mental state is contained by the mother. (Hinshelwood 1987, p230)

Ganzarain elaborates upon this with a suggestion that the group can be experienced by its individual members as an entity representative of the mother and so in the group setting the individual may regress to an infantile interaction with the group, and since projective identification will be at work within the group this will also lead to the re-enactment of mother-infant interactions. Ganzarain suggests that as “internal objects are projected on to other individuals in the group in an attempt to force them into assuming desired roles, they are also projected on to the group entity”. (Ganzarain 1992 p205) As an embellishment of this concept it is also possible to view the group as a transitional object performing the holding function during the process of separation and individuation, in the sense that a transitional object is utilised to assist in passing from the state of being merged with the mother to being separate from the mother. (Winnicott 1988)

Bion developed a construct of the group performing a holding or containing function by describing the relationship between the container, (the group) and its contents, (the group members). He isolates three kinds of relationships. Firstly he describes a situation akin to an institution where there is a rigidly held social order, where the group as the container crushes its contents. Secondly he describes another akin to a revolutionary situation where an idea or a person destroys the established social order, and finally he describes a relationship in which the container and contents manage to accommodate each other so both are able to develop and grow. (Bion 1970) Hinshelwood suggests that while the first two relationships represent non-therapeutic containing, the third represents flexible therapeutic containing, in the same way as a mother, though pained by her child’s acute distress, holds the child’s feelings until her understanding is projected into the child so that he may grow as she does in the process. (Hinshelwood 1987)

Taking direction from Freud, Bion also proposed that the behaviour of an individual in a group is a critical indicator of the individual’s inner world. The inner world has dynamic processes, particularly fragmentation and integration. For Bion the defence mechanisms which individuals have, the denial of internal and external reality, splitting, projection and idealisation are evident in group situations. (Bion 1961) Robert M. Young appears to go further than this, by suggesting explanations of both group and social phenomena can be governed by the same principles which govern individual phenomena. (Young 1994)

It is possible to extrapolate from Bion’s work on groups certain principles which would inform the tension that exists for workers when they weigh up what is happening for the individual and what is happening for the group. Firstly Bion infers that the psychology of the individual is in essence group psychology. Each member’s behaviour influences the behaviour of others in the group. Secondly, if there is potential for a group to be released therapeutically, it is essential to recognise that the oscillating emotions of the group and its members have an impact on the apparently conscious expectations of each of its members. (Bion 1961) Young in describing his experience in groups communicates this process through what appears to have been painful personal experience. Remarking on the interaction and the amalgamation of the inner world of the individual and the inner world of the group, he infers that it is helpful for those who work in groups to be aware of the constant potential of a group to oscillate spontaneously from being a task oriented group to being a group “in the thrall of psychotic basic assumptions”. (Young 1994 p91) For all who work in children’s homes this resonates powerfully.

Bion observed how a group could swing from “work group mode” which, if sustained over a period of time offers the possibility of growth and development, to “group mentality” in which a connection is made to unacknowledged aspects – basic assumptions – of the individual group members. In this mode, time, growth, and task performance are lost. According to Bion each of the different basic assumptions which he specifies, throws up leaders who tend to be “elected” out of the operation of primitive group processes. (Bion 1961) Menzies Lyth saw these elections as arising as a consequence of a process of splitting off the unacknowledged facets of other individuals, and projecting them into the leader or an idea, agreement being reached rapidly and collusively as to which member or idea it should be. The individual who is “elected” is likely to find the natural characteristics which suited her for the role exaggerated by the involuntary acquisition of similar aspects by other members, until her own identity is almost obliterated. (Menzies Lyth 1989) This is a cautionary tale for workers caught up in a group and its processes, who find themselves engulfed in a situation where their role as both an externally appointed facilitator, and parental figure, with all the formal responsibilities these carry, may become confused by the role assigned them, or indeed to others, by the “group mentality”.
In a study which may to an extent be adumbrated by the behaviourist or cognitive quality of requiring an observable, and preferably positive result, Duffy and McCarthy, working with young women in a residential setting suggest that the group processes described by Bion, if managed judiciously during the routine and ritual meetings of the group can encourage individual emotional growth. It is their view that development is possible in a situation where two conflicting messages, those of confrontation and support, are simultaneously experienced. When this occurs individuals become able to take more responsibility for their actions and sustain changes subsequent to the group. Though conceding that the group may be influenced by both adolescent energy and adolescent alertness, they argue if the staff group leader and the staff can contain the changing culture of the group by feeding it back immediately, so the group culture switches from “that of the streets, to the domestic, to the judicial court, much as in the same way as Bion describes his adult group switching from a theocracy to a playgroup” (Duffy & McCarthy 1998 p154 ; Bion 1961) For Duffy and McCarthy if these energies are held within the group by competent facilitation, then positive changes of atmosphere were evident in the overall life of the group. (Duffy & McCarthy 1998)

Just as there is a concern for residential child care workers – untrained and ill-informed as they often are about group dynamics, and forced all too frequently to fall back on what Ward describes as “intuition” that “is not enough” – carrying out the role of facilitator in both formal and informal group settings, in the same way there is also concern for the manager of the home carrying out her group leadership role. Ward notes the intense pressures for the manager to stay on task at the same time as staying in touch with the individual and collective anxieties within the home. (Ward 1998) Rose observes that though the pronounced reliance of children and staff on one charismatic leader has been viewed with concern in recent times, children and staff invest a great deal of significance in the person who is the head of the home. This is a phenomenon which is widely evidenced and of course would not have surprised Freud ! Rose however suggests that if the leader is too overtly significant then the staff may begin to feel less mature than before they came to the children’s home. Nonetheless, given that the leader can hold to the kind of position Duffy and McCarthy describe, for Rose it becomes important that the leader should not underestimate or retreat from the dynamic significance of her leadership role in the overall group, or the young people will cease to be held to the therapeutic task. At the same time he maintains the necessity for continual dialogue between the head and staff about the centrality of the leader’s role, for if this ceases, then individual members of staff begin to act out feelings in the ways that seem to imitate the young people, and where there is conflict between the staff and the leader, anxiety is fuelled among the children, excited by their early experience of parents in conflict. (Rose, M. 1990 p52-3) Menzies Lyth goes further and stresses that by entrusting responsibility to non-management staff, they are enabled to provide positive ego, superego and defensive models which are fundamentally important to emotionally disturbed children whose personality development is immature and damaged. The ego and superego strength of staff having been fostered by the delegation of management tasks allows them the opportunity to demonstrate it to the children effectively, who in turn, she argues, become more able to be involved in control over their own circumstances and are given less opportunity to consider themselves as helpless and victims of uncontrollable circumstances. Pertinently she suggests insecure staff will make insecure children feel even more insecure, more anxious, and inevitably, less predictable. In a regime which manages delegation of tasks efficiently, it is, she continues, possible to achieve consistency and to avoid presenting children with conflicting and confusing messages. (Menzies Lyth 1989).

