A Residential Treatment Center for Adolescent Males with Behavioral and Emotional Disorders
Directive Therapy
Directive TherapySM is the treatment model used in Varangon Academy. It is a cognitive-behavioral therapy that was created more than forty years ago for adolescent treatment and has undergone numerous changes over the years to improve its effectiveness. Independent, longitudinal studies over six-year periods have shown a success rate of 87%. Success was measured with only one criteria–did the adolescent return to a treatment facility or enter the corrections system during the six-year period after treatment. There are many ways to measure success but most of them are subjective in nature–has there been some improvement, is there less acting-out, etc. Our measurement standard is objective and is a yes or a no.
Directive Therapy is proactive. We require the patient's participation as the major change agent in his treatment. We believe that therapy is an educational program and only the adolescent's full participation will give the possibility for success.We are trying to teach the adolescent a way of dealing with the world in which he lives, and his emotions, that is more beneficial to him than the dysfunctional model he has used in the past; the model that necessitated his treatment program.
If you think about it, there are only three areas in which you can make errors leading to dysfunctional thought processes and behavior. Those areas are: perception, decision-making, and response contingencies. While this is a simplistic model it comes close to the realities of a very complex mental system.
Perception is the most important of the three elements because all else depends on it. If you perceive a situation as threatening and respond to it as a threat, you create a threat since the other participants will in turn have to respond to a real threat from you. On our units the adolescent is placed constantly in situations where he must examine his perceptions of events. He is given immediate feedback as to the accuracy of his perceptions. The only way to effectively improve perception is to be placed in such situations in a controlled environment and learn from your mistakes.
Every element of the patient's decision making is analyzed and feedback is provided. This occurs over and over every day so that the adolescent can learn more functional decision-making skills. Specific groups are provided that deal with how we make decisions. If you take a look at how you make most of your decisions, you do not sit down with pen and paper and analyze all the pros and cons on both sides or all sides of a problem. That is fine. If there is nothing wrong with your decision-making process, you are happy and successful in life, then do not analyze the process. If it is not broken, do not fix it. For the adolescents in our programs, however, it is broken and it does need fixing. Consequent to this, every aspect of the process is minutely analyzed. We are attempting to shape improved decision-making skills though continuous learning experiences and modeling behavior. The only way to improve such a process is through repetitious increments of learning in conjunction with didactic material detailing effective decision-making skills.
Varangon Academy provides psychotropic medication regimens formulated and continually monitored by psychiatrists and nurses for those patients having disorders requiring such drugs. Scientific literature totally supports the need for such medications when biochemical imbalances or anomalies are present in the central nervous system. Even in those cases necessitating drug regimens, however, emphasis is placed on the learning aspects of the therapeutic environment and the need to aid the adolescent in developing more effective coping skills.
Most studies presently suggest that 80% of an individual's personality traits are based on genetic factors. Some of these innate traits are simply proclivities and others are more likely to be expressed in behavior with or without intervening environmental factors. Remember, however, that the other 20% is based on learning and experience.
If you have a deck of fifty-two cards and only ten cards (approximately 20%) can be changed, you can always win if you can control those ten cards. With medication to help with genetic factors where needed and therapeutic learning to improve coping abilities, perceptual acuity, decision making, impulse control, anger management, anxiety, delaying of need gratification, long term planning skills and social interaction skills we have an excellent chance of making meaningful changes.