The Community Concept of Treatment

 

by CARLO TELA,  MSW, OGPA, AGPA

 

 

Social worker Carlo Tela has been a member of Browndale's professional resource bank since its inception in 1966. Before that he worked with John L. Brown at Warrendale for 7 years. Here, he discusses the Browndale concept of resi­dential treatment for emotionally disturbed children with some of the child care staff working in the therapeutic family homes.

 

 

Carlo: I'll begin by saying that, traditionally, children with emo­tional problems have long been regarded — and still are in many quarters — as "different" chil­dren, as a unique type of child.

This is a professional attitude which compounds the problems of the children. During the past 100 years or so the medical pro­fession has been very successful in defining the problems of emo­tionally disturbed and mentally ill children. However, when the medi­cal profession declared "these children have special problems" they rounded them up and placed them in special institutions, often huge institutions — some of which are still with us — isolating these children with the special prob­lems from the comunity and iso­lating the community from them.

In doing this they were being true to the medical model, treat­ing emotional problems and prob­lems of social adjustment as though they were infectious dis­eases. The children were surrounded by all the antiseptic pro­cedures of the hospital and cared for by medical personnel or, at least, persons supervised by medi­cal personnel.

But whatever the special needs of the emotionally disturbed or mentally ill child he is first of all a child and his basic needs are not dramatically different in kind or quality from the needs of any other child. So the milieu into which we place him while we try to meet his special needs must at the very least be equal to the milieu in which the normal child lives. It is to these very basic re­quirements that any special treat­ment techniques or accommoda­tions to his special needs must be added.

There is an ever-present dan­ger that persons working with emotionally disturbed and men­tally ill children become focussed on pathology. They tend to forget that the vast majority of children grow up to mature and healthy adulthood. And the vast majority of children grow up within fam­ilies. So the family must have something going for it.

When we look at the life his­tories of the children who come into residential treatment we find that most of them have never had the experience of being parented. Some of the children have lived in a succession of foster homes and institutions before coming to Browndale; others have grown up in families where the parents, be­cause of their own desperate un­met needs were unable to meet the needs of their children.

Most of the children who come into residential treatment have never experienced a normal fam­ily life. We only compound their problems and inadequacies when we place them in a hospital or institutional setting. They don't need less than "normal" children; they need more.

This is the rationale behind the Browndale therapeutic family. Having accepted the fact that the basic fundamental needs of the emotionally disturbed child are the same as the basic, fundamen­tal needs of any child, we accept the family in nature as the model for the structure in which we re­habilitate the child.

 

 What are the essential ingre­dients which make up the family in nature? Well, first of all there is a momma and a poppa, broth­ers and sisters; and the family lives in a house which is identi­fied with all the other houses in the neighborhood—it isn't radi­cally different from the house in which the family next door lives.

Now the momma and poppa in the ordinary family don't go to a special school to take courses on how to raise children before they become parents. The average momma and poppa who success­fully raise their children to be­come mature, functioning adults aren't child experts. They are adults who have reached that point in their own development where they are prepared to take on the responsibilities of parent­hood.

The point I am making here is that a normal, mature man or woman does not need to go through a two or four year train­ing course before he can begin dealing with the basic needs of an emotionally disturbed child. As adults, we have all experienced family life and have accumulated, albeit unconsciously, the knowl­edge of the sorts of things which children, all children, need. More­over, if medical experts could meet the needs of emotionally disturbed children they would have been more successful than they have been in their treatment programs over the past 75 years.

Therefore the persons we re­cruit to staff our therapeutic fam­ily units are ordinary young adults — not social workers, not psychol­ogists. Now, some of the behavior they encounter in living with emo­tionally disturbed children will be outside the range of their previous experience. But they have on call a wide variety of experts in child development and treatment—psy­chiatrists, psychologists, social workers, pediatricians, nurses, education and other experts, sen­ior child care staff who know from first hand experience what it is like to run a therapeutic family unit. All these people in the Browndale professional resource bank are there to share their knowledge and experience with the child care staff: To shed some light on why a certain child may be behaving in a certain way and to suggest methods of handling the behavior which will be thera-peutically beneficial to the child. The Browndale therapeutic par­ents have available to them, 24 hours a day, 7 days a week, a vast storehouse of knowledge and experience. But — like parents in the community — they, as the per­sons who know their child better than anyone else because they live with him all day and every day, make the decisions on how much of the experts' advice they will accept.

