The homes were asked in one open-ended question to describe the ideas that guided treatment and care. A majority of the homes (79%) gave answers. Some gave detailed descriptions and others answered more briefly. Different aspects of care and treatment were mentioned. The concept of "milieu therapy" was widely used but with many meanings.
Milieu therapy! Trustworthy relationships, trustworthy adults in order to make it possible establish an inner structure.
We work with milieu therapy from a psychodynamic perspective. As care workers we try to balance the longing for regression with ego strengthening progressive work.
A large proportion of the answers expressed the importance of humanistic values in care treatment.
We see the youths for what they are doing and not for what they have done. We don't give them rules to obey but trust them and then the change starts.
Several homes described the importance of family work.
We work mainly with cultural clashes and problems in family relations, and the entire family is involved in treatment.
The importance of the relation between the young person and the staff was frequently mentioned.
Forming a good relation with the young person is a prerequisite for success in treatment... Give respect... Be a reliable adult who stand by the young person and give shelter in his/her anxiety and chaos.
There were however differences with respect to which aspects of the relation were most valued. Some stressed aspects of the relation that had to do with professional treatment. Other homes stressed the personal caring aspects of the relation. The importance of learning skills in different areas was also mentioned as a basis for treatment. Examples were given of educational skills and practical and social skills.
Some homes saw different kinds of experience as important.
A beautiful country environment with animals (horses, dogs, cats etc)... experiences that don't distract the young person to destructive behaviour.
Adventures therapy such as climbing and diving.
Some homes had special target groups, such as immigrants or girls and described their approach as being adapted to these groups.
We only accept youths with immigrant backgrounds. Half of the staff therefore has an immigrant background.
Other examples are unique as in the case of one home that described an approach based on working with the youth's dreams and one where massage was mentioned as a basis for treatment.
These examples indicate a large variety of basic ideas in treatment and care. Some of the homes named established models that were primarily psychodynamic or variants of psychodynamic theory. Others referred to methods such as cognitive behavioural therapy and social skill training. The majority of homes described the basic ideas in care and treatment without referring to existing models or theories. One clear polarisation was in the approach of ordinary everyday experiences or the need for common sense responses (Ward, 2004) as opposed to a professional therapeutic approach.
A major problem in descriptions of the basic grounds for treatment is the variation in the use of concepts and the confusion of ideas that exists (Dartington Social Research Unit, 1998). To overcome some of these difficulties, operational definitions were created for five approaches in residential care. Each approach was defined by three or four statements relating to what the homes believed to be helpful in the care of youths with different psychosocial problems. The homes were asked to mark on a five-graded scale the extent to which they agreed with the statements. Below follows a description of the operational definitions of five orientations in residential care.
The relation between the young person and his/her key worker (or equivalent) is essential in the treatment.
The young person's problems and symptoms are grounded in early deficient relations that strongly influence their ability to understand and to relate to other people.
The aim is to attain a change in the young persons' internal world to help them understand and relate to people in a new way.
The psychodynamic concepts of transference – counter transference are essential in our understanding of the treatment process.
In order to help youths we need to help their families.
One of our main tasks is to mobilise the resources that exist in the young person's network.
Our work aims to change the interactions in the young person's family.
We use reinforcement strategies to change the young person's behaviour.
We use instruments to measure behavioural change.
We make use of programs for training different skills (for example anger management and social skill training).
We perceive ourselves as substitute parents for the young persons during the time the youths live here.
The most important task is to provide a good homelike residence for the young persons.
We want to give the young persons the experience of living in a well functioning family.
We deliberately use peer group processes to attain individual behavioural change.
One important aim is to clearly mediate values to the young persons.
For us the feeling of solidarity between youth and adults is the basis for upbringing and education.
Dartington Social Research Unit. (1998). Towards a common language. Dartington. Dartington Social Research Unit.
Ward, A. (2004). Towards a theory of the everyday: The ordinary and the special in daily living in residential care. Child and Youth Care Forum, 33, 3. pp. 209-225.
Andersson, B., Johansson, J. and Hwang, C.P. (2007). Long-term residential care for youths in Sweden – approaches to treatment. International Journal of Child and Family Welfare, 10, 1-2. pp.32-33.