Listen to thisThere is a small community in the United States in education and therapy that identifies as relationship-based. This community parallels the Child and Youth Care (CYC) community in many ways, though the communities do not appear to be in direct relationship. What kind of relationship could develop between these two communities? While both center the importance of relationships, they have separate traditions, and different frameworks for practicing relational care. These communities have much to offer each other, and a deep and rewarding relationship seems possible. A few initial and valuable exchanges of strengths are explored, in what amounts to a scratch on the surface of possibility. These strengths include CYC’s broad theoretical lens, and valorization of direct care work, as well as the United States relationship-based community’s supportive supervision model, and orientation toward work with groups.
Introduction
The international Child and Youth Care (CYC) community and a small but resilient relationship-based child development and care community in the United States’ are separate traditions that share relational cornerstones. My perspective is that of an American, recently introduced to the CYC community through the 2024 Unity Conference, noticing similarities and differences between the CYC tradition and the community I have been a member of in the United States. I ask “what can we learn from each other?” in both directions, and offer the beginnings of answers.
While the fundamental needs of children are experienced across international borders, child and youth care (CYC) is not a familiar term or field of study in the United States (see editorial note). Child and youth care is an international tradition of study with a special focus on children in the most need of care. As this is published in Relational Child and Youth Care Practice, the reader is aware that “relational” is a bedrock theme of CYC.
In the U.S., when children are identified as in need of care, the bureaucratic systems that respond often gravitate toward behaviorist approaches. While some practitioners and organizations in the U.S. practice behaviorist approaches with elements of a relational approach, behaviorism does not center relational approaches, and more often is anti-relational. CYC studies and its relational philosophy are not part of the mainstream conversation about children’s care and education in the U.S. In my 22 years in therapeutic education at that point, I was never aware of the CYC field of study until a podcast host from Tennessee (Dr. R. Scott Lee of The Thoughtful Teacher Podcast) recommended CYC-Net.
However, there is a similar tradition of relational care in the United States. Over the years the international CYC community and the U.S. relationship-based community have evolved in parallel directions. In my community, the term relationship-based is used, rather than “relational.”
The roots of the United States’ relationship-based community
I seek to communicate about child care trends within the United States, a nation of 340 million people with myriad and significant subcultures. My experience has mostly been in the Greater Boston region of Massachusetts. Throughout my career I have endeavored to learn about trends in other parts of the country through reading, travel, and communication. This I can say with confidence: the U.S. is large and polymorphously diverse. On a broad scale it is possible to notice and talk about trends, tendencies, cultures, and subcultures within the care and education of children and youth. Imagine this complex system as a river. We can observe the direction of the river, note the speed of its current, and recognize significant tributaries. But we cannot understand or describe every eddy, aquifer, beaver dam, and tide pool. Similarly, it is impossible for an individual to absorb, let alone articulate, all the fascinating subcultures, trend-buckers, and creative learning spaces across the nation. I ask my reader to be patient with these limitations, and I welcome dialogue.
First, it must be clarified that in my experience, the existence of a relationship-based youth care community in the U.S. is tenuous. While there are schools and institutions that identify as relationship-based, communication between these entities is sparse. The group includes Community Therapeutic Day School in Lexington, Massachusetts, and Education Alternatives in Cleveland, Ohio. Some associated professionals, including myself, have worked within and consulted with public schools to establish relationship-based therapeutic practices. As this article will discuss, these traditions flow from research and theory primarily developed in England between about 1940 and 1970. England is home to a school and charity called The Mulberry Bush, which developed from the same therapeutic tradition. However, cross-Atlantic communication between these aligned organizations is no better than it is within the U.S. itself.
The relationship-based child education and development tradition in the U.S. is strongly grounded within the discipline of psychology. The tradition most significantly developed out of post-WWII England, from the attachment studies of John Bowlby and Mary Ainsworth (Reinstein, 2006, pp. 9-12). Pediatrician and psychoanalyst D.W. Winnicott’s work built further upon these ideas, as he developed his theories of how a holding environment functions to support the development of children (Winnicott, 1965).
Winnicott was interested in reaching a wide audience with his ideas about how to support the healthy development of children, most notably through his series of radio broadcasts through the British Broadcasting Corporation from 1943 to 1962.
