Adolescents in a therapeutic community: treatment implications for teen survivors of traumatic experiences.

This article describes an adolescent with a history of severe traumatic experiences and treatment in a residential program for chemically dependent, severely emotionally disturbed youths between the ages of 12 and 18. It begins with a description of the long-term treatment program, the types of clients admitted, and the treatment activities provided. Basic findings from an outcome study conducted within the program made predictions regarding the length of time of residential treatment for drug addicted, severely emotionally disturbed adolescents regardless of trauma history. Pretreatment psychiatric functioning was addressed by utilizing GAF scores from the DSM-III-R for each of the participants in the study. Of 102 participants in the study, 34 were survivors of sexual abuse, physical abuse, or devastating natural disasters. A clinical case of a traumatized adolescent is presented in relation to adolescent identity, the distinction between adolescent and adult treatment, and a variety of treatment strategies that can influence an abused adolescent's long-term recovery from both addiction and trauma, including retention in treatment, the developmental stage of adolescence, identification and diagnosis of trauma during adolescence, building a working alliance, individual psychotherapy, psychopharmacology as an aid to psychotherapy, psychological debriefing, and group psychotherapy.