Treatment Architecture Then and Now: A Conversation with Dr. Laura Dunn and Doug Bodin

Mental health treatment for young people has changed dramatically over the last two decades, but are today’s approaches helping or unintentionally keeping families stuck? In this episode of The Reframe, host Doug Bodin is joined by Dr. Laura Dunn, Chair of Psychiatry at the University of Arkansas for Medical Sciences (UAMS) and Director of the UAMS Psychiatric Research Institute, for a thoughtful conversation about the evolving landscape of adolescent and young adult mental health care. Dr. Dunn also happens to be Doug’s sister, bringing an added layer of familiarity and candor to the discussion. Drawing on decades of experience and their shared background in family systems thinking, Doug and Dr. Dunn explore the rise of “slow motion crises” among young people, the impact of technology and overaccommodation, and why families often struggle to recognize when support has turned into enabling. They also discuss the evolution of therapeutic consulting, shifting cultural attitudes around mental health, the value of experiential and mentoring-based interventions, and why building confidence often starts with helping young people reconnect with the real world. Listen in for a thoughtful conversation about parenting, treatment, and the changing architecture of care.

Key Points From This Episode:

• Introducing Dr. Laura Dunn and her perspective on modern mental health care.
• Why therapeutic consulting requires a “360-degree” family systems approach.
• How family systems often get overlooked in traditional treatment models.
• Why many clinicians struggle to address family dynamics in practice.
• Acting in vs. acting out: how adolescent behavior has shifted over time.
• From risk-taking to isolation: the rise of “slow motion” crises.
• How technology and the pandemic reshaped adolescent development.
• Hope and fear: the “twin pillars” of codependency in families.
• The growing challenge of “failure to launch” in young adults.
• Why overaccommodation can unintentionally keep young adults stuck.
• The role discomfort and autonomy play in building resilience.
• How “slow motion relational interventions” help families create change.
• Why consistency, cohesion, and accountability matter for parents.
• The debate around overdiagnosis, accommodations, and mental health treatment.
• How mental health labels can become part of a young person’s identity.
• Key ways mentoring helps young people build confidence through real-world action.
• What was lost in the decline of wilderness therapy programs.
• Why treatment works best as part of a larger long-term care blueprint.

Links Mentioned in Today’s Episode:

Laura Dunn on LinkedIn

Douglas Bodin
The Bodin Group

Transcript

SPEAKER_01 0:00

The going out, raising help, drinking, you know, sex drugs, and rock and roll. That's just not as prevalent because kids are more isolating, they're at home, they're online, they're gaming, self-harm. So it's not the risk taking, it's the risk averse. And so that's a dramatic shift.

SPEAKER_00 0:24

Welcome to the Reframe, where we have real, unfiltered conversations about mental health, parenting, and addiction treatment in a changing world. Hosted by Douglas Bowden, a therapeutic consultant with 35 years of experience, we explore the shifts shaping mental health care, featuring experts pioneering new approaches and offering practical advice. Join us as we challenge old narratives and reframe the way we think about the challenges in mental health treatment. This is the reframe. Let's dive in.

SPEAKER_01 1:12

And I'm joined today by a very special guest, Dr. Laura Dunn, who's the chair of the Department of Psychiatry at the University of Arkansas for Medical Sciences, or UAMS, where she also serves as the director of the Psychiatric Research Institute. She has been at Stanford and a bunch of other places. She has published more than 200 articles in very prestigious journals. And most importantly, and the thing about which I think she's most proud is that she's my sister. Laura and I are going to be talking about consulting and the nature of how things are going in the world out there for therapeutic services for adolescents and young adults. And I'm very glad to have you here, Laura, on the reframe.

SPEAKER_02 1:54

Thank you for having me, Douglas.

SPEAKER_01 1:56

I'd like to start by maybe having you tell me about what you think about me. No, I think what I'd like to this idea for the podcast came about because we've had obviously many conversations over the three decades I've been doing this, and our shared mother, Miriam Bowden, was one of the pioneers of educational consulting 45 years ago or so. And so I think you have a unique view into this world for being in the psychiatric, the academic world. And I think because of that, you have that perspective and can bring questions and things we might not get from anyone else. So I that's a big part of why I wanted you here. And the fact that we used to practice doing interview shows.

SPEAKER_02 2:39

We always wanted a talk show.

SPEAKER_01 2:41

We always wanted a talk show, so here we go.

SPEAKER_02 2:43

And so you finally, you're finally your dream has come true. And yours. No, and then uh yeah, when I started listening to your podcast, I thought, well, it'd be really great to hear from you as well as your guests. So, because I think that, you know, I'm listening to it somewhat knowing what you do, but I also think, particularly as a psychiatrist, I don't think most psychiatrists would know what a therapeutic consultant is. I don't think we get trained at all in a lot of the things that you do in your work, which probably shows up a lot in your work and in the industry. And even when you talk about the industry, I think that's not always clear what that means. So I I kind of wanted to maybe help you unpack and illuminate some of the terms that you're using and also talk about the work you do so that people could just learn more about you and your work and kind of and and also the innovations that you've done, not to sound like a an advertisement for you.

SPEAKER_03 3:42

It's okay.

SPEAKER_02 3:43

Yeah, so do you want to talk about maybe sure? Sure. Do you want to talk about you?

SPEAKER_01 3:48

Let's talk about me. I think the term educational consultant is is kind of a misnomer, but yet we're we're always branded. We're the therapeutic consultants are lumped in with the educational consultants, and there's a lot of similarities, of course, and we have sort of the same genesis. Early educational consulting had a lot to do with placement in traditional boarding schools or colleges, and it was a referral service, a matchmaking function. And I think that part of what I'm very proud of is that I think our firm was one of the pioneers in bringing a more therapeutic orientation and a specific approach to doing this that I think is really the model for many, if not most, of the therapeutic consultants who are doing great work out there today. What that means is that we want to really understand a broad range of the needs of an individual. So that means doing a 360-degree evaluation, not only by interviewing the parents, interviewing the child, which in many cases these days is young adult children, even older than just young adults, and interviewing their care providing team, both currently and historically, reviewing documentation, really getting a full understanding of the broad range of that individuals needs from a number of perspectives, and at the same time educating the family decision makers about the range of options that exist and the approaches, and really functioning as the architect of a plan. And I think this is a really important distinction, that it's not just, hey, what's the best place for X? It's you know for an eating disorder or for bipolar or for substance abuse, but taking into account so many factors, I think most especially the family system, which often gets missed, especially nowadays. And I think we'll get to that point later. But functioning as that architect allows us to help create, and certainly with in the case of an adolescent and young adult, as much as possible with that individual's active participation and ownership of that process to the extent possible, and see that project through, be able to make changes as it's warranted. If we are placing someone into a therapeutic program of some sort, being able to advocate for that individual's needs and the family's needs throughout that process and into aftercare and beyond. And what are the steps necessary to sustain success, to sustain the shifts, the changes that are occurring for them as things progress, not just sort of a catch and release or referral?

SPEAKER_02 6:26

What are the most common misconceptions that you get from whether it's families or therapists, psychiatrists, other providers outside of the family, what are most common misconceptions that you have to handle when people first interact with you?

SPEAKER_01 6:43

Well, I think that there's what we get from a lot of professionals, psychiatrists, psychologists, and a lot of people who don't know us but know of us and think they know what we do, they very commonly will call us up and say, Hey Doug, what's a great program for X? That's the kind of thing that I frankly I bristle.