Living with emotionally dis­turbed children can be a frustrat­ing experience because the chil­dren will continue to reject all your concern for them, all your attempts to help them, all your efforts to provide pleasurable ex­periences for them, until they have accepted you as a trustworthy person, and that can take a long time. Staff living and working with emotionally disturbed children need opportunities to unload the build-up of negative feelings. They also need opportunities to come to terms with their own needs and frustrations, otherwise they may unconsciously act out some of these through the children. The Browndale staff therapy program was instituted to meet these staff needs. It is essential that any per­son working with emotionally disturbed children goes through a therapy process himself.

 

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So the Browndale therapeutic families differ from ordinary fam­ilies in the community because they have readily available to them the knowledge and experi­ence of the Browndale profes­sional resource bank and the advantages of the staff therapy program. Also, the male staff works full time with the children; he doesn't hold an outside job as fathers in the community do.

There is another very important difference between the Browndale therapeutic family and the family in nature and that is in the family in nature there is a biological tie between parents and children im­possible to duplicate artificially; the Browndale therapeutic "par­ents" have to work very hard to establish ties of relationship with the children they care for.

Having said all this, let's take a quizzical look at our therapeutic families to see whether we put into practice what we say and whether we are, in fact, meeting the standards of the average fam­ily in the community.

Have we succeeded in creating therapeutic families in which we successfully convey to the chil­dren that although we are not bound by biological ties they can depend on us to meet their emo­tional as well as their physical needs? If we are not prepared to let the children in the therapeutic family develop a dependency re­lationship with us we are failing to meet their emotional needs as children. If we don't meet their dependency needs, which they have in common with all children, they will be crippled in their at­tempts to grow up into self-reliant, mature adults because they will continue to search for the depen­dency relationship which they never had as a child. The whole process of growing up depends on the human relationship between child and parent.

Having established the need of every child to have parents — sub­stitute parents if he has none of his own, or his own cannot meet his needs — let us look at how we group children who come into care.

It has been the tradition, again because the problem has been looked at from a medical view­point, to group children homoge­neously: that is, to put children of the same age, the same sex, the same problem type, together. This type of living arrangement is an unnatural one.

At Browndale, we follow the structure of the family in nature as closely as possible when group­ing the children. We group hetero-geneously: placing in one thera­peutic family children of different sexes, varying ages, different per­sonalities, different problems and different strengths. From a treat­ment point of view we have found that the interaction between an aggressive acting out child and a withdrawn, inhibited child, for example, benefits both. Moreover, these heterogeneous groupings provide a natural living environ­ment for the children.

In the therapeutic family, from the moment he wakes up each morning the emotionally disturbed child can share the everyday ex­periences of the normal child liv­ing with his own family. As he goes through the routines of get­ting ready for the day ahead, he can look out of the window and see cars driving down the street, the other parents going to work, the other children on their way to school,  the  school   he  probably goes to, too.

After school, he can play with the other children who live on the street. He can invite them to play in his garden, go and play in theirs. No hospital ward or insti­tution can provide him with these experiences of normal social in­teraction.

The emotionally disturbed child is not a different species of human being. He is the same human child with the same human needs, plus the special needs that have arisen out of the deprivations he has suf­fered. We cannot meet those spe­cial needs by further depriving him of all the experiences that a child growing up in his own fam­ily enjoys.

However, there's more to a therapeutic family than providing an outward show of normalcy. When we talk about parenting in the therapeutic family we are talk­ing about commitment. Who feeds your children? Who bathes them? Who buys and keeps their clothes in good repair? Who takes care of your lawns? Keeps the basement clean and tidy? Takes care of the kitchen? Makes the living room look attractive? The kind of home you keep says something about their worth to the children who live in it.

