We’ve all heard the age old proverb “it takes a village to raise a child”. With mental health care taking a sharp, yet important, turn towards exploring the effects of trauma and adverse childhood experiences, the saying may be more important than ever.
Last week I met with the teachers from a private school in Adelaide to brainstorm new solutions for a 16-year-old who, although thriving academically, had ruptured relationships with a few of his teachers. These teachers were fed up and tired. I acknowledged that when I first met this boy, I found our initial sessions challenging, but addressed the warning signs showing that maybe our work wasn’t as effective as it should be. Things changed and his family reported significant improvements at home.
But school remained an area of concern and the teachers organised a meeting. The morning of the meeting, I read a wonderful Maggie Dent article reminding me of the importance of engagement and where the responsibility really lies.
While even an average therapist is likely to help the majority of his or her clients, there is one looming problem, not spoken of publicly, that plagues the field of mental health: dropouts. As Maggie pointed out in her article, we can’t teach the student if they don’t show up. For mental health professionals, we may say that person is not ready, doesn’t think he or she has a problem, is in denial, resistant, lying, precontemplative, or any other term placing blame on the client for not engaging in the service we’re providing. Although these terms have been used for decades, they haven’t prevented dropouts or predicted what person is likely to benefit from our services.
When I started working with this boy I took the risk of dropout seriously. I knew that if my service did not benefit him or the family early on, they were more likely not to come back. Also, issues in our relationship can forecast future dropouts. Favouring these two key areas, I found where I could change my approach and address issues in our relationship to improve his engagement in the therapy process.
As a survivor of severe, early life trauma, this boy has struggled to keep positive relationships with authority figures around him. While some teachers work seamlessly with him, others find themselves in a constant power struggle, arguing over minute details that interfere with the experience of other students and escalating to the point of warnings, detentions, and risk of suspension. While these processes may work for other students, this particular adolescent tends to internalise what has happened, becoming more withdrawn and disengaged in the classroom. This approach wasn’t working.
I give this school immense credit. Inviting in an outsider and hearing a different point of view does not happen all the time. And in truth, sometimes these consultations are uncomfortable and challenging. After all, we were all trained differently and come from different fields. What was said in the meeting was, however, positive, focused on outcomes, and collaborative. I started with the idea that, together, we had the opportunity to do some profound work for this boy, a survivor of unimaginable early life experiences. While he had that “tough guy exterior”, he was cut deep and knows where his struggle hid.
I brought up the importance of engagement and relationship. As a therapist, I can take the usual route of calling my client resistant or in denial, but this will not improve the chances of me helping him. As a teacher, we could say he is the delinquent child that takes up the majority of my time in the classroom and disrupts the other students. This approach is also unlikely to solve the problem. As parents, we can say to ourselves, “he just doesn’t get it” or "he needs to pull his head in". Again, these approaches are more likely to distance ourselves from the boy, breaching collaboration and potentially rupturing future attempts to help.
We came up with a new plan that shifted responsibility to this boy’s “village”…the adults. We brainstormed ideas for engaging the boy using the all his key strengths. Caring about social justice, athletics, playing with younger children, and working one on one with the educational specialist of the school were all identified.
One teacher courageously acknowledged that teaching the 90% of students that respond to her is easy. Addressing the 10% that tend to disrupt her classroom is very challenging. She is absolutely right. If therapists don’t address their rates of dropouts, things are likely stay the same. It is not the child’s responsibility to engage with us, it is ours. From the first day in the bush or our initial session in our office, engagement is the responsibility of the professional. Using our relationship to earn this engagement, we can make sure that the young people who need our services the most, those most vulnerable, will stick around, giving us the opportunity to be the best “village” we can be.
Will Dobud MSW
It’s hard to capture the energy of a room full of therapists focused on one thing: Finding how to make therapeutic services more effective. Along with myself (an American attending from Australia), professionals from Norway, Singapore, Sweden, Canada, Denmark, Chile, and America travelled to Chicago for a three-day advanced intensive training attempting to answer this very question.
