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REHAB Treatment for Young Adults

By Bonnie A. DenDooven, MC, LPC

Ad·o·les·cence is defined as a period or stage of development, preceding maturity. But what happens when chronologically your son or daughter becomes an adult and emotionally they are still locked in immature, self-destructive patterns that you thought they would out grow?

For a therapist working with young adults and their families, REHAB is a process of untangling the mystery of maturation gone wrong. Getting young adults sober from drugs and alcohol is just the tip of the iceberg. Unless the underlying issues are addressed, the young adults are precariously at risk to return to the immature habits that put them at risk to start with.

Karen Horney, pioneer psychotherapist who focused on the struggle toward self-realization, held that basic anxiety brought about by insecurities in childhood was fundamental to later “character development“. (Footnote 1) In other words, some anxiety and some insecurity are needed to produce maturity, much like the baby chick in an egg needs to press against the adversity of the hard egg shell in order to emerge strong and capable from the hatching process.

In 1969, a publication changed how we treated children. The “Self-Esteem Movement” was birthed when psychologist Nathaniel Brandon published a widely received and highly acclaimed paper called “The Psychology of Self-Esteem” and argued that “feelings of self-esteem were the key to success in life“. (footnote 2) A 40-year craze of self-esteem building began then. This craze changed how parents and teachers treated anxiety and insecurity in children. The “Self-Esteem Movement” encouraged parents and teachers to remove as much anxiety as possible from the lives of children. Suddenly it was NOT okay to give 1st, 2nd, and 3rd place trophies for fear that some child would feel less than others. Teachers put away red markers previously used to grade papers because it might make students “feel bad”. Parents began a chorus of constant praise and admiration such as “You’re so smart!”, and “You’re so pretty!”;, and the killer, You’ve got so much potential”. Research now shows that by age 12, children no longer believe these overworked compliments and see these compliments as an attempt by adults to manipulate them. (Footnote 3) Worse, the self-esteem movement created children who may have high self-esteem but who cannot tolerate any form of anxiety or insecurity. Without tolerating basic anxiety and insecurity they cannot produce character in themselves. Teenage use of drugs and alcohol to medicate the anxiety and insecurity is leaving us with a generation of addicts who live by the cognitive distortion, “I should never feel bad.”

In the therapy room, when working with immature young adults (ages 18-29), it is easy to detect patterns. The newest research on addiction indicates that attachment disorders underscore addiction, but what does that mean? Karen Horney wrote about how the authentic self emerges. She described three classifications of how we relate to others. It is in our relationships with others where authenticity or the lack thereof shows up. To see attachment disorders in action, therapists watch how young adults: (1) Move toward people, (2) Move against people, or (3) Move away from people.

In essence, it is a simple and brilliant way to look at this thing called attachment disorder and to prepare therapeutic interventions that are effective. In the close conformity of the REHAB environment, these reactive positions of relating to others become visible, and set patterns readily emerge in the day-to-day required activities. Following are the three categories and ten patterns

Attachment style of Moving toward People:

Pattern 1: The need for affection and approval; pleasing others and being liked by them. The feelings of peer pressure are too powerful to resist and results in CODEPENDENCY and trauma bonding to unhealthy “friends” Young people can become just as addicted to “the lifestyle” of the drug world as they are to the chemicals.

Pattern 2: The need for a partner; one to love and who will solve all problems – the emphasis is that “love will solve all problems”. This results in love addiction and sexual promiscuity with either an inability to disengage from abusive relationships or the inability to be without a relationship. These are the REHAB residents who strike up romantic or sexual liaisons in treatment.

Attachment stylse of Moving against People:

Pattern 3: The need for power; the irresistible urge to bend the rules and achieve control over others. While most people seek strength, an immature young adult may be desperate for it.

Pattern 4:
The need to exploit others; to get the better of them. To manipulate, operating from the underlying belief that people are there simply to be used staff splitting and using humor to control a room (they are just an audience). People become objects and the immature adult operates without empathy.

Pattern 5: The need for social recognition; and limelight. The immature young adult manifests as desperate for recognition; they posture before staff, lie, cheat, and steal in order to be the center of attention, or become the clown and the butt of their own joking, never taken seriously. This need is an act of moving against people because it connotes beating others out for attention.

Pattern 6: The need for self respect; an exaggerated need to be valued can result in an overly inflated ego and a young person who is not in touch with their own limitations and unable to see their own character defects. This pattern forms Narcissism and self-blindness.

Pattern 7: The need for achievement; though virtually all persons wish to make achievements, some are desperate for it. Some are so driven for success, that they sacrifice relationships, health, and sometimes integrity for it. The paradox is that achievement is an elusive line that seems to move just as soon as a goal is met. The success never satisfies.

Attachment styles of Moving away from People:

Pattern 8: The need for self-sufficiency; taken to the extreme, some are independent to the point of becoming “needless and want-less”. ISOLATION and LONELINESS ensue, along with an inability to live among others interdependently.

Pattern 9: The need for perfection; while many are driven to do things well, some young adults display an overriding fear of being even slightly flawed. This perfectionism causes “Fear of Shame” to become a driving force in their life, causing them to quit tasks they enjoy if they can’t be the BEST.

Pattern 10: The need to contain; some find a need to restrict life to within narrow borders – to live as inconspicuous as possible. The ultimate result of an extreme of this pattern are ANOREXIA and DEPRIVATION. We find young people who have gravitated toward living alone and homeless. They find it difficult to rejoin others in the REHAB community.

In a REHAB environment, a young adult is forced to display every coping skill they have ever engineered. For many, it is the first time they are in close quarters with so many people 24-hours a day. If their tendency is to move toward and enmesh and give away their soul in order to deal with the anxiety, we see it in the friendships they form and as a failure to confront others out of fear of rejection. If the tendency is to move against others to cope, peers will react to them- against postures are offensive and conflicts with ensue.A tendency to move away from others manifests as depression, rage and laziness.

The best REHAB treatment centers are those that know how to manage, not eliminate, the anxiety and insecurity, in fact many activities are designed to increase the anxiety. Activities are planned to strategically intervene on the coping defenses above. As the defenses are exposed and the resident is taught to tolerate anxiety and feelings of inferiority, gradually the immature self begins to grow more confident and merges into a whole and complete self. This new self has character and is capable of navigating the adult world. The alternative is to stay immature, without a confident self, and to medicate with drugs and alcohol or other self-defeating behaviors.

Bonnie A. DenDooven, MC, LPC, CSAT, CMAT

mailto: Bonnie@TurningPointHelp.com

Bonnie A. DenDooven, MC, LPC, CSAT, CMAT is a former business owner-turned-therapist. The author of the MAWASI© for therapy and healing of financial disorders and work disorders. She is a former primary and family counselor and assistant clinical director for Dr. Patrick Carnes at The Meadows. Bonnie was schooled in Gestalt therapy and is a member of Silvan Tomkins Institute of Affect Script Psychology, an advocate of Martin Seligman Positive Psychology, and a champion for the initiative for VIA Classification of Strengths and Virtues (jokingly referred to as the “un-DSM”).

Footnote 1: Neurosis and Human Growth: The struggle toward self-realization, 1950

Footnote 2: http://www.chabad.org/blogs/blog_cdo/aid/1073778/jewish/Why-Hasnt-the-Self-Esteem-Movement-Given-Us-Self-Esteem.htm

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