If you go to a 12-step meeting one of the slogans you’re likely to hear is “keep coming back”. It’s meant to welcome you, and be encouraging. And it is. But with respect to rehab, you don’t want to “keep coming back”. As a therapist of 20 years, I can’t tell you how many times I’ve heard something like the phrase “I’ve been going to rehabs for years,” from weary drug addicts who are still suffering, wanting to get clean. They are not so much unmotivated as stuck with something that is more than an attitude, and something closer to an embedded way of being: I want to feel better, not get better.
Find a program that does not collude with this misguided goal. Here are a few tips and explanations:
1.) First of all, size matters: the size (as in number of beds, # of patients participating in activities); the size of a case manager/therapist caseload. If a program has more than six beds, or offers groups with more than 8 participants, the tendency is for treatment to become unwieldy, possibly unsafe. If a therapist has more than half dozen patients on their caseload, it is unlikely they will have sufficient time to devote to one individual or family. I’ve observed these phenomena over many years, and depict numerous examples in Working Through Rehab.
2.) Secondly, ask questions about the influence of patients’ rights groups, community licensing bodies. Some programs are more answerable to external regulators than others, which isn’t necessarily a good thing. In my book, I chronicle several instances wherein outside agencies influenced program procedures, often based upon societal norms, and not for the better. Often, accommodations served to enable problem-behaviors of substance abusers, not protect individual’s rights. This is a similar view to that offered in Dr. Drew Pinsky’s 2004 book, Cracked: Life on the Edge in a Rehab Clinic.
3.) Thirdly, observe the proscription of depth therapy in rehab settings. Note the tendency of programs to sell short-term models that address behavior and cognition, but not underlying feeling states, maladaptive patterns of relating to others—attachment difficulties, and trauma. For example, anger management skills and mindfulness training are well and good, but they don’t address pervasive distortions of self and others. Furthermore, dovetailing with item #1, if a therapist is too preoccupied with multiple staff meetings, producing rote documentation, communicating with collaborators on largely pragmatic matters, in-depth focus with any one individual or family is more or less squeezed out.
4.) Finally, hear with some distrust the phrase “fun in recovery”. This language is pitched to teens in order to get a buy-in, but while teen programs should include recreational activities, make no mistake: recovery, or meaningful change, is not fun. If you are a parent looking to place your child in rehab, I suggest the requirement of “fun” has not worked, and reinforcing this idea may have you or your child coming back, again and again.