SPEAKER_02 7:06

I know you bristle at it. So I was about to say, I think that it it irritates you when that happens.

SPEAKER_01 7:11

I bristled at you about it.

SPEAKER_02 7:13

Yeah, yeah, you have. You have. So how do you then take that bristling and turn it into educating that person about what you do?

SPEAKER_01 7:24

I do a podcast. I like to ask questions. I like to try to find out what are some of the other factors that may be contributing to that behavior.

SPEAKER_02 7:32

So, what kinds of things do you think that mental health care professionals have been missing, if that's a fair question, that you might end up unearthing in your 360-degree evaluation? You said you're trying to figure out what the factors are that may be contributing to the depression and anxiety. So I'm curious whether you're identifying things that just haven't been surfaced in the young person's treatment thus far. I mean, they all they wouldn't be coming to you if things were going really well in their treatment, right?

SPEAKER_01 8:02

Sure. And they all they also come to us once they've tried and failed. I'm using air quotes, a number of other things. So there's already a lack of trust in the system and in care providers and whatnot. The things that they're missing, I would say nowadays, the thing that gets missed the most frequently is the family system. And this is factors like the proliferation of technologies for therapies, and many of them are good and research-backed and evidence-based in the aggregate. But if you look at what that does is it it sort of over-pathologizes the child. There's a lot of focus by the parents on how do we fix the child, young adult children. You know, how do we fix them? How do we give them the externalized resources or motivation or other containments that are all external without really attending to the relational aspects of the family or dynamics that are occurring within the family that are contributing significantly to the problem, which is not to blame the parents, is to say I think our system has evolved to a point because of economic forces, cultural factors that really put everything onto the individual without attending to some more of the nuances that are at play just as much.

SPEAKER_02 9:23

Well, that idea of identifying the factors in the family system is not new. I mean, we were raised on that language, and I think it's really interesting that we both actually ended up in fields, since I'm a geriatric psychiatrist, you know, where part of the attraction for me is with in working with the family system. But what I think I'm hearing is that the healthcare professionals, I mean, I don't maybe it's a lot of self-blame here, but I think we're not trained in really analyzing, identifying, working with the family system because in some ways we also were treating the patient, you know, the way the system is. Yes, but also, you know, unless you are coding for billing for family therapy, you know, you're not necessarily most of the time, they're we're not talking with the entire system and probably a lot of times not even taking into consideration. I can't speak for child and adolescent psychiatrists, and I'm certainly not speaking for psychologists or other therapists who I think probably are trained, I think do get more training kind of informal history of and in theory around family systems, but I'm not really sure how often that theory is actually put into practice in therapy.

SPEAKER_01 10:45

Well, they're not necessarily compensated for it, as you point out. Exactly. They don't have the time for it. And often they're touching that patient for a small period of time. And these types of things take time and take the trust, the relational element of working with a therapist who can attend to the multidimensional nature of these situations.

SPEAKER_02 11:07

Yeah, exactly. So then do you find yourself educating providers about family systems?

SPEAKER_01 11:14

I I wouldn't say educating because I don't want to come at it with the belief that they don't understand it. I think that when I do get to know a new referral source, a therapist, a psychiatrist, for example, they are so grateful that it's part of what we do, that we attend to. Because I think they recognize that they are limited in what they can do. And so when I do meet someone new and I'm able to explain the depth that we get into and the broad range of concerns that we're focused on, I would be almost universally impressed and relieved because I think they recognize these things. And I think they're frustrated themselves that they can't attend to all of that, that they are limited in being able to touch on just one aspect of what that individual is and the pressures that they're getting from their bosses, insurance companies, oftentimes the parents themselves who are pressuring a clinician to do things in a particular way for a particular outcome.

SPEAKER_02 12:10

Yeah, and to fix my kid.

SPEAKER_01 12:12

Fix my kid.

SPEAKER_02 12:13

Right. Send me the bill, fix my kid. Yeah. So actually, so speaking of the kids, I know we've had a lot of conversations over many years about the types of cases and clients that you have seen over the years. So I know, and in the last, I don't know, five, ten years, maybe, I've heard you talking a lot more about different types of things that you're seeing. So, do you want to talk a little bit about what's different now in the kinds of clients that you're seeing? Maybe give an example of the type of client you typically see today versus one you would have typically seen 20 years ago.

SPEAKER_01 12:53

Sure. Well, some broad strokes, first of all, and I think this is borne out by many conversations I have with professionals in all sorts of settings all over the country on a regular basis. And that is that, and these are the broad strokes. Kids today are acting in, not acting out. They're growing up too slow, not growing up too fast. There's many different examples I could give of that. We sort of joke around. A lot of kids today, you know, and the statistics are all out there. They're not going out for the most, again, these are generalizations, but the going out, raising hell, drinking, you know, sex, drugs, and rock and roll. That's just not as prevalent because kids are more isolating, they're at home, they're online, they're gaming, self-harm. So it's not the risk taking, it's the risk averse. And so that's a dramatic shift. And I would say that trend was starting 10 or so years ago, but greatly accelerated during and through and after the pandemic. And I think that that's that's something that we've tried to adapt to. And certainly we see substance use plenty, but it's not the in-your-face crisis. It's not the I I used to joke about you know, Monday mornings, I would get lots of calls from parents whose kids had been arrested or wrecked the car on, you know, Xanax and alcohol the prior weekend. That was a routine thing. And now that's extraordinarily rare. We don't have the immediate safety jeopardizing types of situations that were just routine. It was like an emergency room around our offices. For two and a half decades, I've been I was doing this work. And now it's what I call a slow motion crisis. And so there's not the same in-your-face challenges that parents used to face. It's now kids are isolated, they're depressed, and they're anxious, they're online, and it's not in your face. It's sad, but I think it takes a lot more to get to the point where parents take action because it's not evident immediately that your child is at risk of not growing up, developing, maturing into a parent.

SPEAKER_02 15:06

Yeah, exactly. And so how do you know? How can you know as a parent, okay? My, I don't know, let's take an example. 14-year-old daughter is spending a lot so much time in her room. Okay, how do you know when that's something to be concerned about? How what should you be monitoring?

SPEAKER_01 15:23

I think we as a culture are still figuring that out. I think that there's this interesting push-pull between parents who want to have their kids be online, be attached at school and in other environments, because I guess they want to keep track of them. To me, it seems insane that kids are going to schools with devices that are, you know, full-blown computers, televisions, gambling devices, porn devices, you know, the whole bit on a 24-7 basis. And so I think what has become normalized makes it really hard for parents to understand what is problematic use versus what's just, hey, this is what everyone's doing. I'm hoping that the culture starts to shift, and with Jonathan Hayden, his evangelism or some minimum ages for access to social media and smartphones, et cetera, that we start to shift what's normal. And so it's not as hard for parents to make that discrimination between normal behavior. But I also think it's it's analogous to substance abuse. What is normal experimentation and how does that slippery slope become addictive behavior or behavior that is depriving them of other opportunities to grow and develop, problem solve, meet challenges, and get stimulation that's not generated by a device?

SPEAKER_02 16:43

Yeah, I think like as I'll tell you what a psychiatrist would say like, how do you determine whether something is, you know, whether symptoms are diagnosable as a disorder? And a lot of times it's whether it's impairing functioning in work, school, home, et cetera. But that's sort of our typical criteria. But I'm just thinking to myself, how difficult is that to fare it out when you know maybe they're only talking to their kid for half an hour a day because they're also online for multiple hours a day. Well, oh, that's a very good point. Right, because because everyone's on their on their devices.

