Hunter R. Slaton said:
Burning Tree is known for its tough clients and tough treatment. When The Fix got an alarming complaint about its practices, we investigated to see if the rehab was guilty as charged.
In January, The Fix received a complaint about a Texas rehab called Burning Tree, which has been featured in our Rehab Review since last July. We get such complaints on a fairly routine basis; however, this one was so detailed and disturbing that we could not let it pass. So we undertook an investigation. Here’s what we learned.
According to the complaint, which was made by a relative of a client, the rehab invades its clients’ privacy by censoring mail and listening in on phone calls, engages in isolation and humiliation, and practices questionable therapies, such as confrontations and unusual “contracts”—a rehab term for an agreement between a client and a counselor for the client to modify his or her behavior in some way. In the view of the complainant, all this—and more—amounted to “cult-like activities” at Burning Tree.
Opened in 1999 by founder David Elliott, Burning Tree is a long-term rehab with two facilities, in Kaufman and Elgin, Texas. Its target client is the “chronic relapser”—a serial rehabber who can’t stay sober. One alumnus told The Fix, “Burning Tree is the perfect place for someone who has had multiple failed attempts at sobriety and is looking for a different experience.”
Other alumni called Burning Tree “high accountability” and “no-nonsense.” “The treatment and the staff are very tough love,” one ex-client said. “They were strict because I wasn't the best or easiest ‘student,’” another said. “There were a lot of tough-love approaches thrown at me.”
But at what point does a confrontational, tough-love approach stray into the territory of psychological cruelty and abuse? Did Burning Tree cross the line in its surveillance of client reading materials and mail and in practices that an addiction-treatment expert called “a form of shaming”? Or are these necessary and effective measures when dealing with a population of, in the words of the rehab’s CEO, “classic manipulators”? These questions go to the heart of addiction treatment, and raise concerns not only about what is helpful but about what is ethical.
What are the actual facts in the Burning Tree case? Our first stop was the Texas Department of State Health Services (DSHS), whose director of media relations was initially cooperative, telling The Fix that their office had received two complaints—not just the one we had received—against Burning Tree. State officials were investigating both, with the outcome due in the next couple of weeks.
But a few days later, the spokesperson reversed her position, and said that a previous determination from the Texas Attorney General made information about such complaints and their outcomes confidential. In a letter to The Fix, Texas DSHS Public Information Coordinator Sherry Mansell wrote: “All records made by the commission during its investigation of alleged abuse or neglect in an alcohol and drug abuse treatment facility licensed by the commission are excepted from disclosure.”
So that was a dead end. The Fix next spoke to a therapist who had been contracted to work at Burning Tree for “a couple of years.” She was familiar with the situation, and said, “This person making this complaint may be rude, but they are not wrong.” (The therapist asked to remain anonymous.)
Asked about specific allegations in the complaint, the therapist offered confirmation. She said that clients’ five-minute weekly phone calls are monitored by a rehab staff member sitting in the room with them. “Every piece of mail was opened prior to somebody receiving it.”
As for “questionable therapies”—which the complainant said included making clients wear clothing inside-out, not allowing them to speak for up to a week and making them lie down outside in the dirt—the therapist said she was aware only of the no-speaking contract. Although what the complainant alleged is a “slight exaggeration,” the therapist conceded, sometimes clients are contracted not to speak to certain individuals or family members for some amount of time.
“I was very worried for this man’s life,” said the therapist, referring to the client named in the complaint. “And he was not the first.” But the most galling thing about Burning Tree, she said, was its leadership’s arrogance: “They are always right, and the client is always just a liar or a shameful person.”
We took the allegations to Burning Tree’s CEO, Brian Percox. Throughout our interview, Percox was surprisingly forthcoming—in an industry where client confidentiality is an oft-cited bulwark—even offering unsolicited information about the complainant herself. “We thought of suing this woman,” he said. He noted that both complaints concerned more or less the same things.
Percox denied that client phone calls are monitored or mail opened prior to distribution, noting that both acts are illegal. The five-minute, once-a-week phone call policy is accurate, however—and “the reason we do that is to protect the family,” Percox said. “These are classic manipulators we are dealing with.”
Books and music may be disallowed, but not because they are non-12-step-appropriate, Percox said. Rather, counselors make decisions as to whether or not specific materials are in line with “general spiritual principles”—or, as one former client put it, “recovery-related.” Marilyn Manson CDs, for example, and the book Fifty Shades of Grey do not make the cut, Percox said.
Percox also addressed claims of “questionable therapies.” The “inside-out-clothing” exercise, he said, is called a “disarray contract,” which, while “pretty rare,” is sometimes given to clients (with their agreement) who have “everything together on the outside”—i.e., being sharply dressed and well-groomed—"but not on the inside.” So the client agrees to dress crazily or poorly for a certain amount of time, sometimes with clothing picked out by another client.
As for the “no-speaking” contract, Percox said that it is more often for periods of 48 to 72 hours, and only during group sessions. And yet, he added, “We have done it where you can’t speak at all for 48 hours. But only if it’s necessary—and very rarely.”
