Decoding Today’s Adolescent Substance Use Treatment Landscape, with Trish Ruggles

Hopestream for parenting kids through drug use and addiction
Hopestream for parenting kids through drug use and addiction
Decoding Today’s Adolescent Substance Use Treatment Landscape, with Trish Ruggles

At some point along your child's road to recovery, you will almost certainly need to make some difficult decisions about treatment. If they’re an adolescent, this becomes an even more complicated decision. And while I do have some personal experience with treatment, it's been 9 years since my son went to a wilderness program and residential treatment, and a lot has changed since then.

My guest on today's episode is Trish Ruggles, a licensed clinical professional counselor and therapeutic educational consultant with 15 years of experience. She has intimate, on-the-ground knowledge of the wide spectrum of mental health and substance use treatment and works with families to match the right treatment setting with a young person’s therapeutic and academic needs.

If you're a parent of an adolescent who is looking into treatment options (or you know someone who is), or just want to learn what the options are for future reference, this information will be absolute gold. By the time you're done listening, you will have a broad overview of nearly every option there is, the strengths and weaknesses of each, and professional advice about which might be right for your adolescent child.



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Trish: Really, what it turns out is that it doesn’t matter what fancy degree your therapist has. It doesn’t matter how much the program costs. What matters is therapeutic relationship and then length of stay. Those are the two greatest predictors, regardless of age, regardless of what you’re doing. It’s as simple as do you have someone you connect with therapeutically and how long have you been there?
Brenda: You’re listening to HopeStream. If you’re parenting a young person who misuses substances, is in a treatment program or finding their way to recovery, you’re in the right place. This is your private space to learn from [00:01:00] experts and gain encouragement and support from me, Brenda Zane, your host and follow mom to a child who struggled.
This podcast is just one of the resources we offer for parents. So after the episode, head over to our website at hopestreamcommunity. org. I’m so glad you’re here. Take a deep breath, exhale, and know that you have found your people. And now let’s get into today’s show. 
Well, hello. It is so good to be back together today.
And I’m really glad you’re here because the conversation that you are about to listen to is one that could make a big difference in the approach that you take to treatment for an adolescent. There have been a lot of changes in the adolescent mental health and substance use treatment world in the past few years.
Some good, some not so good. So this information is vital if you are considering treatment now or thinking that down the road it might be something that your family is going to look into. [00:02:00] In order to get the most current and accurate information on this subject. I turned to a trusted partner who’s not just knee deep in the data and information.
She is literally in the hallways and kitchens and sitting around the fire pits of these programs as a therapeutic educational consultant. Trish Ruggles is a licensed clinical professional counselor, certified alcohol and drug counselor and national certified counselor. And she is the founder of Pathfinder Consulting, a therapeutic consulting practice based in Portland, Maine.
Trish has more than 15 years of experience working with children, adolescents, and young adults. She’s been a clinician and addiction counselor in several prominent treatment programs. And in 2017, she began working as a therapeutic consultant. She helps families who have a variety of needs related to things like mood and anxiety, trauma, substance use, self harm, suicidal ideation, [00:03:00] personality disorders, ADHD, executive functioning issues.
Nonverbal learning disorder, or NLD, school refusal, social skill challenges, and defiance and other concerning behaviors. As a part of her regular work, Trish travels the country, visiting programs, meeting with the owners, therapists, and even students so that she has boots on the ground knowledge. And she knows at a very surgical level what’s happening at any given moment in the treatment world.
And because things change pretty quickly in this space, a new conversation with Trish would yield details and insights not available anywhere else. We talk about the kinds of issues families bring to Trish and what has changed in the last few years. She runs us through the end to end spectrum of available treatment options for adolescents.
We talk about the post treatment landmines for young people and how to navigate those and a ton more that you definitely don’t want to miss. You are going to [00:04:00] learn so much like I did. Here is me and Trish Ruggles. Enjoy.
Hello, Trish. I’m so thrilled to have you here today for a really interesting conversation around adolescent treatment. It is a hot topic for sure in the HopeStream community. So thrilled to have you here. Thanks for joining 
Trish: me. Happy to be here. Happy to talk about this. Uh, it’s, 
Brenda: well, you do this all day, every day.
So I figured we need to go to the source. We need to go. To the person who is dialed into the world of adolescent treatment because it really is different than adult treatment and even young adult treatment because there’s just a lot of factors that I’ll let you explain. Um, but I think it’s really [00:05:00] important because things are changing.
Even from when my son was in treatment, he went the first time in 2014. And so that’s been nine years, like a lot has happened since then. So I’m really looking forward to the conversation to get the, the nuts and bolts, the kind of the truth of what’s going on so that parents are just more informed and educated because usually we come into this and it’s like, I’ve landed on Mars.
Yeah. The language. Yeah. I don’t, I don’t have the right clothing. 
Trish: Right. Yes. And I’m, I’m in my 21st year on Mars. I know the language for sure. This is 
Brenda: yes. And this is what I love to tell parents is about, you know, working with a consultant is it is your 21st year on Mars. Your heart is not invested in the young person who you’re working to help as much as you care about them.
You’re not their mother, you’re not [00:06:00] their, you know, father. So you have a beautiful ability to be objective that we as parents just don’t have. We just, we’re too 
Trish: invested. Yeah, I say I have no skin in this game. I’m just here to give you all the education so that you can make an informed decision. I’m very passionate about that.
I grew up working in the field with consultants who were more directive and like, you have to do this. This is the thing you have to go here. You have to go now because X, Y, or Z. And that worked for those clients and for maybe those consultants. But when I became a consultant six years ago, I, one of the first things that I decided was that.
I was going to sit with parents as long as it took for them to make decisions that they felt good about, felt informed about and that fit them because I may be the expert in this field, but they’re the expert in their family. 
Brenda: Yeah. And so kind of speaking of that, so you’ve been doing consulting [00:07:00] work for six years, but I know you’re also therapist.
And so tell us a little bit about how you made that transition and, and how I would imagine having a therapeutic background is extremely helpful. 
Trish: Yes. Yeah. Talk about that a little bit. So I primarily worked in boulders programs. I almost only worked with adolescent boys, older age, adolescent boys with substance use and defiance and sort of that like tough exterior, but they were, I called them my steel covered marshmallows because they were all oozing with sadness and anxiety and hurt and trauma on the inside.
