Development through polarization and integration: A presentation of a model and an organization for providing training and organizational development for milieu therapeutic organizations.

DEVELOPMENT THROUGH POLARIZATION AND INTEGRATION
A presentation of a model and an organization for providing training and organizational development for milieu therapeutic organizations.
SEDAC is an organization that has provided ongoing training and organizational development for between 4 and 6 milieu therapeutic organizations, that work with children and young people with serious psychological/psychiatric difficulties, since 1999. Each of the organizations has between 7 and 23 clients at a time in treatment from 1 to 5 years and between 8 and 18 employees with various educational backgrounds. In this paper we will present the way SEDAC is organized, the principles it is built on and what experiences we have made over the years.
Negative emotions, emotional pain, projective processes, and self-destructive and violent behavior are some of the ways disturbed children, adolescents, and young adults present their difficulties daily to the staff at residential treatment centers. Usually we speak of the following: The possibility of change arises from containment and integration by the staff, while polarization processes are ever present.
It is important to consider that polarization processes also are a necessity and a prerequisite for growth and change. Bion has given us the container-contained model and the model of the dynamic interaction between the paranoid-schizoid position and the depressive position. These processes are ever present in the everyday work the staff meets while working task oriented.
Working with milieu therapy the self – the self of the single milieu therapist as well as the ‘self’ of the organization - becomes very important ‘tools’. This work demands patience, ability to receive and work with projections, ability to use boundaries and stay in a reflective mode 24/7. Temptations to regress are everywhere.
In the classic education of psychoanalysts and psychoanalytic psychotherapists as well as group analysts, the model consists of personal analysis or psychotherapy, theory, and supervision. To some extent knowledge and experience with organizations is also included. In creating a model for staff of varied educational backgrounds, to learn to take upon them the role of milieu therapist, a more differentiated model is necessary. In radical milieu therapy the organization is defined as the therapist. The organization must offer clients the possibility of working on their own development in a protected holding environment based on a culture of inquiry, being met and seen for who you are without judgement or moralizing.
Working with children, adolescents, and young adults that at best develop slowly, the continual focus on development must be organized systematically and ongoing.
In order to work on the primary task, it is necessary for the organization to support the staff and their work through:
Meetings: task defined meetings concerning treatment, leadership and planning of all types within the organization, plus meetings with the public authority that has placed the adolescents in the institutions, and work with parents.
Supervision: Systematic supervision of both staff groups and leaders.
Leadership and cooperation: Focus is on cooperation and the culture of inquiry in the organization. In SEDAC this includes group relations work in each organization, for staff and leaders in all four organizations together, and for the leaders of all four organizations together.
Theory: Psychodynamic theory of development, milieu therapy, and organizational psychology are the focus for learning theory.

References:
Bettelheim, B. (1950). Love is not enough. Free Press. New York.
Bronstein, C. and O’Shaughnessy, E. (ed.) (2017). Attacks on Linking Revisted. Karnac, London
Dockar-Drysdal, B. (1993). Therapy and Consultation in Child Care. Free Association Books, London
Kornerup, H. (ed.) (2009). “Milieu-therapy” with Children. Planned Environmental Therapy in Scandinavia.
Perikon, Denmark and Karnac Books, London
Visholm, S. (1993): Overflade og dybde. Om projektiv identifikation og det modernes psykologi.
(Surface and Depth. On Projective Identification and the Psychology of the Modernity). Copenhagen: Politisk Revy.
(2013):Forfremmede søskende. Om åben og skjult familiedynamik i organisationer (The Promoted Sibling. On Open and Hidden Family Dynamics in Organizations). Copenhagen: Hans Reitzels Forlag.