Learning to Endure Hope: The Power of Incremental Mastery with Dr. Ross Ellenhorn

Hope can be terrifying, especially when it has led to disappointment before. In this episode of The Reframe, Doug Bodin speaks with Dr. Ross Ellenhorn, founder of Ellenhorn, a robust community integration program, and co-founder and president of the Association for Community Integration Programs, about the “fear of hope” and why people often resist change not out of a place of despair, but self-protection. Drawing on decades of clinical and community-based care, Dr. Ellenhorn explains how repeated disappointment erodes faith in yourself and the world, and how small, incremental experiences of mastery can rebuild it. He makes a powerful distinction: the task is not to inspire hope, but to help people endure it. Challenging the medicalised, industrial model of treatment, he addresses the commoditisation of care and the risks of investor-driven systems. He also offers guidance on how families can thoughtfully evaluate mental health programs. From therapy as art to community as medicine, this conversation reframes recovery as a deeply human process. Listen in for a thoughtful rethink of how change truly happens.

Key Points From This Episode:

• What it means to have a fear of hope and how it prevents you from moving forward.
• How repeated disappointment erodes your ability to hope.
• Staying stuck as a logical strategy to avoid further pain and disappointment.
• The difference between inspiring hope and enduring it.
• How small, incremental mastery rebuilds confidence over time.
• Self-efficacy as a lived experience, not a language exercise.
• The unintended harms of a medicalised, industrial treatment model.
• Therapy as a relational art rather than a manualised technique.
• Pride, dignity, and the psychological impact of ostracism.
• Belonging, ritual, and community as forms of medicine.
• Ownership in therapy: why recovery cannot be outsourced.
• The risks of forced treatment and commoditised care.
• Reframing “codependency” as love shaped by fear.
• Why it’s so important to give people the ability to talk about their life experiences.
• What to look for when evaluating mental health programs.

Links Mentioned in Today’s Episode:

Dr. Ross Ellenhorn

Dr. Ross Ellenhorn on LinkedIn

Ellenhorn

Douglas Bodin

The Bodin Group

Transcript

SPEAKER_01 0:01

The people that are having the hardest time are people that have high hope and high fear of hope. So they're that person who's afraid of hope on the cliff. And we might think that person is in despair. That person doesn't have any hope. But really, what they have is hope. They're just resisting it, which is terrifying them. Because the last time they hoped, it took them in a really horrible place.

SPEAKER_00 0:26

Welcome to the reframe, where we have real unfiltered conversations about mental health, parenting, and addiction treatment in the changing world. Hosted by Douglas Odin, 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 Americans and reframe the way we think about the challenges in mental health treatment. This is the reframe. Let's dive in.

SPEAKER_02 1:09

Today our guest is Dr. Boss Ellenhorn. He is the founder and CEO of Ellenhorn, a robust community integration program with offices in Boston, New York City, and Raleigh Durham. He's the co-founder and president of the Association for Community Integration Programs. Welcome, Dr. Ellenhorn. Welcome to the reframe. It's really great to be here. I enjoyed our conversation the other day prepping for this, and I thought we'd jump right into uh, I think this, I'm actually hoping this podcast will be a little controversial and ruffle some feathers a little bit. But we'll start with what is the fear of hope? You're you've written books about this topic and others, and I'd like to just jump right into that.

SPEAKER_01 1:48

Yeah. It's probably best to describe if I kind of tell you the story of it, which is that I was running a day treatment program, you know, a publicly funded one, and I had a group that was open, so people would come and go. You know, they'd stick around for a few months and then go. And it was really a group for people that just weren't moving forward in their lives. And I began to ask them, what is it that gets in the way of moving forward? And almost nobody talked about their symptoms. They talked about what it means to get excited or raise expectations, not only in themselves, but in treaters and in their families, and the fear of doing that. What happens when you move forward? All these dangerous things happen. People begin to think, well, if they did that today, they can do that tomorrow. They can get better at it. So every time you do better, you're at risk of somebody expecting you to do more than that. There's little steps along the way, and every step you take means looking at where you are right now in relationship to the goal you have. Then there's just these experiences you've had, especially in the mental health system, where you thought this was the time where you would no longer need to be in the hospital or be in a residential program, and bam, you're back again. And you've let yourself down and you've left your parents down and all of that. The weirdest job in the world is to be a psychiatric patient. What does it mean to wake up every morning and people are like, hey, buddy, have you changed yet? It's day six. You're supposed to change here. What a crazy life. Everybody's eyes is are on that. So I began to think about what experiences of significant disappointment do to our ability to hope. Hope is a mindset. It is the mindset, it is the number one mindset, it is the only mindset that gets us through uncertainty to the things we yearn for. That's what it's there to do. And when you hope for something, that thing you hope for becomes more important to you, more life-giving than before you hoped for it. So your parents ask you, you know, what do you want for your birthday? You can't come up with it. The minute you say bike, bike becomes the thing that will complete your life. And so every time you hope, you're risking not getting that thing. And what I think happens when people don't get those things, when they're really big and important, is they have these experiences that they can't quite make their lives work. They can't get their needs met. And that the world won't meet their needs. And that's a horrible feeling. And so they want to avoid that. The only way to avoid it is to not move forward, just to stay the same. So staying the same becomes a logical strategy for the terror of hope. And there's a grace to it because what you're doing is protecting hope. I've got this little bit of a hope. If another bad thing happens, I might not have hope anymore. That's the secret life in my mind of a psychiatric patient or somebody in an addiction program. But they're surrounded by therapists who are hoping for them, wanting them to change. And so they begin to push back, and then they get called treatment resistant or in denial. When in reality, they're like, I'm afraid of heights, I'm on this cliff, and you're standing right next to me, telling me to jump. Who's the person in my life I want away from me as much as possible, as quickly as possible? And so that to me is the dynamic that I'm hoping therapists and also family parents and parents who are looking after their kids begin to kind of break down and think about that it's not just about despair and hope. It's about how do I get to hope without being too afraid of it. And I'll just tell you one more thing. So we've developed a scale. It's a legitimate scale, it's a scientific scale now. And then what that means is it's not a scale for fear of success, fear of failure, anxiety, depression, all the things you might associate it with. It's not a scale for scale for this one thing. What we found is that the people that are having the hardest time are people that have high hope and high fear of hope. So that they're that person who's afraid of heights on a cliff. And we might think that person is in despair. That person doesn't have any hope. But really, what they have is hope. They're just resisting it. It's just terrifying them because the last time they hoped, it took them in a really horrible place.

