Crisis Intervention in Residential Treatment
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Crisis Intervention in Residential Treatment

The Clinical Innovations of Fritz Redl

William C Morse

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eBook - ePub

Crisis Intervention in Residential Treatment

The Clinical Innovations of Fritz Redl

William C Morse

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About This Book

All settings where disturbed children spend time, such as camps or residential schools, are periodically faced with crisis situations. Methods for dealing with these crises and for counseling the children involved are continually needed. Crisis Intervention in Residential Treatment is both a demonstration of how essential Fritz Redl's treatment concepts remain today and a tribute to his genius. The authors bring order and reason to the quest for better ways to understand and respond to confrontation and aggression in residential treatment settings. They provide practical and successful strategies to cope with these situations and prevent them from occurring. By exploring and expanding some of Redl's most important theories and practices, the authors encourage a new generation of child care workers to find the same stimulation and satisfaction in his work as his original followers found. The contributors, each deeply affected and influenced in his or her own way by Redl, provide not only a moving tribute to a great child care worker and innovator, but also a rejuvenation of some of the most valued ideas in the field. Sharing Redl's concern for daily practice with very difficult youngsters, this understanding book focuses on the action setting and the development of theory from practice, not the application of theory to practice. By concentrating on such topics as the use of life space interviewing, aggression and counter-aggression in staff, and the contrast of interpersonal and ecological perspectives with current "get tough" approaches, Crisis Intervention in Residential Treatment is an eminently useful guide for everyone dealing with children in group settings. Psychiatrists, psychologists, social workers, teachers, and residential personnel will all learn effective ways of coping with and preventing crisis situations.

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Publisher
Routledge
Year
2013
ISBN
9781135837396

What’s Old — Is New:
Fritz Redl’s Teaching Reaches into the Present

Henry W. Maier, PhD
Professor Emeritus
University of Washington
EDITOR’S NOTE: Maier’s paper provides an excellent portrayal of Redl’s timeliness. We see the introduction of the combined interpersonal and ecological perspectives. With the ‘get tough’ emphasis today, the exposition on punishment is for all of us. Assessment and treatment were one for Redl. Maier points out that contemporary child and youth care still struggle with Redl’s messages.

