Speaker 0:00

Today we have Tana Fry on the podcast. Okay, Tana, what does progress look like at Havenwood before behavior visibly improves? And why do we pay close attention to that stage?

Tana Frey 0:11

That's a good question. Well, is a hard question as well. Because typically, when parents are sending their children to us, the hope and the expectation is that there will be a very quick behavior change. I think a lot of our families have been in multiple programs. This is not the first time that they've had to place their child in treatment or have gone to detention or things like that. And so I think there's always in the back of everybody's mind, I think myself included, is there is a hope that there will be something, the magic button, the magic pill, whatever it is, right? That this will just be the thing that changes everything. There's typically a lot of frustration when kids first get here. And families, I hear a lot of from families of, well, why they're doing the same things they've always done. Why are they not changing yet? Sometimes it gets worse. We kind of expect that as well when we look at the theories and things behind extinction bursts of behaviors. If we're looking at the research done around that, we do have this expectation that it's probably going to get worse first before it gets better. And as a therapist, for us as a program, we go back to stages of change, the stages of change model, and look at, well, where is this individual? And with the stages of change, typically, like most of our students, our kids, come in at pre-contemplation stage, which is this idea of I'm not even in a place in my life where I am recognizing there's things that are problematic or recognizing that there's things that I want to change. Anything that is wrong, any problems that I do have are somebody else's issue. The next one after that is contemplation, which is where we're looking at maybe there is something. Maybe there is something I need to do differently. Maybe there is something that I'm doing that's making my life end up in these ways that I don't like. Maybe there's things that are problems in my life. And so moving for us when kids first get here, working with families and understanding that typically progress initially looks like we're moving from pre-contemplation to contemplation. So nothing really has happened yet behaviorally. But if emotionally, mentally, I can get from it's not my fault, nothing is my fault. It's all my parents, it's all the staff, it's all the peers, right? It's everybody else. And if I can shift from that to actually, here's what I did, here's my stuff, that these are the things I'm doing that are causing problems in my life. These are the things that are ending up with these situations and or consequences that I don't like instead of blaming everybody else. And so initially, that's one of the things I look for is can we shift? Can we move from it's not my fault to here's the things that I'm acknowledging are mine? And can we move from unsafe behaviors to a desire to have safe behavior? So maybe I haven't quite gotten to the point where I can make the behavior change, but am I getting to a place where I'm starting to talk about wanting to be safe, that I don't like that I continue to self-harm and I want to change it. I just haven't started yet. And again, that would be kind of along those stages of change model of I'm acknowledging there's things that I want to do differently, and I'm willing to start talking about it, even if I'm not willing to completely start doing yet.

Speaker 3:24

Okay, great. How does designing treatment around the nervous system change how clinicians respond to resistance or regression?

