An Interview with Journalist Kenneth R. Rosen
Kenneth R. Rosen is an award-winning journalist and best-selling writer of “Troubled: The Failed Promise of America's Behavioral Treatment Programs.”
Maya Hsu: Hi, welcome to this installment of the Seattle Psychiatrist Interview Series. I'm Maya Hsu, and I'm a research intern here at SAS. Today, I'm joined by Kenneth R. Rosen, who is an award-winning journalist. His book, Troubled: The Failed Promise of America's Behavioral Treatment Programs was an instant number one bestseller on Amazon, a New York Times Editor's Choice, and one of Newsweek's most highly anticipated books of 2021. He has personal experience with the tough love industry and how it often fails the young adults of this country. He's also been featured on NPR, The Sun Magazine, and the Very Bad Therapy podcast, which is how I found him.
Ken, would you like to introduce yourself, and maybe start off by talking a bit about your own experience with wilderness therapy?
Kenneth Rosen: Maya, thanks so much for the opportunity, and for reaching out. I think this is great.
My experience with therapy started back when I was 16, after a few years of individual one-on-one therapy and outpatient treatment programs that didn't work for me. I was taken in the middle of the night by two transporters to a wilderness therapy program in upstate New York. Over the course of the next 288 days, I would stay two stints in wilderness in upstate New York, while also being shuttled between a therapeutic boarding school in Massachusetts, and a residential treatment center, vis-a-vis ranch in Southern Utah. So, my tackling of Troubled which was a product of journalistic endeavoring, as well as a personal unearthing of my own past issues, and time spent at these programs, was an attempt to understand what had happened to me back then. And what had happened to me in the years that followed those programs and that type of treatment.
So, while wilderness is discussed in Troubled, I also follow four students who went through residential treatment centers, therapeutic boarding schools, and then into their adult lives thereafter.
Maya Hsu: Great. And for our listeners who are unfamiliar, can you define and distinguish wilderness therapy versus a residential boarding school, and versus a therapeutic treatment center?
Kenneth Rosen: Wilderness therapy is often sometimes called adventure therapy, or outdoors therapy. And I think it's a misnomer because it leads people to believe that it's something that it's not. Wilderness therapy, in a large portion of the country, is a holding place for children to sort of ease their way into more residential programs. So, they're stripped of their civil liberties, and taken to remote places, and given uniforms, and told to hike and fend for themselves in a wilderness theater, as it were.
The point of this is to ingratiate those students and those clients with a sense of a hierarchy in program language, and also the therapeutic language that they'll be using in the programs to come. A lot of times the rejuvenating capacity of wilderness is missed in large part because of how students get to these programs, to the wilderness programs, which is through a transportation service, which I briefly outlined that I went through, is when two men or women come into the room in the middle of the night, and take them at the request of parents, in large part because parents feel that their children might be flight risks, or that the programs require this sort of treatment to ensure the safe transportation of children to these programs.
Unfortunately, recent studies have shown that that transportation in and of itself is very traumatic and leads children to then miss out on all the rejuvenating qualities of wilderness. I think nobody will argue that spending some time in the woods is a great thing. That fresh air is healing, no doubt. It's just an unfortunate side effect of the way we treat children in America, writ large, that they feel the need to be transported against their will.
Maya Hsu: Great. So, what I heard was that wilderness therapy is an avenue toward a therapeutic boarding school, or a behavioral intervention center later on. And that the lack of therapeutic benefits that don't happen is due to that traumatic transportation system that often happens in the beginning.
Kenneth Rosen: Correct. In part a lot of the residential treatment facilities that I researched, and spoke to for Troubled required it to be part of the acceptance package into their program. So, a child had to go through therapeutic wilderness programs beforehand. Some programs had, at times, had that integrated into their school, so that it could be a one step to the residential program straight from wilderness, rather than a secondary program.
But it's not only the fact that they're transported to these programs, but it's also that some of the staff members at the wilderness programs aren't necessarily qualified to handle the students, and the needs that they have, whether it be psychologically, or physically, or emotionally. When I was in wilderness and when a lot of the people who were mentioned in the book were in wilderness, they would meet with licensed clinical social workers or therapists maybe once or twice every week... once or twice, every few weeks. It wasn't a consistent therapeutic environment, that day-in day-out 16 hour environment was run by people who had an interest in outdoor education, who liked hiking, who had a keen sense of direction, but weren't necessarily equipped as a licensed clinical social worker would be, or a clinical psychologist.
Maya Hsu: I remember from the Very Bad Therapy podcast, you talking about the lack of adequate supervision, and training with the counselors of these programs. And that even very, very recently, maybe within the last year, you found that still their hiring requirements are that you only have to be over 21 to be a counselor of these programs. Can you talk a little bit about the impact of having untrained counselors on these grounds of these programs?
