The original 12 Steps come from the Alcoholics Anonymous’ foundational agreements, where an alcoholic progresses through 12 distinct stages toward maintaining sobriety; recent adaptations of 12 Steps have adopted Higher Power verbage, thereby opening the meetings to non-religious persons. With the phenomenal success of AA, many other programs have adopted similar, appropriately-adjusted steps for their particular symptomology. 12 Step groups require participation in regular meetings, anonymity, sponsors, personal accountability but with tremendous support and acceptance of “shortcomings”, including relapse(s).
16 Steps’ model focuses on a holistic approach to viewing people in their wholeness– “mind, body and spirit.” This conceptualization views addiction as a complex web of social factors, physical, pre-disposition and personal history.
In attempting to buttress parental rights while simultaneously protecting its young citizens from unacceptable threat or harm, the Federal Child Abuse Prevention and Treatment Act (CAPTA) (42 U.S.C.A. § 5106g) defines child abuse and neglect, at minimum, as: "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation or an act or failure to act which presents an imminent risk of serious harm." Federal and State laws also define civil and criminal sanctions for maltreatment.
Volumes of research attempt to isolate academic conditions in relation to national income, gender, income inequality, poverty, school location and class size, etc. While each of these play significant roles in general trends, schools that offer excellent learning environments (consistent, holistic, stimulating curriculum) and a child’s early literacy development have proven to be key elements toward escaping the trends.
An empirically-based psychotherapy which argues that “psychological suffering is usually caused by the interface between human language and cognition, and the control of human behavior by direct experience.” ACT seems closely related to CBT but also leverages meditation and mindfulness as tools to help the client profoundly accept his/her reaction and avoidance first, before seeking to behave in such a way as to skirt stress.
Everyone is familiar with the maxim that addiction is insanity is “doing the same thing time and again, always expecting a different result.” On the ground, this definition seems a bit trite and judgmental, and likely useful for a more concrete mindset. A more biochemical definition includes the often unconscious and compulsive aspect: “in addiction, pursuit of rewards persists, despite life problems that accumulate due to addictive behaviors, even when engagement in the behaviors ceases to be pleasurable.”
According to the Mayo Clinic, ADHD includes “a combination of problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior”, any and all of which affects school performance, social relationships and self esteem. “Symptoms sometimes lessen with age.”
To adopt is to “legally take another’s child and bring it up as one’s own” (Oxford Dictionary). Silverstein and Kaplan (1982) listed 7 considerations that every adoption introduces: Loss, Rejection, Guilt and Shame, Grief, Identity, Intimacy, Mastery/control, and that every adoptee and new family deals with inside the new relationship.
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Unlike medical treatment or even psychotherapy, the support principles of Alcoholics Anonymous (“AA”),organized ~1930, start, fundamentally, that the addict, with sponsorship and firm guidance from addicts before, can effectively combat addictive urges for the remainder of his/her life practicing 12 codified principles. Membership is voluntary and private; participation is free.
Because of alcohol’s prevalence and accepted role as a social lubricant, the addiction to alcohol is an extremely difficult addiction to conquer. Much research points to total abstinence and (at least, initially) avoiding high-risk situations as the first guideposts, and 12 Step programs or other professional or peer support can assist Mild-to-Moderate alcoholics (persons capable of maintaining some level of sobriety). Family and friend support is extremely beneficial, especially if they recognize their enabling behaviors (see Codependency). For persons consumed by alcoholism, detox followed by inpatient treatment (psychotherapy, abstinence, peer support) often breaks the addictive cycle long enough to provide clarity, structure and initiative for the addict.
"...We are composed of more than 30 member facilities offering residential care to adults with serious mental challenges, including schizophrenia, bipolar disorder, depression, personality disorders, and disorders combined with substance abuse. We deliberately keep our membership low in order to have personal knowledge of one another’s facilities, which lets us offer you informed recommendations. We are dedicated to providing you with information and guidance that will help you through this process..."
Researchers are recently analyzing the myriad opportunities other practitioners have long known about; that domesticated animals can bring not only friendship and distraction to anxious or bed-ridden patients, as well as any person that is desiring contact and affection, but that the positive effects are measurable and predictable. Equine therapy (the study of the interaction between patient and horse) has been extremely well-received at RTCs, and offers an engaging and highly-desired practice between the student and the program’s horses.
Includes intense, excessive and persistent worry about situations that do not appear anxiety-producing for most people. This fear and perseveration may remain at a static, uncomfortable range but can spiral and culminate in a “panic attack”, (exacerbated in part by shallow breathing and pounding heartbeat). Examples of anxiety disorders include social anxiety, phobias and separation anxiety disorder. (See School Refusal)
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Situations that induce anxiety in normal teens develops into excessive dread, disabling some children through teen years; often, symptoms emerge around age 6. While medication is still commonly prescribed, recent studies (including the Child/Adolescent Anxiety Multimodal Study (CAMS)), “CAMS clearly showed that combination treatment is the most effective for these children. But sertraline [Zoloft] alone or Cognitive-Behavioral Therapy alone showed a good response rate as well.
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“Art Therapy is a mental health profession in which clients, facilitated by the Art Therapist, use art media, the creative process, and the resulting artwork to explore their feelings, reconcile emotional conflicts, foster self-awareness, manage behavior and addictions, develop social skills, improve reality orientation, reduce anxiety, and increase self-esteem.” http://www.arttherapy.org/
Due to neurodevelopmental differences, persons with “Aspergers Syndrome” or mild Autism exhibit significant impairment in social, occupational and other areas of functioning, such as an inability to read social cues, discomfort in social situations, often having inordinate focus and recall regarding some particular interest. The previously-independent diagnosis of Aspergers has been absorbed into Autism Spectrum Disorders in the DSM V.
The diagnosis of autism is often suspected in the first years, as some children display autistic-specific ways, like failing to make eye contact, not responding to verbal communications or displaying repetitive behaviors and preoccupations. For a description of early indicators of autism, the American Academy of Pediatrics has developed the M-CHAT (https://www.m-chat.org). There are many other formal diagnostic tests that professionals use to assess ASD. There are a wide range of behaviors and skills on the autism spectrum, from highly verbal to entirely non verbal. Proper diagnosis provides caretakers with guidelines for helping support as much self-sufficiency as practical.
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Almost universally misconstrued as “breaking people down”, behavior modification is a much more sophisticated and well-researched conceptualization that B.F. Skinner developed at Harvard University. His main addition to then-common operant conditioning theory was the introduction of “reinforcement” and the appreciation for “successive approximation” when shaping behavior.
In this model, salaries and bonuses are attempts at behavior modification, as compliments and recognition may also be reinforcers for smoking cessation or public-speaking, etc.
Behavioral Tech is the name for the Linehan Institute of model of training. Treatment facilities and treatment teams have go through the stringent training to be listed in it. If a program is listed as a Behavioral Tech program and is listed in the “DBT Clinical Resource Directory (CRD)” at least one member who has completed either the Dialectical Behavior Therapy Intensive Training™ or the Dialectical Behavior Therapy Foundational Training™ through Behavioral Tech (BTECH) or the University of Washington Behavioral Research & Therapy Clinics (UW BRTC). Only members who have completed training are listed. Listing is voluntary and does not include all persons who have been through BTECH or UW BRTC trainings. The CRD is a resource, not an endorsement, of DBT providers. Behavioral Tech, LLC does not certify DBT practitioners or programs, nor does it make specific referrals.
In addition to this resource list, you may wish to consult other resources including your doctor or other trusted professionals, your state's psychological or psychiatric association, local university psychology or psychiatry departments, or your local chapter of the National Alliance on Mental Illness. Inquire into the credentials of any practitioner before choosing a therapist.” from http://behavioraltech.org/resources/crd.cfm
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Previously referred to as manic-depressive disorder, bipolar disorder is a “brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out daily tasks”. (National Institute of Health) People with Bipolar Disorder often are unaware of the extreme thinking during the manic state, revelling in the feelings of grandeur, energy and purpose; it is important for observers to identify this behavior as falling drastically outside the person’s usual mood or behavior.
Although there are boarding schools for all ages around the globe, in the US, the majority of boarding schools serve high school aged students. Boarding Schools provide a diverse approach to traditional pedagogy, from Military Schools to Pre-Professional arts programs, to focusing on a type of learning disability or learning challenge, or have learning support programs.
Boarding schools, regardless of their size, are privately-funded socio-educational communities, where students live, attend school, and are expected to participate within the community. A distinguishing factor for boarding schools, in comparison with residential treatment schools, is that its students voluntarily attend school and are self-motivated and accountable for their education. If you are researching boarding schools for the middle school aged student, there is a distinct class of boarding schools called Junior Boarding Schools.
“Boot camps” are at-risk teen programs designed around the military approach for its primarily military style. The focus is on dissolving a teen’s individual focus with a new focus on their place within a (fighting) system. Boot camp programs for teenagers have been shown to be effective in short-term behavioral change, with incarcerated juvenile offenders, but the model’s efficacy requires continuing oversight.