Tana Frey 3:32

That is another really great question, right? At Haven, we really design everything around a lot of the research that has been done in working with individuals with early childhood trauma. And the shift that has come within this industry, as there's been more research coming out with how trauma impacts our brain, how trauma at a young age impacts the way we see the world as we get older. It's really shifted the way that treatment is seen as being effective and successful and helpful. And so it's shifted, I think the industry overall has shifted from a very regimented behavior modification approach of here's the punishment and rewards sort of thing, to understanding that the traumatic experiences that these individuals have had have really impacted how they view the world and has kind of created a lens through which everything is filtered through. And so treatment is more, especially at Havenwood, is more designed to be aware of that lens and to have an understanding that a lot of these things that people would look at as like out-of-control behaviors or problematic behaviors is really a trauma response or a survival technique that they have developed because of those things they were going through. And when you're working with these very complicated situations and very tough, tough behaviors, or when you are looking at, like when you're looking at a kiddo and you're trying to think, why are we doing this, right? Why do we keep doing this thing? When you can take a step back and remember that they're not seeing the world the same way I'm seeing the world, that there is a lens that they everything is getting filtered through that is essentially telling them they're unsafe, that people around them, especially adults, are typically dangerous and not trustworthy. Usually that they're not a good person, that they've also internalized that. And that their behaviors and the things they're doing are a reaction to those beliefs and those fears. The majority of kids we work with don't feel safe the majority of the time. If they're awake, they're usually on guard and hyper-vigilant because they don't feel safe in their normal life. Even though there may not be anything threatening anymore, they still feel they're still trying to protect themselves and keep themselves safe and keep themselves from being harmed because that's what they had to do as a young child. And so, in looking at treatment through that understanding, instead of looking at it through, well, here's a behavior I don't like, and so I'm going to give you consequences until you stop it, really helps us get to what's behind the behavior. Can we work on those pieces? Can we help you address the fears? Can we help you start to recognize what safety even feels like? Because for a lot of our kiddos, safety is more uncomfortable and than being on guard, right? So as soon as they start to trust someone or as soon as they start to feel like somebody is safer or is taking care of them, sometimes we'll see an increase in behaviors because I'm terrified and I don't know how to handle that fear. And so looking at it that way versus you're just doing something I don't like really helps us identify and work on the root pieces versus just the behaviors. Obviously, when it's a safety issue, safety sort of behavior, that kind of becomes the focus because we can't work on the underlying stuff when we're not safe. And so that would be kind of the only time where we do look at we've just got to focus on the safety pieces. And we're doing that with the understanding that there is something beyond this, right? That there's something behind these behaviors. It's not just you deciding you want to break the rules and deciding you want to do X, Y, and Z and hurt people and hurt yourself. That there's a lot more to it than that.

unknown 7:16

Okay.

Speaker 7:17

What's a clinical practice we use that looks unconventional but consistently leads to a deeper healing?

Tana Frey 7:23

I guess the first thing that came to mind for me, so I've been working in this industry for a long time. And Havenwood was the first program I've ever worked at that saw the value and created a way to provide safe touch for the students. Most of the programs I've ever worked at have just kind of taken a hard, no physical contact between the staff and the kids. There's not going to be hugs. We're just not giving any sort of physical comfort or connection. And there's reasons, there's very valid reasons for that. And so when I first started at Havenwood, I actually was incredibly uncomfortable. I walked out there and I'm in the gym and it's during school, and there's a million kids running around, and like staff are putting their arm around their shoulders and just giving them a side hug and helping them walk to class. And when kids would be upset and would cry, and they would just hug the staff. And I like my heart rate like rose and I got super uncomfortable because I was like, oh no, this is bad. Like we're like lawsuits are coming. You know, I was freaking out internally. And because that's not how it's typically done, right? There, and again, there are valid reasons for not allowing kind of safe touch in a program. And it is one of the things that I have recognized at Havenwood as being a huge support to the kids and to see these students and these kiddos who have been very like averse to seeking out comfort from adults in their life, for them to get to a place where they recognize like this is a safe staff and that there is an appropriate way for them to offer me that comfort, right? Like side hugs are the most common where that is a safe thing to do. I've seen that with multiple students also lead to them feeling more connected and safe in their own families, right? That we can also do this in our own families. And so I would say that is a definitely a very unconventional, it's not necessarily a therapeutic technique because it really is just about connecting and comfort. And obviously it has to be done correctly. And so there's roles around it, there's ways to maintain healthy boundaries. And that's again another piece that the kids are learning as well. But being in a program that offers kind of just that safe touch, it's really interesting to see how with some of our more just aggressive kiddos and our some of our kids that are just scared all the time, how they start to seek that out and how they find comfort in recognizing like I can be around adults and I can actually seek out comfort from adults and have that be okay.

Speaker 9:52

How does Havenwood avoid turning therapy into another performance or compliance task for students?

