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Opinion & Essays - November, 2001 Issue #87 

“My Child is Going into Residential Treatment:
What Should I Expect?”

A Clinician’s Perspective

By Jonathan Mack, EdM, MA, CDMHP,
Wenatchee, Washington

[Jonathan Mack, EdM, MA, CDMHP, former Assistant Clinical Director of Rancho Valmora, a residential treatment facility for adolescents in northern New Mexico, presently works as a County Designated Mental Health Professional in Wenatchee, Washington.]

To parents and families who have been living with a difficult adolescent, the decision to admit the child into a residential treatment facility can bring a sense of relief. The family has become weary of the familiar patterns of conflict, aggression, power struggles and manipulation within the home. However, there also exist patterns of conflict, aggression, power struggles and manipulation that occur after a child has been sent to an in-patient treatment facility.

Having a child in treatment can be a painful and difficult time for the entire family. Knowing what to expect can help increase tolerance for this discomfort. Of course, every family’s experience is unique, yet there are four common patterns which, from a clinician’s perspective, are mostly likely to emerge as the child works through the treatment process:

1) Before they feel better, the child is very likely to feel worse. As strange as it may seem, your child’s problem behaviors most likely developed, in part, as coping skills. Even destructive behaviors such as aggression, manipulation, substance abuse and self-mutilation served to help the child deal with thoughts and feelings they perceived as unbearable. When a child is no longer able to use these coping mechanisms, the unwanted thoughts and feelings are likely to come rushing in. Understandably, this can feel overwhelming and unmanageable. This experience involves facing the unspoken and unresolved problems head-on. It is necessary to allow the child to begin addressing underlying issues and to work toward developing healthier coping mechanisms. Unfortunately, this painful, difficult and frightening work often triggers an attempt to return to old, self-destructive coping mechanisms. It is the job of the treatment center to keep your child safe while they go through this difficult period. Responsible programs support the child in developing healthier coping skills to replace the old behaviors. However, this takes time.

2) Family functioning is likely to get worse before it gets better, even among family members back home. As you know, raising a difficult child has an enormous impact on the entire family. Slowly, subtly, the family interactions adjust to this stressor. Changing these patterns is uncomfortable and involves all members of the family. The old Scottish expression “the devil you know is better than the devil you don’t” comes to mind. Although the situation at home has probably been conflictual and unpleasant for some time, there is likely to be a certain amount of resistance in the family to change, even positive change. Confronting familiar patterns often increases the anxiety and discomfort for family members. Other problems may emerge, such as conflicts between parents that have been set aside due to their focus on the difficult child. Addressing these problems as they arise is an important step towards changing the patterns that keep things “stuck.” As uncomfortable as exploring these subjects may be, working through them is an important step towards a happier, healthier family environment.

3) At some point, the child is likely to begin hating the facility more than they hate you. This is generally a good sign. It usually means that the facility is “pushing their buttons” and is challenging them. This is often an indicator that the child is beginning to engage treatment in a genuine manner. Prior to treatment, the child most likely expressed anger toward family members inappropriately. Once the child begins to “thaw out” in treatment and to get in touch with more feelings, there will probably be a struggle to avoid these feelings (as occurs in us all). Since “dumping” these feelings on those close to him or her has worked in the past, it is likely to be attempted again. When this happens, the child is likely to try avoiding these problems by pulling for the parents to become the “rescuer”.

4) Your child is likely to pull for you to “rescue” them. When the child begins to transfer his or her anger from the parent onto the facility, the parents often feel so relieved at not being the “bad guy” for the time being, that they are vulnerable to being manipulated by the youth. Further, the youth likely understands this if the parents feel guilty about putting the child into treatment. Unwary parents can be manipulated into undercutting the treatment process, or even into pulling their child out of treatment prematurely. In many treatment modalities, the child is likely to become extremely uncomfortable before change occurs.

Some models, such as the Positive Peer Culture model, depend upon this experience of increased anxiety to begin to stimulate the process of value change. Remember the maxim that “discomfort precedes change.” You may get calls from the child begging to be removed from the program once the child begins to become aware of the extent of their problem behaviors, or of the impact of these behaviors upon others. Parents who are prepared for this type of telephone call have an advantage over those who are unaware. The child will likely say things such as “this place isn’t helping,” or “I’m better now, I’ve learned what I need to know and am ready to come home.” This is also a point when families tend to be vulnerable to the “romanticization” trap. The idea that things “weren’t really so bad” can creep in. The child is also likely to play their “trump card”: the statements or behavior that they think are the most likely to hook their parents in.

The remedy for this increased manipulation is increased communication: both communication between family members still at home, and communication between parents and staff. Find out who your contact person at the treatment center is, and don’t be afraid to make a pest out of yourself. While it is obviously vital that you monitor your child’s treatment and safety, removing them from treatment prematurely is frequently counter therapeutic. At the very least, it reinforces the lesson that manipulation pays. It is also likely to cement resistance to addressing problem behaviors, and pulls you into the role of “enabler.”

Parents who keep these patterns in mind are likely to have a decided advantage over those who do not. Besides serving as a support for the parents as their child goes through treatment, awareness of these patterns is likely to also keep the child more focused on his or her treatment. This both increases the chance of successful treatment outcomes, as well as helps the family to move ahead as a stronger, more loving unit. The process is difficult, but positive outcomes can, and do, occur. Good luck!

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