Why Maturity is a Basic Admission Requirement at Sunshine Coast
The other day I took a call from a mother (I will call her “Stacey”) whose 34-year-old son (“Martin”) was struggling with alcohol and living in her basement. Martin had a long history of addiction, starting when he was 14. Martin struggled to hold down a job, even though, according to Stacey, he had above-average intelligence. Martin spent most of his time alone in the basement and had few friends.
When Stacey asked Martin to get help, he refused. At the same time, Martin blamed Stacey for his problems and would become verbally abusive whenever Stacey expressed concern about his drinking. Stacey decided that the only way to get Martin into treatment was to hire an interventionist. In the event that the family intervention was successful, Stacey was hoping that we would have a bed available so Martin could go directly from the intervention to the facility.
After listening to her situation, I informed Stacey that, unfortunately, we could not accept Martin into the program. Martin, I explained, would be better suited for a program that encouraged him to, as Eriksen (2007) put it, “attend to social norms of right and wrong behavior, to other’s feelings and needs, and to reconcile [his] own needs with the needs of others, all in the service of maintaining relationships” (p. 176). In other words, Martin needed a program that would help him develop basic living skills so that he could take the critical step of establishing a life for himself. Since it would likely take time for Martin to develop these skills, I also suggested that Stacey find a program that offered a long-term option (at least 60 days but, preferably, six months to a year).
We are a Program for Adults
Sunshine Coast Health Centre is a program for mature adults. This means two things. First, we require applicants to be 19 years of age or older. Governments like our home province of British Columbia deem 19 years the age of majority. Once a person reaches the age of majority, they are assumed to be in control of, and responsible for, their decisions and actions.
Second, we require that applicants have a past history of having taken steps toward living independently, such as attending college or a trade school, working (preferably not in the family’s business), renting their own place, being in a committed relationship, or raising a family. Research in developmental psychology suggests that a small, but significant group of adults fail to develop the necessary capacity to assume the responsibilities normally associated with adulthood. In this blog, I describe our policy on admitting such individuals.
Characteristics of the Imperial Stage of Human Development
In a perfect world, all people who reach the age of majority would have the social and emotional capacity to think and act like adults. Unfortunately, this is not always the case. Research has shown that approximately 6 percent of adults remain stuck in a developmental stage more typical of adolescence: the imperial stage. According to Harvard psychologist Robert Kegan, individuals at this stage consider other people a means to an end. They focus on satisfying their needs but lack the capacity to appreciate that others have needs, too.
Determining whether an action is right or wrong for someone at the imperial stage comes down to a fear of negative consequences. For example, Michael worries about how going to treatment might invoke difficult, even painful, emotions while overlooking the fact that Stacey’s well-being would be drastically improved if he agreed to go to treatment and begin the transition to adulthood. Since individuals at the imperial stage are still not fully aware that others have minds of their own, they may feel hurt and angry when others are not perfectly attuned to their need “for satisfaction, comfort, relief, [and] embrace” (Kegan, 1982, p. 139). They expect others to be “mind readers.”
During adolescence, most individuals transition out of the imperial stage to the next stage in Kegan’s developmental model: the socialized (aka the interpersonal) stage. Those who remain stuck at the imperial stage are often unemployed, have criminal records, and struggle with addictions at levels significantly higher than the general population (Eriksen, 2007).
Our Program is Designed for People at the Socialized Stage of Human Development
Adults who remain at the imperial stage may not only struggle with the demands of society, they also appear to struggle with the demands of addiction treatment. Our program is designed for people who have managed to reach the next developmental stage in Kegan’s model: the socialized stage.
Briefly, the socialized stage is the stage when external sources most shape our sense of self and understanding of the world. Unlike the imperial stage, the socialized stage is marked by a concern for how others view us. Individuals at this stage value social norms associated with family, society, and culture. According to Kegan (1994), the socialized stage is the stage reached by the majority of adults (58 percent).
The socialized stage, however, brings with it a different set of challenges. People at the socialized stage often lack a strong sense of self, which is problematic in two ways. First, people who lack a strong sense of self look to external sources for direction and validation. A good example of a person at the socialized stage of development is ‘Gloria’ from a classic training video with famed psychotherapist Dr. Carl Rogers. In this video Roger is working with Gloria, who is concerned that she is not doing a good job talking to her teenage daughter about sex.
Not only does Gloria want Dr. Rogers to tell her what to do, she is also seeking reassurance that she has made the right parenting decisions thus far. Second, people who lack a strong sense of self also struggle with meaning and purpose because they have not taken the time to reflect on their own values apart from what they think others consider important. According to Viktor Frankl, author of Man’s Search for Meaning, people who lack meaning and purpose often turn to drugs and alcohol to fill the void; what Frankl referred to as the “existential vacuum.”
The Self-Authoring Stage – Our Goal of Treatment
One way of understanding the goal of our drug rehab and alcohol treatment programs is its facilitation of clients’ transformation from the socialized stage to Kegan’s next developmental stage: the self-authoring stage. According to Kegan (1994), 35 percent of society are at the self-authoring stage.
Those who are regular readers of our blog may be familiar with the concept of authorship (see a detailed examination of authorship by Program Director, Geoff Thompson, PhD.). Yalom (1980) defined authorship as the process of becoming “aware of creating one’s own self, destiny, life predicament, feelings, and, if such be the case, one’s own suffering” (p. 218). Individuals who reach the self-authorship stage begin to critically reflect on – and take responsibility for – their thoughts, feelings, and attitudes, particularly those they may have unknowingly internalized from others.
How Clients at the Imperial Stage can Negatively Impact the Treatment Experience of Their Peers
In my experience, three problems arise when you admit clients that are at the imperial stage. First, the larger peer group suffers. Clients who have already developed basic life skills have a hard time relating to a fellow adult who has not. When a peer group is no longer cohesive, clients are robbed of a potential source of personal transformation. Some clients even leave treatment early if their peer group experience is negative.
Second, clients who lack social skills often “act out” and tie up precious staff resources, to the detriment of other clients. Third and finally, family members of imperial-stage clients put an additional strain on staff resources. Habituated from years of “putting out fires,” family members of imperial-stage clients have a hard time standing back and trusting in the treatment process and allowing their loved ones to work through challenges on their own.
Modern Society Demands Self-Authorship
According to Kegan (1994), the demands of contemporary society for self-authorship are well over the heads of much of the adult population – the 64 percent of North Americans who function at the imperial or socialized stage (thus the name of his book, “In Over Our Heads”).
Our program is designed to help individuals transition from the socialized stage to the self-authoring stage. That is difficult enough. Admitting clients at the imperial stage and expecting them to do the same is setting them up for failure. In these cases, such individuals may be better suited for programs that focus on developing empathy and living skills.
Eriksen, K. (2007). Counseling the “imperial” client: Translating Robert Kegan. The Family Journal: Counseling and Therapy for Couples and Families 15(2), 174-182. doi: 10.1177/1066480706298919
Kegan, R. (1982). The evolving self: Problem and process in human development. Cambridge, MA: Harvard University Press.
Kegan, R. (1994). In over our heads: The mental demands of modern life. Cambridge, MA: Harvard University Press.
Yalom, I. (1980). Existential psychotherapy. New York, NY: Basic Books.