Tana Frey 9:59

I think the the first piece is that we don't have, we don't have a set amount of time. Kids have to be on our stages. We don't have a lot of time expectations. And so that that allows us to be able to create more of an individual treatment for each of our kids. And we have kind of guidelines for each of our, if I'm creating a treatment plan for a kid that comes in, I'm looking at what kind of things do I want them to do in therapy, including extra therapy work, like where are there things that I think would be helpful for them that they'd be willing to do? There's a lot of different and different for each stage. So if I'm working with a student who's on the safety phase stage, excuse me, the safety stage, that's going to be very different than someone that's on a relationship stage. But there's on each of those stages, we're focusing on a specific area in their treatment. And so since we don't have here's the checklist, right? Everybody has to do these things. Everybody has to, all therapists are doing the exact same thing. It allows us as therapists to work within the framework that Havenwood has created for trauma treatment and for working with these families and helping them get to the next step in their journey. And we do that with that umbrella, right? So we're all working under this same framework. We're all working under this same sort of structure, but we have a lot of freedom to be able to create that independent and individual program for each of our kids, which helps it to stay away from becoming just routine and becoming we're just checking off the boxes and going through the steps instead of it being something that is more applicable to each of our kids individually.

Speaker 11:46

Okay, it makes sense. Where do you see traditional residential models unintentionally reinforcing traumars?

Tana Frey 11:53

When I'm training new staff, one of the things that I try to explain to them is that our kids, the kids that we work with, are typically very familiar, I wouldn't say comfortable, but they're familiar in getting very critical responses to their behaviors. And there's reasons for that. There's certain things that if we do in the world, in our society, we are going to get in legal trouble for, we're gonna get grounded at home for right. And so our kiddos are very used to doing something and having a very critical response to that thing, especially when the behavior is harmful, when the behavior is breaking, intentionally breaking rules, creating a lot of problems for the people around you. And for our kids in our program that have had the trauma that they've gone through in their childhood, especially if that's connected to that trauma is related to physical abuse, the immediate kind of punishment consequence system that a lot of programs historically have utilized is kind of just recreating that same message and that same sort of trauma model they learned at a very young age. And some of our, honestly, some of our kids would initially they would say they would prefer that. A lot of our students get frustrated with just being in treatment and they'll say things like, I just want to go back to juvie or I just want to go back to detention because it is a very cut and dry. You do this, here's the consequence. But what that's doing is it's reaffirming over and over again that one, like the adults around you are not safe, you're not in a safe situation, and that you're a bad kid because the things you're doing immediately result in a pretty critical response from the people around you. And that's not to say that there shouldn't be consequences for our actions. And what we see is that when those consequences are able to be a more natural result, a more natural consequence of the thing that's happening, and it's able to be connected to the relationships that we're working to build with those kids, that has more of an impact. And that actually disrupts that whole kind of cycle and method that they're used to. Because if I can scream at you and you're not automatically screaming back or hitting me, and instead you're sitting with me and talking with me and like explaining to me how me screaming at you impacts the relationship and impacts my ability to go and do more fun things with you, like that's gonna start impacting me. That's actually gonna start mattering versus it just, I'm gonna do a thing, you're gonna hit me, it's gonna get over, it'll be over, it'll be done, and then until I do it again, and then I know you're gonna hit me and it's gonna be over and done with. And so when we have really rigid behavior modification kind of models in treatment, even though we're not abusing the children, we are still recreating that same sort of cycle where it's I'm giving you a consequence without it actually connecting to anything that really matters to you. And the families that come, they've experienced this in their own homes. Many families that come to Havenwood will have stories or talk about how I've taken everything away. They've lost their phone, they're grounded, they can't use the car. Some of our families, like all of their items, you know, all of their extra things have been taken in this attempt to consequence and punish the behavior in hopes that it will change. And the problem is that we're engaging and we're working with kids that have learned how to survive worse earlier in their life. And so even though these consequences are not fun and I don't like them and I want my phone back, it's not impacting me in the way that you want it to, because this is just a continuation of the things I learned as a very young child.

Speaker 15:46

How do you decide when a guest needs more structure versus more relational safety?

