Fritz Redl and David Wineman (1952) Controls from within: techniques for the treatment of the aggressive child Glencoe: Free Press
Controls from Within is the second and companion volume to Children who Hate (1951), largely about the authors’ experiences of trying to treat delinquent boys through the Pioneer House project. The books were subsequently combined and issued as The Aggressive Child (1957). While Children who Hate is primarily concerned with describing the behaviour of the young people, Controls from Within outlines the techniques used by staff to manage the young people’s behaviour until they became amenable to ‘treatment.’
– Recording interventions and their impact is important.
– Managing behaviour is ultimately an individual’s responsibility.
– Young people who cannot manage their behaviour need a supportive milieu rather than individual interventions.
– Staff need complete flexibility of action.
– Activities are central to managing the daily experience of disturbed children.
– There are at least seventeen ways of influencing behaviour, of which punishment is one.
In this summary I have frequently substituted 21st century UK English for the mid-20th century US Freudian terms used by the authors.
In the Preface they point out that ‘controls from within’ do not arise as a result of ‘controls from without’, even though it may be necessary to use ‘controls from without’ to manage some of a child’s behaviour. They stress that Pioneer House had many imperfections but that only by recording what they had attempted could they attempt something better.
In the Introduction, they argue that the common factor among children who do not have the resources to cope adequately with everyday decisions is hate. Yet alongside their apparent inability to deal with many everyday tasks is a remarkable ability to fashion explanations for their not being able to do something and to find others who will support them in their decisions, which is not amenable to traditional therapeutic interventions based on the interview nor to traditional educational interventions.
The difference between ‘normal’ children and those who hate is that, while neither always behave perfectly, ‘normal’ children will respond to interventions which remind them what is good behaviour. But, since even ‘normal’ children, if they have been put under certain types of stress, may not respond positively and need further support from sympathetic others, not surprisingly, working with children who hate, who are often being placed under all sorts of additional stresses, can be particularly difficult.
In Chapter I Structure and strategy of a treatment home, they argue that the problem with traditional institutions was that ‘treatment’ is tacked on, usually, to a very unsympathetic regime and that, while creating a regime which is supportive of what goes on in treatment sessions is an important step, with children who hate it is not enough. Everyone, including the ancillary staff, must be able to contribute directly to the ‘treatment.’
This involves accommodation which not too different from what a child is used to, where they can use the facilities in ways which may not have been envisaged by those who planned them, where there is space for different activities to go on simultaneously and where the non-verbal messages built into the accommodation convey that it is genuinely cared for as a place for children who are valued. Similarly the daily routines have to convey staff care for the children and any activities have to emphasise the value of having fun.
Staff must be able to reassure children that they can protect them, among other things, from other children or from themselves, so that they do not need to be afraid. In doing the latter, they need to allow children enough leeway to enable them to express their anxieties and yet set limits to their behaviour whose rationale the child can understand. There needs to be plenty of positive reinforcement and also opportunities for the child to retreat from the immediate demands of her/his environment. Above all, the child must experience no damaging interactions.
To achieve that, staff must have complete flexibility and ample resources to manage the situations in which children find themselves, including promoting positive peer group relationships.
In Chapter II Programming for ego support, they begin by pointing out that many different activities have been described as beneficial for children but without ever saying what the benefit is. Typically an activity may be a viewed by adults as a diversion, a bribe, a right, an exercise in skill development, an exercise in socialisation, a supplement to their education, occupational therapy or a therapeutic device.
Above all an activity must be managed so that it does not damage anyone, for example by deliberately highlighting a known weakness. Beyond this, it needs to be able to release tension, minimise frustration, accommodate to the child’s range of experiences while avoiding conjuring up painful ones from their past, accommodate to the group’s cognitive development and also to any norms of the group, start gently, finish gently and only go on for as long as conditions are favourable.
It is useful to name activities so that children can talk about them without confusion later and to try and manage the stimulation children get from activities so that they are neither over-stimulated nor lose interest. It is possible to widen the range of activities in which children might be interested and also to `plan’ some of the activities while still being ready to change the activity to meet a specific need.
