No Hopeless Cases

Mr. Veerman: What type of child comes to your Chateau Blanc clinic?

Prof. Hart de Ruyter: We have acting out children with weak ego structures who have de­veloped disturbances before the Oedipal phase.

I have always been interested in the weak ego children be­cause for a long time there were no treatment facilities for them. There were facilities for neurotic children because we knew how to help them. But these acting out, ego weak, delinquent chil­dren were dismissed as hopeless cases for whom little could be done.

But I am an obstinate sort of person and I sometimes think there are no hopeless cases, there are only children whom we don't yet know how to help. I coined the terms "psychopathic behavior" and "developmental psychology" back in 1933 when almost everyone else accepted the concept that psychopathy was an anomaly present in a person at birth. I strongly re­sisted this idea because if one accepts it one must also accept that there is little one can do for these people.

I had an interesting discussion with Hanselmann on this subject while on a trip to Switzerland after the Second World War with some children who were suffer­ing from severe malnutrition. He was still of the view then that it was a waste of time to try to rehabilitate the acting out, ego weak child. He thought the most one could do was to house them and care for them as humanely as possible and keep them out of contact with society not only to protect society but also to save the children from a lot of misery.

My own views have always been much more in accord with Aichhorn, whom I met later. I agreed with Aichhorn that if one refuses to accept the concept that the personality of the acting out, ego weak child is fixed at birth and unalterable, one can really do something to help this type of child. This brings great responsibility to oneself as an educator, but it brings hope and great possibilities, too. In my work I have come into contact with very few children who could not be helped. Not that they can all achieve a perfect social ad­justment, but they can gain in­sight and get a lot of happiness out of life.

Before the outbreak of the Second World War I was in gen­eral psychiatric practice in Zaanstreek but when the Germans occupied Holland I was not al­lowed to continue with my work as a psychiatric consultant for special schools and so I had a lot of free time. It was during that time that I worked out a plan for a psychiatric service to chil­dren which would also aid those government departments — Wel­fare, Justice — which are re­sponsible for neglected children, and angry children who get into trouble.

I later visited some of the gra­duates of municipal children's services who had been placed with families some distance from Zaandam. It had been impossible to visit the homes during the war, or keep track of what was hap­pening to the children, and I was shocked by what I saw. Many of the children were abused. They were often forced to do the jobs around the farm that no­body else wanted to do. Some of the farmers, however, had really made the children part of their own families. I realized that it was possible to place these children in foster homes but it was essential to extend super­vision and support to the fosterparents to help them cope with the problems which were bound to arise and to make sure that the children's best interests were served.

After the war, I discussed my project for child psychiatric ser­vices with my friend and former teacher Professor dr. A. Querido who was then head of psychiatric services for the city of Amster­dam. Professor Querido thought my project quite feasible, but told me I should start it in Am­sterdam, not Zaanstreek.

So in January 1946 I started working with psychiatric services for young people in Amsterdam and I continued with this work until 1951. It was a very fruitful period for me, indeed. It was a time when everyone was full of enthusiasm and it was really a revelation what one could do. I had the cooperation and as­sistance of medical doctors, nurses, psychologists

and social workers as well as other psy­chiatrists. It started as parttime work but our service grew so fast in response to need that it developed into a team which saw many thousands of children a year.

In 1951 when Querido left I took over from him as director of psychiatric services for the city of Amsterdam. It was an in­teresting job but it involved me in so many conflicts with officials and board members that when the University of Groningen asked me if I would come and work for them I was happy to accept. I came here at the end of 1952 and have never regretted it. There were practically no psy­chiatric services for children in this area when I started but we have been able to build up a service here. We started with 14 beds at the University Hospital and no outpatient services. Now, besides the hospital beds, we have 14 beds in the Chateau Blanc residential treatment centre, a child guidance clinic and psychiatric outpatient ser­vices for young people. We have a consultation service with all the child protection services in the northern provinces of Hol­land. We have no beds for ado­lescents at present, and can only take them for short periods, but we hope to have an adolescent unit before long.

New ideas hard to accept

One cannot do things as quickly as one would like to. One meets resistance. But a lot can be done with consultation and gradually things grow.

I think resistance comes be­cause new ideas do not fit in with the old ways of doing things, the old standards which have been laid down in the past. People become fixed in their opinions and prejudices. It's hard for them to consider new ideas which may mean they have to change their way of doing things.

