Child and adolescent psychiatric clinics of North America
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Child Adolesc Psychiatr Clin N Am · Apr 2004
Historical ArticlePsychoanalysis and the early beginnings of residential treatment for troubled youth.
One of the intentions of Aichhom, Redl, Wineman, Bettelheim, and Anna Freud in their writings about group care was to advocate for the need to simplify the lives of youths who had known only chaos, to create an atmosphere in which everything has a purpose and predictable positive responses were given unconditionally. Recent efforts, such as those by Greenberg et at, have focused on building community-wide early interventions to forestall later emergence of emotional or behavioral disorders. The efforts also mark a shift away from punishment and exclusion for troubled children at school to more inclusive systems of positive behavioral interventions and support by providing a place to achieve academic and social behavioral success. ⋯ This enhanced awareness of a child's impact on others through the marginal life-space interview, together with enhanced awareness of one's own wishes and thoughts as provided by the milieu and individual therapy, may offer the best means for helping a young person return successfully to the community. Although it is increasingly difficult to support young people in long-term milieu therapy, the concerns initially expressed by Anna Freud and her Viennese colleagues, continued in the work of Bettelheim, Ekstein, and Redl, suggest that attention to a child's understanding of self and experience and focus on the interplay of dynamics between the child and the social milieu continues to offer an important means for therapeutic change. This remains true, even at a time when pressure for "mainstreaming" children with special needs together with financial constraints and reliance on psychopharmacology have altered more traditional understanding of the provision of residential psychodynamic treatment for troubled young people.
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Child Adolesc Psychiatr Clin N Am · Apr 2004
Review Case ReportsContemporary issues in the psychiatric residential treatment of disturbed adolescents.
This article reviewed the current challenges to the provision of residential treatment for disturbed adolescents, described the Menninger Clinic's model for short-term residential treatment that has been developed over the last 10 years to meet these challenges, and provided a case example to exemplify the role of such newly developed concepts as "mentalizing" in the provision of psychiatric treatment. Stimulated by the alarm of the costs of health care in general, residential treatment is highly scrutinized by private third-party payers and public funding sources. ⋯ The essential ingredients needed to ensure that treatment is effective and that treatment gains are sustained were described. Finally, a case was used to illustrate current views of understanding some of the processes that engage patients and stimulate changes in several variables.