FRITZ REDL’S WORK: A PROLOGUE FOR TODAY’S PRACTICE

Redl’s innovative ideas of yesterday are very much in evidence and have real relevance for today’s child and youth care practices. A truism attributed to Albert E. Trieschman surely applies here as we examine Redl’s contributions: “What’s old — is new” (Maier, 1988, p. 5).
We find evident, shades of Redl in the current uneasiness with large-scale theories and the replacement of these by situational explorations and practice directions. These ideas were already voiced in the mid-fifties in a little article of Fritz Redl addressed to teachers and mental health practitioners:
Please avoid any theories for the time being. This is not the moment to decide just which part of whose stock of knowledge applies best to your case. Your child is still your child, a person of a given age, of given characteristics, who has grown out of very specific circumstances into equally specific character patterns and is doing, right now, very unique and very specific things. You have to look at him [or her] and what he [or she] did long enough to know what is really going on inside and around him [or her]. (1955, p. 4)
This shift, from preoccupation with fitting youngsters into theoretic paradigms toward establishing what is really happening to the youngsters in question and what that behavior then means in the world they and we live in, is essentially in line with today’s practice.
Actually, in the 1950s such an admonishment was likewise seen as a paradigm shift; a revolutionary departure from preoccupation with intrapsychic phenomena and with the perception of children’s behavior manifested in a vacuum. Redl’s interactional and situational emphases — i.e., understanding children’s behavior circumscribed by the world in which they live — are now cited as interpersonal and ecological perspectives. Today these are established working platforms.
In looking into the work of one of the contemporary leading “gurus,” Urie Bronfenbrenner, we find his conceptual framework of ecological human development (1979) akin to Redl’s concern with the intervening personal and environmental forces. It is not clear whether Bronfenbrenner actually was familiar with Redl’s earlier efforts, but he decisively advanced these earlier concepts.
There seems to be a newly awakened attention to interactive humanistic and ecological factors (earlier identified as “milieu”). They are currently reflected in the human services — especially in group care (Krueger, 1990a). This emphasis is reappearing after decades of experimentation with psychodynamic, behavioral, and other grand-scale formulations for engineering social change.
It is of interest to note that this latest paradigm shift is consistent with events at the end of this century, when political liberalism, an acknowledgment of essential connections across natural and ethnic boundaries as we search for a pluralistic society, is apparently assuming center stage.
Another illustration of the legacy of Redl has to do with his repeated call to perceive “discipline” as an issue of child care rather than child control. This was an essential point for him, which he advocated throughout his professional life (1966, pp. 355–377). Especially noteworthy are his strong assaults on physical punishment, which surely had a role in the decline of its use in current child and youth care. Lest we forget this powerful position, his statement and that of Dave Wineman deserves to be cited here:
We are against the application of physical punishment in any form whatsoever under any circumstances. Even for the normal child we reject the idea that physical pain will “teach” the youngster, that the entrance to the character of a child leads through the epidermis of his hindquarters, or that physical pain will solve things by giving a child the chance to pay for his sins and thus end his guilt feelings. The implication of physical punishment is always, no matter how mild a form is being used, that physical violence will “change” a child, or will motivate him toward a more social approach to life, people, and values. Sometimes it is admittedly meant to be a “behavior stopper” only, but even then we can show the enormous price we pay for such a technique in terms of the poisonous by-products, even should the surface goal be achieved. (1952, p. 211)
In a different sphere of professional concerns it might be of interest for the scope of this publication to note Redl’s advocacy to merging child and youth care interests with social work. As early as fifteen years ago, he recommended:
Right now, I think what should have happened in the field of social work may be a combination of education and the development of child care workers, because as a child care worker you ought to be specially trained; it is a mixture of nursing and social casework and group work. I would like to see child care work as part of social work and nursing combined. (In Gottesfield & Pharis, 1977, p. 91)
Such a merger faltered around 1955; but it was successfully accomplished in the mid-eighties in the University of Pittsburgh’s Department of Child Care/Child Development and the School of Social Work. Around the same period, the Center for Research and Youth Development and the School of Social Work came together within one department at the University of Minnesota School of Child and Youth Care; at the University of Victoria, British Columbia, the School of Child and Youth Care and the School of Social Work adopted a mutual commitment to a joint graduate degree program. Thus far, however, these structural unifications have not brought about a substantial merger with educational and practice endeavors.
The major thrust to advance Redl’s original pertinent work for the group care field has come from people following his teaching and involved in the training of child and youth care workers. Just to name a few: Jerry Beker (1972, and as editor of the Child and Youth Care Quarterly); Larry Brendtro (1969, 1983); Thom Garfat (1985); Mark Krueger (1990a, b); Norman Powell (1990); James Whittaker (1969, 1974); and especially Albert E. Trieschman, by way of numerous well-focused lectures and writings (1969) and the actual practice designs for his residential care and treatment program, the Walker Home and School. Trieschman himself saw much of his practice, teaching, and writing anchored directly in Redl’s precepts. It is significant that still today practitioners in the care fields find stimulation and concrete direction for their work in Redl’s writings. His contribution to today’s group care practice is specifically reflected in the following three areas: (1) assessment and treatment as a multi-faceted experience; (2) from the marginal interview to central care involvement; and (3) teaching as a personal learning experience.