Because All Kinds of Therapy intends to inform on private placement and parent-choice programs, does not recommend this approach to working with troubled teens or young adults. If you want to find a therapeutic, outdoor intervention, a completely different approach than the “boot camp” model, look at the wilderness therapy approach.
BPD is most easily distinguished for observers by the person’s inability to regulate their emotions, meaning relationships are fraught with excessive drama. “People with BPD often have intense and stormy relationships. Attitudes toward family, friends and loved ones may shift suddenly. Relationship problems are common and the behaviors are difficult for loved ones to manage effectively.” (National Education Alliance for Borderline Personality Disorder)
Repeated aggression, in the form of physical, verbal, and now electronic harassment, has deleterious effects on children’s physical health, sleep and eating patterns, academic success and sense of self. Communities, and parents, are beginning to interrupt the expectation that this is an acceptable rite of passage and many schools have impressive anti-bullying policy and enforcement.
The Child Trauma Academy (CTA) is a not-for-profit organization based in Houston, Texas working to improve the lives of high-risk children through direct service, research and education. http://childtrauma.org/about-childtrauma-academy/
Christian Therapy or Counseling, is an approach that works with clients through the lens that God -- Father, Son and Holy Spirit and Biblical Scripture -- are the guiding forces from which to draw wisdom and strength and work through whatever the struggle may be. The key to Christian Therapy or Counseling is that you must believe in the guiding principles. There are also Pastors (who are not licensed therapists) who might work with families through the Christian Counseling programs. Like all types of counselors, it is important to understand their training and to inquire if they are licensed.
Residential Treatment programs may also include “bible-” or “God-centered”, or "philosophies and practice”, with varying levels of adoption expected. For some programs, “turning yourself over to Christ” is required and all the staff personnel are Christian believers. Other programs provide more flexibility in practice, though spiritual guidance is provided as part of the base program model. For the purposes of residential treatment program listings on this website, integration of licensed therapists and outcome based treatment approaches to achieve the licensure by the state is required. It is important that if you are interested in these treatment programs and approach, you visit the program and ask these questions to confirm they meet your expectations.
There are programs that focus on treating Chronic Pain. Because recovery from chronic pain is rare, treatment focuses children, adolescents and adults on managing with medical, biofeedback and therapy. Chronic pain can last for weeks, months, and even years. It does not always ease with medication. Chronic pain can have a distinct cause, such as a temporary injury or infection or a long-term disease. However, some chronic pain does not seem to have a cause. Like depression, chronic pain can cause problems with sleep and daily activities, reducing your quality of life. Chronic Pain can also be tied to Substance Use Disorders and can co-occur with Depression.
The key to treatment and recovery has been a holistic approach and a treatment center that focuses on the specific type of Chronic Pain that is experienced.
Conceptualized as the unconscious willingness to enable a partner’s alcoholism, the definition has expanded to include anyone in a relationship of dependence. 12 Step and other support groups intentionally push participants to recognize and discuss their accountability for feeling “needed”, as a counter for codependency.
Like most other behavioral psychotherapeutic models, CAT supposes that a person’s aim-directed activity is the consequence of ordered sequences of aim generation, environmental evaluation, plan formation, action, evaluation of consequences and, if necessary, remedial procedural revision.
Psychopathology develops when some procedures continue because of revision errors. CAT uses the jargon of “traps”, “dilemmas” and “snags” to define these procedural “flaws”.
CBT is founded on the perspective that the way we perceive something may actually be the reason we understand the situation in the way we do, so that the client’s focusing on the present and problem-solving can generate a more client-satisfying interpretation of the outside world and the future.
CBT teaches skills for the client to recognize thinking errors and distorted thinking.
Founded in 1966, CARF accredits over 55,000 different types of Aging Services, Behavioral Health, Child and Youth Services, Employment and Community Services, Opioid Treatment Programs, and many wilderness therapy programs, etc. There are several different options for accreditation: Options include 3-Year Accreditation, 1-Year Accreditation, Provisional Accreditation, Non-Accreditation, Preliminary Accreditation. Analogous to OBHC’s accreditation for wilderness therapy providers, CARF is an independent, nonprofit organization offering third-party accreditation to residential facilities in the private-treatment field. CARF provides a standard of business and treatment practices for members to meet, and during an exhaustive on-site survey, assures an applicant achieves their standard. CARF accreditation can cover 3 years (or 1 or Provisional) accreditation.
The Council on Accreditation (COAnet.org), founded in 1977, is a small but expanding international, independent, nonprofit agency that accredits Human Service Organizations. COA’s mission is “to partner with human service organizations worldwide to improve service delivery outcomes by developing, applying, and promoting accreditation standards.” COA accredits the full continuum of child welfare, behavioral health and community-based social services. Their accreditation assures the administration (HR, outcomes, risk-management), Service Delivery and Standards (client care) are set at a high bar.
Self-injury and self-harm are deliberately harming one’s own body to cope with emotional discomfort. It is not intended as suicidality, as the act of self-injury relieves the stressor, temporarily; it can become repetitive, induces shame or hiding, can cause scars and serious injury. Cutting often is done in places (upper thighs, back) that are difficult to discover inadvertently.
The diagnosis of depression follows two (2) years of persistent symptoms of hopelessness, irritability, fatigue and ennui, possibly including suicidal thoughts or attempts. “Major depressive disorder is one of the most common mental disorders in the United States.” After other possibilities are controlled (thyroid, heart conditions, substance abuse, etc.), treatment for depression likely includes medication and psychotherapy; most prescriptions require 4-6 weeks to reach the effective dose. (For unresponsive severe depression, ECT has shown to be highly effective, with few long term side effects.)
The Mayo Clinic lists numerous post-considerations in combating alcoholism (and other addictions), after the substance is no longer accessible and detoxification has safely completed. These other considerations include individual and family-systems training, a spiritual practice, medical and psychological treatments. Detoxification often requires medical supervision, related to length of use and the dependence of the body on the substance; alcohol and opioids are particularly dangerous during withdrawal. In all situations re: detox, seek professional medical advice.
Many families wanting a clinician, pediatrician, or psychiatrist for a particular diagnosis starts with the medical professional known to them. The family doctor or family therapist may refer to professionals (such as endocrinologists, neurologists, psychologists) able to perform formal testing to confirm or clarify a particular diagnosis. If investigating possible therapeutic disorders, (neuro)psychologists can perform tests to assess a differential diagnosis (ie mental or behavioral changes, depression, etc.), to provide a baseline of information against a particular treatment, reveal daily functioning (i.e., to understanding cognitive or behavioral treatment or types of therapy that could be needed)
Caveat: if a teen is seeing a clinician for assessment and diagnosis or having formal testing, the assumption is that the student is healthy (i.e., not intoxicated or on recreational drugs, is well rested), is somewhat interested and engaged in the 2-5 hours of testing.
For the purposes of this website, many treatment facilities which specialize in Diagnosis and Assessment provide clinical oversight and many have formal assessment pieces too, but the key difference is that the participant is not experiencing success in a home environment and is in an intentional residential or wilderness therapy setting, because the participant is not interested or engaged in their process. These settings allow for stabilization of the client to ensure the participant is psychiatrically and behaviorally stable before valid assessment and diagnosis can occur.
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The first of 4 pillars of Dialectical Behavioral Therapy focuses on skills training, to help the client practice acceptance and to become familiar with living with cognitive dissonance through the behavioral skills of Zen Buddhism mindfulness. These skills promote Mindfulness, Distress Tolerance, Interpersonal Effectiveness and Emotion Regulation.
“dialectical” means the synthesis of opposites and helps describe the skill and the mission of this therapy - the practice and goal is to simultaneously accept the current situation while acknowledging that it must change. DBT was initially created to work with chronically suicidal borderline clients, and entails 4 major aspects: behavioral skills training, phone coaching and individual therapy and lastly, therapist support through ongoing consultation. While DBT has been shown to be effective in drug dependence, depression, PTSD and eating disorders, it is commonly the first and foremost milieu for borderline treatment. DBT has been designed for outpatient therapy, but some residential treatment facilities have used it and have significant training and are listed in the Behavioral Tech Directory. Some of the programs on this site are listed.
Overcoming a drug addiction requires will power, possibly requires medical support (see Detox), individual and group addiction-specific therapeutic support, extensive practice with coping skills and relapse prevention. Self-help support groups, often using the 12 Step model or other group support, help decrease the sense of shame and isolation that can trigger a relapse. The need and acceptance (not to mention the economic expansion) of sobriety residential programs underlines the value for structure, experience and community for the most-difficult early cravings. Because almost ⅔ of clients diagnosed with substance dependence disorder have a co-occurring mental disorder, programs must include integrated treatment with different types of therapy woven into the treatment process. “We are also increasingly learning that these poorer outcomes result as much from these separate and contradictory systems of care as from the diagnoses themselves…”
Any psychological difficulty combined with drug or alcohol addiction is qualified as “dual diagnosis”, as both disorders combine to create a sum very different from the individual parts and treatment of dual diagnosis is more complicated. Many people with mental illness “self medicate” with drugs or alcohol, and are therefore very susceptible to develop dependence.
