Yellowbrick’s experience is that it is crucial to embrace the moment when individuals and/or families feel ready to start treatment regardless of the source of motivation. It is a big step and taking action when readiness comes together can spare a lot of future suffering, conflict, and regret. Yellowbrick does all it can to facilitate getting started. Call an Admission Coordinator at 847 869-1500 ext 233. The Coordinator will speak with you about your individual and family context and refer you to the Business office for a discussion of financial and administrative matters. Yellowbrick will check your Verification of Benefits, usually on the same day, so send a copy of the insurance card to cnavas@yellowbrickprogram.com. This usually gives an estimate of how much insurance is likely to reimburse families for fees paid directly to Yellowbrick.

Achieving Effective Outcomes in Intensive Program (PHP/IOP) Treatment

The greatest challenge, and the central source of therapeutic power within intensive program treatment, lies in the effort to create a community experience that includes both staff and patients. Community is the heartbeat of the therapeutic process because it offers so many naturalistic opportunities for human interaction. This is true all the more when the model of treatment is that of an open therapeutic community within which relationships are established on the basis of collaboration rather than on power, control, or responsibility for patient choices being located within the staff. Such a community provides multiple opportunities for patients to learn to face and resolve conflicts, to use words rather than actions to ask for what they need and to begin to empathize with others. The community also allows for young people who are struggling to meet kindred spirits, to feel less alienated and be less alone, to make friendships, to find support, and to substitute human relationships for substances, compulsive behaviors, and symptoms.

What You Can Do to Help Make Treatment Work for You

Patients sometimes experience the community as “living in a bubble,” different from the real world in that peers and staff are more understanding and tolerant of people’s issues than they believe people in the “real world” are likely to be. Alternately, sometimes people experience the community as all too real, bringing up painful realities that they may have preferred to avoid facing or thinking about. The fact is that there is truth in both of these perceptions. An open therapeutic community can be a place where people have deep empathy, understanding, and tolerance for others’ struggles and, at the same time, it involves a process that asks people to learn to talk about their conflicts with others, their own troubling inner world, and the problematic behaviors which communicate from disconnected parts of self.

Clinical experience informs that it is inevitable that individual core difficulties that bring a person to treatment will emerge in the cauldron of community life. If a person has been lonely and has had difficulty feeling a part of things, these feelings of alienation are likely to emerge at some point, in some fashion. If a person has had issues comparing themselves to others or with competitive feelings, these are bound to come up. If anger has been a problem, or if the way a person has expressed it has pushed people away, it is almost certain that this problem will be expressed in that person’s relationships within the community, and so forth. In fact, it is common that the peer with which one has the most upset, or even hateful feelings, is the one who often has the most to teach you!  Core repeating patterns in our relationships, which express important, and usually unacknowledged aspects of ourselves outside of our conscious experience, often hold the troubled but encrypted feelings which have been the engine of our emotional and functional difficulties.

Sometimes when these patterns emerge in treatment, often with self-damaging or risky consequences, the patient (and his/her family) feel worried and discouraged. “This is a therapeutic community! Why am I still feeling this way? Why is this still happening?” The answer is, though it may not feel consoling at the moment, that all of us, as humans, have a remarkably tenacious tendency to repeat our own long-practiced patterns of relating to others, to ourselves, to our own feelings, even if these patterns have led to disappointment, danger or destructiveness. We all bring ourselves and our core patterns with us wherever we go. They will not change by the magic of being in the presence of supportive others. The advantage in treatment within an open therapeutic community is that these patterns become part of the process of a “living laboratory in real-time treatment” where there is an opportunity to be curious, explore, challenge, and otherwise work with them in vivo, in real life, in real-time.

The open therapeutic community and treatment program is designed to take advantage of the reemergence of these core troubles: as opportunities to witness them as they are occurring in our midst; to understand them more deeply; to see how they may have been a person’s adaptation to difficult circumstances; to help the person judge for themselves if these ways of being are getting them where they want to go; to help the person see and to learn alternative ways of coping or relating.

A note about feelings: While therapeutic work frequently focuses on helping patients to recognize and to articulate their feelings, our goal is to assist the individual in bringing emotions back into their rightful place as a part of the understanding of the self, alongside the person’s values, needs, wishes, and thoughts. We recognize the importance of emotions, but we don’t value them as truth anymore or less than we do the person’s ideas or their value system. Knowing one’s own feelings is an essential part of decision-making, but feelings alone can also lead us astray.  We know, for instance, that the person with anorexia feels fat while actually starving to death. The open community model is designed to help individuals learn to exercise their judgment, identify their core values, as well as to be in touch with their feelings.