SPEAKER_01 17:17

Right. So if their usage is abnormal, then maybe so is mine.

SPEAKER_02 17:21

Yeah.

SPEAKER_01 17:21

Yeah. Again, analogous to substance abuse.

SPEAKER_02 17:24

Analogous to substance abuse.

SPEAKER_01 17:25

And when you talk about impairing their ability to function in normal daily life activities, well, even what are normal daily life activities has shifted as an adaptation.

SPEAKER_02 17:35

It's right, right. The denominator has changed.

SPEAKER_01 17:38

Exactly. That's a smarty pants way of putting it.

SPEAKER_02 17:41

Yes, exactly. Exactly. How do I know if my 24-year-old is not developing normally, so to speak?

SPEAKER_01 17:52

Well the answers are all the same. No, I I think that what really is more complex with a 24-year-old or an 18 to 30-year-old, well, let's take that mid-20s range because especially in expensive places where we're based in Silicon Valley, and our clients come from all over, but in communities where it's expensive enough that kids kind of for economic reasons have to return to the home, save some money, work for a while. But a lot of them get stuck. And this is one of the biggest shifts for us in the last. We've worked with young adults. Personally, my caseload has been primarily young adults for a couple of decades. But more and more our clientele on the consulting side and on the mentoring side are these young adults who sort of semi-function. And they'll either attempt college, come back, or even complete college and come back, or never start college. And they'll they'll sort of languish but with glimmers of hope. You know, the attempt. What does that mean? What do you mean? I'm gonna make that up. I think what that means is you you get you get these little pieces like trying a couple community college classes, or working DoorDash, or becoming certified as a substitute teacher, or dog walking, or maybe uh some online gig work. You know, we hear about the gig economy. Well, that that's helpful for a lot of people, but it also can give the impression that kids are functioning or that they're so impacted by the economic circumstances that they have to sort of languish. And it's hard for parents to distinguish in a neighborhood, for example, or in your community of other parents who talk. What is sort of a normal life? All three of my kids came home after college and always worried a little bit, you know, are they gonna take hold and get going? Or because I I see all these horror stories and as you know, they've all taken off. But what's the distinguish between someone who's back from college and kind of working on the next job and doing stuff and will take hold versus the same kid down the street who might have come home or be in the almost the exact same circumstances, but that becomes years. That becomes more and more inertia of not moving out of it. And they're sort of becoming so comfortable at home doing minimal stuff, and the parents are scared, but not so scared because it's the acting out or substance abuse or the things that we all used to worry about, that it just becomes habitual. It became I use the word inertia because I think everyone's in it, the the parents, the kids. And only in hindsight do they see, wow, that really became very problematic. And they all say, well, we should have known we never should have X, Y, and Z, but how does one really know that distinction?

SPEAKER_02 20:48

Let me challenge or I guess question a little bit. I mean, I think inertia, that's true. There's inertia, but is it fear-based, right? I mean, what is the kid afraid of? What are the parents afraid of in these situations? Why are they so stuck?

SPEAKER_01 21:03

Well, you know, we've hit on both of my twin pillars of codependency, I call them, which are hope and fear. What are the fears?

SPEAKER_02 21:10

Well, I think Well, they have to be two pillars of codependency. Right? Because they're code- Yeah, because they're codependent.

SPEAKER_01 21:19

Right. Well, the co is that both sides are getting their needs met by meeting the needs of somebody else. So I think what what's the fear? The fear on the part of the parents is that if they push them, they might alienate them, their child might not like them, or they might turn to something more dangerous, that they will languish or fail out. So of course they're giving the converse message that they don't believe in their child by continuing to sustain their lack of progress. The child, I think, is fearful because we're in a fear based culture where we can get into the over identification with mental health disorders, which I think is a big part of the problem that a lot of the kids that we see who have languished at home for multiple years. By definition, our clients tend to have mental health diagnoses, but there can be an overemphasis on that or their impairment because of that. That is very different than how things were even five years ago. There used to be an aversion to having any mental health diagnoses, and now there's a prerequisite and an identification and excuse making oftentimes with the diagnoses.

SPEAKER_02 22:26

I mean, this is such an interesting topic that we could go down a rabbit hole about it.

SPEAKER_01 22:31

Divide this into two episodes.

SPEAKER_02 22:32

Yeah, but do you feel like and now I'm just sort of interested in like poking around to see like, okay, how do you feel, or how what are your observations when talking to, particularly with parents? Do you think the parents are also over-identifying in some way with the diagnosis? And then also using that, incorporating that as an excuse to kind of justify that fear of setting limits or pushing the kid. Are the parents also doing it? The kid might be doing it, in other words, the whole scene.

SPEAKER_01 23:01

I think their parents don't know what to do because I think they're inundated with so much information and so many experts telling them what to do, or telling them you need to give them time or adjust to this or accommodate that, that they're almost paralyzed. And I think that in their guts, they sort of know it often. And again, these are generalities, but I think oftentimes they know it, but are too fearful to address it. And the in-your-face implications just don't exist. So it's it's the soft crisis, it's the slow motion crisis that doesn't give them the mandate to address it in any more proactive way that we used to have when someone was, you know, smashing mailboxes, you know, hanging out the window of a car drunk on a Saturday night.

unknown 23:43

Yeah.

SPEAKER_02 23:45

Yeah. But we shouldn't talk about your teenage years too much. So when you say slow motion crisis, though. I will neither confirm nor deny. When you say slow motion crisis, so like typically, how long do you think that crisis has been going on? Like when you see a young adult in their, I don't know, mid-twenties, and you start getting the history, what are you learning? Maybe give us some, give me some examples, the types of things that you could have been tuned into, with the benefit of hindsight. Here's what was going on 10 years ago, eight years ago, et cetera.

SPEAKER_01 24:23

For a lot of them, you know, I don't know that there's anything they could have done differently because a lot of times there are kids who may have been, you know, that mild to moderate learning disabilities or some quirkiness, or maybe you know, on the autism spectrum. And they probably would have done fine. And there's a lot, you know, probably every call that I take, without exception, mentions how the pandemic lockdowns devastated their kids. And so the kids that I think were sort of marginal, or not marginal, but but who were you know doing fine, they they probably would have been okay and gotten through, I think just dropped off. And many of them never came out of it. So our young adult population, that average age has shifted upwards. And so they were languishing. And I think if they were to apply hindsight, they would say, oh, well, as soon as they came back from failing out of college for the second time, we should have A, B, and C. But how were they to have known at that point? I think that what I would probably say to parents now is that there should be a very clear message when someone comes back from college or is back in the house about how long that's going to last and what those expectations are going to be. That a parent needs to shift from being the parent of an adolescent and the responsibilities that accrue for the parents for that individual versus that shift. And it's a big shift that needs to be made when they become adults to expect adult things of them, even if they're coming back and living in the house. And that it should not be a blank check with an unlimited time frame, and that it should be clear early on that this is temporary, that this is something that is a launch pad, but not an unlimited menu for.

SPEAKER_02 26:12

Okay, so how so what does temporary mean? Because I bet a lot of people think that or might say it, and then they bet they like with substance duties, right? Well, this is the last time.

