When a child or adolescent client comes to residential treatment, they typically go through four different phases. The first phase is the “Honeymoon” or Assessment phase. During this time, the client is discovering whether or not their new setting is safe, getting to know others and learning and testing the rules. A client may stay in this phase for any period of time, typically anywhere from an hour to a few months. Anecdotally, I have noticed that children with a more significant history of trauma typically honeymoon for a longer period of time. When you consider that clients are discovering whether or not the placement is safe, it makes sense that children or teens with serious histories of trauma would honeymoon longer. This phase is important because the client needs to know that there are safe and this is time that they do it. Additionally, this phase helps with the later phases because while the child is “on their best behavior” they have the opportunity to earn relational “points” with their staff and peers. Later, when they feel safe enough to act out, staff can call upon positive memories with the client to recall that the client has positive parts, in spite of the fact that they are using non-adaptive parts at the time.*
After the child learns that they are safe, they transition into the Resistive phase of treatment. This is the phase where as a counselor, I have most of my more absurd behavioral stories from. (I remember one night coming home and tweeting: “I got whipped in the face with a belt – otherwise, it was a good night.”) During this time, the child is showing the behaviors that got them into residential treatment. They are acting out and testing limits to a greater extreme. It is important to note here that not all children act out in a physically aggressive way; some kids act out by attempting to control or manipulate relationships through triangulation, slander, or gossip. Additionally, some kids act out internally, cutting and purging being some of the more common ones I have seen. It is at this phase that the child begins to recognize their own behaviors that brought them to treatment.
Following the Resistive phase of treatment, comes the Explorative phase of treatment. During this phase, children begin to be willing or able to ask for help understanding why they act out the way that they do. They begin to understand the reasons for their acting out. It is important to note that all non-adaptive coping techniques were adaptive at some point. There are obvious examples, like the child that screams or tantrums to get what they want. Examples that have interested me more over the past year and a half of working in residential treatment are the unexpected ones, like an adolescent who would squawk like a bird during times of stress. Their interest in non-utilitarian relationships also increases exponentially during this time. This is where the “beef” of residential treatment occurs – it is where we as treatment counselors, cease to be compared to babysitters or correctional officers and become counselors. It is here that we use our specifically “counselor” part.
Finally, the last phase is Integrative. During this time, children are learning to integrate the skills and coping techniques that they have learned in treatment to their home environments. They are learning to integrate their past behaviors, past coping techniques, new skills, new relationships into one whole and integrated person albiet and appropriately made up of a variety of different parts. It is at this point that discharge plans are made, and the child prepares to leave treatment. There may be some backsliding at this point, but that is fairly normal with the stress of impending discharge.
*One of the most effective interventions that I have learned is using “Parts language.” By identifying the child’s various parts obviously (“angry part,” “crying part,” “curious part”) or more descriptively (“gangster part,” “entertainer part,” “puppy part”), counselors model integration of the whole person. It is reasonable to expect to see an entire post devoted to Parts language someday.