Many parents are often concerned about placing their child in residential treatment, especially if the best placement is far from home. Because of this fear, parents can sometimes then question if residential placement is necessary since outpatient and inpatient therapy tends to create a few days of what seems like peace. I have worked as an intern for inpatient, outpatient, a full therapist in outpatient, a staff for residential, and now a therapist in residential. This experience doesn’t account for other forms of treatment like an Intensive Outpatient Program (IOP) or Wilderness Program.
Outpatient therapy allows the child to remain at home and work on issues on a weekly basis, or as the therapist and family deem necessary. Outpatient therapy is typically utilized for relatively minor issues that can be resolved within 6-9 months or semi-moderate issues that may take a year or two, depending on frequency and approach. As an outpatient therapist we work with schools and other community services to make sure that the family has the support that they need, while addressing some of the deeper issues and while the patient is remaining safe in their environment. Outpatient therapy tends to be the middle-man in the therapy lineup. As an outpatient therapist we have to be aware of where our client is at with how much their behaviors interfere with their overall functioning and evaluate when to step them up to a higher level of care and hopefully have them finish therapy.
Inpatient level of care is for an imminent threat to self and/or others and cannot contract for safety. Inpatient level of care is for stabilization, typically lasting 3-7 days depending on the intensity of the risks and available supports at home and the community. As a therapist in the inpatient setting, the focus is to find ways to subside the feelings that created the high level of risk. Psycho-education groups, individual sessions, and family meetings are utilized to develop skills and supports to be more successful in the community and at home. It can be common for there to be repeat visits when outpatient modalities are not working and more long-term solutions are then discussed.
Residential Treatment is for when all the others weren’t enough. Having seen the other two phases of therapy, residential treatment is definitely the most challenging, but I am able to see the most changes. Residential treatment provides 24 hour care and submersion in therapy to get the greatest amount of gain. Having been a staff and now a therapist in a residential setting it’s remarkable to see the difference that can happen in a child in a relatively short amount of time. Like all types of therapy, the amount of change and the time to make the change, depends on the willingness of the child and their parents. In residential I often see my clients outside of therapy a few times, either just running into them or briefly meeting with them to work on minor issues that come up. In between therapy, they get support from groups and staff to help them address issues and work on skills. The important thing to keep in mind is having a good way for the client to transition back home so that the skills and issues they worked on while in residential treatment translate back to home. By creating a good transition plan and practicing it while still in residential care give the client a chance to not just get good at treatment, they get good at life. I know from experience, nothing is more relieving as a therapist than to have someone coming out of residential treatment having worked on their core issues and having worked on the maintenance side of their core issues.
Working as a therapist in residential treatment is probably the most rewarding area of therapy that I’ve worked in. My experience here at Sunrise has also made it even more rewarding where we have quality staff and a quality program. I’m really proud to work in a program that works with girls to help them get back on their feet and be good at their lives.
- Written by Melissa Hartman, LCSW, Therapist and DBT Specialist