Abstract
The “Troubled Teen Industry” refers to a network of federally unregulated programs marketed toward the behavior modification of teens through therapeutic intervention and elite education. The true nature and structure of these programs, however, remains relatively unstudied, with the consequences of program attendance largely unknown or based on anecdotal evidence. This study systematically analyzes 77 open-source testimonials of former program attendees for themes of coercive control and isolation. Thematic analyses revealed high rates of coercive control within these narratives. In total, 66 narratives mentioned themes associated with coercive control that were unrelated to isolation. Specifically, respondents experienced frequent psychological abuse, gaslighting, humiliation, and name calling. Additionally, a total of 69 narratives contained themes of coercive control specific to functional or structural isolation. The lack of privacy combined with fear of staff retaliation for disobedience lead to structural and functional isolation among program attendees, preventing program attendees from engaging in help-seeking behaviors. Study results provide critical information as to the functioning of these programs, the experiences of youth involved with these programs, and how youth involved may be affected. Such findings justify the dedication of resources to further research this population and encourages the development of federal policy regarding the functioning of these institutions.
The “Troubled Teen Industry” refers to a network of behavioral modification programs—such as therapeutic boarding schools, residential treatment programs, religious academies, or wilderness programs—marketed to parents as a mix of residential treatment and educational programs for “troubled,” challenging, and wayward youth. These programs claim to mix therapy for delinquency or mental health concerns (e.g., substance issues, depression, anorexia) and elite education for its students (Pfaffendorf, 2019). The federal or state governments do not claim oversight over the programs in this industry. As a result, it is unclear how many of these programs exist, how many minors are in residential treatment programs, or how these programs operate, including how they benefit or harm those served (Chatfield et al., 2021; Friedman et al., 2006).
Despite the claims that these programs are therapeutic and beneficial to attendees, there is little evidence to say the treatments at these facilities are effective rehabilitative tools (Pfaffendorf, 2019). Youth are often introduced to the program against their will, violating legal and ethical informed consent rules required for mental health treatment (Becker, 2010). The severity of this deception may be made worse given children are often informed they will be attending these programs through “staged” kidnappings (Friedman et al., 2006; Robbins, 2014). While parents are trusted to make decisions in their children’s best interest, program participants may experience significant trauma, including betrayal trauma (i.e., trauma perpetrated by someone with whom a victim has a significant relationship; Freyd, 1996; Friedman et al., 2006; Smith & Freyd, 2014).
Once at the facility, prior participants have claimed that administrators and other residents engage in abuse (Pinto, 2007). Such reports often reflect coercive control established and maintained through fear (Hamberger et al., 2017) including physical, sexual, or emotional abuse, intimidation, isolation, or deprivation of basic needs (Callaghan et al., 2018; Duron et al., 2021). As such, residential facilities may foster an atmosphere with an expectation of negative consequences for any act of perceived disobedience and exploits vulnerable attendees (Duron et al., 2021), reflecting themes of institutional betrayal (i.e., harms done by an institution to persons who are dependent on the institution; Park et al., 2023; Smith & Freyd, 2014).
The current study will unpack the experiences of youth who have been enrolled in behavioral modification programs—in their own words. Relying on open-source testimonials of former program attendees drawn from the Breaking Code Silence Network, we engage in thematic coding to ascertain the presence or absence of coercive control and both structural and functional isolation within the testimonials. Among testimonials that report coercive control, behaviors are thematically coded to provide direction on future research on this hidden population and provide insight on betrayal trauma and/or institutional betrayal experienced by program participants.
Behavioral Modification Residential Treatment Programs
Behavioral modification programs are marketed to parents as residential treatment and educational programs for “troubled” youth. These institutions generally combine educational classes with group therapy (Golightley, 2020), with the primary focus being behavioral modification for delinquent youth with spillover into mental health and substance abuse treatment (Mooney & Leighton, 2019). Youth may be sent to the program for a variety of reasons, including delinquent offenses, substance abuse, or self-destructive behaviors (Golightley, 2020; Mooney & Leighton, 2019). They also may be enrolled for mental health conditions, including eating disorders, anxiety, or bipolar disorder (Golightley, 2020; Mooney & Leighton, 2019). The programs are not inherently based on delinquent behavior and therefore are not part of the criminal or juvenile justice system. This distinction means that enrollment is not dependent on court orders or legal sanctions, but is determined by an attendee’s legal guardian (Chatfield, 2019; Magnuson et al., 2024; Tucker et al., 2015). As a result, participants may attend due to an inability to meet the expectations of their family, such as insufficient grades, perceived “poor attitude,” style of dress, or sexual orientation (Golightley, 2020; Mooney & Leighton, 2019). The intention of the program is for youth to leave “socialized” to the mindset the program and parents deem acceptable, often revolving around discipline and obedience (Chatfield, 2023; Golightley, 2020).