In summary, if child care workers are able to acknowledge the therapeutic possibilities of the group – a group consisting of workers as well as children – and to recognize the complexity of the group’s dynamic, as indicated by the theoretical stances which have been explored, so it becomes possible for them to understand how the group’s behaviour mirrors the unexpressed feelings of its individual members. A worker’s recognition of this process might enable her to be closer in touch with each of the young people’s specific emotional needs and so help her become clearer about them.

A residential child care worker operates as a group worker in a special way. Her work cannot merely be seen as a timetabled task in a busy week, although some of it may take that form. It is much more a continuous involvement with a living group to which the worker and her colleagues belong, and which gives them opportunities to intervene for caring therapeutic purposes. Since workers are so much part of the children’s life they are experiencing the conflict which can envelop the group, and though at times life in a children’s home seems to be an endless round of quarrel and crisis, as a consideration of some psychoanalytic theory has shown, these conflicts often represent crucial issues in child development. Veiled in the projective petty bickering, shouting and acting out within the group, may be poignant questions concerning separation anxiety, identity, sexuality, social inability and other emotive issues. From this it can be seen that the worker’s task is to use these conflicts constructively, and in a paradoxical sense to welcome them because used skilfully they can be a means of helping children acquire fresh learning, better ways of coping and some self-awareness.

As has been seen there are dangers as well as opportunities in working with groups and it demands insight and skill from the worker. The dynamic of the group encompasses processes that can hurt and damage individuals within the group if they are not husbanded towards help and care.

 

Chapter 3: Individual needs: the “one-to-one” child and adult relationship within the group care setting.

Dockar Drysdale, a powerful advocate of residential group work, offers the reminder that one of the most frustrating and difficult situations in residential work is to find that, having established contact with a young person on an individual basis, it can be difficult to maintain this in the life of the group. The opportunities to work with individual children can be so limited that it is easy for the fragile bond between young person and worker to be broken in the stress and strain of the group situation. (Dockar Drysdale 1990)

Winnicott suggests that the capacity to be alone is based on the successful experience of being alone in the presence of someone. (Winnicott 1965) Though it is certain that young people in the midst of emotional crisis when first placed in a children’s home may find individual engagement with a member of staff much more threatening than being in the group setting, Gianna Henry offers the reminder that often tears are not tolerated in the group culture of a children’s home. They may be “silenced by loud music or by eating vast amounts” but the crying child reminds the others of “the weak and more vulnerable and tender part of themselves”. (Henry 1995, p6) Clearly the worker trying to facilitate the process of helping a distressed child get in touch with his painful feelings in these instances is unlikely, initially at least, to find the group setting sufficiently helpful.

Much of the criticism of residential child care has been based on the possibility of the depersonalizing nature of group living, and while as has been noted, Bion amongst others has argued that the individual’s inner world can be given expression through the unconscious dynamic of the group, (a process, Bion suggests, which if adequately facilitated can lead to positive therapeutic gain for the individual), (Bion 1961), Kennard observes, as he considers the future of Therapeutic Communities, the existence of a contemporary momentum within health and social services which emphasises the “centrality of the individual”. He proposes that the therapeutic group care movement needs to complement the core concepts and skills which it has developed in the group care setting, with an approach which acknowledges and serves the needs of the individual. (Kennard 1998) What Kennard seems to overlook, locked it seems in a defensive position in the face of mighty empires of health and social services, is that a such a dual approach may already be the kernel of therapeutic group care.

Rose, acknowledging a responsibility to work with a young person both as an individual and as a member of a group, believes that unblocking the way to personal freedom and eventual personal fulfilment is achieved in large part as a consequence of work between a young person and his special worker. He suggests that a principal therapeutic task for a worker is to address the reality of pain and inadequacy experienced by a young person, and speaks of the probability that such an engagement is most likely to take place in an informal individual context. (Rose 1990) The essence of such an engagement is illustrated by Fritz Redl recalling his work with troubled children as the Director of the Pioneer Project in Detroit during the 1950s. Redl contends that troubled children cannot always cope with, or make themselves available for, what he calls the “pressurized-cabin style” of “classical” child analysis either as a member of a group or as an individual. Redl insists that even in a group living setting, the most valuable therapeutic time is made available when adults are given the opportunity to interact individually with a child at any given time in his daily life experience. Redl sees such interaction at certain times in a child’s life, as being less threatening since it occurs more naturally than in the timetabled artifice of the “therapeutic hour”. Redl describes this engagement as the “life space interview”. Redl argues that what happens in this interview is held by somebody who, though not in the strictest terms the child’s therapist, has to exercise subtle strategies and techniques in the same way as the psychoanalyst during the course of the therapeutic hour. Although Redl breaks down the life space interview into numerous elements, with his own unique nomenclature, – for examples: “drain-off of frustration acidity” ; “reality rub in” ; “new tool salesmanship”, and the more self-explanatory, “support for the management of panic,fury and guilt”; “symptom estrangement” and, “ego proximity and issue clarity” – he principally views the life space interview as, in the long term, an opportunity for “the clinical exploitation of life events” or, in the short term, as an opportunity to provide “emotional first aid on the spot”. For Redl the decision about which of these two directions an interview will take depends on the situation which has arisen, and the worker’s interpretation of the potential of the situation. (Redl 1966 pp42-48) This places a great deal of expectation and responsibility in the individual staff member. Aichorn , the first to set up a residential therapeutic group project strictly based on psychoanalytic principles, also based his work on the recognition that the therapeutic spirit of the project’s had to be centred in the care staff . For Aichorn it was not enough to comprehend at a conscious level what the child was saying and doing. The workers had to be able to “live” themselves into the situation so that the child’s experiences become their own. (Aichorn) This appears to get to the core of the therapeutic approach but begs the question, “How does the worker achieve this without being emotionally destroyed herself?”