Kenneth Rosen: Well, the children are always marked as troubled from the get-go. And so, when the programs ultimately fail, wilderness ultimately fails a child, and they relapse, or they go back to doing drugs, or sexually deviant behavior, or what have you… they blame it on the kid who was inherently bad before, or just difficult. Rather than saying that the people who were meant to care for them in those programs, the ostensibly trained individuals who could handle different situations, whether it be a traumatic situation, or any number of difficult children who are experiencing trauma and dealing with things that are cropping up from their past, end up not being able to handle that, whether it be first aid, or just any clinical psychological training.
So when you have someone who's 21, who's fresh out of high school, who just has a high school diploma, they're oftentimes making the situation worse. If not, just setting a low bar for children to go on living the way they had before, without the supervision, without real mentorship that they need in order to benefit from such a program. Of course, a lot of the programs are in such remote places that getting the type of staffing that is required to care for children in need, and at-risk youth, it's not always possible. But there needs to be a more stringent and due diligence on the part of the programs in looking for, and hiring staff, who can better their programs, and who can offer more insight to children as they need it.
Maya Hsu: Are there other types of wilderness therapy options that don't fall into the category of this type of program that you're describing, where the counselors aren't fully trained to help kids with their mental health issues?
Kenneth Rosen: So, the third prong, I mentioned two prongs initially, I mentioned the transporting to the programs is an issue. The second is the staffing of the programs is an issue, the unqualified nature of some of the staff. The third is the fact that children can't leave, or communicate with their parents. That they are restricted to this environment against their will. And having gone through AA, having gone through therapy all my life, I know that you are not going to change if you're forced to it.
So, to answer your question, the better programs that I've seen are the ones abroad, the ones outside of America. The ones that offer a child an opportunity to have this experience, to go into wilderness therapy, or adventure therapy, or outdoor behavioral therapy, and experience it for themselves. And if they don't like it, or if they're finding it difficult, or if they want to go home, they're allowed to. And in that way, you give the agency to the child. And the child is then making the choice to be in therapy. And that's already empowering rather than stripping them of their rights to feel empowered.
And people who run these programs overseas, I'm thinking specifically of one in Australia, they have come out with recent studies as well that suggest that the transportation of the kids is so effective in damning the child through the rest of the program that it almost negates any sort of positive behavior, positive outcomes from wilderness therapy.
Maya Hsu: I'm so curious, is this the case for the majority of programs in the U.S., all programs in the U.S., are there some that you've heard of over the years, like private companies that run more modern, more updated versions of these programs with maybe not that kind of transportation process?
Kenneth Rosen: I think this gets to one of your next questions, is that after I published a book, I did receive a lot of letters, and notes, and emails from people who run smaller programs for disadvantaged youth, for neurodiverse children, all different types of smaller programs who said that, "This isn't me, that my program is not like the ones you described." And I heard them and I still hear them.
The issue is that in the course of reporting Troubled and interviewing more than 100 former staff, and parents, and people who went to these programs, the majority of the time people were sent to the programs that I've described that required transportation, that stripped children of their right to feel unique, and heard, and cared for, and then sent them on to several other programs without ever giving them the true treatment that they need. And I've never disputed the fact that a lot of the children, including myself, needed some sort of help or treatment.
I wouldn't have written the book, if I felt that there was a minority of programs that were doing this. That these were programs that were just the odd person, odd program out. These are the majority of programs that I came across privately funded, even some who received federal funding. So, there are programs that are doing good, but I'm not, as a journalist, here to say, congratulations, you deserve a profile and an award. I'm here to say, there's a problem with the majority of the programs that are operating in this realm, and they need to be looked at, and adjusted.
Maya Hsu: Sure. Something else that stuck out to me from the Very Bad Therapy podcast was how you talked about how students, or the kids who were sent to these programs were extremely motivated to alter their behavior so that they could go home. And that the problem behavior would stop in the short-term so that they wouldn't be sent back. Can you talk more about that, and maybe any other misconceptions about how therapeutic or effective wilderness therapy is?
Kenneth Rosen: The identified patient has always been in this privately funded, troubled teen industry, wilderness therapy included-- the identified patient is the child. And time and again, I found that the identified patient should be the family, the parents who inevitably have not changed by the time the child comes home. With that said, the child comes home and has to act accordingly because they are afraid of being sent back to a program, or messing up and having their parents call someone to take them again in the middle of the night, traumatic as it was.
