| |
Therapeutic School Placement: Parallel Processes of Change
in Children and Their Parents
By Molly Baron, M.A.
When I was invited to speak at a NATSAP member’s Family Weekend,
I knew instantly what I wanted to talk about – The Stages in the
Process of Psychological Change - in a therapeutic setting such
as this program / school. I chose to focus on the parallel
experiences of parents and their children during the difficult
process of placing a child in a therapeutic school. Granted that
each child and family are unique, there are, nevertheless, goals
that are common to nearly every adolescent client I encounter.
Developmental Milestones:
For all adolescents there are certain developmental milestones
that are critical to their successful transition to young
adulthood. Whether as a result of family conflict, mood
disorder, learning disability or substance abuse (or some
combination thereof), many of my clients have stepped out of the
“developmental mainstream.” As a result, their capacity to
tolerate frustration, delay gratification, resolve conflict, and
sustain reciprocal relationships is impaired. I consider the
achievement of age-appropriate, developmental maturity a primary
goal of placement in a therapeutic setting.
Self-Care & Care for Others: Two aspects of
maturation are the capacity to care for oneself and, perhaps
more importantly, for others. Self-care, including establishing
appropriate boundaries, accessing and expressing feelings in a
healthy manner, and setting and achieving meaningful personal
objectives is an important aspect and measure of adolescent
health. Similarly, the ability to care for others, in a balanced
and empathetic way, without either sacrificing one’s own
integrity or relying on manipulation in order to fulfill one’s
needs, is an essential objective of the therapeutic process for
adolescents. No small task, eh? When I talk about placement in
these terms with parents in my office, their heads nod rapidly,
a non-verbal acknowledgement that, “This is exactly what my
child needs!” There is often a simultaneous expression of
incredulity; “Is this actually possible?”
Parental Alignment: That question, or some
variation, creates the opening for what, I believe, is the most
important conversation I have with parents about placement. In
my opinion there are two critical criteria that are essential
for successful outcomes. First, the parents must be aligned with
each other. It matters little whether the parents are married,
divorced or none of the above. What matters is that they are
able to function as a team in communicating to their child that,
while they may differ on many issues, there is no disagreement
about the need for treatment and their commitment to the
process. The second, and equally important criteria, is that the
parents must be aligned with the program. Many children in
distress have learned and mastered the maladaptive art of
manipulation. If they are to learn healthier and more effective
ways of getting their needs met, their ability to use the old,
dysfunctional techniques must be blocked by the united front of
parents, therapists, team leaders, residential staff and
teachers.
So, to the matter at hand…how does this process of change occur
and what are the typical stages in this process?
Stage 1: The Leap of Faith
For the adolescent and parents alike these first steps in
treatment echo the earliest years of development, as they
require the reestablishment of trust. Trust in those
professionals involved in the treatment process, which requires
nothing short of a leap of faith; trust that, despite the
painful twists and turns their relationship has taken, there is
still an underlying bond of love between parent and child. In my
experience the first stage lasts, on average, about one to three
months. There are a number of factors that impact the amount of
time a particular stage lasts; was there an initial intervention
such as a therapeutic wilderness program, how severe is the
symptomatology, and what is the intensity of the therapeutic
intervention?
Although this discussion is primarily oriented toward the
parent-child experience of treatment, the professionals involved
need to remind themselves with each new family that while this
may be the fiftieth or hundredth or thousandth client for them,
it is the first experience of this intense process for this
family. That sensitivity needs to infuse each contact, each
recommendation, and each intervention. It is that personal
connection to each child and family that allows a sense of trust
to be generated and the resistance to change can begin to ebb.