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The Equine Assisted Growth and Learning Association (EAGALA) model of equine therapy is renowned for its structure, code of ethics, adaptability, and proven success. It focuses on a team approach between the horse, the equine specialist, and the mental health professional to create opportunities for the clients to work through challenges and figure out solutions for themselves. The goal of this approach is to help the client realize that he or she has the ability within to solve problems and overcome obstacles.
An eating disorder is the consistently unhealthy relation to ingesting food, either eating too much, followed by purging (via vomiting, excessive exercise, laxatives, dieting, etc.) or anorexia (or self-starvation), where the sufferer has a motivating irrational impression that they weigh more than others can see. Similar to drug addiction, the first step in Eating Disorder treatment is controlling the immediate environment - getting compliance behavior around a healthy weight, containment from purging behaviors, CBT and group therapy to help reduce discomfort and gain support, and nutritional counseling. Long-term maintenance for more severe sufferers is available with 12 Step models and other group support.
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An educational therapist recognizes a child's current learning challenge, understands the coping mechanisms that previously “worked” to mask the learning challenge, and then helps build the child’s confidence and competence from the point where true learning stopped and masking began.
This professional diagnosis of a learning disability helps reframe behaviors that are often mischaracterized as the child’s opposition or distractedness.http://childmind.org/article/what-is-an-educational-therapist
In the last decade, interest around and research into the client-horse bond and using horses to develop self-sufficiency, self-confidence and overall feelings of well-being have been prolific. In a 2005 article called “New age or old sage? A review of equine-assisted psychotherapy”, Karen Frewin and Brent Gardiner pointed out that because horses are prey animals and therefore remain alert to potential threats, they are sensitive to incongruence between overt and emotional messages from their human counterparts; because they are both herd animals and very large, horses are quite responsive to physical touch, voice volume and tone, and these animals provide a wonderful mirror for experienced therapists to utilize.
Executive Functioning is the constellation of higher-order processes that allow adults to consider the “Big Picture” and strategize, and delay gratification; in general, it is the ability of the brain to plan, organize, remember, manage time and remain flexible, when necessary. Many sufferers of emotional or learning disabilities do not have this combination of functions, but good interventions help accommodate and improve for deficits as well as improve the fundamentals. With ... neuroimaging and other technologies, we now know that the last major growth spurt of the brain, fully wiring the critical prefrontal cortex, takes place around the ages 19 to 25. This frontal lobe development makes possible the kind of thoughtful reflection that is a hallmark of adulthood, in contrast to [normal] adolescent impulsivity and reactivity.” Deficits in executive function are hallmarks of learning disabilities, mood disorders, autism spectrum, and can be argued as a cause for some “complicated launching” (Sophia K. Havasy, Ph.D, “Brain Development and Executive Functioning”)
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Exposure Response Prevention Therapy (ERP) is one of the typical methods of therapeutically and systematically “habituating” patients who suffer from OCD, as traditional talk therapy has not been shown to be effective. The ERP strategy requires the patient to tolerate small amounts of stressor, and to reduce the power of a recurrent and emotional compulsion through staged reduction; in essence, ERP retrains the client’s brain through desensitization that the neurochemical signals that presently translate to full panic instead mean there might be danger, and eventually that the trigger may have no significant meaning for the client at all.
Expressive Arts include the many models of therapy that focus on the act of creating, rather than the end product. This includes acting, imagination, dance / movement; “alongside talk therapy, or in some cases, exclusive to talk therapy, clients are encouraged to explore their responses, reactions, and insights via pictures, sounds, explorations, and encounters with art processes.” (Good Therapy.org)
This fascinating and powerful therapy was discovered by Francine Shapiro, Ph.D in 1987, following her own realization that moving her eyes back and forth gave her stress-reduction. EMDR developed as a tested, reliable treatment that relies on aural, visual and/or kinesthetic bilateral stimulation during talk therapy, which helps the patient discuss trauma and emotional content but prevents the brain from over stimulating. Shapiro calls this process “adaptive information processing”.
FAILURE TO LAUNCH, is a pejorative jargon term used in two different ways: for 18 + year olds who withdraw from college due to performance problems, or the college grad who moves home and is not motivated to move out. Both of these situations might be symptoms of anxiety, depression, executive functioning weaknesses, social skills weaknesses, entitlement, or lack of life skills. Many of the young adult treatment options have tracks or specifically focus on developing life skills, treating the underlying psychological weaknesses and successively increasing challenges on young adults toward their full independence.
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The Family Choice Behavioral Healthcare Interventions Industry (FCBHI), also referred to as “private-pay” treatment providers focus on the treatment/recovery options for teens and young adults who are primarily going to pay for the treatment out of pocket and not through an insurance-driven model. This subset of the larger Behavioral Healthcare industry has many boutique treatment centers that are owner run and operated that specifically focus on troubled teens and young adults. In 2016 the first economic impact study was completed, estimating that in the state of Utah alone, FCBHI brings in over $423 million each year. This was a low number because of many different factors from the economic modeling that was used by the University of Utah. However, this number is the only benchmark for the FCBHI, to over 3 billion dollars annually on a national level. Many of the FCBHI industry members are also members of NATSAP and OBH
Note: some of these treatment providers like Wilderness Therapy programs are becoming more successful with insurance reimbursement in 2017.
Given in 21 sessions over a 9 month period, Family Focused Therapy is a therapy for Bipolar Disorder consisting of sessions 1 - 7 covering psychoeducation about BD and then focused Communication training on expressing positive feelings, listening, requesting changes and constructive anger expression. Sessions 15-21 conclude with problem-solving skills.
Maudsley Method or Family-Based Treatment (FBT) that is designed to treat anorexia nervosa (AN). This type of treatment was conceived by a team of child and adolescent psychiatrists and psychologists at the Maudsley Hospital in London.
There is a great deal of research that has been done at the University of Chicago and Stanford in this country to show the efficacy of the this type FBT treatment.
The Maudsley approach is a type intensive outpatient treatment (IOP) where the family is an active and positive role in the child or adolescent's treatment. The goals are around restoring the child’s weight to normal levels for age and height; give the control to eating back to the child and encourage typical adolescent development through an in depth discussion and the developmental issues that pertain to each particular child.
There are three phases to the Maudsley Approach that are within 15 - 20 treatment sessions over a 12 month period.
Phase I: Weight restoration
Therapist focuses on the dangers of severe malnutrition associated with AN.
Phase II: Returning control over eating to the adolescent.
This phase of treatment is about the adolescent taking more control over their own eating.
Phase III: Establishing healthy adolescent identity
This phase does not begin until the adolescent is able to maintain weight above 95% of ideal weight on her/his own and self-starvation has ended.
Read more about all three phases here.
Gambling addiction (also called gambling disorder, compulsive gambling or pathological gambling) is the first process addiction disorder to be formally recognized by the American Psychiatric Association (APA). In the latest edition of the APA’s diagnostic manual, the DSM-5, gambling addiction is grouped together with substance use disorder. Gambling addiction is defined as “persistent and recurrent problematic gambling behavior” leading to significant psychological, social or occupational dysfunction. According to the diagnostic criteria in the DSM, gambling addiction is associated with a preoccupation with gambling, a need to bet more money more frequently, restlessness or irritability when attempting to cut down on gambling activity, “chasing” losses, and the continuation of gambling behavior despite obvious negative consequences.
Submitted by: Cosette Rae, MSW, LICSW, ACSW, CDWFCEO, Founding Member, Program Director, reSTART
Generalist Programs - For the purpose of this website, the generalist residential programs provide stability and structure but with the emotional competence necessary for treatment of general teenage and emerging young adults issues; they do not intentionally accept the myriad more complex diagnoses that require specialized populations or treatment structures.. The programs in this category have varying levels of care from the most restrictive to the least restrictive.
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The Good Lives Model offers a respectful and engaging treatment model for sexual offenders. “A central assumption of the GLM is that offending results from problems in the way an individual seeks to attain primary human goods… (for example, happiness, relationships/friendships, and experiencing mastery in work and leisure activities). Identifying the primary goods that are most important to clients, and those that are implicated in the offence process, constitutes a fundamental component of assessment because treatment explicitly aims to assist clients to attain these primary goods in personally meaningful, rewarding, and non-harmful ways in addition to addressing re-offence risk.” (From the Visiting Experts presentation, Ward, Yates, & Long, 2006; Yates, Prescott, & Ward, 2010; Yates & Ward, 2008; http://www.unafei.or.jp/english/pdf/RS_No91/No91_10VE_Prescott.pdf.)
Drs. John and Julie Gottman’s couple therapy “supports and repairs troubled marriages and committed relationships, but strengthens happy ones.” In finding that couples’ interaction had enormous stability over time, they also discovered that most relationship problems (69%) never get resolved but are “perpetual” problems based on personality differences between partners. Gottman Couple Therapy evolved out of Dr. John Gottman’s early lab and the research/evidence-based underpinnings continue to reinforce this methodology.
Intellectual Disabilities are characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills. This disability originates before the age of 18.
Intellectual functioning (known as “intelligence” or as IQ) is a measurement of learning, reasoning and problem solving. Disability requires an IQ score of 75 or below.
