We continue our series of videos taken from our interview with Lon Woodbury. Here Lon talks about how effective aftercare can be, and why treatment programs should incorporate it into their services:
We encourage you to check back here throughout the week to see more of Lon Woodbury’s interview. The posting schedule will go as follows:
“These days, the medicine cabinet is truly a family affair. More than a quarter of U.S. kids and teens are taking a medication on a chronic basis, according to Medco Health Solutions Inc., the biggest U.S. pharmacy-benefit manager with around 65 million members. Nearly 7% are on two or more such drugs, based on the company’s database figures for 2009.” Read the rest of this entry »
“I messed up,” the text message began, “and I just wanted you to know that I cut myself today. But I’m back on track.”
Is this a relapse? She’d been free from self-harm for over 13 months. How would you have responded to her?
In my mind, there is a big difference between a momentary lapse and a full-blown relapse. I had the following conversation with parents at a Family Weekend years ago, an event we hold for three intense days every other month of the year. All of the parents in my group that weekend had girls who were coming home soon.
“I can’t wait for my daughter to come home,” one father said. “New Haven has been wonderful! All of her problems are fixed.” I find that all too often parents expect their kids to be “fixed” when they return home. Even after spending time at New Haven, arguably the most systems-focused residential treatment center in the country, they still believed that treatment is an event and when it’s over, they were done working. “Oh, no,” I told him. “Your journey has just begun!”
“What happens when your daughter returns home and you find her spending hours on the internet? What happens when she skips her curfew? What happens when you find pot in her backpack?” He began to sweat. He stewed. Finally, he couldn’t take it anymore. He lunged across the room at me, red-faced and yelling. “What is the point of this? I came here to feel better about my daughter!” He accused me of doing “poor therapy”, then sat down.
“I’m trying to prepare you for the inevitable,” I said. And we had a robust discussion about how his daughter, in particular, was going to bring home a young man he didn’t like, was going to accelerate into sexual behavior faster than he would be comfortable, and they would have to deal with it.
“I’ll kick her out on the street!” he said. “I won’t tolerate it.”
“But what if it’s not a relapse? What if it’s a one-time screw up? I doubt you’d kick her out if you knew it was an honest mistake. She might ‘lapse’ but not ‘relapse’. So how will you define the difference between a ‘lapse’ and a ‘relapse’?” I asked.
In the end, the group decided together that a lapse is a one-time event which is reminiscent of past behavior. A relapse, on the other hand, is a persistent pattern of the behavior we thought we left behind.
It’s easy to recover from a lapse. Yet it’s also easy to allow a lapse to become a relapse.
So, what stops a lapse from becoming a relapse? They wanted to know!
Two things will keep a lapse from becoming a relapse: #1) consistent, healthy relationships with parents and friends; #2) parents unified and consistent about implementing rules and structure in accordance with established family values.
We spent the balance of that Family Weekend session outlining ways to keep their relationships with their daughters fresh and alive. We outlined rational rules and boundaries which were neither too permissive nor too restrictive.
About ten months later at another Family Weekend, the angry father returned. He sought me out during a parent group and apologized for his attitude. “You were right,” he said . Turning to the other parents in the room, he laid out his daughter’s lapses and how he’d helped her keep them from becoming relapses. He never “kicked her out on the street” and she was doing reasonably well.
He’d realized the truth: our journey does not stop with the end of treatment. We continue on, we fall down, we scrape our knees. It’s how fast we get back up that matters.
So here’s how I responded to the text I mentioned at the beginning of this post: “Thanks for staying connected. As long as you are back on track, that’s what matters. Call if you need to talk.” After all, it was just a lapse.
I received an email from a parent this week, outlining in great detail his recommendations for the treatment of his daughter. At first, I was irritated that he (the parent) would have the audacity to outline for me (the professional) a treatment plan for his daughter. After all, if he wanted to dictate treatment, why didn’t he simply take her home and do it himself?
The reality is, I was being arrogant. His message to me, if I read between the lines of his six-paragraph email, was that I was missing something in the treatment of his daughter. If treatment had been going well, I wouldn’t have received the email in the first place. Once I set my personal insecurities aside, I was able to see that he made some very good points. His recommendations for treatment were actually fairly sophisticated and good ideas.
This is a small example of what I would call “family-driven care”.
Family-driven care is spreading like a wild-fire in residential treatment. The Building Bridges Initiative, founded in 2005, will be having the largest conference in its history in Omaha in June of this year http://www.buildingbridges4youth.org/. The Initiative advocates that families need to be treated less like “problems” and more like “partners” in their own treatment. If I truly believe in this sentiment (and in my own training and philosophical orientation toward treatment) then I will be partnering with parents and children as a matter of practice.
One of my concerns, watching my own mother go through cancer treatments, was the apparent ineptitude of the doctors who sometimes were assigned to her case. Not only that, but their arrogance because they supposedly knew more than I did was also irritating. The truth of the matter was that they were not always right, and she suffered sometimes because of their mistakes. My friend recently went through this with his own mother, who was in the hospital for over a month. Had the doctors listened to him, his mother’s stay could have been reduced by weeks.
So, I need to challenge myself, cast off my pride, and partner with the families who seek my expertise. After all, when I really think about it, the lessons I’ve learned in my career that have had the most impact on the way I perform treatment I learned from my clients anyway!
