April 17, 2014

Maximizing the Outcome of Residential Treatment

By Stephen G. Biddulph, M.A.

Enrolling a child in a residential treatment program often evokes strong emotions in parents that range from relief and hope to guilt and sorrow. While these are normal feelings for parents, how you act upon these emotions can significantly influence how much benefit you and your child get from treatment. It works much to the benefit of the child, the parents, and the care-givers when parents learn and practice the following methods to maximize true growth in treatment.

Accept the Need for Care

You will get out of residential treatment what you put into it. Your child may be resistive to treatment, but you, as a parent, need to be focused, resolute, and positive. If you will get on-board and support the program and the professional staff working with your child, your teen will adjust more quickly and positive growth will occur more readily. This may take swallowing pride and breaking denial on your part, but it is healthy and necessary.

Take Responsibility Instead of Finding Fault

Effective care does not place blame; it requires responsibility. Blaming condemns self and others for mistakes. Responsibility holds one accountable for solving problems. Blaming ourselves and others is a wasteful practice. Truth is, there is plenty of blame to go around. While understanding the cause of problems is helpful in finding solutions and preventing future reoccurrences, blaming prevents progress and wastes time and money. Successful parents do not blame themselves, their child, or circumstance, neither do they try to project blame onto care staff. Rather, they take responsibility to solve problems.

Support Instead of Rescue

Successful parents support their children, but hold them accountable to resolve their own problems, instead of rescuing them. Especially if your child suffers from a physical, emotional, or psychological disability, you may be tempted to protect him/her by making excuses for them, trying to modify the program to meet what you think are their needs, or treating them as if they are incompetent to help themselves. Parents who fall into this trap, buy into every complaint and excuse made by the child. They spend their time interfering with and trying to control the treatment staff, manipulating, and refereeing every situation that comes up. This modeling behavior empowers your child to resist working his program and taking responsibility for progress. It keeps him/her weak.

Learn Your Role as a Team Player

Successful parents learn early in treatment to play their role in treatment and become a team player from the beginning. Your role is not to control. Your role is to step back into a support role to your child. Your role is to provide the direct care staff with information and insight to your child. Your role is to provide positive support and unconditional love to your child. You become a cheerleader and a fan, so to speak, instead of a bedraggled player or would-be coach that has been drug up and down the field of life by your child. You work with the staff to identify and resolve problems, rather than create more by trying to direct and control. Take responsibility to work on your own issues and prepare yourself and your family for your child’s return. The sooner you learn to play your role, the more powerful your influence will be.

Build Positive Relationships

Four important relationships determine the success of treatment. Successful parents recognize and foster these relationships. They are: (1) your child’s relationship with himself and his/her recovery, (2) your teen’s relationship with you, (3) your relationship with treatment staff, and (4) your teen’s relationship with treatment staff.

Teen’s Relationship With Self: A misbehaving or troubled teen is often a discouraged and angry teen. Self-esteem and self-confidence are usually low. They are often confused, hopeless, and misdirected. During treatment, the acquisition of self-esteem, self-confidence, and a desire to improve must be done independent of parents and family, although the continuing support provided by loved ones is essential. All the relationships in treatment should promote a teen’s self-esteem and self-mastery. Successful parents recognize this and help their child create their own psychological autonomy (the ability to think and act responsibly for themselves).

Parent – Child Relationship: (Red arrow) At the time of admission, your relationship with your child may have been pretty stressed. You have placed them in treatment partially to try and recover the relationship that you once had. Successful parents recognize that they cannot force or rush the redevelopment of a relationship with their teen. Rather, they recognize that a healthy relationship with their teen is an outcome of the development of other relationships. Successful parents show unconditional love, but require the child to earn their respect and trust. They play a support role, not a control role. Successful parents also recognize that for a healthy relationship to develop between them and their child, they must work on their own issues, even as their child works on his/her problems. If you find yourself trying to control treatment, not following the professional guidance of treatment staff, and disregarding treatment protocols, then, you are too enmeshed with your child, and you are actually harming treatment.

Parent – Staff Relationships: (Blue arrow) Successful parents recognize that the relationship they establish with the treatment staff will ultimately affect the quality of relationship they have with their child. Form a strong, supportive bond at the beginning of treatment with your child’s professional care-giving team. The parent-staff relationship is especially vulnerable in the early phases of care when trust and confidence is just beginning to grow. This is because the child will attempt to sabotage and undermine their parent’s trust in the staff so that they can manipulate their way out of responsibility and growth. If a child can create distrust in the minds of parents for treatment staff, they can successfully jam the treatment process and escape accountability.

Teen – Staff Relationship: (Green arrow) The rapport that develops between your child and staff is critical to growth. If a relationship of trust and mutual respect does not form, it is highly unlikely that positive growth will occur. For this reason, successful parents do not resent positive relationships that form between their child and staff, and they do everything possible to promote and encourage this relationship. Parents that rescue their children by interfering with this relationship diminish the potential for their child’s true growth. Wise parents do not necessarily buy into their teen’s complaints, but encourage them to work it out with their team staff. Develop from the beginning a trusting relationship with your staff. Make the staff earn your trust, but also listen to them and help them when at all possible.

