Sending Your Teen to Residential Treatment: Guilt and Fear

How to Hold an Injured Bird: Letting Go When Your Child Needs Residential Treatment

Now that fall is here, I've been taking long walks (those of you who have called me during one know these are part of my own self-care). On one of them I was listening to Jay Shetty's conversation with Andrew Huberman on On Purpose: The Simple Habits That Will Transform Your Health. Most of it is a protocol episode: morning light, cortisol, sleep. Then Shetty told the Buddhist parable of the injured bird, and I thought, "That's the same concept I talk to parents about all the time." A man finds a bird with a broken wing and asks how to hold it. Too tight and he crushes it. Too loose and it flies off before it has healed.

I spotted three hawks on that walk, each one a bit eerily close, tucked into the trees within twenty feet of me. It was not lost on me that I was hearing a story about an injured bird while this was happening. It also wasn't lost on me that I could be the one who got hurt. A hawk once went after my neighbor when it decided he had gotten too close to its nest.

When Letting Go Feels Like Giving Up

Sending your child to residential treatment may feel like the loose grip. You're sending them away to be cared for by others because you couldn't do it on your own. Or you send them to boarding school because they need more structure than you can provide at home. With this can come shame (the mistakes you made as a parent, the sense that you weren't enough), guilt, and a sadness that gnaws at you. I know; I was there with my own child.

I want to reframe this for you. It may feel like a loose grip, but it isn't. It's the grip that is right for the circumstances. Of course you wish the circumstances were different and that your child didn't need the help, but wishing that away is putting your head in the sand. You are placing your child in the care of professionals trained to help them heal from their mental health struggles and get back to their education. They will be in an environment where they're doing things that build self-esteem, self-worth, and confidence.

The Tight Grip: School Refusal, Substance Use, and Keeping a Child Home

The tight grip looks like the hovering or bulldozing parent, the one who is so fearful that they keep their child at home even when the child isn't going to school, is using substances, is self-harming, or has become an emotional terrorist who terrorizes not only the parents but the siblings too (I wrote about this in my blog on glass siblings). These parents tell themselves they're doing right by their child, but by letting fear keep their child at home instead of in the care of trained professionals, they may be doing their child harm.

Parents often think homeschooling a school-avoidant child is the answer, not realizing that homeschooling lets the child avoid the very thing that makes them anxious, which reinforces the anxiety. Researchers at the Yale Child Study Center call this family accommodation: the changes parents make to their own behavior to spare a child anxiety. Their research has found that accommodation can keep a child's anxiety going over time. Eli Lebowitz and his team developed SPACE (Supportive Parenting for Anxious Childhood Emotions), a treatment that works with parents only and helps them reduce accommodation while staying supportive. In a randomized trial of 124 children ages 7 to 14 with anxiety disorders, published in 2020 in the Journal of the American Academy of Child and Adolescent Psychiatry, SPACE was as effective as individual cognitive behavioral therapy. I trained in SPACE, and it informs how I talk with parents of school-avoidant kids.

They may shrug off their child's weed use as a way to manage anxiety, without understanding what it can do to an adolescent brain (more on that in my blog on adolescent THC use).

And they don't see how much therapeutic work happens in the peer milieu. One client at a residential treatment center told their mom they'd gotten better about showering and brushing their teeth because they were embarrassed not to in front of their peers.

Parenting from a place of fear

The philosopher Jiddu Krishnamurti wrote about the fear underneath this kind of parenting. He argued that much of what passes for parental love is rooted in anxiety and control (you can hear him talk about it here). When parents push or mold a child, it is often because they are afraid the child will fail, suffer, or not fit in. He also saw how anxious parents stop seeing the child as a person in their own right and start treating them as a project, or as a continuation of the parents' own ambitions.

Kahlil Gibran says something close to this in The Prophet, which I wrote about in Your Children Are Not Your Children. For a parent holding tight, a therapeutic program or a boarding school may not fit the life they pictured for their child. Letting go of that picture is part of finding the right grip.

Is Residential Treatment Safe? When the Fear Is About the Programs

I understand why parents are afraid. There are bad programs out there, ones we would never refer to, and the stories from people who went through them are terrible. Some of those people now work for programs we do refer to.

Licensing and oversight have improved; Utah now has some of the strictest oversight in the country. [[In 2021 the state passed SB 127, which requires programs to document every use of physical restraint and seclusion and report it to the Utah Office of Licensing. The law also limits the use of restraints, seclusion, and sedating medication, and it increased inspection requirements.]]

We vet every program we refer to [[, and we visit and evaluate more than 100 schools and programs every year]]. Parents hire us to suss all of this out. When we assess whether a child needs residential treatment, much of it comes down to one question: is your child safe at home? (I wrote about this in When Your Child Isn't Safe.)

Three Kinds of Worry

Hiring a therapeutic consultant does not end the worrying, but it changes what the worry looks like. Before placement, the worry is about today. Is he high? Is she cutting? Will he go to school?

After placement, the house goes painfully quiet. Your son is angry about being sent away, and he lets you know on every call. He's not wrong; you did send him away. You hold both: you made the right decision, and he experiences it as abandonment.

Then he comes home, the energy shifts again, and the first months are hard even though everyone has better skills. That's three different kinds of worry over two or three years.

Check Your Grip

Whatever phase you're in, check your grip. Every few weeks, ask someone whether you're holding too tight or too loose right now. It's hard to see on your own. [[That someone might be your partner, your own therapist, your child's therapist at the program, or us.]]

[If you're trying to figure out which grip your family needs right now, we'd love to talk.

Jennifer Benson, MSW, is a partner at Crossbridge Consulting. She trained at the Columbia School of Social Work, in the SPACE program at the Yale Child Study Center, and as a parent coach. Talk with Jennifer here.