Early Intervention Program Provides Prevention for Troubled Youth
In this interview, I met with Alex Georgakopoulos CEO and Therapist at Coyote Coast Youth and Family Counseling, http://www.coyotecoast.com, to talk about what an early intervention program looks like.
How do you decide whether or not a teen can remain in the home and receive early intervention services, as opposed to being referred to an out-of-home placement?
When we look at why a teen might need to be referred for treatment versus staying in the home we assess several factors:
- Can we support the parents in changing the way in which they are responding to the young person? Are the parent’s willing to be flexible in terms of how to create space for their teen? Can the parents change?
2. If we can create some sense of safety, can the young person come forward with their behaviors?
3. Can we have real dialogue among the family members around the stress?
We see teens with anxiety and depression in the early stages of in-home treatment. A teen’s anxiety can manifest in different behaviors. For example, the teen may be abusing drugs or alcohol, cutting, socially isolating themselves, performing poorly in school, or experiencing low self-esteem. We want to create a safe place for the young person to talk about what’s really going on. What’s at the heart of the matter?
We call our approach a “wrap-around” approach because we’re actually working with psychologists, therapists, and psychiatrists, teachers, administrators and learning specialists—anyone closely involved with the teen. If a young person is in individual therapy we try to access the individual’s therapist, not to interfere with therapy, but to see if we can draw the kid out. So often the parents say, “I don’t have any clue what’s going on in individual therapy.” Individual therapists can sometimes hold a little too rigidly to maintain confidentiality especially when there’s a crisis.
When we’re doing the family therapy we want to connect with the individual therapist to ask, “Would you be willing to see if we can draw this young person out?” We’ll work with the parents to try to create greater safety and we’ll try to get the teen to share what’s going on. Ultimately, if we can create that level of dialogue within the family system, the literature shows that the behaviors will decrease because there’s a safety in bringing things to the surface. The shame gets minimized or reduced when the young person is able to talk openly with his or her parents.
The teen can also be talking about their issues in individual therapy, but that’s once a week or maybe twice a week in an intensive situation. In addition to individual therapy, we sometimes layer in mentoring. If for example a kid is struggling with getting really anxious coming to school we may set-up an “in vivo” experience (a living experience). It’s hard to know what’s really going on with the teen unless you actually experience the stressful situation together. In one particular case the mentor made a suggestion to the teen. “When you feel comfortable with me, we can actually drive to school together and—you don’t even have to go to school that day—I can work with you around your emotional reaction. That’s kind of helpful for the mentor to see what’s happening and to ask the teen, “What’s happening right now?” Where are you feeling the anxiety in your body.” This teen really thought about that and mulled that over.
In terms of our family therapy work, we want to be able to create a level of open communication and interdependence within the family. The idea is that we create a level of safety for a young person to say, “I’m really struggling in this area and this is what I’m struggling with”—and the parents can respond from a place of compassion and love and validation for coming forward as well as being clear around their stance—that’s what we’re striving for.
Sometimes it doesn’t work. Sometimes a young person isn’t able to come forward because they’re so stuck. Sometimes the parents aren’t flexible enough to create a sense of safety. In summary, the assessment looks at three things. Is the parent system flexible? Is the teen capable of coming forward and is the family able to talk about the stress in a supportive manner? Usually, you need all three of these things to happen in order for the young person to move into a place of health within the family system and within the community.
Is it the parent’s role to advocate to make the community a safe container for the young person or is it your role as the family therapist?
In our treatment mode, the family therapist conducts family therapy and acts as the intensive case manager. We’re talking to anyone involved in the teen’s treatment and coordinating care for the teen. That’s the wrap around approach. When we aren’t communicating as professionals, it’s confusing for parents and teens. We, as professionals, can give different advice if we’re not talking and coordinating care.
In cases where parents are not attuned to their teen, how important is it for the parent to understand their parenting style so that they can connect before they correct?
