Shirah Vollmer MD

The Musings of Dr. Vollmer

Treatment As Pause: The Question of Residential Treatment

Posted by Dr. Vollmer on July 29, 2015

When a person has lost his way, either to an eating disorder, substance abuse, and/or depression, should that person enter into a program which relieves them of daily responsibilities so that they can focus on their mental health, or should they continue in their home environment and integrate mental health treatment into their life? This question has no answer and it is surely not one size fits all. To take the question further, could it harm people to go to a residential setting in that this is a regressive experience, and as such, it could make the re-integration into adult responsibilities more challenging? On the other hand, to leave a person in their home setting, then the triggers remain and they may not be capable of re-booting their lives. In the days of “evidence-based medicine” there is no evidence for either approach. We swim in the dark, hoping that with support, patients can get better. Our level of ignorance about these decisions is deep and yet not easily discussed. Every program wants to believe that they have the “answers” to mental suffering, when, in fact, no one does. What we do know is that residential programs create a stressor at discharge which, for some, can send them right back to their original place of distress. For others, the discharge is a new beginning, where they feel grateful for a second chance at life. Likewise, keeping people at home, for some, allows them to reconfigure their lives slowly and carefully, avoiding the stress of discharge, whereas for others, the home environment is so toxic that staying there does not allow for reflection and growth. We, the mental health professionals, need to  honestly say that we do not know what will help an individual, but with our experience, we can make a  guess. The data are not in yet, so we rely on intuition, which is inherently flawed. That, my dear readers, is where we are at.  Humility is not only important for healing, it is important for healers too.

4 Responses to “Treatment As Pause: The Question of Residential Treatment”

  1. What helped me to deal with crippling PTSD was to no longer work but comtinue to be at home and still take care of my family responsibilities. I was not doing well at my job or taking care of my family, but I really started healing and being more functional once I stopped working. I realize this I’d not possible for everybody, but I’m sure being away would have not helped me, it would have been even more stressful.

    • Hello Pattspathtohealing,
      Thank you for chiming in. Yes, leaving one’s family is a whole set of issues which I did not address. Thank you for expanding my post. SV

  2. Shelly said

    I’m sure you therapists weigh both the patients’ safety, public safety, and the ability of the home environment to deal with the patient when deciding on residential treatment. And I’m further certain that you recommend one way or the other but do not force the issue (unless it is a matter of life and death). The decision should be everyone’s, not just the therapist’s because the identified patient affects everyone. I am not supportive of the fact that someone with some type of mental illness should not be held accountable and is not responsible for the havoc they play on everyone’s lives–even though the excuse is always, “But he or she is ill!” Identified patients still need to recognize that they have responsibilities too and there’s no running away from them.

    • Yes, Your points are well taken. Public safety is a very important reason for taking someone out of their environment into a separate residential setting. The problem is that in the short-term, residential treatment seems appealing, in that it offers an exit from the current situation, but in the long-term, it could do more harm than good, in that it does not promote emotional growth and responsibility. However, as with all of my posts, one size does not fit all, and so we are left to speculating about how to intervene when a person has lost his way- internally speaking.

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