Buyer Beware: The Troubled Teen Industry (TTI)
32 years after it caught my family in it’s web, the troubled teen industry is alive and apparently thriving. They drew us into their hell in 1990. Aaron had been cycling rapidly through depression and mania and was regularly overcome with a frightening alternate reality that I could not reach into to provide any comfort. In that place, he saw suicide as a better death than the one his delusions had in store for him.
He spent 3 weeks in a psychiatric hospital that gave us a neuropsychiatric evaluation with fascinating information about what they saw as an imbalance between the hemispheres of his brain, but no practical suggestions to help him function any better. That stay just about exhausted his lifetime cap for insurance coverage for mental health, and Aaron was still hallucinating and intermittently suicidal upon discharge. The hospital recommended long-term treatment but had no solutions for how to pay for it short of relinquishment of custody to the state of Texas.
I called a psychiatrist in Colorado whose secretary I had stalked a year or so before until she convinced him to see us. He said he knew a place where we could, if we moved up there, keep Aaron home at night. We desperately wanted to believe that someone somewhere had a solution.
Straight Inc. was the single worst choice we could have made. I spoke to a mom whose son had started there at 12 years old, and she believed it was helping. We picked Aaron up at the hospital and drove to Dallas for his intake. To pay for it, we came home and began selling everything of any value, Dan’s drum set, his military dress uniform, and eventually even our home so we could move up and Aaron could live with us again. That never happened.
We moved all right, but he could not progress to the stage that allowed him to live at home. We did not know about the profound abuse that he was experiencing, but we should have. There was an incident right after I opened my home to other children in Straight. I walked in on 2 “old-comers” (youth in upper phases who were responsible for managing “new-comers” like Aaron) restraining a boy. I had heard them yelling and opened the door to see them holding Cabby on the floor by force and yelling at him. I stopped them and that behavior did not occur in our house again – or did they just learn to be quiet so I would not hear them?
Every day, the “phasers” (youth in the program) went to “the building” where they spent their days in confrontational encounter style groups. They were made to sit up straight, military style in rows of blue plastic chairs with metal legs from early morning until we picked them up in the evening. There were dozens of very strict rules about where they could look, what they were allowed to say and when, even what they were allowed to think about. On Friday nights, families came together for our own group that sort of mirrored that of the kids. We were encouraged to confront each other and to confess our faults publicly. At the time, I had such limited knowledge of mental health and was in such fear for Aaron, I was willing to try just about anything that promised any hope at all.
After having separate youth and family Friday groups, we all gathered in a one large group, all sitting in those same blue plastic chairs, the parent group facing the much larger group of our children lined up in rows and sitting ramrod straight. We were encouraged to confront our children lest they die of addiction. It was harsh and desperate. But then there were celebrations when a youth would yell “Coming home” and run to their families arms because they made phase 2. Aaron did not come home, but having put all of my eggs into this basket, it had to work, right? I was admonished not to quit before the miracle.
I should have known when his arm was broken and there wasn’t a clear explanation of how, but it did not occur to me that anyone would deliberately torture my child. Yet they did, as we would find out years later. For somewhere around 11 months, he was both physically and verbally assaulted regularly. Aaron was restrained, made to stay awake for days on end sitting in his underwear and being sprayed with water when his eyes began to close. His hallucinations began to merge with the reality he found himself in. When they failed to force compliance, they shipped him off to their original facility in Florida, while we stayed back in Texas bringing other youth into our home night after night. Straight was the lynchpin, around which the remainder of Aaron’s life derailed.
I began writing this blog after going to a mental health administrators conference and seeing an exhibitor representing a “wilderness therapy” program in Utah. I asked about their staffing and practices, and told him about my concerns. I watched his spine stiffen and his face close. I wondered if he too was a survivor?
How do you know whether a facility is legitimate or one of the many troubled teen industry programs that prey on children and their families? Here are my list of questions to consider:
Ask about allegations of abuse. Google the facility and staff, and look for complaints.
How do they deal with conflict or behavioral issues that come up? Do they use punishment (retribution) or restorative approaches (coming to consensus, enabling the offender to make amends).
Are youth responsible for disciplining each other? (Many of those youth who “progressed” through the upper phases also struggle with having perpetuated the abuse onto someone else). This is very different than legitimate peer to peer supports. In authentic peer to peer support, the focus is on support, sharing lived experience and nurturing hope - they are not disciplining each other.
How do they engage families? What transition supports do youth/families have as they exit the program? How transparent are they? Do they provide evidence based parenting guidance (vs toughlove)
What are their thoughts on toughlove? It is a failed strategy from the 1980s that endorses often harsh consequences for undesired behaviors. TTIs incorporate it into their ethos. It persuades families that the abuse is therapeutic. It is not.
What is the programs’ overarching therapeutic ethos or philosophy of change?
o Behavioral modification strategies easily escalate into abuse when they are not working, especially in the hands of an unqualified workforce. It usually doesn’t work well for children who have serious mental illness and/or histories of trauma. Ask who imposes consequences and what do those consist of? If they advocate for breaking the youth down to build them up; don’t walk, run away.
o If they claim to use Cognitive Behavioral strategies, can they articulate what that means? (it has a focus on changing one’s thoughts to shift feeling states and therefore behaviors). Same with third wave behavioral theories such as Acceptance and Commitment Therapy & Dialectical Behavioral Theory (these build mindfulness and distress tolerance on top of CBT); do their practices match their stated theory?
o 12 steps alone are not sufficient when working with people with mental illness, trauma histories, or teenagers.
Who are their staff? Are they licensed (LPCs, SWs, MFTs, OTs etc have a code of ethics and are answerable to their licensure boards). How often will your child see them and for how long? Who is with your child most of the day and what external training do they have? It is sadly common to hire people with no experience, knowledge or skills, and then put them in charge of so called therapeutic activities. This is a red flag. Get a list of staff and google them, TTI staff seem to pop up in other abusive settings when their last gig closes down.
Where have the administrators worked before? Again, they seem to pop up in another like program when one closes. Google them.
Do they allow youth in their program to speak to family and others without a chaperone? Can you call your child whenever you want?
How do they use restraint? Who restrains and how frequently? Are restraints part of their routine or do they recognize them as a sign that something needs adjusting in the program?
Trust your gut, if something feels wrong, leave. Sometimes doing nothing at all is better than doing something that will make it all worse. And it can get much worse.
Look especially critically at wilderness programs, boot camps, boarding schools, even religious programs. Are they licensed in your state and what does that mean?
Ask the TTI survivor network to do some searching for you info@endthetti.org
Are there advocates or family groups that can help families find and access sound alternatives that support success? We need more family and youth run advocacy that are independent of the organizations they seek to hold accountable. Your state may have a Statewide Family Network, Federation of Families chapters, or networks of mental health providers who may be able to suggest alternatives. See if there are strong wraparound or early intervention for the prevention of psychosis programs; perhaps even school based supports. There are solid alternatives that have much better outcomes and will be worth the investment in time. For help finding family run organizations, the National Family Support Technical Assistance Center (www.nfstac.org) is a resource, as is the National Federation of Families (https://www.ffcmh.org).
Here are some videos to watch about TTI:
https://www.youtube.com/watch?v=9rrQ3KX39-Y
https://www.youtube.com/watch?v=Av0jhwRLOAc
You can also search #breakingcodesilience for more survivor’s voices