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The Ugly Middle– when you know treatment and change is happening

It is not a clinical phase or event, but in 10 years of supporting families through choosing a treatment program and support through the placement — it happens every time.  It occurs when change truly starts happening for the teen or young adult and the family system is called upon to do “their” individual and family work.  It sounds like the uncomfortable moments when the teen complains about the program or looks like your child not doing schoolwork or their emotional work.  It is in those moments that the family feels powerless because the program is telling the family — “you need to hold this line” or “your child can not come home because of x.” Your teenager has become so uncomfortable because their previous, maladaptive coping skills are no longer working and when this happens… you are in the “Ugly Middle.

transitions in treatment for young adults

These elongated moments of discomfort include the referring professionals, as well, because this is the time when families reach out to their referrer to the program, sometimes showing a strong distaste and distrust for that person because it can be the most uncomfortable time and you as a parent feel powerless, frightened, possibly exposed. Or the family wants to save or rescue their teen or young adult from the uncomfortable time and “work” that they are doing. This can be the result  when families rushed the placement, engaged with programs that they do not trust or the family did not visit before enrollment and have struggled to get even to this point — these families may want to pull their child against medical advice (AMA). The intention to fade the Ugly Middle is why you were asked to visit before enrolling and develop some trust with the people and model of your child’s program.  


But this inflection point is unavoidable.  And, it will come again. It is a time when the family system has to look at how they deal with these types of situations and commit to support their child in a new way, rather than rescue.  It can be a terrifying time for all involved because it it now, in this awkward and unstable place,  that the patterns must be reworked and examined and acknowledged and the whole system can then evolve and grow and work. This is the “Ugly Middle” and if you as a family have not had this moment, you are not working hard enough.  Despite the feeling, walk forward; real change is happening and you as a family are growing.  

It feels like your child was sent away, but you have to look in the mirror and you have an opportunity to evolve and change and grow and show your teen or young adult — you are not paralyzed  by change.  


The Ugly Middle can feel very disempowering, but it is a time that you and your family are being supported to change your own patterns as a system and individuals.  

You will make it through this phase.




About the Author

Jenney Wilder M.S.Ed launched All Kinds of Therapy in 2015, as the only independent online directory for the Family Choice Behavioral Healthcare Industry. With an impressive case of ADHD and her starter career in the 90’s in Silicon Valley, the dream for creating a website with features like side-by-side comparison and an integrated newsletter was born. Jenney stopped counting treatment centers and all types of schools that she has visited when she hit 500 many years ago. She was the sponsoring author of the only Economic Impact Study of the Family Choice Behavioral Healthcare Industry, which revealed the only true financial figures about this industry (in Utah). Jenney has a Masters in Special Education from Bank Street College (NY) and a Bachelors of Arts focused on History from Wheaton College (MA).