A family recipe, a childhood memory, a Depression-era handout
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In March 2007, when he was sixteen years old, Kenneth R. Rosen was awakened in the middle of the night by two strangers who told him to get dressed and come with them. The men, hired by his parents, didn’t say where they were taking him, but his recent behavior — violent scuffles with teachers and police, drug and alcohol use, expulsion from school — was enough for him to guess. After being forced into a van, Rosen was taken to a “wilderness therapy” program in the Adirondack Mountains. He later went to a therapeutic boarding school in Massachusetts and a residential-treatment ranch in Utah. In all, he spent 288 days in the programs at a cost of tens of thousands of dollars.
Rosen’s situation is not unique. His recent book, Troubled: The Failed Promise of America’s Behavioral Treatment Programs, follows four teenagers — two of whom he was institutionalized with — through their experiences with for-profit “tough love.” He estimates that at least sixty thousand American teens are sent each year to such programs, which combine group and individual therapy with strict rules, manual labor, and, in the case of wilderness therapy, harsh environmental conditions.
These techniques for dealing with so-called troubled teens sprang from several groups in the 1970s, most notably the confrontational therapeutic program called Synanon. Accounts of physical and emotional abuse followed Synanon’s rise, and the organization fell apart in 1991, but similarly structured businesses sprouted in its wake. And they were profitable. In 2010 just one company had more than two hundred facilities and revenues of $3.4 billion. Just as with Synanon, the more recent programs have attracted attention for hundreds of cases of sexual, physical, and psychological abuse. In the past eighteen months two children have died after being restrained by staff at these programs.
Rosen emerged from treatment with what he says were more issues than he started with. He spent time in juvenile detention but eventually went to college and became a journalist with work published in The New York Times, The Atlantic, Newsweek, The New Yorker, and Wired. For Troubled he combined his own experience and reportage with firsthand accounts from others who sat for interviews and gave him old journals and documentation of their time at the programs.
My interest in Rosen’s story comes from my own teenage years. In 1994 I was sent to a wilderness-therapy program where confrontational therapeutic approaches were combined with hundreds of push-ups a day, manual labor, manipulative psychological techniques, and severe consequences for minor infractions. (When a fellow patient ran away with a backpack full of crackers he had hoarded from the cafeteria, we were all ordered to send our backpacks home. I didn’t do this in a timely enough manner, so I had to wear my pack filled with gravel for several weeks.) I was there for ten months. A number of teenagers I was in the program with had been placed there by the state. Many had suffered trauma or been emotionally and physically abused at home. When I looked one up recently, all I found were mug shots from his arrests. There are numerous similarities and differences between my experience and Rosen’s, but the commonality is that it was traumatic for each of us, and the years immediately afterward were difficult.
Rosen spoke with me via Skype twice this spring from his home in Italy, both before and after he traveled to Iraq and Syria for a reporting project. He believes that tough-love programs ultimately do more harm than good, and he cited a number of reasons why: extremely low hiring standards and pay for staff, lackluster regulation by state governments, and very little accountability. More than anything else, he says, they are an example of the ineffectiveness of one-size-fits-all congregate-care settings, in which children are kept under twenty-four-hour supervision in highly structured environments. “You can’t place [people with] several different types of maladies into a room,” he says, “and fix them all at once.”
KENNETH R. ROSEN
© Sharona Jacobs
KENNETH R. ROSEN
© Sharona Jacobs
Cohen: What’s the scope of the troubled-teen industry today?
Rosen: There are hundreds of programs across the country — at least a hundred in Utah alone. Some are extremely profitable. Many are under private ownership, which makes it difficult to get records on them. That’s why I decided to speak to former clients [people who were put in the programs as teens — Ed.], psychologists, therapists, and counselors to paint a picture of the industry.
It was hard to nail down concrete numbers in part because it’s so difficult to get data on minors. I tried to piece together an estimate of how many children are sent away to these programs annually, and it’s in the tens of thousands. Conservatively at least fifteen thousand are admitted to wilderness programs every year. The number who go to residential programs is a lot higher. And there’s a difference between the programs that admit foster children, who are wards of the state, and the private institutes that are primarily funded by parents, some of whom mortgage their homes or take out loans to pay for their child’s treatment.
A lot of the gatekeepers and associations that accredit these programs are run by industry insiders. The academic research about wilderness programs and residential-treatment facilities is mostly funded by the programs themselves, so it aims to convince parents that this is a good alternative to local, community-based treatment.