SPEAKER_02 6:00

It's self-protective to avoid hope at some level.

SPEAKER_01 6:04

It is. And we all do it. And it's not great for us. It doesn't help us move forward, but it also makes sense. And it comes from our respect for ourselves on some level and our love for ourselves. It's like, I'm not gonna do that right now. It's not a smart move. And everybody's telling me to. So yeah, it's self-protective. It has some sense to it. Yeah.

SPEAKER_02 6:26

What are the things that individuals can do or parents, family members to help inspire hope, to help create that for people in a meaningful way, in a way that can be dipped into and utilized in whatever progress, however, we might want to define that, that they want to make in their lives.

SPEAKER_01 6:45

Yeah. Well, pardon me for this. It's not about inspiring hope. It's about can I endure hope? Because, like I said, these people are rating high in hope. They do well on the hope scale. It's how do I endure the hope? And that really takes this other slightly religious term, which is faith. How do I build faith in this person in themselves and in the world? And in themselves, that means helping a person any way you can to have minor experiences of competence. And I mean minor. You might have to start really small because that person is afraid of everything that shows they're becoming competent. And sometimes you have to do that by tricking them. You're not saying, I want you to make a sandwich today so you can feel more competent, you know. You're just having to make a sandwich. But you're trying to kind of have as many moments of success as possible, not making a big deal about it, but allowing them to begin to feel like they can kind of control their lives. Because fear of focus about I can't handle it. I'm not competent enough to handle it if there's disappointment. So you're trying to have them feel like they can handle it. You're sort of working on that.

SPEAKER_02 7:57

That's the underpinning of our mentoring program, which is to provide the opportunity for young people to experience small successes incrementally, over time, and ideally relationally. And I know that's one of the things that you speak to quite a bit as well.

SPEAKER_01 8:13

Yeah, yeah, absolutely. Yeah. I mean, when you and I talked earlier, I was I was happy, very happy to hear I was talking to somebody that wasn't talking about skill building. You were talking about mastery, self-efficacy, the social psychological things you develop when you get good at something. Life skills, having life skills, having being able to, I don't know, pay your bills is first of all insulting that we think people they actually need to be taught to do that. Most people are resisting doing that because they're terrified of moving forward. What the important thing about paying a bill is how do you feel afterwards and what does it do for you therapeutically? And then how does it motivate you afterwards?

SPEAKER_02 8:58

How does someone working with that individual, without directly attacking those skills, help to connect those dots for someone that they recognize how those small pieces of mastery are impacting their growth at a foundational level?

SPEAKER_01 9:14

Yeah, there's two answers to that. One is reflective of my devotion to what I research, which is that I have found that actually if you have a conversation with somebody about fear of hope, they get really excited. For some reason, they like that better than you're broken and sick and you've got a mental illness. And they get it. They get it. They're like, oh, that's the thing going on. And if you can have that conversation, you're ready to talk about self-efficacy because you're saying, well, you know what? The way to do this is not to make you change too much right now, but to actually help you kind of begin to feel good and competent at things. If you can have that kind of conversation with somebody, they're in a pretty good place to listen. A lot of people aren't. And then that's the second answer, which is self-efficacy doesn't take insight. You don't have to say, oh, because I did that, I'm feeling better about myself. Self-efficacy is a self-evident event. If I fix a bike today, I'm gonna feel better. And I may not say it's because I fixed the bike and I feel more competent now. It's not a languaged thing necessarily, right? And so you don't have to point it out. Most of the stuff you don't have to point it out. That there's a whole language to our behavior that reflects back to us, you know, and tells us where we are in the world and how we're doing.

SPEAKER_02 10:24

How does the um mental health industrial complex work for or against what you're what you're speaking to? It's a loaded question, I recognize.