Speculation states that the number of adolescents in these programs has grown. Current estimates suggest 50,000 to 100,000 participants, if not more, reside in a program at any given time (McKay, 2017; Chatfield, 2019). This is significant given that in 2021 only 24,894 youth resided in residential placement sanctioned by the juvenile justice system (Hockenberry & Puzzanchera, 2023). Yet, there is no regulatory body with authority over these programs on a federal level (Golightley, 2020). While states have adopted some regulations (Mohr, 2009; Chatfield, 2019) and many programs do employ licensed social workers, therapists, and behavioral specialists (Chatfield, 2023; Dobud, 2022), many others do not (Mooney & Leighton, 2019; Pinto, 2007).
Further, facilities are able to avoid state licensure requirements or monitoring by claiming exemptions and private accreditation (Mohr, 2009; Mooney & Leighton, 2019). By designating the program as a boarding school, rather than a treatment program (regardless of the educational services), programs can circumvent state licensure agreements (Mohr, 2009). This lack of oversight is often dismissed, as programs typically embrace private accreditation standards through The National Association of Therapeutic Schools and Programs, despite this accreditation being specific only to this form of institution (McKay, 2017; Mooney & Leighton, 2019).
This programming has also not yet been granted, on any level, the resources for program evaluation or for model specification and program implementation (Whittaker et al., 2016). With this limited oversight, many concerns never come to the attention of authorities. As a result, there is no knowledge as to the demographic spread of the population, no existing list of the programs themselves or how many there are, the staff or their credentials, nor how many minors are enrolled in such programs (Chatfield et al., 2021; Friedman et al., 2006). It also means there is little knowledge as to how the programs operate, including how they benefit or harm those served (Chatfield et al., 2021; Mohr, 2009). With the primary focus being behavioral modification alongside little to no regulation presents significant risk for the mistreatment of program attendees, specifically the risk of behavioral modification through abusive tactics such as coercive control.
Coercive Control and Isolation Within Residential Treatment Programs
Coercive control is a dynamic established and maintained through fear (Hamberger et al., 2017) and at its core is used to control a victim in all areas of life, including their sexuality, familial or social relationships, and finances. This can be done through surveillance, manipulation, isolation, intimidation, and degradation (Hagan et al., 2021; Lehmann et al., 2012). Such behaviors establish power over the victim such that the victim no longer feels as though they may make independent decisions (Hagan et al., 2021). Patterns of coercive control are generally defined by three things: intentionality of the abuser, control of the abuser over the victim as a result of the threats made, and victim’s perception of the behavior (Hamberger et al., 2017; Slakoff, 2022).
Coercive control within the context of these programs is a form of abuse in which an individual uses controlling behaviors to intimidate, isolate, threaten, stalk, or abuse others who do not hold significant power or authority (Callaghan et al., 2018; Slakoff, 2022; Stark & Hester, 2019). Although coercive control is generally conceptualized as occurring between intimate partners (Stark & Hester, 2019), the same dynamic can be found among authority figures and their subordinates. Therefore, it is not dependent on an intimate relationship but revolves around power dynamics. Consequently, this may also extend to residential facilities. In residential facilities, the staff may develop an atmosphere with an expectation of negative consequences for any act of perceived disobedience, exploits the participant’s vulnerabilities, wears down the participant’s resistance to the rules and treatments, and then exploits those negative emotions in response (Duron et al., 2021). This is an inherent form of institutional betrayal. Youth are dependent on the institution for their needs— educationally, physically, and emotionally. If coercive control is prevalent through the imbalance of staff and attendees, the institution itself is not only responsible for these wrongdoings but acts as a catalyst for wrongdoing perpetration (Monteith et al., 2021).
While all forms of coercive control can be severe on their own, they can become especially worrisome in the context of isolation. Isolation can facilitate abuse by preventing help-seeking (Hagan et al., 2021; Lehmann et al., 2012) and is often characterized as being forbidden from seeing someone, having restricted use of transportation or communication, or being pressured or forced to halt contact with friends, family, and peers (Hagan et al., 2021; Lehmann et al., 2012). Youth frequently enter the programs through “staged” kidnappings (Dobud, 2022; Golightley, 2020). These kidnappings are typically facilitated with the child’s parents through a third-party transport, or “escort” service (Robbins, 2014; Tucker et al., 2015) and are very real to the child being escorted (Chatfield, 2019). Moreover, those who do not enter the program through a transport service are often given little notice of their attendance prior to leaving their homes and their subsequent program arrival (Pinto, 2007; Golightley, 2020). Although parents have the legal right to send their child for behavioral modification treatment, the efficiency of the treatment is questionable if the participant does not consent and the youth’s connection with conventional society is severed (Becker, 2010; Tucker et al., 2015). In some cases, parents sign over temporary guardianship to the program to allow for this transport (Robbins, 2014; Tucker et al., 2015). Moreover, one frequent claim of attendees is that residents are isolated upon arrival and must earn back the ability to communicate with their families (Chatfield, 2019; Magnuson et al., 2024). Attendees are not allowed to leave campus, communicate with family members or friends, or communicate with prior school attendees following their exit (Golightley, 2020; Pinto, 2007). Such isolation may prevent students from confiding in one another or a relative to seek help.