Cohen: How did you arrive at that estimate of fifteen thousand teenagers a year admitted to these programs?
Rosen: Fifteen thousand is just in wilderness programs. I managed to get that number by reaching out to private education consultants — who often get kickbacks from the programs — and asking them roughly how many children they had referred to a wilderness program in the last year or two. As far I can tell, about three-quarters of referrals result in a child being placed in the program. After speaking with senators and state legislators who are working on regulating tough-love programs, I believe the total number, including residential treatment centers and therapeutic boarding schools, is at least four times that. It seems that, since the recession that started in 2008, the industry has boomed. People looking for ways to fix their wayward children see this as a silver bullet.
Cohen: What was your experience in these programs like?
Rosen: I was taken from my bed in the middle of the night and spent sixty-something days in the wilderness, then went straight to a therapeutic boarding school, where I tried to run away. I got into trouble for that and a lot of other stuff, and they kicked me out. I went back to wilderness therapy. From there they sent me to a ranch in Utah. I was so institutionalized by then that I knew exactly what words to use. I knew exactly how to behave to get out of there in the shortest possible time. And, man, I flew through that program. I was the ideal patient, to the point where everyone viewed me as a Goody Two-shoes. I was just playing the system. The counselors saw me as a model kid, and when my dad heard that, he pulled me out and brought me home. My therapist cautioned against pulling me. I believe he knew that I was just giving lip service to everyone.
After I left the programs, I struggled with substance abuse and developed a difficult relationship with alcohol. I went off the deep end — you know, making up for lost time. I went to juvenile detention six months after leaving my last program. And juvenile detention was far less corrosive than my 288 days in these programs. That’s my personal experience with it.
Cohen: Did you experience or witness the type of abuse that you write about in Troubled?
Rosen: Yes, I tried to corroborate people’s stories through others who were at the same programs, but it also fit with what I saw and what I heard from the hundred or so other people I interviewed: a boy who was sodomized with a broomstick by a counselor; young women who were made to lick their bowls and utensils clean every night; the general encouragement to “hold others accountable” by ratting on other clients who break program rules. I was given silent treatments or made to face a wall in the dark for a long time or isolated from the group. In my last program there were some Fight Club situations going on — and not just involving kids but also the counselors: they would make kids fight each other, and then the winners would have to fight the counselors. Because I had been in a military academy for two years and had witnessed some heavy abuse and hazing there, it was like a continuum for me. If I saw anything that I haven’t disclosed in writing or in public, it’s probably because I’ve internalized it in some way.
Cohen: When you say a Fight Club–type scenario, this is not part of the therapy, right?
Rosen: Correct. This is what a lot of the industry folks seem to turn a blind eye to: The therapy comes only once a day, or in one-on-one meetings with your therapist once a week. But the counselors, the residential staff you’re spending most of your time with, are often just twenty-one-year-olds with no social-work or psychiatric background. Some have only a high-school diploma. That’s where a lot of the problems arise.
Parents believe these programs will offer the best treatment and return their child home mentally, physically, and emotionally fit, but you can’t send your child to a remote place, far from any metropolitan city, and expect them to receive the sort of care you would find in a more centralized location. Right now a bill is moving through the Oregon State legislature that would prevent programs from posting a job listing with the only requirement that the applicant be twenty-one years of age. [It recently passed. — Ed.] They need to vet candidates and find people who can provide the therapy and treatment that is supposedly being offered at these programs. Because of where these jobs are located, the businesses just can’t draw the sort of talent needed to treat children with various maladies and complicated needs. Some of these children do need help, but is this the right type of help? Over the years counselors have been charged with sexual abuse, physical abuse, and predatory behavior. These crimes underscore the notion that there’s no real process for making sure children receive proper care.
Cohen: And the lack of oversight — what can explain that? I definitely saw people get restrained in ways that seemed unnecessary at times: a kid who defiantly cursed at a staff member was body-slammed and then put in a straitjacket and medicated. And there were plenty of sadistic counselors who would refuse to let you speak to your parents or would mess with you psychologically. Do the people in charge of these places know what’s going on?