Facilitated by psychologist Scott Miller PhD, the training focused on implementing the internationally recognised Feedback-Informed Treatment, or FIT. For those that have worked with me individually in Adelaide or attended one of our adventure therapy expeditions, you are familiar with the process and the measures we use to make sure our services are working. We have also written in the past about how we use this feedback from you for tailoring our services.
One of the biggest takeaways for me involved how we can go about improving our “Culture of Feedback”. That is, how to make sure that those we work with, both clients and colleagues, are comfortable voicing essential concerns that can make our collaborative work together ever more important for them.
At one point during the training, I found myself sitting in a circle with four colleagues. None spoke the same language. Being in the United States, we stuck with English. Just as in a therapy session, we had to communicate and problem-solve. It needed fine-tuning, however. I could not speak with my usual speed and they needed to sense whether they felt comfortable speaking in what may be their second, third, or fourth language. What an experience!
When I came across Scott’s work and research it immediately fit with the ethos and vision of True North Expeditions, which began with two important assumptions. The first acknowledging that it is not common for young people, adolescents in particular, to willingly seek and engage in a therapeutic service. More often than not, a parent or school will make initial contact with us. The second is that this should not concern us as we need them engaged to deliver a more effective service. We use a genuine and collaborative relationship to improve this engagement.
As we covered over 40 years of research during the first day of the training, we continued to come back to that one word: Engagement. No matter the reasons for a young person coming on our program, engagement is the key to long lasting, positive change. Feedback-Informed Treatment gives us one way to routinely assess engagement and ensure people are progressing in our services.
With that in mind, it was gratifying to sit with colleagues from all corners of the globe to talk engagement, relationship, and “leaning-in” towards the people we are looking to help most.
There has been no time for jet-lag as my day began with an 8:30am session and now I’m off to the hills for mountain bike ride.
Until next time, see you on the trail!
“Success or Failure is the child’s responsibility. Privileges and Parenting are the parents.”
Privileges, Discipline, Consequences, Punishment, Rewards…There is no perfect parent nor a perfect model for parenting and navigating through the millions of articles, books, and posts discussing what works for parenting the perfect teen can be daunting. This morning I listened to a fantastic interview with a family therapist Neil Brown from California as he talked his upcoming book about ending the parent-teen control battle. I’m excited to read his new book as I thought he presented great tips for parents stuck in control battles with their children.
Whether its school refusal, anger management, sibling rivalry, risk-taking behaviour, or drug and alcohol taking, change in the family dynamics can start with a new type of talk with our children. “The Talk”, as it’s referred to, begins with a discussion of all the things we hope do not change about our son or daughter. Whether its their musical talent, athletic abilities, or passion for helping others, acknowledging their strengths and assets will let your child know that this discussion has nothing to do with control. We begin with the positive vision of our teenager that can slip away during times of stress.
Both you and your child know that this conversion is occurring because there are some concerns you are having about the direction your child is headed. Bring them up and talk about it. However, this is also your time to be firm about the changes that will take place.
For this post, we are not going to talk about punishment, consequences, or rewards…but privileges. You can explain that privileges are earned regularly. For instance, having a mobile phone is a privilege. Staying out late with friends or going to a party is a privilege for getting done what needs to be done. They are not punishments or bribes that will be taken away for bad behaviour but what you’ll need to earn each week. Privileges are about your child managing their relationships, family, school, self-care, and work responsibilities.
For Example: “Because things have been difficult at school we are going to need to make some changes. First of all, whether or not you succeed or fail is up to you. I cannot control what work you do and do believe that you are capable of anything you put your mind to. I’ve seen you do your homework thousands of times and be great at it. But today, success is your responsibility, and I cannot control that. Parenting, however, is my responsibility and things like going out late with friends, your mobile phone, spending money, etc. are privileges that will need to be earned. If you’re trying your best in school and struggling to improve your grades, that is ok. What we do need to see is that you are attending all your classes, completing your homework, and being respectful at home. School is your responsibility, and you need to do your responsibilities just like we need to do ours. When this happens, you will have earned your privileges. Like we said before, that is fully up to you. I’m on your side, and I want you to earn your privileges. I want you to have them, be happy, and be successful because I love you. Today you have let me know that you are not ready for these privileges. When you have shown that you are ready to earn them, then you’ll get them back.”
