How to Put Your Kids in Residential Treatment… Sort of…

 How to Put Your Kids in Residential Treatment… Sort of…

How could sending your kids away actually help them? Interesting question.

In the short-term, kids tend to experience significant changes while at Residential Treatment Centers (RTCs). They can move from total mental and emotional dysfunction to thriving in 8-12 months in such an environment.

Unfortunately, the long-term prognosis isn’t so great. Children often revert back to old symptoms after they return to old environments. They are likely to retain some gains from residential, but not all. This shows that people’s symptoms arise in strong relation to their environment.

What is it about RTCs then?

RTCs aim to apply the basic principles of human development, and generally have better resources to do so than many families.

1. First and foremost, they seek to do no harm. The most direct way to induce anxiety, anger, and depression is to use inherently harmful actions or words. Corporal punishment is illegal in most residential settings. Shaming language, or anything that is critical, accusatory, insulting, passive aggressive, or judgmental, is detrimental to mental health even if it is accurate. The point is that a child in residential can behave in aggressive, lazy, or narcissistic ways, but never be given the message that they are bad. Though never executed perfectly, this aim of residential treatment makes it different from the experience in most homes. Employees, often in or seeking careers in mental health, without personal connection to the kids in treatment, are less easily distressed by their emotions, and thus less likely to shame children than are family members. Employees that feel personally attacked by mentally ill residents don’t last long in these settings.

2. Next, they cater the experience to a child’s emotional age (not their actual age). This means they set boundaries and rewards that allow a child to progress from where they are at, not where others expect them to be. 

For example, a 15 year old may enter an RTC in a depressed state where he will not talk, make eye contact, or perform any tasks besides eating and sleeping; the emotional equivalent of an infant. There is no pressure to change, just a total lack of rewards. He has unconditional access to food, shelter, and attention, which are basic needs and prerequisites for emotional health for all people. When he isn’t shamed or criticized for not talking, not cleaning up after himself, or not doing school, his brain will develop a greater sense of safety. He might start uttering short sentences and making small requests (becoming a toddler). His privileges increase as his brain capacity allows him to perform increasingly complex tasks (going to class, completing easy assignments). He is eventually allowed the freedom of a 6 year old (e.g., being in the game room without supervision). If he breaks a rule, he is not shamed, criticized, or lectured, but restricted to the freedoms that his emotional capacity allows for healthy development (back to being supervised for a short time). This is upsetting for him, but not damaging. As long as he is given the persistent message that losing privileges is not the same as being bad or unlovable, and that his emotions are allowed to happen, he will feel safe enough to bounce back and keep growing.

*There are many ways to unwittingly make someone feel unlovable. See “Therapeutic Interaction Model”.

There is no rushing this process. This 15 year old may take 3 months before he talks to his assigned staff members, and 6 months before he attends class. At no point is he pushed or told that he has to do anything–the rewards and boundaries must speak for themselves. Compelling someone to change before they feel ready sends the message that however they currently are is not good enough for you. This message evokes anxiety, and makes someone less likely to make long-term change.

When kids (and all other animals) are allowed to grow up at their own pace, they are at less risk of getting stunted.

3. RTCs have the resources to foster growth. This is the tricky part. Parents can learn about these principles and their perfect applications, but it's still much easier said than done. Life happens. We aren’t always able to give our children attention when they ask for it, like they could get in residential. We can’t give them intensive therapy sessions 3 times a week. We can’t enforce our boundaries 24/7 like a team of fresh, constantly rotating residential staff. We can’t always withhold our anger and defensiveness; we likely will hurt our kids more than an untriggered, trained professional would. Some RTCs have a 1:1 staff to client ratio. You might be a single parent (or functionally single) with 6 kids, all of whom are having a hard time, and your mental health isn’t so hot either.

So what does this all mean? That we all should ship our kids off to treatment? No. Residential may be better for some kids than many home environments, but a well-resourced parent is always better than a well-resourced boarding school. And RTCs may do a poor job implementing these principles anyway.

So how do we get well-resourced? We have to start where we’re at. Maybe your kids are raised by television 8 hours a day, and getting yelled at by you the rest of the day. That’s ok. Things are like this for various reasons, none of which is that you are a bad person or bad parent. When you take stock of how things are and why they are, you’ll find some compassion for yourself and your situation. With a little self-love, you might find you have the capacity to yell a little less, and give a few more minutes of your attention. With a little more room to think, you may be able to better identify the things on your plate that can be shuffled around, and the unprocessed traumas unnecessarily weighing you down.

Knowing the principles of residential treatment can help us know what to work for, NOT where we should already be. Kids and parents both need to know that they don’t need to change to be “good enough.” You are doing the best with what you have. That’s all anyone can ask. When shame isn’t driving the need to change, change comes naturally, and feels good when it does.