Monday, January 16, 2017

The Relationship Between Shame, Teen Treatment, Duel Diagnosis and PSB

By Stephen C. Schultz


I recently had a conversation with an allied health professional concerning a student who was already placed in a residential treatment program. The family was from the Boston area and were huge Red Sox fans. They are a close family and never planned on being in this very personal and lonely place concerning their son. This particular student has a history of being in previous treatment programs and sexually acting out at some of those programs. Each time he would be separated from the rest of the group, additional staff were brought in and the parents were asked to find another placement within 24-48 hours. This particular student has a low/average IQ and has been diagnosed with being on the spectrum. I got the call because this student, who is underage and is in another program, sexually acted out with a 20 year old.



We had a good conversation and I’m sure the family is in good hands with their consultant. My purpose in sharing this message isn’t to “armchair quarterback” this clinically complicated situation. It is simply to re-frame how we tend to think about Problematic Sexual Behavior (PSB) and how we can better discuss these issues with families when their teens are burdened with a problem.

On more occasions than I can count, referring professionals will share with me clinically significant behaviors from a client. These behaviors and thoughts meet clinical criteria for admission to Oxbow Academy for the 90 day evaluation. It is often stated during the follow-up conversation;

“However, the sexual issues are not the ‘primary’ concern or diagnosis. The parents would like to try a different program first.”

I think it’s important for us to understand that the terms “Primary and Secondary Diagnosis” were set up and established as a way for insurance and third party payers to prioritize what they would pay for. Again, it is language that has been adopted from the medical model. In an effort to meet the needs of third party payers, mental health treatment plans soon followed suit. This had very little to do with Mental Health science or research. We all know, in the world of mental health, the therapeutic process doesn’t happen in a linear manner.

For example, think about the client diagnosed with Depression and Chronic Substance abuse. Simply treating the depression does not take care of the addiction issues. And, switching it around does not guarantee the depression will subside either. Hence, we describe these situations as the client having a co-occurring or a duel diagnosis. It’s the same situation for a student diagnosed with ASD, NLD, ODD, Anxiety or Depression who is also engaged in compulsive sexual behavior. Comorbidity is what we are dealing with and all of the symptomatology must be dealt with simultaneously.

The issues surrounding comorbidity need a very clinically sophisticated and integrated treatment regimen. Unless a program has a system in place to clinically assess all sexualized behavior and thought processes by the student, it is like having a biopsy on a cancerous lump in your arm and not exploring to see how wide spread the cancer is. That is why these sexual issues re-surface time and time again with these students when they are in a more generalized treatment setting.



I have been asked, “Doesn’t the student experience ‘shame’ when they participate in the polygraph process?” My answer is NO! In fact, it’s quite the opposite. They work closely with their therapist and family through the disclosure process. Its difficult family work, but the students learn that their parents are there for them…no matter what gets disclosed. Often there are some pretty raw emotions and a lot to work through, but this is where true healing begins. When they pass the polygraph, it is a liberating, emotionally freeing and cathartic event. It is actually the opposite of a shameful experience.

Dr. Brene Brown, a research professor at the University of Houston has taught that there is a difference between shame and guilt. Guilt is actually a good emotion to feel. It helps us recognize how some of our behavior may not be congruent with our personal values and encourages us to change and improve. 

Shame on the other hand is destructive. Shame is more about how we think and how we attribute our self worth. Shame is destructive and tries to convince us that we have limited worth. Shame encourages us to continue destructive behavior.

Parents also need to make sure they ask about any research the program is doing. Not simply outcome surveys, but actual data gathering and interpretation. The program should have visible and verifiable processes in place to not only gather data, to interpret data, but also to inform the treatment process in real time.

So, the next question is, “How do we help parents understand this?” I have seen family after family say they wish someone would have mentioned Oxbow earlier in the treatment process. These families have been faced with embarrassing situations, perceived treatment failure and the depletion of financial resources.

