Ready To Start
Yellowbrick’s experience is that it is crucial to embrace the moment when individuals and/or families feel ready to start treatment regardless of the source of motivation. It is a big step and taking action when readiness comes together can spare a lot of future suffering, conflict and regret. Yellowbrick does all it can to facilitate getting started. Call an Admission Coordinator at 847 869-1500 ext 233. The Coordinator will speak with you about your individual and family context and refer you to the Business office for discussion of financial and administrative matters. Yellowbrick will check your Verification of Benefits, usually in the same day, so send a copy of the insurance card to firstname.lastname@example.org. This usually gives an estimate of how much insurance is likely to reimburse families for fees paid directly to Yellowbrick.
Achieving Effective Outcomes in Intensive Program (PHP/IOP) Treatment
The greatest challenge, and the central source of therapeutic power within intensive program treatment, lies in the effort to create a community experience which includes both staff and patients. Community is the heartbeat of the therapeutic process because it offers so many naturalistic opportunities for human interaction. This is true all the more when the model of treatment is that of an open therapeutic community within which relationships are established on the basis of collaboration rather than on power, control or responsibility for patient choices being located within staff. Such a community provides multiple opportunities for patients to learn to face and resolve conflicts, to use words rather than actions to ask for what they need, and to begin to empathize with others. Community also allows for young people who are struggling to meet kindred spirits, to feel less alienated and be less alone, to make friendships, to find support, and to substitute human relationships for substances, compulsive behaviors and symptoms.
What You Can Do to Help Make Treatment Work for You
Patients sometimes experience the community as “living in a bubble,” different from the real world in that peers and staff are more understanding and tolerant of people’s issues than they believe people in the “real world” are likely to be. Alternately, sometimes people experience the community as all too real, bringing up painful realities that they may have preferred to avoid facing or thinking about. The fact is that there is truth in both of these perceptions. An open therapeutic community can be a place where people have deep empathy, understanding and tolerance for others’ struggles and, at the same time, it involves a process that asks people to learn to talk about their conflicts with others, their own troubling inner world, and the problematic behaviors which communicate from disconnected parts of self.
Clinical experience informs that it is inevitable that individual core difficulties that bring a person to treatment will emerge in the cauldron of community life. If a person has been lonely and has had difficulty feeling a part of things, these feelings of alienation are likely to emerge at some point, in some fashion. If a person has had issues comparing themselves to others or with competitive feelings, these are bound to come up. If anger has been a problem, or if the way a person has expressed it has pushed people away, it is almost certain that this problem will be expressed in that person’s relationships within the community, and so forth. In fact it is common that the peer with which one has the most upset, or even hateful feelings, is the one who often has the most to teach you! Core repeating patterns in our relationships, which express important, and usually unacknowledged aspects of ourselves outside of our conscious experience, often hold the troubled but encrypted feelings which have been the engine of our emotional and functional difficulties.
Sometimes when these patterns emerge in treatment, often with self-damaging or risky consequences, the patient (and his/her family) feel worried and discouraged. “This is a therapeutic community! Why am I still feeling this way? Why is this still happening?” The answer is, though it may not feel consoling in the moment, that all of us, as humans, have a remarkably tenacious tendency to repeat our own long practiced patterns of relating to others, to ourselves, to our own feelings, even if these patterns have led to disappointment, danger or destructiveness. We all bring ourselves and our core patterns with us wherever we go. They will not change by the magic of being in the presence of supportive others. The advantage in treatment within an open therapeutic community is that these patterns become part of the process of a “living laboratory in real-time treatment” where there is opportunity to be curious, explore, challenge and otherwise work with them in vivo, in real life, in real time.
The open therapeutic community and treatment program is designed to take advantage of the reemergence of these core troubles: as opportunities to witness them as they are occurring in our midst; to understand them more deeply; to see how they may have been a person’s adaptation to difficult circumstances; to help the person judge for themselves if these ways of being are getting them where they want to go; to help the person see and to learn alternative ways of coping or relating.
