Mother Teresa said, “In the West there is loneliness, which I call the leprosy of the West. In many ways it is worse than our poor in Calcutta.”
In my experience, loneliness is best predictor of relapse. If a young woman finishes treatment successfully but returns home to no friends, even if her parents are “there” for her consistently, she will relapse within a very short amount of time. Teens need a support system outside of their immediate families.
Think about it: if someone loves you and wants to be around you, and they are not required or expected to do so, doesn’t that make you feel good? Parents and siblings are supposed to love us. But friends are not. Once we experience love and validation from others outside of our immediate families, something within us changes. We begin to believe that we DO have value and that the nice things our parents have been telling us about ourselves could possibly be true.
Mother Teresa went on to say, “There is a terrible hunger for love. We all experience this in our lives – the pain, the loneliness. We must have the courage to recognize it. The poor you may have right in your own family.”
Residential treatment centers have fallen short. We have not incorporated teens’ friends into treatment and transition as well as we should. Well before they transition – even from as early on as admission – we need to provide teens with ways of connecting with good friends. We can provide them with easy ways of keeping in touch with the friends they make in treatment through creative use of social media, such as Facebook and Ning, cell phones and instant messaging. We can help them determine more effectively – on their own – which friends at home are supportive and helpful. And then we should get them to connect with those friends in creative, non-electronic ways.
One young woman went home during treatment and invited her friends to a “non-alcoholic party”. She was nervous that they would think it was dumb. She was even more nervous that no one would show up, because she planned it for a Friday night – a night when “everybody goes out to party”. Well, she had a great turnout and she led them in a game of “supermarket relay”. She formed teams of two, each team filled a cart in the supermarket with goods, they all switched carts, and the first team to put the goods back on the shelves in the correct places won. Her friends had a blast and many commented that they didn’t know they “could have fun without getting drunk”.
Many teens think that being “clean” means being lonely. This young woman returned to finish treatment with a new confidence that she could be successful without having to be lonely.
“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.
