Book reviews –

Book reviews — Residential Treatment: A Cooperative, Competency-Based Approach to Therapy and Program Design by Michael Durrant

Gumz, Edward J

Most residential treatment programs have a unifying theme, which is one of three predominant themes. Some programs emphasize a psychodynamic approach whereby psychopathology is dealt with through corrective emotional experiences within the context of individual therapy and a therapeutic milieu. Another theme is a revisionist version of the above model whereby a psychiatric understanding of the troubled youth and his or her family are deemphasized. The focus is, instead, on connecting the treatment milieu, youth, and families and on promoting life skills as the essential goal. The third theme is the use of specific, cognitive-behavioral approaches in the design of residential treatment.

In his book Residential Treatment: A Cooperative, Competency-Based Approach to Therapy and Program Design, Michael Durrant formulates a fourth approach to residential treatment. Durrant states that his book is about “the way we think rather than what we do [in residential treatment]. Durrant advocates a cooperative solution-focused approach that can be adapted to any existing residential treatment program. Although Durrant is a practicing psychologist in Australia and most of his examples are from residential treatment settings in Australia, American readers will find these examples relevant in America.

Chapters one and two are theoretical in nature. Durrant strongly disagrees with the approach that affirms therapy as the heart and core of residential treatment. Rather, Durrant holds that staff, youth, and family need to consider the context of residential treatment because reframing takes place in terms of this context. New meaning is created by participants which, in turn, makes new behavior possible.

Durrant shows his skill in reframing residential treatment in chapter two, where he uses the anthropological concept of the rite of passage as a way of viewing residential treatment. The goal of residential treatment is not to cure but to assist in the transition from unhealthy to healthy status. During this rite of passage, residential treatment can provide a context for intensive practice and experimentation.

Chapters 3-12 deal with the framework of residential treatment, including admissions, discharge, discipline, parent involvement, and therapy. Each one of these topics is examined from a solution-focused perspective in which staff, youth, and families can cooperate and achieve new meaning and behaviors. Interspersed throughout each chapter are examples of Durrant applying a solution-focused approach.

Durrant’s primary objective–convincing the reader to think differently about residential treatment–is done very well. For example, in chapters three and four he discusses the importance of reframing (describing a situation in a different way that gives it a different meaning). This serves as a basis for developing a theme essential for the youth’s placement. The theme focuses not on the youth’s problem but on signs of competence or control. Durrant stresses that families need to play a role in developing a theme.

In chapter five, Durrant stresses the importance of goal setting. The predominant model is the staff’s focus on the child’s discharge (“What will you be doing when things are better?”). Durrant’s grass-roots point of view sees staff not as doing something to children and families to make them better, but as working with children and families to act and develop competence.

Chapters six and seven deal with structuring residential treatment programs for success. By focusing on solutions rather than on problems, residents experience the success firsthand. Chapter eight deals with a key issue in residential treatment–discipline. Durrant provides many examples that illustrate the benefit of letting natural consequences of behavior take their course. Chapter ten highlights the key roles parents and staff play in residential treatment. According to Durrant, although “everything that happens in the program must be judged according to whether it may further disempower parents,” all major decisions affecting a child in residential treatment need parent input. Durrant indicates that “the single, most important factor in the effectiveness of residential programs is the extent to which the front-line staff experience themselves as valued and supported.”

In various sections of the book, Durrant briefly discusses the administration’s role in fostering a staff that values itself and the role of public policy in providing funds for residential programs. Further discussion of these factors would have been useful.

Chapter 12 discusses the role of therapy in residential treatment. Specific therapeutic techniques and methods are secondary to their overall focus. As therapists in residential settings know well, therapy can take place in the living unit, the dining room, or around the pool table.

In summary, this is a well written book, and the author’s presentation of theory is supplemented by excellent examples from residential settings. Durrant’s clear exposition of the use of a solution-focused approach to build competence for youth and families is a refreshing approach to the difficulties of residential work. This book is must read for all who work in residential settings and want to make their work more interesting, rewarding, and beneficial to others.

Copyright Family Service America Jan 1995

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