SPEAKER_01 10:35

Yeah, no, no. I mean, I consider myself an emerging adult. And so I'm finally kind of laying off too much of an attack on the system because it's sort of adolescent of me, you know. But the fact is, it's pretty counter to building a sense of a person's hope. It's pretty much about saying you're spoiled and broken, spoiled as like spoiled meat, that something's wrong with you. And it's pretty factory-oriented. That there's a kind of warranty and that if you're not doing well, you know, you have to go back to the factory and get fixed, and then you're let back out. It puts all its resources behind walls instead of where life exists in the community. It's insane. That it thinks that a person can get better or that the way they get better in a hospital will last when they get out. It thinks that there's some sort of magic in locking a person away from alcohol and they stop drinking. Instead of, we need to help people in the community who are dealing with this because that's where the challenge is. It doesn't put resources there. And it it has this insane thing, kind of mental illness. It's full of people who think they can figure other people out and put them in categories. It's kind of a crazy delusion these people have. And these people, by the way, they actually have like conventions and they meet and they all agree that they figured out people. So it's it's really about kind of putting people in categories, which is which is also something that's very disturbing for people when you're the receiver of it. So it's got all kinds of significant things that are sort of anti-care. So schizophrenia is triggered, probably has some biological component, although we really haven't been able to find it. So it may or may not, but we know that it's triggered by stress and isolation. The way we treat people for schizophrenia in the United States is the first person they meet is typically a police officer who then gets an ambulance and they go to an emergency room and they sit by themselves, if they're lucky, for 48 hours waiting for a psychiatric bed. Then they end up on a unit with a bunch of strangers and they're psychotic during this with a bunch of strangers, no sense anybody's caring for them, in utter isolation. That is pro-psychosis. It stresses and isolates them. Suicide is basically the research shows it's about a person who feels like they're a burden. I'm worth more in my death than in my life. And they're not getting needs math. These are the kind of things that they're now saying or they've been saying for years, is really the thing behind it. It's the same as somebody who's got an injury who kills themselves, and they feel like I'm now a burden to the world. My death is worth more than my life. And we treat suicide in a way where people feel like burdens. We throw them in the hospital, we don't listen to their story. There's a high rate of suicides after people get out of the hospital. There's all kinds of ways in which we're not thinking through what the kind of more human things people need. Not things like how do you cure this diagnosis, but the human things, they need purpose, they need belonging, they need to feel like they're connected to the world. I don't see how somebody recovers without those things. I don't see how somebody gets better.

SPEAKER_02 13:44

Well, and I think for a lot of folks now that that we encounter and we hear about how young people are identifying with their mental health disorders as part of what they presume will be with them their entire lives. This is part of who they are, and sometimes even uh gives them a sense of community to have that engagement or that investment in that mental health disorder or label.

SPEAKER_01 14:08

Yeah. You and I have a philosopher we disagree on, but I'm gonna I wanna I'm gonna just use them without mentioning him, but just reflecting on there's a group of people in our culture who have been sanctioned by our culture to decide who's normal and abnormal, which means to decide whether you belong or not. We're tribal animals. Are you in the tribe or not? I get to decide. That group then tells people you're in the abnormal part, but I know how you can get out of it. You gotta see me. It's very close to what religion has done. When religion is oriented towards power, religion's got all these beautiful qualities to it. When it uses sin as a way to kind of coerce people, you're sinful, you gotta come see me to take care of that. That's power. That's an act of power. That act of power reaches its crest when you no longer have to tell people and they just do it voluntarily. I have an anxiety disorder, I've got a this, I've got a that. It's won the game. There's no longer coercion needed. And that's sort of where we are in some ways.

SPEAKER_02 15:12

Is that related to one of the topics that you speak to, which is uh therapy as technology? Yeah. Versus an art, which I which I presume is also related to the relational piece and creating connection as opposed to and instigating with the technology of the various types of therapies that are promoted most these days. Yeah.

unknown 15:34

Yeah.

SPEAKER_01 15:34

I mean, it's an interesting thing, and I and your listeners may not be completely aware of this, and new therapists aren't aware of it. But there's really a giant divide in the therapy field between us old people and and and what's being done now. We believe that therapy was this place where one person helped give form to another person's experience, helped them feel like that experience was not just incoherent, but had some way of kind of holding it. Not not so much that it's a category, but some sense that there was a sort of way where you could kind of understand it and hold it between the two of you. And then in doing that, in me being able to give form to your suffering, you would begin to feel like you can kind of manage it and do something with it. It was and it was all about that relationship. It was all about the same thing a parent does for an infant, which is everything I'm doing in my holding of you is communicating to you that I recognize you because I'm recognizing the discomfort and I'm moving towards it. Recognition and care become the same thing. And that's where therapy came from on some level. And it was an improvisational art form. It was we don't know where this session is gonna go, but I'm here as one improviser who's not in front of everybody, you know, this is the star of the show. I'm here in a compassionate way, walking you through it. There's a famous philosopher named Suzanne Langer who basically says the same thing about art that art isn't the expression of emotion, it's giving shape to emotion. So that's why I think it's an art. I think it's a kind of art. And that's so different than I've got this model that fixes borderline personality disorder. And I've got a manual, which is what you have for a car. I've got this manual and this manual, and if we use this manual, it'll fix the person, except for those ones who won't behave and go along with our treatment. And those ones are called treatment resistance. It's just a whole different way of looking at it. They talk in our field about intervention, not just interventions like when you get a person to go into treatment, but let's try this intervention. The word intervention means to cleave something from something else, the from something that's passive. When you intervene, you're taking something and removing it from something else. That's really different than the listening models that we were trained in. There's this remarkable video of Carl Rogers, you know, the greatest psychotherapist that's lived, greatest practitioner of psychotherapy, where he's with a group, he's doing a group therapy session, and the first thing he says to the group is, I'm excited about this group, but I'm also nervous because I don't know where this is the greatest psychotherapist in the world, because I don't know where this is going to go. And the whole thing could fall apart. I don't know if it will, because there's all I'm also excited that we're gonna get somewhere. He's beginning the therapy with uncertainty, not with prognosis, not with a plan and all those sorts of things. That's a whole new world of therapy.