Accepted psychotherapeutic practice would counsel the worker to be aware of the projection and transference in her relationship with a child. To an extent Laing, discussing the treatment of adult schizophrenics warns against adopting an intellectual, scientific defence in such a situation. This, he argues divorces the therapist from the therapee and restricts the possibilities of effective therapy. Laing seems also to imply that someone who has come close to a schizophrenic experience, and who has recovered, is more likely to understand the schizophrenic patient. (Laing 1961)While many in residential child care would be sympathetic to Laing’s warning about professional defences, Bettelheim specifically referring to Laing, takes a more cautious view of his suggestion that it is advantageous to have shared the experience of someone who is emotionally troubled. Bettelheim argues that while a worker may have experienced a psychotic state similar to that which a child is going through, and may therefore have more spontaneous sympathy for such a child, it is likely she will have very little empathy since, he argues, psychosis is unique to the individual and can only be understood from what the individual has experienced. For Bettelheim it is essential that such a worker would have to be able to place sufficient distance between her own experience and that of the child’s. Bettelheim, no doubt reflecting the influence of ego-centred psychoanalytic culture in the United States of America, insists that it is important for therapeutic child care workers to have a strong and well integrated ego so that it cannot be overwhelmed by the worker’s own primary forces or by exposure to the child’s. (Bettelheim 1974 p283)

Concerned objectivity of the kind espoused by Bettelheim is always difficult to achieve, Staff need to be helped to become aware of their own feelings and prejudices in order to step aside from their influence and stay in touch with the therapeutic task. Rose warns that it takes a long time to establish a staff attitude that is predominantly therapeutic. The staff also need to view a young person’s behaviour in terms of what it reveals without therapeutic need. At one time a young person may need control. At another it would be important to understand that even bizarre behaviour is only an unconscious attempt to manifest internal confusion or fear. Thus behaviour provides an opportunity for the member of staff to help relieve anxiety, or to help the young person clarify what he is actually feeling for the purpose of advancing the process of long term therapeutic gain. (Rose 1990)

The residential child care worker will more speedily cultivate an appropriate balance in her therapeutic and caring relationship with a child if she can begin to have an understanding of the underlying aspects of a child’s personality, which make her feel the way she does about him and him feel the way he does about her. Here psychoanalytic theory with its emphasis on psychic development may have value for the worker, as may also classical psychoanalytic practice, in its emphasis not only on the individual therapee but also in its post- Freudian recognition that the influence of the therapee on the therapist is an analytical measure. That part of a residential worker’s role which is to reflect on her interaction with an individual child, may find that the foundation of her work will rest firmly in Freud’s theory of the unconscious. (Freud 1915) His theories of child development are also foundations on which lie the work of later psychoanalytic theorists. (Freud 1905) Recent and increased concern about the prevalence of sexual abuse, both in family and institutional settings, has led to critical resistance in the social work profession as a whole, and in earlier feminist thinkers, (For example, Rush 1977) not only to some issues of gender in some aspects of his theory on early childhood development, but also of the wider influence of his later ambivalence about seduction theory. (Freud 1897-1904). From a theoretical and practice position, the workers, critical of Freud’s position, are in the company of Jung and Ferenczi (Jung 1912; Ferenczi 1932), but a more plausible explanation of their resistance may be that frequent exposure to the emotions of children who have been sexually abused arouses uncomfortable feelings from the workers’ own pasts.

A safer and less contentious start of a consideration of individual development, may be Erikson’s psychosocial theory of development throughout life. Like Freud, Erikson proposes that children move through phases, but unlike Freud, who argues that infants and young children must gratify staged impulses, including the oral, the anal and the pre-genital phases, Erikson substitutes impulses which must be gratified, for issues that have to be dealt with through a sequence of stages. Freud believes that if impulses remain ungratified then infantile behaviours are likely to continue into adulthood. Erikson suggests that throughout life each of us has to contend with important issues which include, amongst others, how to trust ourselves, trust others, what our identity is, and how we can be intimate with others. Erikson believes failure to resolve an issue when it is critical, has long term effects on our self-concept and on our relationships. What both Freud and Erikson offer those caring for a troubled child is the insight that the socially difficult and sometimes challenging behaviour of a child, represents a transference of feelings which is rooted in the child’s past experience and not in the present. (Erikson 1950)

D.W.Winnicott and Melanie Klein place less emphasis on chronological aspects of developmental constructs. They are more cognizant of the influence the external world has – over which the child has little control – on the child’s inner world. Children placed in children’s homes have varying degrees of emotional disturbance, and each has a unique individual emotional predicament which is more associated to trauma experienced at any time, or times, in childhood, than it is to chronological age. Winnicott and Klein, in offering explanations of how each child’s emotional development is qualitatively and quantitatively different, can help workers understand that the experience of each child is unique and that each child should be cared for accordingly. (Winnicott 1960; Klein 1921, 1946) Winnicott’s stance on the emotional development of the child introduces the concept of the process of integration, a position, he argues, which is fundamental to healthy emotional development. It is engendered by a mother’s acceptance of the entire range of the instinctual feelings in the child, from anger at frustration, to love at the fulfilment of his basic needs. Winnicott believes that the process towards integration occurs during the period when the baby is dependent on the mother. At this time he argues that the mother is preoccupied by her baby. She identifies with him and anticipates his needs. It is her demonstration of love for the child, while he manifests a range of hostile feelings, her containment of his feelings through these negative episodes, her provision of good experiences, and her consistency throughout this period which leads to successful integration of the personality and to individuation. Winnicott suggests that through this period the preoccupied mother is providing a “holding environment”. This resonates of Bion’s notion of the mother, in a state of maternal reverie as the container of emotions. (Maher, A. 1999) Winnicott argues that the source of any consequent emotional disorder will lie not in the child but in the failure of the “holding environment”. For workers in children’s home this helps situate the significance of seeing a child not simply as a member of a group but as an individual, particularly when a child, struggling with conflicts within his inner world, is impelled towards conflict with his outer world. Workers who provide emotional containment or holding for the child in the face of negative interaction with the group, may provide hope for the child. Accordingly it was Winnicott’s view that the emotionally troubled child placed in a children’s home must be in an environment in which the child is provided with an adult who is specifically committed to him. (Winnicott 1965)

