How to Know When It Is Time to Consider Residential Treatment

The decision to enroll a child in a residential treatment program is one of the most difficult choices a parent will ever make. Jeremy Lotz (MA, LPC, NCC) knows. He has guided many young people and their families through their residential treatment journeys, both as a therapist at Shelterwood (2010-2017) and in his current therapy practice, where he often consults and cross-refers with Shelterwood.  

“I am a huge proponent of residential treatment, but I try to remain hard-to-convince that it’s necessary because I want it to be a last option,” Jeremy says. “Full-time residential should be a nuclear option for adolescents and young adults.”

Jeremy suggests five questions parents can ask if they are considering a residential therapy program for their child.

  • Have we tried everything else? Jeremy says he reserves residential programs as the last option for struggling teens. Try other options first: Have mentoring, outpatient counseling and/or medication helped? Have you tried a short-term stabilization period at a psychiatric hospital, if necessary, or a trusted relative’s home?

    Usually parents who are looking at residential programs have exhausted all other options, stretched the limits of their own mental and emotional endurance, and are concerned for their child’s safety at home.
  • Have we discussed how we’ll minimize the risks? Jeremy tells parents to approach residential treatment as a last option because it carries two big risks for teens.

    “First, it can very significantly fracture attachment bonds with caregivers,” Jeremy explains. “It’s pretty impossible—at least at the beginning—for the child to not feel wounded at being sent away.”

    Jeremy says parents need to make sure the benefits of a residential program will outweigh the risks for their child. And they need to talk about the ways they can realistically mitigate those risks.

    How can parents nurture the bond with their child, even when most residential programs will limit contact for at least the first few weeks? Jeremy suggests talking with the admissions team about how to stay actively involved in treatment and being consistent in your communication.

    “I encourage parents to write letters,” Jeremy says. “There should be a whole pile of letters and postcards and photographs waiting for the child.

    “You can also be on time and enthusiastic for every phone call,” he continues.”That’s how you can nurture the attachment wounds, if there are any.”

Secondly, Jeremy says there’s a logical risk to housing groups of struggling teens together. “A student can learn bad habits from others, and a student can give bad habits to others.”  

Jeremy also says parents should understand how peer influence works in residential programs and how it might appear to change their child’s attitudes and behavior at the beginning. For example, maybe all the cool kids in a new kid’s unit say they hate school. It wouldn’t be unusual for that child to mimic that attitude early on in an attempt to fit in.

“We want parents to know how to interpret the peer influence,” Jeremy says. “It usually starts off negative in residential and then becomes increasingly and sustainably  positive.”

This is the powerful bright side to the peer-pressure risk. “Residential treatment takes negative peer influence and puts it on its head,” Jeremy explains. “Teenagers can get each other to do anything. We complain about it when they get each other to do bad things. But teenagers will get each other to do chores, to take phone calls, to do work, go to sessions, give forgiveness. All after staff has begged and pleaded for that exact same thing to happen.”

  • Have we talked to other parents? As parents get serious about residential treatment programs, Jeremy says they should reach out to other parents. Talking to someone who understands your concerns is very helpful. “Every good program has referral parents who can answer questions.” Jeremy says. “Talk to parents before you enroll.”
  • Have we visited the facility?   “A visit to the program can help give a real ground-level perspective as to what your kid may experience,” Jeremy says. Jeremy suggests asking to see actual rooms, not model spaces set up for caregiver tours to make sure the facility is functioning in an authentic and transparent way.
  • Can we commit to our decision and communicate it clearly? Jeremy says two things can make the transition into residential treatment much harder on a child. The first is if parents don’t follow through on admissions day.

    “Bring a support person with you, if possible,” Jeremy advises. “Bring a best friend, a relative or a pastor. Somebody whose function is that you see it through.” If parents get cold feet at the last second, and bring the child home instead, it will be much harder to get a child in real need of treatment to go back the next time.    

    Secondly, Jeremy says some parents will say whatever they think they need to say to get their child to agree to go. Oftentimes, this means making promises they can’t keep about the length of the program. Once the child is in the residential program, they have to make a big mental shift from waiting out the time to putting in the hard work of transformation. “The number one thing that kills residential outcomes is a child who’s depending on time served not growth demonstrated as the ticket home,” Jeremy explains.  

Jeremy has empathy for families who are asking these questions and making these tough calls. “The parents I worked with at Shelterwood were some of the most well-researched, informed parents in the world.”

But because physically separating the family is so painful, many parents will second-guess themselves.

“In fairness to parents all over the country,” Jeremy says, “Most the time, when a parent believes long-term residential is needed, it is.”

Are you currently working through these questions? Would you like someone to walk through them with you? Reach out to our staff at Shelterwood. We combine academic excellence and individualized therapeutic care with the goal of real heart transformation. Let’s talk about how we can help your teen know their worth and find their purpose. (800) 584-5005

Posted in Parenting, Parenting Resources, Parents, Transformation