Structural isolation is another concern within these programs and occurs when the victim faces physical restriction of liberty and autonomy by the abuser (Hagan et al., 2021). This includes physical and social isolation, with the victim having no way to contact others for help. There is also the possibility of functional isolation, which refers to isolation through fear, in which the victim does not feel safe seeking help even when they have the access to do so (Hagan et al., 2021). With parents potentially signing away guardianship to the program facilitators, attendees may be disconnected from their primary source of assistance upon arrival. Many of these programs also have policies that restrict communication with other attendees, friends, and family (Chatfield, 2019; Pinto, 2007). If attendees already have limited communication, they may be unable to or fearful of revealing their victimization to those who exist outside the program walls. Previous research has revealed that functional isolation is often driven by the elimination of privacy and a lack of reliable or safe social support (Hagan et al., 2021). Such programs are thought to have high rates of microregulation (Chatfield, 2019), in which attendees’ everyday life is carefully monitored. Assuming this is the case, attendees’ daily tasks and functioning is dictated by staff though constant surveillance—a known coercive control tactic. Constant surveillance reduces privacy, isolating victims and limiting their ability to engage in help-seeking. Nevertheless, how attendees experience such behaviors—in their own words—remains an open empirical question.
Current Study
There is significant risk that students sent to behavioral modification programs are not receiving rehabilitative treatment, but instead may be experiencing coercive control, inclusive of different forms of isolation. The current study thematically analyzes open-source testimonials from prior program attendees to investigate their experiences. The exploratory nature of this study allows us to examine if elements of coercive control and isolation are present within these testimonials. If so, we examine the types of control tactics used. Furthermore, we investigate the presence and role of structural and functional isolation within behavioral modification institutions.
Method
The open-source data for this study was collected by the first author from the Breaking Code Silence Network, a website dedicated to spreading awareness of residential treatment programs while promoting the creation of regulatory legislation within states that house these programs. These open-source testimonials from previous program attendees were primarily collected and published between July 2020 and February 2021. The testimonials, as published, were then pulled from the website in November 2021 for thematic coding and cross-referenced for agreement with the second author. Neither author has any affiliation with the original data source.
The data was not originally collected for research purposes. These statements were obtained by the website as advocacy scripts for those who wished to share their stories with the intention that such statements could be used as evidence for the development of federal legislation, and are publicly available without any need for logins or external verification by the viewer. Respondents were not directly recruited and offered their testimonials at their own discretion. The authors received approval from their affiliated Institutional Review Board.
In their original submissions, participants were invited to write about their experience in a program or facility. Prompts centered on writing about what was done to them or what they had witnessed firsthand being done to others. There were no parameters for submissions except that it must be their own experience and could not include what they only heard or read from another attendee secondhand. With a lack of concrete parameters, there was not a designated length or structure within testimonials. However, most submissions were roughly two to three pages. Common themes among these entries included why they were sent to the program, how they entered the program, experiences of isolation and abuse, stories about individuals that attended the program alongside them, and their perceived long-term consequences of attendance. The ability for respondents to provide their stories with their own emphasis on what was the most important components of their time in a facility was a key factor in choosing to use these testimonials as our data source. With no regulation and no validated list of previous attendees, they are a difficult to reach and possibly vulnerable population. Therefore, the use of compiled testimonials for an exploratory analysis provides a framework for understanding this population. Doing so also allows for greater sensitivity when approaching this population for primary data collection in the future.
Information collected was not externally verified by the network. Instead, participants were required to complete a legal declaration of fact for the group to have a record of due diligence that all information is truthful and factual. Attendees also submitted their age and the year(s) they attended one of the programs. This information was collected as verification of attendance but was not accessible as part of the open-source data. They were also asked to submit a photo of themselves at “the age [they] were taken.” No photos, however, were attached to the testimonials. Collectively, such mechanisms improve the validity of the statements that were submitted.
Analytic Plan
With exploratory phenomenological research, our assumptions align with grounded theory research in that the patterns that may emerge from the data are initially unknown to researchers (Glaser & Strauss, 1967). This process allowed researchers to avoid developing preconceptions regarding what they expected to see and objectively compared testimonials to develop themes and categories as they appeared and evolved (Creswell, 2007; Glaser & Strauss, 1967). The first author systematically examined each testimonial to assign codes and identify themes that emerged repeatedly. It was evident early on that many testimonials mentioned victimization. Initially, the focus was on all references of physical assault, sexual assault, and emotional abuse. During coding, it was found that although all three forms of abuse were present, respondents frequently mentioned emotional abuse and coercive control, and often did so multiple times. Given this, we refocused our coding to extract information regarding coercive control tactics, specifically psychological abuse, gaslighting, and humiliation. Although still a form of coercive control, we coded for isolation separately as isolation from support structures (initially coded individually as isolation from other students, isolation from parents/family, or isolation from friends external to the program) may differ from isolation within the program. Isolation was then categorized into categories of functional and structural isolation.
The threshold for saturation in qualitative research is lower than quantitative research. Phenomenological research is often advised to have at least three participants (Finlay, 2009; Giorgi, 2008) and generally up to 10 participants (Creswell, 2007). For this study, researchers used Atlas.ti, a computer-assisted qualitative data analysis software to code for specific themes across 77 testimonials. This is well above the threshold needed to have a sufficient number of variations to discern individual experiences from the phenomenon as a whole (Finlay, 2009; Giorgi, 2008). Reliability of thematic coding was verified by the second author through randomly selected testimonials. In total, there was 85% agreement on seven randomly selected testimonials for the definitions of these concepts. Where there was disagreement, usually around the theme of gaslighting and if an incident fit the definition, the authors discussed the logic behind the initial inclinations until a consensus was reached. Below first names are used for each of the selected quotes and match their respective testimonial on the Breaking Code Silence Network. These names were not changed because they lack external verification or any identifying information but allow cross-verification between this study and the network itself and among the themes presented.
