CYC-Online 72 JANUARY 2005
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The next twenty-four months

Bruce Gray, Donalda Campbell and George Delatolla

This article looks at how residential programs can obscure the boundary between therapy and reality, making it harder for youth to successfully make the transition to work. Specific strategies are proposed to increase the reality focus of group care programs, including the need to re-define the role of the child care worker. In an effort to re-evaluate effective staff responses, “problem” behaviors are viewed from both a family and developmental perspective.

As youth in residential treatment programs grow older, they need to begin to make the transition to living independently, a part of which is to make a decision about work, train for a job, and get practical, work-related experiences. The task of the three authors was to organize and implement job preparation programs for two groups of youth – young people 19-22 who were struggling to live independently, and youth 16-18 and still in care. We began by reviewing our experiences in designing and implementing vocational training and life skills programs. During the course of our discussions, one particular image began to emerge and become more sharply focussed. We were struggling with youth psychologically mired in what Erik Erikson (1968) called adolescent “identity confusion.” What also became clearer was that the problems older youth were dealing with might be avoided if group care programs changed their focus. Our objective became to identify both the rationale and direction for these changes.

Having moved out of a traumatic past, many youth in our programs seemed better able and more inclined to stand still than to move forward. The future, with all its work-related demands, was far more disturbing than it was challenging. The youth were willing to be trusting of adults and prepared to be cared for, but confused about making decisions on their own and helping themselves. The boundary between treatment and reality seemed very unclear, especially when youth being prepared for work and independent living began to be preoccupied with personal problems. This preoccupation interfered with the time, energy, and attention that work training required. In one sense, it was as if they perceived the world to be one large “therapeutic milieu,” with the bus driver, work supervisor, and co-worker responsible for doing the “life-space interviewing” the child care staff had done previously.

To help avoid this situation, child care staff need to be sensitive to the fact that, as helpful as therapeutic group care programs can be, they can also have the potential to create problems for youth when the time comes for them to move Out into the real world. Two such problems became clear in our discussions. The first was the lack of separation between personal problems and work. This can occur, when a youth tells his boss he’s late because the alarm clock didn’t work and the staff forgot to wake him up, and besides he’s a little depressed because his mother called and he couldn’t just hang up even though he felt like it.

The child-caring milieu tends to be very protective and supportive of youth, with the structure of the program environment compensating for the youth's inability to organize his or her own daily schedule. If this process continues for too long, a youth learns that external forces are ultimately more responsible for his actions than he is. An example of this type of dependency is seen in the child who never has to wake herself up in the morning because staff assume responsibility for her punctuality. When she is living on her own and her boss asks her why she is late for work three times a week, she explains with genuine indignation that no one dragged her out of bed, forced her to do her household chores, prepared her breakfast, ironed her clothes, and pushed her out the door in time to catch the bus. Perplexed by an employee who blames everyone else for her actions, the boss secretly questions her integrity and asks her to look for work elsewhere. With no practical experience in dealing with people unwilling to consider this type of reasoning, the youth is at a loss to understand why she lost her job and becomes depressed. If staff choose an empathic counselling approach to her current emotional crisis, the cycle begins again.

The child-caring milieu also encourages youth to focus on personal problems whenever they occur. Employers, however, do not accept explanations such as “I’m mad at my mother,” as valid reasons for poor work performance, nor do they prescribe relaxation techniques for youth with chronic psychosomatic complaints; they ask employees who do not complete assigned tasks to look for another job. For a youth an essential part of preparing to work is to be able to keep personal problems separate from the job and to understand that task completion is the only thing about which the boss cares. To learn this, the youth requires practical experiences within the therapeutic environment and can be acquired by staff insisting on task completion despite emotional upset in order to create a clear boundary between “therapy” and “reality.”

The second is the distortion of reality. A youth who only types 35 words per minute and has poor writing and spelling skills, does not understand why she is not qualified to be an executive secretary with her own office and a car allowance.

