What is planned environment therapy?

A short answer might be that it's a way of living and working together, where the environment is carefully planned to benefit those within it. But of course, it's a little more complex than that.  While therapeutic communities are the most obvious example of planned environment therapy in action, the term is an 'umbrella' which can denote different ways of working that incorporate a culture of openness, participation, reliability and communication within clear structures and boundaries.

Planned Environment Therapy and therefore, the Trust, has at its heart the needs of people with disturbed and unhappy lives, among whom are some of the most vulnerable and problematic members of our society. These include adults and young people with personality disorders or drug and alcohol addictions, as well as children showing signs of severe emotional disturbance.

Such conditions are very often rooted in damaging childhood experiences of deprivation, neglect or abuse. They can also result from traumatic events or circumstances that disrupt and disturb whole families.  Self-harm, suicide and violent or disruptive behaviour are common symptoms. Many of these individuals will end up in prison, in psychiatric hospitals or in the confusion of unhappy relationships, often with consequent harm to the next generation.

It has long been known that there are very effective ways of helping people overcome early emotional damage and deprivation - but these approaches are not widely recognised or put into practice.

The Trust was founded in 1966 to promote therapeutic, planned environments for children, young people and adults showing signs of severe emotional and psychological disorder.  Working this way with very disturbed individuals is difficult, exhausting and demanding work, requiring high levels of skill and psychological understanding. There is a huge need for support and training, research and education about effective therapeutic approaches. That, in a nutshell, is the reason for the Trust's existence.

The term 'planned environment therapy' was coined by PETT founder Marjorie Franklin some time before the Second World War to denote this way of living and working particularly with disturbed, delinquent, and traumatized people: an approach which was first deeply tested and developed in the work of the Q Camps Committee between 1935 and 1945.

A working definition

Adrian Ward (Ward 2003:11-12) gives a working definition of a therapeutic community for children and young people:

‘It refers to a specialised unit for children, usually residential and often incorporating education as well as care, and usually organised on the basis of offering therapeutic help and support over a period of perhaps two or three years. At the heart of this work will be a recognition of the need to understand and address the impact on children of traumatic early experience (for example, of serious loss, neglect, abuse or extreme attachment difficulties).

Such experiences are likely to have had severe consequences for the child’s capacity to be looked after, to make friends or to be part of a group, to learn and be taught, or just to respond appropriately to everyday interactions. The view which will be taken of these difficulties is that they are unlikely to improve without intensive and skilled psychotherapeutically informed help on a 24-hour-a-day basis.

The underlying theory base will be explicitly psychodynamic, though other perspectives [particularly systemic and attachment theories] may also be included, and this theory base will be used to understand staff dynamics and the management of relationships in the whole place, as well as to explicate the difficulties facing the children and their families. The staff will normally be well trained and supported themselves, with regular opportunities for both supervision and consultation, and with a full programme of daily and weekly staff meetings.

The place will be arranged so as to offer intensive levels of support to young people both individually and in groups, and in scheduled sessions as well as in the course of the everyday interactions of daily life. The life of the place will be focused on regular weekly (and in many places daily) “community meetings” in which young people and staff will discuss and resolve issues arising in daily life as well as other matters of concern.’

As with therapeutic communities for adults, those for children involve an element of democracy, based on the principle ‘that all members of the community can and do contribute to each other’s growth and development’. Behaviour is seen as a communication, something to be understood, but also requiring children (and adults) to face the reality and consequences of their actions. However, children also ‘have immediate needs for the ordinary nurturing and loving care which any young person needs.

The community has to find a way to provide this “intensive care”, even though these very troubled youngsters may find it very difficult to acknowledge that they have such needs at all, and may indeed reject the offer of it with great rage, confusion and even violence. .... The aim ... will be to develop a culture in which it will be possible for young people to understand, support and help each other, - and thereby also help themselves, and mature towards responsible adulthood. .. Learning by ‘doing and being’, and by reflecting, is part of the business for everyone involved.’