And they just built this, this external shell that made them look like bad kids. And so he usually had a lot of fireworks in my group for sure. But that was, that was my population. That was who I was primarily working with. And. Right around 2017, I started to realize that like the quality of my life wasn’t that great.
The quality of my work was [00:08:00] amazing. I worked with these amazing people. I felt very challenged. I was constantly growing. I was getting different trainings, like my therapist, education, and career goals were being met and exceeded. I didn’t have any friends or a life outside of work, which I will say is it for a lot of me.
Really good adolescent and, and to some degrees, young adult, but definitely adolescent inpatient therapists is their lives are pretty consumed by their work and most of their friends they work with. And, you know, I. I can tell you with quite a bit of certainty that if you sit a bunch of clinical professionals down and, you know, they’re in a coffee shop, they’re going to have a pretty twisted conversation pretty fast.
So I would love to be a fly. Yeah. Yeah. Even, even outside of work, if your friends are only clinical professionals, you’re going to talk about things that are still pretty [00:09:00] stressful, even if you’re not talking about clients. And I just started to wake up and realize that I needed a change. And this happens for a lot of therapists, it’s like we go on a gap year, I guess you could call it.
And I took a break from the therapy world and I, I actually worked, I live in Maine. I worked at L. O. Bean in a gear store department at L. O. Bean for eight or nine months and just Like let my brain and my system settle and did a lot of yoga and, you know, didn’t drive two hours into the woods every day.
Did my own personal therapy, met a lot of people that don’t understand clinical phrases. Like I like to joke that my normal friends say that their husband’s bipolar and that’s because his mood changes rapidly. And I’m just like, yes, you have no idea what you’re talking about. And so when I saw the increase of the quality of life, I knew I couldn’t.
I wasn’t going to stay working at Beans for the rest of my life, and I needed to get back into this world. And I had been talking with [00:10:00] another consultant whose name is Ben Mason, been in this for decades. And we talked for quite a while. It wasn’t an impulsive decision. I wasn’t sure of it. He wasn’t sure of it, but he took me on as an associate six years ago.
And I was pretty hesitant about what this work was going to be like. I’d only ever been on the therapist side talking to consultants, didn’t know if I’d be good at it, but you’re right. My experience as a clinician has been invaluable. My, particularly my experience in wilderness has been invaluable because I can, Very, very clearly explain to parents why it’s useful, how it’s different from what they perceive it to be, what their child’s experience will be like, and tailor what it would look like specifically even to what their kid’s presenting with.
And I don’t know if I could do that if I hadn’t worked there and also been. Just a therapist in general and understanding things. I’m also a drug and alcohol counselor And so I think that’s another layer of information that [00:11:00] can be challenging for people to truly understand addiction and substance misuse and experimentation and the different types of substances and how they affect us and the warning signs and all those sorts of things so There are great consultants that don’t have clinical backgrounds at all, and they do this work very well.
I just don’t envy them, right? So that’s the short, shorter version of how I ended up here. I love the 
Brenda: work. It gives you a leg up, I think, because you have so much insight into what’s going on with a young person, especially with substances. Like you said, there’s just so many nuances. And if you’re working with adolescents.
It can be really hard as a parent to say, is this a phase? Is this, you know, cause we all kind of go back to, well, I don’t know. I smoked some weed when I was in high school. So to be able to have a third party assess that [00:12:00] a little bit 
Trish: more objectively is helpful. Yeah. I can even remember distinctly one conversation with a mom where I said, you know, is he sick a lot?
Does he get a lot of like cold medicine and cough syrup? She’s like, yes. How’d you know? I’m like, I hate to tell you, but he’s not sick. Those are great ways to get high. Okay. And she actually got so upset. She’s like, do the pharmacies know this to CVS? Know this? I’m like, I don’t, I actually don’t know. It’d be a great question, but now you know, and so there shouldn’t be any cough syrup or cough suppressant pills allowed in your house.
Brenda: Right? Yep. Those are all the little things you got to know. Okay. So thank you for that. That’s really helpful to have that background. I would love to just get a little bit of an idea of. What you’re seeing today, which may be, may or may not be different than six years ago when a family approaches you, what are they saying?
Like, what are they coming to you with? Cause I [00:13:00] think a lot of times families don’t know, like, at what point do I engage with somebody to start Looking at solving this problem. So what is usually showing up in a family when they knock on your door or 
Trish: call you? Yeah. So there’s definitely treatment trends that we all see, and they’re usually an impact of parent culture and, um, social culture, uh, influences from.
The media, all different things that impact these greater trends of how mental health is showing up. I would say in the last 6 years, especially the last 4, there’s been a high for me, at least. increase in self harm and, uh, not, not just self harm, but really severe self harm. So only in the last year, 18 months have I had clients endorse having cut deep enough to need stitches multiple [00:14:00] times.
That’s a question I’ve always asked throughout my career because it’s the question you’re taught to ask. And it’s always been no. No, no, no. It’s never gone that far. No, nothing’s ever gotten infected. Uh, but now it’s, it’s very severe self harm and I’m seeing also an increase in, it used to be more ideation, ideation without a plan, ideation with a vague plan, but now I’m seeing families calling post two or three attempts.
Some of them are unlikely to have been successful attempts and some of them were very nearly. Successful attempts. And so that’s one huge. Increases that I’m not saying that I wasn’t seeing self harm and suicidal ideation. I’m just seeing it so much more severe and is that because parents are waiting longer?
I don’t know. Is that because the climate’s changing for clients? I don’t know. I will say OCD is also something where we’ve seen a huge increase in OCD and disordered [00:15:00] eating, which isn’t like that eating disorder where you need to go and get a feeding tube, but it’s a couple of clicks down where you’re controlling a lot of your world.
And food is one of them and it’s becoming concerning. Seeing a lot more of those since the pandemic makes a whole lot of sense. We were locked up with our food. We were scared of germs. So these two disorders have taken a lot of rooting and control for clients. And then I’m definitely also seeing younger and younger substance use.
And I’m also seeing a resurgence of alcohol for a very long time. Alcohol was something that. Lots of my clients were not interested in or not having access to. But I think it’s definitely, um, one of human beings favorite ways to alter their mind and feel better. And so it’s definitely something I’m hearing more of.
Generally, another really big trend is I’m having a lot of families come. With all the tenants [00:16:00] of needing an immediate placement, like they are in a crisis, their child’s in the hospital, their child has gotten involved with the police multiple times, been expelled from school. All their friends are talking to them, restraining orders, like lots of reasons to at least take a pause and do a short term intervention, if anything.
