Getting the Right Help for Troubled Teens

Residential treatment centers focus on helping the child take personal accountability. Through individual, group and family therapy, residential staff work on shifting the child from blaming others for his problems to acknowledging that he is where he is because he made poor choices.
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In light of the recent Sandy Hook tragedy, early intervention and appropriate mental health treatment for troubled teens must become become accessible for everyone.

Note: For the sake of brevity, I use the pronoun "he" although the following also applies to girls.

A teenager is ragingly out of control. He ditches school or gets expelled. He spends hours playing video games and watching cyberporn. He breaks curfew, does drugs, punches holes in walls, argues incessantly with parents and engages in high-risk sexual behavior. He has run-ins with the law. Unable to calm the chaos in their home, and after much agonizing, the parents finally send the child to a residential treatment center.

When you read this scenario, do you have any of these reactions?

"It's the parents' fault that the kid is messed up."

"The child will feel abandoned."

"Kids are abused in those places."

"I would never send my child away."

Sometimes these reactions are justified. Some parents are not cut out to be parents. Some parents do reject their children. Some residential treatment centers (RTCs) do use atrocious interventions and are, or should be, shut down.

But more often, these judgments are based on extreme cases picked up by the media. A horror story about abusive practices at a boot camp is more attention-grabbing than gradual healing at a well-run RTC. Judgments also come from the unrealistic notion that good parents should be able to raise any child at home.

The truth is, some children cannot be raised in a regular home or attend a regular school -- at least for a while.

As a clinician who works with families with challenging children, I have come to believe the following:

  • Good parents can pour time, money and their best intentions into helping a child who doesn't respond to conventional treatment.

  • Young people often look back at their time in residential treatment and realize their parents were trying to help them, not get rid of them.
  • There are many excellent, progressive RTCs staffed by mental health workers who have a mission to help children -- not con parents out of money.
  • Most people who think they would never "send my kid away" have never had a child who cannot be contained at home.

    Some Kids Need More Than Outpatient Therapy

    Well-intentioned outpatient therapists are sometimes "duped" by out-of-control kids whom they see once a week for an hour of individual therapy in their office, rather than see them in other contexts where children's problem behaviors are more evident.

    Explosive children can be charming, and if they regale the therapist with tales of their "terrible" parents, the therapist often aligns with the child, unwittingly disempowering the parents.

    Outpatient therapists who have never worked in residential treatment may have biases against sending kids away and advise parents against it, thereby enforcing parents' shame about their inability to manage their child at home.

    How To Know When It's Time to Try Residential Treatment

    • You have read every parenting book and behavioral strategy -- from sticker charts to time-outs to behavioral contracts to one-on-one behavioral support in the home -- and your child still doesn't get better.

  • Your child had been given numerous psychiatric diagnoses, none of which totally fit. He has been on different medications, but none result in long-term changes.
  • Your house is a war zone everyday. Your child is routinely explosive and scares younger siblings. You are exhausted and the stress of managing daily crises is taking a toll on your marriage.
  • Your child has been expelled from school, is addicted to video games, drugs or alcohol, and has had multiple run-ins with the law.
  • Your child engages in self-injury, threatens to hurt others or kill himself.
  • Your child has had a psychiatric hospitalization.
  • How Residential Treatment Helps, When Nothing Else Does

    • RTCs focus on helping the child take personal accountability. Through intensive individual, group and family therapy, residential staff work on shifting the child from blaming others for his problems to acknowledging that he is where he is because he made poor choices.

  • RTCs have level systems so children learn the consequences of their actions. If they make poor choices or don't do their levels work, they don't gain privileges. The levels system incentivizes children to change their behavior.
  • RTCs provide structure and containment that is impossible to achieve at home. Most RTCs are in remote areas where there is nowhere to run. Therapists, behavioral staff and a levels program provide intensive scaffolding to support the child as he learns coping skills that he can then use to regulate himself. When a child can utilize coping skills, he feels in control and begins to make better choices.
  • RTCs are particularly skilled at helping parents recognize the ways they are unwittingly colluding with their child's behavior, and learn tools to change their own behaviors. Parent workshops and family therapy (usually via phone) are essential for the child to return home successfully.
  • How To Choose a Residential Treatment Center

    • Hire an educational consultant or school placement specialist to guide you through this process. These professionals will generally require psychological evaluations of your child to determine the appropriate placement. There are many different programs available: wilderness programs, RTCs, therapeutic boarding schools. Each program is unique; some focus on younger children (as young as 8), others on adopted children and others on teens with sexual acting-out behaviors.
  • Do your own research. Visit the school. Talk to the therapists. Observe staff. Interview alumni families. Is this a place you feel comfortable sending your children?
  • When working with parents who can't bear the thought of sending their child away, Educational Consultant Lucy Pritzker says, "It's about getting your child the right help at the right place, regardless of where it is. Having a child stay at home and continue on the downward self destructive path they are on -- that is abandonment."

    Early Intervention Is Key

    The longer you wait, the more time your child has to become entrenched in failure. With a negative self-concept, a child's behaviors will likely escalate to serious drug use and arrests. Once a child nears his 18th birthday, when he is legally able to make his own choices, you are essentially a "lame duck" parent. If you wait too long, your window to help your child turn his life around will be closed.

    For a list of educational specialists throughout the United States, visit

    For more by Virginia Gilbert, MFT, click here.

    For more on mental health, click here.

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