Tana Frey 15:52

For me, they need to go hand in hand. And usually it's going to come back down to safety as well. If you're engaging in things that put either you or someone else in danger in some way, then you're going to need more structure, right? I need to make your world a little smaller because I need to be able to keep you safe. And I can't do that when your world is so big. And with that, if I am shrinking your world, so if that means I'm sending you to our higher acuity house where there's less kids, more one-on-one, one time with staff, that you have less freedoms, things like that is the time where I also need to be leaning it very hard into the relational piece and building that relational, that relationship with you and creating relational safety. And so it's if I'm doing one, if I am creating more structure, I should also be matching that with working on the relationship. If the behavior is not an unsafe behavior and it's just maybe it's breaking a rule, it's just creating some chaos at the house. That may not be a behavior that needs to be structured, right? It can be something that we can just talk about and lean into and be like, dude, what's going on? I think a lot of our kiddos like to date while they're in treatment. It's teenagers in a small area. And so they will date each other. And that's one of those things it's not allowed. It's against the rules. And when you come to me in session and tell me that you started dating one of your peers, I'm not immediately punishing you for that, right? I'm not sending you to our hierarchy house. I'm not telling you you can never talk to them again. I am leaning into the relationship that we've created that has made it safe enough for you to come tell me this, knowing it's against the rules, knowing that I don't think that's a smart decision. I don't think it's smart to date and treatment. And so that we can talk about it. And so that I can't force you to break up with the person and I'm not gonna try, but we can talk about when things are not okay. We can talk about when, hey, it seems like your relationship with this person is really impacting your ability to do well in school because you're refusing to go to class now because you just want to be with them. And so now you're unable to go and do these activities because you're on academic flag and like all of these things that we can kind of go back through. And here's the natural consequences of the choices you're making. And it's safe enough for us to talk about these choices you're making because I'm not immediately shutting you down for making them. Right. And so that would be where if it's not an unsafe behavior, right? If you're not putting yourself or someone else at risk and you're not doing harm to yourself or someone else, then I don't necessarily need to punish you. I don't need to make your world smaller. I need to be able to work with you on that thing and help you start recognizing how the choices you're making are impacting the goals that you say you want to work towards. So when I have a student that's, I really want to go on the honor roll outings at the end of the quarter, but I'm refusing to go to class because I want to be with my partner out in the gym, it's okay, let's put those dots together, right? These things you're choosing are not going to help you get to where you want to be for the honor roll activity. So what do you need to do differently? And the kids will only come to us with the things they've done when they feel like it's safe to do so.

Speaker 19:14

What role does experiential therapy play when talk therapy isn't accessible yet?

Tana Frey 19:20

You know, experiential therapy. Which really just doing anything differently, though we're not just sitting and talking, so I'm doing art, we're going for a walk, we're working with the horses, we're listening and dancing to music and then talking about the song or whatever it is, anything that just kind of gets our full body engaged or does it differently. Teenagers already therapy is kind of hard, and it can be hard for teenagers in general to want to sit and talk for an hour about their problems every single week. And so one, doing something already helps them feel more at ease and or willing to just kind of in talk because it doesn't, it doesn't seem so intense. But then when you are doing things like equine, working with horses, and then you have this whole other animal, this whole other creature, right, that we can pull into therapy that we don't have any sort of control over what they're doing that is going to impact and bring things up for each person that's in that session. So when I bring a dog in, or when we go and work with the horses, or we have an art assignment and we're just doing something to this art assignment, like it's going to bring things up that makes talking about that thing easier and safer. And sometimes, especially in working with the horses on equine, it will bring up things that we didn't even think about, like still being an issue. But for me, I like to do a lot of art. I like to bring art into therapy as much as I can. A lot of my kids like to draw and doodle, and even just giving them a notebook when they walk in the door so they can just doodle while we talk makes the sessions more, I guess. They're they talk more, they engage more, they're not as resistant. But it also to help build the relationships again, makes it so there's less resistance to the therapy process in general. One example for me is I I have a I had a student who loved doing collages, and that was something that she kind of discovered of herself while she was here. And we were talking about some of her early childhood trauma. She'd had a lot of therapy around, but it was always really resistant to getting deeper. Then I asked her to do a collage about one aspect of her early childhood, and she ended up doing it on a completely different aspect of this same area of her life, kind of answering a whole different question that I was hoping we could get to at some point, but I didn't think when I gave her the original question. I didn't think we were ready for to go that deep. But for her, being able to create a collage. Of it made it, she was excited to tell me about these things and it was excited to sit with me and talk with me about this is what that experience was for me when I was three years old. This is how I view those things in my life now. And it was a conversation that that her parents had been pushing her to have for years in therapy. And so I've seen utilizing different experiential options and techniques in therapy. I've seen that happen over and over again, where it's all of a sudden we're talking about something that you didn't think you were going to talk to me about. And you just find yourself telling me about these things, or you find yourself realizing something as we are working with the animals or as we're walking or going through a hike or building, building things that we're utilizing tools and skills and passions that you already have or that you're excited about or that you want to learn and connecting that to your life. And connecting that to you in a way that makes it less threatening, makes it seem less clinical, and honestly also makes it seem, for some of these things, makes it more fun as well.

