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Ironwood offers an intensive 9-12 month customized therapeutic component that is designed to re-orient the child to the reality of life and regain a sense of responsibility for emotions and behavior. This includes a treatment plan, developed through individual therapy, family therapy and group therapies. Clinicians evaluate the child and family regarding the level of disengagement and begin the work of reconnection and attachment. Ironwood provides a structured daily program intended to initiate and establish pro-social behaviors and re-define roles. Victim roles, learned helplessness, bullying, tantrums, withdrawal, and holding hostage those you love, is replaced with reality-oriented roles driven by mindfulness toward self and others. In an effort to reduce impulsivity, our therapists begin the development of teaching coping skills to increase the residents’ ability to manage emotional and physical discomfort and increase tolerance for frustration. With 24/7 adult guidance and mentoring, adolescents begin the journey from their out-of-control lives to a step-by-step passage back to a life influenced by a strong connection to family, friends, nature, and community.
At Ironwood, therapy is founded on the basis of relationships-relationships of trust, truthfulness, confidence and honor. When students are willing to engage with a trusted therapist-then learning, change and growth can begin. Therapy take many forms and is conducted in many locations: walking or hiking throughout the campus, on a trail ride, sitting on a bench next to the pond, around a campfire or in a therapists’ office. Each resident sees their therapist individually, twice a week, for the first level of our program (approximately 30 days), after which one of those sessions becomes a weekly family therapy session, conducted through video conferencing and in person, during Family Weekends (held 5 times per year). Residents also participate in up to four weekly, clinician-led group therapy sessions. Groups include: Outdoor Experiential Learning Group (also known as Wilderness Experiential Learning); Addiction and Recovery Group(s); Equine Assisted Psychotherapy (EAP) and Dialectical Behavioral Therapy (DBT).
The Outdoor Experiential Learning Group follows a three-prong scaffolding of: Briefing, where pre-activity guidelines, rules, safety considerations, etc. are given and the activity is framed for the group; doing the activity with minimum input from the clinical facilitator, intervening only if safety is at risk; and debriefing, where the process of the group is discussed and connections are made. Ironwood’s natural, rural campus is intentionally used in these experiential groups to create a non-judgmental, healing and safe environment, in which to apply the real and metaphoric lessons learned in the group to life situations with which our residents are struggling. The experiential impact can be beneficial for all participants, as these groups engage our residents on cognitive, affective and behavioral levels.
The group counseling model used in Experiential Learning Groups uses a carefully planned and/or sequenced and processed series of experiential activities to elicit behavior change. Experiential interventions also enhance the engagement of our residents in the overall treatment process. In these groups, our residents respond positively to physical engagement, cognitive challenge, playful nature or activity base of the treatment process with interest and enthusiasm. They develop and maintain engagement in the treatment plan and are able to apply elements of this plan to “here and now” experience.
Experiential interventions also provide opportunities for residents to practice behaviors that align with the expectations of the therapeutic milieu. Initiatives and natural consequences provide hands on teaching in personal and social responsibility. Appropriate social skills and cooperative behaviors, such as effective ways to manage anger, share emotions, and process interpersonal issues within the group, are modeled and practiced.
The lessons residents learn and the skills they develop and practice in the Outdoor Experiential Learning Group parallel the themes of the levels at Ironwood. Engagement, effective communication, personal responsibility, self-awareness, and mindfulness take time to develop and are all integral parts of the process of achieving our ultimate goal of reengaging with their families and transitioning successfully back home.
The Addiction and Recovery Group(s) are split into two segments: an education oriented group and a recovery oriented group. The first segment is focused largely on education and prevention. Topics include diagnostic criteria for levels of substance abuse, the disease model of addiction, an orientation to triggers of substance abuse, a survey of specific substances of abuse, process-oriented addictions and cross-addiction, the negative effects and long-term consequences of continuing use, the dynamics of relapse and the necessary components of successful long-term recovery. This segment also includes developing heathy coping and decision-making skills and discovering alternative interests. The second segment revisits the same initial topics only delving deeper into each area. Stages of change are discussed for each level. Motivational interviewing is used to help each resident progress through the stages of change and toward abstinence or symptom reduction. An introduction to the 12-step model of recovery is taught in this segment. Residents complete workbooks focused on substance use history, negative effects of use, triggers and warning signs, high-risk situations, relapse prevention planning and sober support networking. All residents then present their work for processing with the group. It is in this stage of reflection residents are able to look at underlying causes of behavior and how this may result in negative relational patterns with family, friends and their community. Building coping skills and developing a solid plan for abstinence, outside of Ironwood, can also significantly improve the self-esteem, cultivate personal growth and help to reunify the families of the residents.