Then, too, people feel threat­ened by disturbed behavior. Each person has problems con­trolling his impulses. Whether or not a person becomes disturbed depends a lot on chance — on secondary influences and cir­cumstances. When one meets a person who cannot control his impulsivity, he presents a threat to one's own control. So there is a tendency to want to have disturbed or deviant persons locked up out of sight.

These problems exist, but in spite of them there has been a great deal of progress.

I am amazed how many young people are interested in this work. People of my own age, over 60, are interested too. But the people in between are not so interested in hearing about new ways of doing things; they have a tendency to rest on their laurels and stay with what they know.

Mr. Veerman: Has anyone be­sides August Aichhorn influenced you?

Prof. Hart de Ruyter: I have been helped a lot by the views of Professor Erik Erickson. And by Dr. Stirnmann, the Swiss pedia­trician.

Trust and Mistrust

I first discovered the terms "basic trust" and "basic mis­trust" in an article by Dr. Stirn­mann in which he presented the concept of security "das Geful des Geborgenseins".

If a child knows security in his relationship with his mother, if he knows that if he is hurt he can run back to mother to enjoy again that feeling of safety, then he enjoys exploring his sur­roundings. The child who enjoys basic security in his relationship with his mother starts out in life with a basic feeling of trust, a belief that there are kind, de­pendable people in the world to whom one can turn for help.

But if a child has never felt security in his relationship with his mother, he will not have the courage necessary to explore the world or face the reality of it.

It is known that many ego weak children have a feeling of mistrust about everything and everybody. Such children do not have confidence that if they run into problems they will be able to get help in overcoming them, either from within themselves or from other people. They do not believe there is any help avail­able to them.

Need to regress

My idea was — and I have been able to realize it, more or less — that one must start with that phase of emotional develop­ment where things first started to go wrong. That is usually in an early stage of the child's de­velopment. If one can take the child back to that phase, and meet the needs which weren't met then, the child's develop­ment will proceed at a rapid rate. The child makes up for time lost.

Mr. Veerman: How do you "take the child back"?

Prof. Hart de Ruyter: We en­courage regression at the clinic by offering the children a very tolerant, nondemanding environ­ment, and regression comes na­turally. Placed in such an en­vironment, these children will go back to a stage of functioning which is natural and easy for them. And they never go further back than they need to. It is essential that at this point of their treatment they are in con­tact with staff who are able to react to them as warm, loving, human beings.

Regression is no problem, but helping the child rebuild his new self is hard work. Individual con­tact with a foster mother or crea­tive therapist is very helpful in this.

I like creative therapy* be­cause it is hard for these chil­dren to verbalize their feelings.

When, through the creative therapy, the child has revealed some of his feelings I ask him to tell me in words what he is saying by his behavior.

Very often a child will say: "Do I have to say that I am afraid?"; I tell him: "Of course. Then we can try to find out what it is that you fear."

These children feel themselves to be very destructive and full of aggression because they are afraid in such a chaotic way. The child who has not yet formed an ego is full of diffused aggres­sion. He is not afraid of separa­tion from any particular person because he cannot form an at­tachment to any particular per­son. He will smash or damage any project, steal from or try to hurt any person.

One of the direct conse­quences of regression is that it enables one to help the child structure his fear and his anger. This can only be achieved through the medium of an emo­tional relationship with the child.

The first thing the child be­comes aware of is the conse­quence of his aggression. He is being aggressive against a par­ticular human being, often the human being he loves most.

At the point at which the child can achieve an object relation­ship without being afraid of los­ing that relationship, the aggres­sion disappears. When the child no longer feels himself to be threatened, he loses his fears.

At first the children experience the tolerant environment of the clinic as a threat. They don't understand it because they are filled with mistrust. So they ask: "What are you going to do with me now?" When they first come they usually ask where the iso­lation room is. They are used to being shut up in a room by them­selves when they get upset or angry.

We often have to do something we don't believe in because of regulations imposed upon us from outside. For example when we established the clinic in Chateau Blanc Villa, in a lovely residential neighborhood, the neighbors objected to us being there. They could be appeased only by the building of a high fence around our property, which wasn't useful to the children ex­cept as a challenge.

