A Mix of Individual, Family, and Experiential Therapies
By Mirela Loftus, MD, PhD, Ian Parker, MSW, and Michael Roeske, PsyD
As we know, the youth mental health crisis has revealed limitations in the availability of services, especially for more severe and chronic cases, leaving clinicians and families overwhelmed and uncertain. Many young people are requiring longer treatment stays than inpatient hospitals can provide and a more intense approach than outpatient services. Residential Treatment Centers (RTC) for adolescents and young adults are designed to address that gap.
To complicate the matter, there are a wide range of options and settings considered residential treatment—including home-like settings, campuses, wilderness programs, substance use detox and rehab centers, state- or privately-owned programs, etc.—as well as a vast range of therapeutic models. This adds to the overwhelm of already stressed families and even clinicians when looking for effective help. A great range of psychotherapies and their integration also occur in residential settings. Despite all these variables and the great need in our communities, evaluation research is uncommon.
In our work together within a national provider of residential treatment, we emphasize mind-body interventions such as yoga, meditation, adventure, and equine therapy, health and fitness groups, music, dance and movement therapy, mixed martial arts, and art therapy. We adhere to a medication philosophy of only using medication when other less intrusive treatments within the psychosocial are not helpful enough. Family therapy and the belief that the caretakers must be part of the solution is considered integral to our psychotherapeutic approach.
We often tell parents that their child will most certainly not like everything that we do, but if we can expose them to various experiences, work their mind, body, and emotions in harmony, we may just find something they relate to and find a refuge.
Alongside these interventions, we use more traditional therapies of individual therapy and group counseling. The use of interventions from Mentalization Based Therapy (MBT), Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT), Eye Movement Desensitization and Reprocessing Therapy (EMDR), Transference-focused Cognitive Behavioral Therapy (TFCBT), Brainspotting, and Attachment-Based Family Therapy are common.
Altogether, our engagement with youth and their families in our residential setting led us to believe that a systemic therapeutic approach feels right. That is a lens we cannot lose sight of: to view our clients, their symptoms, maladaptive beliefs, and behaviors as either originating from or being exacerbated by their relational systems and for the treatment to reflect these values. And, as any honest clinician will tell you, “it takes a village” to move the treatment process forward. We lean on other members of the treatment teams to maintain integrity in our individual approaches.
Psychotherapeutic collaborations may include our art and equine therapists, and adventure teams to receive feedback about the clients and their progress and ask for suggested interventions. For instance, an art therapist may explain how a patient’s inner journey unfolded through clay, painting, drawings, and collages, methods touching deeper than talk therapy can hope to reach. An equine therapist may discuss a youth that relates to our horses more than any person they have met, caring for them, existing in silence with them, and finding a peaceful companion they can lean on (quite literally at times).
Perhaps the most memorable experience involved a depressed, disenfranchised teen, with poor confidence and low self-esteem, who came alive while practicing martial arts, finding a spark, an inner connection, a sense of belonging, and an unknown talent. We often tell parents that their child will most certainly not like everything that we do, but if we can expose them to various experiences, work their mind, body, and emotions in harmony, we may just find something they relate to and find a refuge.
Evidence-Based Outcomes in Residential Settings
Every clinician wonders if what they are doing is working. Little outcome research has occurred in residential settings, though, where nearly two thirds of patients present with severe comorbidities and histories of multiple treatment episodes. This is troubling given the high risk and costs of services associated with residential care and the seeming explosion of need. To take on these challenges, we have led a sophisticated, systems-wide outcomes monitoring program which is now run through our recently created Center for Research and Innovation.
Download Newport’s 2022 Outcomes Report
Download our new Science of Healing report to learn how Newport Healthcare is changing the lives of young people and families. The visually rich, in-depth report includes:
- Teen and young adult patient profiles, including risk factors
- How we achieved a 75% decrease in teen suicide risk—and a 50% decrease in teen depression
- Key well-being increases in young adults—up to 5x greater
- Survey results from patients, parents, and referents
- Testimonials from our alumni
In 2021, when teens were struggling the most, the anxiety scores on the Generalized Anxiety Disorder scale (GAD) went from severe (16) at admission to mild (9) at week 5, and the depression scores on the Patient Health Questionnaire PHQ went from moderately severe (19) to mild (9) respectively. Similar changes were noted in well-being as measured by the World Health Organization (WHO), in suicidality using the Beck Hopelessness Scale (BHS), and in family and attachment relationships using the Family Assessment Device (FAD) and the Relationship Structures Questionnaire (ECR-RS). It is well known that therapeutic alliance is one of the predictors for treatment outcome. Our teens indicated a very high working alliance through the Working Alliance Inventory-Short Revised (WAI-SR) by week 3 (44) which was maintained at week 5 (44). Ongoing data collection will hopefully further the evidence behind our treatment model and will be reviewed for publishing.
The data collected over time has shown that residential treatment can have a very positive effect. To us, this much is clear: if we truly seek to turn around our current youth mental health crisis, families must be able to find and know how to access and determine what is effective care for their children. And as clinicians, it is imperative that we involve them in the treatment and truly embrace and respect the multiple disciplines that are part of the collective village.
Mirela Loftus, MD, PhD, is the Medical Director for the Newport Healthcare residential treatment centers for adolescents and young adults in Bethlehem and Fairfield, Connecticut.
Ian Parker, MSW, is a licensed clinical social worker and a Newport Healthcare Clinical Director, overseeing a 52-bed adolescent residential program located in Bethlehem, CT.
Michael Roeske, PsyD, is a licensed clinical psychologist and Senior Director of the Newport Healthcare Center for Research and Innovation.
This article was originally published in AACAP News, a publication of the American Academy of Child & Adolescent Psychiatry.