SPEAKER_01 26:23

Well, let me put substance abuse aside for a moment. So I would say a year, if I had to give a timeline. And I think then that's gonna people would say, well, you know, you you can't live around here with a single person salary. And I'd say a couple things. One, yes, you can. It's not gonna be that comfortable. You might be renting a room somewhere, and you might have to be working a lot of hours. But that's how one starts to develop that work ethic, the grit, and the motivation to further oneself because you want to live better. And I think even with parents subsidizing a little bit, getting out, getting autonomous is important. Or maybe they can't live in the most expensive place on the planet in the history of time.

SPEAKER_02 27:01

People used to move a lot. Yeah. I mean, the other thing, yeah, you used the word comfort earlier, you know, and accommodation. And I was I actually wanted to come back to that because I think I think that is a factor that's going on that maybe we maybe don't even want to admit to ourselves. Like we know we want our kids to be comfortable, we don't, you know, et cetera, et cetera, but that's not necessarily helping them. In fact, it might be but that's about us.

SPEAKER_01 27:26

That's our our discomfort with their discomfort.

SPEAKER_02 27:28

Yeah, so so exactly. And we I know we've talked about this tons, we've had many conversations about that, that that's something that now, in my view, I'm not in your I mean, I that I think a lot of parents have trouble tolerating the kids' frustration, the kids' discomfort, even from a very young age. And then if you don't sort of address that discomfort in yourself and your own your own anxieties about your kid, then I think that's contributing to what you're seeing later on. Even, I mean, I know we're talking sometimes about kids who may have you know underlying learning disabilities beyond the spectrum, etc., have mental health diagnoses, but I think it's true across the board that parental anxiety is natural, but I think that the way that we cope with it now has changed a lot.

SPEAKER_01 28:25

We have the affluence to support it. Yes. And the other thing is that our generation, I think, has a lot more involvement with their kids. Yeah, no, don't kidding than the prior generation.

SPEAKER_02 28:37

Yeah, mine's texting me right now. No, I'm just kidding.

SPEAKER_01 28:40

Well, you know, the involvement that we have in our kids' lives for the generation of parents, you and I being that sort of generation of parents that had the ability, the affluence, the time to be much more involved in our kids' lives than prior generations were able to. And I like being around my kids. I think we like having them with us. You know, emotionally, I would love to have my kids close by in my house, you know, all the time, hanging out, having fun. It's fun. It's awesome. It serves my needs, but it doesn't serve theirs. And I think that's the distinction that we parents have to make and recognize in ourselves where our needs, when they're super exceeding our kids' needs to develop, despite the discomfort, that's what we have to go through, absent the in-your-face crisis.

SPEAKER_02 29:24

How much pushback do you get from maybe pushback is not the right word, but resistance, I mean, from the parents that you work with, you know, when you're trying to get them to set limits, not give them a brand new Tesla when they graduate high school or whatever it is. Because those are some of the things you have to deal with, right?

SPEAKER_01 29:42

Those are the obvious ones, but I think the more difficult ones are when, well, a couple things. You know, one, we see a lot of families who will build ADUs for their kids with the expectation. ADUs for those of you who don't know out there are these small little houses.

SPEAKER_02 29:59

I don't know what the acronym for like tiny accessory dwelling unit, I think.

SPEAKER_01 30:04

Yes, on their properties, or just setting things up with a a seeming expectation that they're going to be there for you know an extended period of time, if not forever. That has its own normalization, that the families have the resources to do that. And so I think that it's not the obvious cases like buying them a Tesla. And it's more the ones who have, you know, fairly legitimate disorders and things that are going on. We did already talk a little bit about the over-identification with mental health diagnoses and how that helps the kids' language. But I think that overly indulging that or not expecting things of their kids because of that, and creating scenarios where there's no expectation for rent, for duties around the house, for participation in anything, that's the more difficult one because the question is how do we set a limit when they are unable to do anything with that limit? You know, I deal with 26 year olds, 28-year-olds living at home, it's been years, and we create what I call extrication plans. So how does that look?

unknown 31:10

Yeah.

SPEAKER_02 31:10

I mean, that's that's a little what does it mean? So tell me what that means.

SPEAKER_01 31:14

It means establishing a document, and I don't have a template for it because I really want parents to have to wrestle with the content and what they really can and can't live with, because typically they've made threats or brought in other experts or whatever to try to convince their kid to do something that is going to appeal to their kid enough to quote motivate them. When in fact, parents can't control that. I really have to talk with the parents about how to control only that which you can control, which is your own limits and boundaries, and to, in essence, let go of the outcome and then to draw up what are the clear, consistent, credible, and cohesive boundaries and limits. And at the same time, often, what is the offer? The offer is that you can work with the Bowdoin Group Mentoring Program and have the resources for you to establish on this timeline that we're going to offer you of continued largesse or support, whatever, but it's time limited. Here's the timeline to establish that independence. You can take advantage of that or not, but despite your participation, here's the here are these markers and these deadlines. That's also part of what I call the slow motion relational intervention, which is that a lot of these kids, young adults, do ultimately need to be in treatment programs or they need to be in independent living or transitional living type programs, of which there are many out there. And so we invite them to participate in this process that will help them. Ideally, they're they're taking ownership of this with me to identify those places that they can go because they recognize that parents are finally setting these limits with my help, and that they have no alternative other than either being homeless, which none of my clients ever have been, or going to one of these programs. And I think that what's interesting about that is that when they see a logical, reasonable plan taking place, that they have a part of defining. In fact, I want them in the lead on creating that blueprint with me, with the parents' support, but that they are part of the planning, they're actually relieved because those kids, to your point about fear, they are very fearful of it. They're smart, they recognize that they're languishing, they just don't know what to do about it. Much like an addict who's stuck in their disease, these young people recognize that they're not progressing, they're not moving forward, and they don't know what to do about it. And so by working with me on that plan, they start to see that there is a pathway out of this. It's not a quick, easy fix. It's not just some person they have to go to and talk to a yet another external force, but rather something that they can participate in, design, and it makes sense to them, they go, they do it. And that's a huge part of what we've been doing.

SPEAKER_02 33:56

I don't think I even realized until we were talking about it just now that sometimes that takes a while before this planning process and this engagement process and getting the kid to buy, I'm saying kid, young adult, let's say, to buy in, as well as the parents, before they actually end up going to a program if that's what if that's what they end up doing.

SPEAKER_01 34:16

Yeah, that's actually a really important point because you asked, you know, how do I educate at the beginning of this? You asked, how do I educate clinicians or referring other referring professionals about it? That's why I call it a slow motion relational intervention.

SPEAKER_02 34:28

Did you coin that term? That's very good.

SPEAKER_01 34:31

Yeah, I've been using that forever, you just don't pay attention.

SPEAKER_02 34:34

Um the An SMRI.

SPEAKER_01 34:37

That is exactly right, ironically. Yes. No, I I I think that it can take months, not typically that many, but it takes some time to establish for the parents where are they willing to draw these limits and for them to get comfortable with it, and then to establish the relationship with the young person and the trust in me and in this process and the recognition that this is actually a viable pathway out of their stuckness, their misery, their stuckness, their inertia. And it does take some time. It takes several meetings, it takes exploring different possibilities, it takes the kids building trust that their parents have really made these shifts. So a big part of what I'm working with with the parents is how do they start to demonstrate in small ways that things are changing, that they've made these shifts. In fact, I ask them to take ownership of their stuff, not to say, hey, here's someone who's going to help you, but rather we are getting help in recognizing what we can do differently so that we're not, again, another force putting all this blame on the kid. But the parents have to take ownership of where they have not been clear, where they have not been consistent, where they have not been credible, and they've certainly not been cohesive. So that's a big part of it. Is this then this is where I think it's a family system intervention too, if we want to point a new phrase.