To me, one of the most impor­tant things that parents do is take care of their children physically. If you do not see this as a com­mitment of first importance to the children in your therapeutic fam­ily, then you will find it hard to get through to them with other kinds of communication. One of the most important things we do as child care staff is communicate with the child. But when we are dealing with children who have great difficulties in communicating with people it is almost impos­sible to communicate with them on a verbal level, especially if they are children who were dam­aged emotionally before they developed language. With these children we have to use a lan­guage more universal than words. We communicate with these chil­dren through touch and through physical care.

 

You can talk to a child for half an hour and even if he under­stands what you are saying he can deny the communication. You touch a child for two minutes and the communication will get through.

When you provide a child with food he likes, appetizingly cooked and served, when you take good care of his clothes and posses­sions, you communicate with an honesty that transcends words, and in a way that cannot be de­nied or twisted. The very first con­tacts an infant has with the world around him is through the intake of food and through the ways in which he is handled and physi­cally cared for. So whenever you have a problem with communica­tion, I would suggest you go back to the primitive, instinctive ways of communicating. These are the methods by which you will estab­lish a rapport with your children. This is what I mean when I say your task is not one of talking. Talking to kids comes later, when the main job of treatment has been done.

Now, let's have some reaction to this.

Staff: Well, it all seems like very basic stuff Carlo. But you get the kids' problems to deal with all the time, quite apart from dealing with the  day-to-day  parenting roles.

Carlo: Would you like to ex­pand on that a little bit? The kids have problems, yes. So what is it the kids do with those problems which makes it hard for you to go back to this simple way of living with them?

Another staff: I think we can profit from taking a look at what we, as quite young individuals in our early twenties, feel about hav­ing these kids depend on us as parenting people: at how it fazes us to try to fulfil the parenting role, to constantly focus on what the kid needs, on how we can modify what we are doing with him all the time to best meet those needs.

 

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 All this takes some doing. There comes a time when you are tempted to say: to hell with it, this kid is just frustrating me. I don't want to accept that much dependency from the child that I always have to focus on what he needs.

Carlo: Let's talk about this. If you were the child's natural par­ents, you would begin fresh, you wouldn't have to undo anything. But the reality you have to deal with is that the child comes to you already having had an experience of life situations. He has experi­enced at least one family which didn't work for him. In most cases he will have had an experience of several homes including foster homes, group homes and institu­tions, which didn't work for him. By the time he comes to us he has no trust that the grown-up who is in charge of him — you — really will be able to take care of him.

Moreover, when he begins to get the feeling that maybe you are different from most grown-ups he has had experience with, he'll fight the feeling, and you, because to accept you as a trustworthy adult means letting down his de­fenses and he fears if he does that he might get clobbered again. He may not think this out con­sciously but this is his instinctive reaction.

So when the child comes to your house and you go about the business of caring for him and showing him in many different ways that you welcome him, you won't find a friendly ally in the child. Chances are that he will fight you and everything you are trying to do for him. You will go into the kitchen to prepare supper and he'll follow you and try to abuse you, calling you names, in­sulting you, trying to disrupt your preparations. You serve him some of the food you have prepared so carefully and lovingly and he will call it some disgusting name, re­fuse to eat it.

All of you, I am sure, have ex­perienced the frustrations, anger and disappointments that I am de­scribing. You work hard all day, setting up nice programs for the children, trying to help them have fun, cooking appetizing meals and the reaction of the child you are trying to help is: No, I don't want to. I don't like it. The food is lousy. I don't like this house, it stinks. I don't want to stay here.

These are the ways in which the children tell us about the prob­lems they are struggling with. It isn't that they don't like the house, or that they wouldn't like you if they could be sure that you were going to be around for a while. What they are saying is that they don't really believe that they de­serve all these things: a nice house, good food, affection. They aren't sure that they deserve to go to the school that all the other children go to, that they can really have friends living down the street.

 

Dealing with the defensive re­actions of the children and our own disappointments around these reactions is very hard, espe­cially for new staff. Here is where the professional people in our re­source bank can be of great assis­tance, helping us understand the dynamics behind the children's reactions, giving us advice on techniques for handling behavior so that things are easier for the child and for us. But any formulas that the experts give us can only be ways to help us survive the first barrage so that we can go on and do our real job — providing the disturbed child with a normal life experience.

