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This topic raises two different issues:  Guidelines for what schools and programs do for and with families, and the responsibilities of families, primarily parents, to support schools and programs. We address the former in the paragraphs that follow; we address the latter on this linked article.

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FamilyLightsm is an educational consulting firm specializing in work with families with a young person with behavioral, emotional or psychological difficulties.  We offer in-depth personal guidance to families on a fee basis and free guidance on the internet. FamilyLightsm attempts to be fully objective and accepts no advertising nor referral fees. The only revenue at FamilyLightsm comes from client fees. 

Most resources offer some kind of family communication. Many speak of family seminars and telephone therapy.  One speaks of the skill of their family therapist in handling psychodrama in family workshops.   That addresses process.  What are the programs  trying to accomplish with families? They need to tell us that and get started on meeting those goals the day the young person walks in the door.  (For parents who have been beaten down with ongoing disruption at home that might involve a brief respite period for families to rest and re-group, but the work needs to get started soon).  However, parents who expect to see change in their sons and daughters without change in the entire family system are on a track that leads only to disaster.  Therapeutic schools and programs that attempt to sell their services suggesting that they can effect permanent change in a young person without change in the fanily system are fundamentally dishonest. This is especially true with short term programming.

In the best situation, the school or program will collaborate with a family therapist back home who will be working with the parents and perhaps siblings while a son or daughter is in a structured residential setting. Incredibly, we hear of schools and programs refusing to coordinate with a therapist back home.  We see coordination with a family therapist at home as the ideal arrangement.

What we do not hear about frequently are the family issues that are most frequently involved in crises and relapse after treatment. Clinicians and researchers who have studied family systems demonstrate that if we remove one member of any family from that family, cause change in that family member, then reinsert that family member into the family, the changes that family member made come under attack by the rest of the family, no matter how well intentioned. This exerts enormous pressure on the changed member to revert to old patterns. Meanwhile, in the absence of the member who has left, another member of the family will almost invariably assume the role of the absent member, thus sustaining the negative behavior of the absent member.

The remedy for this is to change the family system in parallel to the changes occurring in the client who has gone to residential placement. The family that refuses to change is probably wasting its money by sending the client and the programs providing service to that client are not taking the process of change seriously.

This is not about a pre-determination that parents are at fault when their children have difficulties that need to be addressed.  One thing that residential school or placement does not accomplish is to "fix" a family member, then return her home so that everyone can now live together comfortably.  In the healthiest of families, when an individual is removed, lives separately, and changes, (while the family has also grown in maturity) then returns after a substantial period of time and much positive change, he  will not fit into the family easily under most circumstances. It is as if you have a jigsaw puzzle with pieces that slowly ooze into different shapes when removed from each other.  In that fantasy situation, if one piece would be removed, and kept away from the otherwise assembled puzzle, then try to put it back in the puzzle, it will probably not fit. Under the best of situations, the removed individual will grow emotionally while absent from the family and the family will also progress in a somewhat different direction.  Or, as Thomas Wolfe said, "You can't go home again."  Actually your child can go home again if you make sure that your child's growth and the family's growth remain compatible. 

One of the misunderstandings of the 1980s and 1990s was to recommend almost all kids coming out of therapeutic and personal growth schools go to boarding schools after the therapeutic school and not ever return to live with parents.  That is because even the graduates of the those schools were learning to live responsibly but not teaching them and their families to re-unite happily and successfully. The personal growth and therapeutic schools noticed that those who did not return home had better outcomes, and accordingly began to encourage only boarding school following the therapeutic or personal growth school, unless the student was ready for college.

This did not seem strange in the 1980s as these schools began to come into their own, because at that time the schools were patronized largely by people who would have sent their children to boarding school even if they had not needed a behavioral or therapeutic intervention.  It was perhaps manipulative when the patronage of these schools broadened to include many families who would never have considered boarding school if problems had not arisen.  In many cases these people were not told that once their son or daughter would not likely come home again. 

We call upon schools and programs and referring professionals to be very clear and up front with parents about what might be needed for a smooth transition home.  When you send  your son or daughter to a residential school to program  for mental health purposes or behavioral correction, you should plan on this being the beginning of a permanent separation into adulthood, unless you very purposefully and  deliberately work with professional input on family dynamics and also work with a parallel process to what your son or daughter is experiencing in their residential setting. In addition, you should expect to need more support during the time your son or daughter first return home than a therapist can provide in a 50 minute hour at her office.  Some schools provide for some parts of this but too few do, and none we know of currently do the whole job.  Transition services can fill the gap in many cases. 

The methods with families that get results are the methods that were initiated about three decades ago (and improved upon by a later generation of therapists and researchers) loosely described as family systems therapy. The originators include, Salvatore Minuchin, Murray Bowen, Nathan Ackerman, Virginia Satir and others. Programs taking this issue seriously will be able to describe therapeutic roots going back to these pioneers.

The most toxic and yet most pervasive characteristic of families that have not gotten their family systems issues resolved is often called the “Karpman Drama Triangle.” If you Google those three words, you will get many descriptions of it. We urge you to read our favorite description of it, Lynne Forrest‘s “Three Faces of Victim.” Programs that do not have a strict family systems model need at least to intervene in the Karpman Drama Triangle in each family with a client in residence, if they expect good outcomes. Without either built into their family work, outcomes will be severely compromised.

The argument is sometime raised that this is not a concern in young adult programs, as there the issue is to provide for healthy autonomy for the young adult. While we agree that family issues need to be pursued differently when the client is headed for independent living and will not be returning home, the core of family systems issues remain crucial to success. Young adults typically are interested in a healthy adult to adult relationship with parents after leaving home. This much contact remains toxic if family systems issues have not been resolved.

Schools and programs taking family dynamics seriously, encourage regular telephone contact between the student / client and parents while the student /client is away, especially during the last few months.  If at all possible, they collaborate with a family therapist back home that the parents engage with in person.

There is an additional concern here. If the young person in treatment is involved in twelve-step work then we believe that it is important that the parents also experience twelve step work in their own lives.  Normally, that would mean taking an active role in Al-Anon, Nar-Anon, or Families Anonymous.

Therefore our guidelines are

  • Every program accepting residential clients will either keep families focused on issues parallel to the person in residential treatment or will be out front that they are not effectively preparing young people to return to their own homes, as opposed to moving on to boarding schools.
  • Every school and program encourages parent work with a competent family therapist back home closely coordinated with the school or program.  When a therapist back home is not available the school or program itself will take responsibility for addressing family issues seeking results comparable to what his happening with the young person in treatment.
  • Every program accepting residential clients will be sure that the families of these residential clients correct patterns in their family systems that jeopardize the success of the client. Preferably the programs systematically apply methods based upon the principles developed by Minuchin, Bowen, Satir, Ackerman and others associated with them, as those principles have been updated. As a second choice, every family is confronted about interaction consistent with the Karpman Drama Triangle. It is not necessary that every short term program implement this form of family intervention if those programs consistently recommend follow up at programs that will do so.
  • Every program adheres to FamilyLightsm Guidelines for Transition and Aftercare.
  • We encourage and appreciate use of self-help groups such as Al-Anon, Nar-Anon (not to be confused with Narcanon which we do not recommend), and Families Anonymous. When a young person in treatment is involved in twelve-step work the program should also be requiring parents to participate in twelve-step work.  However, we do not believe that by themselves, these twelve step fellowships serve as an adequate substitute for the services recommended in the above bulleted items, no matter how important the twelve-step work is.

Feedback is invited. We will publish selected feedback.  Email FamilyLightResponse@yahoo.com

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last updated 4-27-09

 
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