Transforming Hate to Love

An Outcome Study of the Peper Harow Treatment Process for Adolescents

Melvyn Rose

• Publisher: Routledge
• Year: 2003
• ISBN:
  9781134773602
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychotherapie

PUBLICITY TITLE By offering views on the causes and treatment of delinquency this book contributes to the currently topical law and order debate First book to analyse long-term treatment of abused children in a residential setting - no direct competition

1

INTRODUCTION

Most of the youngsters at Peper Harow had either experienced serious abuse in their early life, or had not been given enough emotional nourishment for normal psychological development. Lacking the personality strengths appropriate for adolescents, they frequently regarded other people and the environment around themselves in a way very different from that of most young people of their age. They would, for instance, feel persecuted by minor adversities, or would regard their own hostility and abusiveness towards others as merely trivial, or even in some perverse way as appropriate! They diced with seriously destructive lifestyles, or activities such as drugs or prostitution, all of which behaviour had derived from their malfunctioning personalities. Unless they could be helped to see themselves and the world around them more realistically and unless they could develop the strengths needed to cope with that reality, their future prospects seemed inevitably catastrophic. They would be unable to sustain adult intimate relationships, or worse, they would become increasingly violent or criminal, or they would suffer a steady deterioration in their mental health, or become alcoholics or drug addicts. They would suffer and cause suffering to others and would be likely to become a permanent burden on the resources of society. This was Peper Harow s challenge then—to what extent could it develop a residential programme that would enable its residents to gain a more normal lifestyle instead? This, of course, had been the objective of many other institutions—Approved Schools and Borstals, Maladjusted Schools and Adolescent Units—but the success of those institutions had been worryingly inadequate, despite considerable organisational and financial investment.

So much fear was ingrained at the root of the Peper Harow residents’ beings that the emotional energy normally devoted to growth and creativity had instead to be spent in ‘keeping the lid on’. This emotional foreclosure was actually a compulsive defence against the reality of their painful life experiences. The youngsters, without being consciously aware of it, felt themselves compelled to deny how terrible they fantasised themselves as being. It was as though to acknowledge such unconscious feelings would somehow confirm that they truly were that monstrously bad and dangerous and that, if this were so, they would indeed deserve nothing but punishment and suffering. At the least, they would not be entitled even to hope for normal relationships.

Peper Harow was itself a most disturbing experience for such young people, because it deliberately set out to counter their self-destructive, compulsive defences by offering them the best environment it could muster and the best adult commitment which the staff as a group could create. All of this social, intellectual and emotional nurture was paradoxically frightening and threatening, because until then many youngsters had become emotionally numbed by their continual adverse experience. They had few positive expectations from others, or from themselves, whereas at Peper Harow the most enormous expectations both attracted and challenged them and these were presented in forms that could not easily be resisted.

Few ordinary people understand how terrible life is for such youngsters. Everyone is clear when they produce behaviour that is terrible for other people—especially when their teachers, the passers-by in the local shopping mall, or homeowners with years of hopes and hard work tied up in their possessions, are abused or frightened or robbed by aggressive teenagers. And it is absolutely right that no one’s personal injuries should give them the right to hurt others. It is also true that even human beings who have experienced the most fortunate upbringing and education are still so often selfish that we actually need a structure of law and of social values to help us keep our exploitativeness of others and of our environment within bounds. For most of us, it can be argued that punishment for our transgressions does have a salutary effect. Perhaps most of us are deterred from wrongdoing, as much because of our fear of the consequences as because of our own moral beliefs and self-respect.

But the youngsters at Peper Harow were exceptions to this. For all the qualitatively varied discussions about deviant behaviour and crime that take place constantly in our rapidly changing society, the differences between those for whom sanctions are effective and those whose transgressions are worsened by punishment are almost never made clear. Right and wrong does matter to most people. Our experience of being considerate towards others in turn results in a positive response towards us. For most of us, this expectation was germinated by the exchange of our very first loving smiles in infancy. However, if instead of smiles and instead of tender sensitivity to the infant’s vulnerability and towards his or her as yet undeveloped ability to make sense of their environment, a baby had been beaten or screamed at or worse, he or she would not thereafter be spontaneously on the look-out for the opportunity to please others in order to attract their positive attention in return. Instead, he or she would be rendered constantly anxious and would even resist the very nurture that was so vitally needed, being unsure about what might also accompany it. Therefore, real food itself might often be angrily rejected. Forcing a parent to wait endlessly for a positive response can be a potent weapon for a baby But would such anxious anger encourage his or her parents’ sensitive determination to understand what is upsetting their baby, or would they instead respond to the baby’s knocking a plate to the floor, for instance, by ‘teaching him a lesson that he will never forget’?

