Problems of staff interaction with spontaneous group formations on a children's psychiatric ward.

Abstract

When we speak of impulse to such and such action, of tendency to such and such behavior,of striving toward such and such goa1,or use any of these words which sound as if you, a unit, have these things in you and as if they can be studied by and for themselves, we are talking, according to the structure of our language and the habits of common speech, about something which is observably manifested as action in a situation. The situation is not any old thing, it is you and someone else integrated in a particular fashion which can be converted in the alembic of speech into a statement that "A is striving toward so and so from B."concept has been helpful in dealing with the problems that have arisen around the formation of spontaneous groups in a children's psychiatric ward. As Sullivan would say, the staff, whether nurse, attendant, or psychiatrist, becomes a participant observer (11,12).Red1 (2), Bettelheim and Sylvester (3), and others have reported upon the dynamic processes within groups of disturbed children in the preadolescent age range. Bender (4) speaks of the destructive and disintegrating effects such spontaneously formed groups may have on ward management and on the therapeutic program. The destructiveness of these groups often tends to invite their suppression by the staff. Even when suppressed, they may develop as secret or underground activities. Stewart and Axelrod ( S ) , as well as Bender (4), report efforts with group therapy programs to meet these problems. Such programs, however, in our experience, often fail to prevent such spontaneous group formations and their destructiveness.Since the opening of this children's ward in the fall of 1944, at which time there were more aggressive than neurotically inhibited children in the ward population, many spontaneous groups have been organized, often in direct opposition to the nurses and attendants. At one point in the history of this children's ward, the group members actually feared disapproval and punishment from one of its dictatorial leaders more than from the nursing staff in charge. Many efforts a t curbing such activities were tried, such as attempts to forbid organization of such groups, restriction of the privileges and even the temporary isolation of the leaders, as well as directed group therapy programs. The turnover and change of staff were constant. Sutton (6), too, experienced and reported this problem of frequent resignation of nurses on such a children's psychiatric ward.

Childhood schizophrenia and allied conditions.

“…The residential care staff must be particularly sensitive, he feels, since there is often not enough personal individual stimulation in the group life to promote the child's active personality growth after he has begun to accept personal relationships. Konopka ( 307) stresses the importance of (80,82,213,214,269,312,418,419,460,498).…”

Nursing in the psychiatric treatment of children—Panel, 1961: 3. Nursing in hospital psychiatric therapy for psychotic children.

“…All facets of the ward program are outgrowths of the experience and the philosophy of the Children's Service staff during the past 14 years (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Under the direction of Dr. S. A. Szurek, there has developed in this time an in creasingly integrated clinical unit.…”

Langley Porter Clinic, Children's In-Patient Service.

“…Some of them have been present in the ward census throughout most of these six years. Their parents, we find, are no less troubled than parents of other children and with an understanding of their particular troubles they are no less and no more ''accessible" for therapeutic work (16,17,20,21,27).…”