The link below consists of an experience I had while speaking to students at a more generalized RTC. Please don’t hesitate to pass this along to others that may find it useful.

Tuesday, December 20, 2016

Navigating the Highway of Healthy Communication

By Stephen C. Schultz


“I was on the road in my car last week. It was a long stretch of highway where it is easy for your speed to creep up. I looked in the review mirror and saw blue and red flashing lights. I watched as the right hand of the officer extended to lift a microphone to his mouth. He was obviously running my plates. I glanced at my driver’s side mirror and observed as his door opened and he stepped around the edge of the door and closed it with a single, fluid motion. In a cautious and calculated manner, with his right hand resting about hip high on his revolver and his left hand carrying some paper, he was at my door in ten easy strides.”



Ok…now that you have read that first paragraph, what are you feeling? Did reading that stir any emotions? Could you relate to my experience? How many of you are smiling? You’ve been there…right? You know the feeling. Often there is dread. Sometimes there is fear. Most times there is frustration because you were just going with the flow of traffic. When you first see the lights, there is that sudden twinge in your stomach. Would you like to know what I was feeling?

I was happy! I was thrilled! I was relieved! My car happened to be broken down and I was sitting on the side of the road.

Now…that probably isn’t the response you were expecting. But, this article isn’t really about how we feel when interacting with police officers. This article is really about communication and why there is often such heightened emotion when communicating with others.

Everything I stated in the first paragraph was factual. It was the truth. However, there were some details that weren’t mentioned that could have changed your perspective. The other interesting thing about communication is that when we are the receiver of information we subconsciously relate what we are hearing or reading to our own experience. If there is missing information or it just doesn’t quite sound right, we fill in the “Gaps” so the story flows and makes sense to us. Did any of you fill in some “Gaps” with the police story?

The other thing that is interesting about this situation is that you not only filled in some gaps, but you felt emotion from it. Many of you actually felt emotions associated with reading this article.

So, the bottom line is that…you felt emotion that created a physical response…over an article you read…where you filled in the gaps of missing information…with your own experiences from the past.
  
Is it any wonder we encounter communication problems within our communities, work and families? Think about the intricacies of being a parent. The interactions with teaches, other parents, employers and co-workers. Think about the day to day communications that take place. It’s amazing any of us have friends or family! (Said with a wink and a smile.)

The question then becomes; “What can we do about it?”

There really isn’t much we can do about what others say or how they communicate. The focus needs to be on us and how we receive information. If something doesn’t make sense, ask a question. If you read something that doesn’t sit right with you, think it through from all angles. If someone says or does something that makes you angry, pause for a moment and see if you are “filling in gaps” of information. You may want to read this other article I wrote where I discuss the emotions we feel and where they come from. It’s entitled TheRoller Coaster of Life.




In a study by Dr. Albert Mehrabian, he was able to conclude that when we communicate with each other, only 7% of the communication is verbal. This means that we are taking cues and interpreting different aspects of our interaction in ways other than simply the words we use. He found that 55% of our communication with others is actually us interpreting the other person’s body language. This includes their stance, if they are fidgeting or moving around, if they touch you, turn their back on you or make eye contact. The other area of significance is the other person’s voice. He found that 38% of  the communication is the tone of voice and inflection someone uses. So, the reality of communication is that 7% is what we say…93% is how we say it.

Is this information that can help us at work? What about with our family? Are our children experiencing healthy communication through technology; for example, social media and texting? Without healthy communication, groups of employees, city communities,  private and non-profit organizations will all continue to fill in the gaps with personal "narratives". In the long run, filling in the gaps with our own narratives isn't healthy for anyone. Therefore, be aware of your communication, listen to others beyond their words and have a healthy balance of in-person interactions! What are your thoughts? Please share a comment. 

Tuesday, December 13, 2016

A Rescue Program – Saving Calves & Kids


Guest Blogger
Clinton Dorny
Executive Director
Discovery Ranch for Boys


Having worked in the helping profession for over 15 years now, I am constantly amazed at the value of Experiential Therapy and the use of animals in the healing process. The students who come to us at The Ranch, struggle in life due to early childhood trauma of some sort. They often fight the good fight against anxiety, depression and other mental health or developmental concerns.