As far as disturbed teenagers are concerned, a punitive response to their inappropriate behaviour may be a significant further step down the road to catastrophe. It certainly will not make things better! Nevertheless, the purpose of all the attention and nurture and tolerance at Peper Harow was not, as some of our envious neighbours felt, to reward the undeserving and to make a mockery of justice. Its sole object was to reconstruct, or often to construct for the first time, the emotional, intellectual and social conditions that are the foundation of a normal personality. If this process were to be successful, it would not mean that the young person would thereafter be reborn as an angel. At best, he or she would have been set free to become an adult among other adults, capable of developing and sustaining a moral base to his or her life, capable of germinating positive goals and capable of generating the sustained effort necessary for bringing these aims to fruition. But it would also inevitably mean that, like most adults, he or she would also fall short of their ideals and would sometimes feel inadequate and unable to identify with the self-image that they would most like. In other words, they would have been given the key to adulthood—albeit problematically later in their lives than is normal—but they would only have been liberated to make what they could of it, for better or worse. Peper Harow’s success would have been in restoring to them the birthright to which all youngsters should feel entitled.

However, starting from where they did, even limited goals would often seem as unattainable as Everest! And yet the youngsters themselves frequently spoke of their hopes of being ‘sorted out’—as though this would free them from any problems and enable them to achieve their most desired aspirations. What is more, they often assumed that staff must have attained just such perfection, or otherwise what ‘know-how’ could they possibly have to impart? Perhaps such naive over-idealisation of the staff and of their own anticipated rewards arose from several sources, which in fact tell us something about the mental contortions people seem to need to put themselves through in order to risk an attempt to change the way they are. Unless they could encourage themselves sufficiently with the fabulous temptations of success, they would fear never being able to make a sufficient leap of faith and imagination to trigger ‘lift-off’ on their therapeutic journey. Sometimes the staff did not altogether discourage such unreality. The youngsters’ unexpected willingness to consider what the staff were offering often came as a surprising relief from their unremitting resistance. Often the youngsters felt that unless they could almost deify staff in their minds, it would be impossible to believe that relationships with them would be any different from their past experiences of adults. But, simultaneously, the youngster’s compulsive ability to deny truth and even reality could exhaust the most committed adult.

Because of this sometimes collusively unrealistic perception of a successful outcome, idealised ‘success’ at Peper Harow was typified in fantasy as someone who was leaving to go to university, who was evidently creative, astoundingly patient and kind to others, with exceptionally righteous standards of honesty and personal behaviour—in other words, a paragon of all the virtues and abilities! Although one or two ex-residents do seem to have developed remarkable personal qualities, it is hardly surprising that most of them are no better or worse than the rest of society. Moreover, such unreality at Peper Harow sometimes concealed other people’s achievements, although from their individual starting situation these might have been equally remarkable. Among those interviewed for this study were a high proportion who left Peper Harow under a cloud. They either were asked to leave and were regarded as failures, or they stomped out in high dudgeon. Many are still bitter about this and believe that their life would have turned out to be radically better if they had achieved more at Peper Harow. In fact, almost without exception, they acknowledge that such experience as they were able to take with them has had an infinitely worthwhile effect on their life since. What has frequently astonished those who were staff at Peper Harow has been how well even so-called failures have turned out. It may have taken them some years of struggle beyond their residential experience to attain a realistic sense of who they are and of what they want in life. However, what they repeatedly say is that it was the actual experiences with which they did engage at Peper Harow that have sustained their struggle towards later achievements and self-respect.

In Healing Hurt Minds (Rose 1990), the author set out to write a purely subjective description of how the healing programme was developed at Peper Harow. But however anecdotally interesting this might be, it demonstrates the need for an additional opinion of the treatment process—one that derives from the ex-residents’ views of their experience. Has the youngster’s experience there really had anything to do with the way they say they are living today—as many as twenty-five years later? The ex-residents’ views about the relative worth of one aspect or another of their experience inevitably vary, not just according to the level of their emotional capacity to recognise and engage with different forms of nurture, but also according to how well-developed the resources actually were at the specific time they were at Peper Harow. Several ex-residents from the earliest days describe experiences that would definitely not have made for security. Others describe visiting after some years, to find that the physical and material environment had developed to a standard that made them realise how much they themselves had missed.

