Effective residential treatment involves four major pillars or tenants. They are: Structure, Nurture, Engage, and Challenge. All four of these pillars are used at the same time throughout treatment and without one the whole system fails.  That being said, at different points throughout the individual’s phases of treatment, different pillars may be emphasized at different intensities.

Structure involves creating, teaching and maintaining safe and logical limits or rules.  For instance, depending on the population of the treatment center, certain types of violent literature may not be allowed.  Although censorship is generally frowned upon, if a child has been a victim of rape, exposing them to literature involving rape may re-traumatize the child, thus slowing down the whole treatment process.  Therefore, literature involving rape may not be allowed at a treatment center because of the danger of re-traumatization.  That rule is created and taught to clients with reasonable and logical consequences for breaking the rule.

Nurture is another important pillar of treatment.  Giving clients positive messages in ways that are receivable is a prime responsibility of the therapist and counselor.  Nurturance should be appropriate to the client’s developmental level, treatment plan and culture, among other qualifiers.  For some clients, sitting on the ground playing legos (ie: parallel play) is nurturing and developmentally appropriate, while for other clients having a conversation about some item of pop culture may be nurturing.  Know your client population and work to serve them, not a pre-conceived conceptualization of them.

Engaging clients is very similiar to nurturing them.  An area where this may differ from nurturing is that engaging clients seems to be more of a group, than individual process.  Engaging with clients means sitting in psychoeducational groups or community meetings.  It means participating in recreational activities with the client.

Challenge is all about not only the specific behavioral and cognitive changes the client should experience for success, but also believing that clients can be successful.  As a counselor or therapist, we must believe that our clients can change.  It is out of this belief that we issue questions and challenges to our clients and hold hope, even when they may feel it slipping out of their fingers.

Again, without any of these pillars, the whole structure falls down.  Effective therapists and counselors, especially in residential treatment settings, remember these pillars work to use them effectively within the therapeutic environment.

Structure, Nurture, Engage & Challenge: Without one, the whole thing falls down

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