Adults & Adolescents – In Treatment Together
I have mixed feelings about putting adolescents and adults together in treatment. I have been on both sides of the equation (treatment as an adolescent and treatment as an adult), and definitely have a stronger opinion about it now that I’m older.
Pros:
- Adolescents can learn a lot from adults who often have been in treatment before and have some more insight into the disorder.
- Adults are (hopefully) more mature and less competitive. Eating disorders in general are competitive… and I’ve just found that when you have a large group of ED high school females in a room, who are not necessarily in the best place, you could be in for a disaster. Sometimes just having a couple of older people in the room is enough to keep everyone from competing as much.
- Adults can learn a lot from adolescents. They have a different perspective, and sometimes you need that.
Cons:
- Being an adolescent and seeing adults in the group can cause some hopelessness that you’re never going to get better. It can give you the sense that people never really do get better and that you’re going to struggle with this the rest of your life.
- As an adult, I often feel like a bad role model — especially if I’m having a hard time and an adolescent is doing well. I feel like as the older, “more mature” one, I should be responsible for setting the example.
- Adolescents still live with their parents and (hopefully) their families are very involved in their treatment. I’m always a little jealous since my parents were pretty anti-treatment and didn’t (and still don’t) think that eating disorders are really problems. Sometimes interacting with others’ parents brings up stuff that you haven’t thought about recently (maybe that’s good, but it feels bad).
- Adults and adolescents have different bodies, ideal weights, nutritional needs, etc. I know adults who have a really hard time being on the same meal plan as a 15-year old, with all the info they’ve heard about slowing metabolisms, muscle loss with age, etc.
- Tiny, underweight adolescents are triggering. It’s hard to not compare yourself to someone who is 15.
- Adolescents and adults are (obviously) at different stages in life. Sometimes it’s hard to relate to one another and certain sessions may not seem helpful for one group or the other.
This is just the start of a list — I’m sure there are 100 reasons. Personally, as an adolescent, I was really happy to be in treatment with older women. I really looked up to them and thought that they were so wise — they knew so much and had so much insight. There were a couple of people who I wanted to be like. There were also people who I did not want to be like, and it was motivating to me. I definitely told myself that I would NOT be one of those adults with an eating disorder. It wasn’t until I WAS an adult that I started feeling guilty about still struggling and/or being a bad example.
I don’t really think you should be in total treatment together. I don’t know how many places are big enough to have separate adolescent & adult tracks, but I think places should.
I was 23 when I went in– most girls were in their late teens/early twenties. Even though I was youngish, I’d been out of college for a few years & self supporting, plus I had parents who weren’t supportive [to be fair, they had no idea I was in therapy, in treatment, had an ED].
There was a lot of competitive/weirdness amongst the high schoolers, but I don’t think it was tempered by the older women present. And as far as triggering goes… I think teens say more inappropriate things, I had a 15 y/o girl tell me I had her idea of the perfect body. I’ve never had any older patients say things like that, you know?
I don’t feel like adults should HAVE to feel like role models. You’re there for you to get better, and there was too much of a sense, especially among the mothers in the group, that the older women were taking care of the younger ones.
Plus I got REALLY pissed when some 15 y/o who’d been sick for less than a year tried to tell me how easy it was once you let the program help you/blah blah go recovery. [She's been in at least four times since.]
And I think staff need to work differently with adults than adolescents, and when they work with you as one group that gets lost. I didn’t like being treated a child, but some of the groups seemed off-topic for kids who weren’t living on their own.
I don’t know how you draw those lines though, honestly. There were women in their thirties and older who had never lived on their own, should they really be with the adults, or would they relate better to the younger patients? What about patients who were younger but effectively independent adults?
I don’t know what the best solution is. I just know that in my experience, it wasn’t helpful for me to be in treatment with people who were at such different life places than me. I don’t know if that would have changed if the other patients were my age though– I think a lot of it had to do with life goals/educational stuff/job stuff.
I don’t think I’ll ever go into treatment again. But I’m really intrigued by the idea of executive style rehab. For professionals. Where you’re treated like a grown up. I think there’s something to be said for making the patient more accountable for their life in a realistic way. [Which is maybe why FBT works well for the younger kids?]
I agree that there are definitely pros and cons, which is why I think ideally there should be some time together and some time apart (in the ip or day program setting, for example). I know that I am in such a different place then I was as a teenager, and I think if I were to have to sit in a group now with my teenage self I would kill her, honestly. I was just in complete denial and complained a lot. In the inpatient setting (and maybe even in the IOP setting), I think a lot of teenagers in inpatient are in by their parents, whereas more adults are there because they know there is a problem, so it creates a very different outlook on treatment.
I think there is also something to be said for separating, especially in inpatient, the people with more “chronic” eating disorders and those who are just starting out, and particularly those who are still in denial and perhaps only there because they were forced by parents or others. While I am sure a lot of the differences between myself now and 9 years ago is that I am an adult and so have different priorities and commitments, I think a lot of my differences when it comes to treatment needs and outlooks also comes from just having dealt with this a long time. I no longer need to be convinced that it is “not just about being skinny”, nor do I need to spend hours exploring my relationship with my parents. Obviously not living at home is part of that, but also, I have already done that! I think a lot of adults in treatment are those who have been suffering for awhile, so it is hard to sit there and relate to others who are just starting out. There just isn’t the same insight and the same struggles.
chylo: I don’t know much about executive style rehab – sounds like something I should read more about. I think that being treated as a grown up would definitely change the treatment dynamic; which might not be a bad thing. I wonder if the patient role is important in recovery? I know that personally, it’s easier for me to be healthy when I’m not the one making all of the decisions. I don’t have to give myself permission to eat — I just have to because those are the rules. You of course have to move away from that at some point, but I think that in the beginning you sometimes need to not be treated as an adult. I have a really hard time trusting treatment; I always want to have some hand in making all the decisions. I know i’ve written posts on this before, but maybe I do need to just sit back and follow directions. With the eating disorder — even though you’re a grown up — you don’t necessarily know what is best for you. You’re not taking care of yourself. I’m not sure if I’m making sense with all of this, but I just think you’d have to definitely be in a different stage of recovery to enter an executive style rehab.
BL: I completely agree about having a separate program for “chronic” eating disorders. While on one level I hate to make that distinction (where do you draw the line? What makes an ED chronic?), I have been in those groups where everyone around me has had an ED for less than a year or just has bad body image issues. I didn’t want to talk about my history because it seemed so chronic (for lack of a better word) in comparison. I didn’t feel like I could relate to a lot of the things that they said. Also, it’s always frustrating to be in a group where those around you are just realizing that it’s not JUST about the food. That there are other things going on too. That dawned on me 7 years ago — and not to minimize the importance of that realization, but talking about that just is not helpful at this point!
I guess that the personalities and dynamics of the group are probably more important than the varying ages. There are some amazing 15-year olds that are so mature beyond their years — and some pretty immature adults. I think that professionals need to be so careful in evaluating individuals to add to a group… between different ages, disorders, motivation levels, personalities, treatment history, etc., there are a lot of things that can make a group competitive or just unhelpful.
Thanks for your feedback, both of you!!