We invited a number of former residents during the 2016 Fall Family Festival to talk about their Mountain Valley experience. Click on the link below to listen to their stories.
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Mt. Washington Ascent on the Cog Railway – A Blog by Colleen Donohue
A relaxing start to Sunday morning as residents gathered together to depart for the Mt. Washington Cog Railway. The roads leading were winding and filled with new scenery around every corner. The van was filled with music and singing, as well as questions like “how much longer?!?” The first sight of Mt. Washington made most of the residents “oooo” and “awww” as they were unaware of just how big the mountain really is.
As we arrived to the base, it was a quick walk to the platform where we were greeted by the various engineers. The bright orange car was awaiting our arrival – the world’s first mountain-climbing cog railway. The residents were able to move freely throughout the car and ask any questions they may have had. The cog climbed for about an hour with stops along the way to allow other trains by. The vastness of the mountains caused some of the residents mouths to drop. The visibility was over 90 miles, which is near to perfect. They were fascinated by the pitch of the train and just how high we were climbing. Once at the top of Mt Washington, standing 6,288 ft tall, residents moved about the lookout points, and walked through the historic sites nestled in the rocks on the summit. Some residents felt compelled to one day climb the mountain to know what it feels like to have the satisfaction of accomplishing the highest mountain in New Hampshire. On the descent residents were able to see a new perspective on the scenery.
The day came to an end with a rewarding snack in the parking lot and a view of Mt. Washington stuck in the rear view mirrors.
Colleen Donohue Residential Counselor/Adventure Module Leader
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From the Desk of the Executive Director – The Other 23 Hours
THE OTHER 23 HOURS
During a recent trip to the Philadelphia area where I met with several experts in the treatment field of OCD and anxiety disorders, the topic of the importance of what happens out of the therapy session or therapist’s office, within a residential setting doing exposure work. After discussing the clinical component of Mountain Valley – the multiple individual therapy sessions per week, how we implement the enhanced exposure and response prevention (ERP) work within our clinical programming and in the therapeutic milieu; the role of the clinician vs. the role of the residential team in effecting our Cognitive Behavioral Therapy-based ERP clinical program came into the conversation.
As we discussed the above and how effective exposure work can be, especially within the ‘container’ of a 60 to 90-day specialized residential treatment program, we also discussed the type of training for the residential program staff in supporting the clinically-driven exposure work. I shared with this psychologist the Mountain Valley- developed training curriculum for our residential staff. “Residential Exposure Specialist” (RES) training is provided for all of our residential staff and is delivered by our clinical team and supervised by the residential program and clinical directors. She appreciated our focus on this, highlighting the importance of the “the other 23 hours.”
About Our Residential Exposure Specialist Training
After 90 days of successful employment and after receiving our basic curriculum centered around safety-related issues such as, driving, therapeutic boundaries, and instruction in CBT and ERP for OCD and anxiety, residential staff are enrolled in the Residential Exposure Specialist (RES) training. RES training consists of a blend of didactic instruction from the clinical staff including utilization of the Behavioral Tech™ (http://behavioraltech.org/ol/index.cfm0 on-line training platform, documented supervision by our clinical director – a licensed psychologist and supervisor of the clinical team and program – “in vivo” work with each therapist and their caseloads, and finally a written test. After successfully completing the RES training, residential staff are given an hourly raise and are then eligible for designing and implementing clinician assigned exposures during residential programming time, such as on a hike, or a trip off campus into one of the local communities, etc.
Mountain Valley’s residential program staff are typically recent college graduates who are drawn to our unique program model not only for the professional experience of working within our setting and with our population, but also because of the unique, holistic programmatic model we provide. Our residential staff typically have bachelor’s degrees and specific credentials related to our programming such as degrees in Health Education and Promotion, Therapeutic Recreation, Environmental Science and Psychology. These “millennials” bring an energy and a desire to work on a team and grow personally and professionally. Offering a competitive salary and good leadership is key, but training and growth opportunities are paramount to making their professional experience rewarding and thus ensuring our clients get the best possible treatment. Residential Exposure Specialist training as well as other opportunities for continuing education are additional ingredients in what sets Mountain Valley apart.