And they’re, they’re not. Moving forward, and I had a colleague several months ago explain with a metaphor of what he’s seen because he’s been doing this the same amount of time as me in the field of therapeutic work. He was is an executive director of a program, and he said, it’s like our families.
Before the pandemic used to be the frog that was thrown in the pot of boiling water and immediately would jump out. And most of the time, if they called us, it was going to move forward into a placement. And now it’s like our families are their frog in the lukewarm water that has [00:17:00] the burner on under them and they’re slowly cooking.
And unable to jump out of the water because they don’t necessarily know. And so one of the things that I think we are guessing happened is that everybody’s distress tolerance had to increase during the pandemic. And therefore they’re having a harder time testing the reality of a crisis because we all had to live.
We just had to live with one. There’s nothing we could do about it. There was nothing we could change. So we just had to tolerate it. And so now this is just a theory. But I would say it’s held true now for two years. Almost everybody I talk to has endorsed it the exact same way, but families are calling in, in an undeniable crisis.
I definitely have families call in situations where it’s like, eh, we could do treatment. We could not do treatment. And let’s sort of walk through that. But we have these families that are [00:18:00] calling with severe, severe concerns and they’re like, well, we’re not really ready to send him away. And I try to do my best to build a relationship.
I save all of their information, I save all my notes and I say, look, here’s what I’m worried about. Call me if you have any, any change in your, your desire for treatment, I can move fast and help quick. I’m saying that a lot more than I used to. 
Brenda: Yes. That is very interesting. And I think you’re, you’re hypothesis about.
Our distress tolerance and just living in a state of crisis for a couple of years does make it hard to then look at something like a young person who’s struggling and go, this is probably something we need to act on very quickly because we all, we’ve all been in that boiling water. Really interesting insight.
I think that’s, that’s probably something good to, you know, for people who are listening to think about. Like [00:19:00] if. If we hadn’t gone through COVID, like jump back to 2018, and if the same behavior was going on, would I feel the same way about 
Trish: it? I sometimes ask them, if your best friend was describing this to you, what would you do?
Because our tolerance for other people’s distress didn’t change, we’re still able to objectively look at things outside of ourselves and say, that’s messed up. Yeah. Someone needs help. Like, you can’t live like this. Yeah. It just seems to be skewed on us. And so, yeah, I get a lot of parents too that can be like, yes, I totally hear that.
I totally agree with that. And I, I believe them. I believe they’re rational. Intelligent people and they understand it. I think there’s still a desire really after this scary and depressing and anxiety provoking time to keep our family very close to us. I think that’s impacting it. I think there’s a lot of things that we shouldn’t be blaming on the pandemic anymore.
This is one that I [00:20:00] feel very confidently is still. And probably going to impact generations of this desire to be close to each other, 
Brenda: right? Which is good in some ways, you know, if you don’t have a kid in crisis, if you don’t have a young person cutting themselves to the point where they need stitches, that’s exactly a stick.
Exactly. However, if you are, it’s time to, to do something about that. And I, and I can totally relate because I delayed, delayed, delayed. Seeking treatment because you just can’t imagine what that’s going to look like. So what I really wanted to pick your brain about was the, the end to end spectrum of what is available from a treatment standpoint for adolescents, because.
I think it’s confusing for parents. Sometimes we think wilderness therapy is the only option, which I know is not. And here’s where I’m coming from the state of Washington, where our age of consent isn’t [00:21:00] 13. 
Trish: Yep. So I did my internship in Washington, so I know that really well. Yeah. Cool. Yes. So it’s 
Brenda: a nightmare because as a parent, you lose control of your child’s medical records and assessments and all of that.
Yet, you’re still responsible for them for the next five years until they’re 18 with your hands tied behind your back and you can’t, you can’t force treatment. And so I imagine there’s other states like ours, it’s so messed up. And I remember the police in my living room so many times saying, your son is going to be dead or in jail if you don’t do something.
And I was like, well then help me out because. I can’t get anything from his therapist. I can’t get anything from our pediatrician. They just come out of the room and they look at me with these giant eyes. And that’s the information I get. So trying to understand what, what our options were, I thought there were no options, right?
[00:22:00] Because I was like, well, He’s not going to go, I can barely get him to go to a therapy appointment. I’m bribing him to go to therapy. So that’s why I really wanted to have you talk to us about what those options look like. Yeah. 
Trish: I think everybody knows individual therapy. I think everybody knows family therapy.
I don’t think I need to rehash psychiatry. What I will say that I feel very strongly about is It’s not any therapist can work with adolescents having worked with adults and young adults in my life. It’s like, Oh, this is so easy. This is, this is what it’s supposed to feel like adolescents. They’re not, their brains are not fully developed.
You’re, you’re working in the middle of. life stage developments. And so they’re more complicated to work with. And when you’re looking for a therapist for your child and they list, I work with adults, I work with families, I [00:23:00] work with couples run. If they say I work with children and adolescents only hire them immediately.
Brenda: And those seem to be hard to find. 
Trish: It is really hard to find because it’s exhausting work. It’s exhausting work and your clients are not easy. To engage with and a lot of them miss sessions and don’t come and are stopped. Yeah, right? So it’s hard but they’re out there and obviously understand their communities in which you don’t have a plethora of choices and you do what you need to do I will add that Tele mental health.
It’s it’s on the way to being generally accepted. So there are going to be more options. There’s a state compact. I can’t tell you how many states. I know my state’s going to be part of it. Hopefully where if you’re licensed in one of the compact states. They’re going to allow you to telehealth practice in the other [00:24:00] compact states.
So not everybody’s on board yet, but that’s, that’s the hope. And so then that would open up a lot for you. Uh, I think adolescents are more interested in texting therapists sometimes or doing an on demand call or FaceTime, or I think before maybe the last five, six years, that was a hard no in our ethics.
I think that’s changing. Essentially, we talk about boundary crossings. And if you’re just meeting for your hour in your office, you’re not crossing many boundaries. You have a lot of control. There’s no gray area and no one can accuse you of being unethical. And so it is per therapist’s decision, but I still see a handful of young adult clients because of their ease.