For our Rehab Reviews, The Fix uses alumni of the facility as an important source of information, and we contacted them again with our questions about this case. In general, their answers split the difference between Burning Tree management’s version and that of the complainant and the therapist.
For instance, alumni denied that mail is opened by staff before it is given to a client. Rather, “Burning Tree requires that the client open the mail in front of staff,” said one former resident, adding, “Additionally, if there is something that may affect the client’s treatment—divorce papers, death, nude photography—the clinical team can help the client process and stay focused.”
Another ex-client, who said his experience at Burning Tree “was nothing but helpful,” echoed this account. “Prior to anyone receiving mail it was opened in front of a staff member. They never read your letters but simply checked to assure no contraband was in the package,” he said. Both alumni denied that staff listen in on phone calls, although they do monitor the length of the call with a timer.
Are these practices and "therapies" helpful, harmful or just irrelevant? Clearly it was time for us to call in an expert. Practical Recovery President Tom Horvath, PhD, is the founder of Reunion San Diego, an addiction-treatment center that in many ways stands opposed to Burning Tree’s confrontational approach.
Horvath was reluctant to say that certain aspects of Burning Tree’s approach couldn’t ever work. “[With the disarray contract], they want someone to open up. What they are doing is essentially a form of shaming,” he said. “I wouldn’t ever do that. But if I were to put somebody on a contract like that, they would be allowed out of it on a moment’s notice.”
Yet these contracts—more pedestrian versions, it should be said, are common at many rehabs—are not the most troubling allegations against Burning Tree. More serious is the rehab’s alleged disregard for clients who also suffer from underlying mental disorders.
The rehab’s website claims, “Dual diagnosis of addiction, and any underlying psychological conditions..., is not divided into component parts and treated separately. Rather, all possible elements and factors are addressed through an integrated approach that acknowledges that each has a simultaneous impact on the other.”
But Burning Tree does not use an “integrated approach” in treating a dual diagnosis, according to the therapist. In fact the rehab basically does not treat clients’ mental issues at all, she told us. “Really it just amounted to them sending that client to see me [once a week] for a few minutes.”
The rehab’s confrontational practices, she said, are an attempt to “break [clients] down mentally, which does not work for people with underlying mental disorders.” She said, “I’m willing to concede that this could be a difference in philosophy of treatment—but only for substance-abuse cases.” She also claimed that the rehab took some clients off all their prescribed medications, without consulting a psychiatrist. (Percox denies this, saying that only Suboxone and methadone are disallowed, Burning Tree being an abstinence-only rehab.)
Percox countered that the facility does adequately care for its dual-diagnosis clients, providing once-a-week psychotherapy with a licensed master’s-level therapist. Yet he also concedes that “primarily we are a treatment center, but we do do co-occurring disorders.”
When asked whether the rehab attempts to “break down” its clients, Percox’s denial was emphatic. “We treat the chronic relapser. Our belief is that they’ve never truly been treated for their spiritual malady,” he said. A former resident agreed. “If you are a chronic relapse addict like I was, you need to be confronted about your lies, as well as be held accountable.” Percox made no apologies: “We are confrontational, but we do it in a loving, honest way,” he said.
But confrontation, said Horvath, is “the one thing that should not be done.” While he was only cautiously critical of certain Burning Tree practices, Horvath took a hard line against its treatment philosophy. “Confronting people is harmful, and there is very clear evidence about that now. Getting in somebody’s face and insisting that they accept the label or the notion of a disease or a particular approach to recovery—that makes people worse.”
The evidence appears to support Horvath. According to a 2007 study in Counselor: The Magazine for Addiction Professionals, William Miller, PhD, and William White, MA, concluded: “Reviewing four decades of treatment outcome research, we found no persuasive evidence for a therapeutic effect of confrontational interventions with substance use disorders. ... Several have reported harmful effects, including increased drop-out, elevated and more rapid relapse, and higher DWI recidivism.”
As for the Texas DSHS’s investigations into Burning Tree, a state official reported that no enforcement action was taken against the rehab. “The state came, did interviews and a review, and nothing came of it,” Percox said. Yet one thing did raise concern with the state in Burning Tree’s accreditation audit. “We used to not give their [driver’s] license back if they left until after 96 hours,” Percox said. “We did it as a retention tool.” But state investigators said the rehab could not continue this practice. “Now we give their license back in four hours, but we won’t give them a ride to the bus stop”—which, Percox noted, is a long way off in rural Texas—“until 96 hours.”
It became clear during the course of this investigation that Burning Tree—while it is apparently on the right side of the law—engages in practices that might give many people pause, especially if they are considering it as a treatment option. Yet despite conclusive evidence that confrontational approaches like Burning Tree’s do more harm than good, numerous alumni testified that the place is a “welcome” alternative for some addicts who have been through the rehab mill.
Burning Tree’s hard-core practices are controversial—and are likely to remain so for as long as the debate between confrontational and self-empowerment approaches continues. So buyer, beware. Information and education about what a rehab experience is really like is the best weapon in your arsenal. The Fix remains committed to uncovering these experiences in our Rehab Review, and—should they be warranted—future investigations.
