Understanding Treatment at the Austen Riggs Center

We all grow up in families where, inevitably, moments arise when a child’s needs exceed a parent’s capacity to meet them. In many cases, these mismatches remain minor and manageable. With time and communication, families adjust, and development continues.

But some mismatches disrupt development because they are emotionally overwhelming, unacknowledged, or simply too frequent. A child’s innate neurological makeup may lead them to be chronically out of sync with their parents. Or a parent’s previous trauma may limit their emotional availability. Or families may unconsciously carry the effects of trauma that were never recognized or understood in previous generations.

Children adapt to preserve the caregiving relationship, which they need to survive. If they decide a traumatic experience is their fault, they can still believe their parents are good. Over time, survival strategies like this continue to shape expectations, relationships, and identity long after the original context has changed.

Although these adaptations once helped children cope, they often complicate adult relationships, including in treatment. Many of our patients find themselves unconsciously reenacting early family dynamics, experiencing their therapists or other staff members repeating the roles of misunderstanding or injurious caretakers. Even minor misattunements—an ambiguous tone, a missed cue—can trigger intense reactions: withdrawal, rage, or despair.

Clinicians in traditional settings may misinterpret these responses as resistance, defiance, or dysfunction, labeling patients as“noncompliant” or “untreatable.” At Riggs, we see these reactions not as pathology, but as meaningful expressions of unmet developmental needs and unresolved trauma. When such patterns emerge in the therapeutic relationship, they offer an opportunity for understanding and change.

At Riggs, we approach intense emotional reactions not as problems to be suppressed but as communications to be understood. This means approaching intense reactions with empathy while also holding ourselves and our patients accountable.

Empathy means asking: What might we have done that triggered this? Where did we fail to listen or understand? We seek the truth in the patient’s experience, validating emotional reality and helping them bear what once overwhelmed them. Understanding the present moment often frees patients to join in reflecting on the impact of their past.

Accountability reflects our confidence in each person’s capacity for adult insight and responsibility. By holding patients accountable for their behavior and helping them recognize their impact on others, we support their developing capacity for broader perspectives and more flexible relationships.

Balancing empathy and accountability foster psychological integration, trust, and a sense of agency.

We conduct treatment in a completely open setting—without locked units, seclusion, or restraints—because we trust our patients to share responsibility for their care.

In more restrictive environments, control measures like locked doors or restraints often unconsciously mirror the traumatic conditions many patients endured in childhood—conditions where autonomy was denied, emotions were punished, or the caregiver inspired both fear and dependence. These measures can retraumatize.

At Riggs, we respond to intense affect—rage, despair, suicidal feelings—not with coercion, but with shared emotional labor. Patients, families, and staff bear it together. This strengthens agency, mobilizes mature capacities, and deepens trust in the therapeutic process. We intervene more actively only when a patient’s safety is at risk.

Healing at Riggs extends beyond the therapy room. Our therapeutic community includes an activities program that fosters creative expression through art, music, writing, and performance. A work program gives patients the opportunity to contribute meaningfully in settings such as the nursery school, greenhouse, library, and kitchen, taking up roles that reinforce responsibility, competence, and connection. Through patient government, individuals help shape community life and exercise leadership.

These programs promote recovery by enhancing strengths, encouraging engagement, and restoring dignity through work, creativity, and shared governance. They support a shift from helplessness to agency.

Patients don’t just repeat early dynamics with their therapists; they live them out across the community. They may idealize some staff and hate others, unconsciously recreating childhood divisions. These enactments can strain the staff system itself.

At Riggs, we use a systems psychodynamic lens to understand these patterns. Rather than blaming individuals, we treat the staff system as a therapeutic instrument. We reflect, interpret, and metabolize the dynamics together.

In outpatient settings, patients often react strongly to people outside the therapist’s reach—family members, colleagues, or friends. At Riggs, where patients and therapists are members of the same community, we can often observe these dynamics as they unfold, making them readily available for exploration and understanding. The community becomes a living extension of the patient’s internal world, enabling deeper insight and fuller integration.

We don’t aim simply to relieve symptoms or change behavior. We join patients in exploring how they became who they are and how they might change. This frees them to identify and pursue their own goals.

In a community that fosters emotional honesty, mutual responsibility, and genuine participation, patients can become active agents in their healing. They can move from being passive recipients of care to active authors of their lives.