Thrive | Emerge™


Failure To Launch In The Young Adult Population:
Using A Cohort Model To Build The Capability For Independent Living 

by Rick Silver, MD

When my daughter was four, she was standing with my father outside his Florida home. The vacation, the ocean, the beckoning warmth of an early spring day spoke to her young heart of a sense of possibility. Anything she wanted was within her grasp. She had spied a flower on a nearby tree and asked, “Grandpa, can you get me that flower?” He reached up to the lowest branch when she stopped him. “No, THAT one,” she commanded, pointing to a blossom another three feet up the tree. “But honey,” he implored, “this one is so much closer.” “But I want THAT one!” she directed again. And Grandpa, being a dutiful, loving man, pulled a ladder from the garage and obtained the sought-after prize. My daughter’s eyes grew wide as he handed her the flower, and she remarked with the wisdom only a four-year old child could muster, “See Grandpa, if you really want something, you have to go after it!”

For a child, or young adult, filled with this joy and excitement, all of life’s possibilities are, with a little assistance, eminently achievable. What a delightful way to live one’s life! As parents, we hope that as our children begin the journey into independent adulthood, they will still be moved by this same child-like enthusiasm for the world.

But for “failure to launch” individuals, struggling with such challenges as depression, severe anxiety and executive dysfunction, this inner drive can be buried beneath self-doubt borne of years of failure, leading to helplessness and a loss of hope.

The “failure to launch” population can be defined as the group of young adults aged 18 to 25 years who have had multiple failures in several settings, such as higher education, vocational training, employment and relationships.

This complex set of factors can stall young adults in their development.

Factors Contributing To “Failure To Launch”

  • Poorly treated psychiatric disorders, including depression, anxiety, ADHD and substance use
  • Poor self-esteem from academic, employment or social “failures”
  • Inadequate time management, financial management and social skills
  • Difficult family dynamics, including parental challenges in understanding how to motivate and coach their child
  • Life goals not been clearly defined
  • Not belonging to a community that provides accountability and meaning
  • Poor self-care habits
  • Poor ability to regulate intense emotional states, leading to avoidance of new challenges
  • Impulsive decision making
  • Lack of mentors

The Cohort Model: Intensive Immersion

Helping these young adults recover a sense of intrinsic motivation -- a sense of passion, hope and dreams -- is a critical aspect of any treatment model attempting to transition this population to independent adulthood.

At its core, the Cohort Model is a tightly coordinated set of treatment activities involving the young adults and their parents. The model assumes (Figure 2) that, through the emotional support of an intentional community or “tribe”, intrinsic worth is recovered, leading to an increase in intrinsic motivation and the ability to live a more independent life.

Figure 2: Cohort Model Assumptions

Foundational Principles

Several principles are crucial to this model:

1. All factors that affect psychological and physical functioning must be addressed simultaneously.

No single emotional, familial, social, biological or experiential factor is sufficient to explain the significant level of dysfunction in this population. Issues typically requiring attention include:

  • Biological – medication management
  • Emotional – psychotherapy for grieving the loss of a “normal” childhood
  • Cognitive – executive function coaching
  • Parental – for clarifying dysfunctional dynamics and improving communications
  • Substance Abuse
  • Social – to overcome social anxiety and to modify maladaptive social behaviors
  • Emotional Self-Regulation – mindfulness for coping with emotional impulsivity
  • Self-Care –coaching for sleep, exercise and diet
  • Heart and Soul – Real life experiences to provide success and to awaken a sense of passion
  • Financial –money management coaching

A comprehensive approach, particularly when coupled with daily feedback leading to timely corrective actions, allows for sustained changes in functioning.

2. Treatment must be delivered by a coordinated team of practitioners who monitor closely and correct problems quickly.

3. Treatment occurs in an intentional community of peers which encourages honest self-expression, resolution of feelings of shame, improvement of self-worth and development of accountability and responsibility.

A deep sense of shame and perceptions of “not good enough” often blocks progress in the “failure to thrive” population. Locked inside this emotional bunker, the young adult seldom ventures forth to challenge these fundamental assumptions.

The key to progress lies in a nurturing environment of peers and “elders” – a substitute family or “tribe” – in which compassionate partnerships provide a fertile ground for the young adult to practice life skills, including:

  • Self-acceptance –Participants can open up emotionally to peers who “get them.” This chance to share emotional secrets can initiate the first crack in their emotional armor.
  • Emotional awareness and intimacy – Individuals begin to recognize their capacity to form healthy, fulfilling emotional ties. Practicing one’s own emotional skills with feedback leads to improved ability to manage emotionally challenging situations.
  • Emotional self-regulation – Emotional impulsivity can lead to excessive emotional displays, providing opportunities to practice self-regulatory techniques, such as breathing, mindfulness and “take five.”
  • Honesty/Accountability -- One coping mechanism to minimize shame and the fear of disappointing others is to lie. Peers exert a powerful influence on one another to “live up to your word”.
  • Self Worth/ Group Worth – To feel worthy and valuable inside oneself and one’s community are deep human needs. Playing a key role in the identity of the group shifts the individual’s experience to a sense of belonging and purpose.
  • Conflict Resolution – Young adults can reduce their oppositional behavior and take emotional risks, leading to better problem solving and increased confidence in handling stressful situations.
  • Goal Setting and Follow-through – Individual goals are monitored by group members, encouragement given and corrective suggestions for setbacks offered.
  • Self Care –Modeling and supportive chiding help improve sleep, exercise and diet habits.

4. Intensive, immersive treatment provides structure to the young adult’s schedule.

Since the opportunity for “spin out” is high, frequent contact among the members of the treatment “family” ensures continued progress of the young adult.

5. Working towards achievable goals allows the young adult to practice life skills and to experience small successes.

Close support leads to achieving goals, including returning to school or work; establishing relationships with peers; improving life organization skills; and gaining clarity regarding strengths.

6. Everyone is passionate about something – help them find it and they will blossom.

7. No one is broken – but we all have much to learn.

8. Parents must be a part of treatment” family” consisting also of providers and young adults.

Program Activities

These principles are brought alive through coordinated group activities involving either the young adults or their parents and lead by psychiatrists, psychologists, social workers, ADHD life coaches and fitness coaches

Suggestions for groups include:

Emotional Wellness Group –provides an opportunity to build a sense of community or “tribe”, to explore feelings about the struggles of this life stage, to get support for individual goals and objectives.

Life Skills Group -- discussions on specific life skills and goal setting to encourage practice of these skills outside the group.

Mindfulness Group – teaches mindfulness skills for emotional self-modulation.

Self-Care Group – to establish habits of exercise, diet and regular sleep patterns.

Community Group -- ropes courses and hiking are geared towards team building and reinforcing practices from the other groups.

Parent Support Group -- for issues of loss and grief associated with a “special needs” child; and for learning how to support their young adult using executive functioning techniques.

In addition to these group activities, a variety of other program activities can support the development of each young adult, including coaching, family meetings, medication management and psychotherapy.

The Cohort Model has the potential to catalyze the movement towards independence in a treatment-resistant population. Further implementation of and research on this approach will allow for verification of its strengths and clarification of its limitations – and will hopefully move many young adults to lives filled with hope, possibility and joy.