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3 APTO 1 (1959)

handle is hein.journals/ijotcc3 and id is 1 raw text is: RETURN POSTAGE GUARANTEED The Journal of the Association for Psychiatric Treatment of Offenders [ February, 1959, Vol. 3 No.1 The Treatment Philosophy of APTO MELITTA SCHMIDEBERG. M.D. Psychotherapy of offendrs should be regarded as a distinct sub-specialty, requiring special technics which differ from those of general psychotherapy. Out-patient psychotherapy, as usually practiced today, is so much geared to the neurotic patient that, even when its methods are modified, it is still unsuited for most offenders, who in essential points represent the opposite of the neurotic. On the other hand, institutional treatment of criminals has unavoidably severe drawbacks because of the artificiality of the treat- ment environment. Since the offender should be treated whenever possible under the temptations and stresses of normal life with which he has hitherto failed to cope, i.e., as out-patients, we must therefore develop new technics and a new treatment philosophy. Most offenders have no real wish to change, and they submit to therapy only under direct or indirect pressure. Psycho- therapists, as a rule, do not like to treat patients who are not genuinely motivated. However, psychotherapy will fail to make an essential contribution to social problems unless and until it undertakes to handle this special type of patient. Treatment of offenders should be community- oriented rather than therapist-oriented. Treatment of neurotics is based on the fiction of an idealined patient-doctor relation which, even for neurotics, only occasionally holds true. This fiction is based on two assumptions: that the patient is frank, cooperative, ready to make sacrifices and anxious to change and that the benevolent therapist helps him by expressing sympathy and encouragement. Since the first premise does not apply to offenders, it is doubtful that the second applies either. APTO's treatment philosophy is based on close cooperation with the courts and probation and parole services.Our therapists accept the un- flattering fact that the patients usually see them initially only as an alternative to prison. This is the same reason that the offender visits the proba- tion officer. Like the latter, our therapists try to convert this enforced relation into a genuine one, which can then be utilized to socialize the patient. Success in therapy depends upon making this conversion. More important than the technic of the therapist is his attitude; he must feel that by socializing the offender he is doing something positive for, and not against, his patient, and that by inculcating social values and developing self- control and responsibility he is turning outcasts into acceptable and accepted members of society. The patient must learn that the fact that he has been wvronged as a child or later does not justify his breaking the law and that knowing the causes for his behavior does not justify it. Indiscriminate encouragement is dangerous, as are indiscriminate analytic interpretations. We must be guided by definite social values and clinical goals. APTO cooperates closely with the courts, but we arc not employed by them. The patients re- ferred by the courts are seen either in the offices of the association or more often in the private office of the therapist. The latter feature of our treatment plan in itself has a socializing value. We provide diagnostic reports to the courts, keep in close contact with the probation officer during treatment and give, upon request, progress reports. This can be done without harming- the patient, and the cooperation with the probation officer and the information we receive from him are invaluable. Motivation and constant remotivation of the patient, first by the probation officer, then by the intake psychiatrist, and again and again by the therapist, is an essential aspect of treatment. Our staff consists at present qf a Clinical Director, the three members of the multidisciplin- ary Intake Staff, fourteen therapists, several testing psychologists, social workers and reading in- structors. These personnel see the patient for a token fee or without charge. Most therapists prefer to handle the family as well. In some cases, we have found it useful for more than one therapist to have contact with the patient. Generally we do not regard therapy us a one-to-one relation taking place within the confines of the therapist's office, but rather a broader process involving the entire community. That the patient has to learn to get along with his probation officer, to stop his law- breaking activities, to take a steady job, and soon, are not only practical necessities but steps in therapy towards the goal of socialization. Special Difficulties In - Working With Adolescent Offenders (Part I) RUTH OCHROCH, Ph.D. In the second act of the musical West Side Story, a gang known as the Jets gather and, having evaded the cops after a bloody fight with a rival gang, sing a ditty to the police officer on the beat about the perils that face delinquents in court. They enact a scene in which the judge sends the delinquent to a psychiatrist. The psychiatrist, after a successful snow job by the delinquent, declares magnanimously that this here boy don't have to have his head shrunk at all. He is suffering from a social disease. He needs asocial worker. Aspects OfAuthority - In Treatment JOHN DE LORIA As in the treatment of the nonoffender, an in- creased awareness of self, a well as an increased understanding of the world in which he lives, are of first importance in the pyochiatric treatment of the offender. The development of insight in these areas will enable the offender to see how his feel- ings motivated his behavior and to use his esergies more economically and efficiently in behalf of wholesome personal and social growth. The liter- sture regarding the offender is replete with illus- trations of his tendencies to act-out conflicts impulsively, to seek immediate satisfaction of needs and desires, to evade responsibility and to avoid close, enduring relationships with other persons. The primary aims of psychiatric treatment are also shared by probation, which attempts, through social casework principles, to re-orient and re-educate the offender, so that he can har- monine his needs and desires with the requirements of social living, thereby avoiding conflict and/or difficulty isr the ommnmity. l-isiregentlyfr er - sary in asisting the offender to regain his normal status in sociery, to re-interpret the meaning and value of authority to him, so that he will learn to modify characteristic, and undesirable, ways of reacting to it-directly or indirectly. When psychiatric or social casework treatment of the offender is being considered within the framework of an authoritative setting such as probation, it must be kept in mind that the pro- bation agency is part of society's system of organ- ized social control. The therapist, whether psychiatrist or social worker, is not only concerned with understanding and modifying behavior, but with assisting in its management and control. The protection and safety of the community takes precedence over individualied treatment plans and goals. The offender's continuing freedom is Cninued an pg, 4 P10, Costinued an page 2

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