Another title for this article could have been "Helping a client cross a non-existent finish line." Our industry has engaged in extensive discussion on how to address the treatment resistant client, but there has been less discussion on how to address the client with treatment fatigue.

Let's begin by looking at the dynamics that impact a treatment fatigued client. Many of the clients who are enrolled in wilderness programs, boarding schools or residential treatment centers have already worked with individual therapists, family therapists or other community-based interventions. For both the parent and the child (and the therapist), these interventions may have felt like putting a finger in the dam; the issues were just too difficult to address in once-a-week meetings. The client may have felt that just as things would get a little better, he would have a setback and would be in the doghouse again.

Once in program, the client hopefully gained new insight, self-esteem, clarity and personal accountability. The client will have had an opportunity to see changes in his parents, as well. Things start to feel 'fixed'.

The issue at the heart of treatment fatigue is the fact that change (personal change and family change) is a process, not a product. The client who is preparing to come home and re-integrate with family will be better equipped if he understands that there are going to be setbacks. The statement often heard is that program graduation represents the start of the work, not the end.

The problem is that the adolescent brain is wired toward instant gratification; patience is not an innate skill for most adolescents and young adults. This means that a client coming out of a program, even if he intellectually recognizes the fact that there is more work to be done, may struggle to maintain patience and commitment to the process.

Yet there are ways to help the client remain engaged in his process of growth, even if he is fatigued. The coaching approach is ideally suited to the client at this phase for a couple of reasons:

• The first advantage to the coaching approach is the emphasis on helping the client reference and build upon previous advances that he has made.



• The second advantage of the coaching approach is the fact that it provides a solutions-focused response for the client. During the post-program transition (or the later stages of residential treatment), the coach can provide tremendous support for the client simply by helping him remember the gains that have been made and also by helping him find ways to apply new skills in the home/community environment.

Let's take a hypothetical scenario:

Coach: I understand that there was a bit of a disagreement about the home
contract over the weekend (or during the home pass).

Client: My mom doesn't ever listen and it makes me mad. We're right back
to where we were before.

Coach: That sounds frustrating. Just out of curiosity what was the
disagreement about?

Client: I don't even remember. I am just tired of home contracts and
treatment b.s.

It is at this juncture in the conversation that the coach can address several different issues at play and help the client establish a different perspective.

One possibility would be to help the client explore gains that have been made. The coach might ask, "so what did you feel like doing?" The client could then explore the fact that in the past he indeed would have slammed a door (or punched a hole in the wall) and that in this case he did not, probably due to a new skill set. In this way, the coach is able to help the client see that even though there may be setbacks, the client's hard work in treatment has led to an increased resiliency in difficult situations. Once the client realizes that he is applying new skills to difficult situations, he may be able to explore other strategies as well. In this scenario, for instance, the client might be receptive to a discussion of other strategies to stay calm in stressful situations, such as progressive relaxation and new communication patterns with parents.

Another possibility in this situation is to help the client normalize the situation. Adolescents have an extremely strong desire to be accepted and "normal." Indeed, treatment fatigue can also be described as the fatigue of being different. The client in the hypothetical situation above could benefit from a coach who supports him in understanding that disagreement within the family system is normal and that it is the response to disagreement that is most important.

In closing, the client who is fatigued might be wondering when he will be finished with the hard work. A coach can help the client recognize gains he has made and the value of staying committed to the process. One final thought: the discussion above is equally relevant, perhaps even more so, to the fatigued parent.

About the Author: Ben Wahl, MSW, is the Founder, Program Coordinator and Lead Mentor of the Collaborative Coaching Program which was founded as a home-based support program in 2004.. He has worked with adolescents for over ten years as the director of an outdoor education program and as a staff member in wilderness therapy programs and residential treatment centers. He holds a BA from Wesleyan University and an MSW from the University of Washington. benw@ryther.org www.collaborativecoaching.net