What Now? Maximizing The Success of A Therapeutic Placement

by Sarah Finney, MS, LMFT

The journey taken by parents who have decided to enroll their child in an out-of-home therapeutic program is often long and difficult. An enormous amount of emotional and financial resources are invested in this process, and parents’ hopes for their child’s future are closely tied to their decision. Once enrollment in a school or program has occurred, it is helpful for parents to understand what they can do to yield the best results possible—how can they influence the positive outcome that they desire? As an Educational Consultant, I have coached parents on ways they can maximize the investment they’ve made by enrolling their child in a therapeutic school/program. I do this by identifying and discussing with them some of the most common pitfalls I have observed parents make while their child is away.

Pitfall #1 Alignment Problems

It is essential that parents know how to participate effectively as a member of their child’s healthy support system. Members of the support system, which includes parents and the professionals assigned to work closely with their child, must together establish themselves as part of the team dedicated to help the child overcome their current problems and create a more successful future. Members of the team can function most productively by having open and supportive relationships with one another through trust and communication. Without developing a trusting relationship with those professionals working directly with their child, parents cannot function effectively as a member of the team and be properly aligned with the school/program. If parents do not have a strong level of trust and communication with their “teammates,” it will be very difficult for them to align in specific efforts to help the child.

After being in a therapeutic school for some time, John confided in a letter home to his parents that the school had changed and he no longer felt safe there. As one example, he stated that his therapist seemed always to be attacking him, and that she wasn’t open to really listening to his feelings. He stated that without a good relationship with his therapist, he worried he may not continue to make progress with his anxiety and depression. He suggested his parents bring him home, so he can find a therapist who will be more helpful to him, and return to his home environment that will be safer for his continued growth. After reading the letter, John’s parents grew very concerned and began to discuss the possibility of bringing him home and getting him the help he needed there.

In the example above a phone call to the therapist to clarify what was occurring, or what was said from her perspective was necessary to maintain healthy alignment with the program for the benefit of the child. She would have explained that John was being challenged in therapy to acknowledge some of the thinking errors and recurring thought patterns contributing to his feelings of anxiety. Although this was hard for John, who prefers his therapy sessions to be more nurturing, it was crucial for him to understand and acknowledge these maladaptive patterns so that he could be empowered to change them.

Communication, trust, and correct alignment with the program will greatly contribute to any child’s success. When parents and program aren’t aligned, the child’s progress can quickly stagnate. Children can avoid dealing with their own defenses or issues by focusing on the lack of alignment occurring within their support system. They may attempt to split those they perceive as not trusting or working closely with one another. A lack of healthy alignment with parents and program can create anxiety for some children and distract them from making progress. Even worse, children can interpret their parent’s lack of healthy alignment with their program as a message that they themselves don’t have to trust or take their program seriously. Children may even conclude that their parents don’t really believe their struggles are serious enough to warrant being there and accepting the help and support offered. When this occurs, the negative impact to a child’s success can be remarkable.

As an educational consultant, I have found three things that have allowed parents to maintain a healthy alignment with their child’s support system while in treatment. First, they must have a sufficient level of trust in the program in which they place their child. If they do not have a good level of trust, they should either find a way to develop this trust or not place the child there. There are active steps that can be taken to develop this trust. The family can turn to their educational consultant, who has in-depth information about the integrity and reputation of that program. The family can visit the program, interview staff and students there. Parents can also ask the program for a reference list of other parents. Whatever needs to be done, parents should do it. Secondly, parents should communicate openly and honestly with the key staff (often the therapist) working with their child. They should not agree with their child to keep confidential what their child reports to them about their school. Children should know that their parents will share information with the program staff to insure that the program meets their needs. Children should also know that if a problem arises, their parents will address it in cooperation with the program. When parents help their child understand this working relationship, they reduce the likelihood that their child will try to split them and the therapeutic team. Finally, it may be helpful for some parents to work on personal, marital or co-parenting issues that may be interfering with their ability to trust and communicate openly with their child’s key staff members.

Pitfall # 2 Boundary Problems

Most parents have heard the term “boundary” as it relates to child rearing. Healthy boundaries create physical and emotional safety for children, which allows for healthy development. When children are small, parents focus on teaching them boundaries that are primarily physical in order to ensure their safety—it’s not safe to play with sharp objects, it’s not OK to hit others, don’t talk with strangers, etc. When children grow older, they need to learn emotional boundaries from their parents. One important boundary to teach is the distinctive roles for parents and children. A parent’s role is to love, respect, support, protect, guide, advise, understand and sometimes discipline children. Parents do this in order to teach children healthy lessons about themselves and the world around them. A child’s role is to love, respect, and accept guidance from their parents.