However long the initial period lasts, there are certain common
experiences for students and parents. Most adolescents,
confronted with a novel setting, will run through their
repertoire of coping strategies – anger, manipulation,
withdrawal, etc. Their letters and phone calls often contain
threats: “if you don’t get me out of here, you’ll never see your
grandchildren;” regrets: “I’m so sorry for all the pain I’ve
caused you;” promises: “I’m ready to work on my issues;”
manipulation: “but I need to be at home so we can work through
our issues together;” confidence undermining: “I’m not like the
other kids here – they are heroin addicts and juvenile
delinquents.” The point is, children are exquisitely aware of
what pushes parental “buttons” and, as long as activating those
triggers has the desired outcome (parental uncertainty,
rescuing, guilt, etc.), the child does not have to learn the new
coping strategies. By frustrating the effectiveness of those old
strategies, a motivation is generated to learn new and healthier
means of getting their needs met.
Parents, during the initial phase, are asked to endure their
child’s pain and frustration. It is possibly the most difficult
thing for a parent to do. From infancy we have rushed to
ameliorate a child’s pain, anger, frustration. There comes a
time, however, when parents must gradually remove themselves as
the arbiter of their child’s discomfort if the child is to
develop his or her own capacity to interact directly and
effectively with the world. The first couple of months of
placement can feel like a crash course in enduring a child’s
pain and frustration without rushing in to fix or rescue. Many
parent experience a conflicting range of emotions at this time:
guilt, grief, and relief.
Guilt: Sometimes they come in rapid succession; at
other times, parents experience these difficult emotions all at
once, wondering if it is the myriad of their mistakes and
miscalculations that has created this painful situation, they
are paralyzed by guilt. While guilt may be a legitimate, even
healthy response, it should not be the basis for making
decisions about how to respond to a child’s distress. Guilt may
be most useful in motivating parents to explore their part in
this process and what they may need to do to become effective
agents of change in their child’s treatment.
Grief: Grief is a complex response to the loss of
the dream of a child’s adolescence. Parents may have anticipated
watching their child play in a championship basketball game, or
dance in a jazz recital, or choose a dress or tuxedo for the
prom. The sense of loss, while perhaps most intense at the
beginning of placement, is an emotion which remains throughout
the treatment process and, if it goes unacknowledged or
unaddressed, can at any stage undermine completion of the
process. Parents may feel that it is trivial, in the light of
their child’s situation, to mourn a missed game or dance or
holiday. As a result, they may not feel they can express those
regrets. Yet it is the feelings that aren’t discussed that gain
power and take on a life of their own. Those involved with the
family can help by encouraging parents to talk about their sense
of loss and to reframe the current losses in the context of
future possibilities for their child. Indeed, the overriding
goal of therapeutic placement is to create the possibility of a
healthy future for their child.
Relief: Oftentimes, mixed up with the guilt and
grief is a surprising relief: Relief that their child is safe,
relief from constant pressure of fear and worry, relief from the
cycle of anger and regrets, relief from the lack of sleep and
constant tension.
Stage 2: Temptation Time
I call the second phase “Temptation Time.” The teenager is now
eating well, sleeping well, experiencing success in school and
in relationships, exercising regularly and learning to explore
and express the feelings that sabotaged their progress toward
emancipation. They look really good. The changes in their
teenager raise the parents’ hopes – “maybe things really can get
better,” “maybe we can have those dreams after all,” “maybe we
can be a family again.” These are important and valid hopes,
although sometimes they are fueled by the pressure that the
child’s absence has placed on the family system… “What do we
talk about if we are not arguing/worrying about our child?” It
is not unusual for the pressure of coping with an out-of-control
teenager to have put incredible strain on a marriage or to have
forced parents to neglect other children or responsibilities.
There is a subtle temptation to bring the child home at this
stage; to re-establish the familiar, albeit unhealthy status
quo. It is what he/she wants; it’s what you want too.
Personal Change: This is the moment when it is
time to talk about what change means. In my opinion, personal
change is the single most difficult process we can undertake.
And it is a process in which there is no substitute for time.