The use of animals in the therapeutic process has been a part of what we do at Discovery Ranch
since its inception. I have always tried to share the value, respect and care we place on the animals in our care. They are just as much a part of the “treatment team” as our clinicians.

For this reason, I’d like to share some details about the integration of animals into the therapeutic process. It has come to my attention that there is a misperception or misunderstanding about what we do with our calf program. 

Please allow me to educate you on what the normal process is for the bulls at dairies and how we save and adopt them.


When bulls are born at dairies they are normally discarded, in other words…bopped on the head and killed at birth.  Dairies see them as a waste product and don’t want to waste their mother’s milk feeding them.  However, they keep and raise the females to garner a return on their milk production.
Dairy cows need to have a calf every year in order to keep their milk supply going.  So, dairies are constantly in the process of increasing their herd.  We purchase the day old bull calves from the dairies and raise them until they are 5-6 months old. Our students are the ones responsible for raising them. They feed them each day, clean their hutches and care for them medically. The calves are then sold to local farmers and ranchers. We’ve had some students, along with their families, adopt their calf and place it in an animal sanctuary.

Tuesday, December 6, 2016

RedCliff Ascent Research - for those who want the best


By Stephen C. Schultz


As I started to think about writing this blog post, I was caught up in some memories of being at outpost. For those who aren't aware, outpost is a section of private land in Southwestern Utah that is owned by RedCliff Ascent. RedCliff is an Outdoor Behavioral Healthcare treatment provider, or better known as a Wilderness program.

Outpost is where the families go for graduation. It is a place where there is fresh water, shelter and emergency supplies. There is also a very cool replica of an ancient Native American Kiva. You can learn more about outpost here in this article entitled;

An Open Letter to Parents Researching RedCliff Ascent




I decided that an intriguing story or experience I had while in the back country hiking with a team of students wasn't what a parent would want to read when it came to research. By the time you truly want to know if a wilderness program works, the last thing you want is a bunch of fluff.

RedCliff has been doing research for well over 15 years. So, please click on the link to the Wilderness Advisor. It is a publication that describes and reports some of the research that has been done over the years at RedCliff Ascent. When you want the best, make sure you ask about research. RedCliff is truly a research informed treatment program.


Click here for access to The Wilderness Advisor


Friday, November 25, 2016

Are the Holidays a good time for a family intervention?

By Stephen C. Schultz


As we enter this Holiday Season, I hope the Holidays bring meaningful time spent with family and the joy associated with renewed relationships.

It is sad, but true…every year RedCliff Ascent has an increase in inquiries around the Holidays. Teens that tend to be struggling anyway seem to escalate their behavior around the Holidays for some reason. If you are a parent and find yourself in this situation, please know that you are not alone.



Adolescents who are struggling with depression, anxiety, peer relationships or trauma typically tend to view the world in a very narrow and rigid manner. This really is not a judgment as much as it is simply stating a fact. It is difficult for them to move beyond the very ego-centric orientation that they have adopted around their environment and their relationships. Some would say this is “normal” adolescence complicated with emotional concerns.

Some adolescents, those struggling in school or those who tend to act out with anger, maintain a very guarded view of their relationship with their parents.  It is not uncommon for an out-of-control teen to view his or her parents more as contemporaries rather than acknowledge the parents have achieved a higher level of experience and wisdom throughout their lives.  Some adolescents blatantly demand that they be the ones in control of the family dynamic and not their parents.  They conceitedly see themselves as peers to their parents.

Tuesday, October 11, 2016

Evolving Women - Demonstrating Character and Competence

By Stephen C. Schultz


The breeze was cool and the sun was warm on my face. An occasional droplet of water and the swirling of mist created the illusion of sparkles floating through the air. The grass was green and so were the trees, even though autumn was fully entrenched. You see, I was sitting amongst some high desert pine trees and juniper bushes at Discovery Ranch for Girls.