This Talk is delivered with a positive tone while being assertive and firm. That is the parent responsibility. Your child’s responsibility, however, is earning the privileges back.
Important to note with this talk is that it is not critical, demeaning, blaming, or controlling. It does not invite a power struggle and does not offer one. It respects your child’s responsibility and ability to choose while exercising the parental leadership required in the parent’s responsibility.
I found it interesting to hear Neil Brown go through this talk during the interview and could see the art of delivering this talk with assertively but with a firm tone. If you’d like some more information about this type of talk or family therapy, do not hesitate to contact me.
See you on the trail…
Before I get your hopes up, this is not a tutorial on how to win in the UFC. It is more like how to accomplish the art of fighting. However the following quote does derive from Sun Tzu’s ‘The Art of War’:
“If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself, you will succumb in every battle.”
During our relationships and interactions with others, our aim is never to ‘win’, but rather to learn. Although Tzu’s theory is in the context of battle and to produce a rather different outcome than we hope for, it still holds some relevance. Knowing ourselves, and attempting to understand our loved ones is imperative when we argue or fight. If we know what triggers us, what upsets us, we can listen to ourselves.
It is quite difficult to engage in any form of interaction when we are not regulated. And often when we are upset we are not regulated. Our heart rate increases, we feel hot and sweaty, and the need to raise our voices. All of these things happen at a physiological level and are difficult to control. It is possible, however, to realise this before we react.
It’s never a good time to engage in something that may be conflicting when we are not at our usual emotional state. Yet more often than not, it is the exact time we engage in an argument or disagreement, because we feel that sense of injustice and that burning sensation, and we need to fix it!
The neuroscience behind this is quite simple. If our body is not regulated, our brain will try to repair it and bring it to a healthy space - one where we feel comfortable and calm. Rather than lashing out as we often do, we should regulate first, then attempt to engage in conversation. Below I’ve written five tips for ‘learning how to fight’.
Know yourself: From birth, we are social beings. We may have many altercations with many different people in our lives. Knowing ourselves and how we respond and to what we respond, is hugely important for our closest relationships.
Once we know what triggers us: We may still be triggered, so the key here is to recognise the feeling and take a deep breath. Recognise and regulate, before you react.
Once we can understand the certain things may trigger us, we can have a conversation about this with the people around us. This discussion leads to empathy and understanding.
Our aim is never to ‘win’: Our intention is to find common ground, negotiate, understand, empathise, and learn from each other. A relationship with two people willing to listen to each other and attempt to place themselves in another's shoes is one that can grow.
Acceptance and forgiveness: After an argument, acceptance and forgiveness are vital if we hope not to argue about the same thing more than once! If we cannot let go, we have not succeeded in ‘learning how to fight’. Often this might be because we feel unheard, or perhaps we need space and time to reflect.
There is no doubt in the link between the quality of our mental health and our physical wellbeing. In fact, persistent stress is associated with physical ailments like high blood pressure, heart disease, obesity, and diabetes. For the general public, these medical conditions warrant a trip to the doctor. The stress, however, is more likely to remain untreated.
There are many reasons why people decide not to see a therapist or mental health professional. Finding time in our busy schedules, the stigma associated with seeking support, and the costs of such services are likely candidates for preventing us from engaging. Furthermore, one study found the general public to have little confidence in how effective therapy can be. A shame, since the findings are clear that therapy is widely effective for numerous emotional and behavioural issues.
The purpose of this blog is to look at mental health services from a Cost/Benefit perspective viewing, in particular, what return on investment there is. This fits in with my recent efforts to help therapy clients see themselves as “Consumers” who are purchasing a service with an expected outcome.
The first area worth exploring is Work. In Australia, depression is the leading cause of disability in the workplace. In fact, it is the foremost cause of disability worldwide. It is estimated that over one million adults are living with depression and two million with anxiety. Additionally, nearly eight Australians take their lives each day. The numbers are bleak and not encouraging and investing in our mental health is worth it.