Mountain Valley’s Clinical Programming – ERP
Mountain Valley uses empirically supported treatment modalities for OCD and anxiety disorders. Our program and facility are managed using industry best practices. We are licensed by the State of New Hampshire, Department of Health and Human Services and nationally accredited by the Commission on Accreditation for Rehabilitation Facilities (CARF). Residents are typically with us for 60 to 90 days.
What We Treat
- Mountain Valley is uniquely organized to treat the following:
- Obsessive-compulsive disorder
- OC-spectrum disorders
- Generalized Anxiety Disorder
- Panic disorder and agoraphobia
- Social anxiety disorder
- Tic disorders, Body Focused Repetitive Behaviors such as Dermatillomania or skin picking disorder
- Co-morbid disorders such as:
- ADHD
- Depression
- Disordered and “finicky” eating
- Somatization disorders (conversion disorders)
Treatment Modalities and Services Provided
- Enhanced Exposure and Response Prevention (ERP) – individualized and group work
- Individual Treatment Planning – Three individual sessions per week
- Family therapy and education – centered around family accommodation of anxiety
- Thematic Group Therapy – DBT skills, Expressive Arts
- Mindfulness based Cognitive Therapy
- Clinically-informed academic component
- Therapeutic Equine Program
- Trauma-Focused CBT
- Recreation Therapy
- Medication Management
- Executive Functioning support
The above programming takes a team of talented and supported clinicians and energetic residential program staff. Engaged managers ensure we are maintaining a robust, creative and continuity of care based on current practice guidelines.
To schedule a visit to Mountain Valley’s White Mountains Region of New Hampshire, contact Don Vardell at dvardell@mountainvalleytreatment.org. For more information go to www.mountainvalleytreatment.org.
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From the Desk of the Executive Director – Learning and ERP
Maximizing learning when designing and implementing exposures for clients with debilitating anxiety and OCD is well documented. Balancing the teaching of skills and acceptance with reducing the fear response seems to predict the most successful treatment outcomes.
Here at Mountain Valley Treatment Center, located in New Hampshire’s White Mountains Region, we embody this practice of maximizing exposure opportunities for our co-educational adolescent and emerging adult residents during their 90-day residential treatment. Focusing the psychoeducation, design, and execution of individualized exposures on campus and in nearby communities optimizes the inhibitory learning process while reducing fear without the emphases being solely on fear reduction or habituation.
Mountain Valley’s CBT-based ERP curriculum and therapeutic milieu consists of individual, group and family therapy along with a holistic experiential education curriculum focused on mindfulness, environmental stewardship, recreation, and health and wellness. Residents co-design their treatment and exposure plans, participate in individual therapy, thematic group therapy, and specific ERP focused groups. ERP specific groups consist of psycho-education, hierarchy development, individual exposure practice – interoceptive and in-vivo – and group review.
Be sure to follow Mountain Valley on Instagram and Facebook to see how we are implementing ERP work in our unique environment.
Don Vardell, Executive Director
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Dr. Alex Young’s Latest Blog Post on Interoceptive Exposure
In today’s blog, Dr. Alex Young, Mountain Valley’s Director of Clinical Outreach, writes about Interoceptive Exposure.
Mountain Valley is currently under construction and, like everything at Mountain Valley, we are building with Exposure Therapy in mind.
Unhelpful beliefs about body sensations are common issues amongst residents at Mountain Valley. Often, our residents feel their normal body sensations are warning them of danger–danger they might be getting sick, something bad might happen, or that they might draw negative attention to themselves. These unhelpful and often inaccurate beliefs about body sensations play a monumental role in maintaining anxiety. Biased beliefs often result in biased behavior, with the most typical biased behavior being avoidance. Our residents are very good at avoiding the things that make them uncomfortable. This avoidance makes sense–nobody wants to purposefully do something they think will be uncomfortable or embarrassing. However, even though avoidance works in the short term, the biased thinking that drives the avoidance tends to grow and spread into all aspects of life. Eventually, life becomes more about avoiding than participating and life gets very limited.