Rose, while considering some of the limitations of group work agrees that there are needs which can only be fulfilled through a child’s relationship with a special worker. At Peper Harrow, where Rose worked, such a worker was termed a “guru” and in other children’s homes they have been known as “keyworkers” and “link workers”. (Rose 1990) It is a paradox that social work literature subsequent to the 1989 Children Act tends to emphasise the administrative tasks of a special worker, potentially therapeutic as they may be, such as writing reports, convening case conferences, keeping case records, and making sure the child attends outside appointments, while legislative guidelines place the building of a trusting relationship with a young person at the core of the residential worker’s responsibilities. (Whitaker et al 1998) Rose maintains that in a children’s home the relationship between the child and the special worker is critical to the therapeutic task. He points out that though the special worker is rarely a trained therapist, she will have to contend with transference phenomena which might test the most insightful of psychoanalysts. However Rose believes that for the child newly arrived at a children’s home, the special worker should be first a kind of companion and limit her therapeutic role to that of listener, and to become a person with whom the child can begin to practise his ability to trust. She will become a person who is to be tested to find out if she will eventually be rejecting. In time however, supported by personal supervision to discriminate between what she feels and what she thinks the child feels, the special worker will begin to hope for emotional growth in the child, but will be able to see such growth as not solely a consequence of her influence on the child but also as a consequence of the impact on the child’s life of all the children’s home’s resources. (Rose 1990)

Another function of the special worker is to provide consistent care for the child who has experienced life as a series of unpredictable physical and emotional disruptions. Winnicott believes that if what he calls “ continuity of being” for the infant is broken, healthy development is checked. He sees “continuity of being” as a biological process ongoing in the face of emotional setbacks, and also as a continuity of experiences for the child in relationship with his mother. He argues that during the stage of total dependence on the mother and during the stage of relative dependence, the infant’s emotional health develops and proportionally, so does his inherent potential to grow as an individual. (Winnicott1988) Few children in homes have experienced a continuity of being with a mother or mother substitute, and all too few realise their inherent potential. (DoH 1998)
Erikson, as we have learnt, considers that the realisation of inherent potential to grow as an individual is achieved by the mastery of a series of developmental issues, and so a satisfactory outcome of an infant’s first challenging situation is also vital. Erikson suggests for the infant, the achievement of a separate identity is dependent on the infant’s experience of good mothering. Erikson and Winnicott offer similar explanations of the struggle an emotionally deprived child experiences to develop a sense of identity. Erikson represents identity as the individual’s ability to experience himself as a being who has continuity and sameness and who can act accordingly. The achievement of self-esteem depends on attaining this sense of identity. Erikson believes the children who miss this experience are prevented from developing a defined self. (Erikson 1968)

For Winnicott the emotionally deprived child experiences his mother as rejecting when he exhibits aggressive feelings, and consequently rage and hostility becomes unacceptable to such a child. This child does not succeed in recognizing or accepting his aggressive feelings and continues through childhood, adolescence and adulthood to deny them or project them on to others. (Winnicott 1975) Winnicott describing what a child must experience to develop tender feelings, also offers an explanation of how a child may fail to demonstrate concern for others or to show regret for his hostile behaviour. In tolerating such behaviour, the residential child care worker begins a process which attempts to ameliorate earlier rejection and offers re-assurance and hope to the child.

Melanie Klein also emphasises the significance of the child’s relationship with his mother in influencing his relationships with other people. For Klein the child perceives people as he perceives his mother, and whether he regards people as friendly or hostile depends upon his infantile experience of his mother. Winnicott and Klein agree that this determines how his relationships with others develop. Klein’s explanation of integration describes the infant’s anxiety when there is discomfort or frustration in his relationship with his mother. This anxiety gives way to feelings of comfort at being held and fed, feelings which the infant perceives as coming from a good object. Klein believes that an infant’s perception about the objects he needs is shaped not only by external reality, but by his phantasies about them. In phantasy he splits the good object, the good and satisfying mother, from the bad object which frustrates him so that he can accept what is good and disown his hostile feelings which he projects on to the bad object. For Klein, this perception allows the infant to have a loving relationship with another person. As this perception deepens, he is increasingly able to tolerate and accept as his own, residual feelings of hostility or envy at the omnipotence of the mother, and his anger at the inevitable frustrations. In Klein’s model of the integration process, the infant with the good mother becomes able to tolerate loving and hating in the same object without splitting and projection. The infant starts to appreciate his own goodness as he appreciates goodness in someone else close to him, like his mother. He can also accept his own negative feelings because experiences within the infant-mother relationship show that these feelings are not destructive. As the infant perceives these feelings as less threatening, the negative feelings are more acceptable, and less splitting occurs. (Klein 1921)

A significant feature of Kleinian theory when considering children in residential care, is that it offers an explanation of why the emotionally deprived or unintegrated child projects hostile and aggressive feelings on to other people. By using projection as a defence mechanism and thus attributing their own unacceptable feelings to others, the child can disclaim them and deny any responsibility for events which may occur as a consequence of any episodes of their hostile behaviour. Failure in the worker to recognise this projection from an unintegrated child, has the potential to destroy her relationship with the child.

Not all young people in a children’s home are unintegrated. Many show, despite their acting out behaviours, that they have the potential for developing loving relationships. Such a child is often the one who raises most staff anxieties and is mistakenly labelled unintegrated. Winnicott connects the behaviour and anti-social attitudes of such a child with deprivation during infancy, but he sees the acting out behaviour in such a case as that of a child who experienced something which in terms of nurturing in infancy and childhood which was “good enough” but was then denied it. For this child Winnicott suggests that there has been sufficient growth and organisation of the individual at the time of the deprivation for the child to be aware that he has lost something. Accordingly the deprivation is traumatic. The child has been led to hope that his world was a good place. When the deprivation occurs, the child experiences a feeling of hopelessness which he expresses in anti-social behaviour. Winnicott regards this anti-social behaviour as the child’s claim upon the environment which he perceives as owing him something. The extraordinary demands which such a child makes on those charged with his care – especially any adult whom he suspects may be able to help him – are seen by Winnicott as an expression of hope that the environment will be able to meet his demands and repair the original failure. A perception of the demanding behaviour as communicating a sense of hope, offers a signal that the child has not abandoned his attempt to recover. (Winnicott 1961)

Adrian Ward suggests that for the worker who perceives herself as the sole target of a child’s demanding acting out behaviour, and who has no sense of the child’s inner world, the unconscious part of the child’s communication will not be seen as a projection of the child’s feelings on to the worker. The worker who is aware of this projection, and perceives it as a transference based on the child’s previous experience of significant adults, usually his parents, may by reflecting on her own feelings about the child, that is her counter-transference, come to understand why she feels protective towards the child, while with another she may feel angry and, with yet another feel helpless and hopeless. (Ward 1998) In the latter scenario the development of a healthy relationship between the child and the worker will remain a possibility while in the former it will remain improbable.