As an employer, I know that wellbeing within our organisation is key. If an employee is struggling emotionally, it is likely to result in less productivity thereby hurting the business. Because depression keeps talented and skilled individuals out of the workforce, it is worth the cost and will likely lead to return on investment.
As a parent of a teenager, it is no different. How can we tell when a child is struggling emotionally? They may be experimenting with drugs and alcohol, disengaging from school, or self-harming. All being a cause for concern, the impact of this path can lead to struggles in adulthood.
Viewing therapy from the perspective of a consumer does involve reviewing the cost and benefit of such services. Different rates of reimbursement exist worldwide, and there are many types of helping professions (i.e. social workers, psychologists, counsellors, etc.) that make it challenging when searching for the right support. If you want the best chance for getting the most out of therapy here is what you need to know.
The most effective therapists achieve results within eight sessions and just under six months. The link between heart disease, the leading cause of death for adults in Australia, and stress is one reason to make therapy an option. Effective at reducing stress and anxiety, seeing a competent therapist is an option of preventative medicine. It also works fast.
But how do you find the most effective therapists? Imagine that you’re buying a new refrigerator. You have found two that interest you and you start comparing. Most consumers are not concerned about how the product works but if it works. Now, imagine that you’ve taken the courageous step to reach out to a therapist. Your primary goal is to find a professional experienced and skilled at helping people in similar situations to you. And yes, it is ok to ask your therapist how effective they are. They should know.
Therapy is a collaborative journey. It involves a therapist and participant working together to overcome obstacles, which in turn, leads to a healthier and more productive life. The return on investment is there. For our children, therapy can lead to increased independence, performance, and happiness. All well worth investing in. For adults, physical health, improved relationships, and more productivity in the workplace are all ways we can get ahead in life.
There are many ways to reduce stress and therapy is only one of the many valid options. It is, however, an option worth investing in.
See you on the trail...
This week we were visited by Nadia from Radicool Reptiles to join us in one of our sessions with a client. The idea of huge slippery, slimy, and slithery reptiles hanging out in the office was a little bit nerve racking and anxiety provoking for us!
We discussed why such a fear may be and pondered on the strange social construction that such animals are viewed as fearful and how this is engrained into us. Nadia mentioned that in her experience she notices many younger children rarely showing any fear of the snakes. We also know that a trained, well handled python is not at all putting us at risk at all – it should be scarier getting into a car!
So we welcomed Nadia and her love, excitement and knowledge into the office and as our young person sat, calmly and fearlessly with a 3 metre python, Will and I stood back and watched, asking questions to allow us to feel more at ease.
During the session Will bravely managed a huge python around his neck, and explained his reaction as strangely calming, having a snake around you like a coat. Will mentioned that it was kind of like a weighted blanket that many children and adults are given as a calming and soothing tool.
We spoke about how we often we work with and see professionals in the mental health field working with therapy dogs, or horses in equine therapy and how working with snakes incorporates another element or layer to the experience of therapy with animals. As Nadia explained, snakes are so misunderstood that having an element of perceived fear, children and adults experience a kind of whirlpool of emotions as they learn about what makes snakes dangerous, how to embrace our fear and work through it, and eventually hold or touch a snake and feel such a different sense than fear.
The processes teaches empathy, as Nadia asks children to pretend they are a snake, how vibrations may upset or frighten them, how they have no arms and legs to defend themselves with.
We’re feeeling very grateful to have had this opportunity and we’re excited to collaborate further with Nadia to compliment some of our therapy that we already do in the bush and in the office.
Working with troubled young people and families involves a tight rope act of making sure children are progressing while their parents feel supported and hopeful during the therapeutic process. We all know that the power of intention can change our attitudes, feelings, and behaviours and this is no different when it comes to how we see therapeutic treatment. I use the word treatment here not to relate therapy to a medical endeavour but to acknowledge therapy as a process aimed at helping people get better over time.