Rosen: I think it’s a matter of who they are going to believe: the troubled teens who were sent away by their parents, or the counselor they’re paying by the hour to look after the teens and uphold some semblance of order? If a client discloses abuse by a counselor to a therapist, it’s always going to get back to the counselor, and then the counselor is going to get mad, and who knows what that will lead to. The therapist might think the client is embellishing the story in order to have his or her program time frame shortened. I think the therapists and counselors view everyone as a hard case. They’re not listening to the kids. One of the biggest problems with reporting on this industry is that so many people within it will dismissively say, “That was an isolated incident,” or, “That doesn’t occur at my program,” or, “These former troubled teens are lying again.”
One group at one of my programs had twenty-six individuals. A decade later — which is far beyond the scope of the efficacy reports that come from the industry — about three-quarters of them were either dead or in prison. I’m not saying that’s the scenario for former clients of every program, but I’ve heard from countless individuals who’ve had a difficult time finding their fellow clients. And when they do find them, they’re in jail, or they’re in prison, or they’re in the depths of despair. The industry will say the programs weren’t at fault; the kids were already troubled: “We did our best, but we failed.”
Cohen: What would count as success?
Rosen: Success to me is interior. It’s a matter of how you feel inside: Do you feel settled? Do you feel accomplished? Do you feel content? Do you feel like you know who you are most days when you wake up?
I think most former clients will say that they don’t feel like themselves; that they don’t feel settled; that they feel trapped in some way. Maybe they can’t articulate it, but they are missing something. There’s a “lost child” aspect to so many who went through these programs.
I always felt like I was bearing this weight that nobody else could understand. I never trusted my emotions. When I felt angry, I thought I was being irrational. When I felt sad, I thought I was being overly emotional. When I was in an abusive relationship, I thought I was the one at fault. When I was turned down for a job, I thought it was because I was worthless and should just crawl back into a hole. I didn’t want anyone to see me, lest they realize what a bad person I was — given how often I’d been told I was a bad person in the programs.
Cohen: Did any of the former clients you spoke to see any value in the experience?
Rosen: There were people who said they really enjoyed being outside. They enjoyed camping, being away from the computer and their friends for a little bit. The common thread among those people was that they weren’t admitted to another program after wilderness. They were gone for anywhere from one to three months, and then they went home, which is not the typical experience.
For many, if they did take something away from the experience, it was “Oh, I deserved that. And I want to do better because I don’t want to go back to one of those programs or go to jail.” That sounds good on paper: you taught someone not to want to go to jail. But it’s punitive. It’s scaring kids, not reckoning with the underlying issues: the family, inner turmoil, trauma that could have been treated with cognitive-behavioral therapy or another evidence-based approach. I spoke to more than a hundred people. I wouldn’t have written the book if fifty of them had said they had a really great experience. The responses leaned toward it being a bad experience, something that traumatized them. Many just wanted to put it all behind them.
Cohen: Do you think most would have been better off not attending these programs?
Rosen: We can’t know for sure. I have known parents who didn’t send their misbehaving kid away, and the kid did really badly. I’ve also seen such kids do really well. I have heard stories of parents who cut the kid off completely, and the kid ended up overdosing and dying. I’ve heard of parents who sent their kid to a program and then financially supported the kid for years, and the kid squandered all that money on drugs. The point is that every child needs individualized treatment. And it needs to be community based. You can’t just throw them into a herd of children with different problems and hope they turn out OK. I’m happy that some people did come out OK, but the people who end up worse off vastly outnumber the handful of success stories.
Cohen: You mentioned community-based treatment. What does that look like?
Rosen: Community-based treatment can be an in-school therapy program, meaning that children are receiving therapy at the public or private high school they normally attend. Another form of community-based treatment is an intensive program at a local hospital, with the child still going to school and living with the family unit and keeping the same friend network.
Cohen: Are community-based programs as widely available as tough-love programs?
Rosen: Absolutely not. In the U.S. good mental health care is hard to come by, and when you do come by it, it’s very expensive. States aren’t apt to put funding into community-based treatments when they can outsource the problem to these congregate-care, for-profit, troubled-teen programs. I was talking with a representative of a law firm based in Chicago just the other day who said that, at least in Chicago, parents can seek state funding to send the child to one of these residential treatment centers or therapeutic boarding schools. The parents are exploiting a little-known loophole in the Americans with Disabilities Act that allows them to petition public-school districts for money to send their children to a private institution if the public schools fail to maintain their child’s “emotional well-being,” definitions of which are loose.