One of the common problems I see working with parents and children is blurred boundaries. In some cases, parents cannot manage their need to be liked by their child, abdicating their role as parents and, instead, trying to be their child’s best friend. A friend is not what children need from their parents. In other cases, parents attempt to live out their own dreams by co-opting their children’s lives. For example, parents might try to share their children’s friends and activities. Or parents might push their children too much to pursue the parents’ dreams, rather than understanding and encouraging their children to pursue their own unique goals and dreams. These unhealthy boundaries, while their child is enrolled in a program, can seriously compromise the success of the child during and after treatment.

Jennifer insists that her daughter come home from her therapeutic wilderness program without continuing with the aftercare program that has been recommended. She knows her daughter needs more help, but cannot bear the thought of being away from her any longer—she’s her best friend.

Roger shares with his daughter Ella information about an upcoming intervention created for her that was shared with him in confidence by Ella’s program therapist. He tells Ella what the intervention will be, and coaches her on the type of response her staff will respond favorably to. He wants her to “ace” the challenge.

Gillian shares with her son David, on their weekly phone calls, details of her marital problems with his father. She asks for his advice about what to do to save their marriage.

The above examples clearly demonstrate the lack of healthy boundaries within the parent-child relationship. Some boundary problems can be less obvious, but still have damaging effects. Boundary violations create a lack of emotional safety that can lead to increased anxiety. When children (and people in general) feel emotionally unsafe, more of their energy is focused on managing that lack of safety, rather than focusing on their treatment goals.

In most families with whom I’ve worked, parents blur boundaries with their children without knowing they are doing so. In many cases, parents have experienced abuse or poor boundaries in their own childhood. These experiences make it difficult for parents to know or practice healthy boundaries with their children. I recommend that parents talk with their child’s therapist to determine if their boundaries are appropriate and contributing to the success of their child’s treatment.

As an educational consultant I often make the following points about how to utilize professionals and others involved in their child and family’s care. These points can be particularly helpful when addressing boundaries within the family system:

Ask for and be receptive to hearing honest feedback about the boundaries you are establishing with your child.

Present situations that are problematic, if you need guidance or clarification.

Give the professionals permission to give you difficult feedback, and let them know that although it may be hard, this is information you need and want to know. Be clear with the staff at your child’s program about your commitment to grow as a parent and your expectation that they will help you in this endeavor. Ask for their advice.

Remember that it is OK to have made some mistakes. No child arrives with an owner’s manual for his or her parents to follow perfectly. Making and learning from previous mistakes will provide parents’ the opportunity to learn and fine-tune their parenting skills.

Pitfall # 3 Over-doing it

Over-advocating, over-doing or over-managing on behalf of a child while at home or in treatment can hurt rather than help that child’s chance for success. Simply put, too much of a good thing can be bad for you (and your child). Parents that try to take care of EVERY problem that arises in their child’s treatment, or school day, or relationships, may also be taking away EVERY opportunity their son or daughter has to overcome a challenge, gain in self-confidence and learn independence. So while it may feel counter intuitive, doing less can do more for a child than parents might realize.

But no healthy parent enjoys seeing his or her child experience pain. Isn’t the parent’s job to protect the child from this? Yes and no. There are indeed many appropriate times in which children need the assistance of their parents. These situations can occur more often when children have behavioral or emotional disabilities. A parent can easily justify why, more advocating, doing and managing on their child’s behalf is necessary. Some efforts to help or ease the pain of their child may have been appropriate at one time. However, assisting and advocating can be taken to an extreme. When over-managing occurs, children get the message that they can’t handle whatever the problem is. They also miss the chance to use the current struggle as an opportunity to grow and learn.

When Lily told her father over the phone that she was having some minor conflict with a few of her roommates, he became anxious that this conflict would have a negative impact on her ability to focus on her treatment goals. He called the director of the school and insisted that they address the problem right away by allowing his daughter to move into a different room with girls that she got along with better.

In the above example, the father’s intervention seems well intended. However, it interferes with his daughter’s ability to grow through overcoming something difficult. While coaching parents on this topic I have found that asking them questions similar to the ones below allow them to better reflect on the negative aspects of micro-managing their children’s lives.