Because, basically, what it all comes down to is this. Either you get caught up with the child's own pathology and confusion and agree with him that he is a hostile so-and-so, impossible to live with; or you demonstrate to him over and over and over again that you have a different idea about him than did all the other adults he met up with in the past. It's very hard to communicate with a child when he first comes into treat­ment because most of the people he has met up till now have given up on him sooner or later. And he expects that eventually you will, too. Sooner or later the other adults he has had contact with in the past agreed with him that he was different. All the structures and institutions that society has set up to "help" emotionally dis­turbed children reinforces the be­lief that they are "different". At Browndale we say to the child: You are not different and I'll prove it to you. It won't help the child to say this to him in so many words. We need to talk about the special ways of communicating with and handling children that show them that we do care about them, that we are convinced of their worth as human beings.

Staff: It's partly a time battle: Seeing who can last out the long­est. The kid's defenses have been reinforced by so many experiences with adults he's hardly going to break down.

Carlo: Not at the first fight, anyway.

Staff: And that's where he gets you at his own game.

Another staff: Yes, but by ob­serving him you can see what kind of a game he's playing.

Carlo: Well, let's spell it out. Consciously you want the child to come in and join your therapeutic family. You're not there to fight the child. Now, he may perceive you as another grown-up who's going to do him in. How are you going to demonstrate to this child that your focus is on meeting his needs, even though he may be confused about what you are try­ing to do?

Staff: But you can't do anything with a child, however focussed you are, until you have a feeling for him.

Carlo: As child care workers, if we are going to parent the child, we have to begin with knowledge of ourselves — where our needs begin and end and where the child's needs begin and end.

Staff: I know you have to focus on the child's needs, but...

Carlo: But what does it mean to you when a child turns you down? How does it make you feel when a kid succeeds in making you mad?

Staff: You need to know what's going on and you can sort all that out, but if you get caught up in it, it just blocks everything for the kid.

Another staff: You can have all your focus on the child and his needs, but if you aren't involved with the child, if you don't have a feeling for him, then he's not going to get a feeling from you.

Another staff: Yes, but with some kids your transmitter sends out one message and their re­ceiver gets another.

 

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Another staff: If you have a great concern for that child it's going to get through however much he tries to block it. If you focus on the child's needs it will be much more profitable for the child. You can have a feeling for a child while still not being able to focus on his needs.

Carlo: You have to be prepared to involve yourself. He is, for the time being, your child. And if you aren't going to meet his needs who will?

I think what you are all talking about is the difficulty of convinc­ing him. Think about it for a moment. Here is a child whose 14 years of life experiences have been such that he has ended up in a treatment centre. What is there so special about you that just by looking at you he can say: "Yes, I've finally arrived. This grown-up is different." How is the process going to happen? Through hard work and sweat, day in, day out. At some point the child will fight you even harder, because if we begin to reach him, if we begin to get through to him, that means he is going to have to alter the way he perceives the world outside — if not all of it, at least you. You keep making dents in that armour of his which makes him say: No grown-ups, in spite of what any of them say, are to be trusted, or relied upon. After 6 months, or two years, he will be saying that no grovn-ups are to be relied upon except Shirl, or Rich, or Rob. Well, that's the first step right there. Once you have succeeded in getting him to think that, then you have really reached the child in a way that no other adult has ever reached him. From then on, it's a question of time, and more of the same thing, until all areas are open for communication.

This is really what we have to become more conscious of: what is the message we give to the child when we set up the table this way, when we structure the house that way. This child who comes into your house has the opportunity to experience, perhaps for the first time in his life, the normalcy of the 24-hour daily life of a family which should be as normal as the life of the family next door.

The other extreme is this: are we so hung up, or inhibited, in reacting to the child that we don't know how to behave to­ward him? The new staff mem­ber who comes in asks: "What am I supposed to do?" I would say to him or her: "Go and do whatever would be normal to do with a child of your own at this time of day." If it is 7 o'clock in the morning the normal thing to do is help the child get up, pre­pare and eat breakfast with him. Life itself, all around you, tells you what it is O.K. to do. It isn't really a question of what you are supposed to do but what you, as an adult, are prepared to do.