Child psychiatrist Kajetan Kasinski (in Ward 2003) described 'planned environment therapy' as 'probably the first unified model for the therapeutic community work with young people'. Writing in 1971, Maurice Bridgeland said that it was, 'the most generally acknowledged theoretical base for work done with maladjusted children in this country'. More recently, in 2009, Danish Hans Kornerup describes planned environment therapy (which he also calls ‘milieu therapy’ [a specialist form of social pedagogy], ‘the most complex form of treatment that exists. At the same time, when carried out in a sufficiently deliberate manner it can also be the most effective form of psychotherapy available for dealing with some of the most intractable developmental issues and conditions.'


Wider applications

The planned environment therapy or therapeutic community approach has wider applications, not only to residential child care more generally but also to the work of foster care (where a helpful daily living experience is similarly crucial), to the work of the day in family centres and children’s centres, in schools, particularly special education, in psychiatric day units and secure institutions for young offenders, and so on.

It is generally recognised that effective work with an emotionally disturbed child requires an understanding of the child’s experiences of attachment and identity, of separation, loss and trauma, and of the way these affect the child’s inner world and its expression in behaviour. There is attention to the family system and often work with the child’s family, also taking account of social influences – such as poverty, social class, culture, race and ethnicity, and the oppressions that may go with them.

What is less well understood is the capacity of the most emotionally damaged children for attacking the very help they are offered, because they find hope of change at first unthinkable and later unbearable. Hence the exclusions from school, the foster placement breakdowns, the moves from one residential placement to another, leaving a wake of confusion, anger, conflict, division and despair which threatens to engulf those who try to help. The disturbing feelings raised by working with these children need to be both understood and managed for the therapeutic task to be achieved. It is here that ideas based in the planned environment therapy / therapeutic community approach can be helpful to workers in other settings.


The ‘holding environment’

The events of the day take place within a group of people living and working together. Much work is ‘opportunity led’, a thoughtful responding to events as they arise. There is commitment to a ‘culture of enquiry’, an expectation of openness of communication, Here one of the major misunderstandings arises - the belief that therapeutic communities are ‘permissive’ and encourage an unbridled acting out. On the contrary, children are confronted with the reality of their behaviour and helped to think about their feelings rather than act on them.

The aim of work with the child is, (in the words of Peper Harow therapeutic community director Melvyn Rose) to turn ‘thoughtless acts into actless thoughts’. The emotional containment of the ‘holding’ or ‘facilitating environment’ (Winnicott 1965) [today we speak more comfortably of ‘enabling environments’], is about providing clear and reliable boundaries (some emotional, some physical) within which there is freedom to explore and think.

It is difficult work, making great demands on the self of the worker in managing emotional boundaries likely to be under constant attack. It requires a willingness to start from a stance of’ not knowing’, using the capacity to think and to integrate thinking and feeling, rather than defend against feelings through avoidance, projection and splitting.. This is another aspect of the ‘culture of enquiry’. It is a democratic stance in which only a limited amount of authority derives from position and the greater amount from how a worker is in informal relationships within the group. So it is not only the children who need a ‘holding environment’.

So too do their workers and carers, since effective work requires the provision of a mental space in which it is possible to think about the meaning of a child’s behaviour and to respond accordingly, and in a coordinated way with other people in the child’s life. The culture of opennesss, participation, reliability and communication within clear structures and boundaries both within a team (or foster family) and more generally within the organisation (or network), through clear leadership, the use of meetings, a trust in together facing and sticking with a problem, offers a helpful model for such work.



References and further reading:

  • Bridgeland, Maurice (1971) Pioneer work with maladjusted children: A study of the development of therapeutic education, London: Staples Press.
  • Kasinski, Kajetan. The roots of the work: definitions, origins and influences in Ward (2003)
  • Kornerup, Hans (ed.) (2009) “Milieu-Therapy” with Children: Planned Environmental Therapy in Scandinavia (published by Perikon (Denmark), distributed by Karnac Books (London).
  • Ward, Adrian et al. (eds) (2003) Therapeutic Communities for Children and Young People. London: Jessica Kingsley.
  • Wills, David (1945) The Barns Experiment. London: Allen & Unwin.
  • Winnicott, D.W (1965) The Maturational Processes and the Facilitating Environment. London: Hogarth.