And then, of course, those of us responsible for the venture were inevitably more limited in skill and insight when we began. Our own calibre and maturity also varied. Was the practice we did effect really good enough and, where it was inadequate, could it have been put right had we known what we know now? Even with the wisdom of hindsight, there may still be intractable emotional conditions for which we do not yet have an effective response. For instance, although Bowlby’s work after the end of the Second World War left one in no doubt as to the serious psychological consequences of deprivation (Bowlby 1966), the extent and seriousness of child sexual abuse has only been widely recognised comparatively recently. Had we been more alive to that issue in the earliest days of Peper Harow, it is probable that addressing its consequences would have boosted our understanding of the significance of all our relationships within the Community, with the result that there would have been more effective help.

Goffman and others had by 1970 already defined the further injury that is caused to vulnerable people by the tendencies of closed institutions to depersonalise individuals (Goffman 1968). Those who saw their institutions as therapeutic communities assumed that they were expressing a culture and style that would counter such dangers. Several of us at Peper Harow had previous experience of institutionalising establishments. Thus we would have been quite shocked if we had realised how difficult it was going to be to avoid our own programmes developing a similar depersonalising effect, especially when our permissive and democratic style was supposed to be so libertarian! Yet we still pressurised residents to be compliant and to accept, without too much question, the authority of the hierarchy. After all, the hierarchy saw itself as being ‘on the side of the residents’! Yet if liberty had not been regarded predominantly as the freedom to co-operate, could the Community have existed at all? It was a problem that the 1969 Children and Young Persons’ Act had set out to address, that is—how to meet the needs of children and adolescents in a way that can manage their behaviour yet still restore their potential future lives. Twenty years on, the government was still trying to effect legislation (The Children Act 1989) that would bring this about! However, some of the consequences of this well-intentioned legislation and its associated governmental reports and guidelines, have actually been to inhibit rather than to enhance the therapeutic endeavours of residential centres.

It is obviously unacceptable that institutions specifically established to care for young people should abuse them in any way. Several notorious cases in recent years have demonstrated how especially vulnerable such children are.

It is a common belief that only ‘bad’ agencies and only ‘sick’ people are involved in residential abuse. The reality is that even those agencies with exceptional risk management policies are not free from the possibility of employing a high-risk person.

(Bloom 1993:91–92)

However, the treatment process, especially with disturbed adolescents, can be damaged by inadequate insight and unmanaged attitudes and behaviour that may not be legally, or even consciously abusive.

Treating youngsters who are moderately to severely psychiatrically disordered in institutional settings often arouses in staff intense sexual feelings. ‘Erotic’ rather than ‘sexual’ is the preferred term…to indicate that although some of these reactions are, in the final analysis, indeed sexual in nature, the way they are manifested usually assumes many deceptive forms…such as ‘too much hugging’, ‘too much “spoiling” ’, or to use a currently favored term—too much ‘bonding’.

(Ponce 1993:107)

Such behaviour becomes abusive when it adds to youngsters’ existing confusion or misunderstanding. To a young person who has been seriously abused, a hug may not mean the same as it would to a child in a well-functioning family. Instead, it may feel like the first step that will end in frank abuse. Thus the young person’s fragile trust of the adult may freeze at the very moment where his or her real need is for it to take root and grow. The consequences could even be the essential failure of the programme for that youngster.

The specific emotional needs of young people in residential settings are complex and varied, and both the Children Act 1989 and its sequential guidelines, The Care of Children 1990, attempt not only to protect children, but to ensure that their needs and their individual rights as children are both properly met. Sometimes these conflict. For instance, in order to ensure the absence of abuse and also that all protective legislation, including health and safety legislation, is being met there can be as many as twenty inspections of a small children’s home in the same month. It is very difficult to enable children to feel that they share the ownership of their home and its process when so many strangers are allowed access without regard to the feelings of the children or staff. Attempts to ensure the protection of a youngster s sense of individuality may produce policies—for instance, that all children should have their own room, or be supervised by a night shift of waking staff—without any reference to their psychological needs which may be completely different for one youngster than for another.

What tend to be overlooked and certainly not understood are the psychological needs of children in care. A recent survey of all the children in the care of the County of Essex, for example, found that almost all of them required some kind of psychological help (Bunce 1994). Unfortunately, in local authorities the focus cannot simply be upon understanding and meeting the complex needs of the child in care. It also has financial obligations and various responsibilities towards its electorate as well as towards other groups with special needs, and in addition has to follow the requirements of central government.