At Mountain Valley, we help our residents systematically re-engage with these threatening body sensations and test out their biased beliefs. This is a therapeutic process known as Interoceptive Exposure. Interoceptive exposures target typical body sensations such as shortness of breath, increased heart rate, dizziness, lightheadedness, etc. In order to stimulate these sensations, we have our residents engage in activities such as breathing through cocktail straws, sprinting for short distances, spinning around in chairs, and holding their breath. It is with this type of exposure in mind that we have designed a new building on the Mountain Valley campus. Set to be finished in mid-2017, our retrofitted exposure barn will include balance beams, tire swings, and other recreational space to help our therapists and exposure specialists facilitate these types of exposures in a safe and fun atmosphere.
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Mountain Valley Embraces the Giving Spirit this Thanksgiving
To celebrate the 2016 Thanksgiving season, Mountain Valley Treatment Center donated home-cooked meals to local community members. Spearheaded by Kimberly Gauquier and Hannah Bolstridge, staff members and residents in Mountain Valley’s Farm-to-Table groups worked diligently in order to fulfill the requests of the Haverhill Welfare Office Director, Leslie Ramsay. MVTC was asked to prepare four full dinner baskets (feeding approximately six family members), along with three individual plated meals for single or elderly community members. In order to complete the task, Mountain Valley utilized resources such as:
- home-grown produce, homemade pies & baked goods
- locally grown turkeys
- other locally sourced ingredients
In order to fulfill the requests for the baskets, MVTC began reaching out to local farms to acquire ingredients that were not available fresh from the MVTC community garden (in this case, turkeys, green beans and potatoes). After gathering ingredients, the Farm-to-Table groups began preparing the side dishes a few days ahead of time. Each side dish was packaged in disposable tin containers that could be easily baked and re-heated by the families at the time of their meal. Turkeys were requested to be given to families un-cooked. An appreciative Ramsay came to Mountain Valley this morning (11/22/16) , so that she could deliver the baskets to the families.
Each full dinner basket consisted of:
- 1 whole turkey
- 1 homemade pumpkin pie
- Mashed potatoes
- Squash
- Green bean casserole
- Homemade dinner rolls
- Stuffing
- Homemade cranberry sauce
- Gravy
Each individual plated meal consisted of 1 serving each of:
- Cooked turkey
- Homemade pumpkin pie
- Mashed potatoes
- Green bean casserole
- Squash
- Homemade cranberry sauce
- Gravy
- Dinner roll
In order to fulfill the request for individual plated meals, MVTC will prepare one full Thanksgiving meal, which will be delivered to the Haverhill Police Station on Thanksgiving Day. Each individual plated meal was packaged in disposable tin containers that could be used for re-heating. The Haverhill police officers on duty were responsible for delivering the individual plates.
Mountain Valley recognizes the importance, if not obligation, of being a good neighbor – therefore community service initiatives such as this happen frequently. MVTC is proud to be a member of the Upper Valley and surrounding communities and finds great satisfaction in helping those less fortunate than ourselves.
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Mountain Valley Past Parents Remain Supportive
Mountain Valley is so fortunate to receive the support – in every definition of that word – from the parents of our graduates. By talking with prospective families as part of our Parent Partners initiative, attending Fall Family Festivals, and making charitable donations in support of programming, financial aid and facilities (to name just a few), our “past” parents do much to ensure that our current residents are able to able to have a meaningful, successful therapeutic experience during their time here.
One such couple, Laurie and Michael Schuftan, wrote the thoughtful letter below soon after attending our reunion with their son, David.
Dear MVTC:
We wanted to take a moment to tell you how wonderful the 5th Annual Mountain Valley Treatment Center Reunion was this past Saturday. It was truly amazing to see how many former residents and their family members returned to this very special place.
Michael and I are so thankful that Mountain Valley exists. Other parents expressed similar sentiments to us, literally stating that MVTC saved their children’s lives.
As Carl Lovejoy stated numerous times throughout the day, it was remarkable that people traveled from far and wide to return to a TREATMENT CENTER!! Although the past residents went through difficult times while in treatment, obviously many realized how important those experiences were, and those bonds that were made with individuals going through similar trials and tribulations were to be cherished.
We stayed until after 5:00 pm, when David and his group of friends were, at last, able to give their final hugs and say final good byes for the day.
We are proud to continue to support the invaluable work the the Mountain Valley Treatment Center does to help this population of kids.