Speaker 23:10

How does Havenwood protect clinicians from burnout while still asking them to do emotionally heavy work?

Tana Frey 23:16

So, and I think I talked about this a little bit in my last interview. I had left adolescent treatment and was just doing private practice. I kind of was like, I'm done, I'm never going back, I'm exhausted. I had been doing adolescent treatment for in some capacity for like 18 years by that point, I think. And I was tired. I was really tired. I was really burned out. COVID was really difficult. Working in a program during COVID was a whole new set of problems and emotional and physical challenges. And so when I did, after about two years, year and a half, I was like, okay, actually, I do want to go back to Alice and treatment. One of the very first questions I asked was how do you guys essentially help encourage your employees, especially your clinicians, to have a work-life balance? Because I'd worked several programs where the expectation was that the therapist was always the number one point of contact all the time. And so I was really excited when Havenwood, Josh and Janie was talking to, said, Oh, we already have that system in place. Let us tell you about our on-call system and how that works and how each department, we have someone from each department that rotates every week. So if we have five therapists working at Havenwood, I only have to be on call every once every five weeks, right? And so when you're on call in those after hours, you're the one that's handling the phone calls, right, for that week. You're the one that's handling kind of the crises for your department. I don't have to be managing all of the medical concerns because that's not my department. But if I'm on call, I'm communicating with the medical staff that's on call. And that was a huge one for me to know that Havenwood had already created a system because they recognized we need our staff to not work, right? We need them to be able to have time where they can just not have to worry about what's going on campus and that they don't have to respond to parents right away, that there's somebody else that's in charge of that right now, right? And that was a huge one for me because having to work all day and then go home and still have to be accessible all night was one of the primary reasons why I got burned out so quickly with the program I was at previously. And so that is one thing that I've seen that Haven Wood does really well is recognizing if you're not working, don't work. Go home, be with your family, don't answer your emails, don't answer, don't parents can call the on-call line. They don't need to call you when you're not working. And so that was a big one is that they've already set had that in place and set that up. The other piece is that there is an awareness that there is a life outside of work and an encouragement to have a life outside of work, where we do all want to be available and like when there is a crisis that's happening or we need we need something covered or something that we all do want to be able to jump in when we can help and where we can help. And Havenwood doesn't have the requirement that you're available at all times. And if I am coming in at 6 a.m. and not leaving till 7 or 8 p.m., I'm gonna get talked to about that. My my boss is in a very kind way is just gonna be like, Tana, what are you doing? This is not okay. You need to go home, versus being really excited that I'm putting in all these extra hours and I'm spending all my time at work. Like it's actually gonna be a problem and I'm gonna get sent home essentially if they see that like you're not taking time to go recharge.

Speaker 26:51

What outcome matters more to you than symptom reduction? And why?

