Rediscovering our Work in Aftercare
After over six years of work in wilderness therapy, I decided last summer it was time for a shift in the work I was doing. The wilderness will remain a transformative setting for personal discovery, however, I became increasingly curious about how young people struggling with substance use and a variety of underlying issues reintegrate into the “front country.” This was a discussion I had frequently with clients and parents as they prepared to leave the wilderness: how do I take a profound healing experience and apply it to my life outside, where familiar stressors and environmental factors return? How do I continue to engage in treatment after so many months and so much effort?
These are questions that don’t have simple answers. I imagine that if you asked a handful of professionals you would receive a variety of responses. I knew the work that the team at Skyline Recovery was doing aimed to help young men find these answers for themselves in order to prepare them for a life they truly want to live. I was all in on that mission!
To me, there are several factors that help facilitate change in a primary treatment setting. Things like adequate therapy, sobriety, sleep hygiene, nutrition, exercise, community, and connection come to mind. The setting itself excels at providing containment, safety, routine, and simplicity. It’s an exciting time where growth can happen quickly. Similar to when one begins a weightlifting routine for the first time and witnesses gains they believed would take many months, if not years.
What many weightlifters find after a period of several months of growth, however, is a plateau. When they arrive at a plateau, the response may be to stop lifting altogether. Alternatively, it could be to change the way we lift weight. The introduction of new variables, exercises, and timings helps to create a dynamic experience our body is not accustomed to. Clients may experience plateaus during their primary treatment experience, or they may not until they arrive at aftercare. It happens for all of us in one way or another, and it becomes an opportunity for us to discover deeper aspects of our personal work. In transitional living, we see it evolve in a different way as we introduce experiences such as looking for work, going back to school, or romantic relationships.
That’s what I love about the work we are doing at Skyline Recovery. All of the staff are committed to pushing beyond the maintenance stage in order to help encourage growth that lasts well beyond the client’s time in treatment. If we are to help clients push through plateaus, we must be willing to help them change their routine and expand their therapeutic comfort zone. This is where experiential approaches such as Somatic Experiencing, Somatic and Attachment-Focused EMDR, and Brainspotting come into play. They encourage us to go beyond the limitations of verbal expression rooted in the thinking mind. They help us to learn to listen to our body, feel our feelings, and sit in the reality of our experience without needing to completely make sense of it. Different therapeutic interventions, like different exercises, help us engage in a completely different way.
Another aspect of a therapeutic plateau is treatment fatigue. Many of the clients I worked with in the wilderness (and at Skyline) have been to treatment several times. They start to feel the weight of burnout, and a desire for additional autonomy or control. Finding a way to allow them to be treated without it feeling like treatment is essential. Allowing for flexibility and increased freedom helps build motivation and can reduce feelings of powerlessness. Taking group and therapy outside, and encouraging clients to expand their life outside the program are a couple of ways we try and reduce treatment fatigue.
From the get-go, Skyline felt more like a family than a sterile treatment program. The owners take a caseload and spend a significant amount of their day interacting with clients outside of the therapy office. Whether it was ping pong in the garage, telling stories on the couch, impromptu smoothie runs, or taking someone to an appointment, the variety of interaction and time spent feels significant and unique. It ends up feeling more like we are in a community together, working toward common goals. Having interactions that feel more casual and natural help ease the belief that clients are just “stuck in another treatment program.”
The part I love most about my work as a therapist at Skyline is the effort and attention we put into the development of our community. One of the many things wilderness and residential programs get right is the emphasis on authentic connection and establishing a healthy culture in the milieu. This helps folks who have felt like outsiders begin to feel seen, a critical component often missing in young people’s lives. And yet in wilderness, it sometimes felt easy. Everyone was out in the woods together, with very little distraction. At Skyline, we all intentionally tell parts of our story to the clients. We work to relate with them in a healthy way in order to reduce shame and loneliness. A lot of work goes into developing an atmosphere that says “we’ve been there, and we see you.”
With this kind of relational and immersive approach, I think we help increase connectedness during an initial period where that can feel challenging or overwhelming. The more that clients feel a part of a community that’s built around authenticity and depth, the easier it is to stay the course and trust the process. It’s when we feel disconnected and alone that we question the purpose, feel lost, and experience greater fatigue.