Communication, Learning and Therapeutic Process in a Children's Psychiatric Hospital

Abstract

Some principles which have appeared to be helpful to the staff in working with children showing serious behavioural difficulties in a children's psychiatric hospital, have been described. The necessity for dealing with the very disturbed behaviour focuses on the ‘here and now’ interactions characterizing the therapeutic milieu. These principles are intended to help the staff maintain a frame of reference which will facilitate the milieu. These principles are: 1) The child's behaviour may be viewed as an expression of his beliefs. 2) Active confirmation of beliefs is sought. 3) Behaviour should be viewed in interactional and not in structural terms. 4) The frames of reference of staff and children are distinct. 5) The importance of contradictory messages. 6) There is often confusion between the thought and the action. 7) Staff function as behavioural models. 8) Significant communication must be actively maintained. 9) The importance of verbal communication. 10) It is essential to establish a hierarchy of treatment aims. Communication theory appears to provide the most satisfactory framework within which to examine these principles. Reference is also made to some recent learning theory formulations which focus on the social context of learning. It is essential, if the psychiatrist is to facilitate therapeutic behaviour by the child-care staff, that he can communicate in a way that has meaning in terms of their actual role. Early treatment aims consist of avoiding confirming beliefs we wish changed, reflection of feeling, helping to discriminate between thought and feeling, maintaining affective interchange and providing suitable behavioural models. Methods of facilitating socially desirable responses are very briefly considered. Positive staff responses to the socially appropriate behaviour which even these very seriously disturbed children show, appear likely to be effective provided these are accompanied by congruent staff behaviour. Some reasons why these principles require constant reaffirmation and reexamination are proposed and comments made on their teaching.

The Residential Treatment Response of Disturbed Children Using Serial Ratings of Adjustment

“…An intensification of disturbance has been noted in some children whose experiences with therapeutic adults failed to confirm their pathological expectations (1) . This failure appears to threaten defences against interpersonal involvement, with arousal of anxiety and increased efforts to obtain the anticipated responses from others.…”

The Therapeutic Paradox*

“…The concept of a hierarchy of treat~ent aims is fundamental (1). Cert~m approaches may be untherapeutIc because the child's frame of reference results in the reinforceme?t of beliefs we wish to change.…”