This was a successful, though aberrational, effort to bring deep psychoanalytic thinking to a broad public. While some of Winnicott’s ideas influenced mainstream parenting conversations, his ideas now largely thrive in psychoanalytic communities, as well as in a diffuse and relatively small group of schools and centers that provide services to children and families. In this sense, Winnicott’s efforts to reach a broader audience and perhaps depathologize psychoanalytic thinking were only marginally successful.
Similar to the CYC community, the focus of the U.S. relationship-based community is on students with high levels of need. However, given the U.S. community’s alignment with psychology, “high levels of need” are most often identified in psychological terms, rather than in terms of having basic needs met. Privation or deprivation, in the language of John Bowlby and Michael Rutter (1972). To encounter this caring community, a child must demonstrate behavior that gets the attention of adults who can find help.
In the U.S., services are delivered after the identification and diagnosis of a disease, disorder, or disability. This structure has fundamentally required children and youth to be pathologized to access care. Once the disease, disorder, or disability has been identified, care can potentially be provided through the insurance and medical system, and/or through the special education system. This has located relationship-based care for children in need mostly in a subset of specialized day schools, residential programs, and a few public-school inclusion programs.
Mainstream child development approaches in the United States: Turning a blind eye to privation and deprivation
The American Dream narrative, a fixture of the collective American consciousness, contributes to pathologization. Deprivation is the loss of basic care, and privation is never having it in the first place. There is little room within the collective American consciousness to acknowledge the obvious negative effects of loss, or of not having basic needs met in the first place. There is a strong belief that every adversity only strengthens one’s upward rise – if only they are worthy. The fact that some people are unable to thrive because they experienced loss, or because they never had in the first place, does not fit the narrative.
On a broad policy level, the debate over worthy and unworthy recipients of assistance continues without end. On the individual level, we don’t have an overt means to judge children or individual families worthy or unworthy of care. As a more palatable alternative to judging worthiness on the individual level, we have pathologies to determine who is deserving of care. Put another way, to account for difficulty there must be something dysfunctional about the individual, not the society in which they live. The message of this system is that if one is not thriving in the United States, there must be something diseased or disordered about them.
Despite the obvious truth that privation and deprivation lead to increased difficulties for children, U.S. cultural themes of rags-to-riches, meritocracy (real or imagined as the case may be), and the pulling up by one’s bootstraps make them unpopular concepts.
The dominance of behaviorist approaches in the United States
The relationship-based child education and development tradition in the United States centers relationships, attachment, and psychodynamic theory, rather than behaviorism. However, the relationship-based tradition represents a small minority among child care and child development services for those in need. For at least the last few decades, the strong trends in the U.S. have favored simplified, surface-level interventions that have roots in the behaviorist tradition of American psychologist B.F. Skinner. While Skinner’s ideas were and are seen as anti-therapeutic in many circles (Kohn, 1993), they nonetheless have taken a firm hold in U.S. child care and education systems.
As addressed earlier, to gain access to specialized care in the U.S., children generally require a diagnosed disability in psychological terms. Autism is an increasingly common diagnosis (Cardinal et al., 2021), as is attention deficit hyperactivity disorder (Abdelnour, Jansen, & Gold, 2022), among diagnoses classified as neurological. However, there is no shortage of diagnoses to choose from. Some common diagnoses include mood regulation disorders, oppositional defiant disorder, and post-traumatic stress disorder.
Diagnosis naturally leads to treatment. To that end, applied behavior analysis (ABA) is the most popular approach to treating autism in the U.S. The fundamental premise of behaviorist approaches like ABA is that we can adjust the behavior of children by formulating, calibrating, and delivering consequences to behavior. Often these consequences are intended to behave as incentives (reinforcers), which are generally preferred over negative consequences (punishments). The staff who deliver this approach are referred to as behavior technicians. Generally, “technicians” are associated with machines, not humans, but this vocabulary reflects the anti-relational roots of the behaviorist approach. Within programs organized around behaviorism, the view is often espoused that it should not matter who delivers the response to behavior, as long as the staff member follows the plan’s instructions. Frequent rotation of staff and student pairings is often advocated in order to avoid the development of personal relationships.
While ABA is not usually explicitly delivered outside of specialized programs, behaviorist approaches frequently remain the default in responding to any sense of disruptive behavior in U.S. schools. A functional behavioral analysis (FBA) is generally the first step toward providing more services to students who are perceived as having difficulty meeting behavioral expectations. Like ABA, FBAs are rooted in Skinner’s behaviorist theories, as are the interventions recommended after an FBA.
