Albert E. Trieschman, James K. Whittaker and Larry K. Brendtro (1969) The Other 23 Hours: child-care work with emotionally disturbed children in a therapeutic milieu Chicago: Aldine 0 202 26023 2
The Other 23 Hours explores in detail the relationships and non-verbal behaviour needed by staff who have not been professionally trained in child care to provide a therapeutic milieu for children. While other authors had looked at the contributions such staff might make from time to time, this book focuses entirely on their contribution.
– Behaviour changes through day to day relationships.
– Staff have a distinct role as `companions’ to children.
– Activities are crucial to children’s development.
– Each stage of every day needs to be handled sensitively.
– Temper tantrums are normal.
– Recording assists child care workers.
In the Preface, the authors say that the book is based on work undertaken at Walker House, Needham, Massachusetts with 7-12 year old children.
In Chapter I Understanding the nature of a therapeutic milieu, Albert Trieschman says that the book is aimed at child care practitioners and outlines the concepts that underpin the work: that the adults, as ‘companions of children,’ suggest alternative ways of behaving by altering, interrupting, substituting or inventing behaviour. They also teach children to cope with sadness or loss.
It is important to know the child because there are many ways of intervening and you need to understand what behaviour needs altering. Many children in residential care have ‘defective egos’ and need support to deal with some daily events which can be provided through relationships, group mood and structure, organisational culture and the child’s own skills.
He outlines the various learning processes available to children and the frameworks of rules and interventions that can support learning.
In Chapter II Establishing relationship beachheads Larry Brendtro looks at the concept of relationships, why children might resist relationships and how relationships can be developed both from the child’s and from the adult’s point of view. He discusses verbal and non-verbal communication and in particular the implications of physical contact for peer rivalry and sexual stimulation and its role as anxiety producing stimulus and in aggression.
Staff should not try to make themselves attractive people to children by, for example,
– being easy on them,
– becoming ‘one of the boys’,
– criticising other adults as a way of ingratiating themselves with children,
– becoming a new ‘parent’ to the child,
– getting involved in hostile interactions,
– getting involved in power struggles with the child,
– allowing children to think they are anti-child.
Instead, they should gain a child’s trust by trusting the child and being there for them when they are in a crisis.
In Chapter III Program activities: their selection and use in a therapeutic milieu, James Whittaker discusses the place of activities in the therapeutic milieu, the range of possible uses of activities and how to select an activity based on the needs of the child. Activities may be helpful during transition times, to meet specific needs of a child or a group or as part of a wider project. He concludes with a number of hints on how to get the best out of activities.
In Chapter IV Managing wake-up behavior, James Whittaker outlines the difficulties children may have waking up because they need to deal with other people. He suggests engaging with them conversationally and non-verbally rather than pushing them, possibly offering incentives and paying attention to dress.
Since food is crucial in a therapeutic milieu, it is important to provide plenty of alternatives and to sit with the children if possible.
As they move off to school, some may need incentives and others restraints, but children normally see school as a welcome change.
In Chapter V Managing mealtime behavior, Albert Trieschman and James Whittaker warn that the transition from an activity to a mealtime may be difficult; the key task is to manage the accepting, handling, passing and eating of food. They discuss the therapeutic management of meals and end with hints on helpful staff behaviour at mealtimes.
In Chapter VI Managing bedtime behavior, Albert Trieschman stresses the importance of being able to manage situations before you can teach people alternative ways of behaving and warns that children learn from everyone, not just the staff. He reminds us of the framework for understanding behaviour outlined in Chapter I and that for a child there is a range of external stimuli associated with going to bed, for example, a bath or shower.
He suggests developing a routine to reduce stimuli which accommodates the child’s own routines, their relationships with staff and the group mood at bedtime and outlines how staff at Walker House handled the two hours or so until lights out.