How does having accountability improve a child’s self-esteem and social success? How often do you as a parent allow your child to experience the natural consequences of their decisions?

What will your child believe about herself if she is not given the opportunity to struggle and learn to advocate for her needs? What skills may be poorly developed if she has not had any adversity to overcome? What can you do to encourage her to develop her own voice?

By experiencing and overcoming obstacles on their own, children learn a variety of problem solving and coping skills that leads to increased self-esteem, a sense of efficacy and greater independence. Most parents desperately hope that some day their child will possess all of these traits. Their well-intended efforts to make their children happy by doing too much for them are unwittingly creating the opposite effect.

It is helpful for parents who struggle with this pitfall to identify which of their child’s problems absolutely need their intervention. Most of the problems do not require the parent’s involvement. Listening to their child, validating his or her feelings, and encouraging the child to find a solution using the resources of the program is a better approach. At this point, they can listen to the child’s ideas but resist the temptation to offer any further advice or solutions. By approaching the situation this way, parents are encouraging their child to develop problem-solving skills as well as gain confidence and self-esteem.

If children are not used to this kind of parent response, they may be uncomfortable or even upset that they will have to solve the problem themselves. While working as an Educational Consultant and Family Therapist, one of the most common responses I’ve heard from students, as I’ve challenged them to create their own solutions is the phrase, “I don’t know”. As simple as it seems, the best response I’ve found in this situation is to pause a moment and then calmly respond with “yes, you do”. Then I say nothing more than that phrase in response to “I don’t know” as many times as it takes for them to stop saying it and develop some of their own ideas. Once they begin to formulate solutions, I give them positive feedback about their ideas. I also remind them that because the problem is theirs, they are in fact in the best position to judge which solution would be the most effective. While this new approach may initially frustrate them, the important message delivered through this process is that they are strong and capable, which will help to build self-esteem and confidence rather than dependency and fear.

Pitfall #4 – Unfair/Unrealistic expectations

Striking a healthy balance between realistic and unrealistic expectations is difficult to achieve. Some parents err on the side of expecting too much from their children, while others err by expecting too little. Falling into one or the other of these pitfalls before, during and after their child’s placement can negatively impact their success.

Patricia and Allen are both very successful attorneys who met at Princeton. They have two children, a daughter who will be starting Princeton in the fall, and a son, Jason, who has recently been placed in a therapeutic boarding school due to behavioral problems including truancy and substance abuse. Allen played hockey throughout college and has been very enthusiastic about Jason following in his footsteps. He dreams of someday watching Jason play hockey at Princeton. However, Jason feels like he will never live up to his parent’s expectations. Though very bright, he has a language-based learning disorder that has always made school more difficult for him. In addition, he loves acting and theatre and prefers long distance running to hockey. His father dismisses these interests as a “passing fancy” and pushes him to spend more time training for hockey. He has repeatedly told his son that his greatest wish is to have him play hockey for and eventually join his law practice.

While the inappropriate expectations of Jason’s father in this example are quite obvious, other cases are less explicit. Unrealistic or unfair expectations can lead to a feeling of inadequacy and low self esteem in young people. Children can internalize their inability to meet their parent’s expectations as evidence that they are less worthy of love and success. These feelings can easily turn to anger, shame, resentment and poor behavioral choices during adolescence. It is not uncommon for these adolescents to begin associating with friends who are low achieving and who will accept them simply because they act out in similar ways. These patterns in turn can lead to other problems such as substance abuse and defiance.

But having too few expectations for children can also undermine their ability to succeed. Spoiling children with material goods without allowing them to “earn” them, or not providing them with any responsibility within the home can hurt their self-esteem and create a sense of entitlement. No one wants to feel useless. However, when too little is expected of them, a child can often feel this way.

To avoid this pitfall, parents can review the expectations they have for their child. During this process, they might assess their child’s talents, strengths and weaknesses and then ask themselves the following questions:

Parents report that consciously evaluating their expectations while their child is placed in a therapeutic program can be a beneficial process for both themselves and their child. Some parents have proactively raised and discussed this topic in family therapy where their therapist has been able to offer useful feedback and advice based on their observations of parent and child. This process provides parents with an excellent opportunity to be more deliberate about the ways they engage with their struggling child and take advantage of the support offered by the program.

By understanding and avoiding these common pitfalls, parents can work to maximize the positive impact a good therapeutic program can offer their child. An experienced Educational Consultant can support both the family and their child’s program as they work together to create a positive outcome.

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