Abstract
A retrospective clinical and statistical evaluation of the development of a ‘therapeutic milieu’ with a new concept is made. The effectiveness of this milieu for fifty hospitalized adolescents (thirty boys and twenty girls) in the Adolescent Service of Fairlawn Center is studied and reported. The new concept, defined as introduction of ‘normality as average’ standards and as prearranged expectations, have been incorporated into the structural and living system of the adolescent's life. This concept has been introduced as a principle governing the expectations of the therapeutic milieu.
It is suggested that ‘normality as average’ expectations in the therapeutic milieu protects the already prevailing normalized culture of the ward; furthermore, it challenges the adolescent who denies the presence of conflicts. More significantly, ‘normality as average’ expectation reinforces the process of developmental ‘socialization’ which is so necessary for hospitalized adolescents. Five important components required for the stability of a therapeutic milieu for adolescents are categorically discussed. Emphasis has been laid on the staff-patient-staff communication and intradisciplinary communication to prevent the pathological parental attitudes from becoming the anatomy of the attitudes of the staff. It is suggested that equally distributed authority be delegated to all staff dealing with adolescent behaviour in the milieu. The paper reviewed a two-year retrospective study of the conditions of all patients at discharge.
The effectiveness of a ‘normality as average’ expectations in the milieu has been correlated with a gradual and progressive decline in the frequency and the intensity of daily major vandalism.
This paper focuses on the significance of the development of the cognitive process thinking in adolescence. The effect of this thinking of the adolescent and the cognitive approach in the milieu on the patient's syntaxic judgment is emphasized. Such a capability is viewed as being challenging to him, and is used as an avenue of communication to his behavioural confession and his emotional denial.