In Chapter III Techniques for the antiseptic manipulation of surface behavior, the authors set out seventeen ways of managing the outward behaviour of children, stressing that they never used number 17, Threats and punishments, in Pioneer House:
1 planned ignoring
2 signal interference
3 proximity and touch control
4 involvement in interest relationship
5 hypodermic affection
6 tension decontamination through humour
7 hurdle help
8 interpretation as interference
11 direct appeal
12 limitation of space and tools
13 antiseptic bouncing
14 physical restraint
15 permission and authoritative `Verbot’
16 promises and rewards
17 threats and punishments
In explaining why they did not use threats or punishments, they point out that children have to understand the point of the punishment, see it as directly related to the thing which the adult is interested in, be able to separate the pain of the punishment from any feelings they may have towards the adult and not see it as a rejection. Children who hate have often undergone traumatic experiences which are likely to distort their perceptions of punishment and therefore its effects on them.
In Chapter IV Techniques for the clinical exploitation of life events, they argue that a therapeutic milieu must not suppress the symptoms of disturbed behaviour but allow them to express themselves so that they can be treated, that actions speak louder than words and that interviews with a child must be used to bring them into greater touch with reality.
In the Epilogue they acknowledge that the sudden closure of Pioneer House meant that most young people’s needs had not been met and, though arrangements were made for continuing support, the outcomes for the young people varied from excellent to limited.
Like 21st century cognitive behavioural therapists, Redl and Wineman locate people’s behaviour within them rather than in the situations and relationships of which they are a part, and much of their analysis of behaviour has simply not been borne out by subsequent research, which places more emphasis on the impact of attachments and peer group experiences on children’s behaviour than they do (Ladd, 2005). However, both books are valuable for their detailed accounts of children’s behaviour and how the children tried to explain that behaviour and/or reacted to the interventions of staff.
For these detailed accounts we are partly indebted to their insistence on recording, something about which thinking was at a low ebb at the time they were writing (Timms, 1972) and on which, with the advent of the plethora of form-filling that has been demanded in recent years, child care workers can be forgiven for having ambivalent feelings.
In spite of arguing at the outset that traditional interventions based on interviews will not work with disturbed children and that they need a milieu approach, in practice they end up making interviews within that milieu a key feature of their interventions, much as Dockar-Drysdale (1970) did in her later work with seriously emotionally damaged children. One explanation may lie in Wolins’ argument (1973) that children at the dependency level need an individual relationship which is what they ended up offering.
In that context, their stress on giving staff the flexibility to manage situations rather than being constrained by rules and protocols reflects the need to develop individually responsive relationships with children at the dependency level. Similarly, their emphasis on the importance of activities within the milieu is supported by Wolins’s finding (1969) about the importance of constructive activities in successful group care.
Anyone who thinks they are having difficulties with a child will almost certainly be reassured to know that Redl and Wineman had just the same problems fifty years ago, and anyone who wants to deal with difficult behaviour will find that careful study of Chapter III pays enormous dividends. In one sense, there is nothing new in that they are elaborating the techniques set out by Aichhorn (1925) but the collection of all the techniques for influencing behaviour into a single chapter along with examples makes this book worth reading in spite of the now unfamiliar language of the authors.
Aichhorn, A (1925) Verwahrloster Jugend Wien: Internationaler Psychoanalytischer Verlag See also Children Webmag August 2009.
Dockar-Drysdale, B E (1970) Meeting children’s emotional needs in residential work Child in Care 10(9) 21-33
Ladd, G W (2005) Children’s peer relations and social competence: a century of progress London: Yale University Press
Redl, F and Wineman, D (1951) Children who hate: the disorganization and breakdown of behavior controls Glencoe ILL: Free Press
Redl, F and Wineman, D (1957) The aggressive child: a one-volume edition, containing in their entirety Children who hate: the disorganization and breakdown of behavior controls and Controls from within : techniques for the treatment of the aggressive child Glencoe ILL: Free Press
Timms, N (1972) Recording in social work London: Routledge & Kegan Paul
Wolins, M (1969) Group care: friend or foe? Social work 14(1) 35-53 Reprinted in M Wolins (Ed.) (1974) Successful group care Chicago: Aldine
Wolins, M (1973) Some theoretical observations on group care In D M Pappenfort, D M Kilpatrick and R W Roberts (Eds) Child caring: social policy and the institution Chicago: Aldine