SPEAKER_02 18:30

One of the areas we we touched on the other day was around pride and building efficacy. And we we touched on that already here, but but can you speak to how pride plays out in the context of what we're talking about?

SPEAKER_01 18:44

Yeah. And if you don't mind, I'm gonna I'd like to talk a little bit about dignity because they kind of go together, you know. So self-efficacy is the belief that you can competently achieve things. And there's people that walk around with self-efficacy about everything, you know, it's kind of great. Like, yeah, I can figure that out. If you put it in front of me, it might take me longer than the other person, but I'll figure it out. Pride is closer to self-esteem, which is I'm a worthy individual. I'm blessed to be me. There's so much talk these days about gratitude. You don't hear people say, I feel grateful for being given the gift of this personality. This bus I'm riding is a gas. This is a fun bus to ride, this person that I've been given, right? That's pride. Like, oh yeah, this is, I'm really happy to be me. And that gives a person a significant amount of energy to work on problems in their own life. I can handle it. I can look at this thing that's going on, this depression or this mania, and I can look at it and do something about it because I should, because I'm a valuable person and I gotta do something about it. And people in the psychiatric system, they're injured in their pride. They're ostracized. They've been told that they're an outsider. There's a I'm getting a little tangential, but I'll get back to the point. But there's remarkable research on ostracism called Cyberball, where they they have a person hooked up to an fMRI machine, and there's a little computer game, and they throw a ball, and there's two other participants, and they're told that those two participants are in two other rooms, but it's actually just a computer program. And they throw the ball back and forth to each other, and then all of a sudden the two other participants only throw the ball back and forth and not to the person in the experiment. And the part of their brain that responds to pain lights up exactly like somebody who's who's in physical pain. And the research on that, Kipling Williams, now actually tells people before they go in that's just a computer program. There aren't two people. He gets the same results. That's how connected we are to whether I'm an insider or an outsider. And pride is even if I'm ostracized, I'm gonna be okay. I can handle it. I'm okay. There's there's a me here that can handle that. And dignity is the feeling that you're self-determined and that you're worth it in the world. That you are worth respect. It's the thing that got us to human rights. Human rights is a new concept and it's based on the idea of dignity, of facing life in a way that is worthy of life. And that's another thing that I think is just valuable in treatment. That people with dignity do well in treatment. And when they feel like they've experienced indignities, they don't. And so, how do we kind of raise their dignity and their sense of self-worth?

SPEAKER_02 21:30

I have to go back to what you were saying about that experiment with ostracism and how does our current technological world, specifically social media and whatnot, play into that, maybe giving a a proxy for belonging, proxy for tribe. But can you speak to how that plays out? I know you're you're a sociologist by training. Can you uh touch on this particular very current set of dilemmas that we're all facing and having to navigate with our clients or patients or friends or children?

SPEAKER_01 22:00

Yeah, well, it's really something to take seriously. But we focus on it without focusing on why it might be attractive and how vulnerable people are. So belongingness was once a given. You could get kicked out of the tribe, but because you did something really awful. But mostly it was about how do we always create belongingness. And that came from the ability to feel like we shared in the same deity, we shared in the same ancestors. That created this surround around our psyches that made us consistently feel kind of safe in who we are, and that we that belongingness was almost guaranteed. Robinson Caruso, the guy that gets stuck on the island, that book never mentions loneliness. Because just loneliness was not a problem. Outsider-ness was not really a problem, except for those ones where you just had to kick them out. And so our kids are living in that world. They're living in the world where downtowns have become just outdoor malls, where culture is basically for advertising. It's not part of their daily life, where there is no rhythm to it, there are no rites of passage, there's no customs, there's no traditions. So it's in that void where connecting over the internet happens, and it's in that void where the ostracism that happens in those experiences is profound. If they were protected, they wouldn't be as harmed by this. And so there's two things going on. There's the event, and then there's the capacity to feel traumatized all the time because you're so raw and so out of what humans have been able to do to make us feel contained and safe, which is to create kind of consistent cultures that we can trust and be part of.

SPEAKER_02 23:48

But it also serves to give kids and teenagers and young adults the area to experiment and push outside of their bounds. And I think partly in our culture, we've deprived them of that in our, whatever you want to call it, snow plowing, overscheduling kids instead of going out and playing in the neighborhood, are being scheduled into team sports where there's club competitive sports at age nine. And they're looking, I believe, just naturally for ways where they can find that group or that proxy for belonging or their tribe online. And that seems to have taken the place of what we used to have back in my day, your day, as going out away from parents, away from the domestication of what parenting is, and failing, finding ways to learn on their own new skills. There's that word skills, but the self-efficacy, problem solving, conflict resolution, et cetera.

