Treatment is a form of purposive action. To make proper sense of both its potential and its limitations, we must look at its basic prerequisites. These can be broadly summarised as: knowing what to do; wanting to do it; and having the ability/opportunity to do it. Knowing what to do. This is clearly the starting-point for all action. It presumes that we have been alerted to the need for action and have a reasonable idea of what we are to do. In the context of treating problem children, whether by parents or others, this ‘knowing what to do’ is the result of assessment. Assessments vary in their depth and quality and will accordingly affect what is to be done.
Wanting to do it. It is perfectly possible to recognise that something must be done and to know how it is to be done, without doing anything about it. To take action requires motivation. We take such motivation for granted on the part of the professionals – after all, they are paid to do the job, and ‘wanting’ should not come into it. We cannot, however, deny that if a treatment agent is strongly motivated to sort out a child’s problems he is less likely to give up than one who is less motivated. We see possible instances of this in cases of non-accidental injury or when child guidance sessions are terminated due to poor parental response.
Another important aspect of this is the need to create appropriate motivation in the child. We now recognise that, other than in tiny areas of the surgical or drug-related treatment of young children, we cannot impose treatment on children. Although it is often difficult we must try very hard to create some sense of commitment on the child’s part. This is, of course, centrally recognised in behavioural treatments, but it is no less valid and and necessary in the use of other methods. Underlying this is the generally accepted notion that children are not passive lumps to be subjected to treatment but rather active participants, whose co-operation will make or break the treatment. Despite the originally zealous claims of even behaviour modifiers, we now know that we cannot treat a child (that is, remedy his problems) against his will.
Because children often do not know what is in their best interests, and indeed frequently become the subject of treatment precisely because of their self-damaging behaviour, enormous difficulties result. The way out is to consider that creating motivation for and commitment to treatment is itself part of the treatment effort, directed at the child, the parents and other people significant to the child.
Having the ability and opportunity to do it. Knowing what to do and wanting to do it come to nothing if we do not have the wherewithal and the opportunity to carry out the task. ‘Ability’ is a blanket term which encapsulates both personal qualities (such as intelligence, warmth and sensitivity) and professional skills (such as being able to interview, to carry out microsurgery or to run a therapeutic group). ‘Opportunity’ refers to the availability of the setting and occasion for the appropriate interaction of the treatment agent and the child. We may believe that the only way to stop repeated suicide attempts is by sorting out the distorted relationships at home. But if the family refuse point blank to have anything to do with us, our chances of carrying out that sort of treatment are somewhat limited.
Masud, H. with Lyons, J., Muckley, A., and Swainston, M. (1988) Treating Problem Children, London. SAGE publications.