Systemic strategies for dealing with problem children in institutional settings

Family therapy when a problem child enters residential treatment is complicated and treacherous because of the need to coordinate what may often be competing hierarchies (parental, residential, school). If the goal of residential treatment truly is one of deinstitutionalization, of reintegrating the child into his/her home, school, and community, the family therapist must see to it that the parental hierarchy is the primary one and that all institutional hierarchies are kept secondary. This paper presents, through a discussion of the forces that operate as institutionalization of children progresses and through case illustrations, a framework in which family therapy can be conducted within a residential treatment setting.The author expresses appreciation to Barbara DiCocco, MSW, Phyllis Stern, MA, John Rhead, PhD, and Karen Meckler, MD, for their helpful comments on the initial draft of this article and to Linda McClure, MSW, and Larry McAvoy for their administrative support.