Wilderness Therapy: A Critical “First Step” in Adolescent & Young Adult Treatment, Clark H. Hammond, Ph.D.

In the world of therapeutic treatment for teens and young adults, there are myriad options that can become tremendously overwhelming to parents looking to make those critical decisions: Inpatient vs outpatient treatment, short-term rehab facilities vs long-term care, residential treatment vs wilderness therapy and more.

But how do you decide which program to commit to? Technology is a wonderful thing, and information is constantly streaming through the internet, bringing literally millions of data to your fingertips. While this is an invaluable resource, it doesn't take long to recognize the challenge in sorting through it all. Drinking from a fire hose is a tough way to quench your thirst. The best use of resources up front then is to find, hire and follow the counsel and direction provided by an experienced educational consultant.

A good consultant knows the industry. They will have a variety of experience in the academic and therapeutic worlds, and has traveled extensively to identify the programs and people that provide the best care in the industry. They get beyond the marketing messages of brochures and websites, and really get to know those who will care for your child. It is always a leap of faith; but you don't have to leap blindly. Utilize your consultant and trust their expertise.

They may recommend that your child begin his or her journey at a therapeutic wilderness program, and perhaps continue on to another placement to further the emotional, therapeutic, and/or academic work you and your child has begun. This often raises questions about the best use of time and financial resources. Some parents may wonder, “If my child may require longer-term treatment at a residential facility anyway, why bother with wilderness?” As a professional in this industry, and a licensed therapist with experience in both domains (wilderness and residential), I'd like to shed some light on the power of the wilderness, and why I believe it is an important first step in treatment for many adolescents.

First, the power and focus of the wilderness allows for an in-depth & accurate assessment. The personal challenge, elimination of typical distractions, and intense clinical focus provide opportunities to more clearly understand therapeutic issues. Proper assessment leads to proper treatment. Making a long-term commitment to a residential program has enormous ramifications, and you want to get it right. While there are no guarantees, beginning your child's path to wellness in the right wilderness program provides the time and opportunity to not only begin the journey toward change with intensity, but better understand your child's needs therapeutically, academically and emotionally. This understanding is critical in selecting the residential setting your child will best be served in.

Second, the wilderness provides an opportunity to move through the initial stages of change more efficiently. One of the most practical models for the process of change was developed by Prochaska, Norcross & DiClemente (see their book, “Changing for Good”). This powerful, integrative philosophy of change describes the process of changing any negative behavior in six stages: precontemplation (resistant; denial), contemplation (considering the possibility), preparation (getting ready to commit), action (implement initial changes), maintenance (staying on course; developing new habits), and termination (move to new way of being). Experience shows that teens and young adults move through at least the first 3 or 4 stages of change at a much higher rate, and with deeper impact, in the right wilderness setting than in a residential treatment environment. This means that wilderness can be a powerful first step in long-term care by better preparing participants to begin the next placement further along in the process of change.

In summary, the right wilderness setting is powerful. It is challenging. It is often a tremendous “wake-up call” and much more. I have seen individuals and families grow emotionally and therapeutically more in 8 weeks of wilderness than in 6 months of residential care. I have seen them recognize their issues, recognize that those issues need to change, begin in earnest to walk a path of health and well-being, and feel self-confident as well as appreciative at the end of their wilderness experience. I have seen “wilderness kids” enter a residential setting and perform at a much higher level than other kids that have been in the program for months, but skipped the wilderness piece. Why? Wilderness provides one of the best opportunities to assess, arrest problematic behavior, offer space and opportunity for deep self-reflection, advance through the initial stages of change, and prepare oneself for longer-term progress, in or out of the home.

A Parent's Role in the Young Adult Treatment Process of Growth, Support and Self-Care, Beth J. Fogel MSW, CSW

Does this scenario seem familiar? You have just made a decision to help your young adult son get into treatment by enlisting Deborah Thomason. She presents affordable high quality placement options, arranges all of the intervention details and guides you and your family step-by-step all along the process. The intervention goes off without a hitch. Taking the hard line with your son worked better than you expected and he finally agrees to go to treatment. Within a few hours, your son is safely on his way to treatment. The wheels of his plane have barely left the ground and you are already on the program website trying to ascertain what you as a parent can do while your son is in treatment. There's lots of jargon that you quite don't understand yet. It's all so new. Your adrenalin is still pumping just as hard as it has for these last 2 years.