According to hospital regula­tions we must have an isolation room. So we have one but we hardly ever use it. Occasionally a child will have a psychotic out­burst and for his own protec­tion and the protection of others we will take him to this room, but a staff stays with him. If the staff person has to leave a child alone for a while, they can talk to each other over the microphone sys­tem.

When a child loses control

There is always the problem of what do you do with a child who has temporarily lost control of his impulsivity.

One solution is to give the child medication. This will quieten him for a while and when he wakes he will often be more receptive than usual, as is any human being when he first awakens from sleep. That initial wakening period can be used very intensively and it has hap­pened that this can be the be­ginning of relationship with a child.

The other solution is to stay with the child and personally see him through this psychotic epi­sode, holding him if necessary. We, too, use holding to contain children when necessary. In the "Warrendale" film we saw that children who lost control were held in front of the other chil­dren. We don't do that. If a child has to be held we take him away from the group because we think it would frighten the other chil­dren to keep him with them while we held him. This may be a dif­ference of culture, rather than technique. The Dutchman is a very private person.

Use of foster families Mr. Veerman: I think the readers of INVOLVEMENT would be in­terested to know more about the way in which you use foster families.

Prof. Hart de Ruyter: At present we have about 40 children living in 30 foster families. They are all in the vicinity of Groningen so that we can maintain contact easily and get help to them quickly should they need it.

When we first started looking for suitable foster families we had the idea that professional people who had worked in the child treatment field would make the best foster parents for these children. In some cases they did, but we found it difficult to do casework with most of them, Professional people tend to be too fixed in their opinions to accept help or advice from social workers. Their attitude seemed to be that they had learned all there was to learn about children and they were quite capable of handling the foster child without any help from our caseworkers.

So we switched to nonprofes­sional families and we have had far more success with them. We get our families mainly through personal recommendation. Peo­ple often become interested in taking a child because they have friends who have a foster child. These are really the best people to get because they are realistic about what's involved. The worst kind are the ones who are unrealistically idealistic.

When a family is recommended to us we talk to them to find out if they have a genuine interest in the work and realistic expec­tations about what is involved. Our foster families represent the broad spectrum of Dutch society: we have farmers, ministers of the church, skilled and unskilled industrial workers and teachers.

Try to match interests

We always try to place a child with a family whose interests and way of life will be compat­ible. The crucial factor is always the child's present interests ra­ther than his background. For example, we would not place a child who came from an intel­lectual family with another intel­lectual family if we thought the child would be happier living with a family which raised horses. Similarly, if a child who came from a laboring family shows intellectual or artistic promise we try to find a family with similar interests to provide an environment which will en­courage him.

We always talk to the child before he goes into a foster family to try to make sure his expectations are realistic. We sometimes talk to the children in groups about this. We talk to the family, too. We try to make the transition as smooth as pos­sible. It takes a lot of work but it is worth it because it brings better results in the long run. We are lucky in being able to find quite a few married couples of around 45 years old whose children have grown up and left home and who want "to see feet under the table" again. These people often provide good place­ments for adolescents.

We have to talk with them to make sure they don't expect too much from the children we place with them. Because they have brought up their own children successfully they tend to think all the children need is good food, good care and kindness. Our case workers' job is to help them understand that their own children behaved well because they had no reason not to. But the child we are bringing them is full of mistrust and will have to test them time and time again before he can feel safe in trust­ing them.

Mr. Veerman: How do the foster parents and your staff share the responsibility for the child?

Prof. Hart de Ruyter: This is often a difficulty. I would like to know more about how they do this at Browndale.

We try to delegate responsi­bility to the foster family, and have the caseworker serve in an advisory capacity. This usually works very well. The caseworker

can explain to the foster parents that the child is provoking them in order to find out whether or not they really care about him. It's the only way he knows to find out and he has to be sure they care for him before he can risk investing his feelings in them because he has suffered so many disappointments in the past. The caseworker can help the foster parents discover ways of coping with the child and helping him.

But we run into problems sometimes when the child makes a superficial adjustment without coming to terms with his diffi­culties or real feelings. The fos­ter parents are happy because the child is behaving well, is easy to live with and they don't want to upset the apple cart. The child avoids confrontation because he is afraid he might be moved from the family.

Then the caseworker has a hard job. He, or she, knows that when the child encounters a really stressful situation, which is bound to happen sooner or later, his superficial adjustment will break down. Sometimes we are unable to make any progress until a crisis does occur. Then it is obvious to everyone that all is not well. This makes the case­worker's job easier because everyone is motivated to do something about it and this often results in a step forward in the right direction.