For most of my clients an essential goal of treatment is to move
from an external locus of control (parents, teachers, the law,
etc.) to an internal locus of control (their own sense of self
and values). This type of lasting change occurs because the
adolescents, through the treatment process, begin to alter the
way they see themselves and the world. The beliefs and attitudes
which drive their decisions begin to shift – being honest feels
good, completing a task creates a sense of competence, caring
what someone else thinks or feels generates a feeling of
connection. From this alteration in perception comes genuine
change in behavior, not out of fear of punishment or due to
material inducement, but because there is an internal impetus
for their self-image and choices to become more congruent. In
turn, these new ways of being in the world generate new
experiences of efficacy and fulfillment. Each success fuels the
developing sense of self-worth and the belief that things can
indeed be different and better; i.e., change is possible.
Therefore, to fall prey to the temptation to bring a child home
at this fragile stage is to risk short-circuiting the very
process of change before there is sufficient time to internalize
the new attitudes and beliefs. Parents need to hear from the
treatment team a realistic assessment and appreciation for the
child’s and the family’s progress, acknowledging the gains and
outlining the challenges which remain. In this way, a new
balance can take hold in the family, which lessens the
temptation to return to the status quo.
The Plateau: Before discussing the third and final
phase in the treatment process, I would like to talk about a
common experience and a cause for concern on the part of the
parents – the plateau. Rather than view periods in which no
change appears to be taking place as stagnation or as a failure
of the process, parents and students should be counseled to
expect plateaus and regard them as opportunities to practice new
skills. We may have become so habituated to moving from crisis
to crisis that we fail to appreciate the lulls, the plateaus.
Stage 3: Transition
The last phase of treatment is a time to consolidate these
gains. During the Transition Phase considerable pressure is
placed upon the enhanced communication skills that have been a
focus of treatment since the beginning. Learning to express
feelings and learning to listen to others generates a sense of
comfort and confidence internally and interpersonally. Moving
toward a transition out of treatment places demands on these
skills as student and parents negotiate the looming questions,
“Now what?” What will the realization of the treatment goals –
maturation, individuation, family reintegration – look like for
this child and this family?
Many of the old challenges will return, although in different
forms and with less potency. These renewed challenges do not
signify a failure of the process. To the contrary, they
represent a fresh start, a chance to do things in a new way, in
a healthier way. What are those challenges? Re-establishing
trust on a day-to-day basis. Its 12:15 on a Friday night, a 17
year-old who has never been in treatment is 15 minutes late for
curfew…when he gets home, his parents say, “You’re 15 minutes
late. You need to be home 15 minutes early tomorrow night.” When
a 17-year old who has been in a therapeutic boarding school for
18 months is 15 minutes late for curfew, his parents are trying
to decide when to call the police.
Haunting Fantasies: Other challenges are those
fantasies, those dreams which have “haunted” the process from
the outset: “I just want to graduate with my class,” “If my son
doesn’t come home for his senior year…?” Honestly, you can’t go
back nor, if you think about it, do you really want to. What you
can do, though, is talk about these issues and listen. You have
learned to endure your child’s anger. Your child has learned to
tolerate his or her frustration.
A Labor of Love: It is time to listen carefully to
those who have been integral to the treatment process. You and
your child have learned that his or her therapist wants what is
best for your child. Trust their care and their objectivity.
Together, identify the triggers that, in the past, have led to
denial, avoidance, splitting or capitulation. You have both
learned how to talk about difficult feelings, and you must. In
this way the past does not become the future.
The process of individuation has begun and your child has
regained a sense of meaning and a sense of belonging. This
process of change has been incredibly hard work on the part of
the child, the parents and the treatment team. But it has been a
labor of love.
Molly Baron, trained as an educational and clinical
psychologist, now works full-time as an educational consultant
with McClure, Mallory & Baron in the San Francisco Bay area.
Molly specializes in the placement of children, adolescents and
young adults with therapeutic/special needs.
Articles |
Selecting the “Right” School /Program
NATSAP
Program Definitions | Program Directory Search
Related
Organizations |
Contact
Information |
|
