On 2004-02-08 19:57:00, Anonymous wrote:
"therapists recommend "programs" to keep the teens from having to be "institutionalized." Big difference. One being there are behaviors that need to change and a program is what can assist in that change. Institutions are state or government funded hospital settings where little is done to bring about healthy changes. "
Any residential program is an institution and is institutionalization. A dog still has four legs if you call the tail a leg---calling it a leg doesn't make it one. Calling an institution a program doesn't make it not an institution.
There are private and public hospitals, mental and otherwise, out there and their purpose---which is the only legitimate purpose of non-substance-addiction non-criminal residential treatment----is to stabilize the patient on medication so that the patient can work on behaviors in outpatient therapy.
My problem with the programs is not that it's not possible to do a program *right* that would be beneficial to the patients. My problem with the programs is that the ones I've seen discussed online do *not* do the thing right.
Rules like not talking to other students/patients---and I'm not talking about simply not talking in class, I'm talking about not talking at all outside of "therapy." Rules like not turning your head to look out a window or not slumping your shoulders. Staff that aren't trained to regard application of restraints as inherently dangerous to a patient's life and aren't thoroughly trained--outside the facility and its partners---in non-restraint techniques to de-escalate conflict. Caloric restrictions or failing to provide a daily multivitamin supplement to assist a bland diet---All these are examples of how to do it wrong and do more harm than good.
A *good* program would have a patient/student seen by a psychiatrist within 72 hours of admission, and once a month therafter, with phone consultations with staff and patient if medication adjustment is necessary in the interim. A *good* program would have patients meet with a licensed therapist or clinical psychologist once or twice a week, maybe tapering to once every two weeks near graduation. Therapy should be supportive rather than confrontational.
A *good* program would avoid the onset of Stockholm Syndrome by giving the patient at least three first class postage stamps, three envelopes, a pen, and six sheets of paper a week, with the ability to correspond back and forth with anyone they choose. Exceptions would be threats of violence to or from the patient or critical rants against the patient. Screening out correspondents who are convicted felons or particular persons with whom the patient was convicted of delinquent behavior would be acceptable. Where the patient's choice of correspondent is alleged to be a druggie, the correspondent showing up to a local hospital or physician and taking a drug test (and more accurate follow up to check for false positives, if needed)--once--should be considered definitive about whether the "druggie" accusation is true or false. If it's true, it's okay to prohibit *that* correspondent.
Examples of the kinds of correspondent who should *not* be tampered with, even if they are not fans of the program and not supportive of the program: extended family members, friends with whom the patient is not having sex or abusing drugs (one drug test considered definitive), a boyfriend/girlfriend aged within 5 years of the patient who is not abusing drugs or beating the patient or hypercritical of the patient regardless of whether or not the relationship was sexual, concerned adult friends (church, neighborhood, parents of peers, other--nonfelons, passing a drug test, not having sex with the child or beating the child), child protective services, reporters, attorneys, elected officials, fan mail to non-felon public figures the child admires.
Parents should be encouraged to provide more stamps, etc., if the patient is inclined to write more letters. Letter writing to a broad variety of people is educational and promotes impulse control and healthy communication. If you write what you're saying to someone instead of speaking it, you inherently have to think twice about what you say. Therapists can help by encouraging a 12 to 24 hour cooling off between writing a letter and sending it. They can also help by encouraging the kids to type their letters on the computer and spellcheck and revise them before printing and sending.
Most troubled teens have problems with impulse control. Fostering regular and broad letter writing by using the child's natural desire for communication with friends and the outside world is an excellent therapeutic tool because it forces the teen to practice interposing actual thought between impulse and communication. This directly supports the other efforts in therapy to train in impulse control. It's not what the kid says--even if he trashes the progam up one side and down the other---that has the therapeutic effect. It's the natural imposition of a time delay between impulse and act.
It's entirely possible to do boarding school right, and provide on-site treatment to children with problems.
The problem with the programs is that they aren't doing it right---they're substituting Stockholm Syndrome and temporarily overlaying the patient's own personality with an artificial "program" personality for genuine quality treatment.
