Relational Therapy 101: A Parent’s Guide to Navigating the Relationship-Based Treatment World
“New Haven shows us that we are loved, teaches us how to love, and helps us spread love in our lives.” – Kristin, Alumna 2006
More than 20 years ago we looked around and found that there were no residential treatment programs that treated adolescents the way we’d want our own daughters to be treated if they were ever to need treatment. One of our founders actually worked at a treatment center that was so abusive he would secretly call the parents of the kids and beg them to come and take their kids home! We created New Haven as an answer to problems like this and it grew to be the largest and most successful female-specific long-term residential center for adolescents in the world. We pioneered relational therapy and relationship based treatment with teen girls who needed inpatient care. And we have trained hundreds of professionals along the way.
We now live in a country where “relational therapy” and “relationship based treatment” are at the core of any program that professes to have any measure of success with teens. The vast majority of Americans agree that “tough love” and “boot camps” are not effective. Many different therapeutic programs claim to have “relational therapy.” Many of our former staff have started their own great programs and we are very happy that so many others have followed our example over the last two decades! People from Singapore, Australia, Madagascar, Ireland, England, Canada, Mexico, and many other professionals from around America and the world have visited us to receive mentorship about how to implement our unique brand of relationship based treatment. Relational therapy philosophies are having their day in the sun – and that’s as it should be.
But there is a difference between being relationally oriented and having a wholly integrated relationship-based treatment program. It’s kind of like the difference between someone who knows how to play chess and someone who is a chess Grand Master.
We created this graphic to help explain the elements of great relationship based programs. Most great programs have some of these elements, but only New Haven – the world leader – has them all. As you read further, do a mental check and ask yourself how the programs you are touring as you seek to make this difficult decision rank with each of these critical elements of relationship-based therapy:
1. Warm and Caring, with Good Boundaries and Therapeutic Expertise
Most good programs nail this one. Being warm and caring yet manifesting good boundaries is the first thing New Haven looks for when hiring its staff. Yet those warm and caring feelings are not enough. We know we must truly love every girl who comes through our program and treat her the way we would want our own daughter to be treated. That love is what provides the foundation for healing and makes our program a “Haven.”
In addition, the skilled use of good boundaries and natural and logical consequences is paramount. There needs to be an appropriate mix of warmth and boundaries for any relationship to be considered healthy.
It may seem obvious, but many relational treatment centers miss this key point: simply “loving” someone won’t help heal an eating disorder; likewise, you can’t “love” someone out of an obsessive or compulsive behavior. While it’s true that people won’t pay attention to you if they don’t feel you care about them if you don’t have the skills to help them heal then your relationship with them is worthless. New Haven’s experts don’t only know how to build strong therapeutic relationships with our clients, we know how to use specific relational therapies to move even the most intractable problems toward hope and success.
The following story from one of our therapists illustrates the powerful mix of warmth, boundaries, and expertise:
I spent an hour today with a young woman who had not harmed herself for eight weeks. She had not harmed herself, that is, until today.
As we talked, she unwound tape from her forearms – tape she had wrapped around paperclips pressed tightly against her skin, hidden under the long sleeves of her sweatshirt. She handed me the various bits of metal she was planning to use to harm herself again later, and we talked of her reasons for wounding herself.
All of her reasons boiled down to pain: the emotional pain caused by the shame she suffers for decisions she made in the past; the emotional pain, “burning through her veins”, as she described it, due to the abuse she suffered at the hands of someone who should have been safe and trustworthy.
Her solution to assuaging her emotional pain was to distract herself from it by self-inflicting physical pain. Physical pain is something she can control. It is straightforward; it is easy to understand; it demands attention NOW. Ironically (and effectively), it helps her to numb out and forget.