While it is not clear whether these behaviorist approaches are an effective means of treatment (Department of Defense, 2021), they do have some elements that appeal to educators, counselors, and administrators in the United States. Behaviorist approaches are measurable, understandable, and avoidant.
The effects of the behaviorist approaches are measurable. Whether they are having a positive, negative, or no effect in terms of what is being measured, for many it is very appealing to have a measurement. Additionally, the meaning or value of the measurement itself is not necessarily carefully considered. The whole system rests on the assumption that the adults in charge can identify what needs to be measured and adjusted to benefit the child’s development. A questionable premise.
Behaviorism-based approaches are understandable. They are relatively easy to explain to administrators, and school principals and other administrators like to understand what is occurring within their purview.
And finally, behaviorist approaches are avoidant. Unlike the qualities of being measurable and understandable, avoidance is a feature that is surely at play, but not generally considered or talked about. Behaviorist approaches allow for the avoidance of personal relationships or anything that might suggest emotional investment. This appeals to the basic human tendency to avoid work, as well as to impersonal corporate/educational trends in the United States.
However, within this culture of child care and development, the relationship-based community has demonstrated longevity and resilience. For example, Community Therapeutic Day School is celebrating their 50th anniversary this year. When one way of thinking becomes oppressively dominant, a subgroup of different thinking emerges. In the United States, despite the institutional dominance of behaviorist approaches, it is easy to find those who center relationships in their work among any group of therapists, school counselors, and mental health workers.
The CYC community has something to offer the U.S. relationship-based community
While my exposure to the CYC community has been limited, it is easy to discern themes and contours from which the U.S. relationship-based community can learn. Most notably, psychopathology is not the central language and lens of the CYC community. Whether one has, or does not have, basic needs met is more frequently the starting point of discussion. Adverse events in childhood are also frequently a part of the conversation, but not necessarily in psychological terms, where they are reliably placed in the U.S. within the trauma model.
Many in the CYC community are concerned about trends in CYC that lead it away from its humanistic orientation, and toward psychological concepts along with a dogmatic and incurious devotion to “evidence-based” approaches (Smith & Gharabaghi, 2024, p.174). Evidence-based is in quotations because, while it has become a highly sought-after label, especially for people or organizations with a product to sell, there is no agreed-upon standard for what makes something evidence-based. Claims about evidence-based approaches from corporations, organizations, and individuals do not reliably hold up well to scrutiny.
However, it is clear through a review of CYC literature, as well as during my experience at the Unity Conference in 2024 that the CYC community is more humanistic in orientation when compared to similar efforts in the United States. Smith and Gharabaghi identify the roots of CYC coming from “a realisation that what went on beyond the clinical setting was every bit, if not more, important than what went on in any such [clinical] meeting (p. 175).” This foundational understanding remains strong within CYC when encountered from the American perspective.
CYC’s centering of the word “relational” valorizes all those in relationship to children and youth receiving care. While there are hierarchies of administrators, supervisors, and professionals of various credentials, there is another kind of hierarchy present within CYC valuing those whose role it is to develop meaningful relationships with children and youth. When it comes to the relationships at the center of a relational approach, credentials and job titles do not offer any special advantage. There is a sense that everyone’s role is potentially meaningful and consequential.
The relationship-based community in the U.S. can learn from the CYC community -from broader and more humanistic conceptual thinking, and valorization of the work of being in relationship with children and youth.
The CYC tradition and literature offer a rich breadth of theoretical frameworks from which to approach the care of children and youth, beyond those offered by psychology. Given CYC’s international scope, there is naturally more openness and curiosity about ideas from a variety of cultural traditions. For example, for the Unity 2024 conference, I had the unusual pleasure of meeting in Dublin to hear Mark Smith from Scotland teach about German social pedagogue Klaus Mollenhauer. Undoubtedly a Eurocentric gathering, yet still much more internationally aware and open than what I have encountered in the United States.
CYC’s relational foundation centers the actual person-to-person work of supporting children and youth. Centering relational work ameliorates some negative effects of professional hierarchies. In organizations that provide care for children and youth, the staffers who spend the most time in direct care are usually toward the bottom of the professional hierarchy. Disparities in pay, respect, and work can lead direct-care workers to feel deskilled, unrespected, and not expected to perform creative and meaningful work. Furthermore, professional hierarchies can encourage workers to adopt a siloed job-function mentality, rather than an all-in-this-together mentality. An all-in-this-together mentality is much more effective and relational in the care of children and youth, and more available when all staffers feel that they make highly valued personal contributions.