With sincere gratitude and love,
Laurie and Michael Schuftan
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From the Desk of the Executive Director – “Not All Therapists are Created Equal”
Recently, Mountain Valley Treatment Center, along with our partners International OCD Foundation state affiliates from New Hampshire and Massachusetts, hosted the first Seacoast Anxiety Symposium in Portsmouth, NH. The Symposium was designed to share information about and facilitate a conversation on OCD and anxiety disorders. An impressive line-up of presenters and an expectation exceeding group of attendees made this inaugural event a huge success.
One of the presentations, delivered by Szu-Hui Lee, Ph.D. and Beth Ohr, Psy.D., focused on what effective anxiety treatment looks like across a continuum of care and within different settings. Dr. Lee is a psychologist at Phillips Exeter Academy, a private practice psychologist, and President of NH OCD. Dr. Ohr is a private practice psychologist and with the NH APA. Szu-Hui and Beth, who specialize in treating OCD and anxiety disorders, identified the essential elements of the CBT-based modality of Exposure and Response Prevention (ERP), the “gold standard” in treating debilitating anxiety and obsessive compulsive disorders, within an outpatient, residential and in-patient setting. Their presentation shared information to an audience of varied experience in Cognitive Behavioral Therapy about exposure therapy, the challenges of treatment and – most importantly – the full commitment of a therapist to properly treat it. They presented this information from a perspective of what a consumer should look for and ask of their therapist before engaging with them.
Beth and Szu-Hui referenced the article by Michael Jenike, M.D. ( https://iocdf.org/about-ocd/treatment/how-to-find-the-right-therapist) on the International OCD Foundation’s web site. Here is a summary of what Drs. Lee and Ohr shared and the specifics from Dr. Jenike’s article.
First of all, for a sufferer of life-interrupting anxiety and/or OCD, you deserve to get the right help and therefore you should take control of vetting a therapist. Ask questions. Dr. Jenike recommends specifically and at a minimum, these questions should be asked:
- “What techniques do you use to treat OCD?”
If the therapist is vague or does not mention cognitive behavioral therapy (CBT) or Exposure and Response Prevention (ERP), use caution. - “Do you use Exposure and Response Prevention to treat OCD?”
Be cautious of therapists who say they use CBT but won’t be more specific. - “What is your training and background in treating OCD?”
If they say they went to a CBT psychology graduate program or did a post-doctoral fellowship in CBT, it is a good sign. Another positive is if a therapist says they are a member of the International OCD Foundation (IOCDF) or the Association of Behavioral and Cognitive Therapists (ABCT). Also look for therapists who say they have attended specialized workshops or trainings offered by the IOCDF like the Behavior Therapy Training Institute (BTTI) or Annual OCD Conference. - “How much of your practice currently involves anxiety disorders?”
A good answer would be over 25%. - “Do you feel that you have been effective in your treatment of OCD?”
This should be an unqualified “Yes.” - “What is your attitude towards medication in the treatment of OCD?”
If they are negative about medication, this is a bad sign. While not for everyone, medication can be a very effective treatment for OCD. - “Are you willing to leave your office if needed to do behavior therapy?”
It is sometimes necessary to go out of the office to do effective ERP.
The last question regarding whether a therapist is willing to get out of their office to work with a client – to do exposures in real-life (in-vivo) settings – was highlighted and strongly reinforced by Beth and Szu-Hui. Exposure therapy cannot only occur in an office setting and within a 45 minute to one hour session. This treatment is difficult and requires not only a dedicated client, but a dedicated and properly trained clinician.
Don Vardell, Executive Director
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MVTC Grad, Joelle, Travels from Hawaii for Reunion 2016 – And Shares a Powerful Video Message Regarding Teen Suicide
As many of you know, we held our 5th Reunion at Mountain Valley this past weekend. One very special MVTC graduate, Joelle, and her father joined us all the way from Hawaii. This morning, Joelle sent us the note below, as well as a link to a video she did recently for Speak Life Hawaii, an organization created by four high school students dedicated to initiating the conversation of suicide and mental health, engendering a more educated and empathetic community, and directing suicidal teenagers towards resources for help.
