When I started writing all of this I didn't see Psy's response with the quote from the Marcus review. The thing about the TTI and therapeutic communities in general - is that the level of intervention is the community. The "treatment" effect is the imposition of community norms and community expectations.
I don't want to lump every single program in one bucket - but as I'm sure has been noted here many times, programs have more in common with religious rites of passage than traditional mental health treatment. And as everyone here should know, converts make the strongest believers.
To the extent that rites of passage fit within the context of ones culture, and ones expectation of behavior the harm will be less, and the benefit more (stealing this all from Marcus). Lon Woodbury's daughter probably was actually helped by her experience - she grew up in the industry culture. While Kat, same program, same intervention was harmed, because of how bizarre and culturally inappropriate the intervention was. Lon's daughter talks to her parents and her parent's friends about her experience and they're as familiar with the intervention strategy as the liturgy on Sunday. For Kat, if she talked to most people in her community circle about it, they would treat her like an alien.
As to the way the industry measures these things, and not the human rights advocates, there are some circumstances that should fairly predict whether or not a program will be helpful to an individual youth. If I practice heart surgery on someone who has a heart condition, that's treatment, if I practice heart surgery on someone who has a kidney infection that's malpractice. Likewise, a positive peer culture might make sense for a bored and spoiled youth who is getting into trouble with the law, it should be considered child abuse for a rape victim who is acting out because of their trauma.
Obviously there are interventions that are universally harmful. Whooter, I'd be interested to know exactly what you consider to never be an acceptable intervention.
But most of the harm that those in this community have experienced are context specific. I think we have to admit that there are some interventions that may have harmed us, that have actually helped others - and that the help and impact are real (leaving aside the question of whether they could have been helped in another way). But on the flipside, there should be some recognition by those who work in the industry, that there are interventions that they use that are likely to cause harm should they be used on the wrong person. Given the difficulty that even child protection specialists have with discerning the truth when a parent says one thing and a child says another, it's hard to believe that even in the best of circumstances that a parent will always be a reliable communicator of a child's needs and situation.
That's really the core issue here. Desperate parents are willing to try anything when they feel like their kids are spiraling out of control and programs are more than willing to sell them a solution. The viability or efficacy of the solution doesn't matter. What matters is that it makes the parents feel good and as far as i'm concerned, that's the number one goal of many of these programs -- not helping the kids. Whooter would argue that by helping the kids, the parents are pleased. I would counter that programs need not actually help the kids. All they have to do is get the kids to believe, and openly profess, that they were helped. If they explode later -- well. It's anybody's fault but the program.
The parents are the customers, there's no doubt about that. But what if there is full transparency about what the parents were getting for their money, I don't think it would make much of a difference. The parents who are willing to spend the 100,000 or so, I think they would be satisfied with the dismal long-term outcomes. Even if we could make the argument that the program doesn't help over the long-term, they might take the trade-off of their kids long-term emotional harm for what a program does provide.
Then again... I can't find this research paper anywhere except for on the conference agenda where it was presented:
But Does it Really Last? Confronting Hard Questions About Transition
Home and the Sustainability of Change. Lessons from 200 Interviews
with Families Years After Youth Residential Treatment
In our recent study of 125 families years after a youth’s residential treatment, we
observed ?ve external barriers to long-term, sustainable change: 1) A college
party atmosphere glorifying drugs and alcohol, 2) The destructive impact of some
boyfriends, 3) An un-changed home atmosphere of parent habits and overall family
patterns, 4) A relapse into severe depression or anxiety & 5) Instability associated with
changing medication effects over time. This presentation summarizes and elaborates
our subsequent efforts as an agency to better equip youth to face these challenges by
ensuring personal (and family) change goes deeper than behavioral shifts.
Presenters: Jacob Hess, Ph.D., Research Director, Utah Youth Village; Eric Bjorklund,
J.D., Executive Director, Utah Youth Village