Cohen: Are there any studies that show significant positive results from these programs?
Rosen: There are some industry-produced ones, but none that are legitimate. I know of PhDs at the University of Florida and the University of Michigan who’ve published studies about the inefficacy of these programs, but they are often told by senior researchers on the Outdoor Behavioral Healthcare Council to retract papers from peer review due to pressure from the industry. Objective research is being sidelined because of the industry’s desire for good optics. Evidence-based treatment like cognitive-behavior therapy or EMDR — eye-movement desensitization and reprocessing — is sometimes a component of tough-love programs, but that ignores the larger problem of the underpaid staff who are with the children most of the day; the fact that children are stripped of their civil liberties and can’t write home or communicate freely with the outside world; and the conditions in which they live, which can include restricted access to food, practices of restraint, isolation from their peers, and hard labor on “working ranches.” The treatments individually could be beneficial, but they’re not being applied individually. They’re being applied with a broad brush.
Some of these children do need help, but is this the right type of help? Over the years counselors have been charged with sexual abuse, physical abuse, and predatory behavior.
Some of these children do need help, but is this the right type of help? Over the years counselors have been charged with sexual abuse, physical abuse, and predatory behavior.
Cohen: And the people who could provide oversight — like the therapists or the clinical directors — are not actually living in the cabins or in the wilderness with the kids, right?
Rosen: Right. Someone who works at one of the programs and read my book wrote me describing in great detail the terrible, abusive, illegal things that some counselors were doing to kids. There was a child who would strangle herself, and the staff had been instructed by their superiors to wait until she passed out before acting. In another instance a child who was having a trauma flashback was dragged across the floor to her bedroom. Children were routinely denied prompt and adequate medical care. This woman wrote to me trying to figure out the best way to release this information so that it didn’t blow back on her and so it would have some effect. There’s no federal oversight body to look into the programs. There are disability-law centers and state investigative bodies, but there’s often no reporting method, and if there is one, it’s often swept under the rug. We are seeing some movement in Montana, Michigan, and Utah.
Cohen: What’s happening there?
Rosen: Montana is starting to regulate all therapeutic boarding schools with a religious bent. And in Utah there’s a recent bill to limit the ability of programs to restrain, sedate, and isolate children. It’s a step in the right direction, but I’m pessimistic that these bills will do what they need to do: reform the practice of transporting the kid in the middle of the night; reform the reporting requirements of these programs; reform the requirements for the staff and the level of education and training they need. In Washington State there’s a bill being introduced that would license all education consultants who are giving referrals to these programs and require them to have visited the program facility in the last few years. These sorts of efforts, as you can see, are disparate and target very specific issues. There really needs to be federal oversight in order to create a baseline for the way these programs operate. Without that, I think most state legislative efforts are going to either peter out or have little to no effect.
Cohen: What prompted these actions in Michigan and Utah?
Rosen: In Michigan it was the death of a young man named Cornelius Frederick in April 2020. [Frederick, a Black sixteen-year-old, was tackled to the ground after he threw a sandwich in the cafeteria. Seven staff members restrained him for twelve minutes, some putting their weight on his torso. He later died in the hospital. The death was ruled a homicide, the facility was closed, and criminal charges were brought against three employees. — Ed.] A newspaper there ran an investigative series on tough-love programs. In fact, one of the reporters was a former client of these programs. In Utah it’s mostly an effort championed by [celebrity socialite] Paris Hilton, who was once in a program in that state. They are hoping to shut down the place she went to and others like it. So I think with the attention from her efforts, and hopefully from Troubled, and from the continued outpouring of stories from people who attended and worked at these programs — I think there’s good momentum. But I worry the industry lobby is too strong.
Cohen: In the history of this industry, have there been cases of altruism, with founders who genuinely cared about helping young people, or has it been predatory from the start?
Rosen: I got a lot of pushback after the book was published from people who said I just didn’t understand the industry; that there were programs that were helping people; and that a lot of people who run or work at these programs aren’t doing harm — or, at least, don’t mean to. I think that misses the point, which is that, despite the best of intentions, these programs don’t work. A lot of the people who are with the kids day in and day out aren’t qualified to be supervising children at all, let alone children who are suffering from depression, alcoholism, drug abuse, and sexual abuse, some of whom might have special needs. There are, I’m certain, well-meaning people out there. I’ve interviewed a few who have worked in these programs who came to understand they were part of something they hadn’t signed up for, but who did their best regardless. But they were put into situations where, just like the children, they were set up to fail. These programs are built as a one-stop shop to fix all sorts of problems, and we know from research and academic papers that congregate care does not work: it doesn’t work for adults, and it doesn’t work for youths.