The U.S. relationship-based child care community has something to offer the CYC community
Supervision
The U.S. relationship-based community is a product of its environment. As such, it over relies on psychopathology as a framework for understanding difficulties experienced by children. However, the U.S. community has something to offer the international CYC community.
Supervision is a persistent theme in CYC literature, conversations, and presentations. Supervision is also a core element of relationship-based mental health care in the United States. The popular variety of psychotherapy most closely associated with a relationship-based approach is psychodynamic therapy. Psychodynamic therapy developed out of psychoanalysis. However, in contrast to early psychoanalytic technique where the analyst was conceptualized as a static fixture, psychodynamic therapy uses the therapist’s dynamic relationship with the patient as the vehicle for therapeutic effect. This is an effective approach, supported by evidence (Midgley et al., 2021), and requires consistent supervision.
Supervision, according to this model, should consist of a reliable hour per week for a psychodynamic therapist working at or near full-time. This is the case regardless of whether the therapist is working with individuals, groups, in a milieu, or some combination of settings. While supervision is not psychotherapy, it does parallel psychotherapy significantly. The main distinction is that the supervisee is bringing their professional self to the supervision. Their non-professional self may also come into the supervision dialogue, since the personal and professional selves are embodied in one person. But the purpose of the supervision is to support the supervisee in their professional work, not their personal life. This understanding guides the supervisory work.
Supervision runs parallel to the therapist’s treatment of their patients. The therapist experiences being cared for in a relationship-based supervisory approach. The effect is multi-layered care. The carers are also cared for. The experienced supervisor aims to be as reliable and attuned as the psychodynamic therapist must be for their patients. In this way, while the psychotherapist discusses their work and experience, they also experience receiving the same attunement, empathy, and reliability that they seek to provide their patients.
When we ask workers to provide this kind of relational care, drawing heavily on their empathy without providing them the same, burnout is inevitable. In learning about the communities associated with CYC, I heard about high rates of turnover and impersonal supervision. My research suggests a highly relational and attuned supervision tradition in the CYC community exists, but it does not appear to be in practice in many group homes, schools, and programs. As well as looking to their own tradition, CYC could look to the supervisory tradition in relationship-based therapeutic care for some inspiration and clarity for what supervision can achieve in promoting high-quality work, staff development, and longevity.
Group dynamics
Another theme encountered as CYC practitioners discuss challenges is how to hold useful meetings for residents, students, and other people receiving care in programs. In terms of theory, interpersonal group psychotherapy is a close relative of psychodynamic therapy. They are probably best thought of as overlapping approaches for most interpersonal group psychotherapy practitioners. Both rely on the use of authentic relationships as an important means of locating and addressing issues. The therapeutic schools and programs in the U.S. that I have worked within have relied on regular group psychotherapy meetings, three to five times per week, depending on the program.
A core belief in the group psychotherapy tradition is that the dynamics and processes that tend to play out in groups are present in all groups, regardless of the activity at hand (Yalom & Leszcz, 2020, pp.580-581). A process group does not have a set agenda or activity beyond observing, participating in, discussing, and learning about ourselves and the group, based on what transpires in the group itself. Process groups are an excellent way to learn about group dynamics. They are valuable to anyone tasked with working with groups of any kind, and especially helpful toward understanding the effects of the authority vested in a staff member with the backing of an organization.
Under normal group circumstances, such as group home meetings, milieus, classes, or even a chance gathering, the expectations attached to a leader or authority are often a major concern. Some important questions tend to be present, but usually do not get directly articulated. These include: Is this leader meeting the group’s expectations? How did the group develop their expectations for the leader in the first place? What does the leader make of these expectations? Anyone perceived as an authority will inevitably receive some of the group’s generalized feelings about authorities and parents. How does a leader manage these generalized feelings coming up in the group and being focused on them as an individual?
While these questions seem focused on the leader, they are rich in their capacity to help learn about the group and be in service to its members. To be oriented in relationship, we must start within ourselves and our own experience. This is the group leader’s entryway into deeper understanding and relationship with the members of the group.
The aforementioned dynamics exist whether the group is composed of adults, or children and youth, though groups with children and youth present special opportunities and challenges. As the CYC community knows, working with groups of children and youth can be challenging. In practice, where there is significant challenge there is often opportunity for meaningful and effective work. With sufficient supervisory support and structure, meaningful progress is very likely.