If we look at a program like True North Expeditions we know that it was created to work with struggling teenagers and families. Whether its depression, substance abuse, anger management, anxiety, or academic issues, there is often a valid concern for seeking therapeutic support. Youth courts also recognise the benefits of such services and may refer a young person to see a therapist or engage in some developmental program.
Whether you are the parent or teacher of such a young person, an important question to ask yourself is: “What is my goal is seeking treatment for this child?” This questions helps guide our assumptions towards answering the question of whether it is Treatment or Control we are after.
It is no easy task to stay composed when our child’s behaviour takes a turn for the worse. There are times when they can cause serious stress in our homes affecting siblings, extended family, and even those in the surrounding community. There is no doubt that additional support may be needed to help during challenging times.
There are, however, two ways we can seek help. One is focused on ourselves (Control) and the other being attentive to our child struggling adapt to the world around them (Treatment). When we are in “Control” mode we are not concerned about why children are acting out or hurting themselves. We end up being concerned about making it stop because of the effect it has on us.
In “Treatment” mode, we want to help people get better. With a calm touch, caring attitude, empathy, and perseverance, we will do everything it takes to ensure that the child in front of us has every opportunity to enjoy the highest quality of life. Here are some thinking patterns that can help differentiate the two:
“The other person is in the way of my happiness.”
“This is unfair to me.”
“I just want this to stop – it is affecting me.”
“There is nothing I can do to help.”
“He just doesn’t get it.”
“I will do whatever it takes to help her be happy.”
“I can see that he is struggling right now.”
“I will keep trying something new until it works.”
“Despite set backs, I can see us moving in the right direction.”
Obviously there will be days that are better than others. Some days we may be in our “Control” mode while others we will be aware enough to see that treatment is a process. Small victories happen everyday and change is inevitable. If we choose to notice them, our hearts will be lighter and we will be capable of strengthening our relationship with our child not matter the circumstances.
See you in the trail…
Will Dobud MSW
Many parents that enquire about True North Expeditions and our 14-day expeditions wonder how to encourage their child to attend the program when they may be disengaged from school, substance abusing with peers, or disrespectful at home. Firstly, it is worth noting that teenagers are notoriously hard at getting to engage in therapeutic services and worst, nearly 70% of them drop out prematurely.
For the parents interested in True North, we have found that most have tried previous therapeutic services from school counsellors to medication to clinical psychologists. Feeling as though they have reached the end of their rope, they are reaching out for an alternative. This is where adventure therapy programs, like ours, have been useful.
Because we know that drop out is such a concern we take a different approach from the start of our program. From day one our team is inviting, caring, compassionate, and understanding while being interested in only one thing: How can we be the most helpful?
When preparing a family for an expedition we complete a detailed assessment gathering information from parents, schools, previous psychologists or counsellors, and anyone who has been involved in this child’s wellbeing. From the time the teenager arrives for a program, the focus shifts to the work that can be accomplished with this child and our team.
The adolescents we see are not embodiments of depression or described using any of The Killer D’s: Diagnosis, Deficit, Disability, Disorder or Deficiency. Instead, we work with our adolescent clients based on what the research has to say is most effective. When looking at what works in therapeutic services there is one thing that stands out more than any other aspect. The quality of participation in therapy is a stand-alone factor for predicting outcomes.
If the goal is participation and collaboration then start of youth programs should not be punitive, un-engaging, or prescriptive. It is about providing a service that teens feel is meaningful and beneficial to their lives. This occurs when the service matches the concerns deemed most important by the adolescent while acknowledging their feedback about what is working and what isn’t.
The idea for this blog emerged this week after I received 3 phone calls from previous True Northers (our code name for participants). Three adolescent girls aged 15, 17, and 18 rang asking about when the next program was they could take part in. The youngest said that she had been struggling recently and was hoping for a refresher to help her stay on track. The 17 year old, just about to finish Year 12, had hopes of coming on an expedition after she graduates to share her story with first time students.
The main goal of True North Expeditions was to provide a service that teens care about. This is what we wanted. By caring the most about the people consuming our services we aim to ensure that everything we do acknowledges their feedback about what works. From the food to campsites to journal topics to team activities, everything is done with their feedback on the front line. Without it, therapists are guessing what should work best.
