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This book is about the residential treatment of the severely disturbed adolescent, and deals to a very large extent with general principles of management and with psychopathology in a residential setting. Unlike most books on the subject, it is not explicitly descriptive of any particular unit, although it is based on the author's experience at the Menninger Foundation. The psychoanalytic theory is that of ego psychology as developed at the Menninger Clinic.
The book is divisible into two parts-the residential treatment setting (including the last chapter on the goals and results of treatment) and the disturbed adolescent himself. There are chapters on ‘The severely neurotic adolescents’, ‘Adolescents with ego defects’, ‘Developmental arrest’, ‘Conscience defects’ and ‘The psychotic adolescent’. These chapters would be of interest to all who have to deal with adolescents, though all may not agree with some of the concepts used.
The author describes residential treatment as ‘the form of psychiatric therapy that provides the maximum amount of external support and external direction for the patient … It is indicated only in certain clearly defined therapeutic circumstances … injudicious use of in-patient therapy may produce irreversible emotional regression and permanent personality stunting’.
The clearly defined circumstances referred to are ‘when the disturbed adolescent lacks sufficient personal strength to control his own drives and impulses’, for ‘a profound defect in ego-strength should be present before hospitalization is considered’. Also it should be shown in the diagnostic process that he (or she) is unable to form sufficiently strong meaningful relationships with people in his family. When it is necessary to separate him from his family because of the family disturbance, the author sees the separation experience itself as a growth promoting situation. He vigorously rejects the use of residential treatment as a punishment or as a shock to ‘bring him to his sense