current crisis in psychotherapy at boarding schools: Protecting the interests of the child and of the school, The

Adolescent Psychiatry, 1999 by Gottlieb, Richard M

Despite considerable professional activity by therapists and consultants over the years, and despite the quite unique conditions for mental health work in this important area, surprisingly little has been written about psychotherapy in the special setting of boarding schools. Although only 6 years have passed since I first wrote about the requirements and rewards of boarding-school work (Gottlieb, 1991), a near-revolution has occurred, profoundly although silently affecting these schools, students, therapists, and families alike. These often invidious changes have for the most part followed in the choppy wake of the transition of our national health care system toward a managed-care model. Along with effecting changes in the financial organization of health and mental health, managed care has brought complementary changes in the kinds of treatments available and, perhaps most significantly, in the prevailing models of emotional illnesses on which professionals rely. Furthermore, in pursuit of reductions in mental health care costs, managed-care monitors have turned to less qualified (at times to unqualified or underqualified, and undersupervised) practitioners. Not only has quality of care suffered as a result, but the very concept of expertise itself (experience, qualification) has been undermined.

I was asked to give the keynote address for the April 1997 meeting of the Independent Schools Health Association-a national organization of independent schools, their health care givers, faculty, and administrators-on the subject, "Psychotherapy in the Boarding-School Setting: Protecting the Interests of the Child and of the School." My response to this charge, which forms the basis of this chapter, was to question its premise. It seemed to me then, and it has continued to seem to me now, that the psychotherapeutic enterprise was under siege throughout our health care system. The boarding-school setting is no exception. It is perhaps an irony that the conditions for good, solid psychotherapeutic activity need protection every bit as much as the interests of child and school. Indeed, it is likely that the latter are vulnerable as long as the former lack protection.

For the past 23 years, I have worked with troubled students, consulted with troubled heads of schools about some very thorny issues, treated my share of faculty members and administrators, helped families not to interfere with the school's mission for their children, and participated in admissions processes, readmissions processes, and disciplinary and dismissal proceedings. I have-with great satisfaction-attended my share of graduation exercises during which students and families with whom I had become close celebrated their having made it to the end. We have prevailed against what sometimes seemed insurmountable odds. Such deep satisfactions are among the common rewards for those of us who have chosen to work as educators and helpers with children and adolescents.

Yet, great as such satisfactions can be, it troubles me to have to add that there are new tensions abroad in the greater society that threaten our capacity to carry on this work with spontaneity and creativity. There are enormous hidden costs of complying with the letter of the law, of living in a more litigious environment, and of avoiding trouble. If one risks trouble by being affectionate with a student, if it is difficult to define the line over which one may not safely step, then one answer is to withdraw from spontaneity, creativity, and passionate involvement in the job at hand. This withdrawal, safe though it may seem, represents a sterilization of our work: Very few teachers and other school personnel have pursued their careers as a way to avoid intense engagement with others. Most love this work precisely because of its engagement with others. How many of us would really bring our lawyer along on a date in order to avoid being charged with sexual harassment? And yet, isn't that what we are threatened with having to do in an atmosphere in which so much of our behavior seems potentially actionable?

We face a dilemma, and we need appropriate language to describe it. With constraints, intrusions, directives, and warnings impinging on our small world from the greater society, how can professionals respond without abandoning their missions or without losing track of the reasons why they have chosen this kind of work in the first place? How can educators comply with the legitimate claims of the outside world without becoming frightened into rigidity, emotional withdrawal, paralysis, indecision, apathy, or cynicism?

What Is "Protection, "; and Who Needs It?

The dictionary tells us that the verb to protect derives from a Latin word that means "to cover in front" or "to defend" (also "to cover over or from above" in the sense of providing a sheltering roof). We know from experience that psychotherapy requires protection for its effective conduct: protected space, protected time, protected communications, and protection for both participants from the immediate intrusions of the outside world and from each other. My experience has caused me deep concerns that psychotherapy in boarding schools has become increasingly difficult if not impossible and that-extreme as it may sound-if current trends continue, it is in danger of extinction.