What Happens During Treatment? Demystifying Residential Mental Health Care

Unlike hospital-based in-patient care, private residential facilities aim to provide comprehensive treatment experiences in an intimate milieu that promotes recovery holistically. At programs like Bridges to Recovery, clients enjoy beautiful natural surroundings, home-like facilities, delicious meals cooked by private chefs, and the option of either private or shared accommodation to ensure that you are as comfortable as possible as you begin your healing journey. Some programs even allow you to bring your dog. By attending to your complete range of needs, these programs allow you to fully immerse yourself in the treatment process and receive the maximum benefit from your time in care.

All clients are screened during the intake process to ensure that they are suitable for the program, both in terms of the program itself being able to meet their needs as well as the client being about to productively participate in treatment. This means that not only is everyone there because they want to be, but each client is surrounded by peers who are ready to engage in individual and group-based treatment modalities, allowing you to benefit from the support and compassion of others who understand what you are going through.

Recovery in this type of environment is drastically different than what most people see in movies or television shows. Rather than being stripped of agency and dignity, these types of programs are designed to nourish you inside and out, acting as your guide and partner in healing and always working to draw out your strengths. This is the stage upon which recovery can most effectively happen.

At Bridges to Recovery, we work to create the most positive treatment experiences possible for all of our clients, and we believe that part of creating those experiences is preparing you for what treatment looks like—both the good and the bad. Because each client is an individual with a unique history, we design each treatment plan according to your particular needs, and no two healing processes look the same. However, the following is a rough outline of both how our program functions and the emotional path we see our clients take:

Admission Day

Prior to your arrival at the treatment program, you and/or your family will have participated in a pre-admission assessment and perhaps even visited the facility to make sure it is the right place for you. Even with these steps in place, however, you may feel overwhelmed on your day of arrival, and may even be second-guessing your decision to come to residential treatment. It tends to be best to start this day like any other—get up, have breakfast, and begin your transition slowly. If you would like, your family can take care of all or most of the intake paperwork to give you one less thing to worry about. If you are coming from another treatment program, whether out-patient or in-patient, the two programs should have already been communicating behind the scenes to allow for a seamless transition.

Once the formalities are taken care of, you will be given a tour and introduced to the facility to help you get familiar with your new temporary home and start the process of integration. Staff can help you unpack and answer any questions you may have—they understand that you are probably anxious and are there to support you. At lunchtime you will be introduced to other clients, giving you the chance to start getting to know each other and easing into the community. After that comes your first appointment with either a therapist or a psychiatrist, which is where your treatment journey really begins.

Week One

The first week of treatment is often very much about orienting yourself in a new environment. You are getting used to a new physical space, new social surroundings, and a new routine. You are getting to know your therapists and planting the seeds for a fruitful therapeutic alliance. During this time it is normal to experience emotions ranging from hopefulness to fear—and often both—as your newcomer anxiety dissipates and you start on the path to healing.

Week Two to Three

During the second week of treatment, you are more fully settled into the treatment routine. You may feel more comfortable in group therapies—which many initially find to be a particularly intimidating part of treatment—as you begin to bond with your peers. Because intensive individual psychotherapy is the cornerstone of treatment at Bridges, you have also had the opportunity to start doing serious work with your primary therapist. And this is where things can get hard.

Recovering from psychiatric distress requires delving into the heart of that distress to uncover its roots and expose it to light. This can be a painful process during which you may make difficult discoveries about yourself and your lived experiences. Due to the trust that quickly develops between you and your therapist, you can feel safe sharing your innermost self. But while this is necessary for the healing process, it can also bring up painful thoughts and memories that may make you question the wisdom of seeking treatment; it can certainly seem preferable to keep those feelings locked away and out of sight. Some even experience a crisis of recovery at this point, which can feel as if you are slipping backward rather than moving forward. This is normal and is, in fact, a sign that you are making progress. In many ways it is like resetting a bone—it hurts, but it needs to happen in order for true healing to begin. Your treatment team understands this and will give you every available support during these challenges.

Week Four +

Weeks four through six are typically the time resolution begins. You may now be in an emotional space that lets you give more support to and share your experiences with your peers in group therapies. On an individual level, you and your primary therapist have identified the barriers standing in the way of healing and are working deeply to remove them together. You are gaining confidence and preparing for life beyond residential treatment by creating a solid base for ongoing supports in your home environment, ensuring an easy and positive transition back into everyday life. Of course, if at this point you do not feel that you are in a place in your recovery where you are ready to go home, you can always extend your treatment further.

If appropriate, you may also have received a medication plan during your stay. Our psychiatrists design personalized psychopharmacological protocols for each client and continuously monitor your progress to make sure you are responding well and with minimal side effects. The residential nature of our program allows us to ramp up and make medication changes in response to your symptomatology more rapidly than would be possible in an outpatient setting. Week four is typically when you can typically expect to begin fully stabilizing on medication, although for some it may take longer. This is why it’s important for both you and us to be flexible and tailor both the kind and duration of treatment to your individual situation, which may change during the course of treatment.

In years past, mental health treatment was often marked by family exclusion. From family separation via institutionalization to false beliefs that families themselves are to blame for mental illness, families were not invited to participate in the recovery process, particularly not for those in residential environments. However, as Casey, Lal, and Wada write, “[I]n recent years, this culture has been changing and we see family members becoming involved in the mental health care of their loved one and also in service development, evaluation and research. This shift is in part due to […] increased evidence supporting positive effects of family interventions on the outcomes of individuals with mental illness.” Indeed, research shows that even simple “supportive comments and emotional warmth expressed by relatives” are associated with better clinical outcomes.

At Bridges to Recovery, we know that the support of loved ones can play an integral role in the recovery process, which is why we invite their participation with your consent. Depending on your desires and needs, this may include weekly visits as well as family and couples therapy during treatment, helping you nourish your bonds, resolve conflict, and create a strong foundation for ongoing collective healing. You are also welcome to use cell phones or computers during your time in care to keep in, ensuring that you are never isolated from those you love.

However, we also recognize that not all family contact is healthy at all times, and we will work with you to make sure that your relationships and interactions are promoting, not hindering, your recovery. If we do observe unhealthy family dynamics (such as co-dependency, for example), we will provide you with the support you need to set healthy boundaries. And, of course, you are never obligated to involve your family; this is your choice and, as with all aspects of mental health treatment, it must be made with your best interests in mind.