Results
Due to the lack of parameters for submissions, demographics such as gender, age, race, or sexuality were not consistently provided in the testimonials. If anyone referenced being transgender, they were categorized as the gender they identify with and not their assigned gender at birth. Of the testimonials, 63 (81.8%) had more typical female names (e.g., Isabella, Diana, Sarah), 12 (15.6%) had more typical male names (e.g., Anthony, Daniel, Tom), and the remaining 2 (2.6%) were submitted anonymously with no identifying features within the text. In-text examinations were conducted for testimonials with gender-neutral names. This was typically determined if the testimonial mentioned a same-gendered roommate or pronouns. Within testimonial analysis does not indicate that this disparity comes from the programs themselves, with frequent mentions of both genders in brief references to other students. The gender inequality present in the testimonials may be due to a difference in reporting, rather than a difference in program attendance. While this does not allow us to make determinations about what this population looks like on a broader scale, it nevertheless provides context on attendees and their experiences.
Few testimonials explicitly disclosed they were members of the LGBTQ+ community (Gay/lesbian = 3; Bisexuality = 1; Transgender = 2). For instance, Javier mentioned “‘bans’ with my first boyfriend” or Jack stated “My therapist would not address my sexuality or gender dysphoria.” An anonymous testimonial stated, “It should also be noted that I am transgender.” Other respondents alluded to non-heteronormative feelings and behaviors and there was frequent discussion of other students that were known to be or likely to be LGBTQ+.
Among this sample of testimonials, this indicates that while conversion practices, or interventions aimed at “curing” or changing gender identities and non-heteronormative sexualities (Taglienti, 2021; Trispiotis & Purshouse, 2021; Hill et al., 2022;), may have been present in these programs, they were unlikely to be the primary focus. Conversion programs do fall under the umbrella of these types of programs, and while many related conversion practices such as counseling, group work, and similar behavioral modification therapies (Jones et al., 2022; Salway et al., 2021) are found in these programs, the discussed programs are not specifically designed for conversion practices. For example,
Conversion therapy wasn’t advertised, but it was implemented. LGBTQ+ children were bullied, humiliated, and called degrading names by staff and other kids. Same sex sexually acting out was deemed a phase. I had to give a play by play to my parents and all of my peers, explaining exactly what happened between myself and another girl, describing every movement in detail.
No other demographics could be consistently ascertained. This nevertheless enhances the anonymity of the testimonials that were submitted. Notably, 65 respondents named the program(s) attended, with 55 individual programs named (some with repetition) and several more programs referenced by location or institution type but not were explicitly named. For anonymity and generalization, program names are redacted within the results below. The majority of respondents (72.73%) reported attending one program (mean = 1.42). Other respondents reported passively entering and exiting various institutions over the course of several years, with the highest number of named institutions being eight. In total, 75 respondents (97.4%) indicated that at least one institution attended was considered to be a residential treatment center or a therapeutic boarding school. Other facilities were only mentioned across seven respondents (9.1%), and included treatment facilities not under this subsection of behavior modification programs. These counts do not include legitimate mental health inpatient and outpatient programs (as identified by respondents as not being a part of the industry), non-industry boarding schools, or juvenile detention centers. Eight respondents (10.34%) reported attending at least one program dedicated to wilderness therapy; five of which (62.5%) reported the therapy to be a negative experience. Overall, 27.27% of respondents attended multiple programs, therefore these estimates are not mutually exclusive.
Coercive Control
Overall, 66 of the testimonials (85.71%) mentioned coercive control separate of isolation. Within this broader concept, sub-themes included psychological abuse, gaslighting, as well as humiliation and name calling. Behavioral modification, in these instances, did not occur through therapeutic treatment or empirically backed programming. Instead, attendee behavior was modified through harassment and fear of noncompliance. Even with repetition, the majority of respondents attended different programs from one another, despite the consistency in their experiences. This implies that the use of coercive control is prevalent across different types of programs, regardless of geographic location, affiliation, or program design (e.g., residential treatment program, wilderness therapy). In the following sections we detail each different type of coercive control and the behaviors within each sub-theme.
Psychological Abuse
Psychological abuse is operationalized as a pattern of behavior that causes the recipient to believe themselves worthless, flawed, unloved, unwanted, unimportant, or useless except for serving the needs of others (Haque et al., 2020). Like Ben noted “From my entry into [program redacted] to the time I left, there was one constant. The removal of self-identity, independent thinking, psychological freedom and the concept of the individual.” In cases of psychological abuse, especially among children, their caretaker has failed to provide basic physical and psychological needs (Gilbert et al., 2009). This was especially prevalent within behavioral modification programs, showcased by 146 individual occurrences in 55 testimonials (71.43%). Attendees consistently expressed that their individualism and self-identity was taken and their self-esteem broken down without any means of building them back up. Instead of redirection and rehabilitation, attendees were emotionally beaten into submission. Examples include:
Personally, I remember being screamed at by a 6ft grown man about 2 inches from my face and made to stand up in the middle of a circle of people and brought to tears because he told me that “everyone hates you, but no one hates you more than yourself” They had this way of looking at you and identifying your worst fears and self hate and using it to break you down. Now the point of that was to “break you down to build you back up” but a lot of us either quit or got thrown out before we ever experienced any building back up.
