Allians under tvång : Behandlingssamarbete mellan elever och personal på särskilda ungdomshem

Sammanfattning: This is a study of treatment alliance between staff and juvenile delinquent boys in institutional treatment under the Swedish Board of Institutions (SiS).The aim of this study is twofold. First, the purpose is to explore alliance phenomena in correctional institutions for young delinquents in their qualitative, rather than quantitative, aspects. Second, the study aims to explore possible preconditions - obstacles and possibilities - for the development of a genuine treatment alliance between staff and youth. In a case-within-cases design, eight boys in two institutions were followed throughout their treatments. Through participant observations, interviews, and on the basis of their case files I collected data from both the youths and the staff at different points of time during the treatment. Information from the three data sources was used for the purpose of triangulation and mutual validation.The main findings indicate the existence of two kinds of alliance processes, one a genuine alliance and the other a sham alliance one. The genuine alliance appears to be a rare occurrence at these institutions. On the contrary, close examination reveals that a high level of institutional adjustment on the part of a boy in custody often reflects mere sham alliance. The sham alliance builds upon a strong tacit mutual agreement between the boy and the staff to establish a non-change relation. The stronger the staff-youth agreement about this kind of relation, the stronger the sham alliance. Sham alliance serves the common avoidance of conflicting emotions (at unconscious and conscious levels) and contributes to momentary symptomatic relief. Equally important, sham alliance generates an atmosphere of calm and peace on the ward. Among several factors, one of the most significant obstacles to the development of genuine alliance is the fact that the boy is admitted to the institution not on his own will but typically strongly against it. Factors that promote the development of a genuine alliance within a correctional institution are discussed finally.