1. Show up. It has been said that 90% of success is about showing up. If you can learn to get up and get into the program even on those days when you don’t feel like it or when your thoughts are telling you to stay in bed, you will have won more than half the battle.
2. Be willing. Don’t expect to want to do the treatment. Willingness matters more. Try something that stretches your limits. Try something that someone else suggests.  Accept an invitation. Ask for and take someone’s help.
3. Be honest. About your thoughts, your feelings, your behavior. Lying separates you from the community and from yourself.
4. Practice behaviors and ways of coping that are different than the ones that got you here. Einstein said: “You can’t solve the problem with the same thinking that created it!” Try something new or something that is opposite to your usual way of being, like to come closer to people when you feeling like running away or to treat yourself with kindness when you feel self-destructive.
5. Connect. Allow yourself to get to know others and let them get to know you.
6. Test this proposition: If I allow myself to show my vulnerabilities I will feel safer and stronger than I do when I hide them.
7. Avoid avoiding. Treatment works best as a community and for the benefit of each individual when difficulties between and within people are confronted directly.
8. Don’t be willing to keep secrets, your own or anyone else’s.
9. Struggle with the intention to have respect for the basis of staff recommendations, especially at the time you feel you “know better” or feel something else “is right”.

Working to Earn Secure Attachment

Many people who come to intensive program treatment have significant difficulties in their relationships with others. Sometimes these problems cause patients to isolate and avoid connecting, or to engage in destructive relationships, or to believe that their self-worth depends on a connection with a romantic partner. Frequently patients report that they have a hard time trusting others; that is difficult to depend on others or to allow others to depend on them; that they worry about not being accepted; that they worry about being or ending up alone. A growing body of research points strongly to the fact that these kinds of difficulties have profound effects upon life satisfaction, self-esteem, the ability to feel comfortable with intimacy and with independence: all core concerns for emerging adults. The literature also clearly indicates something that is extremely hopeful: it is quite possible to develop secure attachment as an adult and an open therapeutic environment is well suited to facilitate this process.

Here are some examples of ways that you can help yourself to work on this dimension of your life:

• Work on your relationships by
  • Practice turning to others for comfort.
  • Improve your ability to set boundaries and limits
  • Have less tolerance for being mistreated by others.
• Work on your emotions by
  • Practice recognizing and tolerating your own feelings.
  • Practice expressing what you feel.
  • Learn to access your “wise mind” which integrates feelings and your good judgment.
• Work on yourself by
  • Move toward taking charge of your own life by being more active and less passive.
  • Practice compassion toward yourself.
  • Practice tolerance toward your own vulnerabilities and
    limitations.
  • Actively grieve past losses and traumas.
• Work to develop “metacognitive” abilities by
  • Be curious about yourself and others.
  • Cultivate a “beginner’s mind” which isn’t too judgmental, open to possibility, which considers options.
  • Develop a coherent narrative, your own life story, which helps you to make sense of who you are and how you came to be you.

How You Will Know if You Are Progressing in Treatment

We all hope that treatment will help every patient both to function and to feel better. We know, though, that even in the most successful, best-conducted treatment, progress is not linear but may happen in fits and starts, or involve periods of progress and regression, or may cause some people to feel worse before they feel better. These phenomena may make it difficult for a person, and for their family, to judge whether genuine progress is occurring. Here are some indications that a person is making progress:

• You know yourself better, even if the knowledge is painful.
• If you have been numb or cut off from your feelings, you are beginning to be able to feel a greater range and depth of feeling.
• If you have been overwhelmed by your feelings, then you may begin to feel a bit less overwhelmed by them.
• If you are attempting things that make you anxious but don’t overwhelm you.
• If you have tended to withdraw, then you may be a little more willing to come out of your room or to let others know when you are having a hard time.
• If you are becoming more likely to use words to express feelings or needs, rather than retreating into silence or using actions to express yourself.
• You begin to feel connected to peers and/or staff and that others know you and you know them.
• You notice that your relationships with important others, including your family, are changing- this may be that they feel more genuine or real and that things are beginning to feel more resolved or it may be that, for the moment, the relationships are more tense or conflictual.

It may be apparent from the above signs of progress, why it is that sometimes a person engaged in deep treatment may feel worse before things improve. Approaching those things that have been avoided, while an essential part of recovery, almost inevitably is uncomfortable or frightening or painful in some way. If a person has tended to avoid conflicts then beginning to address these is likely to raise anxiety and discomfort. If a person has used drugs or alcohol to manage their own emotions then being sober may leave a person with intense feelings that they may not yet know how to handle well. If a person has had a history of trauma and denied or minimized its impact then beginning to face what happened and the toll it has taken will, of course, be a painful process.