What the industry, including the Outdoor Behavioral Health Council, and all these other people who are industry leaders, and published their own industry funded studies will tell you is that all of the evidence shows that after six months at these programs children do better. That they're no longer doing drugs, that they're getting better grades… 6 months, 12 months. What they don't don't tell you is that those kids are still in different programs, 6 months, 12 months after those programs.
So, the attrition rate after the lead program in reality, two years down the line is a lot different than what the studies are showing. They're not doing quantitative studies of these children once they graduate, and go off to college, or go off to their first job, or go off to an internship, and see how they fare there. They just see how they fare within this realm of programs, which we talked about a little earlier, wilderness to residential, to maybe a lockdown, if it's necessary, or back to a therapeutic boarding school as they roll back the need for the hands-on treatment.
So, that's I think one of the misconceptions is that one is beneficial, but for the need of the other programs that come later, it's not that wilderness therapy has ever proven well enough because children don't often stay only in wilderness. They don't often go home after wilderness. They often go somewhere else. Are there cases where children go home after wilderness? Of course, but they are among the minority.
Maya Hsu: So, what kind of programs or interventions do you think would be helpful to replace wilderness therapy, or in any case supplement?
Kenneth Rosen: I'm not saying anything should be replaced. And I've long given up on suggesting the crumbling of the entire industry. I think that if American-based wilderness therapy took a play out of the books of foreign wilderness programs, allowing the children more leniency and latitude, working with the parents more directly, shortening the timeframe away from their discourse community, and their friends, and the people who they'll have to go back and integrate with later, rather than stripping them of any way of connecting with their peers. I think those are positive ways of changing.
Of course, there's a litany of reasons why they won't do that. Several of which I couldn't even tell you myself because I don't run a program. But I think that there needs to be a concerted focus on the family first and foremost. And with that, secondarily, comes this idea of intensive outpatient, and group therapy within the community that a child is in. To then, expect them after two years away to go back and function in a society that isn't based on a hierarchy of levels and treatment scoring, is beyond irreconcilable.
So, these local treatment programs, these options for in-school programming should be developed further. And, of course, there are state level state funded options where there are checks and balances. And there are people who are looking into the progress, they're making sure there aren't abuses. These things are available. I just think a lot of times, and this goes back to your question about some of the misconceptions, is that parents feel that they don't have any other choice when they meet with an ed consultant, who says wilderness therapy is great. They feel that they've run the course of every other treatment. It's just not the case. And as states become more aware of what's happening in some of these privately funded programs, I think that there will be concerted effort to bolster the capabilities of community-based treatment.
Maya Hsu: I've got quite a bit of background noise right now. I don't know if you can hear it. Can you still hear me?
Kenneth Rosen: Yeah.
Maya Hsu: Okay, great.
Well, you touched on what in this industry needs to change to serve its clientele, which would be more autonomy, kind of just the overhaul of the current policies, and just some major renovation of structure. Is there anything else that you would change that you might not have mentioned to make these programs beneficial for its clientele?
Kenneth Rosen: I just really want to reiterate the notion that parents should be brought in a lot earlier. There's programs that offer therapeutic lessons for parents on the side, so they can track along with their children in their treatment program, and their treatment plan for the child. But it's just not as intensive. They're not just receiving the same sort of attention that the children are, so there's a dissonance between the therapy that the child is getting, excuse me, and the therapy that the parents need to get.
I often found that the parents really did have a lot of issues that were going on, and inadvertently put those onto the children, so that the safe environment at home, that environment that gives rise to really obedient, and caring and empathetic children was long dismantled. And rebuilding that is very difficult. So going very, very, very far back, having that open discourse with your child and focusing the efforts in-house, I think will yield better results in the end. But, again, I always preface that I'm a new father and I have very young children myself, so I'll learn as I go as well.
Maya Hsu: Yeah. I do agree that a more systemic holistic approach would probably be the way to actually resolve some of these deeper issues that are the root of the problematic behaviors.
Kenneth Rosen: Yeah, I think there's something to be said for just a general ethos of how we treat pain, and psychological ailments, and therapy in this country as a monetized, capitalistic approach to... There's a way to pay for it, to get it taken care of. And if we just pay more money, and put it aside, something will fix itself. It's just not the case. It requires a lot of work.
I don't necessarily want to do all the work. It's very difficult. I have my own life. My children have their own lives. And the same goes for when I was a kid, I had my own life. My parents had their own lives. That division is coarse, and it's difficult to overcome. But there are ways to do it. And there are ways to foster that relationship and really work on it long-term so that when it comes time to grapple with internal struggles within the family, we don't just sit back and say, "Well, if I could send them away for two years, maybe they'll change."
Maya Hsu: Speaking of sort of throwing money at the problem, how much do wilderness therapy programs typically cost?