And I text with them and I’ll do an on demand call if something’s happening in their life, if they need it. And I don’t think that that’s wrong anymore. Um, and so looking for therapists that do things like that, I [00:25:00] think is, is better for your adolescent. I think working with therapists that are gonna, with adolescents, they have to be able to understand the balance between confidentiality and work with families.
So the majority of them are, even if you’re in Washington, gonna request that consent to talk to the parents and have them be part of the process. Again, that’s a difficult dance and the good ones can do it. 
Brenda: Like if you’re, if you’re adolescent, it’s like, Oh, I’m not going to see a therapist. Are there like groups that they could do that might feel a little bit less intimidating?
Trish: Yeah. Group is hard to find. Insider information, lots of therapists don’t like group. Yeah. It’s, it’s a challenging platform. 
Brenda: Especially with adolescents, it’s just like a handful of nightmares in a room. 
Trish: Yeah. It can go, it can go bad very quickly. So for folks, I loved doing group, for folks that are passionate about group, they can, they can really do it.
And so if we’re talking about a one off group, not [00:26:00] attached to an IOP, PHP. Those are harder to find for adolescents, and they’re hard to get enough clients to come to be able to make it work, you know? And so that’s another hardship of group. I was going to talk about IOP and PHP, which I’m assuming your listeners know IOP stands for intensive outpatient, PHP stands for personal hospitalization program.
And they essentially. Take up a big chunk of client’s time, sometimes it’s on weekends, sometimes it’s on the day, depends on the program, and they’re just essentially trying to do a couple of different things. They’re trying to do more intensive treatment than just your outpatient level of care, while keeping clients in, in home.
And they’re trying also to take up some of your time. For the ones that are geared towards substance use, they’re drug testing. They’re also tracking whether or not you need a higher level of care. Um, the tricky [00:27:00] thing, and this is sort of my anecdotal history of understanding these, these two is, they were normed and created for adults and then just sort of put on adolescents, even in just the span of my career of 21 years.
If you think about it, if you’re a 50 year old, 40 year old, even 30 year old, who’s got substance use or a mental health crisis going on, and you’re afraid of leaving your job for three months. You know, you’re afraid your, your wife will leave you, you’ll miss your kids, no one will be able to care for your dog.
Like, there’s all different types of reasons why an adult would say, you know, IOP makes sense. I, I know a couple of people who did this, that they would go to their 9 to 5 gig. They take the train or their car, go to their IOP from 530 to 9 every night during the week. And they kept their jobs, they kept their lives, and they got well.
But they also [00:28:00] have a fully formed brain, and they understand long term consequences. And those are two things that adolescents don’t typically have a grasp of, even the well functioning ones. So when we get into the IOP PHP level of cares for adolescents, the very, very motivated client, which I’m, I’m not going to say is impossible.
I definitely have had. Um, Insightful, motivated 14 year olds, I have, and they want this help and they want to stay home and they want to do it and they go, unfortunately, they’re usually with a group of clients that don’t, that this is just the hours they’re putting in because their parents are making them or courts making them, or this is how they stay out of the hospital or this is how they stay out of treatment.
IOP. It’s. It’s pretty [00:29:00] easy. You go for a couple hours a day. You go to group. You say something. You don’t say something. You go to individual. You say something. You don’t say something. You’re pretty comfortable. All you have to do is hold it together for a couple hours. You go home. You get to do whatever you want to do.
It’s a little different with PHP because it’s so much of your day. It’s a little bit harder sometimes to skate under the radar, but it’s not impossible because you do just have to hold it together until you get home. How many hours 
Brenda: a day would a PHP 
Trish: program be for a new lesson? So the standard is basically a full time job.
It varies, but 40 hours is PHP, 20 hours is IOP, 20, I mean, IOP can go down to two hours a day, maybe 10 hours. PHP can go down, like I’ve heard, 30 hours, but it just, it depends on the program. It depends on your insurance too, what their standards for each of them are, but it’s that same mindset of this is your job.
This is what you need to be doing to get well, if your goal is to get well. Put in [00:30:00] the hours because again, an aside is we’ve been researching therapy for hundreds of years, some more intense than others. And. Really what it turns out is that it doesn’t matter what fancy degree your therapist has. It doesn’t matter how much the program costs.
It usually matters if they’re doing, you know, ethical good work, but it doesn’t matter. None of that matters. It doesn’t matter if it’s an empirically supported treatment like EMDR. Or talk therapy, what matters is, do you have a therapeutic relationship and that therapeutic relationship could be with your, your therapist, your psychiatrist, the nurse, the case manager that facility facilitates your group.
It could be with. the janitor or the person who is, uh, cooking your food and you have developed some trust with these people about why you’re in treatment. So therapeutic relationship and then length of stay. Those are the [00:31:00] two greatest predictors, regardless of age, regardless of what you’re doing. And I mean, it’s, it’s as simple as.
Do you have someone you connect with therapeutically and how long have you been there? And so that’s where IOP and PHP are coming from with their time commitments is the idea is the more time you’re doing this, so not just that one hour of family session and one hour of individual group a week. And maybe if you’re lucky that you have a dynamic group in your town that you’re doing a dynamic group, or maybe you’re even super creative and you got art therapy once a week.
Like that’s only four hours. And that would be insane for most clients that we work with. So IOP bumps it up, PHP bumps it up and gives you a greater chance. of, of getting enough therapy time to, to get to a point of wellness. I prefer IOPPHP for adolescents as a transition plan, not as a first step. But if they’re not working, usually they’re, they’re recommending a hospitalization for [00:32:00] clients that are, are concerning safety wise.
Obviously you’re not going to get hospitalized if you’re still struggling with OCD or. Um, hands down, every family I’m working with now thinks that the hospital is going to provide treatment and ultimately will tell me in the history saying, yeah, they’ve been in the hospital and the hospital does nothing.
Like they’re never any better when they come out of the hospital. And I very kindly say. But that’s not their job. The hospital has one job and it’s a very intense job and that’s to keep people from hurting themselves or others. And that job takes all of their effort, everything they have. So they can’t really get into deep coping skills beyond [00:33:00] just, Hey, you’re stable enough.
We don’t really think you’re going to hurt yourself. And here’s some things that you agreed to try. So like most clients discharged from hospitals without coping skill plan. But it’s not because they learned and have practiced and it can maintain those coping skills. It’s because they’ve indicated some interest in them.