Please take a few minutes to read Joelle’s letter and watch her powerful video. How fortunate we are to be able to work with such amazing kids. Mahalo, Joelle.
Dear Friends of Mountain Valley:
I did this video for Speak Life Hawaiʻi about a year ago, so when Carl asked me to write an introduction, it took me awhile to think about what Iʻd like to say. I write this sitting in my car about to go to school. Itʻs a typical Monday morning, but I had nowhere near a typical weekend. Especially after going back and watching this video, I knew traveling to Mountain Valley and back to Hawaiʻi for the reunion over the weekend was no doubt the best decision I/my parents could have ever made.
I truly do believe there is something magical about Pike, New Hampshire… like an overwhelming moment of mindfulness that seems to just linger in the air. Mountain Valley and the things that happen there are so amazing that when you aren’t there, it almost seems fictional. There isn’t a day where I don’t think of Mountain Valley and the magical people there who have become part of my ʻohana. I am, and forever will be, immensely grateful to those magical people who taught me how to live again.
And that is why I wanted to use this intro to thank all the staff and residents I met at Mountain Valley who have given me the greatest gift of all – happiness. Mountain Valley will forever be my home away from home.
Love, Joelle
https://www.youtube.com/watch?v=h-rAT_k-RRo
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From the Desk of the Executive Director – Adolescent Anxiety and OCD: Why Residential Treatment?
In my travels across the country, meeting with clinical and educational professionals, we frequently discuss the topic of when residential treatment is indicated and the process of bringing families – and teens – on board with the idea of going to a residential program. While in many cases the need is painfully clear, describing the benefits of what a residential placement option can provide, over and above an intensive out-patient program, putting it all into terms that resonate is important for gaining buy-in from skeptical kids and families.
When someone’s fear and avoidance or obsessive thoughts and behaviors get to a place where they get “stuck” in their out-patient work – or cannot get to their appointments, it’s time to think about a residential placement. Residential treatment is designed to break the cycle of dysfunction and disability and create momentum in an otherwise stagnate situation. Resuming more adaptive daily functioning in a therapeutic, supportive and expert environment will lead to positive change. Residential treatment, and the clinical and experiential programming that is part of it, not only provides the opportunity for intense treatment and daily living skills, but also provides a much needed social milieu and group interactions that are essential for growth and overcoming specific anxiety disorders such as social anxiety.
When it is determined that a residential placement is needed, a program with a structure and model that supports the consistent delivery of Cognitive Behavioral Therapy-based Exposure and Response Prevention (ERP) is the standard. A comprehensive and specialized anxiety treatment program that utilizes ERP would typically include:
1. A population (milieu) of clients with anxiety and OCD as the primary disorder. Many quality treatment programs say they treat anxiety – which they do, but have a mix of client presentations and co-occurring disorders such as substance abuse, attachment disorders, and personality disorders.
2. A model of gradual exposure work – imaginary, followed by interoceptive, followed by in-vivo practice.
3. Intra and Inter-session exposure work with a trained therapist or specialist, and opportunities to “rehearse” confronting fears in real world (”in vivo”) situations.
4. Multiple and extended ERP Groups weekly where clients will receive education about ERP and participate in exposure activities.
5. Individual and cohort work on exposure scenarios where clients can develop an exposure plan for similar fears.
6. Data collection during the exposure assignments that includes cumulative rating of the anxiety (scale of 1-10), documenting and communicating thoughts, describing physical sensations, and acknowledging safety behaviors.
7. Exposure work supplemented by weekly individual and family therapy.
While a residential program that specializes in anxiety with a strong clinical component is paramount, the programmatic structure of a residential program should also be fun and include an environment to support exposure therapy. Opportunities for experiential and recreational activities to develop skills and explore passions will make the overall experience more enjoyable and offer opportunities for organic and “accidental” exposure work. Ideally, the program should include other evidenced-based elements to help with anxiety such as mindfulness activities like yoga, nutrition education and healthy meals, fitness and outdoor activities.
Don Vardell Jr., Executive Director
For more information about residential treatment, Mountain Valley Treatment Center, or to discuss whether residential treatment is appropriate for a client with whom you are working, contact Dr. Alex Young, PsyD., Director of Clinical Outreach at ayoung@mountainvalleytreatment.org.