Does this make sense to you? The child may not agree with you, but that isn't really why we get hung-up on it. Are you really pre­pared to try to convince the child that this is what's normal? We could go on all day talking about the theories, the subtleties and techniques of treatment but it won't help us unless we are hon­estly prepared to accept that this is what we do. Are we prepared to have the child react to what we do? Are we the doers? We call the shots. We set the tone in our houses. And it is the child's pre­rogative to challenge us. It's the child's prerogative to ask: "Well, what are you going to do about it, you so-and-so?" It's the child's

prerogative to find out what you are going to do about it, what is going to happen next. A lot of trouble begins when we begin to doubt whether our focus is right.

The child doesn't come to us with a blank life experience. Nor do we come to the treatment cen­tre with a blank experience. We, too, have past life experiences which influence the way we think, the way we react to things.

When I say to you: "Go and act as though he were your own child" what is your model ? Where did you learn the way you behave toward a child? Who showed you that this is the way? Well, you first saw the way adults behave toward children in your own fam­ily. What you experienced there might make you imitate, or might make you behave in exactly the opposite way. Consciously, or un­consciously, what you do and what you don't do will be dic­tated by your own life experi­ences. What does it mean to you when I say: "Go and act like a parent toward this child"? How comfortable, how free are you to do that? How much are you still fighting your own feelings around your parents?

There is a whole area we need to look at here. Can we, at one end of the scale, act as though these were our own kids and, at the other end of the scale, come to terms with our own feelings as children of our parents, and at what point along the scale do we come to terms with our own feel­ings about our own parents? We all come from a family. At Brown-dale, we have established a fam­ily model of treatment. We have to come to terms with our own feelings about our own parents. Otherwise we are going to act out our own feelings through the kids we are now caring for. Are you prepared to talk about your feelings in this area? If you keep yourself firmly focused on the needs of the child chances are that you are doing O.K. A lot of the pressure on the job comes from our feelings around our own relationships with our parents and siblings.

  Staff: What would you say were the main differences be­tween the concept of the thera­peutic family and the medical model of treatment?

Carlo: As therapeutic parents you focus on the total care of the child, partly because he needs total care, and partly because this is the best way to communicate to the child that he is a worth­while human being, a human be­ing worth caring for. The child who comes to Browndale for residential treatment has special needs, but he also shares the needs of all children and before we can meet his special needs we have to pay attention to his basic needs as a child.

The basic thing the child living in the community gets from his parents is involvement. If, as ther­apeutic parents, we are not pre­pared to involve ourselves with the child, nothing will happen. Un­til you come to regard the child as your child and you are prepared to do things for him that no one else will do, you haven't even started treating him. Not until you accept the fact that if he is hungry and you don't feed him no one else will; if he needs a pair of socks and you don't buy them no one else will. Whether your house looks nice and clean and comfor­table or whether it looks like a pig sty reflects your attitude to the children who live in it with you, and don't think they don't pick up the message. If you feel this is your child and he has a right to live with you, how can you toler­ate a dirty living room, a messy kitchen? What are you telling the child: that he deserves to live in a nice house; or that he doesn't, because he is "different" from other children?

Staff: It's a strange thing. Be­fore I went away on my holidays the house looked fine to me. But when I came back, I walked in and it looked like a cold place. That was my first reaction when I walked back in.

Carlo: So ... do you think it was just the fact that you went away and took a break and came back and this gave you a different perspective? How closely do you really look at your houses? Do you take them for granted? Do we dare

compare ourselves with our neighbors, or do we get so caught up with the things that are going on in our therapeutic fam­ilies that we forget what's going on outside in the community?

 

How does your house compare with the house three doors down the street? What kind of clothes do your kids wear? What kind of activities do they take part in? Where do they go and what do they do after school and week­ends? Are they indistinguishable from the other children who live in the community or do they stand out? The more our children look and act differently from the other children in the community the more we are failing them as ther­apeutic parents.

Staff: Sometimes when I walk into our house I get the feeling that I'm going into a motel, that people aren't really living there.

Carlo: Do you have plants in the house?

Another staff: You need pic­tures on the wall, and other things around.

Carlo: Why don't you bring in some of your own things? Do you feel free to arrange the house and decorate it in a way that reflects you? That's what you have to do. How will I know this is Judy's house unless Judy has projected herself into it?

