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Opinion & Essays - Jun, 1999 Issue #58

By: Lon Woodbury

The ongoing debate of Emotional Growth vs. Therapeutic (see Woodbury Reports Issue # 56) may rapidly become an out of date issue. A dynamic panel gave clarity to this on May 13, 1999 at the IECA Conference in Columbus, Ohio. Entitled “Models of Therapeutic Programs,” the panel was moderated by IECA member Douglas Bodin in Los Altos, California, 650-948-8651, with panel members Sue Crowell of the SUWS Adolescent and Youth Programs in Idaho, 888-879-7897, Jared Balmer of Island View, Utah, 801-773- 0200, and consultant Saul Rudman of California, 800-823-2338, participating.

Balmer presented a model that sees all youth intervention programs as having in common five elements (he referred to them as the five food groups of adolescent residential intervention). The difference between a Residential Treatment Center, for example, and an Emotional Growth School depends on the different emphases each places on the use of Psychiatry, Therapy, Structure (he used the term Milieu), Education, and Recreation. For example, a Residential Treatment Center will emphasize Psychiatry, Therapy and Therapeutic Structure in its program, with only minor elements of Recreation and Education. On the other hand, an Emotional Growth School is basically a mirror image of a RTC, in that the emphasis is on Structure, Education, and Recreation/activity, with only a minor role being played by Therapy and Psychiatry.

Saul Rudman presented a grid that expands the Structure Spectrum (Woodbury Reports Issue #35 & page 7 in the Woodbury Reports Directory – Places For Struggling Teens), which gives a graphic way of comparing details between Home-Style, Therapeutic Boarding Schools and RTC methods of adolescent residential intervention.

Crowell, in her presentation of the various models of wilderness programs as intervention for at-risk adolescents, made a distinction of therapeutic sophistication between various successful wilderness programs for this population. She distinguished between “Licensed clinical staff—doing ‘therapy in the wilderness,’” and “Bachelor’s-level counselors—guiding ‘wilderness as therapy’” making the point “Many students do very well in a wilderness program without much clinical sophistication….” What struck me in this panel discussion was how far the profession of working with teens with problems has come in the last 30 years. In 1969, the clinical or therapeutic approach (Adj.-1. Of or pertaining to the treating or curing of disease- Webster’s Unabridged Dictionary, 1996) prevailed. At that time, professionals and the legal system commonly agreed that the only serious solution to emotional/mental problems was therapy by scientifically trained clinicians. Therapists considered themselves scientists, and thus should be emotionally removed from their patients. Professional protocol required the clinician to maintain distance from the patient, who was considered to have a disease that was susceptible to cure through rational analysis and therapy, just like a physical disease could often be cured through proper diagnosis and therapy that often included medication. Relationships, maturity, attitude, spirituality, adult role models and anything else that was difficult to quantify, and are the basic stuff of “Emotional Growth” concepts, all were considered insignificant factors, if even recognized at all by this narrowly conceived scientific method.

Many at that time felt that by applying scientific techniques from the medical community to mental health problems, they were on the verge of creating a miracle, that is, a society with a definitive solution to age-old behavior and emotional problems. This dream, plus amazing profits, was the driving force behind a major building boom in the seventies by hospitals and other facilities to treat all kinds of mental health conditions for young people through such institutions as youth psychiatric hospitals and wards, drug treatment programs and Residential Treatment Centers. Yet, 30 years later, reeling from accusations of “warehousing,” “outrageous costs,” and frequent “lack-luster outcomes,” the mental health industry is seeing major changes. What happened?

Even in 1969, there was a considerable backlash to the direction the mental health establishment was going. Calling the prevalent mental health approach “insensitive to our humanness,” and “an out-of-balance extreme use of the scientific method,” a large number of alternatives were developed in the sixties and seventies challenging the prevailing “scientific mental health” philosophy. Created mostly by lay people, movements such as AA, Synonon, Christian counseling, est and many more strove to prove that the factors of relationships, spirituality, adult role models and emotional maturity, the things discounted by mental health clinicians of the time, were really the most important keys to healing.