In choosing to work in a children’s home, a residential worker will have many unconscious motivations in addition to their objective intentions. Rose contends that the supposed activity of addressing the problems of young people can also become a vicarious way of supposed self-examination. The member of staff may never have fully resolved issues of authority and of discipline, and may have unresolved dilemmas from her own childhood or adolescence. Unconsciously at least identification with the rebellious or the abused child and the opportunity to pay exceptional attention to a child’s unconscious processes offer staff respectable ways of addressing their own problems. Like the young people staff are resistant to addressing painful and frightening psychic dilemmas directly. Yet, having to deal with such problems daily inevitably stirs up their inner world. The member of staff may not be aware of any unconscious tendency to approach his own problems through the young people. Yet, with proper supervision, the member of staff can increasingly recognize the difference between the young person’s problems and her own. The gradual and ongoing clarification of her unconscious motivations is also of great maturational significance for the member of staff personally. As it occurs, so her objective attention to the young person becomes enhanced. Their separate but mutual journey can then become of mutual value. The member of staff will be in closer touch with her own most vulnerable feelings – such as inadequacy or helplessness – as well as with those of the young person. (Rose 1990)

If, as Ward infers, workers become able to recognise these processes of projection and transference and begin to experience them as helpful – however incredible and extraordinary such a suggestion might seem – in gaining an insight into the child’s inner world, and if at the same time as Winnicott suggests they can see such projection and transference as a hopeful response, then it becomes possible that a trusting child-adult relationship, a relationship between two individuals, incidentally of the kind recommended by legislative guidance, can be attained. More importantly such a primary relationship may contain the child sufficiently while he come to terms with his inner conflicts.

As demonstrated, theorists stress the importance of early primary caring relationships in the development of an individual. It is also important to emphasise the critical place a primary caring relationship with a special worker may have in the life of the child placed in a children’s home. It is the residential child care worker’s role to introduce or re-introduce the experience of good primary care to the child, in the face of any resistance she might meet from forces within and without the home. By close and assured involvement in the daily life of a child the worker has an opportunity to begin to make good emotional deficits. Winnicott suggests that by providing this primary experience, the child’s dependency, independency and expressive needs are supported. (Winnicott 1965)

The child in residential care is dependent, his cry for help may come at any time, and be expressed in many different ways. It seems possible that psychoanalytic theory can offer a rationale for what lies behind the cry for help, while psychoanalytic practice may offer way of recognising it and responding to it.

 

 

Chapter 4 Adolescence : the phenomenon of adolescence as an experience for the young person and the parenting figure.

It is a personal view that there are times when it seems that those who work with emotionally troubled young people are inclined to give, it is to be hoped unwittingly, an impression to others not involved with their work, that the youngsters with whom they are involved do not share any normal developmental phenomena with those of their peers in the wider community. Hard pressed workers may find it difficult at times to recall those healthy parts of a youngster. Yet young people in children’s homes grow physically in the way that children who live with their families do. They idolise the same youth culture heroes. They agonise about their appearance. They worry about their sexuality as they struggle to find their adult identity .and they do know all the answers. Like others of their age and culture they are experiencing adolescence. They exasperate their parenting figures, and fill them simultaneously with envy, joy and pride in their youth, idealism and creativity. Somewhat whimsically Winnicott has suggested that the “one real cure for adolescence is the passage of time”. (Winnicott 1965).

Adolescence has been likened to the individuation process in infancy. Where the infant is becoming aware of being a separate person,, the adolescent is physically and emotionally engulfed in becoming a unique adult. (Anderson and Dartington 1998) Certainly Klein’s description of projective identification bound up in the development processes in early infancy might also be seen as valid for the renaissance and search for identity that is adolescence. It is a period when splitting is at its zenith and persecutory anxiety is dominant. The ego is unintegrated, (perhaps for the moment in the context of the adolescent, if the analogy is allowed !), and “liable to split itself, its emotions and its internal objects, but splitting is also one of the fundamental defences against persecutory anxiety.” This according to Klein comes along with other defences including idealisation, denial and omnipotence over internal and external objects! (Klein 1946 pp311-312) These are important notions to retain when considering emotionally troubled adolescents. Young widens the aspect when suggesting that in all of life’s stages a person has a Winnicottian transitional object. Thus the adolescent, who, possessing objects which may represent contemporary youth fads and fashions turns to them, if less intensely than to those of infancy, to ward off feelings of depressive anxiety. (Young 1994) Just as Young points out that the advertising, and no doubt marketing industries have exploited this need for comfort, so earlier Erikson suggested that the technological developments in post – World War II western culture have put more time between early school life and a young person’s eventual entry into the world of work. Erikson argues that this has made the stage of adolescence a more marked and conscious period. Accordingly young people beset as they are by physiological changes brought about by genital maturation, and by their uncertainty about future adult roles, seem concerned with creating a subculture with what looks like a final rather than a transitory initial identity formation. Erikson, also argues that in their search for a new sense of continuity and sameness which now includes sexual maturity, some adolescents have to confront again the crises of early childhood, and for all there is a need for a “moratorium for the integration of the identity elements ……only that now a larger unit, vague in its outline and yet immediate in its demands, replaces the childhood milieu – ‘ society’. ” (Erikson 1968, p 128)

For Erikson these identity elements are also a catalogue of adolescent problems. They include the adolescent’s need for human beings and ideas to have faith in; the need to be defined by what he can will freely; the fear of participation in unavoidable responsibilities which might expose him to ridicule and doubt; a willingness to place trust in peers; leading as well as misleading elders who might give imaginative scope to his aspirations, while objecting violently to what are perceived as pedantic limitations on his self- image. Erikson suggests that adolescence is least tempestuous for the adolescent who is well prepared for the prevailing cultural ideology, and for Erikson this is technological and economic. It is the ideological potential of a society which most powerfully influences the adolescent as he seeks the affirmation of his peers and favoured elders and aspires to do what he feels is worthwhile in life. For the adolescent not so prepared the environment appears vigorous in barring all the forms of expression which allow him to develop and integrate to the next step and he may resist his environment with equal ferocity. (Erikson 1968)