It’s essential for the parent to understand their part in the process. A lot of what we do in our program is help the parent stay attuned. If a parent is anxious or critical we notice that. We don’t want to expose a parent in the session, because we want them to feel safe. A lot of the work in the transition program is to help parents understand their style of parenting and their underlying process. For example, when I’m critical, I’m usually scared. If I’m anxious, I’m scared too. In both cases, I’m feeling out of control. We want to help the parents understand their core affect and what’s really happening for them so that they can change their response from critical or anxious to slow down, attune to what’s happening, and not miss what their young person is experiencing. We want to help the parents understand that if they tune in to their teen’s experience they’ll probably feel less stressed because they will understand what’s happening for their son or daughter. We want to help the parents learn to validate the teen for being open and sharing information, even though the information may be hard to hear.
It’s all in the service of secure attachment. It’s hard because some parents have never had that experience themselves. We can say that secure attachment will lead to greater connection, which will lead to greater ability to meet the teen where he or she is, to respond to them in need—and yet the parent may have never had this experience so they don’t trust it. They need to have the embodied awareness of that happening in order to truly understand how it works. That’s a lot of what we’re working on in family therapy is to help the parents have that embodied experience of slowing down, hearing their teen, validating their teen for coming forward with information, and then respond and have their teen respond to them. This is the hard part because we can do all of this work and the teen may still have a negative response to the containment or the boundary. The parent may feel like:
“We just did all this work and I attuned to my kid and they’re having this negative response to me! What are you talking about?”
We tell them, these are still teenagers, they’re still trying to separate, it’s a long-term process, and not to worry that the connection didn’t happen in this moment, we’re working on it. We also challenge the kids in that session.
“You know, you’ve been asking your mom and dad to listen to you and they did, and you just had this response. I’m curious why you can’t respond to your parents in a different way when they’re doing what you’re asking of them? What’s going on for you right now?”
The markers for progress of success have to do with open dialogue, the ability to connect, the ability to have some hard conversations.
How is it that early intervention may not be enough for some teens?
Sometimes it’s a safety issue. In other cases, it’s about getting the help for the young person that they need. A crisis is a crisis and you’re not going to have an open level of dialogue. You have to get the transport there and ensure the teen’s safety and then begin to work with the family.One thing we see in the industry is that a young person can go to a program and that piece of the crisis, the placement, doesn’t really get processed enough. We see a need for programs to also focus on the crisis, the transport, and the family systems issues. This often gets overlooked and needs more focused attention.
More programs are beginning to focus on the family system and the family process. That’s critically important from our vantage point. But that’s one of the frustrations we have as a family systems oriented program. What we’re trying to do in the early intervention program is remove the label of the IP off the kid because a lot of the behaviors we see are related to the fact that the teen doesn’t feel good about himself, he feels a lot of shame. If we just drill the kid about his or her behaviors—all we’re doing is reinforcing the shame. What we want to do, and we tell the parents this, is help the kid not to be so defensive, but to talk about what’s underlying his or her behavior. That’s hard because some kids aren’t able to do that. Some teens aren’t able to stop the cutting, smoking pot everyday, they are so entrenched in the culture that they do need to out of home placement and the higher level of intervention.
There are some intake calls that are such difficult calls to hear— what’s going on with the teen, what’s going on with the family— that I might even say, “I think you need to talk to this consultant right away. I’m not sure that we can support you given the level of your child’s behavior. Having done the work on the front end for nine years, I have an internal sense of what’s really scary, when the teen and the family are really hurting and they need an intervention. One, to create the space to do the healing because I don’t think the healing can happen at home and two because the behavior of the kid is so dangerous that they need immediate attention
How come parents aren’t aware of the early intervention program?
There are educational consultants who hold the value of in-home treatment, and understand it’s importance, but some who don’t. More and more, the consultants who are working on the front end with us are wanting to try something like this.