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This paper examines the function of the structure and organisation of institutions and their relevance to the clinical work. It discusses the positive contribution which they can make to the joint treatment of the child by a staff team, and some of the dangers inherent in professional relationships in institutions. It illustrates some of the forces which seek to dismantle or alter the formal structures, and how careful attention to these institutional processes can bring clinical rewards. Similarly, it considers how thoughtful use of the physical environment contributes to making the setting therapeutic.
The examples spring from my own experience and from what my colleagues have shared with me about their experience. I am very grateful to them for sharing their thoughts and feelings with me, and for their permission to present in this paper some of the insights which have emerged from our discussions.
In day and residential units staff members work in teams and each member of staff has to find ways of working with his colleagues, whether they are from the same or different disciplines. It may be that most of us come into this kind of work because we are interested in working with children and families. This is the focus of our training, at any rate. However, there is no intrinsic reason why professionals who are skilled at work with clients should be good at working with each other, or have a talent for harnessing the therapeutic potential of institutional living. In fact, only too often the institution is apparently ignored, taken for granted or experienced by clients and staff alike as an unwelcome third party in their relationship. Of course, it is reasonable to assume that the skill of working with colleagues and an appreciation of the role of the institution will tend to develop more readily in work situations where they are already valued.
Children who come to day and residential units usually do so because they and their parents are under such stress