Perhaps out of a misguided fear of offending the child's sensitivities, child-caring programs tend to allow youth in their care to believe that they are more capable than they really are. Serious reading and writing problems are compensated for by small class-room environments and added staff attention. The focus of staff attention is often disturbed behavior generated by anger or depression. Sometimes staff refrain from giving a youth a clear picture of his or her academic deficits for fear of provoking additional emotional responses. Without clear feedback to the contrary, a youth develops a self-serving and exaggerated assessment of his or her employment skills and potential.

An example is the youth who, after a successful year in the woodshop of a special education program, plans on entering the construction and renovation industry as a carpenter, but he has given little or no thought to the steps necessary to reach this goal. Aware of both his academic problems and the over inflated feelings he has regarding his manual skills, staff encourage the exaggerated picture of his current employment potential in order to “increase his self-esteem” and inhibit acting-out behavior. Unaware of apprenticeship, on-the-job training, or working his way “up the ladder,” the youth bounces from job to job, angry about having to do such menial tasks as sweeping floors and working for close to minimum wage. He becomes seriously upset if the boss is “crazy” enough to suggest a training period prior to actual employment. When he reports to staff about the unfairness of it all, they choose an empathic counselling approach, focussed on the goal and not the process, and the cycle begins again. To change these distortions of reality, workers need to help youth to get a clearer picture of their own future in the world of work, especially in the first two years after discharge. As depressing as this can be for some youth, this information can nevertheless also be a motivating factor for increased educational or work performance and thus is essential for realistic goal-setting and decision-making.

Beyond The Other Twenty-three Hours
To further increase the reality focus in residential settings, staff also need to look at changing their roles during the course of a youth's placement. We see this happening in this way.

The focal point of The Other Twenty-Three Hours (Trieschman, Whittaker, & Brendtro, 1969) is that youth in residential programs do not have the internal-coping resources and positive life experiences to change by being with a therapist, no matter how talented he or she may be, for one hour a day. The support and guidance of the total living milieu can have a much more powerful -impact on a youth, enhancing the probability of positive changes. While this is undoubtedly true, change within the treatment milieu is not an end point but rather the mid-phase on the dependence-independence continuum. Further development for any youth requires a shift away from dependence on the program milieu in order to create and maintain personal change.

At the mid-point of treatment, staff need to change their role from milieu therapist to that of consultant and teacher, enabling and encouraging youth tobegin to depend on their own internal abilities to evaluate social situations and expectations, to think about and plan out short and long-range personal objectives, to view their behavior objectively given the demands of different social situations, and to exercise judgement on crucial problems and issues.

To acquire these abilities, youth must be trained in a problem-solving model (Glasser, 1965; Gordon, 1970) involving a sequence of internal, cognitive processes that defines the problem, looks at possible alternative solutions, and evaluates and chooses the best course of action. The decision becomes real when the youth commits to try it, communicates this decision to others who might be effected by it, acts on the basis of this decision, and evaluates for himself or herself the outcome of a serious effort. Obviously, practice over time will probably be necessary in order for most youth to feel confident about being competent to make constructive decisions that lead to positive outcomes (Whittaker, 1979).

As this treatment process develops, a youth's dependence on “23-hour a day” support will diminish. Especially important is the fact that a youth will be making his or her own critical analyses and decisions regarding vocational choices and social expectations, independent of both the interference of his or her own emotional problems and the judgements of staff.

An Ecological Perspective
While laying this foundation for independent decision-making is critical, staff must also note that youth in care need to participate positively and meaningfully in three principal environments: their living units, an educational program with a realistic vocational emphasis, and their families.

Work-related objectives should be set in a goal-setting conference attended by the youth, family members, and teaching and child care staff. The outcome, the exact vocational option towards which a youth is working, should reflect his or her interests, abilities, and decision-making, as well as the “pictures in his or her head” of his or her future (Glasser, 1984). The teaching and supportive processes whereby this internal “picture” can be actualized in the real world needs to be determined by staff and parents, the “significant adults” in his or her life. It can even be instructive for a youth to listen to adults discuss and plan their respective supporting roles: seeing others plan how they can help may motivate a youth to keep his or her commitments during the tough times ahead.