Cohen: In a situation where a child’s home life is unstable — it’s not an abusive household, but it has become toxic — what do you think is a better solution than such a drastic break?
Rosen: Sometimes what it requires is for the parents to take an honest look at themselves and say, “We’re a part of this. We’re also in need of help.” And not “I need help with my kid,” but “I need help with my own issues,” and “I need help making this home a place of comfort for the child.” We’re talking about a family here. The teenager isn’t the only one destroying it. Families need to come together and figure these problems out as a team.
Some programs send the parents therapy packets and maybe let them visit now and then, but for the most part they agree the issue is with the child. Who does that benefit? Are the parents going to change? When the child returns, are the parents going to react the same way they have for years? And how will the kid deal with that? Is he or she going to be strong enough? It’s so much more complex to focus on the family. These programs are a product of dysfunctional family life in the U.S. right now.
To be clear: I fully understand where the parents are coming from. They feel like they have no choice. They’re at a total loss, they’ve tried everything, and they’re willing to resort to what amounts to an experimental treatment, right? Because, as I’ve said before, it’s not evidence based. Personally I just wouldn’t feel comfortable sending my son or daughter to a treatment program that wasn’t tried and true. And insurance companies aren’t going to cover the price: between thirty and sixty thousand dollars a year.
This is part of a bigger question about privatized health care. For-profit health care in this country is devastating mental-health efforts. When you have police answering mental-health calls who aren’t prepared to deal with people in need of psychiatric care, it’s all combustible.
Cohen: It’s such a hard thing to try to explain what happens in these programs. How do you tell people you meet about this?
Rosen: I’m happy to talk with anyone who wants to bring it up, but there’s often no point in a conversation where it would be appropriate. If you’re sitting at a bar talking about high school, you can’t just say, “I didn’t go to prom because I was transported in the middle of the night to a wilderness-therapy program, and I spent 288 days in all at a therapeutic boarding school and a ranch in southern Utah. It was crazy!” [Laughs.] It also just feels so far removed from where I am today. I’ve got my own kids. I live in Italy. Troubled is being adapted into a feature film, which I’m writing, and also a separate docuseries that I’m executive-producing. I’ve got my wife, who’s a saint to deal with me all the time. And I’m calling you from this really great woodshed that I remodeled to have a little place of my own. Thinking about myself as a seventeen-year-old is something I don’t have the energy for. It’s the last subject I would think to raise with someone.
Cohen: I told my wife last week about a recent conversation I had with one of the counselors from the program I was in as a teenager. My wife said that, when I first told her about being in the program, she was simultaneously horrified and heartbroken for me. When I reveal that experience to people, I feel like it never comes out correctly. Either I need to talk for fifteen minutes straight, or I just shouldn’t say anything.
Rosen: “Heartbroken” for you is a good way of putting it. It’s so difficult for a lot of former clients to talk about, in part because they worry that someone will say it couldn’t have been that bad. To disclose something so personal only to be undermined is devastating. And I think that worry stems from the programs, where kids learn not to share or they might get in trouble.
Cohen: Earlier this year I reconnected with a couple of the counselors from the program I was in. They’ve since left the industry. These were just jobs that they took after graduating from college with a psychology degree. They feel sort of conflicted about the manipulative way treatment was issued and the business model itself. Did you speak to former staff members who expressed anything like that?
Rosen: Absolutely. Time and again I’ve heard the narrative you describe. How great does it sound to graduate college and spend a year in the woods? But once they are in, they wish they had known a little more about what they were getting into. They don’t have much control in the program, and they regret it later on.
I’ve had therapists who worked for these programs tell me they didn’t agree with some of the treatment plans or the way therapy was being carried out, but they stayed anyway, hoping to improve some clients’ lives and be the ballast against the more nefarious methods of treatment, such as “thought reform,” a type of brainwashing in which someone’s life story is rehashed over and over and edited each time; or “attack therapy,” where the group berates the client being “treated.” I’ve also interviewed former clients in these programs who ended up going on to teach or work at them because they felt that they could change whatever might have been wrong. But the spokespeople from the industry, who wouldn’t talk to me directly, are very combative. They see my book as an unwarranted attack on treatment they believe to be beneficial, even though it’s not evidence based.