There were writing assignments, most of them being about how I was a bad person, how I manipulated people, why I was a slut, confess every lie I ever told anyone (called a dirt list), what horrible future would I have if I continued down this path, and more. . .
Collectively, these testimonials showcase how program attendees were made to feel unimportant or worthless without any rewards typical of behavioral modification programs.
Gaslighting
Gaslighting is thematically distinct from the overall concept of psychological abuse due to the specific intention of creating a surreal reality for the recipient that aims to make them feel crazy (March et al., 2023; Sweet, 2019). For our purposes, gaslighting is operationalized as the systematic distortion of an individual’s perceptions of reality resulting in confusion, feelings of unease, and self-doubt. Gaslighting fundamentally manipulates social inequalities and institutional vulnerabilities against victims to convince them that their sense of reality is flawed and distorted (Sweet, 2019; Li & Samp, 2023). Gaslighting within behavioral modification programs was most commonly used in convincing program participants that they were being deceptive or misleading regarding the details they shared. Program attendees were repeatedly “berated,” “scolded,” “punished,” and “shamed” for lying about their lived experiences prior to and during their program attendance. Examples of the 45 instances of gaslighting across 32 testimonials (41.56%) include:
We were told that no one would believe troublemakers like us, and if we dared say something, they would do everything they could to keep us until we were 18.
In the vast majority of those times, I was not a danger to myself or others; I dared to think that I should retain some bodily autonomy and control of my own life. The facility used my “non-compliance” to convince me and those around me that I deserved this “treatment” and that I brought it on myself.
While there, I was sexually assaulted by a patron in front of several of my classmates. I did not want to say anything, but one of them told the staff. When we got back, the guy in charge that day called me into the office; I told him I did not want to say anything, and he said: “I have to write it in your file, but that’s probably a wise decision. I mean, come on, who would believe you anyway?”
Each of these testimonials showcase how the attendees’ reality was distorted in a way that makes them feel as if they were going crazy.
Humiliation and Name Calling
Although it falls under an umbrella of psychological abuse, humiliation and name-calling emerged as a unique thematic category, conceptualized as feelings of inferiority, powerlessness, or exclusion as a result of ridicule, contempt, belittlement, or being referred to in a demeaning manner (Elshout et al., 2016). Psychological abuse can frequently be experienced through verbal aggression such as yelling or swearing, emotional manipulation, intimidation, degradation, criticism, or threats without ever being explicitly identified by the recipient of the behavior (Arriaga & Schkeryantz, 2015; DeHart et al., 2010; Capezza et al., 2017). This may be even more common when it is normalized in their environment. Humiliation and name-calling are significantly easier for the victim to identify as a slight against them (Capezza et al., 2017), even if it may not be perceived as abuse, as psychological abuse may compound over time, while momentary humiliation or name-calling is explicit and immediately invokes negative feelings. For attendees, the humiliation they endured was far more explicit and obvious to them, as well as having significant lasting effects. Humiliation for them was not simple name-calling by staff in passing, but a sanctioned, publicized, and psychologically distressing affair. Examples of this includes:
I had been there for three days when they set up a community group (a group where peers call each other out) strictly about my company with her. Staff told 55 students to sit in a circle and tell me something I was doing wrong. I never had in my entire life felt the way I did during that group. Students I did not even know were telling me how horrible I was (instructed by staff members), and my therapist was calling me out for things that I said in my private session.
Throughout the week we’d report transgressions then hash them out in [Problem Solving Group]. Tuesdays were doomsday, your struggles, traumas and insecurities were analyzed and thrown in your face until you submitted. Group would end with the majority broken down.
The voices were deafening, and I hung my head in shame and put my hair over my face. I was then yelled at to put my face up and take responsibility for being the whore that I was. The young man and I were pushed to turn against each other and he, as well, yelled and screamed at me, calling me a slut and a whore, a worthless piece of shit, and telling me he never liked me. The staff encouraged the students to yell and scream obscenities at me, as is what happened in all of our groups, asking some of my close friends how it felt to be “totally betrayed by the slut who always acts like an innocent little girl.” I was 13, and a virgin. Not once did any staff member explain or counsel me on healthy sexuality or relationships. Instead, I was immediately berated into thinking that I was dirty and worthless and that every sexual experience thereafter would increase my worthlessness.
Overall, there were 78 instances of humiliation and name calling across 42 testimonials (54.55%). In many instances, the name calling occurred in front of other students in a formal group setting.