SPEAKER_02 35:55

I was wondering what it must feel like as a parent, too. I mean, I was wondering if there's a lot of guilt, you know, like I that I haven't set these limits. I haven't, you know, by the time you get to a point where your young adult needs, you know, an intervention where they need to go away, or you've got to, you know, hire a consultant, what are the most common things you see in parents? And I don't know if that's a fair question, like emo emotional anything.

SPEAKER_01 36:21

Yeah, boy, it runs the gamut. I I think the first thing is what comes up for me is that I think we have to get past the parents' recrimination of each other. So that that's the first thing because a lot of times what's masking their own sense of guilt is also their sense of blame to another parent. So that's that's one thing that's a big part of it. And that's part of why I use the word cohesive is we have to get past some of that and move beyond coulda, shoulda, woulda and into what can we do now? Where here we are. How are we going to get cohesive and credible? Because our lack of cohesion historically has also led to a lack of credibility.

SPEAKER_02 36:57

Yeah, when you can split your parents, it makes it much easier to see it's a great thing. Not that not that it's necessarily conscious on anyone's part.

SPEAKER_01 37:08

Of course not, but that's why we have to also be transparent. And the parents have to be also transparent and own their stuff in order to establish more of that credibility with the young person that things are different. Not that we're laying down the law, we're not making threats or whatever, but we're just inviting them to participate in a process to take ownership of their adulthood, while the parents at the same time decline to continue to facilitate their ability to not engage in life. In fact, they are depriving them, they're depriving of their child of their child's right and responsibility to become an adult and a functioning and contributing member of society.

SPEAKER_02 37:45

I'm just reflecting like it's so interesting that this is the place that we're talking about, this that this is where we're at. Because I was thinking, like, when we were teenagers, I mean, like you say, people were acting out and we would hear things or see things, but this and and then later in our 20s, I this was not on my radar screen at all.

SPEAKER_01 38:04

No, no. And this is, I think you asked what are parents going through. And I think this is where it's so confusing for them.

SPEAKER_02 38:10

It is confusing.

SPEAKER_01 38:12

Because it's it's not what the parents obviously grew up with as being normalized either, but because it's so ubiquitous, they don't really have a great barometer for what they could be or should be doing. And they're also getting so much information. This is also what's different. They've got so many experts and so many books and so many.

SPEAKER_02 38:30

I was actually gonna bring this up. Yeah. You're just adding to the noise.

SPEAKER_01 38:36

That's right. It's my objective.

SPEAKER_02 38:38

No, I was gonna I was thinking about this earlier in this conversation. You know, what part, this this could get a little controversial here, but we might we might as well, right? I mean, what part sometimes are therapists, psychiatrists playing in perpetuating the pattern of accommodation, of comfort, of enabling, of what you've referred to as over-identification with the diagnosis. Do you see that as part of the issue?

SPEAKER_01 39:06

I don't think it's necessarily the therapists or professionals as individuals, but it's more the therapists and professionals in aggregate as part of the culture. And where has that been emphasized? I think we had this maybe over-correction with the mental health crisis, to where now we have so much accommodation and attention, to where that becomes something that inadvertently becomes one's identification, is as requiring all this mental health attention, that the mental health diagnoses are not consciously, but become the excuses to not function and become the cudgel that kids can wield explicitly or implicitly against their parents to continue to derive that overindulgence of those disabilities. Okay. So this is something that's can I say one more thing?

SPEAKER_02 39:56

I can say one more thing.

SPEAKER_01 39:57

It's my podcast, remember that.

SPEAKER_02 39:58

For now.

SPEAKER_01 39:59

But I I want to make reference to the article, I think it was in the January edition of The Atlantic, where there was a big article that got a lot of attention, and I think also a follow-up article in the New York Times that referenced the huge use of testing and uh and disabilities in elite universities, especially. And so many young people are getting accommodations that it's now become the competitive edge to have this. And those who don't get it, often people with less affluence to get the experts to do the testing and make these diagnoses, are the ones being left behind. So it's that's a it's not any one individual, it's the way the whole system has evolved.

SPEAKER_02 40:40

Yeah, I could even say I remember when one of my kids, the one with ADHD, or the one who's been diagnosed so far with ADHD, you know, was in high school. And I remember being, you know, consciously like, okay, do we apply for accommodations on the SAT or whatever? Honestly, I can't remember what we ended up doing. I think it was not doing that. But I remember having such mixed feelings about it because you're right. If you're if you're a parent or a kid and everyone else is getting accommodations and you also have a diagnosis, but maybe it's not, maybe it's well treated, or maybe it just hasn't held you back that much. Maybe you're a super smart kid and you really don't need that accommodation. So you're saying it's kind of like it's like the nuclear arms race, rather than wrapping it up.

SPEAKER_01 41:27

And I don't think I this is why I don't point the spotlight at any one individual therapist, because and we do testing and assessments too. We do a great job of it. We we find that kids need accommodations all the time because that's why they're coming to us. But it's just that the shift, the Overton window has moved so much into that being the norm. So then where are the kids being left behind who aren't able to access those resources?

SPEAKER_02 41:51

And I think about it like this too. I mean, just again, I'm putting my psychiatrist hat for a minute. Like everybody has symptoms, everybody has anxiety, we all have moods, most people have some degree of mood swings. When we have broadened the diagnosis, oh, let's talk, you know, talking about trauma, right? When we broaden the use of a term so much or even neurodiversity, it can contribute to it becoming almost meaningless. But on the other hand, you know, so I struggle with that because I do see it. I mean, I see people come in all the time to our clinics, for example, who self-diagnose with many different things and may want a specific type of medication to be treated a certain way. But you know, there are people who really do have significant mental health needs. Obviously, you know, that's why I went into the field because I saw the need, and well, that's not exactly why I went in, but because I found it interesting I found it interesting too. So again, you know, there are kids who really, really need serious help, but then there, I think, I think to your point, there has been a lot of latching onto and identifying with diagnoses, and I think social media has fueled it. I I don't think anything I'm saying here is is particularly novel. And and there's not as much stigma. And so I think I've thought about this issue a lot. The stigma and destigmatizing all kinds of things is a double-edged sword, right? We want people to get help for things, right? But we don't want to normalize that thing so much that you know, well, everyone's doing it.

SPEAKER_01 43:29

So what's the one take it a step further because I think there's also there's a social coherency to having a mental health diagnosis. Okay, but make that case just beyond just because I just beyond saying it?

SPEAKER_02 43:42

Yeah, but just because you're saying it doesn't make it so I think it's so interesting. I mean, I totally think it's interesting. I see it very similarly.

SPEAKER_01 43:50

I just want to force you to You want me to steal mammon argument? Yeah, whatever. Whatever that means. I see it when I'm speaking with young People now, and there isn't, and there shouldn't be the shame. You're right, it's been destigmatized. But just the way they often talk about it, and I see it not just in our clients, even our pop culture. There's glorification sometimes of this, the not just the excuse making, but the power of victimhood as being a noble component of where we are in our culture. This is you know off topic, but I see that as being the thing that some people can latch on to and extol as part of their virtue, is their victimhood of their diagnosis.

SPEAKER_02 44:40

I've thought about this a lot, how different things were when you wouldn't have been open about having a mental health condition or struggle, or even like, oh, I'm gonna go to see the school counselor. That was not something that was public knowledge and you would have wanted to hide it. And I don't I don't necessarily think that was a good thing.