So it, it could be a clue to their future coping, but it’s not an indicator of their current coping. So lots of my families are like hospitals are junk, treatments junk, inpatient is junk, residential is junk. They’re, it’s all a lie. because they had so much hope that going to the hospital where they cure cancer and do surgery that that will fix this and there are always going to be let down.
Brenda: Well, yeah. And like you were saying, if length of stay is one of the key, you know, factors in getting well, obviously a three or five or even a two [00:34:00] week stay in a hospital is not, that is just. Triage. Yeah. From 
Trish: my standpoint. Yeah. It’s getting you further away from the thing that’s unsafe. Yes. And a lot of clients aren’t, aren’t in areas that have large or even any adolescent psych beds.
You know, in the entirety of the state of Maine, there’s 12 adolescent psych beds. Wow. 12. So that’s a rural state’s perspective. It, it obviously gets better as you go into a more metropolitan area, but then you have more clients. So it’s just pretty much the same situation. So lots of clients actually do their hospital stay in the ER and they aren’t getting any treatment, treatment.
They’re just being kept safe, which I really try to help parents understand is good. Like they’re doing one of the hardest things to do. And they’re doing it well. Also they’re probably throwing a lot of medications at them, which is, or isn’t maybe a [00:35:00] good idea, but they’re a medical model. You took them to a medical doctor.
That’s what they’re going to do. Yes. And 
Brenda: maybe that gives you time as the parent for those, I don’t know what the average stay is. I always hear like three days, five days, two weeks. Maybe that gives you time while they’re there and safe and being watched and cared for. To make some other plans. Yep.
Trish: Unfortunately, hospitals are now indoctrinated or supportive of the idea that you go from that intensive level of care for safety right to PHP or IOP again. So this is where most of my families encounter PHP or IOP for the first time. You’re usually not going right from. That outpatient therapist’s office into IOP or PHP, they’re usually being recommended from a hospital, and that’s a shift in the last four or five years before hospitals used to say, you need residential, we’re inpatient, we focus on safety.
You need residential, which is more of what [00:36:00] most of the, the people listening are, are here. Forest is like, what’s this residential thing? I was used to that and then it became this jarring. Well, the hospital said IOP. But they were just with them for two weeks and attempted to self harm multiple times in the hospital.
Why would we think that going home for the bulk of the day is a good idea? I don’t know where it came from, but it’s, I think that idea of trying to keep clients in the least restrictive level of care and the most quote unquote normative part of life for adolescents that’s going to high school and living at home.
And so I understand usually where the trouble, yeah, exactly. I understand where they’re coming from and it’s, it’s just really dangerous. And it results in what I, I call sort of like the hospital rinse and repeat where every time something happens, they call nine one one, they get there for a couple of days, they go back.
And, and I think that’s part of the culprit of [00:37:00] families getting stuck more is that they feel like that’s the only thing. And then. They don’t reach out to people like me or like you all in your community. They just think the only thing they can do is go to the hospital. Or in the worst situations, they just stop going.
They have highly suicidal, very dangerous situations happening in their house because the hospital’s not going to do anything.
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Say the hospital does recommend residential or someone maybe in one of your communities say to their friend, Hey, I’m in this community and this is what I did and this is what everybody’s talking about. Come join us. Listen more. And they learn about residential and those options. They might learn about consultants.
I know you just said that you did. An episode with one of my very best friends and close colleagues and travel buddy. So she will probably go into the benefits of having a [00:39:00] consultant in this journey, but we are better than Google. I always say we’re the Google you want Google to be. Yes. If you’re listening, I 
Brenda: don’t know what episode number it’s going to be, but it’s with Joanna, Lily, and you will want to listen to it because we do a deep dive into.
What consultants actually do, and it is not going to Google. 
Trish: So, but say they get to you, they get to me and everybody’s talking residential for adolescence. There’s, there’s two choices typically, which is a 30 to 90 day residential program, which is going to have buildings and structures, and it’s going to be 24 seven.
And it’s going to be continuity of care, high dose therapy, lots of. Outdoor recreation, community and integration, if that’s possible for the clients, mostly going to be all happening on that little property. These are not going to look like institutions. They’re not locked. They’re essentially, usually they look like little boarding schools or little homes.
[00:40:00] And there’s not a huge sign that says like adolescent treatment kids here. They blend in well. There is a higher level of care right above that, which would be an inpatient stabilization center, which is locked. And those are for clients that are a great risk of running away, hurting themselves or hurting others.
And. If that’s indicated and you’re talking to someone like me, I’m going to help you get there. If you call a residential, they’re going to be able to tell, Mmm, this client isn’t going to be safe in our community. They’ll recommend you to go to that level of care. But for the most part, you’re going to be looking at Brick and mortar residential program, or as you probably talk about a lot, clients also look at wilderness therapy.
I, I’m very, I’m very passionate about being the first one to say wilderness isn’t for everyone, and I worked in it for 15 years. I also am very passionate about people understanding we don’t go to wilderness because It breaks people down or is to make survivor men and women [00:41:00] the, the reason why it works so well and is really indicated for adolescence is it slows everything down to a human’s pace.
Nothing can be done faster than a human. And it also takes. Vague consequences and makes them real and immediate. So, Hey, Johnny, if you don’t go to school, you’re going to fail this year and you’re not going to be able to go to college and your life will be ruined. Hip hop, whatever. Right. My brain does not compute 
Brenda: that if I, 
Trish: right.
Right. And. Hey, Johnny. Man, you got to put your boots away like this, you know, in a plastic bag, fold it up and put it in the backpack where all the. So, staff put the boots, right? Because most of these places are taking boots at night, so no one can go and do things they shouldn’t be doing. But they ask them to put them away in a way that keeps them dry.
That’s the goal. And say Johnny is just like, I don’t care, and just puts his boots without the plastic bag in the bag. Well, they’re going to get wet. [00:42:00] Now, there’s a big asterisk. If it’s unsafe, it’s, if it’s 30 degrees out and his boots are wet, they’re going to get frozen. The staff are going to go back into that backpack and make sure they’re in a plastic bag.
And there’ll be a different natural consequence he can get at a different time that doesn’t have anything to do with frostbite, but say it’s a balmy 60 degrees. Those boots are going to get wet and he’s going to wake up in the morning and there’s going to be no dryer to put them in. There’s going to be no Amazon to deliver a new pair.
There’s going to be no mom to say, here, honey, wear mine. There are great ways to wear your boots while they’re wet and not get.