The phone rings and you've just received initial communication from the treatment program and your son has arrived safely and is making a positive adjustment to his treatment environment. Next, the therapist calls to say that your son is being open with his emotions. However, you are still feeling anxious, afraid and worried sick even though there is no more crisis situation. You can't get a good night's sleep and feel exhausted emotionally, physically and spiritually. Every time you look into his bedroom, you fear the worst because this has been happening for so long it's all you know. You can't stop reliving the wreckage your son has caused to your family. What to do?

Parents of young adults need to redefine ways to take of themselves now that your loved one is out of the house and working with highly skilled professionals. Ask yourself, "Who am I when I no longer have a son who is my major raison d'etre or a my project kid?" As a parent, you deserve to live a quality life while allowing your son to experience the emerging young adult life stage transitional process. Reconnecting with passions you had prior to the crisis situation is an excellent place to begin. Yoga, reading, meditation, travel or any new interests you now have time to pursue. Go ahead and give yourself permission to be managing your own personal well-being.

Know that all individuals between the ages of 18 and 30 whether in treatment or not are trying to figure out who they are and what they want. Noted author, Jeffrey Arnett (2004) identifies the main features of emerging adulthood as an age of identity exploration, the age of both instability and of feeling in between…neither an adolescent nor an adult. This is the age of possibilities and a time that your son has an opportunity to transform his life.

You are in excellent hands working with Deborah Thomason. She will assist you in answering questions such as:

• How do I define my new role as a parent of a young adult?
• What emotional and financial boundaries do I need to set?
• How do I reframe my expectations when my son is in treatment?
• How can I let go of the past and communicate a more realistic set of expectations?

Deborah walks alongside you and guides you step by step through the treatment process. You will find Deborah's style of partnering and support refreshing. She will also remind you of the value and importance of taking care of yourself while your son experiences his own healthy separation/individuation process in treatment. As a parent, you deserve to have a healthy adult relationship with your son that is different from before…one that is built upon honesty, integrity, trust, respect and a mutually defined set of healthy boundaries. Trust the process and have faith in the power of growth as you, too, are on a journey toward wellness.

Parent Therapy, Kevin O'Keefe, Psy.D., Licensed Clinical Psychologist

Many parents find it beneficial to receive some therapeutic support at the same time their children are in treatment programs. An adolescent's therapeutic process is often as difficult for the parents as it is for the child in treatment. This can be an extremely anxious time for parents. Personal struggles are likely to increase for a parent because of the emotional duress of having a child in treatment. Engaging with a therapist who understands the entire process benefits the parents and the rest of the family. Having support from a professional who is an impartial part of the process and can advocate for the parents helps parents manage their own anxiety.

 

Families as a whole can also benefit from having the parents involved in therapy while their son or daughter is in a program. Many adolescents experience anger toward their parents while in programs because they believe their parents have issues to work on as well. When parents can have a "parallel process" with their child, it can aid in moving the treatment for the adolescent forward more rapidly. When parents are working on how they relate to their children and taking care of any emotional struggles they are having personally, it can quickly bring a family together. Some of the struggles families present with are difficulties in communication, manipulation, anger, and oppositional behavior. When all components of a family are working toward a common goal, therapy is likely to be more successful.

 

Working on the family dynamic is an important part of the therapeutic process. Exploring what dynamics within the family may be contributing to the difficulties a son or daughter is having can be crucial for future success. Adolescents can leave the home and make incredible gains while in treatment, but if they return to the same environment, they are highly vulnerable to falling back into the same negative patterns. This makes it important for parents to be aware of how they interact with their children in order to make the most of the time and money invested in treatment. This helps parents create a different home environment for their children. Therapeutic support can help parents develop the necessary tools to help their children move through the difficulties they are experiencing and become self-sufficient adults.

But They Look Done to Me… Wendy Turnbow, Ph.D.

Have you ever baked a cake and taken it out of the oven because it "looked" done on the outside only to find that it wasn't completely done on the inside? What happens to the cake then – well it "falls" or sinks in the middle. Well that sometimes happens to kids in treatment. They go on a home visit or two with their parents and the visits go well. The next thing that happens is the therapist gets a call from the parents stating that they feel their child is ready to leave and they want to take the child out of the program.