SPEAKER_01 45:05

I just think, maybe to your point, Doug, like have we just gone so fully in the other direction that there are unintended consequences of destigmatizing to such a degree or destigmatizing has led to an overvalorizing and the overuse often of terms like trauma. One of our episodes was about the pendulum swing to where that that term is overused. And we have also adverse childhood experiences now.

SPEAKER_02 45:35

I was just gonna bring that up.

SPEAKER_01 45:37

Go ahead.

SPEAKER_02 45:38

Just gonna bring that up. Well, so my understanding is that the research on ACEs and adverse childhood experiences, with specific definitions of what those are in the original research, you can identify associations with negative outcomes on a population level, but it was never meant to serve as an sort of an individual predictive tool or even a screening tool in any way. And I don't remember where I read this, but that it's gotten to the point that people sort of believe that screening kids for ACEs is critically important. I don't know that we've actually proved that in any way. The actual literature is that most people are resilient, right? So, yeah, you do want to kind of try to identify the kids who are at high risk for negative outcomes after traumatic experiences, but what those traumatic experiences are matters, the severity, the frequency matters. And I think a lot of that has gotten glossed over in the overuse of, I would call it overuse of the term ACES very broadly.

SPEAKER_01 46:50

Well, and I think that's also a way of getting money and grants and the proliferation of therapy and therapeutic services and in schools now, which wasn't the case 10, 20 years ago. And I think it's a good thing to have attention to mental health issues. But there's also, and I think I've seen this in the state of California with ACEs, the economic principle holds true. You always get more of what you subsidize.

SPEAKER_02 47:16

Yep. Yep.

SPEAKER_01 47:17

And so if if if you're being paid to go and look for these things, you will find them.

SPEAKER_02 47:22

Yeah, exactly.

SPEAKER_01 47:24

And again, and then medicate them or treat them or reinforce for that individual. This is where I think the mental health profession has been complicit to some degree in reinforcing mental illness as opposed to expressing more about their resiliency. And ultimately, do they all need to be in therapy weekly for the rest of their lives and on medication for the rest of their lives, et cetera?

SPEAKER_02 47:45

I don't disagree with you. I was just going to say I think what we have not done, I'm going to say as a field, but that's very, very broad, right? Is to actually say, you know, if mental health treatment, if mental health intervention is a scarce resource, which it apparently is, and I would argue it is, if it's so scarce, then really we need to be careful about how are we spending that resource, right?

SPEAKER_01 48:10

And what everyone Are we allocating it where it's needed most and for those who is the proliferation of everybody having a diagnosis really depriving those who would not otherwise access it, really getting it?

SPEAKER_02 48:21

Yeah. And we could get into lots and lots of like the incentives, the incentives for, let's say, psychiatrist to go into public psychiatry serving the severely mentally ill in like a public setting, publicly funded setting. Those are going to be very different incentives from opening up a private practice in Silicon Valley and not taking insurance. There are different incentives that also affect the allocation of these. So we can't determine how these resources are going to be allocated. But I think you're right that if we're giving 90% of Stanford students a diagnosis of anxiety, what does that mean? I mean, what does that say? What does that say about our field?

SPEAKER_01 49:11

I think that these are all the challenges. What we're talking about now and what we we sort of geek out on together is what's happening broadly. And I think that one of the things I love about the work that we're doing here is that we're we're taking all these concepts and applying them. And I and I think that that holds true for how we approach the consulting work and developing these plans one at a time. But applying the lens that you and I are talking about to how do we apply that to each individual and their family and the team of people around that individual and that family. And how do we help create a blueprint with mindfulness around all these other forces outside of their control that are in action? So I think that's important. And I think it's especially important in the philosophical underpinnings of our mentoring program.

SPEAKER_02 50:01

I was just going to ask you actually. So if you could describe that in because I don't remember when the mentoring program came about, but can you kind of go back and say, how did that develop? What was the need, what were the needs that you saw that the mentoring program was divided in?

SPEAKER_01 50:19

We've been doing the mentoring program now for 11 years, and it came about organically, in the sense that it was someone who had been my client and had gone through a therapeutic wilderness program and on to a therapeutic boarding school, and came back to do an internship with me one summer, almost finished with college. And having a mentor by accident for him, when he returned, it was his baseball coach, was just very informally serving in a mentoring capacity for this young man who was returning to his same community and faced the same challenges, having gone through a year or so of being in a therapeutic program or two. And we just we had a couple of clients that he would sit in with over a summer who needed to kind of get out and do stuff. Stop smoking weed, stop sitting around, stop goofing off. And he took them under his wing and went out and got them jobs at the grocery store, or took them out in the park, not throwing a football, or just spending time with them. And that sort of grew from there to where at the end of that summer, we literally back of the envelope, kind of penciled out some numbers and said, okay, when you're done with college, come back and let's do this more formally. And that's that was the start of the mentoring program. But the underpinnings is really this everything that we're talking about in terms of how do we help kids get out. And I think it's the mentoring has grown tremendously under the leadership now of Trina and Hannah and Jenna. And what we've now formalized is this notion that kids need to get out from their rooms, from their devices, out into the world, doing things physically, in person, in real life, that can start to build the underpinnings of self-confidence, of growth, of competencies, of skill building, sort of applying that zone of proximal development mindset that we're going to continue to increase their confidence level, their self-confidence in doing things that then applies to other domains of their life. So, for example, we do a lot of rock climbing, all sorts of physical things that they didn't think they could do, that they start to challenge themselves, they master something, and then you know what? They can get their homework done or they can apply for a job. And we help them do that. So we're not doing it for them. We're not implementing parents' agendas. We're really working with that individual to identify what their goals are. And sometimes those goals don't have the immediacy of, well, I need to build this skill so I can do my homework better. It's something that might not be immediately relatable to it, but that builds that foundational level of belief in themselves, of something that gives some meaning, some purpose that can help them blossom into something greater. And that's where we've seen a tremendous amount of success of taking it offline into the real world. And I think it just makes perfect sense. And I think more and more people, over the last 10 or 11 years we've been doing it, I've seen that just the word mentoring has exploded. I think people are recognizing the importance of something that is, in our case, deliberately not therapeutic over.

SPEAKER_02 53:31

That's what I was I was just gonna say. I mean, it's it's not sitting across from someone and being asked to talk about your feelings and whatever else you do in therapy. It's very different. And it's it's so again, I'm still kind of amazed that we're at this point that getting people to get out, get a job, do something physical, that that's what some young people really, really need to be pushed initially to do, but just to gain those, well, what was it, the zone of the zone of proximal development.

SPEAKER_01 54:04

So sort of expanding their their range of competencies. They it might for a lot of our clients, sometimes it's just getting out of the house and taking a walk around the block. Literally, we have a lot of clients that are so shut in and shut off from the real world that they're pale. You know, they have not been outside or so infrequently outside because all of their needs are being met in the home. Their stimulation is coming online, their food is coming from DoorDash or parents or what have you, and they have no other outside needs. And so just building that muscle memory, yeah, some routine, sleep habits, nutritional habits. It's amazing to me how many of our clients just need to learn how to make a sandwich. Really?

SPEAKER_02 54:51

Or I believe you now that I've heard you talk about it multiple times. Like it was initially kind of hard for me to believe when we would first talk about this that some how basic some of the things the skills were that some kids need. Kids, and yeah, I'm saying kids, but yeah, yeah.