In Kahan’s recent and comprehensive description of the needs of children in homes, she emphasises that

Residential care staff will be closest to and in touch with the whole child and his world and, in consequence, will be key figures in co-ordinating the work of other professionals.

(Kahan 1994:115)

But the hierarchical relationships in large local authority organisations act against this. Financial exigencies may well determine the institutionalisation of furnishing. Fire regulations may well produce warning systems that are geared to public institutions rather than a private home. The health and safety regulations about the environment and use of kitchens can seriously impede the interpersonal experience deriving from the cooking and eating of food that children brought up in institutions so desperately need. As always, the issue of financial resources effects both the kind of staff who can be recruited and the calibre of essential staff-support systems. Kahan specifically emphasises the different but mutually related and equally essential systems for the training, support, development and professional supervision of staff working with emotionally disturbed children and young people (ibid.: 255–274). Ensuring that staff have time to engage in such ongoing professional programmes also raises costs, as does providing high-calibre professionals to effect them. Were a local authority to ensure this quality of staff resource within a series of small children’s homes, the cost would inevitably be greater per capita than in a large institution. Meanwhile, local authorities’ objectives are inevitably more concerned to reconcile the conflicting priorities of more needs than can be paid for than to focus entirely on the psychodynamic of their staff and children in each of their homes. It is extremely difficult for the systems of control required of officers by the elected representatives not to be mechanistic instead of sensitive to the need for emotional nurture of staff and very difficult children.

Lacking confidence in the outcome of the 1969 Children and Young Persons’ Act, Peper Harow deliberately set out to manage a psychotherapeutic process independently, but soon itself faced similar contradictions between the exigent managerial requirements of an organisational entity and the complex needs of the youngsters themselves. In trying to reconcile these it became impossible, especially at the beginning, for the practice at Peper Harow to be good other than in parts. Fundamental problems also arise from the nature of the therapeutic process itself. And indeed, any kind of programme with disturbed youngsters has its own set of problems to overcome. For example, some adolescents need a strong institution to wrestle with. If their need for aggressive rebellion is greater than normal, then so must be the strength of a community if it is to tolerate and contain the youngsters’ aggression more successfully than the family groups within which the seeds of their excessive hostility have been engendered. However, while determining to demonstrate to one youngster that it is safe for them to be containable and that any limitations to their personal freedom will not actually destroy them, despite the traumatic lessons of their past lives, another youngster’s anxiety in response to group pressure will cause him or her to capitulate compliantly once again rather than to co-operate appropriately. There is much evidence to demonstrate that it is the compulsively compliant who are most vulnerable to sexual abuse. Obviously then, balancing the functioning of communal life so as to do the maximum therapeutic good and no serious harm, demands a highly sophisticated programme. Perhaps our main advantage, as an independent charitable organisation, lay in our ability to respond quickly and directly to perceived need. The director of the programme, for instance, rather than the local authority’s director of finance, albeit with proper safeguards, could make financial decisions that acknowledged the priority of the youngsters’ needs.

The design of this programme at Peper Harow assumed that the Community was a kaleidoscope of interactions between groups and individuals at different levels of group and individual consciousness. It tried to be diagnostically sensitive to the psychological significance of the Community’s everyday life for each of its residents. Special efforts were made to anticipate what any individual might feel in response to an argument in the Community Meeting for instance. This in turn might determine which member of staff would simply sit next to that individual or whether, instead, a member of staff might set time aside to talk after the meeting about some of that youngster’s feelings, or perhaps the member of staff might encourage other youngsters to take the individual off to the music room, or to play a game down by the river. The simplest of interventions can be as profoundly therapeutic as an intensive hour’s psychoanalytic psychotherapy, provided its timing is well judged and the person making the intervention actually recognises its emotional significance to the recipient.

Thus, a residential treatme...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• FOREWORD
• ACKNOWLEDGEMENTS
• 1: INTRODUCTION
• 2: A DESIGN FOR CHANGE AND GROWTH
• 3: BEFORE AND AFTER
• 4: AGENTS OF CHANGE
• 5: LIMITATIONS OF INSIGHT
• 6: BENEFIT OF HINDSIGHT
• 7: METHODS
• 8: SUMMARY AND IMPLICATIONS
• BIBLIOGRAPHY