ASSESSMENT AND TREATMENT AS A MULTI-FACETED EXPERIENCE

A report of any single critical event in the life of a child or group of youngsters becomes illuminated by even more questions. These are not merely idle probing questions; for Redl they are exciting moments of search and searching once more (and ultimately research) (1966, p. 17). So much is happening at one time that there can hardly be room for determining exactly whether a response is internal or external, behavioral, affective, or cognitive. The issue whether a behavior is child-or group-centered also fades. Instead, our task becomes to understand children’s behavior and to learn what they are expressing rather than under what rubric of classification we should account for their behavior. Redl leaves us breathless in his questioning and excitement over all the possibilities to learn and gain understanding from the children’s behavior. It is this enthusiasm about the potential in each assessment that promises an explosion of knowledge and skill attainment. Redl might have equated it to a “scouting” adventure even when looking at so-called routine events. Today, we have become more behavior-specific oriented, as he advocated years ago.
This kind of open-minded assessment leads practitioners away from diagnosis in the more traditional “clinical” sense, which entailed substantiating diagnostic formulations or filling in a grid in the elusive search for causative factors: the why of human behavior. Redl was more interested in and found it more useful to look at how a behavior occurred. Redl’s formulation, emphasizing the circumstances of children’s behavior, is coming nowadays to fruition in many residential and kindred care settings where the child no longer stands alone as the subject of scrutiny. It is currently thought that children and youth can best be understood as they are assessed for their interactions amidst their life events. For instance, the event of a girl knocking over her glass of milk has to be studied for the happenings around the table, in the dining room, in her own immediate personal life sphere, as well as her personal dexterity.
In the milk-spilling episode we are concerned about the child’s ongoing experience rather than her behavior per se. In fact, the designations of a “disruptive child,” “misbehaving children,” “clumsy” ones, etc., are labels possibly gratifying only to the adults in charge; because they can then exclude themselves and the world around them as agents in the child’s misfortune (1975, pp. 569–571). Fritz Redl’s perspective found full acceptance in the “revolutionary” ’60s and ‘70s and now in contemporary efforts such as staying away from stereotypically labeling a child as a “mentally retarded child” when actually he or she is a child with mental delay. Such a perspective is required to overcome the current questionable practice of describing certain children as “abused children” when actually they are children who have experienced abuse and need what every child requires, only more so.
Current-day interest in painstaking efforts to understand the meaning of a person’s experience or verbal account for its ethnic situational circumstance coincides with Redl’s intense exploration into the manifold potential meanings of a single verbal statement. Oliver Wendell Holmes said it succinctly as reported by Jerome Kagan: “A word is not a crystal, transparent and unchanged; it is the skin of a living thought and may vary greatly in color and in content according to the circumstances and the time in which it is used” (Kagan, 1989, p. iii).
Today’s disenchantment with digging into a child’s past history and scrupulous searching for early childhood trauma are supplemented by the desire to learn more fully the spectrum of the child’s or youth’s ongoing life experience. This kind of perusal would include the family and beyond; the peers, school, neighborhood, and possibly the community at large (Tracy, 1990). Such a perspective was continuously voiced in Redl lectures and writings. His vivid lectures while on the circuit (always well prepared but frequently merely laid out on the back of an envelope) were full of the myriad of ingredients underpinning any one situation.
Nowadays the attention to the specifics, the ingredients of human experience, are also referred to as the “minutiae” of life events (Maier, 1990, pp. 19–20). Fritz Redl once used an example of minutiae: the child who hammered a screw into place. If the youngster had chosen the screw driver, one could infer a different indicator of frustration tolerance. At another time he describes a child interrupting a teacher’s talk. He points out the array of possibilities: This child didn’t understand, or s/he was eager for gaining teacher or peer good will, or s/he was all excited, anticipating a significant community event coming up, or many other possibilities (1975). All merit significance, because each one gives “the interrupting behavior” its specific tinge. The same dynamics hold for interventive attempts. A caregiver’s wink with an eye or a firm hand on a youngster’s shoulder can be powerful, minute ingredients to alter an anticipated unwanted behavior of the child.
We are looking here in detail at what Fritz meant with his dictum: “What people really do to one another counts as much as how they feel” (1966, p. 86). This concept appears commonly accepted today as a valid psychological, almost a commonsense, perspective. Years back, however, for persons with his psychoanalytic training and his professional alignments, it was a revolutionary pronouncement!
Redl’s kaleidoscopic understanding of child and youth behavior requires empathic attention to the impact of environmental (milieu) factors. These include psychological and also cultural values (only recently recognized in our actual practice). He would include, as well, factors of which we are just becoming fully aware such as ongoing interpersonal experiences and the controlling and/or allowing aspects of the physical and social settings.
Redl’s views are summed up in the succinct subheadings for the first chapter of his and Wineman’s Control from Within (1952). They interlace all the basic ingredients he felt were paramount for a sound child or youth care environment. These principles, submitted in the fifties, are still, ...

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