As we talked, she allowed her words to spill out, like a trickle of water that has filled a deep basin over time, and has just crested the lip of the reservoir. She surprised herself. It seemed as if she couldn’t stop the flow of ideas and emotions. When she was finished, we sat together for a moment, both emotionally spent, looking at each other, sharing in the silence. We smiled at our emotional connection – the result of engaging in a relationship of trust and compassion.
“You know,” I said, “Over time you will begin to replace your pain with something else. Do you know what that is?”
“You’ve felt it from me today.”
She paused in thought for a moment then spoke: “Warmth,” she said. “And love.”
2. Construct Communities for Optimal Relational Learning
Most great programs also do this one. But only New Haven’s program is completely designed around the idea that relationships are the key to healing. Specifically:
- Small therapeutic communities- Our different “houses” consist of 12 – 16 girls. These therapeutic communities are intentionally kept small so that students have to learn how to build relationships, even if it means talking to someone you’re mad at.
- Home like environment- We make our houses as much as like a home as possible. We have family style meals together, we hang out together in the evenings and help each other with our homework.
- Dedicated staff & dedicated therapists assigned to each house- Because relationships are so vital, we have staff and therapists dedicated to each house. That way they provide a consistency to your daughter’s experience and she can learn to trust the people in her everyday life.
- Lower Caseload and Lower Staff to Student Ratio- New Haven has one of the lowest staff to student ratios in the country, and our therapists have one of the lowest caseloads in the industry. This is done intentionally so our therapists and staff have the time to build relationships with each of our students.
3. Creative Programming that Fosters Relational Practice
We are friendly with our fellow treatment providers – many of them do great work and have very creative programming options for teens. Some programs use point systems and level systems designed to punish and reward clients like you would if you were training a dog. They believe that their level system and “activities” are all the programming they need. But we know that programming is more than activities and accountabilities. Some of our other provider friends eschew level systems entirely, claiming that level systems are archaic forms of manipulation. But we believe that if you have strong relationships and you are helping your clients heal their core issue, then monitoring behavior and providing benchmarks can help provide a sense of progression and accomplishment.
It is for this reason that New Haven has created a proprietary and intricate Values Program – the only one of its kind anywhere – which celebrates and marks important milestones in each girl’s trajectory of change. It is a robust set of interdisciplinary programming, including everything from academic intervention, to clinical and therapeutic tasks, as well as recreation, medication management, social skills and service opportunities. It is the backbone of our relational therapy. The Values Program is the primary vehicle for our unique and time-tested application of relationship based treatment.
Every student receives a Values Binder in which she stores the work she does on her individualized Values Program throughout her stay. Our clients keep their rewards and their artwork, their journal entries and their photographs in these Binders. One young woman called our founder more than six years after she completed treatment. She was then 22 years old. She told him that she’d had to evacuate her apartment in California due to raging fires. She had to gather clothes and food and her pet. And she made sure to take her Values Binder with her – it meant that much to her.
4. Effective with Those Who Experience “Relationships” Differently
Many of our students have been severely hurt by past relationships and are unwilling (at least at first) to trust in relationships again. For these students, it is important to provide safe ways for them to connect emotionally. At New Haven the dogs, cats and horses fill this vital role. Some few programs in our country have caught the vision of the importance of animals in the healing process, and we applaud them.
Some students, however, may not have learned the skills necessary to form deep and lasting relationships. For these students, it is important to teach and model how to have healthy relationships. At New Haven, we do this by teaching the skills in therapeutic groups, then providing opportunities to practice building relationships during free time in the evening and on weekends, recreational outings and multi-day trips.
Other students may not know how to put their emotions into words, or even be aware of how their behaviors affect their relationships. For these students, we’ve built experiential therapy opportunities into each day’s programming. Some teens struggle with non-verbal learning disabilities (NLD) or with reactive attachment disorder (RAD). These kids perceive relationships and respond to relational therapy differently than other children. New Haven’s relational therapy experts are trained to connect with – and assist – all of these kinds of needs.