A note about feelings: While therapeutic work frequently focuses on helping patients to recognize and to articulate their feelings, our goal is to assist the individual in bringing emotions back into their rightful place as a part of the understanding of the self, alongside the person’s values, needs, wishes and thoughts. We recognize the importance of emotions, but we don’t value them as truth any more or less than we do the person’s ideas or their value system. Knowing one’s own feelings is an essential part of decision making, but feelings alone can also lead us astray. We know, for instance, that the person with anorexia feels fat while actually starving to death. The open community model is designed to help individuals learn to exercise their judgment, to identify their core values, as well as to be in touch with their feelings.
How You Can Take Best Advantage of Treatment Opportunity
- Show up. It has been said that 90% of success is about showing up. If you can learn to get up and get in to the program even on those days when you don’t feel like it or when your thoughts are telling you to stay in bed, you will have won more than half the battle.
- Be willing. Don’t expect to want to do treatment. Willingness matters more. Try something that stretches your limits. Try something that someone else suggests. Accept an invitation. Ask for and take someone’s help.
- Be honest. About your thoughts, your feelings, your behavior. Lying separates you from the community and from yourself.
- Practice behaviors and ways of coping that are different than the one’s that got you here. Einstein said: “You can’t solve the problem with the same thinking that created it!” Try something new or something that is opposite to your usual way of being, like to come closer to people when you feeling like running away or to treat yourself with kindness when you feel self-destructive.
- Connect. Allow yourself to get to know others and let them get to know you.
- Test this proposition: If I allow myself to show my vulnerabilities I will feel safer and stronger than I do when I hide them.
- Avoid avoiding. Treatment works best as a community and for the benefit of each individual when difficulties between and within people are confronted directly.
- Don’t be willing to keep secrets, your own or anyone else’s.
- Struggle with intention to have respect for the basis of staff recommendations, especially at the time you feel you “know better” or feel something else “is right”.
Working to Earn Secure Attachment
Many people who come to intensive program treatment have significant difficulties in their relationships with others. Sometimes these problems cause patients to isolate and avoid connecting, or to engage in destructive relationships, or to believe that their self-worth depends on a connection with a romantic partner. Frequently patients report that they have a hard time trusting others; that is difficult to depend on others or to allow others to depend on them; that they worry about not being accepted; that they worry about being or ending up alone. A growing body of research points strongly to the fact that these kinds of difficulties have profound effects upon life satisfaction, self-esteem, the ability to feel comfortable with intimacy and with independence: all core concerns for emerging adults. The literature also clearly indicates something that is extremely hopeful: it is quite possible to develop secure attachment as an adult and an open therapeutic environment is well suited to facilitate this process.
Here are some examples of ways that you can help yourself to work on this dimension of your life:
- Work on your relationships by
- Practice turning to others for comfort.
- Improve your ability to set boundaries and limits
- Have less tolerance for being mistreated by others.
- Work on your emotions by
- Practice recognizing and tolerating your own feelings.
- Practice expressing what you feel.
- Learn to access your “wise mind” which integrates feelings and your good judgment.
- Work on yourself by
- Move toward taking charge of your own life by being more active and less passive.
- Practice compassion toward yourself.
- Practice tolerance toward your own vulnerabilities and
- Actively grieve past losses and traumas.
- Work to develop “metacognitive” abilities by
- Be curious about yourself and others.
- Cultivate “beginner’s mind” which isn’t too judgmental, open to possibility, which considers options.
- Develop a coherent narrative, your own life story, which helps you to make sense of who you are and how you came to be you.
How to Make the Most of Groups
Group treatments are most useful when you allow yourself to be actively engaged in them. This might involve bringing your own personal issues forward. It might involve asking questions if you don’t understand something that is happening or being said. It might involve offering some support or other feedback to a peer.
Sometimes people say that they hesitate to offer feedback because they don’t have a ready solution to a problem that a peer is discussing. They feel, “If I don’t know the answer, then I have nothing useful to say.” It seems usually to be true that what is most helpful to a peer is knowing that he/she isn’t alone with his/her struggle and feedback that conveys “I’m here, I’m listening, I get it,” may be the most useful and supportive thing a person can offer.