Isolation
In total, 69 testimonials (89.61%) contained some reference to isolation. To begin, structural isolation included instances where program attendees were forcibly separated from other students. We identified 87 individual instances of solitary confinement across 42 testimonials (54.55%). Functional isolation included instances of surveillance and monitoring for a total of 52 individual instances across 37 testimonials (48.05%). Finally, to examine the intersections of structural and functional isolation, we examined isolation from support structures, including isolation from parents, family, friends outside the program, and other students. There were 214 instances of isolation from support structures across 65 testimonials (84.42%), indicating the presence of both structural and functional isolation within behavioral modification programming.
Structural Isolation
Structural isolation is operationalized as physical and social isolation through the physical restriction of liberty and autonomy by the institutional staff and administration, and is most clearly found in a recurring theme of “restriction:” a form of solitary isolation mentioned 88 times across 42 testimonials (54.55%). This restriction was often described as solitary confinement similar to those in correctional facilities, where attendees were isolated in a single room for extended periods of time. Participants claimed to have spent anywhere from 24 hr to more than 2 weeks in confinement at a time, many having been sent multiple times. Such isolation physically separated attendees from staff and other students, making it difficult in many cases for individuals to seek social support or to obtain help. Attendees frequently described instances of physical abuse and neglect while in isolation as well, with no potential for help-seeking. Examples of these include:
Starting from my first day at the facility, I was kept in a small room called R&R (short for “Restriction Room”) for almost 2 weeks, or at least that was my comprehension of the time I spent facing the yellow tiles in the corner of the room, sitting Indian style with my hands behind my back. The cold tile was almost as numbing as the pins and needles you’d get when your circulation gets cut off, but that only started after the 6 hours was up and they let you stretch your legs. This was the go-to stress position, if you’re lucky, you’d only have to sit like that for 4-6 hours. . .. but I wasn’t lucky, I got at least 10 hours a day.
I was “out of agreement” a lot, which meant I spent time on restriction. Restriction, for me, looked like extended forced silence, manual labor (including forcing me to do things I had told them I was physically unable to do), and pages of handwritten accountability writing assignments. In severe cases, a tent would be set up a hundred yards or so off the main campus where students on restriction would be required to sleep until our therapists decided we were allowed to rejoin our classmates.
At any time, for any reason, staff could physically restrain you and throw you in something we called OP, “observational placement.” OP was solitary confinement, where you were alone in a small square shed-like thing, where staff could watch you, or beat you, or do whatever they wanted until whenever they wanted. You could hear the screams coming from OP when walking in our straight line to the cafeteria.
I was put into the “quiet room” or an isolation cell every couple of days for being too talkative or for asking too many questions.
Overall, these testimonials showcase how program attendees were physically isolated from others, without any means of help-seeking for abuse endured during this isolation.
Functional Isolation
Functional isolation is operationalized as isolation through fear, in which program participants did not engage in help-seeking behaviors not out of inability, but out of fear of doing so. Functional isolation was present in 37 testimonials (48.05%) for a total of 52 instances of surveillance. There was a distinct lack of privacy among individuals, with staff constantly implementing “arbitrary” rules and seeking out reasons to punish attendees. The loss of privacy contributed to feelings of isolation because attendees have no option but to comply with staff. They often could not act against staff wishes, test boundaries, or confide in other students without fear of punishment. By stripping attendees of privacy in all spaces, it reinforces the idea that attendees lack autonomy. Such feelings can prevent attendees from ever feeling safe and can also lead to psychological isolation from others. As a result, attendees were unlikely to make connections with one another or with program staff, preventing them from speaking out against mistreatment or seeking help. Functional isolation is exemplified in the following testimonials:
Being watched became normal. While you were at the first rank, staff had to be with you 24/7. Staff always had the restroom stall and shower curtain open to make sure you were not doing anything against the rules. . .. I was with staff 24/7, slept on a thin mattress in the hallway with bright lights overhead, and had no privileges. When I say no privileges, I mean none. You sat with staff all day, staring at the wall, letting your mind wander. You could not even have a deck of cards or go to school until the second rank.
My first week here, I was made to sleep on the floor out in the hallway with night staff watching me because they put me on “suicide watch.” I was never suicidal, so this is just one indication of many that something was wrong with this place. To my knowledge, all new students were made to do this.
There was no physical touch, no hugs, no holding hands, not even a poke. Our every move was controlled. Prison inmates have more rights than we did. We had the same schedule every day. We walked in straight lines and counted through doors. We sat on the floors. We used the bathroom/shower with the door open. There was no privacy or hot water, so our 7-minute showers were exposed and freezing.
Overall, these testimonials display how program attendees lacked autonomy and privacy, hindering their ability to develop bonds as a form of social support with other attendees or staff.
Intersection of Structural and Functional Isolation
Functional and structural isolation also worked in conjunction with one another as evidenced across 214 instances in 65 testimonials (84.42%). Attendees claimed that contact with those outside of the institution was extremely limited, if permitted at all. Even when able to do so, their communications were closely monitored, with respondents saying letters were opened and read prior to being sent or delivered, were discarded instead of being sent or delivered, or even stated that they received letters with parts of the text blacked out by staff prior to delivery. With an inability to send or receive letters without interception, attendees communicating through letters had a physical inability to seek assistance from their parents and guardians.