The Supreme Court has said that you can’t sentence an eighteen-year-old to death, because at that age we’re not making decisions on a rational level. Apply that to the troubled-teen industry, which treats children as if they’re lifelong addicts, doomed for life or in need of severe treatment for their issues, and you start to realize what’s wrong.
There’s also evidence that teenagers in general are going through a really rough time right now. The pandemic aside, they’re not socializing with their peers the way we once did. They’re more focused on digital connections and operate better on-screen than in person. Anxiety and depression among teens are at all-time highs. People have attributed that to video games, the Internet, and social media, but those have been around for many years. Whatever’s causing it, these programs have been able to capitalize on the desperation of parents who aren’t sure how to handle these issues in their children.
These programs are selling themselves as a way for kids to disconnect from the troubled society that is harming them and bring them back to their core self. And there’s something to be said for the wilderness experience, right? Fresh air, hiking, exercise — we all know that’s beneficial. But being pulled out of bed in the middle of the night isn’t. And there’s no agreement among professionals whether the sort of therapy practiced in these programs is clinical psychology. State officials have told me there are plenty of state-funded opportunities for communal health care that are more effective, better vetted, and better regulated than some private company that boasts the best treatment ever. And hundreds of people who survived these programs are now claiming abuse. You can’t just dismiss that by saying, “You seem alive and well, so we did a good job.”
Cohen: Today it’s not hard to find information about these programs online — and it’s also not hard to find information about abuse. Don’t parents have more tools at this point to help them make these decisions?
Rosen: Yes, and I think that’s why the programs are coming under a lot of fire right now, because young people are able to get their stories out on TikTok or Twitter or Facebook, or they start their own websites to campaign against the programs. But if you google “troubled teen,” you’ll be hard-pressed to find a critique of the industry in the top results. When I googled “troubled teens,” or “at-risk youth,” or “boarding schools for out-of-control teenager,” I found that most of the sites offering insight into these programs are owned by the industry. One website takes funding directly from the programs. They never vet the companies they recommend beyond sending them a survey to fill out. But there’s also much more information out there from people who’ve attended these programs or journalists covering the industry, and that’s encouraging more people to oppose what I keep referring to as the lobby, which has had a stranglehold on information for so many years.
Every child needs individualized treatment. And it needs to be community based. You can’t just throw them into a herd of children with different problems and hope they turn out OK.
Every child needs individualized treatment. And it needs to be community based. You can’t just throw them into a herd of children with different problems and hope they turn out OK.
Cohen: Who’s behind that lobby? What are some of the largest companies in the industry?
Rosen: I haven’t been able to pinpoint one as the largest, but a corporation called Sequel runs about fifty-five programs across the country. They are one of the more fraught corporate bodies in the industry. A company like Sequel comes along every decade or so, and then it gets embroiled in a controversy and disappears, and another business entity buys up the programs and operates them under a new name. CRC Health and its subsidiary the Aspen Education Group were at one time a multi-billion-dollar conglomerate with more than a hundred programs between them. Then, because of lawsuits or low revenue streams, they started to sell off programs, and the buyers started their own programs under a different umbrella organization, and then more lawsuits came in. It’s a vicious cycle, and it undermines the industry claims that they’ve changed. Maybe they have in some regard, but the fundamental problems haven’t gone away: They still mistreat children. They’re still not vetting the employees. And they’re not exactly licensed to provide the type of treatment they purport to offer.
Cohen: Sequel was pulling in millions of dollars in government funding and private-equity investment and also operated the program in Michigan where Cornelius Frederick was killed. How is it that the states and the federal government allow an organization like this to exist if, as you say, there’s a repeated cycle of abuse?
Rosen: Because the lobby we’re talking about is so strong. When reports of abuse come out, the programs simply say it’s an isolated incident. Some states, like Michigan, have started to look into the way they license and regulate these programs. But in Utah the same senators who are on the human-health-services committees are also on the boards of these companies or are stakeholders in them.
The efforts to regulate the industry have been mostly toothless. Some bills have been passed to look at whether or not these companies are operating under certain licenses, but they often come from legislators I believe have loose ties to the industry. In January there was a job posting on a therapy website for a position in southern Utah. The listing required only that the person be twenty-one years of age and have an interest in children and outdoor activities.