Perhaps the central challenge of working with children and youth in groups is properly calibrating the structure to meet the developmental stage of the group. The aim is to provide them the opportunity to manage the challenges that develop, without allowing for more difficulty than they can reasonably manage. However, with groups of children and youth, the group will mature and develop competencies as they age, which is an advantage that cannot be presumed in an adult group (Murray & Balogh, 2023, pp. 26-42).
What I have just described is a starting point in thinking about what is possible with groups. Like the CYC community, there are frameworks and guiding principles to group work, while the possibilities for the direction and conceptualization of the work are infinite. With thoughtful group leadership, as the relationship within the group deepens, “the accumulation of time and experience in a group… leads to deeper self and social understandings, as well as skill and confidence about being a member of a group (Murray & Balogh, 2023, p.42).”
The nature of a relational exchange
The CYC community and the U.S. relationship-based community share a fundamental respect for the complexity of the relational experience. They share the capacity to hold, tolerate, and make great use of the tension between fundamental principles and immeasurable possibilities within relational care. They most clearly share a humble respect for the power of relationships -something too deep, broad, and powerful to be translated and contained within any one intervention, approach, or philosophy.
Similarly, this article barely scratches the surface of what is possible in the exchange of ideas and collaboration between these two caring communities. It only offers a few starting points for a potentially deep, productive, and unquantifiable conversation.
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Editorial Note
We acknowledge the longstanding and diverse CYC roots within the US as a part of the larger global community. This includes, for example, the historic contribution of the Youth Work Learning Academy founded by Mark Krueger at the University of Wisconsin, and the Department of Psychology in Education at the University of Pittsburgh headed by Karen VanderVen for many years. While both programs have pivoted in recent years, there are several others carrying the CYC spirit of education forward, including places like Indiana University School of Public Health and Woodring College of Education. The global CYC community is also supported by the Child and Youth Care Certification Board (CYCCB), a national entity based in Texas, along with the Academy for Competent Youth Work and the Association for Child and Youth Care Practice (ACYCP), a national association based in Milwaukee. These organizations are responsible for producing the Competencies for Professional Child and Youth Work Practitioners as well as the Standards for Practice of North American Child & Youth Care Professionals. ACYCP partners with the University of Pittsburgh to publish the Journal of Child and Youth Care Work, a seminal resource in the CYC field. The Social Pedagogy Association (SPA) based in Arizona also exists to support practitioners in sharing knowledge and insights. And worth mention are the numerous independent practitioners, trainers, and consultants working to advance CYC principles across various practice settings.
References
Abdelnour, E., Jansen, M. O., & Gold, J. A. (2022). ADHD diagnostic trends: Increased recognition or overdiagnosis? Missouri Medicine, 119(5), 467. https://pmc.ncbi.nlm.nih.gov/articles/PMC9616454
Cardinal D.N., Griffiths A.J., Maupin Z.D., & Fraumeni-McBride, J. (2020). An investigation of increased rates of autism in U.S. public schools. Psychology in the Schools. 2021; 58: 124–140. https://doi.org/10.1002/pits.22425
Smith, M., & Gharabaghi, K. (2021) Wisdom. In Digney, J. (Ed.). (2024) The art of relational weaving: A guide to the essence of relational practice (pp. 174-188). CYC-Net Press
Department of Defense, (2021). Comprehensive autism care demonstration annual report. https://www.health.mil/Reference-Center/Reports/2021/12/03/Annual-Report-on-Autism-Care-Demonstration-Program-for-FY-21
Kohn, A. (1993). Punished by rewards: The trouble with gold stars, incentive plans, A’s, praise, and other bribes. HarperOne
Midgley, N., Mortimer, R., Cirasola, A., Batra, P., & Kennedy, E. (2021). The evidence-base for psychodynamic psychotherapy with children and adolescents: A narrative synthesis. Frontiers in Psychology, 12, 662671. https://doi.org/10.3389/fpsyg.2021.662671
Murray, M. A., & Balogh, L. (2023). The therapeutic inclusion program: Establishment and maintenance in public schools. Routledge.
Reinstein, D. K. (2006). To hold and be held: The therapeutic school as a holding environment. Routledge.
Rutter, M. (1972). Maternal deprivation reassessed. Penguin.
Winnicott, D. W. (1965). The maturational process and the facilitating environment. Hogarth Press.
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From: Relational Child and Youth Care Practice, 38 (1-2), 16-29