So that’s one layer of, of the, the natural consequences. The other one are the social consequences. So lots of people are used to unfriending, unfollowing, refusing to talk to people, just hiding in their room. If things go, things go awry. [00:43:00] So another one of my favorite things about wilderness is that you are living as a group and you are dependent on each other.
So if Johnny sleeps in and misses. So, um, I don’t know if it’s the right word. Um, I don’t know if I’m gonna use that word. Um, yeah, I don’t know if it’s the right word.
And if he continues to repeat this pattern, he’s going to consistently get really good and healthy and appropriate real world feedback from the people he lives with and he can’t escape it. And typically there’s also the therapist and the staff being like, Hey, you know, this reminds me of this pattern you have at home that your parents talked about.
And so the [00:44:00] universe gets real small for Johnny in Wilderness with lots of consequences that are much more immediate and he starts to learn my actions impact others, they impact me, wait a minute, maybe some of those things my parents are saying are real. The noise on the world is turned down so low that you’re left with the real thoughts.
And that’s when you start thinking more clearly about the future. And that’s why wilderness is typically indicated by, for adolescents. In residential. Um, almost like what I talked about with a PHP IOP, that motivated client tends to thrive. A motivated client tends to thrive in residential too, because you’re in your comfy clothes, you’re inside, you can wake up and get a good breakfast and go to morning group and maybe not participate and go to art therapy and maybe not participate and go to lunch and get some good food and have some free time.
Go to the gym and then have evening group and your [00:45:00] family call and you might get pissy in your family call, but then when you walk out, everybody’s just hanging out and playing board games.
And it’s easier, I have one client right now sitting in wilderness and she did phenomenally in residential. She kept relapsing every time she went home and she kept bringing drugs back into the program. So now she’s sitting in wilderness with a lot more reality testing and her patterns aren’t working and it’s really upsetting her and her parents are finally feeling like she’s doing the work.
She’s put off for 18 months. That is not every kid. That is definitely not every kid. There’s nothing wrong with residential. There’s phenomenal programs out there that do great work for your kid. It’s just if they don’t want it, they don’t have to get it. In wilderness, you have to get it because your functioning and your group’s functioning depend upon you getting it.
And again, no one’s going to allow it to be unsafe. [00:46:00] 
Brenda: Right. Totally on the safe thing. And, and the thing that I didn’t really realize when we made the decision to do wilderness is that not only are they getting all of those natural consequences and the interactions with the other kids is you’re also getting world class therapy in that environment as well.
So it’s kind of a double whammy of the real world hitting you. And I love what you said about like the, the technology and fastness and all that fades away because you’re in the middle of the woods or a desert or wherever you are, but you’re also getting this. Therapy. That’s, I just think it’s such a unique thing.
Trish: I think that’s also interesting because I’ve been chewing on this for a couple of weeks. I had an adult colleague who went to wilderness in his treatment journey and he said it was junk. I only got maybe four hours of therapy. [00:47:00] A week, Max, and I’m never going to argue someone else’s treatment experience.
That’s his experience. That’s his perspective. That’s his truth. What I would say to anybody else asking, wait a minute, when you’re in residential, you have all these groups all day long. You see your therapist all the time. It might not be for a full check in individual session, but like there they are, there they are, there they are, there they are, there they are.
Um, and in wilderness. The therapist might be in the group two to three times a week. You’re definitely going to get your individual, you’re going to get your group run by your therapist, but the vast majority of the time you’re going to be with what they’ll call guides or field instructors. How is that therapy?
And that person’s comment about like, I did it. It was junk. I only saw my therapist like a handful of times. Is that every therapist I know in wilderness would say, but I’m everywhere all the time. [00:48:00] And I would have said the same thing. I would come in a group and these clients would say, how did they know to say these things to me?
Like, I know they didn’t come up with this Trish, like, I swear to God, are you like following us? And like, the guides just go and like, when they go for a break, you’re just like behind the group when we’re hiking. No, I train my staff really well. So to your point about world class therapists is that. I didn’t even have to be in my group to be doing therapeutic work.
And my group, and this was when technology wasn’t all that great, so now technology is even better. My group always had access to me or the clinical person on call, and I was always really good about updating.
So, when you look at them, when you compare them, they are not apples and oranges, because they’re not fruit. It’s like fruits and vegetables. They’re related, but they’re very different. It’s like an apple and an avocado. [00:49:00] I guess avocado is technically a fruit, but it gets put in the vegetable, you know, that they’re technically both therapeutic programs.
They’re often put together on lists. But when parents look at them, especially high achieving, highly educated, like my bread and butter parents, I work with a lot of the Northeast families. And so I get a lot of, but wait a minute where they go to college and what’s their degree. And this program has PhDs.
This is MSWs. When we’re comparing those things, they are very, very different. And, and I just walk through the, the truths and what they really look like, and that something I will say to a lot of families is, if you’re always around your therapist, that’s not actually healthy. It’s not actually a good idea.
Yeah. Needs some space. Yeah. If every group is run by a therapist, that’s probably also not a good idea. Like having some real world relatable, highly trained, usually bachelor’s levels, associate levels, [00:50:00] 25 year olds sounds like an awful idea, but it’s actually for adolescents, they almost rather talk to them sometimes.
Brenda: Covered with tattoos and carrying a guitar and. 
Trish: Yeah. And they are living with them. Yeah. Yeah. They’re on the ground with them, usually a week at a time. So there’s often a connection there of shared experience. In residential, they have shift changes. There are some residential programs that will have their staff spend the night for a certain period of days like the wilderness programs do because they do recognize that continuity is really important.
But for the most part, it’s like morning shift, afternoon shift, night shift. And they’re all different people. And so There are kind of hybrids 
Brenda: that do both, like that were kind of residential, kind of wilderness or what does that look like? Cause I, I do hear about that and I’m curious cause I, we didn’t have that experience, but I think that that’s an interesting [00:51:00] concept.
Trish: There’s really only two programs wilderness wise. That would I, I would say qualify as hybrids and one of them is a lot more wildernessy than the other their trails. And Summit Achievement. Summit Achievement is more of the standard hybrid. Because the clients do school three days a week, go on an excursion seven days a week.
Trails, they bounce around between different campuses for their base camp time. And they do have school, they have one week of sort of like school based, and they have one week of equine based, and one week of sort of more off the grid backpacking based. And. You know, they have this cool guy named Science Steve and kids are in a science classroom doing work with amphibians while they’re in wilderness.