Following the conference, staff in youths' living units can support their vocational training programs by (1) providing support for personal problems for one hour per day, and only at scheduled times; (2) emphasizing problem-solving in the real world for the other twenty-three hours, less eight for sleeping; and (3) withdrawing safety nets and staff reprisals when youth fail, in order that they learn to depend on themselves for success.

The educational staff can support a youth's goals by designing a program which teaches (1) basic life skills and problem-solving skills, and reinforces each through role-playing and group discussions; (2) basic work values and skills, with opportunities for real life practice in on-the-job training; and (3) job-finding skills, including practical knowledge about how to complete a job application, write a resume, and interview effectively.

The family worker can assist this process by continuing to meet with the youth and his or her family. In some situations, where there is active and welcome involvement between parents and child, this seems like a natural thing to do. However, as Jay Haley says in Leaving home (1980), there is an absolute need to work with the family even when involvement is minimal or extremely conflictive.

In these situations, the temptation is to work only with the youth. Haley’s argument is that youth who may appear to be socially independent are really psychologically dependent, trapped in “identity confusion” as a self-sacrificing way of stabilizing the family organization. When a youth approaches doing something well, he or she ends this process abruptly by failing again, in order that his or her family can reorganize itself to try and deal with his or her problems. Haley proposes a therapeutic process of reestablishing the parental executive role to clarify the hierarchy in the family organization, and then either resolving the spousal problems or moving the youth out of the conflict so that it occurs directly and not through him.

Even a brief encounter with Haley’s organizational model can alert child-caring staff of the need to re-examine assumptions about and definitions of independence or family reintegration as separate discharge alternatives. Given the determination with which some youth cling to immature behaviors and insist on returning home despite being prepared for and experimenting with “independent living,” family therapy may be the missing component needed to complete an effective ecological picture of helping strategies.

Erik Erikson's (1968) list of behaviors associated with “identity confusion” is exhaustive. Included are running away, changing jobs frequently, staying out all night, having bizarre moods, over-identifying with peer cliques, repudiating adults, making poor decisions, being mildly depressed, experiencing sleep disruption, refusing to follow realistic routines, being unable to concentrate, and displaying open hostility towards socially acceptable roles and expectations. When these symptoms appear in large groups, it is easy for staff either to over-focus on specific behaviors and lose sight of the terrifying confusion which provokes them, or give up hope that a youth will ever make it on his or her own. To see symptoms as normative signs of an age-appropriate developmental crisis becomes even more difficult when staff allow “control” to become the focal point of their attention. As a youth approaches work, however, his developmental needs over “the next twenty-four months” are more appropriately our concern, not the present behaviors which so easily distract us.

Controlling or eliminating discreet behaviors one-by-one will not diminish a youth's internal confusion; these efforts only set up power struggles and focus adult attention on a youth's recurring failures. And, if Haley is right, that is exactly their purpose.

A better choice for staff would be to see these behaviors as representing the best choice a youth can make at the moment, as well as adaptive and normative given the youth's underlying developmental problem. A better response is to arrange an array of services and people, including parents, in a unified effort to help a youth make better choices for himself or herself. We believe there is more hope in this decision and a better chance that this strategy will produce positive outcomes.


Erikson, E.H. (1968). Identity, youth and crisis. New York: W.W. Norton and Co.

Glasser, W. (1965). Reality therapy, A new approach to psychiatry. New York: Harper and Row.

Glasser, W. (1984). Take effective control of your life. New York: Harper and Row.

Gordon, T. (1970). Parent effectiveness training. New York: Plume Books.

Haley, J. (1980). Leaving home, The therapy of disturbed young people. New York: McGraw-Hill Book Co.

Trieschman, A., Whittaker, J. and Brendtro, L. (1969). The other twenty-three hours. Chicago: Aldine.

Whittaker, J.K. (1979). Caring for troubled children. San Francisco: JosseyBass.

This feature: Gray, B., Campbell, D. and Delatolla, G. (1989) The next twenty-four months. Journal of Child and Youth Care 4(3) pp. 33-39

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