All the information we need is in front of us. It is not in an assessment or science journal. Those may be the car that gets us to our desired outcome but without collaboration, participation, and feedback there is no petrol or driver. When things are not working, we go back to the client and openly ask what changes should be made in approach. Not only does this have the potential to fix a rupture in progress but also invites adolescents to take ownership of their therapeutic experience.
As I am currently in writing mode for my doctoral research I have been coming across incredible research about how services that incorporate feedback can triple their effectiveness and reduce drop out rates. I have also seen that youth programs tend to have two different philosophies in approaching youth services: One that privileges a client’s voice and one that mistrusts it.
The problem is that by mistrusting it, we miss the strengths, values, and the skills each person has that are the most helpful in solving problems.
See you on the trail...
Will Dobud MSW
This week I met with two parents concerned with how they could get their son to come see me for counselling. We spoke briefly about what problems they were experiencing at home and some of the things they had tried before, such as previous psychologists, a change of school and many of the normal things that occur when a teenager is struggling with depression and anxiety. As we spent this time together we started brainstorming some ideas for possible solutions. The couple began to disagree.
As this continued it began to grow. In the bush it takes just a small spark to start a fire and I could sense that this conversation, centred around the goal of helping their son, was flaming itself into a larger problem.
I was able to interrupt briefly reminding the parents that one thing was definitely for sure: “The two of you are both interested and invested with the same goal. That is finding help for your son and your family. But sometimes we disagree about how to get there.”
As a psychotherapist, I want people to leave each session with ideas for what they can do to feel better and achieve better results. So as our session winded down I provided an experiment for these parents to try: The Parental Business Meeting.
I explained that the meeting must be scheduled a few days in advance and with one specific aim in regards to helping their child. It needs to be very specific. Ideas such as bedtimes, getting him to school, what to do during the next argument or getting him to a therapist were all options on the table. Improving behaviour would have been too broad of a choice. The parents chose to plan a time where they could meet in order to prepare the best idea for helping get their teenager to see me.
When we feel stuck or at a loss on how to help one of our family members it is obviously very normal to feel a whole range of emotions. This is probably more ok than not (remind yourself of this). One of the issues that can occur is that when we sit to try and find solutions the emotions can get in the way like wearing a blindfold while trying to solve a maze.
While studying in Maryland, I was trained as a firefighter and to run an ambulance (seems like a past life now!). There was a great metaphor that I was taught during this time that has stuck with me when working with families, groups of teens in the bush and in managing my own relationships. Don’t Create a Second Victim.
I was the member of a few firehouses and one that was in a particularly dangerous part of town just outside Washington DC. For me, it felt like what would be the normal ambulance run or call to a car accident was always concealed with something to make it a much more complicated scenario. No matter what happened we had to think on our toes and not let any situation get worse than it already was.
I had to assess any physical risks before stepping into these potentially unsafe situations but also needed to check in with my emotional wellbeing. If I was injured or acted out in a way that put my team at risk then I would have become that second victim that I was trained to avoid. If this were the case, the group would need to not only work on fixing the difficult situation and save an injured person’s life but then worry about one of their team members who had increased the stress of the situation.
The Parental Business Meeting is a good technique for making sure that we are planning actual time for solving problems with our children. Here is how to do it:
It is important to have each other’s back during this time, similar to a group of fire fighters entering a burning building. This time is surely to be stressful for you both and you may have different opinions about parenting. This is ok and very normal.
Honour their opinion and your own. Listen actively to what they are saying and think about what aspects of their solution may be worth trying.
If this meeting does not work or gets too stressful, it may be a good idea to have a therapist or mediator present to help facilitate the meeting.
See you on the trail...
Will Dobud MSW
True North Expeditions, Inc. provides adventure therapy programs and services for children and teenagers in Australia. Based in Adelaide, the TNE team writes about child and adolescent psychology, family dynamics and how adventure therapy programs can connect with struggling adolescents.