Opposition in All Things

In the diagram above, you will note that the dotted arrows extending from each team player (parent, child, staff) point to the relationship, or side of the triangle, opposite from its position. This depicts the potential for positive or negative forces working on that relationship. Specifically, the teen may exert force to disrupt or promote relationships between parent and staff. The parent may either harm or help the relationship between their child and the staff. The staff may either harm or help the relationship between parent and child. As a parent, you should encourage a therapeutic relationship between your child and the staff; you should actively build a united relationship between yourself and the staff; and you should allow staff to assist you in building a positive relationship between you and your child.

Stay the Course

Positive growth is a process, not an event. Successful parents realize this and stay the course until sufficient growth has been realized. Resistive teens typically go through a limit-testing stage and a manipulation stage before they get serious about working their program. The testing stage is frequently characterized with angry outbursts, holding their love and future relationships with their parents hostage if their demands are not met. The manipulation stage includes heart-wrenching pleading, plea-bargaining, promises that often they cannot or do not intend to keep, and frighten parents with fantastic accusations of staff brutality, abuse, and neglect. They know their parent’s buttons and will readily push them if they feel it will be to their advantage. They do this because they do not want to be held accountable or face their issues. Successful parents do not pull their child out of treatment too early or at the first sign of progress. They realize that outer behavior is the beginning of change, not the end. They allow the changes to be internalized through sustained practice. They wait to see that their teen can sustain self-management of problems before they agree to end treatment.

Empower True Change

True change comes not by force or coercion, but by your teen acquiring and applying five important powers in their life. These powers are briefly explained below.

Empower Responsibility: One of the first signs parents should look for in their child’s growth is an awareness and honest admission of responsibility. You should promote openness and trust in your child so that they can feel empowered to take responsibility for their program. Remember that blaming, fault-finding, and rescuing diminish your child’s ability to be honest and take responsibility for accepting help from others. You can empower your child by modeling honesty and kindness and understanding. Every day in denial is a wasted day.

Empower Resolution: Successful parents empower courage to make commitments and resolutions. Most children fail to make resolutions because they lack hope, vision, and trust in themselves and others. Successful parents see problems or mismanagement of behavior as opportunities for growth, not reasons to despair or condemn. They model their own willingness to recognize and admit their weaknesses and mistakes, and they expect their child to do the same. Express love and hope and confidence in your child during treatment. Act in ways that give your child hope and self-confidence.

Empower Action: True change takes courage and persistence. You should genuinely praise your child for the little improvements that they make. Watch for changes in negative attitudes, beliefs, and thinking; for greater control of impulsivity and self-defeating behaviors; for more positive relationships with peers, staff, and your family. You will know that real change is occurring when your child is able to consistently manage their own problems in the treatment environment, and you will know that they are getting close to discharge when they can sustain self-mastery. Do not expect perfection or adult behavior. Remember that your teen is an adolescent, and even the best do not always act rationally.

Empower Healing: Your child needs to heal from the pain and guilt of the past. So do you. Healing comes through talking through issues, listening in a non-judgmental way, and expressing forgiveness and love. Your child and you need to ask for forgiveness of those you have offended and need to forgive each other for offenses committed. Your child will not heal fully if they do not go through the stages of healing, and if they do not make realistic amends for what they have done. Simply saying, “I’m sorry” often is not enough, nor will sweeping past pain under the emotional rug resolve the issues.

Empowering Endurance: Successful parents work closely with their staff and child in preparing a transition plan back home. They commit themselves, along with their child, to recovery, and they make a joint plan of action to sustain new skills and growth. They help their child to have a realistic and meaningful lifestyle for future living. They insist on positive boundaries and limits and the respect of parental authority. They help assemble a positive support team for their child. They also make any changes in their family behavior that would be harmful to their child’s full recovery when they return.

In the end, there is no guarantee for certain success. You and your child have freedom of choice. However, if you will follow these principles, you have a much greater chance of seeing positive, meaningful gains in your child during his or her residential stay.

Stephen Biddulph currently serves as Chief Operating Officer for Provo Canyon School. After a twenty-year career as an officer in the United States Marine Corps, Stephen served as a Licensed Professional Counselor and Licensed Substance Abuse Counselor at Provo Canyon School from 1990-1998. During this time, he also served as director of substance abuse treatment and wrote the Adolescent Recovery Plan published by Hazelden Information and Educational Services. Stephen served as Dean of Students of Southern Virginia University, and has done considerable seminars, lectures, and trainings for Hazelden throughout the United States. He is the author of The Adolescent Recovery Plan, Continuing Care: A Team Approach, and Alcohol: What’s a Parent to Believe. He has been featured on information and education programs related to drug abuse by Brigham Young University and also local radio stations. Stephen returned to Provo Canyon School in July of 2004, as the Clinical Director, and during this time, has been instrumental in developing and implementing significant procedural improvements in the School’s clinical care program. Stephen is a Vietnam Veteran and his personal awards include the Silver Star, Purple Heart, and Meritorious Service Medal. Stephen is married, the father of six children and fifteen grandchildren.

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