It cannot be emphasized enough how important it is to let the child "fully bake" or complete the program. Even a week or two can make the difference between success and failure. Therapy in a treatment program usually follows a three part process. The first step is the learning the phase. In this phase the child is very dependent upon others to help them learn the program and the new skills they need to develop in order to behave effectively. They may do the right thing for the wrong reason. They are afraid not to. The second phase is the practicing phase. The child is now practicing what he is learning to become better at it. He/she is becoming more independent. He/she is now doing things for selfish or intellectual reasons; i.e. for the reward or privileges; because I "ought to" do it. The final phase, and in my mind, the most important phase is the internalizing phase. In this phase the child moves from independent to interdependent. He/she is doing the right things for the right reasons. They want to do it. This is the phase where the new skills/behavior becomes habits.

Habits are not solidified overnight. They take time. This is key to the success of the child. He/she needs to be demonstrating these new behaviors consistently for a period of time to assure that they have become part of the child's repertoire. Like the cake, the child may look done in the parents eyes (on the outside), but still need more time to fully cook. If the child is taken out of treatment too soon, the chances of him/her relapsing are high.

It is also imperative in this process that the appropriate aftercare plans have been put into place. This is where the Educational Consultant is imperative. They are the experts in matching child's needs with the appropriate aftercare setting. If the child is to go on to a step-down program, that program should be in place prior to the child leaving the program. If they are to go home, the aftercare therapist should be in place. It is ideal to have the child see the therapist during home visits, or at minimum, have phone contact with them while still in the program. Their new school should be in place and the child accepted to the school prior to discharge.

Having your child fully baked before discharging them from a program is not only what is best for your child's success but saves you time and money in the long run. Who wants to spend all of that money and emotional energy only to have your child come out of placement before they are fully "baked" and "fall". Even a small amount of time can bring in life-long results. For the best prognosis for your child, listen to the professionals. They know best and really do have your child's best interest at heart.

Codependency: The Clownfish Paradox, Justin Stum, M.S. LMFT & Lauren Roberts, B.S.

Infants are almost entirely dependent on their parents for basic survival needs including love and nurturing. As a toddler, the child is still highly dependent yet seeks independence in small, but important ways. A toddler is similar to an adolescent in that both seek independence and freedom without a strong grasp of consequences. In order for the adolescent to fully understand the consequences, they must experience them. This is one of the most challenging roles of the parent; being able to step back and watch their child falter without rescuing. Many parents, out of love and concern, rescue their children before the fall or directly thereafter, never really giving the child the chance to feel the full weight of the consequence. What is done out of the deepest love, quickly sabotages the child's growth including the trust they have in themselves and the trust the parent has in the child's capabilities to function independently.

As adolescents grow, they naturally seek autonomy from their parents as they explore and interpret the world and the relationships they have within it. At times well meaning parents attempt to rescue and ‘help' their child. A father, helping a small child after a bicycle crash, says, "Hey, it's ok champ. You're a big boy, don't cry, you'll be fine" is not guiding and assisting but telling him how to feel. The parent is also simultaneously becoming more worried about how he'll deal with a crying child than empathizing and supporting the child in the present. This behavior, though seemingly harmless, becomes a pattern that in time becomes a dynamic that stifles healthy autonomy and growth.

Parents with their own personal unmet emotional needs often can use their child to assist them in meeting those needs. As the child gets older and autonomy is more eminent, enmeshed parents tighten their hold with regard to their needs being co-dependent with the child. When parents meet too many of their emotional needs via their son or daughter, the adolescents growth is hampered and their development delayed. Learning to assist and guide ones teen morphs into dysfunction and becomes enabling and co-dependent. The sea anemone and clownfish operate in a co-dependent way. They are connected but they are not autonomous as they cannot function without one another. The fish helps the anemone by eating the algae and protecting it from predators. The anemone benefits by eating meals the clownfish attracts. Parents and children develop similar patterns that keep them each stuck in a rut of enmeshment and unhealthy dependence. Parent-child relationships that function in this manner will misguide the normal teen development and atrophy existing parent maturity. The paradox is simple: what starts out of good intentions of nurturing can become co-dependency and hamper parent and child growth but is hard to detect and work through since it began so innocently.

When co-dependency becomes the norm, a tsunami of symptoms such as: entitlement, selfishness, defiance, and overt reactivity also accompany what parents thought was helping. Parent help that started as a solution, like that of helping a stumbling toddler, can become co-dependency during adolescent rearing that arrests the teen's being able to make healthy choices. Parents that operate within this paradigm often cannot see their marriage or the relationship with their child clearly as they make decisions based on the nature of the co-dependency and not what would ultimately help the teen grown and mature. Family theorist Murray Bowen, has indicated that the intention of family therapy is aimed at locating the balance between individuality and togetherness as a family, parent, and child. For adolescents to unfold in healthy ways, parents need to allow the child to individuate from the family in order to find who they are and contribute their individuality to the family as a whole.