Moved many times

But however hard you try, some placements don't work out. It is heartbreaking to have to move a child because some of them have been moved so many times before. Some children who come to us have had 10, 11, 13 different placements. One child had been in 17 different foster homes and institutions. We had one 9 year old girl who had been moved 11 times. So one hates to move them again. But some­times, for the child's sake, it is unavoidable.

Sometimes illness or other dif­ficulties in the foster families re­quire the temporary removal of the child. In these cases we can take the child into our lock house. In English it would be called a halfway house, I believe. It provides a transition between the clinic and the world outside, as a lock is a transition between one level of water and another. We use the term lock because canals play such an important part in life in Holland.

Sometimes a child stays at the halfway house while we are find­ing him a family to live with. We use it, too, for children of 17 or more. It is difficult to find a foster family for a 17yearold child.

The home is in an ordinary house on the street opposite the hospital. We pay a married couple to live there. The hus­band is a medical student, so he cannot give too much time to the children. But they know he is there, and interested in them, and they can go and talk to him when they need to. Three full time child care staff help the wife look after the children. Most of the children in the half­way house go to school or have jobs.

We sometimes use the house as a temporary home for a child discharged from the treatment centre who later gets in touch with us for further help. For example, there is one girl who was at Chateau Blanc from the age of 11 to 14. When she reached puberty she became very diffi­cult to handle. We don't have facilities for adolescents yet, and we couldn't find a suitable foster home for her, so we let her go home to her parents. But it didn't work out, they couldn't handle her, and she went through a suc­cession of institutions and psy­chiatric hospitals, until February of this year when she started living on her own.

She tried to reestablish con­tact with her family but they re­fuse to have anything to do with her now. Her father, a profes­sional man, regards her as a rotten apple in the family basket who will damage all his other beautiful fruit.

A few days ago she came back to see us. I must say she ap­pears to have made a fairly good adjustment, and is facing up to reality. She has a job working for a company in Groningen. We have found her a place in the halfway house for the time being.

Another graduate of ours who got in touch with us again re­cently is a boy who had been at the clinic but had never been in one of our therapeutic foster families. He was an intelligent boy who had developed well and grown emotionally with us. But we thought he would benefit from the discipline of a boarding school. So he went to school and now has a trade certificate.

While at the school he had kept up an irregular corres­pondence with one of his staff at the clinic. In his latest letter he had written to say that as soon as he got his trade certificate he human being when he first awakens from sleep. That initial wakening period can be used very intensively and it has hap­pened that this can be the be­ginning of relationship with a child.

The other solution is to stay with the child and personally see him through this psychotic epi­sode, holding him if necessary. We, too, use holding to contain children when necessary. In the "Warrendale" film we saw that children who lost control were held in front of the other chil­dren. We don't do that. If a child has to be held we take him away from the group because we think it would frighten the other chil­dren to keep him with them while we held him. This may be a dif­ference of culture, rather than technique. The Dutchman is a very private person.

Use of foster families Mr. Veerman: I think the readers of INVOLVEMENT would be in­terested to know more about the way in which you use foster families.

Prof. Hart de Ruyter: At present we have about 40 children living in 30 foster families. They are all in the vicinity of Groningen so that we can maintain contact easily and get help to them quickly should they need it.

When we first started looking for suitable foster families we had the idea that professional people who had worked in the child treatment field would make the best foster parents for these children. In some cases they did, but we found it difficult to do casework with most of them, Professional people tend to be too fixed in their opinions to accept help or advice from social workers. Their attitude seemed to be that they had learned all there was to learn about children and they were quite capable of handling the foster child without any help from our caseworkers.

So we switched to nonprofes­sional families and we have had far more success with them. We get our families mainly through personal recommendation. Peo­ple often become interested in taking a child because they have friends who have a foster child. These are really the best people to get because they are realistic about what's involved. The worst kind are the ones who are unrealistically idealistic.

When a family is recommended to us we talk to them to find out if they have a genuine interest in the work and realistic expec­tations about what is involved. Our foster families represent the broad spectrum of Dutch society: we have farmers, ministers of the church, skilled and unskilled industrial workers and teachers.