SPEAKER_01 24:43

Yeah. I mean, part of the problem is we've invented this crazy thing for making a child feel safe, which is this idea of parenting. Children used to be raised by their communities. They were celebrated. When a child was born, there was a naming ceremony. Everybody was there because this was a person, this was didn't belong to the parents. They were entering the community. So parents are overscheduling, doing all this crazy stuff because they're not surrounded by a community. They don't have elders helping them out or some sense of tradition where they go every once a week and the whole family goes and everybody's there in the community. All of that stuff. So you're dealing with isolated parents, dealing with isolated kids. It can't be solved until we find ways to build kind of customs and neighborhoods and traditions around people. And the only place to go to get some hint of that is the internet, is to play a game on the internet that you're really good at. And there's a language to it, there's customs to it, there's a whole world of kind of culture out there that you can't find anywhere else. And so it's understandable that it's attractive to them.

SPEAKER_02 25:48

What should we be doing about it? And I know this toothpaste is out of the tube in a lot of ways, but if we're talking to our particular audience, parents, other clinicians and professionals, what are the things that we can do individually with our families and our communities to try to in in at least small ways foster that sense of what you're describing?

SPEAKER_01 26:08

Yeah. I think we should take seriously. Um we should respect things like card games, things that bring people together, and they hang out and they do something together. We should respect it as not fun, but medicine. That is the thing that makes us feel connected. And there's nothing more important, nothing more human than feeling connected to other humans. And so we should be creating kind of our own individual customs that we spend time with. We we were at the Seaport in Boston visiting my son and my stepdaughter. The seaport in Boston, it's it looks like Sim City. I don't remember that game, but it's just like this fake built-up things with these apartment buildings, you know, with the stores underneath them. It's just that whole scene of this kind of fake parks with people doing yoga in them. It's just an artist.

SPEAKER_02 27:06

What? What's that? Ersatz community.

SPEAKER_01 27:08

Yeah, exactly. And and and the whole family was feeling out of control. We just didn't know what to do. We didn't know where to go. We were just sort of walking around. And my son brought a pack of cards. And we played this game called Oh in my family. And my mom taught it to me, and her parents taught it to her. And we sat down for two hours with all the tourists walking around us at this picnic table. And it was a glorious day because we did that. Now, my son plays dominoes every Friday. He has friends call him up and say, Hey, can we get an Oh night going? Like his generation, he's 28, they're hungry for it. And we should be doing more multi-generational things too. The neighbor who has little kids, the elderly person down the week, once a week we're having a Sunday get together a potluck or something like that. We need to be generating these things as much as possible.

SPEAKER_02 27:59

Well, you're speaking to something that we feel very passionate about within our mentoring program. There's another shameless plug, but we try to get them together for social events, for get-togethers, whether it's trivia night, other engagements with games, they do escape rooms, they do any number of things that that serve that function. We we try to create that opportunity for them to have these moments of connection and ideally self-efficacy and that sense of developing some sense of pride and then ownership. And ownership, I think it's a topic I'd also like to touch on with you.

SPEAKER_01 28:34

Ownership. What do you mean by ownership?

SPEAKER_02 28:37

I don't even know. I think it's something we can't really talk about. What I mean by it is that I think a lot of times because of how our systems have evolved, people tend to offload responsibility to others, to the system, to the clinicians, to whatever technology they have, or even into treatment programs to have an external something that is supposed to solve their problem or give them hope or what have you. When in fact we we believe that taking ownership and responsibility for one's growth and development in partnership with others who can be helpful along those lines. But that's what I mean by ownership.

SPEAKER_01 29:14

Yeah, yeah, yeah. No, I think that that's vitally important that we've that people feel like they have sort of accountability to the world and to others, um, and that they own that. And then the other idea of ownership, which is that I own me, which fits with it. I'm the owner of me. And that means I'm responsible for me and my behavior. And then the other version of ownership that's connected to that is I own my therapy. My therapist hasn't owned my therapy. I own my therapy. Or better yet, my therapist and I own our therapy. We're partners. If you don't feel like you own your therapy, it's not, nothing's gonna happen. It's zero. And so a lot of therapy is about getting the person to the place of owning it. I mean, like a lot of it's working towards that. Like it's very hard to get a person to kind of own their therapy, to see it as a thing that they're doing to kind of change themselves. But that kind of ownership, all those different versions with which play off of each other is is sort of vital to feeling connected to the world.

SPEAKER_02 30:13

A lot of times young people are being compelled to go to therapy, um, if not forced by their parents or or somebody else. Can compelled therapy be more harm than help at some level?

SPEAKER_01 30:27

It definitely can perturb future therapies because the person is going to start resisting them more. It can create experiences of being misunderstood. You know, my parents are making me go here, they don't understand what my experience is. It can also work, you know, because like a kid can resist stuff for their own sense of pride and control when what they really want is someone to listen to them. So it also can open a door for them to then own their therapy. But the other part of it is our field has done a great job selling itself as if we're the only way to deal with behavioral problems. We don't tell people that we have really lousy statistics. Some people change in our therapies, lots of people don't, especially addiction treatment. So we're claiming to the world this is the only way to go when you got a problem. And the only way to go isn't really that great. It doesn't necessarily change people.

SPEAKER_02 31:17

But that's what gets monetized. That's what gets reimbursed insurance. That's where you have to have a particular proscribed set of attributes in a treatment program if it's going to get insurance, reimbursement, et cetera. So that has that's the yes, the monetization of it. And something else we've talked about is the commoditization of the patient as a result of that.