Parents can break out of co-dependency when they, along with their teen, work to better understand themselves as individuals. Speaking with your educational consultant about their perceptions and thoughts on the family dynamics can help bring clarity and direction from another professional outside your family. Learning to understand oneself through therapy and/or life-coaching and the nature of the patterns at home will allow each individual to find open waters without losing the consistent current of familial love.

The Abandonment Conundrum, Ian D. Feinauer Ph.D., LMFT

The physical separation with one's child is inevitable. Separation in adolescence is a natural part of life and an essential part of transition into adulthood. The manner in which this separation occurs, however, can be traumatic for both parent and child, especially if this transition does not match with previously held expectations, hopes and dreams of either the parent or the child. Whether through birth or adoption, it was a joyous day when your son or daughter came into your life. As the parent, you had visions of your child going on to college, getting married, and finding a career. Most likely, you did not plan on one day having to sending your child to treatment.

Sending your child to treatment is never easy, even if you have the financial means and understand well the benefits. Guilt, as an emotion, can be very tricky and often prevents us from making decisions, as parents, that are most helpful for our children. I often ask parents if they feel guilty for sending their child away. Although some claim not to, most parents admit to feelings of guilt, even though they also know it is the right decision for their child. Scott Peck in his book "The Road Less Traveled" defines love as: The will to extend one's self for the purpose of nurturing one's own or another's spiritual growth. A definition I like just as well comes from the Chilean biologist Humberto Maturana who defines love as: Creating space for another to reach their true potential. Your choosing to send your child away is, in fact, not an act of abandonment, but an act of parental love.

All parents who have to send their children to treatment face this abandonment conundrum. Seeking outside help through a qualified educational consultant can help you sort through this conundrum of feelings of guilt and fear for abandoning your child and making the hard decision to send them to treatment, which is ultimately in the best interest of your child.If your child is adopted, the separation may seem all the more painful and scary. A fear that your child will feel abandoned a second time is of great concern. Separation is indeed a very real dilemma for all adolescents and more critically for those who are adopted. Each step toward autonomy from you can remind him or her of the separation from his or her birth parents. Indeed, the struggle to be different from you may be what precipitated the events that led to you sending your child to treatment. It is an emotional process of for both you and your child. Luckily, sending your child to treatment is not abandoning your child.

Although you have not abandoned your child by choosing treatment, unresolved feelings of abandonment, stemming from an adoption or other trauma, can be a real source of distress and insecurity, and can lead to addiction and compulsive behavior on the part of your child. Unresolved feelings of abandonment can very much be a roadblock for your child reaching his or her potential and preventing the development of self-reliance and self esteem. It is vital, then, that any unresolved feelings of abandonment that your child may experience have a chance to be addressed and thoroughly resolved in treatment. It is important to remember that, in most cases, you are not the one doing the abandoning; it is your child who, through their behavior, has been the instigator of this separation. This underscores the importance of seeing the therapeutic process through, once you have sent your child to treatment.

Paralyzed by the fear of being rejected by your child, you may be tempted to give in to your childs' requests to end treatment before it is therapeutically advised. Doing so, however, would only enable your child to continue in his or her destructive attempts at autonomy, as you buy into your child's projections of what will make him or her happy. As a parent, you want to be aware that your child is asking you to accept responsibility for his or her unhappiness. However, if you give in to this request, you risk depriving your son or daughter of the opportunity to learn critical lessons of responsibility, accountability and trust. Your job as a parent is simple. It is to love your children, and to give them every opportunity for growth in this life, as painful as that might sometimes be. The act of sending your child away is not an act of abandonment; indeed it is an act of unification and of love.

No matter what your situation may be or what events may have led you to make the decision to send your child to treatment, it is important that you do not leave them to face this process without your support. It is important that the boundary YOU have set is maintained and adhered to. The best way to hold this boundary, and to support them while in treatment, is to maintain contact with your child and to be there for them in whatever way deemed appropriate according to the program in which they are placed. In this way you are not abandoning your child, but co-participating in the therapeutic process with them. Using a competent educational consultant is your safest and most sure way to finding that placement that will best suit the needs of you and your family. An educational consultant, like Deborah Thomason, will be an advocate for you throughout this difficult and sometimes confusing process, and will help guide you through all of the steps necessary so you can reclaim that true connection with your son or daughter.