The treatment modality of TBS's is a failed treatment, it is snake oil, it is inferior to real treatments that actually help.
Community based care is the gold standard for behavioral therapy and treatment.
I don't use the term "behavior modification" because of its Skinnerian implications, the poor understanding of laymen as to the ramifications of various Skinnerian techniques as applied to humans, and the poor judgment of a class of substandard providers in application of those techniques.
Most mental health patients have dysfunctional behaviors and maladaptice coping strategies that need to be replaced with functional, adaptive ones in treatment. Patients need help to perceive the problems some behaviors are causing them and to learn a variety of alternative behaviors and strategies they can select from--select for themselves--to get their needs and wants met without the bad effects of the problem behaviors.
Medical model RTC's have a valid place in the industry because psychiatry still has problems matching up individual patients with biomedical mental illnesses with the medications that will stabilize them without unliveable side effects. When a specific patient's medication match-up is exceptionally challenging to find, the trial and error process can take long enough that the patient needs an RTC for safety, or wants one for convenience, speed, or comfort. It has to be pretty bad for the patient to be more comfortable in an inpatient setting---inpatient mental health care is almost always no fun at all. At least medical model RTC's don't take pains to make the medical stabilization process more unpleasant for the patient.
Substance abuse inpatient facilities, voluntarily and for limited time, or court-ordered for limited time when substance abuse endangers others, have a valid place in the industry.
Behavior modification facilities are contra-indicated for unstabilized mental illness, and are contra-indicated for basic substance abuse for various reasons.
Behavior modification facilities are contra-indicated for criminality because without due process of law, there's too much risk of incarcerating those who are innocent or simple misdemeanants, which does far more harm than good.
Behavior modification facilities, being essentially privately-run penitentiaries---in the original meaning of the term---aren't necessarily contraindicated for felony criminal offenders convicted with due process of law. It's just that private prisons typically have a worse track record for cruel and unusual treatment of inmates, and other violations of inmate rights, than government-run prisons.
Misdemeanants who get jail time are better served with short, finite sentences in jails with other misdemeanants, not felons. They are usually better served with community service and ordered community-based care than jail time.
Behavior modification facilities are simply inferior to community based care for treating dysfunctional behaviors and maladaptive coping behaviors of non-criminal teen and adult patients.
The TBS is a treatment for nobody. Where it's not contra-indicated outright by the patient's serious problems, it's clearly inferior to other treatment options.
I, personally, do not believe it is abusive to require a teen with behavior problems to attend therapy sessions. I do believe it is abusive to punish a teen or anyone else for what they do or don't do in therapy sessions as long as they aren't attacking people or property. I do believe it is abusive to violate therapist-patient confidentiality for teens except for warning of threats of harm to self or others.
This is a very moderate position on mental health including involuntary care of teens, and a very moderate position on incarceration of teens who perpetrate crimes.
Opposing TBS's as a treatment modality for teen problems is no more extreme than opposing freudian psychoanalysis, past life regression therapy, or homeopathy as treatment modalities.
TBS's are frequently harmful, and at best substandard treatment for any psychiatric, psychological, or behavioral problem in the book.
It doesn't matter how well a TBS is run. For any problem that does require taking a kid out of the home, there are better options. For any problem that does not require taking a kid out of the home, taking the kid out of the home does more harm than good--as government literature reviews of extant studies have found.
If I'm morbidly obese, and I eat a calorie reducing 50% of calories from fat, 50 calories of carbs, and the rest from protein every day, I will lose weight. It's a stupid way to do it compared to the optimal solution of balanced diet, healthy glycemic index, moderately reduced calorie, and moderate exercise.
One can be a weight loss moderate and totally, adamantly opposed to starvation diets or diets lacking essential nutrients. An educated, sensible weight loss moderate is totally opposed to those things.
An educated, sensible mental health moderate not only can be but must be totally opposed to TBS's---because, like the crash diet, they're a failed, frequently dangerous, always sub-optimal treatment.
I would not, however, be opposed to a traditional prep school, open campus---meaning in a town or city and students completely free to go into town in their free time, that made appointments for students to be independently evaluated by board-certified adolescent psychiatrists upon parental request, that provided a counseling center for voluntary non-group student treatment with full HIPAA therapeutic confidentiality plus confidentiality from parents, that provided a counseling center with mandatory non-group attendance for students who had committed what would otherwise be an expulsion offense--mandatory being that attendance is a condition for continued enrollment--but still with full HIPAA therapeutic confidentiality plus confidentiality from parents and no punishment of any kind for attendance minus "satisfactory participation," or that worked in concert with a medical model RTC (even if owned by the same entity) only for genuinely voluntary inpatient care or involuntary inpatient care in situations that would qualify an adult for involuntary commitment. Any group therapy should always be strictly voluntary with no coercive measures whatsoever, and should only take place with full, informed consent of the patient.
In other words, Hogwarts with a good, ethical counseling center and timely medical care (psychiatry is medical), and ethical counseling as an alternative to expulsion, is fine.
Note that all Hogwarts thirteen year olds, with permission slips, are allowed Hogsmeade visits. If the school makes one of its selling points how good its mental health support is, it should require that permission slip as a condition of acceptance to the school to prevent the demonstrated hazards of therapeutic abuses.
The reason mandatory attendance without a requirement for satisfactory participation is not a paper tiger is that most people, if they absolutely have to be in the room regularly with a competent, ethical therapist, simply can't help interacting with the therapist. This results in people who don't have genuine problems being inconvenienced and annoyed, and people who do have genuine problems being helped in a way that is highly unlikely to do harm.
Any therapist or psychiatrist who doesn't have, "First, do no harm," as priority one of their ethics is a dangerous quack.
Julie[/i]
