Managing Expectations in Next Levels of Care: Wilderness Therapy Programs to Residential Treatment Programs

INTRODUCTION

Case Study: Adam was an outdoor wilderness therapy superstar. In two short months, he became less anxious, didn’t feel depressed, was motivated, excited to be sober, respectful and loving towards his parents, and willing to work within a highly structured environment. He loved his wilderness therapist, felt confident, and was accepting of his next step — a residential treatment center or a therapeutic boarding school.

Adam quietly began to have reservations about this new residential program after only a couple of weeks. He missed the freedoms he had (demanded) at home. He missed his friends who he felt were “cooler” than these “treatment kids”. He missed home and his parents, which made him more convinced that this program was not the place for him, and believed that he had already done all the work that he needed to do while in wilderness therapy. He decided, although not consciously, to push back.

As Adam began his regression, his parents held the boundary for a couple of months. Afterall, they had carefully chosen this program after touring, meeting staff members, and talking with their educational consultant. But eventually, Adam’s regression seemed to coincide with some of their frustrations with the program. Their frustrations were normal, understandable, and part of an expectations gap in our system of care.

Dear parent,
This is written for you. Please keep these following things in mind:

Speed of Progress/Regression

Even though you are told to expect this regression in residential treatment and to brace yourself, it’s hard not to shift responsibility from the student to the program. Parents are desperate for their child to find the stability they need in order to be healthy. Keep reading, keep working, and continue asking about regression. Be patient.

Access to Information

In residential treatment versus wilderness treatment, you will hear about all the things your child is doing more frequently and from many more sources. In wilderness treatment, you hear from your therapist. In residential treatment, you are hearing from the therapist, program staff, and your student. What does this mean? It means you will hear more about your child’s successes and a lot more about his/her struggles. You have two challenges: 1) Absorb the constant stream of information without coming to quick conclusions (“Why is she suddenly doing so poorly?” “He is ready to come home!” ) 2) Don’t become reactive and mired down by the small details, thus missing the big picture.

Wilderness students are generally in crisis and working on short-term goals for stability and an intricate array of emotional and behavioral issues. In order to stay focused on the big picture in this short-term setting, your wilderness therapist prioritizes the information you receive. When progress is made, that is the focus, rather than the variety of problems that will be fuel for therapy at their next level of care. An example could be a problem area such as disrespectful comments. This is a common struggle for students and is addressed in the wilderness treatment setting, but generally isn’t the prioritized area of concern in wilderness because timelines are short and working toward overall stabilization is the priority.  At a residential program, these ultimately maladaptive and intolerable behaviors get addressed and brought up constantly while working on longer-term goals. Plan to hear about them and understand they will help drive the therapeutic process and help the staff and student to know what needs to be worked on and addressed.

In residential treatment, you will now hear every passing complaint about the staff and the program from your student, whereas in wilderness you just hear what they hang onto over the course of the week and what they choose to write in a letter. Hearing about more concerns doesn’t mean the residential program is not effective or that the wilderness program was better, it is just a different model that allows more freedoms, as well as more access to your student in order for him/her to be preparing to return home.

More Autonomy   

Wilderness therapy is a small and protected community without much, if any, integration with the outside world. In residential treatment, opportunities to make poor choices are greater. With autonomy comes opportunity for mistakes. Parents too frequently hold the residential programs or schools accountable for the mistakes their child makes. It doesn’t mean it is the fault of the program if your child makes a mistake. If your child finds the means to smoke pot, have sex, get into a fight, cheat, or whatever it may be, he/she has sought that opportunity and made that choice. Allow your student to learn from the mistake by holding him/her accountable rather than blaming the staff or program, and allow the student’s choice to inform the therapist and treatment team as to where he or she is at in his or her treatment journey and the process towards making better choices.

In every progress-based transition, e.g. hospital to home-based care, high school to college, t-ball to the big leagues; helpers pull back and the receivers of help are invited to do things for themselves. This is no different in the treatment world. Expect a delay in response time from staff as your son/daughter struggles to work through distress on his or her own. Expect staff to have clearer boundaries between work and personal life as your child is given time to find solutions on his or her own and to grow and learn in a less restrictive environment. Be aware this environment will allow more and more freedoms as the student progresses through the program. Expect less intense and less frequent therapeutic interventions as a greater balance between academics, social life, sports, etc is introduced to your child’s life.

A Long-Term Relationship

We’ve all been there. A few months into an intense relationship, there is a glow. So much has changed, so many new and positive things enter our lives and we focus on these. Eventually, the glow wears off, and we are able to see the flaws, drawbacks, and realities of our partner. In this case, the partners are treatment programs (and their staff) and parents, and you have, in fact, entered a long-term relationship. There will be differences in opinion, conflict, and tough conversations. You will become “real” with them, and they with you.

Programs aren’t perfect. Over the course of a year, staff members will make mistakes, balls will be dropped, and your therapist will become a person rather than a savior, which is all a normal part of life and a healthy part of learning to grow despite frustrations or imperfections.

Parents Regress, Too

In a residential treatment setting, your child is able to push you hard, via phone calls and face to face, and it becomes harder to live the boundaries, emotional regulation, validation, and anything else you were determined to do and began to do a few months ago.

It is also common for defensiveness (or other reactive behaviors) to arise in parents when flaws/ emotional moments, etc. are visible to your child’s therapist or team. It’s easy to be your best self when your child is progressing and you aren’t dealing with their frustrating, even maddening, behaviors and attitudes face to face. If you’re unsure what your reactive behaviors are, consult The Parallel Process by Krissy Pozatek.

Your Role

Have appropriate expectations.

Keep working alongside your student. Students get treatment fatigue and want to give up. You doing your work will role model grit and demonstrate value in what the program has to offer.

Communicate openly and patiently with the program when frustrations arise.

Stay the course. Hold the boundaries the program asks you to, all of them, every time. Picking and choosing sends the message that it is ok for your child to pick and chose which rules to follow. Young people, and even more so young people in treatment, don’t have the judgment or maturity to do this yet. Being unified with the program is as important as being unified with your co-parent.

When your child inevitably complains about the program, validate him/her without rescuing or escalating. This is a tricky skill, so ask your therapist about it and consult the literature.  Encourage your child to solve problems. You can validate his or her concerns and say something like “You seem so frustrated, that must really suck. Tell me more.” or “It sounds like you would just throw in the towel if you could. I know this has been an exhausting few months.”

Final Thoughts

You may put your wilderness program on a pedestal because it was short and the time was fast and intense. You may feel like the long-term residential program is not measuring up. Programs aren’t perfect and that’s ok. If they were perfect it wouldn’t set kids up for success in an imperfect world anyway. Learning to manage mistakes, handle anxiety, trust and let go is all part of the process for you and your student.

Wilderness and residential programs are different. They are a different type of therapy, so we can’t expect the same process, but we can certainly find incredible growth, change and value in both.

Sarah Rothstein, LCSW

Learn more about Sarah below.

 

2 thoughts on “Managing Expectations in Next Levels of Care: Wilderness Therapy Programs to Residential Treatment Programs

  1. Perhaps I am misreading the article, but it sounds like the normal path is for the patient to do the wilderness program and then go into a residential treatment program. Is that correct?

    • Thanks for your question David. Many of our students are referred by Educational Consultants who will make recommendations on the best next step after Aspiro. Sometimes this can be going to a residential treatment center or a therapeutic boarding school, or some other type of therapeutic service or program. Other times the best plan is to go home and put some therapeutic support in place in the home community. We would be happy to talk further about Aspiro and the process. Please call our Admissions line at any time.

Leave a Comment