Adaptive disability can be measured within three areas of behavior:
conceptional - language, literary, measurement of time, money, math and self direction
social - interpersonal skills, social responsibility, self-esteem, social problem solving, and the ability to follow rules/obey laws and to avoid being victimized
practical skills - daily living, occupational skills, transportation, schedules, safety, use of money, communication on the phone or computer.
paraphrased from http://aaidd.org/intellectual-disability/definition#.VPSbQbPF8fg
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Internet Gaming Disorder (IGD) is the newest member of the process addiction family, and replaces the term Internet Addiction Disorder (IAD). It has received an increasing amount of attention in recent years, and has come to encompass a wide variety of maladaptive behaviors, including problematic video gaming, internet gambling and pornography consumption, compulsive online shopping, and excessive social networking. Internet addiction often co-occurs with a wide variety of psychiatric symptoms, including insomnia, depression, anxiety, obsessive-compulsiveness, and substance use, and is associated with social isolation, poor interpersonal relations, family instability, and low academic performance. (Source: “Exploring Internet Addiction as a Process Addiction,” Journal of Mental Health Counseling: April 2016, Vol. 38, No. 2, pp. 170-182.)Submitted by: Cosette Rae, MSW, LICSW, ACSW, CDWFCEO, Founding Member, Program Director, reSTART
An intervention is essentially an “interruption” to promote a reframing of the current situation. An intervention is a structured process that breaks the cycle of dysfunction, typically used to interrupt dynamics associated to the disease of addiction, though responsive toward other relevant maladaptive behaviors, paraphilic disorders, and other compulsive behaviors. (Maladaptive behaviors can range from substance use disorders, paraphilic disorders, and other compulsive behaviors.) The intervention aims to guide the resistant “identified patient(s)” to identify self-destructive behaviors, and how those behaviors impact themselves, family, coworkers, and friends. The ultimate goal of this process is to guide the individual(s) towards treatment.
An interventionist is a professional who helps “intervene” on a maladaptive system. Interventions provide a novel and effective approach when a client is treatment-resistant, however this is not their only function. Typically working with the families, employers or concerned Others, the interventionist works with the group to help identify realistic treatment options based on need, diagnostics, and benefactor. Forming a united front based on concrete goals, the newly formed group will help guide the afflicted individual towards treatment.
From an educational lens, the interventionist will provide direction and guidance on how to heal the system from the behaviors that are causing distress. Treatment can come in many forms, from coaching, intensive outpatient, residential, detoxification, long term care, and in some cases moderation.
An interventionist should be able to do the following:
- Assess the situation (family, workplace, lifestyle) to determine the level of care.
- Determine treatment options and unify the system that is concerned (family, workplace, friends).
- Educate the system on how to appropriately approach in a non-threatening way.
- Provide options for safe passage to treatment.
- Assist the family in making decisions on how to move forward regardless on if the identified patient enters treatment.
An interventionist should be licensed or certified through a credible agency such as the Pennsylvania Board or the Certified Intervention Professional (CIP). Ideally, the interventionist will have been exposed to ethical training and will be transparent with a client if there are any dual relationships (employed by a treatment center, owns a treatment center, paid by a treatment center for speeches, etc).
AUTHORAdam McLean holds a master’s degree in Clinical Psychology and a bachelor’s degree in Marketing. He is working towards his PhD in Clinical Psychology from California Southern University. Additionally he is a Certified Intervention Professional (CIP) with the Pennsylvania Control Board. He is currently the Executive Director of Life of Purpose in Phoenix, Arizona, which means he is overseeing the developing of Life of Purpose in Phoenix, AZ and serves as a liaison to families and the professional community. Adam has a wide variety of experience, from community mental health, to long term extended care, to an outdoor adventure therapy program with traditional treatment modalities for treatment of substance abuse. Additionally, Adam works with the National Association of Drug Court Professionals (NADCP) to establish alternative sentencing for chronic drug offenders.
The Joint Commission, founded in 1951, accredits several different types of healthcare organizations including hospitals, doctor’s offices, nursing homes, office-based surgery centers, behavioral health treatment facilities and providers of home care services with a total of over 22,000. Their mission is to: “To continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.” They provide specific “best-practice” standards from infection control and medication management through intervention documentation and outcomes testing (an example); their “Gold Seal” accreditation to deserving Behavioral Care facilities covers the facility for a three year period.
The Joint Commission publishes information about its members to any inquiring parent, with the Quality Check website (www.qualitycheck.org). Caveat: the measures are reported on one specific aspect of care. The care patients receive at any facility or program depends on many different factors. The Quality Report is one tool to assist individuals in selecting health care services. Individuals should discuss the Quality Report and its contents with their health care providers to make informed choices.
“A learning disorder is a disorder that affects a person's ability to acquire and use academic skills, such as reading and calculating. Learning disorders aren't the same as mental or physical disabilities, and don't reflect a child's intelligence. Instead, learning disorders affect a child's ability to complete a task or use certain skills, particularly in school.”
LifeRing is another alternative to the 12 Step AA/NA model. LifeRing promotes an abstinence-based approach to recovery. They are a support group and their meetings are confidential. They believe that the power to be sober and lead a sober life is up each person’s “ sober self.” “You can get clean and sober regardless of your belief or disbelief in a 'higher power.' We welcome people regardless of their 'drug of choice.' We encourage cross-talk in meetings.
The dried leaves of a hemp plant that contain THC, the psychoactive ingredient released by smoking or ingesting the marijuana. Marijuana possession is still federally prohibited but many states are experimenting with and a few have decriminalized ‘personal use’ possession. There are a lot of slang terms for marijuana and the various different types, like Mary Jane, chronic, & 420.
Because nutrition and food become a battleground for families where a child suffers anorexia, bulimia or other eating disorders, Meal Support Therapy helps bring the parents into the treatment, and highlight the thoughts and feelings around food and meals that the patient experiences. MST also provides many strategies to move from “forcing” to actively assisting a new interaction with mealtime. MST includes role-modeling, boundary-setting, communication and coaching skills.
Medication Assisted Therapy (MAT) combines typical behavioral therapies with specialized medications to treat substance use disorders and tobacco. “Medications are primarily used to treat substance use disorders related to opioids and alcohol. Among the most commonly used medications are Methadone, Buprenorphine, Naltrexone, Acamprosate and Disulfiram.” (http://www.socialworktoday.com/archive/novdec2007p40.shtml)
Research is available at http://www.samhsa.gov/medication-assisted-treatment
A detailed overview of how MAT is provided is found at http://www.socialworktoday.com/archive/091514p30.shtml
This ancient practice of quiet and intense single-minded focus as a practice of spiritual acceptance has gained serious inroads in therapy and therapeutic programming, as a vector for reducing anxiety and impulsivity, promoting peacefulness, compassion, and an “indestructible sense of well-being”.
Moderation Management (MM) is another alternative to 12 Step. The key to this model is it is for those who are not at a crisis point and are interested in assessing where they are in terms of needing help with alcohol or drug use. These are the six assumptions of MM:
Problem drinkers should be offered a choice of behavioral change goals.
Harmful drinking habits should be addressed at a very early stage, before problems become severe.
Problem drinkers can make informed choices about moderation or abstinence goals based upon educational information and the experiences shared at self-help groups.
Harm reduction is a worthwhile goal, especially when the total elimination of harm or risk is not a realistic option.
People should not be forced to change in ways they do not choose willingly.
Moderation is a natural part of the process from harmful drinking, regardless of whether moderation or abstinence becomes the final goal. In other words, most individuals who are able to maintain total abstinence first attempted to reduce their drinking, unsuccessfully.
Moderation programs shorten the process of "discovering" if moderation is a workable solution by providing concrete guidelines about the limits of moderate alcohol consumption.
Clinically, “mood” refers to a persistent emotional state that affects perception, rather than simply the passing feeling. And so a mood disorder primarily refers to depression and mania, and bipolar experiences (see also PTSD). These mood states profoundly affect relationships and work performance. Regularly, sufferers use psychotherapy and often medication to stabilize their moods.
Motivational interviewing techniques are used in MET to help people who presently express ambivalence about drug use generate clearer principles and resistance. MET has shown efficacy in alcohol and marijuana treatment, with less success with methamphetamines. “In general, MET seems to be more effective for engaging drug abusers in treatment than for producing changes in drug use.”
A critical difference in MI is the collaborative intent, that therapy using MI is not an expert-client approach, is not goal-oriented or psychoeducational but rather intends a very different relationship that is more team-oriented.
Narrative Therapy seeks, by developing mutual agreement between therapist and client that the memory and story is nonpathological, to use the act of telling the story as part of the resolution of the dysfunction. In telling and retelling the narrative, the client is asked to include the “absent but implicit” threads,
“Rather than transforming the person, narrative therapy aims to transform the effects of the problem.” (http://www.goodtherapy.org/narrative-therapy.html)
in the presentation of a problem. By exploring the impact of the problem, it is possible to identify what is truly important and valuable to a person in a broader context, beyond the problem.
