In September 2022, James, CEO of a major global corporation checked into a well-established and highly recommended exclusive treatment facility suffering from executive burn out, with high levels of cocaine and alcohol use problems. It was his 4th visit at the same facility and his aims were quite low, as his previous visits had not transformed his life, but had merely provided respite so he could detox.
Within two days of his discharge after a 12-day stay, he resumed drinking and drug use. Unfortunately, this is common and raises the question of why traditional clinical rehab programs often have little impact on high-profile clients.
In this blog we will explore what factors contribute to such low aims, and how programs can be changed to make them more successful, avoiding traditional rehab program failures.
Understanding the Unique Needs of High-Profile Individuals.
Anyone in the public eye has a deep-seated need for privacy and discretion about their private lives, particularly when it involves areas such as mental health or any other issues stigmatized by the culture we live in. Any media exposure can be disastrous for families, careers or social reputations.
Other factors are the intense pressure, stress and expectations which form part of the lives of high-profile individuals. Their platform and wealth create dependence on those around them, and this responsibility weighs heavily. People need them to perform well and judge them when they are unable to do so.
A high-profile life in itself generates huge demands – to maintain a wealthy life-style that they, their families, and those close to them are accustomed to. Curiously, while funding treatment is a challenge for most people, for the high-profile and wealthy person it is time available to receive residential treatment that is often limited so they reduce the treatment time to below that clinically recommended. They are finance rich, but time poor.
Limitations of Traditional Rehab Programs.
To discuss the limitations of traditional rehab programs we need to understand their reliance on a group therapy approach. Surveys from SAMHSA indicate that 80-90% of treatment facilities include group therapy as a major component to their program. This provides peer support and social reinforcement during the treatment. Both 12-step therapy groups, Yalom style groups amongst many others can be powerful tools to deal with the characteristic of denial which is a recognized feature of addiction. “You can’t trick a trickster” is a common observation made in group therapy communities.
Group centered facilities can reduce costs considerably to some degree so that the group community will take care of itself within the framework and schedules provided by the treatment program. Staff to client ratios are greatly reduced.
However, the group approach has some severe limitations for the high-profile client.
First, the facility needs to establish rules for community members. This can create a ‘one size fits all’ aspect to the program. Treatment plans for all clients need to be largely identical, making it difficult to address individual needs.
The therapeutic team will be standardized to adapt to the community approach, rules and schedules. Innovative treatments are not often included. Rules can become rigid, lacking in flexibility. The everyday schedule must suit all members regardless of individual needs.
However, for the high-profile individual, the greatest challenge to group settings is their need for confidentiality and their fear of opening themselves up to people they have only just met. They have so much to lose if their confidentiality is broken. Combine this with the difficulty of peer matching, and we can see how unappealing group therapy approaches can be for them. Imagine a very successful 65-year-old businessman suffering from alcohol use disorder finding himself in a group with 25-35 year olds addicted to methamphetamine.
The Role of Tailored and Bespoke Rehab Programs.
An attractive residential treatment alternative for high profile individuals or high earners are facilities offering bespoke programs. Here treatment can be tailored to the exact needs of every individual client. After a thorough assessment, an individualized treatment program can be created which considers all characteristics of each case. This flexibility is reflected in the modalities used, the schedule itself and the length of treatment. The client is free to choose the therapies which resonate best for them and discard those which seem unhelpful. It also provides freedom to adapt house rules to fit the client’s needs and situation.
In a bespoke environment, there is more opportunity to introduce innovative modalities that the client requests. In all aspects, the client feels empowered and supported by the bespoke environment.
A good example of this at Thera Bespoke was Peter, a highly successful entrepreneur who found his energy levels to be better suited to talking therapies in the mornings, so he was able to change his timetable at Thera to see those therapists only before lunch, leaving the afternoons free for more relaxing modalities and body work. He was also able to arrange work time to be online with his team which considered the time difference between his home and Bali.