Try to match interests

We always try to place a child with a family whose interests and way of life will be compat­ible. The crucial factor is always the child's present interests ra­ther than his background. For example, we would not place a child who came from an intel­lectual family with another intel­lectual family if we thought the child would be happier living with a family which raised horses. Similarly, if a child who came from a laboring family shows intellectual or artistic promise we try to find a family with similar interests to provide an environment which will encourage him.

We always talk to the child before he goes into a foster family to try to make sure his expectations are realistic. We sometimes talk to the children in groups about this. We talk to the family, too. We try to make the transition as smooth as pos­sible. It takes a lot of work but it is worth it because it brings better results in the long run. We are lucky in being able to find quite a few married couples of around 45 years old whose children have grown up and left home and who want "to see feet under the table" again. These people often provide good place­ments for adolescents.

We have to talk with them to make sure they don't expect too much from the children we place with them. Because they have brought up their own children successfully they tend to think all the children need is good food, good care and kindness. Our case workers' job is to help them understand that their own children behaved well because they had no reason not to. But the child we are bringing them is full of mistrust and will have to test them time and time again before he can feel safe in trust­ing them.

Mr. Veerman: How do the foster parents and your staff share the responsibility for the child?

Prof. Hart de Ruyter: This is often a difficulty. I would like to know more about how they do this at Browndale.

We try to delegate responsi­bility to the foster family, and have the caseworker serve in an advisory capacity. This usually works very well. The caseworker

can explain to the foster parents that the child is provoking them in order to find out whether or not they really care about him. It's the only way he knows to find out and he has to be sure they care for him before he can risk investing his feelings in them because he has suffered so many disappointments in the past. The caseworker can help the foster parents discover ways of coping with the child and helping him.

But we run into problems sometimes when the child makes a superficial adjustment without coming to terms with his diffi­culties or real feelings. The fos­ter parents are happy because the child is behaving well, is easy to live with and they don't want to upset the apple cart. The child avoids confrontation because he is afraid he might be moved from the family.

Then the caseworker has a hard job. He, or she, knows that when the child encounters a really stressful situation, which is bound to happen sooner or later, his superficial adjustment will break down. Sometimes we are unable to make any progress until a crisis does occur. Then it is obvious to everyone that all is not well. This makes the case­worker's job easier because everyone is motivated to do something about it and this often results in a step forward in the right direction.

Moved many times

But however hard you try, some placements don't work out. It is heartbreaking to have to move a child because some of them have been moved so many times before. Some children who come to us have had 10, 11, 13 different placements. One child had been in 17 different foster homes and institutions. We had one 9 year old girl who had been moved 11 times. So one hates to move them again. But some­times, for the child's sake, it is unavoidable.

Sometimes illness or other dif­ficulties in the foster families re­quire the temporary removal of the child. In these cases we can take the child into our lock house. In English it would be called a halfway house, I believe. It provides a transition between the clinic and the world outside, as a lock is a transition between one level of water and another. We use the term lock because canals play such an important part in life in Holland.

Sometimes a child stays at the halfway house while we are find­ing him a family to live with. We use it, too, for children of 17 or more. It is difficult to find a foster family for a 17yearold child.

The home is in an ordinary house on the street opposite the hospital. We pay a married couple to live there. The hus­band is a medical student, so he cannot give too much time to the children. But they know he is there, and interested in them, and they can go and talk to him when they need to. Three full time child care staff help the wife look after the children. Most of the children in the half­way house go to school or have jobs.

We sometimes use the house as a temporary home for a child discharged from the treatment centre who later gets in touch with us for further help. For example, there is one girl who was at Chateau Blanc from the age of 11 to 14. When she reached puberty she became very diffi­cult to handle. We don't have facilities for adolescents yet, and we couldn't find a suitable foster home for her, so we let her go home to her parents. But it didn't work out, they couldn't handle her, and she went through a suc­cession of institutions and psy­chiatric hospitals, until February of this year when she started living on her own.

She tried to reestablish con­tact with her family but they re­fuse to have anything to do with her now. Her father, a profes­sional man, regards her as a rotten apple in the family basket who will damage all his other beautiful fruit.

A few days ago she came back to see us. I must say she ap­pears to have made a fairly good adjustment, and is facing up to reality. She has a job working for a company in Groningen. We have found her a place in the halfway house for the time being.