National Association of Therapeutic Schools and Programs (NATSAP) is a non-accrediting association of treatment providers spanning a range of acuity and approaches to treatment for troubled teens to young adults. NATSAP includes therapeutic boarding schools, residential treatment programs, wilderness therapy programs, aka outdoor therapeutic programs, young adult programing and home-based programs. NATSAP was founded in 1999 with the mission to develop and support best-practices and ethics among its member programs. NATSAP requires its members “to be licensed by the appropriate state agency authorized to set and oversee standards of therapeutic and/or behavioral health care for youth and adolescents or accredited by a nationally recognized behavioral health accreditation agency and to have therapeutic services with oversight by a qualified clinician.”
NATSAP is running a long term study with the University of New Hampshire. Many of its members are part of of this study and are designated as “Research Designed Program (RDP).
Neurofeedback is an interactive biofeedback arrangement that allows clients to visualize the brain in vivo, and allegedly helps the viewer to train the brain to behave differently. While results are still controversial, some success has been reported in treating ADHD, epilepsy and some families are trying neurofeedback as a substitute or supplement to psychopharmacology.
Nonpublic School (NPS) is a designation by the state of California in a private, nonsectarian school that is certified by the state to provide special education services to students based on their Individualized Education Plan (IEP). These schools provide an environment, that provides treatment for students who are struggling academically, behaviorally and socially. Many of the treatment programs listed on this website under Teens have this designation. Some states (e.g., CA http://www.cde.ca.gov/sp/se/ds/osplacmntrpt.asp) also require explicit academic standards, if not CA licensed.
Many states have lists of treatment facilities in state and out of state that are approved as temporary alternatives for the state-required (“typical”) adolescent educational track, though each state may call the “lists” something different. The path to a family placing their child in a treatment facility out of state can be arduous.
A nonverbal learning disorder is characterized by a significant discrepancy between high verbal skills and lower motor, and visuo-spatial skills on an IQ test. Because of guarding the deficiency and superior skills at verbal communicating, NVLD people often are verbose; they may “think out loud” and a common complaint is that they “talk too much”. “The NLD syndrome reveals itself in impaired abilities to organize the visual-spatial field, adapt to new or novel situations, and/or accurately read nonverbal signals and cues.”
“Although there is growing awareness of this condition, NVLD is controversial in medical circles. It does not appear in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)”, (the 2015 update doctors, psychiatrists, and therapists use to diagnose all types mental illness and disabilities on the spectrum).
Outdoor behavioral healthcare is the prescriptive use of wilderness experiences by licensed mental health professionals to meet the therapeutic needs of clients. The Outdoor Behavioral Healthcare Council and its member programs have been instrumental in raising the bar for wilderness treatment, facilitating research on the efficacy of wilderness treatment for adolescents, and in promoting the industry.
Outdoor Behavioral Healthcare (OBH) consists of:
• Extended back-country travel and wilderness living experiences long enough to allow for clinical assessment, establishment of treatment goals, and a reasonable course of treatment not to exceed the productive impact of the experience,
• Active and direct use of clients’ participation and responsibility in their therapeutic process,
• Continuous group-living and regular formal group therapy sessions to foster teamwork and social interactions (excluding solo experiences),
• Individual therapy sessions, which may be supported by the inclusion of family therapy,
• Adventure experiences utilized to appropriately enhance treatment by fostering the development of eustress (i.e., the positive use of stress) as a beneficial element in the therapeutic experience,
• The use of nature in reality as well as a metaphor within the therapeutic process, and
• A strong ethic of care and support throughout the therapeutic experience.
As outdoor behavioral healthcare, also know as Wilderness Therapy, became more favored as a treatment option for troubled teens in the 1990’s (and later pre-adolescents and young adults), avoidable and sometimes fatal accidents occurred in the backcountry. As the field diversified, a newer cohort of treatment owners and researchers recognized that collaborating with state regulators and additional self-regulation through shared best practices, and scientific examination (outcome based research), would protect clients and families and improve long-term efficacy.
The OBH Center is a group of “... research scientists [who] are licensed clinicians who hold a faculty position at a university, possess a Ph.D, and have a minimum of two years of ‘mud on their boots’ from experience working in outdoor behavioral healthcare.”
An Obsessive-Compulsive Disorder diagnosis requires obsessions and compulsions that are "time-consuming" (take more than one hour each day) and are not explicable by other diagnosis, or by virtue of substance use or medical condition.
Obsessions are thoughts that are unwanted, intrusive and persistent and the patient seeks to cope by performing a compulsion.
Compulsions are unvaried, ritualized procedures (like excessive hand-washing, locking and unlocking and relocking of door; "irrational" behaviors like avoiding cracks in sidewalk; repetitively touching a shoe or hairpiece; fervent praying, rote recitations, etc) that are necessary to counteract the obsessive trigger.
"The Network/La Red is a survivor-led, social justice organization that works to end partner abuse in lesbian, gay, bisexual, transgender, S/M, polyamorous and queer communities. Rooted in anti-oppression principles, our work aims to create a world where all people are free from oppression. We strengthen our communities through organizing, education, and the provision of support services."
While the very role of children is to “individuate” from the parents, ODD is a pattern of persistent (more than 6 months) defiance and hostility toward authority figures and structure, and these people are aggressive toward peers, as well. Persons with ODD recognize the upset and annoyance in the family system, but are not accountable for this - in fact, they may complain of being unduly controlled and oppressed. “Treatment can help restore your child's self-esteem and rebuild a positive relationship between you and your child. Your child's relationships with other important adults in his or her life — such as teachers, clergy and care providers — also will benefit from early treatment.”
There have been four major changes to the ODD diagnosis in the DSM-5 & those can be viewed here.
PDD Not Otherwise Specified (PDD NOS) was broken out as a separate disorder. It is also sometimes interchangeable with Autism Spectrum Disorder (ASD). And like other diagnosis it has a wide range of intellectual functioning. Most of its defining features are with social challenges in social and language development. With the publication of the DSM-5 it is now part of Communication Disorders. “Some of these include language disorder (which combines DSM-IV expressive and mixed receptive-expressive language disorders), speech sound disorder (a new name for phonological disorder), and childhood-onset fluency disorder (a new name for stuttering). Also included is social (pragmatic) communication disorder, a new condition for persistent difficulties in the social uses of verbal and nonverbal communication.”
Primarily practiced with 3 -11 year old children, play therapy utilizes developmentally appropriate activities and imagination designed to communicate in the “language” of the young child, in order to help identify and help resolve psychosocial complications.
Positive Peer Culture (PPC) is a milieu driven residential treatment model described in 1985's Positive Peer Culture by Harry Vorrath. His book described his pioneering model as primarily peer driven, with students holding one another accountable. Vorrath posited that this change can happen through “self worth, significance, dignity, and responsibility only as they become committed to positive values of caring and helping of others” (page xi). The key to a Positive Peer Culture model is the training that the staff receive and the common language that is spoken amongst the staff to the students. Many residential settings have pieces of PPC, but a program that is all PPC, lives and breathes the language and the values.
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What originally was described as “shell shock” by the military, PTSD is the constellation of symptoms due to trauma (war experience, physical violence, or other events), creating a psychological and perceptual alteration. PTSD is characterized by depression, anxiety, flashbacks and recurrent nightmares, with active avoidance of reminders of the event. Because of PTSD’s generalizing character, psychotherapy and anti-anxiety medication can be extremely helpful in treating the effects. Very recent research suggests that some of the symptoms (e.g., jumpiness aspect of anxiety) may stem from an “... alteration of genes, induced by a traumatic event, changes a person's stress response and leads to the disorder," said researcher Sandro Galea, MD.
Process addictions are compulsive behaviors accompanied by social and emotional (the feeling that is brought on by the behavior), and occupational dysfunction. They can involve a wide range of activities, such as gambling, eating, exercising, video gaming, spending, working and pornography use. Internet Addiction (previously known as Internet Gaming Disorder), Sex and Love Addiction, and Gambling Addiction function in a manner quite similar to drug and alcohol addiction. Process addictions are frequently associated with classic addiction characteristics, such as tolerance and withdrawal, salience (preoccupation or obsession), and cycles of recovery and relapse. The key distinction for Process Addictions is the addiction is to a behavior rather than a substance (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3354400).
The only process addiction that is currently listed in the DSM-5 is gambling.
Written in conjunction with Cosette Rae, MSW, LICSW, ACSW, CDWF CEO, Founding Member, Program Director, reSTART
In contrast with CBT and other direct clinical relationships between symptoms and behavior reduction, psychodynamic therapy (and “depth therapies”) approaches symptomatology as the result of unconscious dynamics. Freuds’ psychoanalytic theory first described the sexual and aggressive forces of the id, ego and superego competing in one’s unconscious; brief psychodynamic therapy, instead of free association and 2 years of analysis, focuses on one issue and the therapist remains active in structuring the sessions and keeping the client focused.
Psychoeducation is a clinical approach to providing information and guidance about symptoms, treatments and resources, first to help the client directly but secondarily, to provide family-system wellbeing and support.
A distinguishing characteristic of Rational Emotive Behavior Therapy (REBT_ is its ‘active-directive” orientation, with a primary focus on the present time. Dr. Albert Ellis developed this therapy from Stoicism and around “disputing” cognitive thinking errors overtly. Essentially, REBT posits that Adversity - Beliefs - Consequences is a linear formula that is primarily based on the existing beliefs, and that changing these beliefs is the key to contentment.
