Psychoanalytic Considerations on Indications for Residential Treatment

In general, residential treatment tends to be perceived as placement within an administrative facility in which various activities take place—a perception that led Goffman (1961) to include residential treatment, military frameworks, and prisons, for example, all under one title. According to Goffman, all of these facilities share a common denominator. They each maintain under one roof three basic functions: sleeping, eating, and working (and educational studies, in children's facilities). A sociological approach such as this perhaps justifies evaluating any residential facility by looking primarily at its sociostructural systems, such as the ratio between staff and inmates. This approach concerns itself primarily with factors such as power, group dynamics, status competition, and so forth.

Contemporary psychotherapeutic residential treatment has tried to cope with the sociological conceptualization via semantic changes. Thus, for instance, the classical concept “institution” underwent several metamorphoses, changing gradually into “therapeutic community” or “residential treatment.” In the same way, redefinition of the role of the worker was attempted in order to temper negative connotations, most obviously that of the staff person who in the past was called a “cottage parent,” later the seemingly more prestigious title of “counselor,” and more recently is referred to as the “child care worker.”

Unfortunately, such semantic changes have not effected significant permutations in the manner that professionals or the community itself actually perceive residential treatment. Negative connotations continue to surface, especially among those professionals in charge of placement and determination of treatment methods and frameworks.

One finds further evidence of this in the written referrals of children to residential treatment, which usually abound in apologetics for this