This is the second of two parts. See Part I
In many countries, family life is at risk and emotional problems escalate disturbingly. The number of developmentally threatened children and families is growing alarmingly. There is a great need for a supportive network for the modern family to guarantee healthy mental growth. Residential care may at times be most relevant for the child and sometimes for the whole family, to build or rebuild the needed relationships and to secure a healthy family. Therefore it is important that residential care nowadays includes the family in the care and treatment of the child. Thus residential care becomes much more a supplement to modern family life than an alternative, though the latter might be relevant where no family exists or can be found able for parenthood.
In 1968 I was appointed by the state as executive director of the new established Udby Treatment Centre. From the very beginning, in dealing with so-called problem children we wanted to focus on the family. Thus we became the first residential home in Denmark to include the family in our therapeutic programmes. All families asking for professional help in Udby have to accept the philosophy of the centre, that parents or parents substitutes are key persons in their children's lives. Therefore they are obliged to involve themselves in the treatment process.
Children referred to Udby are diagnosed to be emotionally disturbed and their behaviour disorders considered as symptoms of emotional disturbances in the interpersonal relations between family members. Therefore the family must cooperate and take part in the daily life and treatment programmes of the centre, as the goal in sight is the return of the child for family living in his or her original family.
Responsibility and consequence are key concepts in the work done to build up the self-esteem and self-confidence in insecure children and their families. The structure of everyday life is very visible and exterior order is seen as a psychological aid to inner order and self-control. Connected to each unit are small houses and flats furnished for having the children's families as short-term residents.
Initially, all children attend our internal school. Outside of school hours the children take part in a very structured group life. Many formal "training groups" are offered on a therapeutic basis daily to the children and their families. All groups are based on an analysis of individual needs. These groups are obligatory parts of the treatment programmes agreed upon in the assessment phase. Also many "interests groups" can be attended on a voluntary basis. In order to train the children for less protected living, at the end of their residential placement, all of them will, for a minimum of six months, take part in leisure hour activities in the local village.
The playground of Udby is a special feature. The philosophy is: "Better a broken arm than a broken psyche". The playground looks quite dangerous and demands courage, skill and daring. Here are ten- metre high towers with top platforms and bridges between the towers from where one can dive five metres down into a safe "spiders web"; here are rope "cars" to drive more than 100 metres, direct into the jungle! This playground is very important in building the self-confidence of the child and strengthening their belief in the social support of people. The playground is an excellent tool when the staff is working here with the whole family.
All training programmes are action-oriented and challenge the hyperactive children as well as the passive ones, along with their very different families.
The family work in Udby is covered in a five-stage programme as follows:
1. A treatment programme is drawn up individually for each family and each family member. These programmes are based upon identified needs. The programme is drawn together with the family members, to ensure maximum motivation.
2. The family comes to the centre on specified weekdays. Work is done with the child and the family. Either taking part in the common unit activities or special therapeutic sessions such as role play and video self confrontation. These activities are called "day projects" and focus specially on the damaged interpersonal relations in the family.
3. The family move, for weekends, for several days and up to several weeks, into the family houses or flats. In these periods the family will be involved in activities specially developed to meet the needs of their particular family. These activities are called "residential family work" and focus on the interpersonal relations in the family.
4. The family comes to the centre once a week for a period of one to three months in order to participate in a specially selected activity fit for the general strengthening of the relations between the child and its family. These activities are called "week projects".
5. The family comes to participate in group work on family life with other families in order to gain insight and understanding in the process of upbringing.
6. The family returns at least every six months for evaluation of the treatment process.
7. The family comes for participation in social events together with other families.
The anxiety fields of each family member are localised and analysed as an important guideline for building up the proper individualised programmes. Energy is given to the process of developing new talents and skills, always in a holistic framework. Counselling and evaluation are currently offered in order to create insight into the process. The staff has to pay attention to many personality factors. Among others: capabilities, knowledge, emotions, desires, fantasies, beliefs, estimations, ambitions, will, body possibilities, social skills, autonomy, taboos and traumas. Most training will be oriented towards interpersonal relations, where severe damage is often seen. Here the family members receive professional help to face and cope with their emotional problems. The dangers in denying the troublesome situations are made visible. Negative energy is transformed to positive. Convincing success must be found in actions.
Later in this process, following upon actions, words can be most useful to underline and describe fulfilled actions in order to stimulate the important process of insight and the feeling of satisfaction.
TThe Udby Treatment Centre can in a broader sense be described as a therapeutic community, where the therapy, normally called training, is placed in everyday situations in order to avoid the clinical, hospital-like atmosphere found in many psychological therapies. We do not want children and parents to experience themselves as patients, but to see themselves as normal families with normal reactions to normal family problems.
Family therapeutic expertise is found in residential treatment institutions, but very often uncoordinated with the external treatment system which brought the families or their children to the residential settings. The time has come to break down inefficient and old-fashioned limits within child and family care. I would propose the establishment of "Family Life Power Stations", "Family Treatment Centres" in the nearby environment of the family in trouble, the family in pain. In these locally anchored centres, families can ask for support and advice. Family work is offered on a preventive and pedagogical scale as well as on a more therapeutic level. Such centres should offer choices, from telephone guidance to residential care and treatment which fits with the needs of each family, each family member.
Reprinted from Child & Youth Care Vol.18 No.11