Staff: You are right because by looking at our house you cannot really say it belongs to anyone.

Carlo: Well, I say it is O.K. if the house begins to look as though it belongs to Judy. You'll have some limitations but you should feel free to arrange the furnish­ings and decorate the house in a way which reflects you. You should feel comfortable about do­ing things to the house which will tell someone coming in: If you don't know me, this is me. The way the house looks tells you the kind of person I am.

Staff: Fixing up the house as a group project really puts a lot of group feeling into the house — painting rooms, sanding and wax­ing the floors. The kids really feel part of it. If you don't put your own thoughts about how a house should look into it, there's a sterile, institutional atmosphere as far as the physical aspects of the house are concerned. But in our houses the couches, the beds, the chairs and tables are given out to us. We don't choose them. I think each parenting couple should get together and agree on what they would like and go out and get it.

   Carlo: I agree with you. That's the ideal. But until we are in a better position financially we have to buy wholesale. But in making a house your own, small things — pictures, plants, ornaments, are much more important than the basic furniture. These smaller things reflect your personality. So does the way you arrange the furniture.

Staff: It can be the same blue couch in 5 or 6 houses, but in your house you might have some bright red cushions on it, you have a picture on the wall that you and the kids found at an auction sale, you have a plant on an end table, a different kind of shade on the lamp.

Another staff: I'd like to talk some more about how hard it is for the kids to trust.

Carlo: The more unreliable the child's life experiences have been, the more firmly ingrained in him is the belief that grown-ups are not to be relied upon. If we are able to care for a child and estab­lish a relationship with him our job is done. At the point at which we establish a relationship with him the treatment is really finish­ed and from then on we are just giving care and love and support while he develops his potential. That's why treatment is so hard. The whole treatment process cen­tres around the skirmishes, the fights, the upsets, the ups and downs. When these things stop, you and the child are really finish­ed with each other. Now he can get what he needs because you have succeeded in removing the blocks and inhibitions that were there. If you want a definition of treatment, there it is. How do you take care of a child who fights you? How do you take care of a child who insists he doesn't need or want your care? How do you meet the child's needs in spite of everything he says and everything he does in an attempt to prevent you doing just that?

Staff: I have found that one thing that really gets to the kids — kind of shocks them in a way, especially if they aren't used to it — is to not only take care of their needs but to be one jump ahead of them; to provide for the child's needs before those needs come up. For example, he might let you know that next week he has a special thing going on in school. He doesn't actually say what he needs for that school function. Usually he knows and it turns into an issue 20 seconds before he is due to leave for school. But if you remember and get everything ready for him in good time ...

Carlo: Yes. And the clue to this kind of thing many times is that he doesn't really expect to get what he needs and so he doesn't ask for it in advance. For instance, if he is invited to join the football team, there will be special clothes and equipment he will need. Chances are that if he ever joined a football team before he had to make do without all the proper paraphernalia. You are saying, let's do it right, so that he can arrive on the football field prop­erly equipped.

Staff: Clothes are another thing. You notice that he is get­ting short of underwear, or socks, and you don't even say anything, you just go out and get some for him and leave them on his dres­ser. Somehow there's a nice feel­ing about it. Because the children notice the new things and they'll wear them the very next day. Nothing's said, but something's been done.

Another staff: There does come a time though, when they like to choose their own clothes, even socks.

Carlo: The point at which you allow the child to make his own decisions around clothes depends on his age and on him, on how much he wants to do this. In the family in the community the older the children get the less the par­ents make these decisions for them. They usually stay in the background, setting a few guide­lines; setting a ceiling on how much to spend, for example.

Staff: We talk about following the community model, reaching community standards, but there must be a good many things that happen in the ordinary home with ordinary people which aren't nec­essarily good things to happen to a child.

Carlo: Yes, that's true; many people abuse their children, not because they want to, but because they don't know any better, or their own unmet needs are so great they cannot focus on the needs of their children. When we talk about parenting children I hope I make it absolutely clear that the focus is on what the child needs, not on what we need, be­cause our needs might sometimes be pathological and meeting them might abuse the child.

 

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The chief value of the staff therapy program is in helping us sort out our needs so that we don't get them mixed up with the child's needs.

