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Opinion & Essays - Aug, 1991 Issue 

Therapy Revisited
By Lon Woodbury

My dictionary defines therapy as, "The treatment of disease or of any physical or mental disorder by medical or physical means, usually excluding surgery." In treating children with emotional problems, this definition carries with it several assumptions. The first comes from the germ theory of disease, that when something is wrong, there must be a specific, physical and measurable cause. This means the therapist must find that cause (diagnosis), determine what needs to be done to eliminate that cause (prescribe), and carry out the plan of therapy to cure the patient. In addition, an important element of the scientific method is objectivity. This means the therapist must be an objective observer outside of the healing process.

This has been the hospital approach to mental and emotional problems for several decades. That approach, by utilizing increasingly sophisticated medical technology, brought about miraculous cures of serious mental problems that previously could not be treated. It was so successful the medical profession expanded the approach to other problem areas over the years. One expansion was in legally defining alcoholism as a disease. This was established in the 1960s. This definition allowed insurance coverage for alcohol treatment centers, which gave birth to a tremendous growth in the number of alcohol and drug treatment programs. A more recent expansion was the explosion of adolescent psychiatric units in the 1980s to treat children with emotional and/or behavioral problems. Studies show there are 15 times more children in psychiatric hospitals today then there were in 1975. (I wonder how much these expansions have contributed to the increase in health insurance premiums and the crisis in the health insurance industry today?) The best thing that can be said about these areas of medical expansion is the results have been mixed. Recidivism alone has been appallingly high.

There is another model which has been successful in working with children with behavioral and emotional problems. This is the education model in that the teacher is personally involved with the students, acting as a kind of mentor. Diagnosis is not necessary, nor very helpful, because the causes of the problem are so diffuse and varied. According to the education model, the problem is seen as missed lessons in emotional growth, not knowing proper behavior, and self-defeating attitudes. The approach of these programs is to develop a structure that helps the children learn the consequences of their actions, learn to make constructive choices, and learn more positive and successful attitudes and behaviors. These programs often see themselves as "whole-child" education, teaching trust, honesty, and responsibility right along with math, English, and science.

If we change our concept of therapy and therapeutic to mean "healing," instead of just "curing," we then have two major ways of approaching adolescent problems, and Special Purpose Schools reflect both of these approaches.

It is my observation that the typical medical model, as found in psychiatric hospitals, is most effective with the child that is damaged psychologically, having serious problems such as manic-depressive, or acute depression. The child that is psychologically intact, or has minimum psychological damage, such as most of those diagnosed as "conduct disorder," "adjustment disorder," or "attention-deficit hyperactivity disorder," does not, in my experience, seem to respond very well to hospitalization. In some cases, hospitalization has even been harmful.

The child who has behavioral and emotional problems, but minimum psychological damage, seems to respond best in Special Purpose Schools that emphasize structure, and in teaching positive relationships, consequences, honesty, hard work, responsibility, etc. True, these types of schools and programs often have counselors, group work, and other psychological techniques, but those are supplementary to the main thrust which is learning through structure. In general, the child who is psychologically damaged does not seem to do well in an environment which is primarily structure. The damaged child should be referred to a program based on the medical model.

Admittedly this is an over-simplification and strongly reflects my experience working in the CEDU Educational system. Also, some schools and programs are such a mix of the two that it is impossible to determine which model predominates. However, as a generalization, it is helpful to the referring professional to keep in mind that the medical and educational model each seems to work best with different problems. Which model is best for a specific child all depends on if the child needs to learn something, or if the child needs to be cured of something."

Copyright 1991, Woodbury Reports, Inc. (This article may be reproduced without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)

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