Winnicott indirectly acknowledges these elements by holding that it is necessary for society “to be shaken by the aspirations of those who are not responsible” though he places the adolescent struggle in a less sociological context than Erikson, and believed, as has been indicated, given the due progress of the maturation processes, that a mature adult will emerge. (Winnicott 1971) His notion of the adolescent phenomenon is more approximate to an Oedipal position, although for Winnicott the adolescent does not wish to murder one parent and possess the other, but he desires the death of both, at the same time of course wishing for their survival. While recognising the similarities with the individuation process in infancy, Winnicott understands the adolescent process as much more powerfully driven. The simultaneous development of forceful sexual feelings and physical power gives the adolescent a potency “to destroy and even to kill” which was absent from the young child’s feelings of hatred. (Winnicott1965) Somewhat less dramatically Dubinsky suggests that physical and sexual maturation offers the promise of a place in a new adult generation which will be better than their parents’ generation. This exaggerated wish to be better than the parents rekindles infantile Oedipal rivalries with both parents and siblings. Dubinsky believes that these powerful re-evoked feelings may be “I want to be stronger and more powerful than my father”, or “ I want to be more attractive than my mother and to be a better mother than her” or indeed, “ I want to be the favourite child”. (Dubinsky 1998 p99)

Winnicott suggests that aggression is a necessary characteristic of the adolescent. The fantasy that he can only become an adult “over the dead body of an adult” implies that “somewhere in the background there is a life and death struggle”. An important contribution from Winnicott is his notion that what is important about the adolescent process will be lost if there is not a confrontation between the adolescent and the parenting figures. If the positive development is to be made the adolescent cannot be allowed to evade the resolutions. He has “to feel real or to tolerate not feeling at all”. The adolescent should be given space to feel defiant in a setting in which his dependence can be consistently met. According to Winnicott it is vital for the parenting figure to permit the adolescent to be immature, even if this is not apparent to the adolescent. “Immaturity is an essential element of the health at adolescence…..in this is constrained the most exciting features of creative thought, new and fresh feeling, ideas for new living”. (Winnicott1971 p45) What Winnicott is bringing to light is that both generations go through the “adolescence” process. It is a uniquely new situation for both, and both have a positive role to play in it. To grow, a young person strives consciously and unconsciously for an adult identity, but this individual process is also important for society if it is to remain dynamic. The vital parenting role is to contain this energy so that it does not become destructive. For Winnicott, adults who recoil in the face of this energy may channel the adolescent towards premature and false adulthood. (Winnicott 1971).

In essence Winnicott’s position allows the residential child care worker to value without incongruity, and to give herself space for, her reflective objective professional role and her adult parenting identity. Just as it is vital for the worker to recognise an anti-social response as a consequence of disturbed emotional development, so it is important to recognise those healthy areas of the inter-generational conflict and to react and act accordingly. The relationship between the young person and an adult is complex. The adolescent provokes feelings in an adult of envy as well as disapproval. The youngster is as Winnicott indicated, dependent on the adults about whom they have powerful ambivalent feelings. Anderson and Dartington though observing the projection towards the parenting figures, which seems to compel the adults to react to the youngster, yet often making adults feel they are behaving out of character, behaving at their worst, and thus leaving the adults feeling helpless, do invoke Winnicott by maintaining that this is not simply a burden the parenting figure must bear, but also “a forum for this adult/adolescent interaction, in which important aspects of adolescent development are taking place”. (Anderson and Dartington 1998 p4)

The adolescent’s uneasy relationship with the adult world is the milieu in which residential child care workers must cope. The worker should sympathise deeply with the adolescent, should care enough to have endless patience to stay up all night with the young person who needs containment just as they should be glad to share social and recreational time with them. However they must allow themselves reflective space. Rose like Bettelheim cautions against mere sympathy. The same disturbed adolescent who stirs up so much commitment from a residential child care worker may, as has been observed, still lurk within the worker, and the group dynamics of a children’s home tends to make the adults a little regressed. So the worker should be prepared to reflect on her own passage towards adulthood back to where the adolescent stands paralysed, but she must only do so to lead the adolescent towards adulthood, and not rejoin the young person in the adolescent state.(Rose 1990) Erikson points to all the developmental stages from birth to death. The adult too, must continue to grow. (Erikson 1950) She also has responsibilities to find space for forming relationships in all the areas of her life, perhaps with her own children.

Socially inclusive as the residential child care worker is rightly encouraged to be, she must remain aware that the adolescent problems of young people resident in a children’s home are exacerbated by inadequate psychological development during infancy and childhood. The inner world of such an adolescent is so painful he is fiercely resistant to even the most sensitive therapeutic concern. Rose points out that the source of the adolescent’s disturbance is the fear of uncontrollable impulses, like rage or panic stirred by the memory of horrific and incomprehensible abuse which he has repeatedly experienced. (Rose 1990) Such an abused adolescent may be further confused by his inability to separate aspects of the abusive assaults which may have engendered pleasure and excitement, from those parts which were agonising and terrifying. Such a young person may resist the adolescence processes since he finds it painful to identify with adults or adulthood.

Jeremy Holmes suggests that an adolescent’s resistance to dealing with the pain of issues from early childhood may also be linked to disrupted attachment. Bowlby’s theory of attachment, Holmes argues, anticipates contrasting pathways of development which are related to secure or insecure attachment. The securely attached adolescent has both an internal and external “secure base” to which he can return when under threat; this allows him to explore his inner and outer worlds. There is a connection between secure attachment in childhood and the capacity in the adolescent for what Holmes calls “autobiographical competence”(Holmes 1996 p) Whereas the secure adolescent is fluent, coherent and apposite when describing their childhood attachments, insecurely attached adolescents, having no secure base to return to are encumbered by an “unresolved narrative style” (Holmes 1996,unpaginated) exemplified by breaks in narrative continuity and logical flow. These disorganised patterns are to be found in adolescents who have experienced severe deprivation or trauma. Where Winnicott suggests that these adolescents resist development towards adulthood. Holmes argues that they cannot achieve a “dis-identification” (Holmes 1996 , unpaginated.) from their childhood because they have not achieved coherence and cogency.

