Prior to entering the residential treatment world in 2005 I was an outpatient therapist for 2.5 years. Frankly, I enjoyed my jobmost of it anyways. I had less stress, worked less hours, and generally speaking, was successful to the extent that I believe I facilitated positive change in many of the clients I worked with. The exception was I was doing little to no good with clients in the 13-18 year-old range. No matter how creative and determined I was to achieve success my outcomes with teens was the same. I also realized most colleagues were going through similar frustrationsteenagers were not resolving their issues in outpatient.
Let me share a few of the reasons why I believe outpatient therapy does not create the environment for change that residential treatment does; especially in regards to trauma, attachment and emotional regulation.
1) Just talk therapy Traditional outpatient therapy is usually designed to be talk/insight therapy. Talk therapy alone does not provide access to the emotional experiences that create change. Residential treatment allows for much more than talk therapy. There are emotional experiences which have deeper impactcanines, rec. therapy, creative arts, groups, and so forth.
2) No Real Relationships Because outpatient therapy is traditionally 1-2 times a week it is difficult to develop a meaningful client-therapist relationship. At Calo, the relationships that students develop with their therapist, coaches and other staff are more meaningful because they are more frequent (all-day every day) and more livestudents cannot put on a good face for an hour of therapy like they can in outpatient. In a recent study of the change agents of therapy, the relationship variable accounted for the highest percentage of change (Blow, A.J., Sprenkle, D.H., & Davis, S.D. 2007).
3) Not Systemic Enough In order for lasting change to take place, therapy needs to address the system that the teen exists within and not just focus on interpersonal difficulties. Issues related to school, friends, community, and so forth are all related to the adolescents ability to sustain gains in therapy. Addressing all of these systemic issues in outpatient therapy is very difficult to do effectively.
4) Too Many Distractions Lets face it, in order for teens to end their destructiveness we need their focus. Freeing adolescents from trouble spots which may include the internet, friends, late nights, school, drugs, texting, promiscuity, television, music, and so forth is extremely beneficial in order to allow the student space to step-back and examine priorities and needs. Many students have commented that after entering Calo they were grateful that they were removed from some of their distractions because they did not realize how much they were getting dragged down. Verbally trying to point out to teens how detrimental some of their choices are is usually unsuccessful. Naturally, teens need to struggle with some of these issues. As a result, Calo and home visits slowly re-introduce teens to these variables after providing them with copings tools and skills.
5) Not Peer Focused Almost any honest teenager will tell you they value their peers more than family during the critical adolescent years. Because teens value their peers so much, Calo leverages this point by providing an environment where teens can support one another, share experiences, and reveal insights and gains in order to help each other. The peer component of treatment is very powerful and helpful.
6) Not Multidisciplinary In outpatient therapy the therapist is the only set of eyes on the teen. At Calo, we believe in a treatment team or multidisciplinary approach. Calo has a recreation therapist, residential coaches, canine supervisor, psychiatrist, and other staff who are familiar with the students treatment plan in order to help the student reach their treatment goals.
7) Safe Environment One of the underrated aspects of residential treatment is the environment which allows students a safe place to practice the skills and tools they are learning. Frequently one of the obstacles I faced in outpatient therapy was trying to convince a teen that they could implement the things we were discussing with success and without ridicule. At Calo, change is not only acceptable, it is embraced.
So, while the outpatient therapist may be incredibly skilled and the cost more friendly, there is no comparison to residential treatment. When an adolescent life has spun out of control, residential treatment may be the best option.