In Chapter VII Understanding the stages of a typical temper tantrum, Albert Trieschman argues that tantrums are normal and should be expected in 7–12 year olds. The typical stages of a temper tantrum are:
– rumbling and grumbling : a period of general dissatisfaction which, if recognised, offers an opportunity to defuse the situation;
– help-help : a raised level of activity during which the child may turn their feelings on the adult who must speak calmly and clearly and use the minimum restraint necessary to remain in control;
– either-or : a period when the child makes impossible demands/threats which the adult needs to avoid being drawn into;
– no-no : a period when the child, realising they have been frustrated, refuses to do anything;
– leave me alone : the beginning of the end as the child begins to withdraw and should be allowed to sleep it off if necessary rather than be subject to any interrogation;
– hangover : a period when a child may fall into a post-upset depression which is often a sign that the child is moving to a point where it is possible to begin to deal with the issues; if there is no ‘hangover,’ it probably means there aren’t any.
In conclusion, he warns staff to beware of reinforcing temper tantrums, for example by kindness, and suggests that, once you understand the issues that underlie the temper tantrum, you can use behaviour modification to reduce it. But the most effective way of preventing temper tantrums is to raise the child’s self awareness.
In Chapter VIII Observing and recording children’s behavior: a framework of the child-care worker, James Whittaker asks why you should record and how you might organise the material before looking at what you should record and some pitfalls that arise in the course of recording.
In Chapter IX Avoiding some of the roadblocks to therapeutic management, Larry Brendtro argues that quality child care can be compromised by factors such as institutional policy, seeking to satisfy your superiors/supervisors, seeking acceptance by co-workers, a particular personal philosophy, a need to control or a need for success or to be accepted by a child.
He argues that quality child care needs real freedom of communication, on-line staff development and personal awareness.
The Other 23 Hours was a watershed in child care in the USA and the UK; though some of its themes had been addressed by Bettelheim in Love is not enough (1950), his staff were primarily drawn from people undergoing professional training and the themes were introduced to illustrate the management of children with particular needs. Trieschman, Whittaker and Brendtro showed how the same ideas could be used by anyone caring for children away from their families to create a therapeutic milieu for the children. They try to tease out some of the ways in which staff can make themselves attractive companions for children and offer some very practical guidelines for managing young children’s tantrums and for recording behaviour.
Yet, in spite of the buzz which was created by the book when it came out, it has had little impact on child care practice and with hindsight it is possible to see why:
– There is no discussion of the overall milieu that staff might be working in or of the support that might be available to them in undertaking the work (Winnicott and Britton 1957).
– There is no discussion of work with parents which we now know (Taylor and Alpert, 1973; Fanshel and Shinn, 1978) to be central to successful child care.
– The discussion on relationships has been superseded by greater understanding both of relationships in general (Weiss, 1986) and of children’s relationships (Ladd, 2005).
– Though the detailed work on appropriate activities may have suggested some new ideas to child care workers, good child workers have always been creative about activities.
– There is no explicit recognition that what worked at Walker House was partly a function of the developmental stage of the children there (Wolins, 1973).
In spite of that, it still contains many useful practical suggestions which child care workers can adapt to their own work and gives people outside residential care an idea of what might be involved in residential care if they cannot imagine what child care workers actually do.
Bettelheim, B (1950) Love is not enough: the treatment of emotionally disturbed children Glencoe IL: Free Press See also Children Webmag August 2009
Fanshel, D and Shinn. E B (1978) Children in foster care: a longitudinal investigation Guildford: Columbia University Press See also Children Webmag March 2009
Ladd, G W (2005) Children’s peer relations and social competence: a century of progress London: Yale University Press
Taylor, D and Alpert. S W (1973) Continuity and support: following residential treatment New York: Child Welfare League of America See also Children Webmag March 2009
Weiss, R S (1986) Continuities and transformations in social relationships from childhood to adulthood In W W Hartup and Z Rubin (Eds) Relationships and development, pp. 95-110 Hillsdale NJ: Lawrence Erlbaum
Winnicott, D W and Britton, C (1957). Residential management as treatment for difficult children In D W Winnicott (Ed.) The child and the outside world: studies in developing relationships Chapter II:6, pp. 98-116 London: Tavistock See also Children Webmag October 2009
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