Jack Trimpey, LCSW, created Rational Recovery in 1986 as an alternative to the popular 12 Step model. In Rational Recovery, there are no meetings, and unlike AA, it is a family-centered approach; participation is private because you purchase the book and the model and work the program by one’s self.
The diagnosis of Reactive Attachment Disorder (RAD) (or the other subtype Disinhibited Social Engagement Disorder refers to the abnormal process of attachment due to social neglect or other situations that limit a young child’s opportunity to form selective attachments. RAD has several criteria that must be met in order to meet the diagnosis according to the DSM-5. Although sharing this etiological pathway, the two disorders differ in important ways.
Because of dampened positive affect, reactive attachment disorder more closely resembles internalizing disorders; it is essentially equivalent to a lack of or incompletely- formed preferred attachments to caregiving adults. In contrast, disinhibited social engagement disorder more closely resembles ADHD; it may occur in children who do not necessarily lack attachments and may have established or even have secure attachments. The two disorders differ in other important ways, including correlates, course, and response to intervention, and for these reasons are considered separate subtypes of the disorders.
“The act or process of becoming healthy after an illness or injury : the act or process of recovering”
Recovery, in the therapeutic world, usually refers to a life-long process of becoming sober (“I am in recovery from alcoholism"). Likewise, in the recovery world, sober persons still refer to themselves as addicts, alcoholics, etc, acknowledging the “one day at a time” condition of sobriety.
Recovery High Schools come in all different shapes and sizes and are located all around the country, ranging from public schools, charter schools and schools where families pay out-of-pocket to attend. The overarching key is that Recovery High Schools focus on providing academic rigor in a milieu sensitive to recovery and sobriety for high school aged students. Learn more about them through the Association of Recovery Schools, which accredits the recovery high schools and provides guidance on how to create a recovery school.
Recovery-Oriented Systems of Care (ROSC) was published in 2010 by SAMHSA to develop a network of community-based services supporting person-centered approaches built on the strengths of individuals, families and communities to achieve abstinence and improve health and wellness for those who are at risk of alcohol and drug problems.
William White’s Overview, http://www.williamwhitepapers.com/pr/CSAT%20ROSC%20Definition.pdf
Recreation therapy improves functioning and skills and thereby provides life satisfaction and long-term wellness by restoring, remediating and rehabilitating clients following injury, illness or trauma.
Once considered a failure of willpower, or an indictment against the treatment model, re-use of drugs or alcohol following treatment occurs in at least 50% of participants and relapse (return to excessive use) occurs in 20-30%. Recent brain-imaging studies show that previous sensitization of (drug) reward pathways makes users far more susceptible to relapse than logic would suggest. Triggers can stimulate the pathway extremely effectively and launch a former user toward use without conscious processing. Because of the predisposition for relapse and possible addiction recurrence, successful treatment includes maintenance (focus on needing recovery, vs. finally being cured), abstinence structure (see Sober Living, 12 Step) and random drug testing, stress tolerance (mindfulness, exercise, etc) and sometimes prescription medication.
RDP is a designation for treatment programs who are members of the National Association of Therapeutic Schools and Programs (NATSAP), to promote the use of efficacy testing among its member programs. To qualify for the RDP designation, programs must either be contributing data to NATSAP’s ongoing “Outcome Research Project”, or the program is efficacy-testing in other scientifically valid measures.
The Outcome Research Project provides a very large dataset on demographics, YOQ changes throughout enrollment, and parent OQ measures over time, as well. Data from actual family participation is “de-identified” and then added to a cumulative dataset managed by researchers at the OBHCenter, who analyze the data for safety and risk management, treatment paradigms across populations, and efficacy studies
The treatment facilities on this site are perhaps not what you are envisioning -- they are not all locked facilities nor sterile institutions -they can be home like settings or ranch/farm settings. There are many different levels of residential treatment for adolescents. (Please see "Questions to guide parents" blog, for deeper investigation into RTCs.)
This website does not try to distinguish between therapeutic boarding school (TBS) and residential treatment centers (RTC). The reason for this is that state governments license schools and programs differently and the labels do not mirror between states; some states do not license adolescent therapeutic programs (read more here). When you are investigating options, you want to compare the facts from this website and then investigate the nuance of a program and the level of care for the developmental level of your child and his/her psychological urgency, and the five areas below:
- Family: How will your family participate in the process? How are family visits done? How long does your child need away from the family system or home setting?
- Psychiatry: Does your child need a psychiatrist on staff or just part of the treatment team and collaborating with the program?
- Activities/Recreation/Milieu: When or does your child leave the campus? What level of supervision in the unsupervised community does your teen need? What sorts of socializing are valuable at this point?
- Education: Does your child need a program that has an integrated education and treatment program? Does your child need need to focus on academic credit recovery?
- Therapy / Group Therapy: Is there group therapy and/or individual? Does your child need more of one than the other? Does your child have the capacity for insight driven therapy or does he need experiential or (peer-supported) group models of therapy?
Making the decision to send your teen to any residential program is one of the hardest decisions a parent or guardian can make. It is strongly encouraged that at least one family member have a formal tour of the program before deciding on a treatment facility. The main reason is while the teen is in treatment there will be positive and negative events; prior to these, you need to visit with the administrators, staff, and students and decide if you can trust the program and process. If your family does not trust the program and the people, it will derail the process. Another reason to visit is to gain a “feel” for the program that no website can give you. And finally, be certain to have the “team” or professional who is working with your teen be part of the assessment of a program.
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Like Play Therapy, Sand Tray was originally designed to help children communicate, and has generalized for adolescent and adult therapy. While clients might build in the sand itself, traditional sand tray includes tiny houses, vehicles, figurines, etc, and the client is able to produce a microcosm in which to enact situations and resolve conflict. Often, the design and interplay within the sand tray is without direction from the therapist, and can reflect unconscious aspects for later analysis.
Persons with schizophrenia suffer auditory and visual hallucinations, general thought disorders and delusional thoughts, straining personal relationships tremendously and making some professional relationships impossible. Schizophrenic symptoms usually emerge from 16 and 30, with very low initial onset after the age of 45. Schizophrenia has a genetic predisposition, can be viral or chemically-induced, and likely has certain brain structures and neurotransmitter relevance. Medication is regularly used to stabilize escalated thought patterns.
Some children refuse school due to social phobia (the debilitating fear of being judged, often for seemingly innocuous behaviors, occurring consistently over weeks), sometimes exacerbated by the challenges of school participation; the typical jostling for social status and/or bullying also exacerbates these children’s anxiety. (see Academic Failure) from NIMH’s nimh.nih.gov/health/topics/social-phobia-social-anxiety-disorder/index.shtml
Seeking Safety is a present-focused treatment for substance abuse, PTSD and trauma that does not include a requirement for investigating the trauma narrative. It has 5 main principles: safety, integrated treatment, focus on ideals, 4 common content measures, and a commitment to therapist self-care.
The Seven Challenges (http://www.sevenchallenges.com) is a drug and alcohol cessation program/philosophy, distinctly different from the 12 Steps. Firstly, the philosophy acknowledges that many younger users/adolescents are not willingly trying to stop using and often find themselves compelled (by involuntary treatment, legal or other life challenges) to reduce use. The Seven Challenges mindset is that because substances often help alleviate emotional stressors, healthy adults - through purposeful, respectful interactions, can quickly help adolescents and young adults develop better skills and thereby provide options for previous obstacle situations. Individual and group counseling components are often included, but the model is highly flexible for the needs of the clients. This treatment model is used by a few of the treatment programs in the FCBHI.
Severe learning disabilities are typically diagnosed at birth or in childhood. A sign of a developmental delay might noticed pediatrician, teacher, or family member and can be the catalyst to prompt a formal assessment. Many of the children diagnosed with a severe learning disabilities have other diagnosis that make finding the right school or program a complex process and sorting out their learning profile.
"Compulsive sexual behavior can be called hypersexuality, hypersexual disorder, nymphomania or sexual addiction. It's an obsession with sexual thoughts, urges or behaviors that may cause you distress or that negatively affects your health, job, relationships or other parts of your life."
Although these are not part of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there are varying treatment centers which are treating love addiction and/or sex addiction for all different ages. There are also treatment programs for adolescents who have issues related to sexual abuse, pornography addiction and related compulsive behaviors. These addictions are sometimes referred to as Compulsive sexual behaviors (CSBs) or hypersexuality or hypersexual disorder.
These disorders are characterized by the inability to set healthy boundaries with regard to emotional and/or sexual attachment. Individuals suffering from love or sex addiction compulsively engage in emotional and/or sexual behaviors as a way to deal with inner issues regarding a fear of abandonment or loneliness or a confusion between love and neediness. For the sex or love addict, these behaviors become destructive to the individual’s physical, social, and emotional well being and often lead to significant consequences such as divorce, legal trouble, or financial difficulty. In the case of children and adolescents the behaviors affect academics, family and peer relationships, especially where isolation and unhealthy relationships with electronics exist.