Holmes claims that secure attachment is achieved in those situations where the parenting figure is attuned to the mood states of an infant. This involves mutual play and emotional involvement at the same time as accepting the child to be a unique individual with his own “nascent self”.(Holmes 1996, unpaginated) Such parenting figures will allow a child’s protests at times of distress or separation without retaliation or recrimination. Here it is possible to see a conjunction of Bowlby’s secure attachment, with Winnicott’s “holding environment” and Bion’s “containing mother”. For Holmes it is the notion of attunement in attachment which links attachment to other psychoanalytic processes. He suggests Winnicott’s emphasis on “hate” and how that is handled, and its significance in the development of self can be linked with the notion of protest as the foundation of autonomy. (Holmes 1996 ; Bowlby 1981; Winnicott1958) This of course connects also to Winnicott’s previously noted idea of the adolescent simultaneously needing to murder the parenting figures while requiring them to survive. If the emotionally deprived, insecurely attached adolescent in a children’s home needs therapeutic space to be helped breach those gaps in his “narrative” continuity, then the worker has in the first instance to provide substitute parenting which encompasses acceptance of “protest” without rigid recriminatory response.

Clare Winnicott too, emphasises the criticality of the residential child care worker’s adoption of an attitude of acceptance in the face of an adolescent’s emotional maelstrom. In attempting to clarify this quality, she suggests that residential child care workers must understand that “Acceptance goes very deep. It is not a passive thing, but an active effort on the part of the worker to know the individual as he is, as a person in his own right, with his own life to live, and his own intrinsic value as a human being. This does not mean that we accept or approve all that an individual does or says, but that we try to reach behind the delinquent act and the deceitful language to the suffering in the human being which causes the symptoms that we see. Acceptance in this sense is in itself a basic therapeutic experience. For one thing it is the opposite of rejection, but in a more positive way it implies to the individual a sense of value, of worth, which is essential to life.” (Winnicott,C. 1964, pp28-29)

In offering this acceptance in a parenting role consistently it becomes possible for the worker’s relationship with the adolescent to become “therapeutic”. Provided with an environment where an expression of protest against past experiences can be safely made, the adolescent can begin to develop an identity and autonomy, and express these in a socially safe way.

 

Conclusions

Psychoanalytic theory has much to offer to the work of children’s homes, not only in the sense of explaining the psychodynamic processes at work, but also in informing how workers may help children. However one of the attractions of psychoanalytic discourse, but one of its problems in a work setting where managing organisations are looking for results, is its encompassing of conflict and contradiction as central issues in human life. It offers explanations but it does not offer a quick fix.

For those who work in children’s homes Bion’s position of seeing the group offering its individual members, through their defences, to give expression to their inner world, is a helpful position, in confronting the projective identification exercised all too often in staff meetings, which suggests that the interests of the whole group must come before those of an individual. The notion that an individual may be expressing the anxiety of the whole group is also useful.

The developmental theories of Klein, Winnicott and Erikson can be taken together as offering explanations of a child who has been healthily nurtured and one who has not. This can help workers stay in touch with what is healthy in emotional development, while encouraging the development of a capacity to reflect and develop empathy for the emotionally troubled child.

Kleinian theorietical stances may help staff understand that the anxieties of individuals, both staff and children, are based in infancy. For some this may accentuate a need to help youngsters regress to those parts which have been blocked, while for others it may mean facilitating the need to work through a process to a developmental stage which in an Eriksonian sense has not yet been achieved. Equally Klein’s notion of projective identification may help the worker understand why she is feeling how she is about one child, and equally it may help her understand why a child behaves in a particular way towards her.

Winnicott’s position on adolescence reinforces this. It stresses the developmental importance of adolescence to both generations. Whether considered as members of a group, as an individual or as an adolescent, young people need to be kept safe while they are allowed to grow. This is achieved by interaction between adult and child, consideration of the child’s emotional position, reflection on this by the adult but also reflection on this by the adult on her feelings and anxieties. Simultaneously Rose offers the reminder that those parts of a child’s development which are healthily in touch with reality, must be responded to in such a way. There are situations which demand therapy and there are situations which require social reality. This is one measure of the efficacy of the therapeutic approach to the care of young people which might have general acceptance.

In a society which appears to require instant answers, and has a government which believes young people with deeply troubling emotional difficulties, will have their problems solved by being sent on time limited “anger management” courses, a psychodynamic philosophy of group child care may struggle to flourish. A psychodynamic approach is one in which many processes, many more than the three which have been artificially isolated in this study must be brought together and considered. Bettelheim and Menzies Lyth have usefully conceptualised this as the therapeutic milieu.

A psychodynamic approach requires time to care, reflect and interpret. Psychoanalytic theory is complex. A psychodynamic approach requires time, and of course financial resources, to offer support and training to staff.

However, just as residential child care staff when under pressure from a young person, resist the possibility of reflection, and look to contain their anxieties by taking immediate controlling action, so, as the opening chapter of this study demonstrates, do governments, to contain their anxieties. Clearly those who believe in the psychodynamic approach to child care have a theoretical understanding of this problem, but need to develop a political will to confront it. The universal group is not yet ready to be the nurturing mother.

 

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Menzies Lyth, I. (1989) The Dynamics of the Social. London. Free Association Books. Cited in “Working with unconscious dynamics in groups” D. C. Challender(1999) in Loving Hating and Surviving. A. Hardwick & J. Woodhead eds. 1999 Aldershot. Arena. p.383.

Duffy, B. and McCarthy, B.(1998) “From Group Meeting to Therapeutic Group” in Understanding Health and Social Care: An Introductory Reader. M.Allot and M.Robb.. eds. London. Sage/Open University. p154.

Bion , W.R. (1961) Experiences in Groups. London Routledge 2000. pp 119-126

Duffy, B. and McCarthy, B.(1998) “From Group Meeting to Therapeutic Group” in Understanding Health and Social Care: An Introductory Reader. M.Allot and M.Robb.. eds. London. Sage/Open University. pp145-154.

Ward, A. (1998) “The Difficulty of Helping” in Intuition is not Enough. A.Ward & L .McMahon, eds. London. Routledge. pp63

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 52-53

Menzies Lyth, I. (1989) The Dynamics of the Social. London. Free Association Books. Cited in “Working with unconscious dynamics in groups” D. C. Challender(1999) in Loving Hating and Surviving. A. Hardwick & J. Woodhead eds. 1999 Aldershot. Arena. p.383.

Chapter 3

Dockar Drysdale, B. (1973) Consultation in Child Care London Free Association Books 1993 p62.