And so it’s possible the problem with so many different transitions and changes and being inside and being outside and being inside and outside is there has to be some willingness. Yeah. So a lot of those really super [00:52:00] resistant clients struggle in those. Settings because they can just shut down and hijack the entire day and the entire team and it can be, it can be harder, but they’re, they are great options for maybe families that are high achieving academic families and value that it’s a little bit more palatable because most wilderness programs.
When you’re out, you’re out. You’re not going to be in a classroom. You might be able to get some cool certifications or, or coursework around natural science or writing, or some programs are doing basic psychology courses. So you get some electives, but you’re not continuing your classwork. Yeah, so The only thing that I would say sort of after that is some of your clients are getting recommendations for a longer term placement.
Most parents are calling them therapeutic boarding schools. I just am continuing to call it long term residential treatment because some [00:53:00] of them Our, like our old definition of therapeutic boarding schools, we just don’t have that many of anymore. We just have longer term clinical residential programs that some of them are higher acuity and some of them are lower acuity.
There used to be this, like, this is a therapeutic program, therapeutic boarding school program, and this is a residential treatment center. And there was a divide. And I’m just moving away from there being an RTC or a TBS. Because one sounds worse than the other and it’s just like everything’s residential treatment, folks.
Everything’s longer term clinical care for your child. All of them will have school. And I, I would say that this just gives your kid more time. The ultimate goal is more time and then more real world immersion as needed. So in some of these programs, clients are getting jobs, volunteering, going to the local high school.
By the end of their time, they’re having their cell phone for half of the day. Some of them not because they’re a higher intensity. [00:54:00] Usually from that level of care, most of my clients are going to go home or they’re going to go to a traditional boarding school. Usually, the traditional boarding school is indicated when home isn’t either a safe place because of the community around them, or the family dynamic is just not working.
And the continued structure of a boarding school is probably going to really help them. And then home, typically, I would say at the very least, I’m asking families, whether they’ve done residential care or not, to not have their kid going back to the same academic environment. You know, school change of some kind or you know, it’s less common now like but families used to move families used to move families used to Maybe have their kid go live with an uncle for a little bit.
That seems to have fallen off, but some sort of change, even if you are going home. This is where PHP IOP, I think is more effective because the kid is valuing being home. They’ve got a [00:55:00] jumpstart on insight. They may already really be invested in some coping skills they’ve started. And this is where I see better results with IOP.
It makes sense. Mm hmm. Yeah. 
Brenda: You’ve got a little bit of a runway leading 
Trish: up to it. Yeah. Yes, exactly. And, and I think kids are more aware that they have some skin in the game because they got to go home. Sometimes they’re not. Usually those were the kids that shouldn’t have gone home, but parents wanted to give them the shot.
But the ones that should go home and it is a good thing for them usually know very acutely how important this is. And they take it seriously. The other thing that I use a lot is, I would call it sort of like, it used to be in home supportive care, but they can’t be in every community. So most of these places have pivoted, especially because technology is so much better now, to doing virtual in home care.
And essentially it’s the most common setup is two coaches, one for the family and one for [00:56:00] the kid. And it’s not full therapy, but these are usually therapy trained individuals that are going to be building rapport with both sets and they’re talking to each other and it’s, you know, you’re going to have your weekly check ins, but texting and on demand communication is expected.
So it’s really very different from your. therapist that has the one hour for you. When this works, the parents are getting in the moment support on issues and the kid is feeling supported and coached. I’ve, I’ve had a couple of clients. Take their coach with them to college and they’re functioning more on social skills stuff and executive functioning than it is some big thing that was related to their treatment.
They just really like talking to this person and they feel supported. For parents, it’s just a lot of, what do I do if, what do I do with like problem solving and coaching at the, at the [00:57:00] worst, really the kid isn’t engaged with our coach, but the parent is. So at least the parent’s not alone. And then at the best, the kid’s engaged.
So I like the best example of this. So I’m going to talk about a little bit of that. So the first thing that I did with my life was I had a client go home from treatment. His parents hired one of these companies and mom and he got in a huge fight and he ran into the bathroom and slammed the door and locked it.
Said I’m going to drown myself or something like that. And she called her coach and then her coach called his coach and. She was able to say, if I give you your phone, will you call your coach? And he begrudgingly opened the door, took the phone, slammed it. And they started talking to their individual coaches and their individual coaches eventually were able to get them to come together.
And then those coaches mediated through the door what needed to happen for him to calm down and come out. And then they mediated their way out of like the whole argument. [00:58:00] That’s the gold standard. It doesn’t always happen, but when everybody’s connected to their coach, it works and your home therapist isn’t going to be capable of doing that.
So usually at the very least, if families are going home, I’m recommending that. Yeah, 
Brenda: it sounds like a really good safety net because what we see a lot in our community is the kids come home, they go right back into the same school, same neighborhood, same triggers, same everybody with the same phone and.
It’s a disaster and it, and I, I think it’s really hard because not everybody can move. And even I know a lot of families that have moved, they’re like, well, it took three days before my kid found the bad kids, you know, the, the dealers and all of that. And I know that there are recovery high schools, but I think there’s only like 40 or maybe 50 in the whole [00:59:00] country.
So I guess that’s an option if you’re lucky enough to live near one. What do you think of 
Trish: recovery high schools? It’s tricky. It’s like IOP. It depends on the culture. Yeah. So, I’ve seen recovery. It could be good. I’ve seen recovery high schools. Largely out west that are ruled with an iron fist. Like I, like, almost like I, I dare you to try to create a subversive culture in this high school.
This is sacred ground, like I dare you. And then there are recovery high schools that are like, yeah, we’re a recovery high school. Come on in. And they kind of hope for the best. But with, I think with IOPS and, and recovery high schools or even therapeutic day schools. They have to be very tightly managed and they have to really balance a hard line between being engaging with their clients and being really, really structured.
And what are their limits and what are their boundaries and what happens if you don’t follow the rules. [01:00:00] So I think that’s one of the reasons why recovery high schools don’t, don’t thrive is because they could be blamed for rightfully so or wrongfully so a lot of relapse. And I think a lot of parents.
Don’t want to do that. I think a lot of kids don’t want to do that. It’s unfortunate because I think, I think the ones that are run really well, just like IOPs, the ones that are run really well, end up with really, really great results. But yeah, that’s, that’s how I feel about, about that. It’s like, I would love, I would love one in every single city.