SPEAKER_01 55:05

And I don't want to sound I don't want to sound as critical or as demeaning when I say those things. I mean these are the things that have evolved as part of our culture. We've allowed for this to happen. I'm not blaming any of the parents or the kids. And I think that again, the pandemic really did a number on everybody because that sort of forced everyone indoors and into an avoidant posture in a lot of ways. And for many, they just couldn't come out of it. Or the culture hasn't come out of it. Well, and it affects it. The culture has not re-re reset, recalibrated.

SPEAKER_02 55:37

And to be fair, it's not just these young people you're talking about. I mean, it's people who could not come back to the office, right?

SPEAKER_01 55:44

Absolutely. And I think that this is where the parents, too, they're at home and they don't want to cause trouble, or they can't be sitting on work calls on Zoom and then be worried about whether Johnny's eating or not, or what have you. And so DoorDash is the easy solution in that moment. And that can become habitual. That can become their own way of avoiding the confrontation or having to force the issue, and that creates the parents' own discomfort or challenge or disruption in their lives. And they're they're trying to get through as well.

SPEAKER_02 56:16

Yeah, it's very, very family systems. It's very everything you're saying. I don't know, we didn't we talked a little bit about this before, but I don't know how many of your listeners know that our our father was a very, I don't know, pivotal early person in the whole family systems therapy world. And I think it's just really interesting that, you know, you and I both end up, but you you you more so, like, you know, utilizing the principles, theory, and practice, you know, of family systems in your daily work. And you've probably invented all kinds of applications that probably were never even imagined by dad. Dad would be proud. He is proud.

SPEAKER_01 57:01

I think not to be too I think he would, but uh you know, Dad would be very proud to listen to this podcast.

SPEAKER_02 57:07

Yeah.

SPEAKER_01 57:08

He'd like to circle the notes and red pen and want to. Make corrections. Make corrections. Yeah, and give us a lot of reading assignments. And I would do the reading. You would do the reading and I would cheat off you. That's right. That's exactly right. The the thing early on in my career was that I I didn't know that it wasn't a thing to be family systems oriented because it seemed so obvious. I think because of how we grew up and what we were exposed to. And we were right there at the formative stages of family systems theory, you know, at the Mental Research Institute in Palo Alto, and I think I washed most of their cars on weekends to make some money. But but also paid attention. And I think it was in the ether, it was in the water we drank, the air we breathed. And and so when I first started this, it just seemed obvious that we would pay attention to it. And that when I started talking about it with programs, I'll never forget my first meeting with Jared Baumer, who's a an a pillar of the private mental health treatment world for decades. And he was extraordinarily gracious and just so encouraging of me as I was talking about these things, and he was saying, well, no one else is talking about this, and this is so important. And he really did it too and was a devotee of MRI and the teachings there. And that was when I first understood that it actually wasn't the thing, and that we started to emphasize at the Bowden group seeking out those programs that emphasized inclusion of the parents and the parent system and doing family therapy as part of what they were doing for the kids. And that was unusual 35 years ago. And not only did we look for them, we also strongly encouraged programs that weren't doing it to develop it, to become good at it, because we would not referring them and including them. And you know, we were the still are, you know, we were the big player and we became that. And then, you know, really encouraging them. Look, we can't work with you if you're not also developing this, if you're not also making sure these things are getting attended to, you're not a viable program to us. How do we integrate you into one of our plans if you're not attending to the things that we see as being vitally important?

SPEAKER_02 59:18

Well, you made a point. See, I learned some things about your work that I didn't know. I mean, I think that's a really important point, that it was so fundamental to your work that it had to be incorporated by programs. I didn't I didn't know that in the way that you just described it. Can I switch gears to one other topic I want to mention, which was I don't know when this changed, but when did things start to shift away from wilderness programs? What happened there? I mean, just kind of educate me about what that part of the industry was and where it is now and what happened. Because I know you know all the details, but I really don't. What's been lost? What's been lost?

SPEAKER_01 1:00:00

Yeah, this is a thorny one. And I'll try to do a quick version. But to me, the value of wilderness therapy programs, when done well, and I want to use that caveat because I think there's been so much attention to the ones that weren't doing things well, that were applying some bad practices. But I think the purest of wilderness programs took, in their beginning, the sense that we're not here to break kids down, but rather to build them up. And, you know, they got accused of brainwashing kids. But in fact, I think our culture brainwashed kids into a particular way and the substances and negative peer influence and and whatnot. And so I think that the value of wilderness therapy, and I still believe in experiential work and experiential therapies, and and our whole mentoring program is built on the concept that doing and accomplishing, going through challenging experiences is what builds one up. And I think that was what I loved and appreciated about wilderness in its formative years and where it became more common. I think that what happened was several things simultaneously, sort of the perfect storm. One was a lot of stories from what are called survivors, people who feel that their experiences were horrendous, abusive, punitive, illegal, harsh, damaging, injurious in all sorts of ways. Some of which I think were were true in some really bad places. That was spurred on by Paris Hilton and her group. I won't go too far into that, but there became a really big online presence of people really attacking wilderness programs writ large, all of them. There was no differentiation among them, but the industry as a whole was branded as abusive. And I think that's now the common understanding among this generation of parents and young people. There was a Netflix documentary, and you know how these things go. They just really create a one-sided view of things. And so I think that combined with a lot of private equity firms came in, bought them, cut corners, removed some of the purity of what the original beautiful mission was of a bunch of tree huggers with therapeutic backgrounds, working with young people to allow them to have these very pure experiences of dealing with themselves, interacting with each other and mother nature and adversity, thereby building themselves up in ways that I have not seen in any other type of therapeutic program. Period, full stop. A lot of that got lost when the big companies started buying these programs and making them sort of universal and often bringing kids in who probably didn't need to be there. You know, one of the things that we did as consultants was we were sort of gatekeepers, making sure that the kids were getting to the right program with the right therapist for the right circumstances and getting their needs met before, during, and after these interventions, which can be very extreme. But I think because they became private equity-based big corporations, they were advertising them to just about anybody, and parents would just send their kids almost as a punitive endeavor. And so I think it got used in inappropriate ways many times. And that just served to really take what was a beautiful and pure and fantastic experience for the vast majority of people, at least the ones that we sent. Again, we were the gatekeepers. We were doing it as part of within the context of a blueprint of a plan as one step in that project, not just a, hey, let's just go throw this at it the way we would some other short-term intervention and expect it to take hold without any broader.

SPEAKER_02 1:03:37

Are there still therapeutic wilderness programs out there?

SPEAKER_01 1:03:40

Yes, they are. And they're they're making some important changes. In fact, I'm speaking with one of them this afternoon because they really want to hear from me and hear about this stuff and about what adaptations do they still need to make in order to both remain true to their mission, their passion, but also adapt to the marketplace. This goes into, I think, what we were talking about earlier that the parents can't conceive of their child's discomfort. Well, wilderness is by definition and by design not comfortable.

SPEAKER_02 1:04:10

Well, I did send one of mine. Do you remember? I sent one of mine to, but you know, it was only a week, right? Outward bound for a week after ninth grade, and it it kind of was punishment.

SPEAKER_01 1:04:23

That's on you.

SPEAKER_02 1:04:24

Yeah. Well, and I don't, I mean, maybe I'm not I don't remember that. And but it was but it was very, very beneficial in a confidence boosting way and getting off the phone kind of way.