Tana Frey 26:56

I guess I there's a part of it that's a really hard question for me because I think for me, safety is always gonna be and be the forefront of my brain. But if I'm looking beyond just helping my kids get to a place where they are safe, keeping themselves safe, I think it would be the willingness to allow like other people, ideally their parents, right? Or the guardians in their life, like the willingness to allow other adults to be the adults in their life, whether, you know, if we're looking at parents like allowing their parents to show up as their parents or like allowing other adults to have influence in their life. So when I have a kiddo or a student who is in a place where they're starting to recognize I don't always have the right answer. I don't know, like my behaviors are not working out for me. And so I'm actively seeking out help from the adults in my life. And when my parents give me some feedback, and even though I may not agree with it or it makes me frustrated, I'm also I'm able to see like my parents are telling me this for a reason, and I may not agree with the thing, but I do know that my parents love me and would never intentionally hurt me. And so there's a reason they're telling me this. I think that's one of the big things for me that I look at is are we allowing other adults or allowing adults to have any sort of influence in your life? Are we allowing our parents to be our parents? Or are we still fighting or are we still really resistant to all of that?

Speaker 28:29

What's a clinical belief you had to unlearn to be effective in this environment?

Tana Frey 28:33

That one is a little hard for me because I kind of started in this environment. You know, I started in adolescent treatment, and that's kind of how I got into therapy in the first place. But I think shifting from more of a consequence-based environment to a relationship-based environment, I still catch myself at times like having to be like, no, no, no, we don't need to immediately create a consequence. They don't need to be punished in this big way that you're thinking of. And so there are still times where I have to like mentally take a step back and breathe and be like, what is that? Is this really what needs to happen? Or are we just frustrated and we're reacting to the frustration? And so that's not necessarily a clinical belief, but I think it's an experience, a way I was taught in managing certain types of behaviors that I definitely had to unlearn. I think something that is different in residential treatment than we're taught when we're in grad school learning about how to do therapy in a private practice setting is letting go of the idea that I am in any way responsible for the behavior choices, right? For the outcome. Because it's it's hard to come to work and check what happened the night before and see the all the incident reports and all I had X number of kids tried to hurt themselves or hurt somebody else last night and everything. And it's hard to not immediately turn and be like, well, I'm doing something wrong, right? If my client's not progressing, some it's because I'm not doing the right thing in therapy. But I think therapists in any situation can relate to that, even though we know we can't control our clients' choices, right? But reminding myself that it's like, okay, let's re-evaluate, right? Am I missing something? Let's check in. Am I doing something in a way that would not be productive to therapy? But if I'm not, then I I need to let them that be, let that be their choices and their behaviors that I'm helping them with. I'm not responsible for. And that's hard. That's hard because we get some very extreme behaviors, and it's really hard to know that you have clients and kiddos that are struggling so much and they're hurting so much. And the flip side of a consequence reward program, like when we talk about the reward part of it, like there is a temptation to be like, you did something wrong or bad, and I'm frustrated with you. So here's the punishment. There's also a temptation to be, I see you're struggling, and I know if I find the right carrot on a stick for you, I can get you to stop doing that thing if I just keep giving you the right reward. And so that's the other side to that whole dynamic is can I reward you essentially into doing the behaviors that I want you to do? And the answer is yes, I can, as long as I continue to have the right reward. And usually that means I have to keep making it bigger and bigger. But all I would be doing is reaffirming to you that you're like that you only do these healthy choices if somebody's giving you something for them. And if that's what I'm doing, I'm setting your family up for a really hard time because your family is probably not going to be willing or able to continually offer you rewards for safe behaviors all of the time, right? And so I'd say that's the other side of things is behavior modification exists because it works in certain aspects. The one I use all the time is potty training. For anybody that's ever had to potty train a kid, but that's behavior modification, right? Here's your sticker chart, here's your treats, here's your whatever it is that we do. But the end goal is that you will start to feel like a sense of like personal desire to do the thing, right? So as a young kid, you get to a point where you want to use the toilet because that's what big big boys and big girls do, right? And so it's the same thing with our kids is absolutely, we could reward the crap out of you to try to get you to do certain behaviors, unless there's an internal piece that matters to you. As soon as I take away the candy bar, like the behavior's gone, right? I'm right back to what I was doing before. And that's not actually helpful to your life, and it's not helpful to your families.