No phones, though we could write letters to our parents and anyone on our approved list of people. All letters were read before being sent to make sure we weren’t saying anything untoward. All incoming mail was also opened and read before we got it.
We had no contact with our family. Only the letters we wrote, which started off handwritten then turned electronic so they could monitor and delete outgoing and incoming messages.
I was not allowed to speak to my family. I attempted once to write them in a letter about some of the things that were abusive at [program redacted], however, I got in trouble for my attempt and was disciplined by the staff in an extremely abusive manner. The letter never made it to my parents.
We were allowed to write home once a week, but you could forget telling your parents what was going on. Your letters were read and if they did not like what you were telling your parents, they would not send that letter and told your parents you refused to write them that week. . .. You see, in the beginning, they tell all the parents not to believe us, and that we will, “try to tell them anything like the school staff abuses us just to get you to take them home.”
The combination of these factors can make participants fearful of retaliation, especially given the control staff has over their needs. Restrictions on communication were not limited to letters, but also included phone calls. Despite access to those with the ability to help, perceiving themselves as lacking autonomy, attendees may be unable to seek help. This was evident in attendees who were permitted to use the phone and how these interactions were allocated and monitored:
I. . . was denied any contact with anyone outside the school, including my family. After 30 days, I was allotted a 5-minute, monitored phone call to only my parents, twice a week. This privilege was often taken away from me as a means of punishment.
We were not allowed to speak with our parents until we became a Level Two or Three, (which took about three months to achieve, sometimes longer), and it was a 20-minute phone conversation once a month, with the staff listening the entire time. You were warned and threatened never to speak negatively about the program to your parents or you would be punished and lose phone privileges. It was not until I achieved Level Four that my parents were finally allowed to come to visit me.
Phone calls with our parents were 5 minutes once every two weeks. They were supervised by a counselor sitting next to us listening on the phone so that we would not say anything incriminating to the school. Our letters were also combed for any information that could be seen as dissent.
Finally, parents were restricted in their physical access to their child once the program began. Home visits were often denied as punishment or were denied at the parents’ request, with claims that it would hinder their progress in the program. Parents could not see the physical condition of their child, nor were they able to see the conditions they lived in on a daily basis. With all methods of communication closely monitored between students and their parents, and communication with their friends from home having also been cut off from society, options for help seeking would be quite limited, if existent at all. In other words, they were reliant solely on the staff.
Not long after this, my parents came for a ranch visit. My parents saw the bruises, and I mentioned a recent runaway attempt by some girls to them. When I came back to the ranch, I was denied all contact with my family for months. No letters, no calls, not even monitored. . .. I fought to prove myself, and eventually, communication with my parents was put back on the table. I eagerly wrote them a letter, detailing daily life on the ranch and expressing my excitement to join them at home soon and start the next chapter. My letter was deemed inadequate, and again, my parents were advised to cut contact.
Attendees that were permitted visits with their parents were allowed these visits after months of attendance. In some of these instances, staff monitored these occasions just as they did the letters and phone calls. In six testimonials the parents, upon seeing the living conditions of their child for the first time and for being able to see their child unhindered for the first time, subsequently removed their child from the program. The restriction of help-seeking behaviors, in this context, maintains the perpetration of institutional betrayal from the program to the attendee.
I went back to [program redacted], being carried out of the psych unit as I screamed that I did not want to go back, and they promised me a “therapy visit” with my parents. To prepare for that visit, I wrote down every reason why I needed a different treatment. Little did I know, my parents were about to pull me and send me to a residential treatment facility that was accredited. The staff would not leave us alone that entire visit, so my parents could not tell me. They left and I felt hopeless. Until a couple of days later, I was pulled.
They did not let my parents visit me until after four months of being there. The second I was alone with them, I told them everything I endured on the ranch. They cried and said they thought they were sending me to a place where I could clear my mind in nature with animals. They could not have been more wrong.
It was not until I achieved Level Four that my parents were finally allowed to come to visit me. Up until this time they had only seen a brochure of the program’s facility, which was completely fabricated. I knew once they saw the living conditions and the facility in person, that they would take me home with them. Thankfully, I was right.
These testimonials represent the lack of knowledge parents may have over their children’s environment in the behavioral modification programs, knowledge which could have prevented the child’s attendance in the first place. The perceived horror parents felt upon seeing and immediately removing their child further indicates the perpetration of institutional betrayal of these youth.
Discussion
Open-source testimonials from attendees of residential behavioral modification programs demonstrate the presence of coercive control, including psychological abuse, gaslighting, and humiliation or name calling. In total, 66 narratives mentioned themes associated with coercive control that were unrelated to isolation. Institutions with this level of involvement in a child’s care and wellbeing have the ability to elicit high levels of trust and dependence, similar to that of an interpersonal relationship (Smith & Freyd, 2013). This level of dependence, even when regulated, can create a program structure that allows for the existence of the unethical power imbalances between program administrators and attendees. When considering frequent instances of coercive control and a difficult-to-balance program structure, it may be inferred that unregulated behavior modification programs, most notably residential boarding schools, contain structures which may act as a catalyst for institutional betrayal (Lind et al., 2020; Smith & Freyd, 2013). There is an expectation for institutional environments to be safe for its attendees (Monteith et al., 2021; Smith & Freyd, 2013). When this condition is not met, as it appears to be the case for some residential behavioral modification programs, institutional betrayal can have drastic consequences.