SPEAKER_01 31:39

Yeah. This is the kind of the trap, which is this trading of people, filling beds, you know, getting the census up. It's really, it's really kind of a cattle mentality towards human suffering. And people become these units, you know, and and therapists in those systems are trying their best, you know, it's not like they're necessarily treating the person in an inhuman way, but but the overall course of the thing is about kind of insurance companies not have to spend so much money, you know, often. That's what it is. But even when you're working without insurance, even if you're wealthy enough to pay for it, these dehumanizing qualities are there. So yeah, so forced treatment, it can work at times, but only if the person's taking ownership. Falling in love has a profound therapeutic effect. Getting a job has a profound therapeutic effect. A new friend has a profound therapeutic effect. A school counselor who pays attention to you and makes you feel special has a therapeutic effect. A grandparent who spends more time, there's I can keep going. Doing well in your soccer team. You know, so therapy is one choice out of a million that can help a person kind of re-emerge in the world. It's just a human process. It's not some thing we invented that's separate from humanity. And so we can give it to people without doing therapy.

SPEAKER_02 32:56

That goes back to the self-efficacy of it, of just building that. You know, we we talk about the developmental pyramid around here that has safety, emotional and physical safety and well-being at the bottom, and then self-esteem, self-confidence, meaning, purpose, worthiness at the next level. And upon those two levels, we start to build healthy interpersonal relationships, all of which are necessary prerequisites for attacking what often comes in our door as the problem, which are academic or vocational pursuits and really building on the foundational levels that you're talking about is where we really try to go with it, whether we're working in our mentoring program or we're considering how to integrate uh a training program or other therapeutic resources with a family as as we're architecting their plan.

SPEAKER_01 33:46

Yeah, yeah. Yeah, yeah.

SPEAKER_02 33:47

That's great, actually. Yeah, that's really great. Yeah. I think it's become harder. You know, I've been doing this for 35 years, and I think it's it's harder because so much is being attacked now where it gets monetized with the schools, tutors, resources, us at some level. And so making that case, this is what I thought the wilderness programs could do a very good job with was giving them the opportunity, often against their will initially, of that self-efficacy, that that pride of achievement or accomplishment, often in ways that don't have any immediate or obvious representation as a therapeutic building at those foundational levels upon which we then build it. It's foundational. It's not necessarily sustainable, but it's foundational when one starts to have that sense of uh self-esteem, which is not a word I I love, but I think it it does matter. And so that's that's where that used to come in quite a bit when used effectively. And obviously, there's a lot of controversy now, and there's bad practices that existed. But nevertheless, I think conceptually, and we've built our mentoring program upon some of these concepts that we've been talking about. But that's that's where that came in historically.

SPEAKER_01 35:03

Yeah, yeah. I mean, those those programs are are are also kind of based on um, they were first reinvent rites of passage. That's what outward bound was, and they were they they were all kind of influenced by outward bound was about rites of passage. Do something difficult that you get through, and then you're now in a new status. We've moved you from this status to that status. And so they they have that that that lost cultural quality to them. They're bringing that if they're good, they brought back that stuff. And a lot of them do. A lot of them think through how to do rituals and things like that. And all of that's uh is really therapeutic, is really good. And it's not necessarily doing something in an office and having a conversation.

SPEAKER_02 35:42

Completely agree with that. And and one of the things that I think is very sad about where our industry has gone is that, again, those things are not monetized. They can't be reimbursed. They're they're they're subtle, they're nuanced, they're relational. And I don't know what to do about that, but it's it's where I think we are. What we can do is observe it and try in our small incremental ways to do what we can within our practices. But are there other are there other things that we can do as as a community of professionals to pay attention to this issue and advocate for the types of things you're talking about, building in, you know, I think just taking a walk with a client can can be very effective. It's it's small, it's it's not a huge deal, but it gets someone moving, gets someone outdoors. But are there other things you can think of that that you do in your in your program or that you've seen in other domains?

SPEAKER_01 36:38

Yeah, I I actually have this strange idea that your way of thinking about a thinking of the world and your insights affect change. I'm joking that it's weird, it's kind of obvious. So, what if we help people be more insightful by helping them learn other ways of thinking about what's going on for them that isn't so medicalized as a disease? I've developed what I think is a really great term for what's called codependency. This term I I've developed myself, it's called love. And I would rather have a parent consider how much they love their kid and how terrified they are. And to know that I'm witnessing that, that I'm appreciating their terror, than to have them leave treatment and say I have a problem with codependency. That is causing a lack of self-efficacy. Because the other one's saying, You're struggling, you're trying to make something happen in your life. You own this. This is part of your ownership of your experience. The other one's this is a label for you, you're broken, you're a problem parent.

SPEAKER_02 37:42

So are you saying that that love allows them to take ownership of what they're doing and what their growth is? I think of codependence as being driven, and this is different from how you use the term hope, but the acts of codependency are driven by hope and fear often, and is often used to control one's as the parent to control our own fear and anxiety over what's going to happen to our child out of love. I mean, it's it's a out of love, yeah, exactly. Out of love.