Another graduate of ours who got in touch with us again re­cently is a boy who had been at the clinic but had never been in one of our therapeutic foster families. He was an intelligent boy who had developed well and grown emotionally with us. But we thought he would benefit from the discipline of a boarding school. So he went to school and now has a trade certificate.

While at the school he had kept up an irregular corres­pondence with one of his staff at the clinic. In his latest letter he had written to say that as soon as he got his trade certificate he thought he would go into the army because then at least he would have a roof over his head. Dutch boys have to serve a term in the army at 18 but he was only 17.

So we wrote to him and sug­gested that when he had gotten his trade certificate he should come and see us and talk things over. If he can get a job in the district he can live in the half­way house for a while, until he can find himself a room or a family who will take him in as a paying guest. Many children who have been discharged from residential treatment centres and institutions experience great dif­ficulties trying to maintain them­selves in society. They need some kind of support to help them cope with the problems they encounter.

Dr. Mik, who works with me at Chateau Blanc has started an open house for young people who need help.

Mr. Veerman: Is this similar to the Youth Advisory Centre in Amsterdam*?

Prof. Hart de Ruyter: It is similar in some respects to the one in Amsterdam. The help is free and the young people can remain anonymous. But ours is a much smaller operation and that has advantages. Dr. Mik runs it on his own with the help of a hip young receptionist, and some social workers who volunteer their time.

He has a phenomenal memory and sometimes a young person will say to him: How do you know that? And Dr. Mik will say: Because you told me that last time you were here. It is hard for the young person to believe Dr. Mik can remember so much without writing it down, but he does.

The centre is on one of the main streets in Groningen. And the recommendations are usu­ally word of mouth. A young per­son whom we have helped will suggest to someone else in dif­ficulties that we might be able to help him.

I often tell the young people whom we help that they are my private social workers. When they are more or less settled themselves they are often very good people to take in another young person who needs help.

Sometimes you get a child who has run away from an insti­tution and refuses to go back. He tells us we can't make him because he has friends who will hide him. So Dr. Mik asks him to bring these friends in and he talks to them and sometimes he finds that it is possible to let the child stay with the friends. If not, if their "help" will do the child more harm than good, we have to find a room for the child or a family with whom he can live.

We have some older children who have graduated from the clinic, who are working and liv­ing on their own in rooms now. They receive intensive casework from our social workers.

We encourage staff to keep in touch with children who have left the clinic if they wish to. This can lead to difficulties some­times because it is against hos­pital policy. Nurses and other child care staff are not encour­aged to have any close personal contact with patients. But if a child who has been through the clinic later gets into difficulties, he often will contact the staff person with whom he was most closely associated. If the staff wants to help him we don't dis­courage this. Sometimes a staff person will take a child into his or her own home for a while. We say it is all right for them to do this as long as they guard against becoming so involved with the child's problems that their own health suffers.

Some staff do become too intensely involved with the chil­dren and they become ill them­selves. When this happens we advise them to stop working for a while; to do some other kind of job, perhaps while continuing analysis. Sometimes they come back to work for us. Sometimes they make good foster parents.

Hard work, long hours

The work is hard and the hours are long. The hospital board tells us that we shouldn't let the staff work such long hours. But I have found that if you can give the staff the sup­port and supervision they need to work as many hours as are necessary to do a good job, this is better for both the staff and children than to say you must stop now because your shift is up when staff and child are in the middle of some important interaction. Because the un­finished business will have to be dealt with the next day, and will probably be harder to deal with the next day. This does not mean, of course, that the staff don't get the free time they are entitled to, and need. It means, rather, that they schedule their

* see page 24.

off duty times for periods when their absence will be least harm­ful for the children with whom they have their closest relation­ships. At Chateau Blanc our schedule of working hours and time off is very flexible so that it may serve the best interests of the children as well as the staff.

Plans for the future

Mr.   Veerman:   Have   you   any other plans for expansion?

Prof. Hart de Ruyter: Yes, there are some exciting new possibili­ties.

We have an opportunity to start a psychiatric centre for young people in the village of Roden. We already have quite a few foster families in Roden. There is some small industry there, farming, and the schools are quite good.

We have been planning the Roden project for 12 years now. We have suffered endless diffi­culties trying to get financing for it; to get a decision on whether the hospital, or the Department of Justice, or some other govern­ment department should finance it.