Furthermore, a total of 69 narratives contained themes of coercive control specific to isolation, including both structural and functional isolation. Constant surveillance and lack of privacy can create an environment in which attendees do not have reliable sources of social support to seek help. Further, isolation when combined with retaliatory actions from staff likely intensifies attendee feelings of seclusion and diminishes their likelihood or ability to seek help from external sources of support. Further, staff’s involvement in these behaviors can make them unreliable sources of support. When considering this in light of institutional betrayal, such behaviors by staff can be especially detrimental to attendees. Failure to report to guardians any wrongdoing done to students, the active prevention of attendees of engaging in help seeking, and failure to prevent harm from ever occurring are all forms of institutional betrayal (Lind et al., 2020; Gómez, 2021; Smith & Freyd, 2014). These institutional wrongdoings are prevalent in the testimonials that were analyzed and appear to occur both on an individual level and systematically across institutions. Institutional betrayal has been known to exacerbate negative mental health outcomes (Park et al., 2023; Gómez, 2021; Smith & Freyd, 2013, 2014), and this case is no different (Chatfield, 2019). Institutional betrayal and betrayal trauma can manifest through psychological symptoms, such as dissociation, anxiety, depression, and post-traumatic stress disorder (PTSD; Park et al., 2023; Gómez, 2021; Smith & Freyd, 2013, 2014). Although not pertinent to the focus of this paper and difficult to systematically collect based on the nature of the data, 24 testimonials claimed to have been formally diagnosed with at least one mental health condition, including depression, anxiety, insomnia, and panic disorders (among others). Of these individuals, 21 were diagnosed with PTSD relative to their time spent within the institution. Several more displayed undiagnosed symptoms. When institutions are designed to protect, and when these institutions betray this trust through abusive behavior and isolation, their harm can have a significantly greater effect.
While not explicitly recognized in the current thematic analysis, it is important to note that these programs have the potential to disproportionately impact marginalized populations. Demographic information, including sexual orientation, was not formally reported within the testimonials, though some respondents indicated they or their peers were sexual minorities. Although none of the programs included in the analysis were designated as conversion therapy, dedicated conversion camps fall under the umbrella of behavioral modification programs (Salway et al., 2021; Jones et al., 2022). Program attendees who were sexual and gender minorities perceived they experienced significantly higher rates of coercive control (specifically psychological abuse and gaslighting) than their heterosexual and cisgender classmates. Discrimination and institutional betrayal have often been linked (Gómez, 2021), making elevated rates of institutional betrayal likely. Furthermore, as has been noted in the coercive control literature more generally, sexual minorities can experience unique forms of control that is tied to their sexual orientation (Stark & Hester, 2019) and experience worse mental health outcomes as a result of these circumstances (Hill et al., 2022; Salway et al., 2021; Taglienti, 2021; Chatfield, 2019; Campbell & van der Meulen Rodgers, 2023; Trispiotis & Purshouse, 2021). There is therefore reason to believe this would also extend to the experiences of attendees, especially if they were enrolled in the program by their parents or guardian because of their sexual orientation.
Significant rates of coercive control and isolation shed light on the lived experiences of the youth involved with these programs. Pre-existing knowledge of the effects of coercive control and isolation allow us to infer that behavior modification programs inflict trauma on at least some of the attendees with negative long-term outcomes. Such findings justify the dedication of resources to further study this population in an effort to develop a full picture of the structure of these programs, their outcomes, and how well those outcomes are achieved. Doing so also encourages the development of policy regulating these institutions. As mentioned within the testimonials, many of the mental health professionals were not licensed. Developing more rigid staffing guidelines may be a critical first step in over-seeing the potential abusive practices within these programs.
There are limitations that merit mention. The present study is limited in overall reliability due to the lack of consistency in the information provided within the individual testimonials. Data for this study was originally collected by the Breaking Code Silence Network to supplement proposals for legislation. This made the data story based, and as a result, the validity of real-world experiences in the testimonials is limited by the credibility of unverified information. Nevertheless, the organization took steps to enhance the validity of the testimonials. Furthermore, key information, such as demographics, are missing, preventing us from establishing a holistic view of the population itself. Nonetheless, the information provided was sufficient to develop a baseline understanding as to whether or not attendees experience coercive control or isolation. Indeed, all of the testimonials mentioned abuse. Nevertheless, findings should be interpreted in light of the fact that respondents self-selected into submitting these open-source testimonials to an activist network designed to spread awareness. They, therefore, may be different from attendees who are not involved in such networks and may have very different lived experiences.
Conclusion
The results of this analysis suggest that coercive control and isolation occurs across residential treatment programs. This knowledge provides a foundation for future research of these institutions, particularly program structure, program efficiency, mental health outcomes, and long-term lifestyle outcomes such as criminal behavior and levels of success. Such studies will provide better insight into how to best serve these populations within programs, as well as support the development of formal regulations for these institutions.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interests with respect to the authorship and/or publication of this article.
Funding
The author(s) received no financial support for the research and/or authorship of this article.