SPEAKER_01 38:14

Yeah, yeah, out of love. And can I help somebody realize that this behavior they're doing that's might be kind of promoting the kid's negative behavior, comes out of their terror and their love. I tell our clients, like, your parents suffer from a mental illness that's called parenthood. Parental love is a kind of insanity, especially if your kid's in trouble. I would like to help people learn those kinds of languages. Are we sure that this is your diagnosis or is it that you're struggling with hope? Because I struggle with hope. You struggle with hope. We both struggle with hope. Can we talk about that instead of talk about you as a broken thing, which makes you feel non-effective? What do I do about it? So I think we have an ability to influence people by those kinds of different ways of looking at things. And then the other thing is that we need to give people the capacity, the ability to freely disclose their experience. So there's all this research on self-disclosure that basically shows it's just remarkable. It raises your health, it raises your ability to sleep, you stop blaming people, you stop scapegoating people. By the simple act of writing something down, even when somebody, nobody reads it. Our clients need to disclose about what it means to be our clients. They need to be able to tell the story of their treatment in a way where somebody's respecting that it hurt them in some ways. And that frees them up too. And we're not giving them an opportunity. We're not we're labeling what they're telling us as these different diagnoses instead of listening to what their story is. The people that come into our program, they suffer from this disease called my friends got further along in life than I did, and I feel horrible about it, and I feel like a bad person, I feel broken because of it. That's their what we call in in the medical world a chief complaint. The chief complaint is what the person feels their problem is. But but our programs take the chief complaint and then say, well, that's depression. There's no chance to disclose. So how can we give people the ability to talk about their life experiences as patients in a way that liberates them too? And when they leave, they have a different way of thinking about themselves. So I just think there's a lot that happens if we just, if we break from those models in our conversations and we take an approach more towards these things we've been talking about, pride, dignity, self-esteem, these kind of non-therapeutic terms, these non-technically therapeutic terms, you know?

SPEAKER_02 40:42

How do you coach your clinicians, for lack of a better word, at your at your program? What types of questions can they ask? What types of what ways can they can they be effective at drawing that out of an individual? Because I'm I'm guessing it's it's not easy. It's a new, it's a different approach than what people are often trained with when you're, especially when you're having to put people in those label boxes. How do you coach people into that?

SPEAKER_01 41:09

Well, I am forcefully the voice of social experience. So when I see the staff moving towards everything being bound in the person's skull, I'm there to kind of push them out of that and question what's happening socially. I've also, you know, I know good enough enough about organizational psychology that I've I've I've found ways to make my staff feel as safe as possible in their work. They work with high-risk clients and the clients aren't locked up. They're not going to be able to think in creative ways about the person if they're feeling anxious and terrified about what's next. And so, how do we create a place that feels containing? And so as we started to expand, every time a team got to 10 people, I would shut down the growth of that team because any group above 10 is an organization, it's not a group anymore. And so I did all kinds of things that thought about how do we contain the staff in these ways. And what and what we're resisting is a natural human thing called attribution error. Attribution error is when you're in your house and you hear someone screaming outside and you think that's a crazy person. You go outside, you discover they're being mugged, you go back into your house and you think that's a crazy person. Our brains are trained because we're so worried about chaos to think of people as not affected by the world, but everything going on in their heads. And the only person we don't do that with is ourselves. We say, I had a bad week. This happened, this happened, this happened. When you're stressed, you move towards attribution error very quickly. It's the person, it's not what's happening. It's not, it's it's what's wrong, not what's happening. That the attribution error gets you to do that. So if you're going to help clinicians, you have to be like the police for attribution error because they're gonna head towards that. They're gonna head towards the diagnosis and the labeling and all that. They're just gonna naturally do it. And you've got to kind of constantly be reminding them that we've got to kind of bring in these other elements, what's happening around the person.

SPEAKER_02 43:11

You've been doing this work for a long time. Do you see a difference in the newer clinicians that are coming into your programs from between now and a couple of decades ago?

SPEAKER_01 43:22

More of the clinicians I meet outside the program, because clinicians that think in that kind of model way and that kind of mechanical way, they won't make it through the interview process. So we'll automatically not feel a lot of affection towards them. We've got a very thick culture. So you're gonna come be a member of our tribe, we need to know that you have some of those inclinations, you know? So I do see all this talk about we in LA, I just hear all these new things, and they're all technologies. It's all kind of a Botox model for treatment. It's like we've got this technology, not a lot's gonna happen between me and you, but you come in, we'll get you this thing, and then you leave. I hear A lot of that, and I hear it talked about like it's intelligent conversation, like this is the best practice, this is the way to do it. But I also see young people getting excited about the old models, they don't know about them, so they think they're innovative, but I see them getting excited. And I think I told you the other day that the recent consumer research on why people go to therapy is not for the models, it's to be recognized and listened to. This is why people go. And people say things like, I know this is going to take a long time. I'm not expecting to be fixed right away. And I've noticed this excitement. I've noticed this excitement from training psychiatrists. Psychiatrists are under training. They're like, what is this thing called collaborative building of a relationship? I want to know about that. So I do think that there might be a shift. On the other hand, I started a program called Cardea, which is a which is in the psychedelic space. We do ketamine and then we do psilocybin outside the country. The psychedelic world is unbelievably medicalized the way we're talking about. It's all about these magic cures, these magic bullets. It's unbelievable how mechanical and industrial it is. One of the things I say is that there's this giant anti-psychedelic movement in the United States, and that's called the anti that's called the psychedelic movement. I mean, so it's really taken hold of these different models and these ways of thinking that it's just disturbing.

SPEAKER_02 45:23

But any of these technologies are getting monetized at some level because that's, again, just the nature of how things have evolved.

SPEAKER_01 45:30

Yep, yep, yep. And you can say you're trained in them. You know, you go, you go, you go for three months and you get this training, and then you got this little thing you can do.

