Effectiveness of Family Centered Therapy for Residential Treatment Facility Clients
by Jason Victory, MS, NCC, LPC, ACS, Clinician

With a background of more than 13 years in the mental health field, I have had opportunities to work with clients in various levels of care, including outpatient therapy, school-based partial hospitalization programs, acute partial hospitalization programs, group home programs and residential treatment facilities. It is clear in all of these settings that recidivism and relapse are very high in the programs that do not include Family Centered Therapy as a modality. The main reason is basic: If the child or adolescent makes significant progress and experiences change, but does not have significant people or an environment that supports these changes, he will more than likely regress to the level of functioning that precipitated his most recent level of care.

Families
The young people I see in residential programs come from diverse backgrounds and present with varied psychiatric and behavioral needs and diagnoses. One factor they have in common is the need each resident has for family and family support. Each resident identifies family in her personal manner, be it blood relations, foster families, adoptive families, peer groups, caseworkers, etc. Additionally, each resident derives emotional support of some sort from his “family.”

Just as they vary in composition, families vary in terms of the levels of support they provide to their children during residential treatment. Some are enmeshed, which means that emotional and physical boundaries are violated. Some are aloof and emotionally detached for different reasons. Yet others are invested and simply need structure and guidance to support the needs of their children.

Enmeshed families clearly need outside agency supervision to ensure no form of abuse occurs. At times, therapy includes helping children and adolescents and their families develop insights into the problematic nature of the enmeshment. At other times, due to the degree to which boundaries have been violated, re-defining family is necessary when children and adolescents are placed into new environments away from the enmeshed families that have exacerbated and, at times, created the disturbances that necessitated treatment.

Regardless of the level, Family Centered Therapy has proven an effective modality in the treatment programming of the young clients in residential treatment programs. Family Centered Therapy must include elements of:
• Psycho education of the diagnoses
• Causes of and contributory factors to the diagnosis
• Parenting interventions
• Communication skills
• Reinforcement scheduling
• Medication education
• Restructuring of expectations
• Self-modulation and self-awareness of reactions of each family member
• Self-care skills of each member
• Role identity clarification
• Clinical homework assignments to be completed during on and off grounds visits
• Analysis of the problematic behaviors and motivational factors to modify said behaviors
• Identification of barriers to success and methods of proactively managing the barriers.

Further, each element needs to be individualized to the personality and cognitive functioning levels of the child/adolescent. When Family Centered Therapy addresses these elements, it complements the individualized clinical work each resident completes during her or his treatment program to sustain the progress within the home.

Psycho education about the diagnoses can assist to alleviate feelings of guilt, remorse and embarrassment by the child/adolescent and family members as they gain insights regarding the organic, internal and external factors that contribute to and cause the foci of treatment. Communication skills need to include verbal and non-verbal language to help each member learn to speak openly with each other without triggering defense mechanisms. An integral part of communication and interventions is self-regulation, to wit, awareness of internal reactions to others and learning to respond to one another appropriately rather than irrationally.

Additionally, role identification is crucial to healthy family relations as well, as each member learns how the role she or he has adopted has contributed to the problematic and positive relations/interactions within the family. Each member becomes educated about structuring roles based upon meeting the needs of every other member. Psycho education regarding developmentally appropriate reinforcement schedules is imperative so that family members are able to provide motivational interventions that meet each child/adolescent’s emotional and behavioral needs to help them function within their communities. Self-care skills of clients and their family members need to be taught, role-modeled and practiced daily so as to become intuitive rather than guided. These self-care skills, reinforcement schedules and communication skills are practiced during family therapy sessions and on and off grounds visits.

Family Centered Therapy can prove to be particularly effective when the clinical team implements unique, individualized interventions. Clinical team members are educated regarding trauma reactions so they are able to implement interventions that are effective and do not replicate unhealthy family dynamics.

Clients are able to learn how to restructure their behaviors to achieve personal educational and vocational goals, rather than continuing to re-enact defense mechanisms that have caused them to not relate appropriately within their communities. Clinical team members can provide unique programming including off grounds work on farms, field trips to colleges, art projects, talent shows, engagement in martial arts and many other opportunities. They then must educate families about how to replicate such programming within the family home to help the child/adolescent realize her or his personal strengths.

Family sessions can occur on the grounds of the facility or within family homes. This combination of locations offers individualized treatment and allows the child/adolescent and family members to utilize skills within their natural environment and the residential environment. Family Day can also be helpful because families are able to interact with their children/adolescents and other families to develop a sense of community. During Family Day, educational group sessions are typically provided to further educate families regarding the aforementioned elements.

Another element that can be critical to Family Centered Treatment is unique approaches to serving the community with an open-minded approach to working with children, adolescents, families, agencies and communities. Treatment teams should also be open to feedback and, therefore, programming and clinical interventions that are individualized and continually evolving to meet the psychiatric needs of the clients/residents.
Finally, the team must take a truly Strengths-Based approach with families. Many of the families whose children are in residential treatment feel stigmatized and downtrodden due to the difficult road they have traveled with their children. The treatment team can tailor therapy sessions and treatment planning to focus on using family and client strengths to overcome the child’s presenting problems. Programming and aftercare must also be tailored to address their strengths, thus enhancing self-efficacy and significantly decreasing recidivism and relapse.|

Jason Victory is a Clinician at the KidsPeace Inventor Center in Orefield, PA, where the techniques discussed in this article are successfully implemented to treat children and adolescents in residential care and return them to their families. This emphasis on Family Centered Treatment reduces the time spent in residential and strengthens support systems after return to their family settings.