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What is Tough Love and Does it Work?


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According to the Oxford dictionary, tough love involves “the promotion of a person's welfare, especially that of an addict, child, or criminal, by enforcing certain constraints on them, or requiring them to take responsibility for their actions.” In North America, tough love sometimes refers to “political policy designed to encourage self-help by restricting state benefits.” Most people have their own definition of tough love and have maybe even implemented the concept in their personal life, strictly or not. To me, I previously understood this concept to mean – I love you enough to be hard on you. And it’s the being hard on you that will elicit the change we both want to see. It is basically the antithesis of compassion, accommodation, or collaboration in an attempt to avoid coddling someone with a chronic issue. While on the surface tough love is seemingly reasonable and possibly scratches your common senses, it turns out that in practice, tough love often goes much farther than simply allowing people to experience the consequences of their own behavior as a tool in self-development. In the late 1960s, tough love became an 'intervention' popular within substance-use faith-based programs and the booming troubled teen industry. Concepts including the troubled teen residential treatment programs have gained increasingly familiarity with the general population since Paris Hilton’s self-disclosures of her own experience in a documentary released in 2020. However, personal accounts since the early 2000s elucidated what was happening within these largely unregulated behavioral modification institutions. Over the last 20 years, it has come to light that tough love is not always very loving but can be used as a cover up for harsh and even abusive treatment.

 

Tough love became the philosophy or the inspiration for various behavior modification programs or troubled teen institutions largely in place to treat substance abuse, behavioral problems, and mental illness. This includes but is not limited to correctional boot camps, wilderness therapy programs, therapeutic boarding schools, and living facilities for troubled (undefined) youth. In 2015, when a friend shared their personal experience in one of these institutions I was disturbed. But I was also, naively maybe, very surprised. How is this happening, and since when is tough love a panacea for anything let alone a legitimate treatment for mental illness?


As a training psychologist, I wondered how this all started and if we, as a field and society, were doing anything about it. It appears tough love was first coined by a man named Bill Milliken in his 1968 book Tough Love about parenting approaches. As we know, it was also during the 1960s that public safety was increasingly addressed with a “tough on crime” philosophy (or political agenda depending on who you are talking to). The movement towards institutionalized treatment of adolescents was stimulated by the court system as an alternative to adjudication during a time in which crime was seemingly at an all-time high. Sending juvenile offenders to correctional boot camps and wilderness therapy programs grew increasingly popular. The trend at this time was “tough love”, including an emphasis on discipline and obedience to authority, would rehabilitate antisocial behaviors and reduce recidivism.

 

Although, in a sense, a practical solution for those parents who fail to find appropriate community treatment for their struggling child, the benefit of these institutions is highly questionable. Behavioral modification is not consistently defined or regulated. In essence, these programs can use therapy speak without any actual qualified therapists. This absence of oversight can result in unqualified and potentially over-worked staff haphazardly working with high-risk youth under minimal guidance of psychologically minded professionals.


 

Much of the research in the late 1990s and early 2000s debunked the tough love myth, and found evidence this methodology can be hurtful. Outcomes of residential treatment for adolescents was mixed, and there was very little evidence that wilderness therapy or boot camps decreased rates of recidivism. By 1997 Congress released a statement indicating “tough love” treatments do not work. In 2004, the National Institutes of Health released a statement about their research findings- specifically, “Get tough treatments do not work and there is some evidence that they may make the problem worse.” Nevertheless, behavior modification programs with a tough on crime philosophy lived on. The appeal of tough love inspired a market for residential treatment for children with serious emotional disturbance. Independent institutions rapidly developed nationally and internationally. The perilous nature of these institutions has been under increased scrutiny since the early 2000s. I am sharing this information here to continue to spread awareness and assist the public in rejecting unhelpful and harmful treatment models.

 

Advocates (e.g., Breaking Code Silence), former attendees, and self-identified survivors have been increasingly outspoken and effecting change at the state and federal level. For too long, there was no legal system set in place to protect these children who were placed for treatment despite there being no evidence that unregulated tough love institutions produce greater results than personalized researched based outpatient treatment.

           

 

If interested in reading more, consider subscribing (email tabitha.echavarria@gmail.com) to be notified of future blog posts that build on this one. I will continue to share scientific research as well as my own graduate school research on a specific set of behavioral modification programs, World Wide Association of Specialty Programs and Schools, and the psychological impact these practices had on their former residents.

 

 

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