Of course, client confidentiality and privacy is much better addressed in bespoke programs where the client meets no peers and is involved in no group activities. This is an important concern for high-profile individuals.
In a bespoke environment, there is more opportunity to introduce innovative modalities that the client requests. In all aspects, the client feels empowered and supported by the bespoke environment.
What are the weaknesses of the Bespoke model?
The bespoke approach is highly client centered. It empowers clients to impact their own treatment program. While beneficial in many ways, this can also create difficulties in treatment, essentially enabling them to sometimes sabotage their own treatment, against the advice of their clinical team. For example, at high-profile clients’ rehab facilities, someone who is not used to following directions may react poorly to a therapist who makes suggestions that challenge their comfort zone. The entitled lifestyle high profile earners are used to can cushion them too much from the discomfort of highly desirable changes in their lives.
Another difficulty with the collaborative program created in bespoke centers is that it can lack any clear objective beyond the client’s vague desire to feel better. The entire residential team is focused on satisfying the client’s wants and expectations – both clinically and concerning hospitality. Bespoke treatment is very costly, so client expectations are high. Internal discomfort in treatment can be deflected by a complaint about a personal favorite coffee not being easily available, for instance.
Clinical teams, when dealing with bespoke clients can lose any coherent view of what the clients are capable of aiming for. Clients themselves cannot be expected to even glimpse their possibilities, due to the anxiety, stress and depression that leads them to treatment in the first place. So, to satisfy the high-demanding client, a coherent treatment plan can deteriorate into an assortment of therapies that the client has chosen, with no real aim in sight. The tail is now wagging the dog.
Benefits of Thera Bespoke’s Zero Protocol Approach.
At Thera and our luxury rehab programs in Bali, the clinical team are highly aware of the tensions described above and offer alternative treatments for addiction. There is an art to curating a treatment program which empowers the client to be involved and active in their own collaborative program yet at the same time maintaining a complete overview of the beginning, middle and end of the entire treatment process. Thera’s job is to inspire each client to glimpse beyond their current limitations, not just deal with them. The glimpse of changed possibilities is shared and cherished with the client at each stage of the program. After all, humans do things better when they know why they are doing them.
The modalities used at Thera are all designed to inspire the client’s belief in dynamic change and potential. The client may choose which modalities to focus on, but they all reflect the underlying thread behind the Zero Protocol approach – the belief that we can all learn to self-regulate in healthy ways and rewire our bodies and minds to unlock hidden potentials in life.
All residential treatment comes to an end. This is a vulnerable moment in recovery, when the client leaves the protective environment that they have learned to trust. The Journal of the American Medical Association (JAMA) estimates that between 40-60% of individuals relapse after completing treatment for addiction – these are similar rates of relapse in other chronic diseases such as diabetes, hypertension and asthma. This is not indicative of failure but rather a signal that ongoing treatment and support are necessary. Ongoing care and addressing co-occurring mental health issues are essential for long term recovery.
At Thera, when creating the initial collaborative treatment plan, each client is helped to understand how vital it is to make the practices learned in treatment lifelong habits. The aftercare programs offered are again tailormade – dovetailing into each person’s unique situation, beliefs and visions. These are not sold as separate packages, but as part of the ongoing recovery journey.
So, we have seen that for high earners and high-profile individuals there are serious limitations to traditional rehab programs. The prevalent group approach creates ongoing problems with confidentiality and with rigidity around the programs offered and facility rules.
There are also difficulties with bespoke units where the clients become over-empowered in the treatment approach and so no coherent treatment plan is presented to inspire them. This leads to a jumbled approach of mixed modalities with neither the client or the clinical team able to set, understand and stick to an exciting treatment aim.
However, Thera Bespoke is proud to offer an innovative approach with its Zero Protocol program which deals with these identified weaknesses. Please contact us directly if anything written here has provided clarity and perhaps touched your heart. It may well change your life or the lives of people you know.