Of course there are lots of things going on in ordinary homes in the community which aren't good for children. When these things result from ignorance of what children need, our therapeu­tic families can help simply by being there, in the community, as an example. You have probably all had the experience of having the children in the neighborhood flocking into your garden, or in front of your house, to play. In some cases this has a tendency to make neighborhood parents a little jealous and resentful. But usually they are open minded enough to learn from us.

  Staff: I get the feeling from families living near us that the average family in the neighbor­hood is doing just the opposite of what we are trying to do. We say, involve yourselves with the kids. But I get the feeling that most parents in the community are say­ing to their children it's O.K. to get involved with the junior hockey league, or anything else, but don't try to get involved with me because I don't have the time or energy. It's like the kids are some kind of push off, you know? The parents say: I will provide food for you and I will make sure I read your end of term report card and make some comment on it; but it stays at that level of in­volvement and it never goes deep­er than that.

Carlo: That's true, unfortunate­ly. A child can grow up in a nice, air-conditioned house, have good food, lots of material things, but his dependency needs won't be met if he cannot enjoy a human relationship with his parents. We certainly can't meet the treatment needs of the children who come to us unless we are prepared to take the child on whenever the child wants to take us on. It's not an easy commitment to make because the child will demand things from me at all sorts of times, at times when I am not prepared to meet his needs, times when I don't want to. He'll push my own feelings and my own needs will come out, I don't have a choice. Either I say to the child come into my group and I'll meet your needs no matter what they are, or I'll say to him I'm not pre­pared to do that so you better go to someone else to have your treatment needs met. There's no in-between.

Staff: I see so many families in our neighborhood putting such an effort into maintaining an im­age for the outside world. It's as though they were saying to them­selves: As long as the neighbors think I have a nice, pleasant, happy family, then everything's fine, we've got the biggest prob­lem licked. Whereas if they spent the same energy that they spend on maintaining a good front into maintaining a really happy family, it would be great.

Carlo: That's true. And this really brings into focus how pre­pared you are to meet the real needs of the children, rather than try to cover up their symptoms to maintain a front for the neighbors. It may help some of these people to see you meeting the real needs of your therapeutic family and feeling comfortable about it.

Staff: The thing that bothers me is that after working in a house for two years most of the child care staff usually move on into some other area of the pro­gram as training persons or super­visors.

Carlo: So they become mem­bers of the resource bank.

Staff: But is that desirable? We end up with two different kinds of

child care staff but the ones with the two years' experience behind them aren't working in the houses.

Carlo: That's right. The child care workers with two years' prac­tical experience of working in a house are very valuable members of the resource bank. When you are struggling with problems of living with a particular child there's nothing like talking things over with someone who has been through it. Not someone who has read it all in a textbook, but some­one who has done, and survived, the job which you are doing now.

Staff: My concern is that the people who are running the houses are rarely people who have com­pleted the two years' training pro­gram. They are people in training.

Carlo: Right, and you are anx­ious about all these new people in our program. But we need new people with fresh approaches, raring to go, ready to flex their muscles and work with disturbed children. If you ask me whether I could run a house I'll tell you I couldn't do it now. I've done it, but I no longer have the energy of a 22-year-old and I'd get too tired. Therapeutic parents need to be young and energetic. Being new to the job, they can bring in fresh ideas and new perspectives. Those of us who have been here a few years tend to get in a rut and have a stake in preserving the status quo for its own sake.

To counterbalance the newness and inexperience of the therapeu­tic parents, all the time they are on the job they are learning: through doing, through seminars, through talking over the day to day happenings with the area social workers and senior child care staff. Most important, through the group therapy sessions, they are going through a process of learning about themselves and their own motivations. And they aren't working off in a vacuum some place. The professional ex­perts in the resource bank don't stay on ice until they are called. They are around all the time, in frequent contact with the staff and the children.

After spending an intensive two years looking after kids — be­ing responsible for them on a 24 hours a day, 7 days a week basis, maintaining a focus on the child's needs when arranging program, routines, your own time off — most people want to slacken off a bit and do something else, have more time to themselves. That's when we say to them: are you prepared, now, to help and show someone else what you have learned during the past two years?