Why Is Inpatient Therapy So Effective?

The therapists that work in inpatient treatment programs are special people. This is a short conversation I had with one and would simply like to share. For privacy reasons, no names are shared. This person knows that she was being recorded.

Rae: Why is it that we see kids make such great progress in a residential treatment?

Therapist: The disruption is important. The living and breathing the different life, the 24/7 accountability, and there’s just excellent treatment that happens in a good program too.

I have been intimately welcomed into people’s family systems as their clinician and that is just so precious, it is such a compliment. There is a level of healing that happens that is so different than you know, seeing a family for family therapy walking in and out of my office.

Rae: How is it different?

Therapist: It’s a different level of attention and commitment. I think there’s a bigger “yes” commitment when families choose treatment, inpatient treatment, that allows their vulnerability to be un-wavered. Like they’ve already taken the leap so they’re more “all in” when it’s a treatment program. I think in private practice they could just choose not to show up the next week and feel like oh, that got scary, or that got hard.

If I poked something too hard, they’re not coming back versus when I’m able to work with a family who’s committed to a treatment process, I feel like they’ve already accepted that they want to do some of the work along the side of their child, and aren’t as threatened by it.

Rae: Do you also see more commitment from the kid?

Therapist: Yes, because part of it is removing them from their previous environment they were living in. And also be removed from distractions and the static of the previous world they were in. There’s still that adjustment transition that’s hard for everyone, but the settling in does happen and it does allow real work to happen.

Rae: What else allows the real work to happen?

Therapist: Community comes to mind. The fact that everyone around you is doing the same work. They’re all in it together. Everyone is living, breathing, doing personal work, going through experiences together, going to school together, often sleeping in the same room together, everyone is doing therapy, you’re going to lunch and sitting with everyone who’s doing all the same work. So there’s a normalcy to it and the fact that the therapy can happen in small little chunks within the milieu, in real time, is the magic.

Therapy doesn’t have to be performative, like I’m going to show up to therapy and have a breakthrough… it’s like it could be 10 PM and I have a breakthrough with this staff member who’s 20 years old who I have a lot of respect for, and really feels like a sister and holy cow I just connected the dots and learned so much. The kids are hearing it in so many directions and in so many ways, and who knows how a kid is going to remember everything. Right then and there we deal with it versus if we had to wait another five to seven days for the therapist appointment.

Rae: Then a week later it’s not even an issue anymore, yet the need for the lesson will come up again.

Therapist: Yep, exactly. The timeliness of it, the exact moment of a teaching moment isn’t predictable, it’s instantaneous in treatment. There’s an instantaneous feedback loop. The good treatment programs have a lot of focus on the experiential because it’s common knowledge now, that the body keeps the score.

Our bodies are so wise, it holds things… We don’t remember what people say, we remember how they made us feel. We are experiential, doing, beings and being in a treatment program versus outpatient really allows your body, your whole system, and your whole psyche to be doing something different. There has been a lot of creativity and places that I’ve had breakthroughs working with students. And with families, the family workshops we’ve been able to have, and bring families here in person for retreats. it’s just so powerful to get families together and be able to help them experience each other in a new way.

Rae: What do you think brings out the effectiveness when a child is doing something experiential?

Therapist: They remember it differently. Because it’s experiential, they actually remember it, especially with kids.

Rae: Can you give an example?

Therapist: I have so many. I have big moments and small moments. One of the big moments was when a family was coming to see a kiddo, and we realized that this kiddo needed something different than our ordinary family circle. So, we did our family therapy session on a canoe trip and the next thing we know, we are doing an adoption ceremony. The dad, officially adopted the daughter that I was working with. It was so beautiful. They constructed a ceremony around the fire with all the other parents watching and witnessing. It was just tear jerking.

I’ve also had little moments of working with teenagers where we have powerful moments because of something I did creatively and spur of the moment. One time this kid needed to cross a threshold, figuratively speaking. She was in such a funk. For many sessions, she was in a funk and not budging into “crossing the threshold”. She was not getting what she needed so I decided to shift gears. I said to her, “Let’s leave this in here and let’s crawl out my window together.”

We crawled out my window and we sat on some hammocks. That is something they remember. They’re like “my weird therapist made me climb out her stupid window as like a way of crossing a threshold.” And guess what… our next session, she crossed the threshold — she got what she needed. Sometimes sitting in an office is just wrong for therapy.

Rae: Do you think you get more respect than the average therapist because you have that kind of flexibility?

Therapist: Absolutely, Yes. I think respect and trust. Because they can see me as a real person.

I’m able to go meet them on a hard day and sit on the edge of their bed when they can’t get out of bed. That’s not possible in a lot of places, and often doesn’t happen at home because families are so busy with life.

Again, that instant feedback loop opportunity that happens from the whole community around you. Your peer group will call you on things. Your staff team, your teachers, the therapist that run a group. We all know and work with every kid, as he or she needs it. We all know the kids’ business, and they think it’s annoying but we all do. You can’t hide from yourself. That’s another way intensive treatment works. Because you can’t hide. You can’t just perform for that hour session and then go back to your world.

Rae: I love that.

Therapist: That instant feedback loop. Not being allowed to “perform” out of therapy. Do things differently, know what the kids needs. It works. And we’re with them side by side through it all. Fortunately, I’ve had the flexibility to do that.

Kids will say they feel safe and respected too. Therapy doesn’t work if there isn’t respect. We respect our kids and they respect us. We disrupt their lives, yet provide a safe and secure place.

Rae: Is there a time-frame of when or how the kid experiences a breakthrough?

Therapist: Everyone is different. Kids can be a very passive about change. When you think of the stages of change like Erickson’s Stages of Change, you can be in the pre-contemplative “I don’t want this” stage while in a program, and still be getting access to a lot of change and a lot of opportunity in a way that you don’t when you’re still at home. The kids don’t know that they’re getting what they’re getting, because it’s so instantaneous, and they’re getting the same information daily, from so many angles, as we spoke about. It’s not contrived, and that works for kids.

Rae: I know you love your kiddos, your clients. I’m sure they feel that from you. And that works too.

At Therapeutic Educational Consulting, we recommend, guide and support for all kinds of therapeutic answers for children, adolescents and young adults. Schedule a no-cost discovery call with Rae Guyer, your therapeutic consultant to discuss options.

Photo credit, Dmytro Sheremeta