Submitted by: Cosette Rae, MSW, LICSW, ACSW, CDWFCEO, Founding Member, Program Director, reSTART
Combining the words sex and texting, sexting is the practice of electronically sending sexually explicit images and messages between cell phones; this practice is legal amongst consenting adults. Sexting has become more and more common among teens whose cell phones now have texting and digital camera functions. While consensual sharing is more common between teenagers in a sexual relationship than expected, recent research is also finding girls are sometimes pressured to send pictures. There can be severe consequences: beyond humiliation and the expense and difficulty of interrupting internet distribution if the image is disseminated, teens who are caught possessing these images can be prosecuted for child pornography.
Some of the shorthand of sexting like:
- RU18 -- Are you 18?
- CD9/ Code 9 -- Parent / Adult Around
- NALOPKT -- Not a lot of people know this.
Workshops are intense, short-term group exercises to highlight and grapple with common issues focused on by the individual participants, where each can become aware of and practice challenging old dysfunctional patterns and to formulate support and planning for the future. Generally, these multi-day workshops are held in dramatically natural environments, with plush creature comforts overnight and during meals. There are different types of clinical underpinnings to these programs and it important for a participant to understand their need and if this model will help to meet that need. A workshop might focus on intimate relationships, family of origin issues, shame or trauma or other general topics, with the group working to discover and test concepts that were unspoken or even unconscious; intensity and value builds as the trust and quick honesty (‘congruence’) generates. Workshop facilitators provide the value of a gentle coaching and guidance, and officiate the need for patience and sensitivity as participants rub up against insecurities and the more raw, untested beliefs.
Workshops are inappropriate as primary treatment; however, they can be profoundly valuable for invigorating individuals and families under duress or seeking new perspectives to life’s challenges.
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Sober Living environments or houses are living places for is generally referred to alcohol and drug dependence that provide a place between a rehabilitation center or residential treatment center to either home or a new life in a community. They have their roots in California and are generally not licensed by the state. The Sober Living Network (SLN) is a wonderful place to start.
The essential characteristics include:
- An alcohol and drug free living environment for individuals attempting to abstain from alcohol and drugs
- No formal treatment services but either mandated or strongly encouraged attendance at 12-step self-help groups such as Alcoholics Anonymous (AA)
- Required compliance with house rules such as maintaining abstinence, paying rent and other fees, participating in house chores and attending house meetings
- Resident responsibility for financing rent and other costs
- An invitation for residents to stay in the house as long as they wish provided they comply with house rules.
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Sobriety means different things to different people. Culturally, many tie it to the 12 Step model which means abstinence. However, how a program or model defines sobriety has evolved in recent years. (See Recovery) In legal terms, sobriety refers to a maximum level of intoxication permissible for operating motor vehicles, etc.
Social Life Skills are tied to an individual’s interpersonal skills with peers, family and the public. They are synonymous with one’s ability to problem solve in the moment, read social cues, or ask or explain what is needed for one’s self.
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While the 12 Step (AA model) is an authoritative approach for entrenched substance addiction, there are some compelling reasons why teens with addiction or substance use histories do not connect with it. SOS offers the social construct of 12 Step but in a secular milieu. “All those who sincerely seek sobriety are welcome as members in any SOS group. SOS is not a spin-off of any religious or secular group. There is no hidden agenda. SOS is concerned with achieving and maintaining sobriety or abstinence. SOS seeks only to promote sobriety amongst those who suffer from addictions.”
Also known as “K2,” “fake weed,” “Bliss,” “Black Mamba,” “Bombay Blue,” “Genie,” “Zohai,” “Yucatan Fire,” “Skunk,” and “Moon Rocks.” Spice is a mix of herbs (shredded plant material) and man made chemicals with mind-altering effects. It is often called “synthetic marijuana” because some of the chemicals in it are similar to ones in marijuana but its effects are sometimes very different from marijuana, and frequently much stronger. Generally labeled “Not for Human Consumption” and sold as incense, Spice has been available for purchase stores that sell drug-related products, gas stations, and online. Because the chemicals used in Spice have a high potential for abuse and no medical benefit, the Drug Enforcement Administration has made the five active chemicals most frequently found in Spice illegal. However, the people who make these products try to avoid these laws by using different chemicals in their mixtures. Sellers of Spice products try to lead people to believe they are “natural” and therefore harmless, but they are neither.
Student and Exchange Visitor Program (SEVIS) is an arm of the Immigration and Customs Enforcement Department of Homeland Security, which oversees international nonimmigrant students and exchange visitors in the United States; the special student extension is based on the consistent requirement that both the school curriculum and then the student conforms to strict educational requirements, while the student remains in the United States.
The relevance for treatment is that this bureaucratic approval is tremendously helpful for non-American students to remain in un-interrupted treatment for longer than the typical “visitor” visa would allow.
To meet the clinical criteria for substance abuse, there must be a “pattern of substance use leading to significant impairment or distress, as manifested by one or more of the following during in the past 12 month period:
Failure to fulfill major role obligations at work, school, home such as repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household
Frequent use of substances in situation in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use)
Frequent legal problems (e.g. arrests, disorderly conduct) for substance abuse
Continued use despite having persistent or recurrent social or interpersonal problems (e.g., arguments with spouse about consequences of intoxication, physical fights)”
Programs that tackle substance abuse issues may be 12 Step oriented, rational recovery, CBT and many other approaches to helping users curtail their use.
Different treatment programs and residential treatment assess and work with substance dependence in different ways and some residential settings do not intend to work with substance abuse or dependence at all.
In order to meet the criteria for substance dependence or “significant impairment or distress, as manifested by 3 or more of the following during a 12 month period:
Tolerance or markedly increased amounts of the substance to achieve intoxication or desired effect or markedly diminished effect with continued use of the same amount of substance
Withdrawal symptoms or the use of certain substances to avoid withdrawal symptoms
Use of a substance in larger amounts or over a longer period than was intended
persistent desire or unsuccessful efforts to cut down or control substance use
Involvement in chronic behavior to obtain the substance, use the substance, or recover from its effects
Reduction or abandonment of social, occupational or recreational activities because of substance use
Use of substances even though there is a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
The American Association of Children’s Residential Centers (AACRC) is a national, nonprofit membership association for organizations that provide therapeutic treatment in residential settings.
AACRC is managed under a partnership agreement with the Alliance for Strong Families and Communities.
The OQ-45 measures Symptom Distress, Interpersonal Relations and Social Role Performance. (The OQ-45 is the adult version of the Y-OQ.) “A product of over two decades of research by Dr. Michael Lambert, the OQ®-45.2 is a self-report Outcome Measure designed for repeated measurement of [adult] client progress while in therapy and following termination. The OQ®-45.2 measures three subscales: Symptom Distress (depression and anxiety) Interpersonal Relationships (loneliness, conflict with others and marriage and family difficulties) Social Role (difficulties in the workplace, school or home duties) The subscales are used to identify and target particularly problematic areas as a focus of treatment. The OQ-45 was developed by Dr. Michael Lambert and Dr. Gary Burlingame with more information available at: http://www.oqmeasures.com/ The YOQ & OQ-45 are the primary measures that OBH and NATSAP are using to measure their outcomes. For more information on this, please see interview with Mike Petree. http://www.oqmeasures.com/measures/adult-measures/oq-45/
THE TEACHING-FAMILY MODEL is one of the few evidence-based residential treatment models backed by extensive empirical research. The model views children's behavior problems as stemming from their lack of essential interpersonal relationships and social skills as infants; and that these skills can be learned through teaching based in Cognitive Behavioral Therapy and Social Learning Theory principles. In this model, treatment is provided by highly trained practitioners that can be married couples or single individuals, know as ”teaching-parents”” who provide supervision and comprehensive skills development to students 24/7.
Therapeutic Boarding Schools (TBS) are a type of residential therapeutic program. Most have an integrated education program. TBS is also a type of license that a state will give to a program and each state has different licenses. The reason for this is that state governments license schools and programs differently and the labels do not mirror between states; some states do not license adolescent therapeutic programs (read more here). These schools generally integrate education and varying levels of structure and supervision physical, emotional, behavioral, familial, social, intellectual and academic development. All residential treatment (& TBS) should have an accredited school that can give diplomas or credits that transfer to other secondary schools. The average length of stay for these programs vary widely.
There are two types of therapeutic experts listed on our website: professionals who make recommendations for residential treatment options and school settings, and professionals who take teens and young adults to treatment centers. It is possible that these two types of professionals have both skills.
The key is that these professionals make recommendations, provide case management or support through a process or provide a fee-for-service. It is the family or hiring party who will make the ultimate decisions about which professional to hire, in which treatment facility to place and how to get the teen or young adult to that setting. When you are hiring a Therapeutic Expert, it is important to know the professional's training and credentials, professional relationship, how communication will be handled, and what their process is for working with families in crisis or through an intervention.
Please read more about questions to ask Consultants, Interventionists or Transport Companies on the Blog. There are different ways to perform interventions and being informed of the options is invaluable for your peace-of-mind.
In support of eventual independence, Recovery and “step-down” programs have developed extensive community networks for clientele with support for employment, sports and other interests, “sober fun”, etc., promoting that clients should extend more deeply into the community and away from unnecessary supervision, in their work to develop independence.