Constructive confrontation: We may believe that the only way to be supportive of another person is to agree with them or to say something sympathetic. We may have been raised or have come to live by the credo “If you can’t say something nice, say nothing at all.” Our experience, both in treatment and in our own lives, tells us that often the most useful feedback is constructive confrontation, e.g., “When you do that it really worries me,” or “When you treat me this way, it really hurts me and makes me mad.” A friend tells a friend the truth about the effect of his behavior.
Complaining when things aren’t going well: When we have grown up in circumstances where our words, our feelings, our requests were ignored or seemed to make things worse, we may have learned to give up our voice, to think that asking for or complaining about something is useless or worse. Groups provide an opportunity to challenge that assumption and to practice using your voice to say what you need or want or to complain about what doesn’t seem fair or right.
Is it still worth talking if nothing changes?: In short, yes it is. Because speaking out helps us to know ourselves and our own values and opinions, even if the other person doesn’t “get it,” or change as a result. Because speaking out helps keep us from harboring hidden resentments or fears and keeps these from corroding us from the inside. Because even if others don’t change, when we find and use our own voice we change ourselves.
What is valuable about groups?
- The main value of group therapy isn’t about the advice you get from your peers or the group leader, though sometimes you do get good advice.
- Groups offer an opportunity to observe your own process, i.e., the emergence of your core patterns and to be able to discuss them. This involves noticing the role you typically play in a group and your reaction to the roles others play.
- Put another way, groups provide repeated opportunities to notice your typical way of handling interpersonal situations and also provide many chances to try handling them differently, e.g., to speak out when you are hurt instead of hiding out, to confront a peer instead of seething inwardly.
- They provide the opportunity to work on learning to establish or to reestablish trust with others.
- They provide opportunities to learn how to address conflicts and differences with others.
- They provide opportunities to learn how to recognize and speak up in regard to your own needs and to learn how to balance these in relationship to others’ needs.
- Groups provide opportunities to learn to express the full range of one’s emotions, to be sad or angry or frustrated or joyful.
- Many people come to program treatment with an intensely ashamed sense of themselves as bad, defective, damaged. We know that shame grows when it remains hidden and secret and that the antidote for the shame within us is bringing it into the light of day. Groups provide opportunities to speak about the shameful parts of one’s self.
How You Will Know if You Are Progressing in Treatment
We all hope that treatment will help every patient both to function and to feel better. We know, though, that even in the most successful, best conducted treatment, progress is not linear but may happen in fits and starts, or involve periods of progress and regression, or may cause some people to feel worse before they feel better. These phenomena may make it difficult for a person, and for their family, to judge whether genuine progress is occurring. Here are some indications that a person is making progress:
- You know yourself better, even if the knowledge is painful.
- If you have been numb or cut off from your feelings, you are beginning to be able to feel a greater range and depth of feeling.
- If you have been overwhelmed by your feelings, then you may begin to feel a bit less overwhelmed by them.
- If you are attempting things which make you anxious but don’t overwhelm you.
- If you have tended to withdraw, then you may be a little more willing to come out of your room, or to let others know when you are having a hard time.
- If you are becoming more likely to use words to express feelings or needs, rather than retreating into silence or using actions to express yourself.
- You begin to feel connected to peers and/or staff and that others know you and you know them.
- You notice that your relationships with important others, including your family, are changing- this may be that they feel more genuine or real and that things are beginning to feel more resolved or it may be that, for the moment, the relationships are more tense or conflictual.
It may be apparent from the above signs of progress, why it is that sometimes a person engaged in deep treatment may feel worse before things improve. Approaching those things that have been avoided, while an essential part of recovery, almost inevitably is uncomfortable or frightening or painful in some way. If a person has tended to avoid conflicts then beginning to address these is likely to raise anxiety and discomfort. If a person has used drugs or alcohol to manage their own emotions then being sober may leave a person with intense feelings that they may not yet know how to handle well. If a person has had a history or trauma and denied or minimized its impact then beginning to face what happened and the toll it has taken will, of course, be a painful process.
