The Community Schoolof Bergen County

For the child whosepotential exceeds performance

P R O F E S S I O N A L M O N O G R A P H S E R I E S

T H E C O M M U N I T Y S C H O O L O F B E R G E N C O U N T Y ■ M O N O G R A P H N U M B E R F O U R ■ A P R I L 1 9 9 6

Defining a "Therapeutic Milieu"by Rita Rowan, Executive Director, Community School

School districts seeking placement for theirlearning disabled or ADHD studentsalmost invariably include in their lEP's a

request for counseling as a related service. Thisreveals an understanding that such children haveproblems beyond the academic delays. They areseen as troubled and/or confused and, thus, critically in need of guidance. They frequently present with incompetence in the social arena aswell. As a result of observation and testing byChild Study Teams, counseling is reciuested, usually in the form of one or two sessions a week,individually or as part of a small group. For quitesome time this recommendation has failed toelicit surprise on the part of our intake staffs.Special education and guidance counselingappear to be coupled in the miiads of many professionals who prescribe for our children. Is such

couriseling effective, or is there another way toprovide the needed guidance and support?

In our view, a comprehensive programhas three parts; (1) organization and structure ofthe program; (2) the therapy (teaching); and (3)pharmacological intervention in some cases. Forchildren who come to Community School, wesee a typical profile of specific dysfunction insubtle neurological processes in conjunction withbasically good motivation and eagerness to dowell. Adjustment problems such as discouragement and withdrawal from challenge and theassociated negative behaviors are recognized assequellae of failure to meet academic and socialdemands. If we modify the environment andkeep challenge well within the child's ability tosucceed, many of the unproductive behaviorswill diminish. An understanding and nurturing

I

environment has a beneficial effect. This environment is what we call the "therapeuticmi l ieu . "

The widely recognized, positive psycho-dynamics supporting our program are rooted incertain philosophical framework that guides ourtheory and practice and allows us to adjust treatment case by case, day by day. Within the context of the group, and through the therapeuticintervention of the teacher in the classroom set

ting, we can achieve the changes in behaviorand adjustment that case managers expect as aresult of counseling. This is the framework ofthe therapeutic milieu.

School and classroom constitute the life

space of the grade school-age child for a goodnumber of years. Children who find this environment hostile and inhospitable deal with it inpredictable, often self-defeating ways. Negativepatterns of coping emerge; unproductive tendencies are intensified. So, we must begin withmodification of the school and classroom.

At both levels. Community School students are grouped in small, manageable numbersin classes that are open and accepting withoutbeing permissive. In fact, firm limits are set;teachers then adhere to the established limitsand students are held accountable. Teachers putin place a structure that provides a secure environment and freedom from the unexpected thatare essential to the stable functioning of learningdisabled children. Simply put, the children mustknow what to expect, what is expected of themand what the consequences of noncompliancewi l l be .

A trained professional staff is the key totherapeutic milieu. These professionals are sensitive to the need for using controlled affect.They maintain structure and order without angeror irritation. They are consistent in theirdemands yet responsive to differences.

Consistency with flexibility is basic . The teaching staff can do this difficult and highly demanding work only if it has the strong support of theadministration as well as proper and ongoingguidance from the support staff. This mustinclude psychological consultations and continuing inservice training.

Encouraging self-esteem is also part of thetherapeutic milieu. By this I most emphaticallydo not mean helping children 'feel good aboutthemselves' by deceptive and manipulative praisethat avoids confronting the real problems.Rather, it means accepting the child's best effortand performance in the areas of deficit and recognizing even the most minimal improvementand progress. Self-esteem is encouraged only bygenuine achievements. Encouragement is thegoal! Children who see themselves improvingcan mobilize the courage to continue. Our children aren't easily fooled; progress must bedemonstrated in concrete and visible ways.Verbal praise not supported by evidence isunconvincing and will fail.

Intellectual encouragement is also part ofthe therapeutic milieu. In attending to theintellectual as well as the remedial needs of ourstudents we effect change. Eor the bright learning disabled child, accomplishments of the intellect give affirmation to their sense of value andworth that may have been sorely weakened byexperiences of failure and ineffectualness.Recognition of intelligence provides one of themost powerful incentives for giving up self-destructive behavior and responding productively to ordinary classroom demands. Conversely,the sense of worthlessness, defectiveness, andfailure to meet even the minimal demands, is themost serious obstacle to effecting a positivechange in adjustment. The principle of providing opportunities for achievement applies inareas other than the academic and is equallyvalid. Helping our children recognize a wide

2

range of talents is another aspect of our effort toe n c o u r a g e .

In behavioral concerns as well as in

learning, helping children take control over theirown lives, helping them to make decisions abouttheir actions and helping them to make sensiblechoices add up to what has now become a fashionable word, 'empowerment'. From the beginning we advocated children's need to understandthat they can change their lives; with guidance,they can experience the power to make animpact on events. As they realize that they cando, and are not simply puppets, moved andmanipulated by external forces over which theyhave little control, our children are truly empowered.

The intervention we have been talkingabout is embedded in the total program we provide for our children. It is the 'milieu' in which

they exist throughout the school day. Teachersact on individual need as they identify it.Immediately, as intervention is required, theteacher begins a dialogue with the child. Aninterpretation of the child's behavior is offered,or an attempt is made to reconstruct the event.The child, therefore, sees the behavior as awhole. This 'therapeutic intervention' at themoment of happening, and with the presence ofothers who may be involved is a far more effective counseling strategy than a delayed session inthe therapist's office long after the event. Theteacher is also able to review previously presented behavioral strategies and help the child to

select appropriate alternatives. What methodcould deal with counseling needs better than theimmediacy of such an approach?

We also provide for a more direct, systematic, and deliberate school-wide plan forguiding behavior. Every classroom teacher conducts a weekly circle devoted to instructing children in social problem solving and decision making. Guided by the teacher, the group acquiresawareness of feelings that signal trouble andlearns a range of solutions. Skill development iscumulative, one building upon the other. Theassociated language is developed and new behaviors are tried out in role playing and simulatedproblem solving. This program of in-class groupguidance has proved effective in developing coping skills for improved social interaction and fostering appropriate attitudes.

The therapeutic milieu here atCommunity School is linked to our commitmentto respect the integrity of the child. We believedeeply in the intrinsic motivation of children toachieve and succeed. We believe that there is inall children an underlying thrust for mastery overtheir world, and that this is what keeps thelearning disabled child struggling to overcome.We believe that no matter what the overt behavior suggests, we are seeing a troubled child wanting acceptance. A therapeutic milieu combinesacceptance, support, teaching, interpretation,and finally intervention. If all factors are inplace, we can reasonably expect positive changeand progress.

3

The Professional Monograph Series

The Community School of Bergen CountyL o w e r S c h o o l

11 West Forest Avenue, Teaneck, NJ 07666(201) 837-8070High School

1135 Teaneck Road, Teaneck, NJ 07666(201) 862-1796