SPEAKER_01 1:04:38

I think when we think about outward bound or gnolls or some of the non-therapeutic, I know they're not that kind of leadership, the outdoor leadership experience. Yeah. I think we all know intuitively, even nowadays, what the power can be of being removed from screens and devices and drugs and whatever other, you know, family conflict, what that can do to someone without any of the therapeutic overlay deliberately infused into it as well. And I think that the good programs done well did and still do bring that sensibility into it in a way that no other therapeutic experience can. And so I think what happened is it just was a conflagration of many factors that branded wilderness therapy as this horrible negative experience for everybody. And that's that's just not the case. It saddens me because I think part of painting it with such broad negative strokes as the media and other online forces have done, is that it scares people away from something that really can, and I think almost always is, if done well, a profoundly life changing experience. And not just in and of itself, but as part of this plan. I I want to really emphasize that because it's not a one and done thing any more so than a freaking rehab. Don't get me started on that world. But I I think that, and this is where I'm passionate about the work that we Do is because it's not just a referral to a program to fix your kid. It is how do we use these different therapeutic experiences and programs as part of the greater blueprint plan that has not just cross fingers and hail Mary and hope it works, but rather it's something that's a design.

SPEAKER_02 1:06:18

I like that when you've been using that analogy of you being an architect of the design of a plant. Because in fact, I don't even recall you saying that until fairly recently. So you may have been saying it for a while and I maybe I just ignored you. But I think it's a really good way of looking at it and helps kind of immediately visualize what you're talking about. It's not one and done. It's not you send your kid to treatment, or it's not even send your kid to therapy once a week and you're done. And I think that's the mindset that you're really I say we, everyone, we're we're pushing back against is that kids need to be fixed, or there's a I actually want to talk more about that whole topic of there's a mental health crisis among youth. Well, is there, or is there a crisis of parenting, a crisis of family, a crisis of culture, all the things that you've talked about, this this whole this whole backdrop, and even everybody, including the governor of my state, you know, talking about there's a youth mental health crisis, we need to do something. Well, sometimes if we misdiagnose the problem, right, or oversimplify the problem, the treatment may be not the right treatment, right?

SPEAKER_01 1:07:36

Ironically, I think that often the use of the term mental health crisis is its own form of gaslighting.

SPEAKER_02 1:07:42

What do you mean by that, Douglas? No, I really want to know what no, what do you mean? It's a gaslighting. What does that mean?

SPEAKER_01 1:07:49

By labeling everything a mental health disorder, by labeling, you know, ACEs, by taking small adverse childhood experiences and branding them as trauma requiring lifelong mental health care, we've gaslit them in a sense. We've told them that they're mentally ill. We're in fact, you know, they're having a bad day or they're having an anxious moment. They don't have an anxiety disorder. That's why I use that term.

SPEAKER_02 1:08:12

And this is where I feel like I'm struggling so much in my own, I don't know, maybe identity as a mental health clinician and you know, leader is because again, I feel like the numbers say one thing. Oh, we have a like, I'll just take Arkansas, like we have a we have a major problem with access to care. We have a very high numbers of ACEs in the state. And you well, when you look at the actual types of ACEs, we do. I mean, we have a very high, say, let's say, parental incarceration rate, right? Very high single parent household. That's not classified, I guess, as an ace. Actually, I don't know if it is. It should be. But you know, childhood abuse or neglect, parental substance use, all of those things, we have very high rates. What does that mean we should be doing about it? I think is a very different question. And so I think it's that going from A to Z without examining what are the consequences of every type of intervention, you know, that we do. That that's what I worry about.

SPEAKER_01 1:09:15

Right. Well, that's why I keep coming back to we're we're talking about these broad strokes, and you and I are in very different segments. Yes. You know, you're I mean, you basically are responsible for a great deal of the mental health care for the entire state of Arkansas. Well, I don't know if I'd say that, but I just said it. But you know, I'm here in the private sector in Silicon Valley in California, and folks who have the the means to hire people like me and like our our firm and access this in the private sector. So it's it's a very different swath. So so I think you're making an important point because I think there is a lack of services, appropriate services oftentimes in the public sector. And then I think we can overdo it here in the private sector or misguide it, or the incentives are aligned with for you know, the private equity has just done a number on this. And I think it's going to continue to that's a whole episode I'd like to do, but but that's really been a problem.

SPEAKER_02 1:10:13

Well, what I'm trying to do, quite honestly, is try to bring you know expertise of people like yourself, particularly people with family systems expertise to try to bring in people to train all different types of providers in the state in various types of screening interventions, but particularly this idea of designing a kind of more comprehensive types of care for kids. Because these kids, you know, a kid in foster care with, I don't know, let's say one parent in prison and another one, who knows where, you know, they still need the same types of proximal zone of development. Zone of proximal development.

SPEAKER_03 1:10:53

Mm-hmm.

SPEAKER_02 1:10:54

That thing. They need to develop competencies. They need, you know, and they don't need to be held back by saying, you know, you're you're damaged. You know, I think that's the other thing. Maybe you're getting at, like, I don't want any kid to feel like you're damaged goods because of this. And that's the part I kind of worry about that we may be over labeling, you know.

SPEAKER_01 1:11:15

Yeah, and again, I it it's a it's a fine line because that's a fine line.

SPEAKER_02 1:11:19

It's it's a fine line, Douglas.

SPEAKER_01 1:11:22

Did I mention it's a fine line. That should be the name of the podcast. It's a fine line. Let's rename it, rebrand it. There can be an overabundance of compassion. Yeah. And that's what I want to say is that it's not for anyone's ill intention that these things are happening. There can be misaligned incentives.

SPEAKER_02 1:11:42

I think that's a I think that's a huge thing because we're talking about this. Like, how do we get people to do family work and do things, all the like the community reinforcement? Well, if there's no billing code in the Medicaid manual or whatever, people aren't going to just do it for free.

SPEAKER_01 1:11:58

But that's true for what the corporations are doing, private equity companies are doing with mental health care and the short-term residentials, where it's a misalignment of you know who's who's really paying who for what.

SPEAKER_02 1:12:08

So it sounds like you need to run for office.

SPEAKER_01 1:12:13

I have so many skeletons in my closet. Well, I hit them in your closet so I wouldn't get caught.

SPEAKER_02 1:12:20

I only have back gammon in my closet. So okay.

SPEAKER_01 1:12:26

Well, that's probably a good place. On that friendly note, let's wind this thing up. So, Laura, I want to thank you very much for being a guest on the reframe or being the co-host or the host on the reframe. It's yeah, I was the host. We've talked about doing this for a while. I think, like we said, you know, we used to pretend to be talk show hosts and who would be the guest. And I think we had to vie for who is going to be the host and who's gonna be the guest all the time. And we were pretending we were Johnny Carson.

SPEAKER_02 1:12:53

We had to fight about this one for a while too. I don't have the fancy microphone, so that's really you have an advantage there.

SPEAKER_01 1:12:59

I do. Anyway, I sincerely mean thank you for taking the time out of your very busy schedule to do this, to participate, to plan for it. And I I think this has been a lot of fun and and pretty illuminating. So thank you for being with us.

SPEAKER_02 1:13:13

It was wonderful to interrogate you.

SPEAKER_01 1:13:15

It wasn't the first time.

SPEAKER_00 1:13:18

Thank you for tuning in to this episode of the reframe. Follow the show wherever you listen to podcasts so you'll never miss an episode. Please share this episode with your friends, colleagues, innovators in the industry, and anyone you feel would benefit from listening. To learn more about the Voting Group and Votin Mentoring, and find additional resources, connect with us at www.thevoting group.com.