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Treatment in cottage programs for children with severe developmental disturbances

Scott Dowling

Many of the problems of the severely disordered children in residential treatment are due to developmental disturbances of varying complexity and severity. Treatment in a group setting is, possibly, uniquely fitted to overcome these problems in latency mid adolescent children.One of the most persistent of prejudices is the view that family structure as we know it is not only the best, but the only moral way to rear children. There is an abhorrence of group living at any age. The use of group living facilities for emotionally troubled children is vaguely equivalent in the popular mind with the mental hospital and the reformatory. In fact, although bad institutions, like bad families, can maim children, good institutions have a healing power uniquely their own.

In the group living program at Bellefaire, 10 to 14 boys or girls live together in a cottage unit. A staff of five child care workers spend their workday with the children – usually two working at any one time. The unit supervisor, the cottage consultant, a psychiatrist or child analyst, and the cottage maid complete the staff. All the daily routines take place in or near the cottage setting. A perpetual round of angry, happy, cooperative, contentious, accepting, rejecting, caring and hating actions and reactions occurs among children, between staff and children, among staff members, and between staff and/or children and the administration. It is a dynamic community. The staff becomes part of the living community of the children; an artificiality of relationship is difficult or impossible.

Almost all of the children’s waking hours are spent with the cottage grouping of staff and children or with various subgroups in school, activity programs and spontaneous interaction. In all activities – bathroom and breakfast table in the morning, school, athletic programs, lunch, afterschool program, (dinner, evening events and bedtime – the child moves with and is concerned with the group.

What distinguishes these groups from those in family life, on the one hand, and from therapy groups, on the other?

Viewed from the perspective of the child’s total treatment, the fundamental characteristic of group living is the number of long continued (2–to–3–year) relationships with peers and staff. A unique interpersonal experience is provided by interaction with each of these individuals. At the same time each individual’s involvement with the child is, compared with family relations, much less intense.

Unlike psychotherapy relationships, either individual or group, the emphasis of staff interactions with children is directed toward the effects of present actions, thoughts, decisions and feelings. This means that at various times the staff member may be a friend, an educator, a source of external control, or an admired object of identification. Additionally, and of special importance to the severely disturbed; areas of staff ego strength replace, for shorter or longer periods, areas of a child’s weakness or incapacity. Staff assist in the differentiation, recognition, naming and verbalization of thoughts, beliefs and feelings. Child care staff help a child to define and to confront automatic stereotyped forms of response to others that undermine the effectiveness of the individual or that push the individual, the subgroup or the entire cottage group toward maladaptive, delinquent or self-injuring behavior.

The development of a stable group structure in the cottage is not seen as an end in itself. This point is at the crux of an understanding of the therapeutic action of group living. Left to their own devices, the children in a cottage will form relationships and show forms of behavior that express their conflictually determined or developmentally determined pathology. Polsky’s descriptions of Cottage 6, with its delinquent group structure, illustrate this. A tendency toward group structure that perpetuates individual pathology exists in any cottage grouping, This tendency provides chances for staff. and the children as well, to recognize and interrupt the individual’s effort to find the niche he unconsciously expects for himself He moves according to the pull of his present ego-characteristics, self-image and perceived needs. The others of tire group respond therapeutically to him in two ways. First, when they refuse to take their assigned places in his actions and fantasies, the youngster experiences turmoil, anxiety, and a sense of disequilibrium. This disequilibrium means the possibility of new, and more mature, gratifying forms of action, thought and feeling. Second, the staff and children help when they provide friendship, education and direction, or make themselves available as objects of identification. The living environment consciously draws the child’s attention to the maladaptiveness of his behavior. It then provides the opportunity and the means through which modifications of ego characteristics, perceived needs and self–image can take place.

There are two kinds of regular experience in the children’s lives that lead the youngster outside the group experience. On the one hand, there are many opportunities to be alone or with a single staff member. On the other hand, they also are led into a progressive involvement in the community and into an awareness of what fears and gratifications lie beyond the confines of their group experience.

Dowling, S. (1975) Treatment in Cottage Programs for Children with Severe Developmental Disturbances. Child Welfare. Vol LIV (6). pp. 398 – 401

 

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