What makes us different? Lana Seiler, MSW, LCSW
So in my experience of treatment, particularly addiction treatment, there is a component that’s been missing, maybe a couple of components that have been missing. This isn’t to say that no other place attempts this because places do. Some do it better than others. But what I’ve found is that we have a problem and whether that problem is addiction, depression, PTSD, anxiety, eating disorders, you name it, gambling addiction, whatever, we’re looking at managing the symptoms that are causing us dysfunction in our lives. We’re also looking at the etiology or we’re looking at where this comes from. So I think in good treatment, we have to really address those two issues.
Most facilities and I understand why and I’ll get to that in a second, but most facilities are only looking at or they’re more heavily looking at how do we manage the symptoms, how do we manage the behaviors that brought us into treatment in the first place? That’s really important because a lot of those behaviors are dangerous. So we have to look at that first and we have to look at it and address it in a really significant way to keep people safe. The reason I think a lot of facilities focus on that more heavily is that it’s a safer way to go and because a lot of times treatment stays are shorter.
There’s a lot of complicated reasons for that, and some of its insurance, which we’re doing our best to try to get longer stays for our patients because we do see that, and there’s a lot of research to support that a longer continuum of care really does correlate with better outcomes. It’s a real thing. We also are involving as many resources, as many family members, everything we can to try to help the patients have a longer stay if at all possible. I think what we’re doing differently is we’re trying to look at maybe a 28-day model or a 45-day model in a way that begins to introduce a solution to the other question, which is where does this come from?
So we may not be able to do full trauma treatment or a full family of origin workaround where these behaviors are coming from or where the person’s vulnerabilities are, but we can, I think, take a fresh look at shorter stays depending on what the individual client’s needs are and incorporate some tailored psycho-education or the beginnings of that work that needs to be done ongoing and putting together a really strong aftercare plan for them that’s geared toward looking at what the vulnerabilities are. I see the reward being greater than the risk, even in shorter stays, of looking into the why’s. If we don’t have time to do all of the work on the why’s, to at least get someone pointed in the right direction, and then we can even tailor the coping skills to address that person’s specific vulnerabilities.
Then when we look at these two questions for people who do have a little more flexibility for longer stays, I think we’re really taking a lot of our time and energy and resources into putting together a program for 56 days, for 83 days, or maybe even longer, to really help people make the psychic shift, make the emotional shift in their negative core belief schemas because the negative core belief schema is going to be driving us, whether we know it or not. The way I describe that to my patients is it’s like having an old operating system that was downloaded when you were maybe eight, nine, 10 years old, depending on when different wounding happened and we haven’t had any updates.
So we’ve grown, our lives have changed. We’re adults. We have responsibilities. We have a lot more freedom, but we’re still running on the same old operating system with negative core beliefs that might be, I’m a failure, I can never get love, the world is an unsafe place, people are unsafe, the list goes on. Some people call these critical thoughts. Some people call them negative core beliefs. But we all have them. So my sort of definition of successful treatment is if not doing work to change the negative core beliefs schema, right, at least looking at what those things are and giving someone a plan to start to update and have a new operating system. Because we can manage the symptoms all day. But if that doesn’t change, it’s exhausting.
One more thing I tell my clients that I think is important to say here is that it’s like walking around with tons of anxiety, tons of fear, these negative core beliefs that are maybe at an 80, right, or a 90. So we have all this distress. When we’re untreated, we’re using coping skills that have to match that. Usually, those coping skills look like drugs, alcohol, sex, reckless behavior, isolation, dissociation, alcohol, all these different things that are really dramatic in order to match the level of distress that we’re at.
When you come into treatment, the distress is still up here, but what do we do? We ask you to use things like breathing, meditating, reading, journaling, right? So there’s a period of time where your distress level is going to be higher than the skills we give you. Now, there are skills like DBT distress tolerance skills that can get close to matching, but they take a lot of work and a lot of time and we have to often do them in repeated cycles. So if we think of walking out of treatment with our distress still up here, it’s going to be a lot of time and energy out of our lives to manage it using coping skills.
Thinking about having a job, having children, having relationships, having fun, having a life, we want to try to lessen that. So if we can do the work in the amount of time we have allotted, we want to really actually bring the distress down. So that way the coping skills that we need to use are not quite as intense and aren’t quite as time-consuming. So that’s my hope for my clients is that when they leave here, we’ve at least taken the distress down a couple of notches. There are some specific ways to do that. Trauma therapy is one of them. Trauma therapy is pretty broad. So we can also talk about that too to kind of get into any sort of teasing out what that looks like and what it looks like for different people. But yeah, so that’s something that I think makes us different.