My coworker Dr. Wouters met with the citizens of Roden, many of whom had expressed fears that the value of houses might go down and the presence of the children might cause trouble in the community,* discussed the project with them and enlisted their cooperation. The mayor has been very helpful too. Un­fortunately, he is leaving Roden, but he has done some very valuable preliminary work for us.

We will have several houses, fairly close together. We have a very good architect who will build our houses with the pointed roofs characteristic of the area so that they won't stand out as being different. There will be two groups of 6 children in each house. We hope that each house will develop its own identity. I remember years ago when we had only 14 beds (at University Hospital) telling a visitor that we hoped to double the number of beds before long. To my surprise he said: What a pity! And when I asked him why, he said that our hospital unit was like a home with its own distinctive charac­ter. But if we doubled the number of beds it would become just like an institution. I thought a lot about this and succeeded in getting a separate house (Cha­teau Blanc) for those additional 14 beds. I think that visitor was right.

Our maximum capacity at Roden will be 72 children. But this can be a flexible arrange­ment. If we discover we don't need more houses, we can or­ganize a different type of ser­vice. We can do whatever is most needed.

Mr. Veerman: What future de­velopments do you see in the child care field?

Prof. Hart de Ruyter: It's hard to say, at my age. When I was young I had ideas about what would happen and many of my predictions were realized. For future predictions you should ask the young people. But I do think that the traditional family as we know it may disappear. Perhaps not in the rural areas, but in the large cities I think it will disappear. What I would like to see happen is more cooperation and exchanges between people in different countries so that we can learn from them and they can learn from us.

Mr. Veerman: What would you say is the most important aspect of work with children?

Prof. Hart de Ruyter: Prevention. If we could do enough preventative work we wouldn't need the treatment centres and the insti­tutions. A number of children who went through our clinic are now married and raising their own families. I don't say there will be no problems among the children of these families. But the important thing is the mothers and fathers will recognize prob­lems when they first begin to show and they will not be afraid to ask for help, and to work with us to solve the problems. They trust us and our philosophy.

Save a child, save a family

"He who saves a child, saves a family," Mr. Blok, the former director of the Gerhard school in Amsterdam used to say. I agree. If you can free a child from his distrust, if you can bring him to believe that there are people who can help him with his problems, who are interested enough, and care enough, to work with him to help him solve them, then he will grow to know he can get help when he needs it. If we could extend this sup­port to all families, then prob­lems would not grow to the size they do now.

People complain that the whole field of social welfare or child care is in a mess. But I say that this wouldn't be so if society were not in such a mess. People on the whole lack a feeling of social responsibility. They dele­gate responsibility for their fel­low human beings to a few pro­fessional people. This results in a dehumanizing process in child welfare. Our system today is better than the old concept of charity but now the danger lies in this tendency toward dehumanization. You find it in government departments, in in­stitutions, in therapeutic tech­niques.

However, I do think this is be­ginning to change. When one reads analytic literature now, the subject of study is not just the therapy relationship but also the human relationship. I have a feeling we are on the right road now.

by John L. Brown

Love and Learning — John Brown attacks the con­cept of motivation in learning and discusses some of the experiences that may thwart an infant's natural desire to explore and discover.

The AntiSchool — John Brown discusses an approach to encouraging emotionally disturbed chil­dren to learn which is appropriate for all children.

Pairs and Triads — John Brown looks at the thera­peutic benefits which occur when a third party impinges on a pair relationship.

Discipline —John Brown discusses different meth­ods of discipline used in society and in institutions.

The Therapeutic Family — An outline of the Browndale philosophy of treatment of emotionally dis­turbed children in therapeutic family units living in the community. Introducing New Staff and New Children into the Treatment Centre — John Brown talks to staff about how this can be accomplished sensitively.

by Mrs. Deborah Brown

The Role of the Child Care Worker — in the Browndale therapeutic family.

by Dr. Otto Weininger

A Little Girl's Search for Sexual  Identity — The story of how a little girl, diagnosed as schizophrenic, worked through some of her problems with the aid of her extraordinary talent for drawing. Illustrated by some of the girl's drawings.

Using Everyday Experiences for Diagnosis and Treatment — A discussion of the Browndale treat­ment philosophy of using ordinary daily life events to do remedial work with children.

by Carlo Tela

The Community Concept of Treatment — A dis­cussion with staff on the practical aspects of the therapeutic family method of rehabilitating emo­tionally disturbed children.

All articles come from the Browndale Magazine Involvement 1970