SPEAKER_02 45:38

So talk to us. I know we've we've talked about what parents can do or clinicians can do or not do. What should an individual be looking for when they're seeking uh mental health help or mental health-related treatment programs or addictions-based programs or resources? Are there some areas you can identify for people to be cognizant of going into those searches?

SPEAKER_01 46:00

Yeah, I mean, I think that honestly, I think that you can partly judge a program by their advertising budget. How much are they spending on a high staff to client ratio and how much are they spending on marketing themselves? The higher the ratio, the lower the productivity demands, the more imaginative and caring a clinician can be. You want them to have plenty of time for discussion and thinking and and all of that. You do not want them feeling like their day is one client after the other. Are there options for individual care or is it all group? Because group group is good for some people, but it really is about money. There's no there's no proof that group therapy is somehow better than individual. What's the level of training beyond these little techniques that's happening for people? And then I have a way of evaluating, which I don't know if parents want to do, is I ask a place, tell me about your energy for good. How would you define it? The energy for good in your organization, tell me what that is. People who can't answer that, I'm done with them. I have no interest in that place. People who come up with like answers that are sort of superficial, they've given me the answer, which is I'm not gonna send that person. But people who talk about the staff love each other, we feel connected, we join together in our compassion for the clients. I begin to feel like, okay, that's gonna be an okay place. And so asking that question, do they have an orientation towards community? Where is this person headed? What's gonna happen with their life and those sorts of things?

SPEAKER_02 47:41

All those things I think are are are vitally important when you're you're interviewing a place to figure out one of the things that I I notice about the advertising slash websites that we have to look at sometimes is how high up on their website does it appear? A request for insurance and verification, you know, when they're when they're really driven by that prescription. That's one marker for how much they're driven by the good of the good energy.

SPEAKER_01 48:10

Yeah. I mean, I I resisted even that call button. I resisted that for years. Even the call, call now. It's like that's something I was trained in. I wasn't trained in talking people into therapy. And so my my website, I think, is really about me trying to sensitively help people learn about other ways of thinking. Uh it's worked. It's been good marketing, but I've never I've never done it in a way where I'm trying to say we're the right place for you, or come to us, or we'll solve your problems. That goes against medical ethics in my mind. It really does on some level.

SPEAKER_02 48:43

I think a lot of times the the advertising or how treatment programs promote themselves is probably deliberately at some level tapping into, as I define codependency, of the hope and the fear. Yeah. And so oftentimes treatment programs can themselves be acts of desperation, of desperate codependency and using treatment programs as as this codependent act.

SPEAKER_01 49:10

Yeah, yeah, that's right. And so you you want programs that are run by people who have an understanding of kind of the dignity of recovery. And you want programs run by people from the field. So that's the other element. I can basically look at a list of programs, and if I pick the ones that I think are really good, it always ends up as clinician run. Because we've been trained to put the client's needs above our own. That's our training. And a program that's owned by an investor, that investor has obligations to other people than the clients. I've been asked to like, can we can get can we get Yelp reviews? And I've said, no. That means I'm asking the parents to work for me. They don't work for me. I work for them. And so those sorts of things I'd look for too is how much am I being sold here? If I'm being sold, that already says something about their ethics. Because that's not what we're supposed to do is as caring professionals, as people in the movement that's about kind of getting healthy and good, we're not supposed to be giving giant that, you know, that's for snake oil salesmen. That's not for people that are serious about health.

SPEAKER_02 50:17

I think that talking about the independence or the clinician run, that's that's definitely the kind of thing that we look for because so many programs now have either been bought up by or established by investors, private equity, et cetera. And that that is a massive conflict of interest and and a commoditization of the of the client.

SPEAKER_01 50:37

It's a part of a larger problem because it's not just mental health, it's everywhere. And if you're noticing that your health care is becoming more chaotic, that you can't get as as quick access to it, that it becomes work to see a doctor, when there's a problem you end up in an R and you wait for four hours and there's no food to give you, and you're sitting there, you're noticing this change towards people that are trying to make money out of this in big time ways. And that's what we're seeing. That's that's what uh for me at least, I can't believe how poor the care is when especially when it's like emergency room care and things like that, you know? And when you look out for a family member, uh, the sense that nobody's helping you navigate the system. These hospital systems depend on families to be the social workers for their for their kids and for their relatives. And if you don't have relatives around you or friends looking out for you, you're screwed in those systems. And that's all a reflection of people pulling money out of these hospitals. It definitely is.

SPEAKER_02 51:43

Well, and this is again self-promotional, but that's what we try to do when we're working with families on the consulting side of helping them create a plan and identify which are the appropriate places to go to or bring into that blueprint that we're developing with them. And um I think it it does try to join with them and try to navigate it from a place of relationship and compassion. Yeah. Yeah. Yeah. We need to end on a hopeful note. I think we've done some time shitting on some of the industry here. So this has been this has been wonderful. And I do hope that this has brought some sense of hope and dignity to our listeners. It's it's been a pleasure. It's been illuminating and invigorating speaking with you today.

SPEAKER_01 52:31

Yeah, you too. It's really been fun. I really appreciate it. Yeah, yeah. Yeah, you're you're good at this. It was nice to nice to do.

SPEAKER_02 52:38

Uh you you you made it easy. And so, Dr. Ross Allenhorn, thank you for joining us on the reframe. Thank you very much. Really fun.

SPEAKER_00 52:47

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