Kenneth Rosen: So, again, we've been somewhat focusing on wilderness therapy in this conversation but, generally speaking, it could be anywhere from $30-50,000 for a full course, whether that be for 30 days or 60 days, generally it's paid out as the first 28 days is X amount, 30 grand, and then 5 to $600 a day thereafter if the child takes longer to complete the program.
Maya Hsu: So, is there incentive then, for counselors and these programs to keep the kids there longer?
Kenneth Rosen: There is, but I'm not necessarily sold on the idea that counselors are doing this because they're not getting the money directly. I think there are probably considerations insofar as where the child goes next after the program. I know that the three programs I went to, for instance, and this is fairly typical, were all owned by the same health group. So, every program was sort of feeding into the next one and my parents were convinced that this was the sort of treatment path that I needed.
Of course, by the time I got to the end of the 28 days, I came back home and I just couldn't function as a normal person among high school colleagues, high school contemporaries, because we had very different experiences. And that followed me into my early adulthood.
Maya Hsu: That makes me curious, what kind of therapy, or healing did you have to do? What did that look like for you after returning back from these programs?
Kenneth Rosen: For me, I ended up going through a lot of trouble. I did a lot of bad things, I got into a lot of trouble as I grew up, and I learned the hard way, a lot of different things that I didn't have to learn. And then, just at some point, at 25, I changed. I decided that I wanted to focus on writing and be a certain type of person, and contribute to society. And I met a woman, and she changed the way I perceived my future. And, from then on, I wasn't really thinking in that juvenile notion of, "Oh, well, instant gratification. I'm only looking a week ahead, maybe a night ahead." Now, I was thinking 10, 20 years ahead.
And this isn't just a silly parable that I'm giving you. This is truth insofar as the adolescent brain developing fully by 25. 19, 20, it still sort of erratic. 21, 22 it still isn't fully developed. 25 things starts to settle in place. And that goes for your brain as well. So, I just figured it out. I don't have a really good answer. I'm not in therapy anymore. Unfortunately, I've been turned off to it. I don't seek it out. I don't want to be a part of it. I find it all to be phony. And I hate saying it out loud because I know it helps people. But, for me, and some of the people that I interviewed, their experience at a young age with therapy was so traumatic, and so difficult that they just gave up. And that even if help were available, and it isn't always available, even if help were available, they'd still choose just to be on their own.
Maya Hsu: And you touched a little bit earlier on critique that you received on your publications. Was there anything else that jumps to mind that you think might be worth mentioning?
Kenneth Rosen: Sure. A lot of parents write to me and tell me that the program was beneficial for their children. Whatever I experienced was not what their child experienced. And that clearly, their child is doing better. And invariably, somewhere at the end of the email, they note that the child just got out of the program. And we already discussed this so we don't need to rehash it. Or that their child is still in the program. Or the child is very young. And it always strikes me as curious that the parents feel the need to write me. And I never get messages from children, or past clients who say, "I had a good time. I learned a lot. And now, I'm a young adult, or an adult who feels more empowered and better off than when I was before the programs." That's never happened.
It's always been a defensive parent who writes and tells me that their reasoning, through no fault of their own... Again, I say that they were led astray, that they were misdirected by an educational consultant, or the schools in which the child was attending. And they want to defend their position for what they sent their child through. And I think it's also sad that they feel they need to do that, in large part, because it wasn't their fault. And they were at their wits end and they chose what they felt was the best option. Unfortunately, the long arm of these programs, the troubled teen industry as it's become known as, is so strong that it makes these parents feel like this is the best option. And it isn't.
Maya Hsu: On that note, is there anything else you would like parents, educators, or therapists to know about these different programs?
Kenneth Rosen: I think do your research as best you can, but consult multiple people, don't just rely on education consultants. Rely on parents of troubled teens, rely on a lot of the networks on social media that will share stories and alternatives to these more drastic solutions. And really just, at the end of the day, it's about communication and setting yourself aside and listening to the child.
I think the biggest mistake that was made... To me, the biggest mistake that people made while addressing me and talking to me as a teen and the young adult was trying to liken their experience to my own. And I find that the most aggravating tactic that therapists and social workers use because they don't know.
My son is two and a half years old and what he's going through right now, pandemic aside, is so inconceivable. And when he's 10 and I'm still 30, 40 years older than him, I won't understand what he's going through. And that's okay. And understanding that and admitting that to a child opens up an avenue of communication that isn't there if you say, "I was your age once, and I get it," because we don't.
Maya Hsu: Well, thank you so much for joining us for our interview series, Ken. It was great to have your perspective and to hear more about wilderness therapy, and these different programs.
Kenneth Rosen: Maya, thank you, I appreciate it.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.