Equine Assisted Psychotherapy (EAP) is conducted using the EAGALA model, which requires the resident (s), a Mental Health Specialist, EAGALA certified Equine Specialist and horse(s) in a private setting. Ironwood has provision for both indoor and outdoor EAP experiences, 8-10 healthy horses and availability for continued education and resources for facilitators leading the group. Students engage in groundwork activities with the horses in an experiential fashion, with little to no interference from the therapist and Equine Specialist, beyond an initial check in and directions. At the close of the session, the horse’s behaviors are discussed and meaningful questions are asked by the facilitators. The student’s own words are then used to draw metaphors that link the experience with the horses back to events or focal points that exist in the resident’s everyday life. This form of therapy is very effective because horses are intelligent, perceptive creatures that will reflect that treatment they receive, as well as respond noticeably to the slightest change in a human being’s approach or behavior.
Each EAP session is an hour long and consists of a structured activity. Pedagogical methods include metaphorical development, experiential stress on the journey instead of the end result, with a behavior based focus in a natural setting. The positive effects of EAP on residents observed daily include: an improvement in leadership skills, building of confidence and self-esteem, conflict resolution skill development, increased self-awareness, better adaptation to stressful situations, improved ability to think outside the box, more creativity and a stronger interest in horses. All of these effects align with the overall purpose our program and help to support the personal growth of the residents.
Dialectical Behavior Therapy (DBT) groups use a skill-based cognitive behavioral treatment model applied for adolescents within a residential setting. Each resident attends a weekly DBT session to learn new ways to change challenging behavior, to communicate more effectively and then develop a greater understanding of their emotions and how to manage them. There are 4 modules within the DBT curriculum that are intentionally broken down into 2-3 month time frames: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. The groups are facilitated with the purpose of teaching each module comprehensively, with direct application to every-day experiences and learning opportunities. Across the social, emotional, and behavioral spectrums, each resident learns skills that help them enhance their awareness of themselves and others, better tolerate stress, cope with uncomfortable emotions, and interact with others (specifically peers, family and authority figures) in a way that empowers and increases self-esteem. Psychoeducational and discussion based approaches are utilized during facilitation using a wide array of traditional and creative teaching materials and resources. The skills are introduced in a manner that is age-appropriate and also with the intention to cultivate positive personal and interpersonal growth. Adapting the traditional DBT model benefits the Ironwood curriculum in areas of uniqueness, individuality, and intention to each resident’s needs. DBT lessons are enhanced when the skills are reinforced daily within the behavioral milieu, during individual and family therapy.
Family therapy is conducted with individual therapist working with the resident after approximately 30 days. General acceptance and engagement in the program is a behavioral requirement necessary for starting Family therapy at Ironwood. The reengagement process includes a “coming clean letter”, which identifies key issues that led to placement in the program and help to establish a new start to the relationships. Identifying unproductive communication patterns and working to reestablish trust are core issues in family therapy. Ultimately, the goal of establishing a new set of rules for the return home is developed through a “home contract”, mutually developed with the family, resident and therapist. Reunification is also gradually supported through a series of 2-3 Family Weekends, where residents spend time with their families in individual therapy sessions, EAP sessions, Parent-child group sessions, family oriented activities and free time, both on and off campus. Families are encouraged to spend as much time together during this weekend as possible. Parents are also invited to participate in a Parent Workshop, which includes relevant topics such as building resilience, communication, and limiting social media. Former families with graduated residents have also returned to lead this workshop and share successful “after Ironwood” advice and answer questions. This workshop is followed by a smaller Parent Only Group session, facilitated by a therapist, intended for discussion and support for the families. All of these events and experiences lend to overall goal of Ironwood to understand the underlying dynamics of the family piece and to create family reunification and connection.