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The role of milieu therapy in the treatment of sexually abused children

Christopher Reeves

So, the first of Dockar-Drysdale's contributions was to demonstrate in certain sorts of disturbed child the continuance of early patterns of behavioral functioning, before the sense of self was established; and to stress the fundamental importance of relating to the disturbed child as he is, not as our wishes, prejudices, or adult perspectives dispose us to perceive him.

Unintegration and the Place of Milieu Therapy
Her second major contribution was to recognize that if such children existed with such specific difficulties, then neither conventional child care, however excellent in quality, nor conventional psychotherapy or play therapy were likely to meet their basic needs. What was required was an environment which would combine both the practicalities of good child care and the psychological insights of psychotherapy; moreover, combine them not as two distinct inputs into the child's life, inputs deriving from different individuals with different specialties, but combined in a single whole. The environment had to provide therapy in child care (Dockar-Drysdale, 1969).

Good quality child care, indeed even the best quality of family care in a foster or adoptive family, would not, of itself, put to rights what had gone wrong earlier on. Therapeutic remedial work was necessary, not simply corrective emotional experience (Dockar-Drysdale, 1980). The really damaged child who had lost the capacity to trust the presence, availability, or interest of a parent could not recapture these by the provision of an abundance or super-abundance of such things. The roots of selfhood had withered and something of a different order was required, not just the fertility of the receptive soil, to cause new roots to spring (Winnicott, 1970).

Psychotherapists, traditionally, saw it as their business to cause new roots to spring, new solutions, resolutions, new developments of a child's way of dealing with defenses. Psychotherapy was and is a recuperative, remedial activity. But as Dockar-Drysdale also perceived, words, insights, even the sustaining power of a transference relationship would not avail an unintegrated child, because such interventions presupposed, both theoretically and practically, the existence of a self and its functioning in the child, in however a partial or damaged way, so as to enable him to own and make use of these insights (Dockar-Drysdale 1967).

So an environment was needed for children lacking a sense of self which could add psychotherapeutic insight to the provision of actual physical care, and which could correspondingly transform the insights of psychotherapy into what might be called interpretations through action, the informed response replacing the insight-giving interpretation. These are the twin essentials of milieu therapy: an environment which can cater for children who have not yet developed a sense of self but whose other development has continued apace; and a setting geared to the needs of such children and combining in a harmonious blend substitute parental caring in all its immediacy and intensity with the insights, objectivity, and in a sense the detachment of the analytic encounter.


Dockar-Drysdale, B. (1967). Play as therapy in child care. In Therapy in child care. (1968). London: Longman.

Dockar-Drysdale. B. (1969). Meeting children's emotional needs. In Consultations in child care. (1973). London: Longman.

Dockar-Drysdale, B. (1980). Therapy and the first year of life. In The provision of primary experience. (1990). London: Free Association Books.

Winnicott, D.W. (1970). Residential care as therapy. In Deprivation and delinquency (1983). London: Tavistock Publications.

Reeves, C. (1993). The role of milieu therapy in the treatment of sexually abused children. Child and Youth Care Forum, 22 (2), pp.111-124

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