As long as they’re run well, 
Brenda: right? Yeah. There, it is so tricky because I know even from our experience when my son went to like a drug and alcohol school thing, he just came out of there with 10 phone numbers of People who he could connect with. And I know they’re not all like that. So like you said, if it’s run well, right.
Trish: And then the other they’re doing cool things, they’re having good community. They like each other. They feel safe [01:01:00] with each other. It’s encouraged and cool to be sober. And there’s usually a lot of like, what I’ve found is there’s usually a lot of extracurricular community activities. So this, these are your friends.
These are your people. It works. And if you indicate any sort of. Not towing the line, you’re out. You’re not part of the community anymore. And so you’re, you’re afraid of being shunned. So you stick with sobriety and then somewhere along the way you’re like, this isn’t so bad. And then you’re not giving your number to people to go do things you shouldn’t be doing.
Exactly. That takes 
Brenda: a lot of work. Yeah. Well, wow. We’ve covered a lot of ground. My, my last question would be what. What do you wish you knew? What do you wish parents knew when they first start engaging with you? If you could kind of put them in a time capsule and shoot them out 10 years so that they could reflect back, what do you wish they knew when they started [01:02:00] this process?
Trish: There’s just like a lot of things that come to my mind. I think a lot of my parents that I work with, even the ones that hire me, even the ones that go through the whole process are so afraid of how this is going to ruin their kid’s life. And what I always say is it’s not going to happen in a vacuum.
You’re going to lose things. There’s grief and loss. There’s holidays. There’s birthdays. There’s even grandparents dying or dogs dying or moves or proms. Graduating with your class. Like there’s all kinds of things that I can’t make happen and happen while you’re in treatment. So I think lots of parents think because their kid’s not doing it the quote unquote right way, then they’re, they’re ruining their life or there’s going to be something wrong with them.
And I just kind of come from the mindset of. They’re, we’re told there’s only one way to do it, like go to high school, get your degree, go to [01:03:00] college, get that degree, move on, get a job. But there’s actually tons of different ways of doing it. The other thing is that most parents want their kid to be happy about going to treatment.
And I usually try to tell them like, this is not what they want. They’re probably going to be unhappy about it, but you can hold two things at the same time. You can be happy with your life and happy that you went there and really, really angry that you had to go there too. Right. And so it is going to be a messy situation.
What I always say to families is organically there’s two paths when your child is struggling to the point that you’re calling me. One is they figure it out eventually. And eventually is usually somewhere in their 20s or 30s with a lot of consequences and problems. And losses anyway, grief and loss is there anyway, or the other road is they never figured out.
And this is their life and it’s prolonged grief and loss. [01:04:00] What you’re offering is building a third road, a contrived road that offers them that chance to change. Now there’s still grief and loss on that road. It’s just shorter usually. And it’s right now, not in your twenties or thirties. So I guess that kind of answers your question.
There’s a lot of little things I want them to know, but I think. I think that, that ultimately that’s what it is, is that life is done very different than what we’re told it’s supposed to be done. And that there’s more people out there than they could even imagine that their journey had treatment involved and you don’t know.
And I wish, so I wish parents could just like inherently know all of those good things about those people out there roaming around doing great things in the world that went through more treatment than their child, but they won’t. [01:05:00] 
Brenda: Well, that feels like a really great place to wrap it up and I’m. So thankful for your time to go through all of this.
It is invaluable in trying to give perspective to families who are in this really hard place, trying to make some decisions, trying to get some context for where we are, where we might end up. And I like that long view perspective that you just gave. We do get, we tend to get very focused myopically and what’s going on right now.
And, you know, one of my favorite photos I have of my son is him in this goofy hat and graduation gown that, you know, 50 kids have put on when they finished their packets at, you know, at residential. Treatment. And he finished high school there. Yeah. And I guarantee you, he would have never been able to finish high school in his traditional high school.
It was a terrible fit. And it’s one of my favorite photos because it’s [01:06:00] such a goofy picture and he, but he’s so proud and he’s holding the, you know, the little thing and. It’s like, this is how it was supposed to be for him. This was the right thing for him. It wasn’t right for him to graduate from the school down the road.
Trish: even though you probably thought you were doing harm by taking him away from that experience. Absolutely. 
Brenda: I, I told our ed consultant, I said, I am willing to forgo my relationship with him for the rest of our life because I figured he was going to be so angry that he would never speak to me again, ever, ever, ever.
This is when he was. 16. And, but I said, that’s okay. I would rather have him alive and have him have a life and have no relationship with my son. And she just kind of looked at me like, are you crazy? It’ll be fine. She was like, he’s, he’s going to be super pissed off at you for a few years and then it’s all 
Trish: going to be fine.
And yeah, it might come up at a Thanksgiving dinner when he’s not feeling great about himself, but yeah. [01:07:00] So. 
Brenda: I was glad to have somebody tell me that she was like, yeah, seriously, I’ve never had a kid never speak to their parents 
Trish: again. Yeah, no, I years. Yeah, I’ve had some rocky conversations, you know, with parents and kids happen for several years after treatment, but.
We’re not robots. We don’t hold just one thing is true. We can hold multiple truths at one time and you can be really mad at your parents for sending them to treatment and be really grateful that they sent you to treatment at the same time. 
Brenda: Trish, thank you so much. This is lovely. And we will make sure and get links to you in the show notes.
So if parents are, you know, thinking about what would treatment look like? I know you’re a great resource for information and 
Trish: guidance. I’ll talk to anybody happily. Thank you 
Brenda: so 
Trish: much. You’re so welcome. Thank you. 
Brenda: Okay. My friend, that is it [01:08:00] for today. Remember you can find all the guest information and resources we talked about in the show notes and those are at brendazane.
com forward slash podcast. We also have some playlists there that we created for you, like the top 10 episodes, coaching episodes, recovery stories, all the good stuff. And if you haven’t already, you may want to download a free ebook I wrote called hindsight, three things I wish I knew when my son was misusing drugs.
It’ll give you some insight as to why your child might be doing what they are. And importantly, it gives you tips on how to cope and how to be more healthy through the rough times. You can download that free from Brenda Zane. com forward slash hindsight. Thank you so much for listening. Stay strong and be very, very good to yourself.
And I will meet you right back here next week.[01:09:00]

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