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Wilderness First Responder training and certification typically involves 60 hours of Emergency Medical Response [urban skills education] training, often focusing on pre-teen through adulthood emergency care (and specifically not considering infant, gerontological or "advanced" care), with the additional hours spent practicing these skills in a wilderness context, with wilderness-relevant equipment.
WFR training courses therefore train its students to prevent further injury, stabilize patients (improvising as necessary), to communicate authoritatively to front-country medical care and to evacuate the patient to definitive medical treatment as soon as practicable.
Dr. Keith Russell’s opening sentence in his seminal 1999 dissertation bemoaned the lack of specificity regarding the terms “Wilderness Therapy” and so he compiled the similarities of existing programs into this defining group of characteristics: must include sense of adversity, immersion into an unfamiliar environment, natural peer conflict and problem-solving, parental involvement, individual and group therapy and “primitive living” skills, including bowdrill and hiking. In the decades since, the field of therapeutic interventions has expanded and left his original stipulations behind.
While many of the components remain integral, wilderness therapy no longer only refers to nomadic, backpacking groups, but also incorporates basecamp models, expedition programs that occur on ocean-going sailing ships and recently, adventure therapy programs have emerged inside the umbrella of “wilderness therapy”.
The Outdoor Behaviorial Health Council has recently developed an accreditation seeking to update the definition Dr. Russell's early attempt. This is an evolving field.
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Wilderness Therapy is a primary treatment provider. It involves safely intervening, clinically assessing and creating an environment for teens and young adults to self-examine and for treatment to begin. Therapeutic interventions work with students for insight based therapy or experiential therapy depending on the age and experience of the participant. Wilderness Therapy Programs use the natural environment as a major part of the therapeutic milieu to create conversation and evoke change; the adventure or unfamiliar aspects provide fertile dialogue about relationships and intentions and generally focus on group dynamics, individual improvements and safety. As evidence to how far wilderness therapy has evolved from a Boy Scouting trip or a weekend in the woods, this blog will attempt to explain the generalities and then the specific branches of what is commonly referred to as “wilderness therapy”.
Wilderness therapy has developed on top of the philosophies of educator Kurt Hahn’s Expeditionary Learning (now world-renowned as the “Outward Bound model”), where staged learning occurs by virtue of group participation, working through challenge and hardship and the omnipresence of the corporeal world. And because wilderness therapy takes place in the “backcountry”, life has fewer but more logical distractions and potentially more visceral consequences; participants are away from the comforts, distractions and the coping mechanisms of choice - peers, electronics, school, substance(s). So, in contrast to expeditionary learning, how did wilderness therapy develop its popularity and what are the present variations? A major distinction lies in programs’ intentions to provide psychotherapeutic treatment; wilderness therapy borrows as much as practical from the Expeditionary model, but adding professional therapists and a treatment team responsible for attending to participants’ treatment plans. In more explicit terms, Dr. Keith Russell’s 1999 dissertation defined wilderness therapy as including “a sense of adversity and challenge confronting the client; the use of natural reward and punishment allowing authority figures to step back from the role of the provider of consequences; a peer mentoring process; a feeling of group development; physical exercise from hiking and wilderness living; time for reflection; an emphasis on self care and personal responsibility; skill mastery, particularly primitive skills and the making of fire, and a strong therapeutic relationship between the client and staff.” While argument continues in the professional research of what precisely does or does not constitute “wilderness therapy”, individual programs and the industry’s associations now seek to prove which experiences, lengths of immersion, models, specific diagnoses, etc., are the critical aspects that generate the proven “efficacy” of wilderness therapy.
Wilderness Therapy Programs provide a comprehensive clinical treatment plan and a discharge summary and recommendations. Many programs host “niche” groups, reinforced with fitting therapist's’ specializations (analogous to outpatient therapist practices) and attract a very focused membership (trauma-informed, Learning Differences, Eating Disorder, Social Anxiety, as well as substance abuse treatment, pre-adolescents, and primary interventions for “failure to launch” young adults. (Field groups are primarily single-gender for adolescents and coed for young adults and pre-teens).
Nomadic Model Nomadic means that a group intends to remain self-sufficient, works toward group accomplishments and that the student will be responsible for packing his/her own equipment in a fitted backpack for the duration of the wilderness experience. Hygiene occurs in the field. Food (and nowadays, often “city” water) is resupplied periodically for the group; unless a medical emergency comes up, the student is immersed in as complete a “wilderness experience” (24/7 for the entire enrollment) as the program can manage.
The student's therapist drives out to the field for formal weekly group and individual therapy sessions. The therapist may or may not stay overnight with the group. The model and training matter, however, when the therapist leaves, as much of the therapeutic tension and purposeful challenges occur outside of therapy days - during the experiential aspects, and beyond the direct observation of the therapist. For this reason, the instructors/field staff act as critical contributors in the treatment team.
Nomadic wilderness therapy programs might have adventure therapy aspects (ropes course, rappelling, mountaineering, whitewater rafting experiences) built in as brief interventions or as part of the natural progression hiking from one location to another but use the routine and friction that naturally develops in small-group-living to enhance a challenging, safe therapeutic milieu.
Ocean-based sailing wilderness programs qualify as nomadic courses, despite the obvious differences in programming. Students live a remote, therapeutically-moderated small-group lifestyle, with regular group and instructor feedback, psychotherapeutic sessions and restricted communication with the “outside world”.
Base Camp In a base camp model, the adolescent or young adult will return weekly to a base camp, for a shower, to meet with the therapist, and to replenish food supplies. This is a place for the student and the group to refuel, metaphorically and literally. The base camp usually has plumbed water (including toilets, showers) and rudimentary beds - and often a location-specific programming. Base camps provide time and logistical convenience for written work, and is often the locale for visits from parents and other professionals (e.g., psychological evaluators).
There are three subtypes of Base Camp wilderness: Adventure Therapy, Backpacking and Horticulture Therapy. All three of these different models use the wilderness in different ways to effect change. Many base camp programs provide excitement via peak experiences to invite self-reflection. Adventure therapy might involve different experiences where the student will be in a car getting from point A to point B to have the mountain biking, skiing, hiking, or climbing experience. Most base camp backpacking programs will hike the students back to the base camp for hygiene and programming that is tied to the basecamp specifically, though pre-teen programs may transport to basecamps. And finally Horticulture Therapy allows the participant to experience and see change using a sustainability and botanical parallel. In this model, students practice stewardship, develop practical skills focused very clearly on a community’s future benefit and do not move out of the camp for the duration. Horticulture Therapy also provides students real-world consequences for their labors, in that the students are nourished from their own gardens.
Several programs report that their base camp model becomes a “home” like experience for the adolescents and young adults, meaning their maladaptive behaviors from home emerge and become overt at the base camp.
Integrated A lesser-discussed model of Wilderness Therapy includes programs that incorporate wilderness as the first phase of their model. There are not a lot of those out there but it is an option to consider for clients who may not transition well or just need less time in the interventional wilderness therapy program to effect necessary changes (it is always hard, before the intervention, to predict the length of time needed). Programs that have wilderness can always place the student back into the wilderness therapy portion of the program if they need a “tune-up” during their process.
It has become common for students enrolled in wilderness treatment to have an independent psychological evaluation while enrolled, assessing the student academically and revealing any concealed emotional conflicts through psychological projective testing. Typically, the diagnoses revealed from the standardized testing corroborate the clinical impressions and diagnosis of the clinician and field staff in the group, but can add layers of nuance regarding treatment recommendations.
Therapeutic Experts, which are sometimes referred to as Therapeutic Placement Consultants or Interventionists or an Education Consultant understand the nuance and differences between these models in general; the expertise comes in constantly assessing the therapist and model specialization in regards to their client’s need. Consultants must stay informed about the new wilderness diversity available for treating autism spectrum disorder, sensitively helping with trauma assessment, programs designed and working with whole family systems or clinically complex clients, and those trained to confront substance abuse and assessment. Knowing how to tease out what is needed for the client and family and speak about why a model (therapist & program) are being recommended is the expertise that therapeutic consultants bring to an initially confusing and complex dynamic. It is exciting to see change happen with a model as much as it does with the therapist and staff.
Women for Sobriety, founded by Dr. Jean Kirkpatrick in 1976, is another alternative to the 12 Steps. A non-profit organization dedicated to helping women overcome alcoholism and other addictions, Women for Sobriety’s "New Life Program” is designed to help women achieve sobriety and sustain ongoing recovery. They have 13 acceptance statements designed specifically for women.
World Professional Association for Transgender Health (WPATH) is a 501c3 organization of professionals, students and other supporting members working to promote “evidence based care, education, research, advocacy, public policy, and respect in transgender health.” They provide training and Standards of Care for working with this population around the world.
- utilized on a session-to-session basis to track progress and outcome;
- brief, requiring less than 7 minutes to complete;
- sensitive to change over short periods of time; and
- available at a nominal cost.”
The YOQ, developed by Dr. Michael Lambert and Dr. Gary Burlingame, is available at http://www.oqmeasures.com/