How Parents Can Help the Process
- Attend and participate in Parents Weekends and activities.
- Parents are encouraged to reach out and seek support from assigned family staff resources. You are encouraged to determine your needs for communication and other forms of support for yourself.
- Become familiar with the concept of connected autonomy. This may require tolerating discomfort associated with limited communication or periods of symptomatic behavior as a means of self-expression as issues get approached in treatment. It is often the case that a period of separateness is necessary in order to reestablish connectedness to self from which emerging adults can then re-approach family relationships differently from prior maladaptive patterns.
- Looking at family history/relationships is not about looking for someone to blame. It is about helping the emerging adult , and the family as a whole, gain a better understanding of how your emerging adult has taken inside the experiences of their history, how he/she has integrated his/her early experiences into their self-concept and view of the world, and the narrative which the emerging adult has created that has shaped their relationship to themselves, others and reality. The unique configuration of this is known as the individual’s core enactment. A developmental, interpersonal neurobiological approach to psychotherapy focuses on identifying and working within the real-time reliving of the core enactment so as to free the emerging adult’s relationship to their needs and feelings and their ability to bring that forward effectively within their relationships and community.
- Request Family Rounds as a strategic planning session within which the emerging adult speaks with family regarding the experience of treatment. This is in addition to Family Therapy sessions. Areas of progress and struggle are noted. Issues which relate to patterns within the family are identified and addressed as needed. If indicated, a plan for family therapy is identified. Treatment planning, including decisions about transitions and length of stay are explored. Parents are encouraged to bring questions that may not have been raised previously in therapy, including questions about finances or other issues previously screened from their emerging adult.
- Family Therapy sessions have the goal of helping the family to observe interactions and mutual influences in the present, improve communication of each member’s experiences, feelings and needs and negotiate areas that require problem solving. While appreciating and honoring the understanding of the how the shadow of the past falls on current shared experiences, the emphasis is on improving communication and negotiated problem-solving in the present.
- Everyone in the family may feel challenged or even threatened by change. It is helpful to anticipate family system changes as well as changes in the emerging adult and the other individuals in the family. Your emerging adult may be creating problems for the family, but it is not helpful to view them as the problem from a family perspective. Symptomatic behavior in an emerging adult often has meaning about issues within the family or about that individual’s relationship to the family as part of the process of separating towards connected autonomy. When any one member of a family changes, this inevitably leads to changes in the family dynamic, often ones that are disruptive at first.
- Parents often focus early in the treatment on the priority of behavioral changes in executive function and plans for continued education or career plans. Most of the emerging adults who come to intensive treatment programs have had their capacity to maintain routine role performance crushed under the influence of disabling emotional struggles and psychiatric illness. This can require an extended period of time for work on symptomatic relief and the untangling of emotional issues within the core enactment, before the emerging adult is able to sustain meaningful efforts in those areas of life critical for adult responsibility and functioning.
- Treatment can be frustrating, discouraging and at times even infuriating for parents. It may raise issues of trust with your emerging adult and professional staff. You are encouraged to express these painful moments in treatment and know that they often occur at moments of potential transformation and profound opportunity for change.
Relationships, and a growing awareness of what happens within them, are the foundation and engine of open community treatment. Intensive program treatment will have the best outcome when relationships involving all stakeholders are established within a community context where openness and trust grow and where all share responsibility and accountability for their own experience and actions, especially as these affect others. Simple, but often difficult actions, like getting up in the morning or engaging rather than avoiding, promote progress in treatment but are often stymied by complex emotional, developmental and family system roadblocks. The identification of these core repeating and self-defeating patterns is an essential part of the treatment process, as is the effort to understand the associated feelings, beliefs, and motivations for these patterns. Using one’s growing understanding to begin to attempt and to practice new behaviors leads to change, though we know that change, by definition, is disruptive which is often fearful and painful. Willingness, honesty, engagement and vulnerability are the four horsemen carrying hope.
At Yellowbrick, emerging adults find their way home.
For more information, please contact Yellowbrick at 847-869-1500.