Winnicott, D.W. (1965) Maturational processes and the Facilitating Environment : Studies in the Theories of Emotional Development. London. Tavistock Publications . p36

Henry, G. (1990)* “Helping Children to Negotiate Separation and Loss”. Unpublished paper. Gianna Henry, Principal Child Psychotherapist, Adolescent Department, Tavistock Clinic. P6 * Charles Sharpe’s approximation of date.

Bion, W.R. Experiences in Groups. London Routledge 2000. p 90-91

Kennard 1998) “The Future of Therapeutic Communities” in An introduction to Therapeutic Communities Vol. 1. London .Jessica Kingsley pp113-123

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 52

Redl, F. (1966) When We Deal With Children. New York. Free Press. P42-48

Aichorn, A. (1951) Wayward Youth. London. Imago Pub. Co. pp4-15

Laing,R.D. (1960) The Divided Self. London. Tavistock. Cited in R.D. Laing : A Divided Self J.Clay London Sceptre pp59-62
Bettelheim, B. (1974) A Home for the Heart. London. Thames and Hudson. p283

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 61-62

Freud, S. (1905) “Infantile Sexuality” in On Sexuality : Three Essays on the Theory of Sexuality and Other Works. The Penguin Freud Library, vol.7. Harmondsworth. Penguin 1991 pp88-126

Freud, S.(1897 – 1904) The Complete Letters of Sigmund Freud to Wilhelm Fliess. Harvard University Press 1985 pp264-265

Rush, F. (1980) The Best Kept Secret : Sexual Abuse of Children. New York. MacGraw Hill.pp

Jung, C.G.(1912) Letter to Sigmund Freud in The Freud/Jung Letters . William McGuire, ed. 1991. Harmondsworth. Penguin.

Ferenczi, S. (1932) Selected Writings. London. Penguin. 1999. pp293-303

Erikson E.H.(1950) Childhood and Society. New York. W.W.Norton pp219-223

Winnicott, D.W. (1967) ”The concept of a healthy individual” collected in Home is where we start from : essays by a psychoanalyst.1986. Harmondsworth. Penguin. Pp 31-38.

Klein, M. (1921) “The Development of a Child” in (1921-25). 1998. London.Vintage. pp1-53.

Klein, M. (1946) “Notes on some Schizoid Mechanisms” in the International Journal of Psycho-analysis. Vol. XXVII pp99-110

Maher, A. (1999) “Using a therapeutic model of thought and practice” in Loving, Hating and Survival. A. Hardwick and J. Woodhead. eds. Aldershot. Arena 1999. p202-203. Citing W.R. Bion Learning from Experience. London. Routledge 1989.

Winnicott, D.W. (1965) Maturational processes and the Facilitating Environment : Studies in the Theories of Emotional Development. London. Tavistock Publications . p75.

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge p83

Whittaker, D., Archer,L., Hicks, L. Working in Children’s Homes Chichester Wiley pp48-49

Rose, M. (1990) ) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge p84

Winnicott, D.W. (1988) Human Nature. London . Free Association Books. p128.

Department of Health (1998) Caring for Children away from Home. London .HMSO .pp6-8

Erikson, E.H. (1968) Identity, Youth and Crisis. London. Faber . pp 159-165

Winnicott, D.W.(1958) Collected Papers: Through Paediatrics to Psycho-Analysis. 1975 London Tavistock Publications. pp210-217

Klein, M. (1921) “The Oedipus Complex in the Light of Early Anxieties” in Love, Guilt and Reparation and other works(1921-25). 1998. London.Vintage. pp 370-419

Winnicott, D.W. (1961) “Varieties of Psychotherapy” collected in Home is where we start from  : essays by a psychoanalyst.  1986 Harmondsworth. Penguin pp103-111

Ward, A. (1998) “The Difficulty of Helping” in Intuition is not Enough. A.Ward & L .McMahon, eds. London. Routledge. pp 46-47.

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 61-62

Winnicott, D.W. (1965) The Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development. London. Hogarth Press. Pp84-88

Chapter 4

Winnicott, D.W. (1965) Family and Individual Development. London. Tavistock Publications. p79

Anderson, R. and Dartington, A.(1998) “Clinical Perspectives on Adolescent Disturbance” in Facing It Out : Clinical Perspectives on Adolescent Disturbance. eds. R. Anderson and A. Dartington . London Duckworth 1998. p4

Klein, M. (1946) “On Identification” in New Directions in Psycho-Analysis: The significance of Infant Conflict in the Pattern of Adult Behaviour. M.Klein, P.Heimann & R. Money Kyrle eds.. London. Karnac Books/ 1985. pp311-312

Young, R.M. (1994) Mental Space. London. Process Press. p 150

Erikson, E.H. (1968) Identity, Youth and Crisis. London. Faber. 1968. p128

Ibid. pp187-188.

Winnicott, D.W. (1971) Playing and Reality . London. Routledge. p146

Winnicott, D.W. (1965) Family and Individual Development. London. Tavistock Publications. p79-80

Dubinsky, H. (1998) “The Fear of Becoming a Man” in Facing It Out : Clinical Perspectives on Adolescent Disturbance. eds. R. Anderson and A. Dartington. London Duckworth 1998 .pp99-100

Winnicott, D.W. (1971) Playing and Reality . London. Routledge. p146

Ibid. p 146.

Anderson, R. and Dartington, A.(1998) “Clinical Perspectives on Adolescent Disturbance” in Facing It Out : Clinical Perspectives on Adolescent Disturbance. eds. R. Anderson and A. Dartington . London Duckworth 1998. p4

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. pp 136-143

Ibid. pp136-137

Holmes, G. (1996) (Holmes 1996 Paper presented at a conference entitled “The changing aims of psychoanalytic psychotherapy” at the Psychoanalysis unit, University College, London, June 1996 * Unpaginated internet document.

Ibid. Unpaginated.

Ibid. Unpaginated.

Ibid. Unpaginated.

Bowlby, J. (1981) “The origins of attachment theory” in A Secure Base. London. Routledge 1988. pp 20-28

Winnicott, D.W.(1958) Collected Papers: Through Paediatrics to Psycho-Analysis. 1975 London Tavistock Publications. pp210-217

Winnicott, C. (1964) Casework and the Residential Treatment of Children. Hitchin, Hertfordshire Codicote Press .pp28-29.

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