5. Form Powerful Relationships with Whole Family System
When they come to New Haven, our students aren’t the only ones who need to heal. Parents and siblings often have gone through an emotionally exhausting period leading up to New Haven. For everyone to heal, therapists and staff must have deep & meaningful relationships with everyone in the family system, not just with the identified patient or the key decision makers.
New Haven doesn’t just invite families to spend time with each other – we require it! We have turned our fair share of parents away who simply would not commit to spending time with their daughter. Family visits on site and at home are a crucial and expected part of our relational therapy.
We expect our staff to interact with our clients’ families. It is a common occurrence to have grandparents, siblings, and extended family attend family weekends, participate in activities on site, and complete assignments which help everyone heal. Our staff are encouraged to keep in touch with our clients (in appropriate ways) even after treatment ends. One mother from Israel flew out to New Haven every 8 weeks for her daughter’s entire 12 month stay. Months after her daughter completed treatment she flew back for an alumni reunion and remarked, “I’m home! Seeing these mountains feels like coming home. After all, you’re family!”
6. Great Relational Teams That Hold Selves Accountable
We hear it almost from every parent, “Our daughter is really good at working the system without really changing.” We get it. When so much of the process relies on having a good relationship, it is hard to know whether you’re seeing every side of a student, just her best side, or maybe no authentic part of her at all. She could be manipulating you!
But at New Haven, we get a thorough and deep understanding of each student’s relationships through weekly treatment team meetings. We get a 360˚ picture when therapists, teachers, nurses and residential staff all come together for 6 hours every week to give each other insight on how a girl is doing and to plan together for her success. The team is then able to create an individualized plan each week that focuses on “what is best for THIS student.”
Even the healthiest therapist brings their own baggage to the therapeutic process. They have their own biases and emotional triggers. In the therapy world we call this transference or projection. When it gets really bad we call it counter-transference. For a relationship to be truly therapeutic, therapists must actively address their own baggage to make sure it doesn’t hurt your family’s healing journey. Many programs are reluctant to require this of their staff. They think it equates to “imposing therapy”. Our response to this is, “If it’s good for our clients, it’s good for ourselves.” There is no hypocrisy at New Haven!
New Haven has the most robust training of any treatment center in the country. Staff are trained alongside therapists in 16 hours of basic training, and then every person in the company receives one hour of training every week, in addition to routinely scheduled monthly and quarterly trainings. There is no greater accountability than being trained alongside your peers.
7. Measure Progress – of Family, Client AND Program, including Mechanisms of Accountability
It is very difficult to quantify relational therapy. And our field has used that as an excuse to rank measuring progress low on the list of priorities. New Haven is widely recognized as the pioneer in the robust use of Feedback Informed Treatment in private, parent-choice residential treatment circles.
New Haven uses the Session Rating Scale created by Scott D. Miller to measure the therapeutic alliance between our clients and their therapist EVERY WEEK. This is a measure of the therapist – NOT of the client. We hold our therapists accountable to good treatment more than any other relationship based treatment center in the country. If it becomes apparent that the therapeutic alliance is not working and the relational therapy is interrupted for any reason, we will switch therapists to ensure that our clients have the best possible fit.
We also measure other things, and we’ve been doing it for more than a decade. Things like family health and progress, client health, depression, anxiety, trauma, social skills, and many more are a routine focus of our rigor. We are excited that some programs are starting to see the value of doing this as well. What sets New Haven apart is the sheer magnitude of what we measure, the consistency of that measurement, and the length of time we’ve been doing it. Additionally, we put the results of those measures into the hands of the therapists in REAL TIME. And to make it even more effective, our therapists share that data with their clients. You would be amazed at what a teenager will do with information about herself. It’s remarkable how much more effective and lasting change is when we are transparent with our clients about how well they are doing.
In summary, the question “What would I want for my daughter?” led us on a path to healing that has resulted in the most relationally-founded program in the country. and Relational therapy and relationship based treatment have been the foundation of our success with over a thousand families for more than 20 years.