Reparenting and deparenting as a paradigm for psychiatric residential treatment

Abstract

Psychiatric residential treatment for adolescents can be conceptualized as a process of reparenting and deparenting. In psychiatric treatment, there is a division between “artificially” created forms of treatment (such as individual or group therapy) and the real experience of daily life which can be seen in the therapist's real relationship with the adolescent (reparenting) and daily experience in the milieu. The designation of parental functions (granting of privileges, allowances, status changes, management, and coordination) to the therapist creates the satisfactions and creative conflicts necessary for reparenting. The theoretical basis of this work lies in Alexander's work on the corrective emotional experience, but also has roots in current object relations thinking. The patient is re-exposed under more favorable conditions to situations he could not handle in the past. By adequate nurturance, deficits are corrected. The therapist must assume an attitude different from that which the parent assumed toward the child in the original conflict situation. Repetition of the same mistakes must be prevented by better understanding, good supervision, and controlled affectivity. Deparenting has a theoretical ground in learning theory. The therapist refuses to reinforce the patient's present state of adjustment by refusing to make the response the patient forcefully evokes, and then there is a possibility of new choices.