There’s never an impartial, outside body investigating these programs. There has been talk about change. There have been many different task forces and initiatives begun on behalf of the programs themselves, so they can say, “We’re looking into this.” One doctor I interviewed in 2018 said that the practice of kidnapping a kid in the middle of the night really needed to change. Just the other day I heard that someone within the industry was “taking a look” at this methodology and considering whether it can be improved in any way. The slow pace is really disheartening. The survivors of these programs who are advocating for change are frustrated. They’re making their voices heard, saying they were abused and subjected to techniques of sedation, coercion, and isolation that aren’t proper treatment for children, or even adults. And the industry says, “We’ll look at it,” then does nothing.
Cohen: If it’s left up to the states, it seems, nothing’s really going to get done.
Rosen: The reform movement is very spread out. There are different efforts happening in different states and on different parts of the Internet, but there’s no one combined effort, and I think that’s hampering any movement toward broader reform. I hear a lot of discouraging comments from wilderness-therapy instructors or researchers who have tried to bring attention to the faults in the programs. Oftentimes they are shut out of conferences or not welcome to speak at annual events because they’re not toeing the industry line. The momentum is there, I think, for a sea change. People are protesting these programs and trying to pull together a more cohesive movement. We just need to keep sounding the drumbeat and hoping the right people will listen.
I was a psychiatric nurse for twenty years, three of those spent at facilities for adolescents, and I can testify to the validity of Kenneth R. Rosen’s descriptions of therapy programs for “troubled teens” [“Sent Away,” interview by Finn Cohen, August 2021].
I left after the bad behavior of unqualified staff went unaddressed by the administration. There was a short supply of listening, respect, or integrity, and I hated to see the patients caught in the maw of institutional ignorance and greed. One of the doctors had been molesting adolescent girls for years; though he was reported many times, he still kept his license.
Oftentimes all one had to do was meet the family of the kids to realize what the problem was.
These kids were sometimes hard to like. The amount of rejection and physical abuse they suffered left them in a rage — a terrible, righteous rage. There was no one to advocate for them.
“Sent Away” reminded me of my experience, in the early 1980s, working at a dental practice that treated adolescents who were in a private therapeutic-treatment program. Though the kids were described to me as incorrigible, troubled youth, they were mostly personable and entertaining.
Being the single mom of a three-year-old daughter at the time, I didn’t give much thought to the program, the kids, or their parents. My assignment was to clean their teeth. We were briefed on how to manage the difficult patients: Rule #1: Once they were in the office, lock the doors so none of them could run away — which a couple attempted. Rule #2: Don’t leave them alone with sharp instruments within reach, because they might try to pocket something to use as a weapon or for picking locks. Rule #3: Don’t discuss the program’s treatment methods, staff, or living conditions.
Decades later I read about accusations of harsher-than-necessary treatment, which focused on peer confrontation, public humiliation, and extreme consequences for rule-breaking that bordered on abuse. The program has since been shut down. After reading Rosen’s interview I came across a disturbing 2017 documentary, The Last Stop, made by former residents of the program. Though it’s been almost thirty years, I recognized one of the kids in the film.
In the meantime I’d become the parent of a troubled twelve-year-old daughter. In 1992, for reasons I believed were justified, I sent her to a therapeutic wilderness program in Montana for four and a half months. It had been recommended by a highly regarded adolescent therapist, and I thought it would be better than waiting for further interactions with law enforcement, truancy, or running away. I was envisioning her eventual spiral toward incarceration or total self-destruction. I was determined to get “it” before “it” got me. Or her. I was a worn-out, scared, and desperate mother, trying to save her child.
Many variables affect which kids get sent away — and why. There are well-intentioned parents, and there are those who simply want to dump their kids somewhere. There are well-staffed and poorly staffed programs. There are kickback therapist referrals driven purely by dollars, and there are those who leave room for negotiating costs. Often enough, by the time a situation reaches a tipping point, it’s hard to keep a calm head. For many parents it’s a do-or-die moment that demands an immediate decision.
I prefer to think that, like myself, most parents’ primary intention is to save their kids from themselves. Success usually relies on the parents’ participation in that process, which means leaving their sense of infallibility at the door. The most effective treatment program my daughter was in required me to attend weekly meetings, no excuses. Honest exchange, forgiveness, and relationship adjustments are necessary to move forward.