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Evans, F.M. (1967). Adolescents out of Step. Their Treatment in a Psychiatric Hospital: By Peter G. S. Beckett, M.D. Detroit: Wayne State University Press, 1965. 190 pp.. Psychoanal Q., 36:451-452.

(1967). Psychoanalytic Quarterly, 36:451-452

Adolescents out of Step. Their Treatment in a Psychiatric Hospital: By Peter G. S. Beckett, M.D. Detroit: Wayne State University Press, 1965. 190 pp.

Review by:
Frederic M. Evans

In this practical manual for the management and administration of an adolescent unit in a psychiatric hospital Beckett directs most of his attention to the special requirements necessary for the treatment of delinquents. Less attention is given to neurotics and to psychotic patients without flagrant conduct disorders because they are minorities in his unit and because they can be treated by minor modifications of familiar outpatient techniques.

Beckett's major thesis is that the patient's faulty internal controls must be supplemented by external controls from the environment. The means to this end are meticulously detailed. The adolescent is presented with a clear-cut regimen of reward and punishment based on his behavior. Acceptable behavior, defined as adherence to the rules, is rewarded by increased freedom, privileges in the form of minor indulgences, prestige, and greater responsibilities. Breaking the rules diminishes these rewards. The child knows precisely where he stands on a ladder from restrictive seclusion to preparation for discharge. He comes to know that there will be consistent and immediate responses to his actions, and so can determine his own progress or retrogression. The emphasis on fair play, the completely open nature of the regulations, and the repeated demonstrations of the consequences of behavior undercut the adolescent's defiance and rebellion.

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