One of these alternative approaches was the CEDU School. It was founded in 1967 outside San Bernadino, California, and today enrolls about 500 students in six schools in southern California and Northern Idaho. CEDU has been a leading advocate and one of the most successful examples of what they called the “Emotional Growth Curriculum” approach to young people with behavioral/emotional problems. In response to an early hostile environment from public authorities and mental health professionals, CEDU had adopted an anti-therapeutic philosophy. This orientation caused them to go so far as to closely question job-applicants holding mental health credentials, suspecting them of having the perceived arrogance of the profession that might infect the school with clinical mental health attitudes.

CEDU School had been very successful in their “Emotional Growth Curriculum” approach, continually growing with an expanding reputation. The popularity was such that while I was Admissions Director at the first North Idaho CEDU School, Rocky Mountain Academy (1984-1989), a major problem I had to deal with was to ensure the school’s enrollment did not grow faster than the staff could handle. Many parents obviously were not turned off by the anti-therapeutic philosophy.

What indicates CEDU was on to something with their Emotional Growth approach, was that throughout their history, a significant portion of their students had been previously treated in hospitals and residential clinical treatment programs, frequently with minimal results, and sometimes with students worse off for their expensive clinical experience.

Yet, many of these same students responded very well to what was considered the essentials of “Emotional Growth”: tight structure, adult role models as mentors, earned increases in responsibility etc.; things that looked nothing like scientific therapy. If nothing else, the success of CEDU and other schools and programs based on “Emotional Growth” as a healing tool has proven that many children with behavioral/emotional problems who were making poor decisions were doing so because they just hadn’t “grown up.” For those students, a structure to help them “grow up” was the main requirement – and the whole apparatus of diagnoses, licensed clinicians, treatment, treatment centers, etc. was not needed and was an unnecessary and sometimes harmful expense.

On the other hand, some children do need much more than Emotional Growth. Fortunately, there is an increasingly wide variety of effective treatment centers that combine the best in intensive therapy with what might be called “a human face,” that is, firm and caring staff offering intensive therapy within a structured emotional growth environment designed to help the student learn how to make better decisions and control or compensate for his/her disorder.

The advocates of “Emotional Growth Schools and Programs” perhaps should declare a victory. Mental Health Practitioners are broadly accepting the concept of providing the child with an environment for emotional growth blended with intensive therapy. In fact, the 1969 concept that kids with problem behaviors can only be helped by licensed and scientifically trained clinicians is being generally questioned and greatly modified. The panel at the IECA conference, for example, accepted the basic assumption that children with behavioral/emotional problems have a wide variety of legitimate options available. These range from schools and programs based solely on the assumptions and techniques CEDU and Emotional Growth schools and programs had pioneered, to those programs based primarily on intense therapy, to schools and programs with various combinations of both. The choice in any instance depends on the individual child’s needs, which is far superior to the prevailing view of 30 years ago that every behavioral/emotional problem needed clinical treatment.

The victory is not that “Emotional Growth” is better than “clinical,” but that it finally is widely accepted in its own right as a necessary and vital element in youth residential intervention, and is being blended into a wider variety of successful programs. The acceptance of emotional growth strategies is perhaps one of the major changes that has occurred in the mental health profession, especially regarding residential facilities. For example, one Director of a very successful licensed therapeutic wilderness program was quoted as saying that his program basically was only 20 percent therapy. The rest was composed of wilderness experience and challenges, peer pressure, relationship skills, and all the other Emotional Growth elements which though not inherently clinical, can be very effectively utilized by either clinicians or non-clinicians. In other words, though legitimately a therapeutic program, his is a blended program that is also an effective Emotional Growth program. In CEDU’s situation, it was accepted by the school in 1990 that some students failed because the school did not have the clinical expertise on their staff to work with those students that needed more than Emotional Growth. As a result, CEDU gradually started hiring some licensed clinicians and therapists to reach those students who were not being reached by strict emotional growth techniques, and blended the two approaches.

This doesn’t mean either approach, “emotional growth” or “clinical” is any more or less “healing” than the other. In mental health residential facilities, the value of the point made by CEDU in the seventies and eighties is that success usually requires a blending. Intense therapeutic institutions are vital for some children, and pure emotional growth programs are still available in the small home-style programs that are cropping up so fast it is very difficult to keep count. Also, for a younger generation that seems to have growing percentages feeling “alienated,” “frustrated,” “angry,” or “out of control,” the “Emotional Growth” concepts have many important and useful implications outside of residential intervention. Thus, maybe it’s time for Emotional Growth advocates to declare victory.

Copyright © 1999, Woodbury Reports, Inc. (This article may be reproduced without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)

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