I looked up and noticed Andrea Burgess walking towards me. Andrea is the Executive Director of DRG and has a long history of working in the mental health field.

As she got closer, I smiled and said; “Hey dove…how ya doing?”

The term Dove is an aspect of her Earth Name she received during the decade she was the Executive Director of RedCliff Ascent. A few years ago, she made the transition to DRG.

She simply responded; “Hey Schultzie!”



We exchanged some pleasantries and spoke about how things were going at DRG. She mentioned they were preparing for the next Parent Seminar and how they were expecting a good turnout. The parent seminar is when the parents come into town from around the country to spend time with their daughters, attend workshop presentations, parent teacher conferences and participate in experiential activities with the staff and students.

I asked how the non-profit organization she co-founded with Staci Bradley was doing. This particular organization, Evolving Women, was specifically established to recognize the contribution and leadership of women in the teen treatment industry.

She mentioned it was going great and the membership is consistently growing. In fact, she said there is a fundraiser activity at the next IECA conference being held in New Orleans that will benefit Liberty’s Kitchen!

I wrapped up my visit to DRG that day. It’s been about three or four days since my time there. Just today, I received a text from Andrea letting me know she had a 1970’s style Wig I can use at the conference fundraiser! That is a very scary image…an image that no one should have to be subjected to!


I’ve been thinking today about this particular cause. What a great opportunity for collaboration, networking, service and friendships to be fostered! What a great way to bring people together, have fun and share in a community who’s foundation is the development of personal character and the demonstration of a collective competence. 

Wednesday, September 28, 2016

One Proud Papa

By Stephen C. Schultz



The heat was radiating across my face. Small beads of sweat were building on my forehead. The sun reflected through the glass. Hot air swirled around me as though I was somehow stuck in the middle of one of those hot air popcorn poppers.

Such is the routine every time I get in my car while staying in St. George, Utah. Even with the windows cracked, it heats up like an oven. Then, when you turn on the air conditioning, it blows hot air for about twenty minutes. However, the fact that I was raised in the temperate climate of the Northwest United States and have yet to adjust to time spent in the desert, is not what this short muse is about. My purpose for writing this piece is actually quite different.


I recently had one of those parental experiences that don’t happen very often. It was an experience that took me by surprise…and since it happened, I have had to think a little bit more about it.

I was in St George for one of my daughters volleyball matches. She is on the team at Dixie State University. They are the defending champions of the PACWEST Conference. This is my daughter’s freshman year and there are obviously senior class mates on the team. So, needless to say, she doesn’t see much playing time in the matches.

As my wife, my youngest daughter and I were all walking into the gymnasium at Dixie State to watch one of her matches, I heard the announcer naming the starters. Standing at the ticket office, I heard him announce, “Amanda Schultz, starting at Outside!” I looked at my wife and we hurried into the gym and sat down.

I looked out on the court and there was Amanda, high fiving other girls, chattering the chatter and looking comfortable like she belonged there. My eyes started to blur a bit. Was I suffering from some unknown desert ailment? No…they were simply tears of joy for my daughter.

You see, others don’t know the commitment and time and determination she exhibited to get where she is. They don’t see the studying of film, the mental toughness, the time in the weight room and the 5:00am workouts with a Navy Seal trainer. She has worked hard. She has been patient. She has been supportive of her teammates. Whatever her success, she owns it! It’s her accomplishment. For that…I am tearfully happy for her. It’s the mastery of these skills and attitudes that she will take into life after volleyball. I have no doubt she will be successful in all of her life’s endeavors.

While this piece recognizes the hard work of my daughter, it is also about all of us...myself included. How many of us hope for "things" to turn out well, but don't take the necessary steps to see it through? How many of us wish for "things" to be different, but don't demonstrate the discipline needed to make it happen? Are there "things" we could be doing right now that will improve our own situation in life or the situation of loved ones?

What do you think?