MOVING MOUNTAINS

Resources

Staff Spotlight: Dara Spezial

The Incredible Brain 

A relatively new addition to the Mountain Valley Team, Dara Spezial, MS, OTR/L, serves as milieu clinician. She uses her extensive background as an occupational therapist to help residents rebuild routines, strengthen self-efficacy, and reconnect with the activities that bring purpose and grounding. The Massachusetts College for Pharmacy and Health Science recently recognized Dara’s passion for teaching with the Outstanding Fieldwork Educator Award, honoring her for work with students at local colleges in New Hampshire and Massachusetts. We caught up with Dara to learn more about her work on Mountain Valley’s growing OT team.

Tell us about your background?

“I knew I wanted to be an occupational therapist pretty early on. I actually did OT myself as a kid because I had a really hard time learning to walk and talk. It was kind of a passion by proxy, learning so much early on in my youth. I ended up at Ithaca College in New York and met Camille Wrege, who was in my same year. She’s my best friend and was my maid of honor at my wedding. We both fell in love with mental health and had a passion for it. We ran a mindfulness club in college which was great, but I didn’t know how to integrate OT into mental health as a career. It was always in the back of my brain.

I ended up working in geriatrics and the work is very fast, which is awesome. For the past six or seven years I’ve been in nursing homes and hospitals, assisted living facilities and homes, doing home care, inpatient, and outpatient work. It’s been fortunate that my employers have seen my passion for the field and they’ve expanded my job opportunities to include fieldwork education with students. I recently received the Outstanding Fieldwork Educator Award for my work with students at local colleges in New Hampshire and Massachusetts. I truly love teaching and educating about occupational therapy.”

Dara Spezial

How did you end up at Mountain Valley?

“I burned out at my previous job. It had massive productivity standards and was very focused on the bottom line. In June I quit and decided to look at what I could do next. I got my ergonomics certification and did some contracting on the side. My husband and I also bought a house after we fell in love with the Upper Valley.

I contacted Camille and said ‘Hey, I know you love your job. Is there any way I could come for a day and see what it’s all about?’ I got to come in and shadow and I fell fully in love with Mountain Valley. This is what I went to school, this is why I want to be an OT. The team has been outstanding and allowed me to have incredible opportunities so quickly in my milieu clinician role. It’s a very special place where we can have freedom in our work.”

Tell us about how your work complements that of the other occupational therapists, Camille and Renee?

“It’s incredible that we have four occupational therapists, including executive director Zack Schafer, when it previously was just Camille and Zack. Camille was doing groups and individual sessions, and it was getting wild as the program expanded. She just needed a hand, so Renee came in and they realized that residents needed individual OT sessions every week. Therapy and OT complement each other so much.

At almost the same time, the former milieu support specialist Kelsey decided to leave for an incredible opportunity at the VA. Mountain Valley needed someone to lead groups, and I jumped in. They also needed someone in the milieu to help with those smaller OT things like if someone’s in actively in a compulsion, I can support them through an occupational therapy lens. I get to educate other residential staff and be that person a lot of the time to get everyone on the same page with what’s happening in our OT work.”

What’s your favorite part about working with the residents at Mountain Valley?

“Their brains are incredible. I’m also kind of a neuro nerd, and I would see a lot of neuro plasticity in the pediatric population I loved early on. When I was in the geriatric work, I had a lot of patients with dementia—that side is fascinating but it’s repetitive work with the same interventions, because the research shows that’s most effective.

Every day is so different here, I love that feeling of the unexpected. I can pivot when I’m working with residents. This worked yesterday but didn’t today. You can see the wheels turning and the light turn on in front of you. It’s incredible, and that feeling is why I got into the health profession. I love helping them grow and learn, and I get to facilitate that every day.”

Tell us about your work with OT modules?

“I lead three to four modules in a week, which often focus on exposures for our residents. For example, the other week we had two residents with contamination anxiety plunge their hands into the dirt while we planted seeds in a gardening module, and everyone was cheering. It was so cool to see them sit with the discomfort and actively do some response prevention while they also engaged with the earth.

With OT groups, I try to match the ERP schedule, but I put more of an OT spin on things. Yesterday residents learned about the four different communication styles, and we did a fun activity where we had them draw pictures on their partner’s backs. It’s nonverbal communication but you can still clearly communicate. The residents loved it and it spun off into a massive game of telephone.

On Friday I lead creative expression, which is really where I encourage them to find that flow state and enjoy some art. Make it free and find some joy while also maybe working on a contamination exposure around paint, for example.”

Where do you see yourself in five years?

“Definitely still at Mountain Valley. I would love to take on more leadership roles, whatever it looks like in the future. I can see where we’re headed and it’s such a beautiful picture—I want to be a part of that.”

What do you like to do for fun in your free time?

“My schedule is really nice because I work 7:30-3 pm, whereas at my previous job I was working 12-hour shifts. Now that my husband and I have a home, I get to garden and we’re revamping our backyard. We live right next to a lake, and we love kayaking in warmer weather. I’m also looking forward to checking out the local trails!”

MOVING MOUNTAINS

Resources

Staff Spotlight: Katharine Call

From Podiums to Psychology 

Clinician Katharine Call knows pressure. As a world-class athlete in cross country ski racing, she pushed herself to be the best and frequently came out on top. But that pressure kept her from living a balanced life, so she stepped down from the sport to focus on helping others. Now she uses her experience to help challenge and support her clients—and cheers on her Olympian brother as he continues Vermont’s dominance in the sport.

Tell us about your background?

“I grew up in southern Vermont in a town called Landgrove. It is very small—the population is less than 200. I was very focused on ski racing for most of my childhood and I went to Stratton Mountain Academy for high school. I ski raced in college and skied on the U.S. National Team for a bit.

I got into skiing because my dad did, but most people also skied in the area where I lived. Even my babysitter as a kid was on the U.S. National Team for cross country skiing.”

Katharine Skiing

 You won three national championships skiing at Dartmouth. What was the best part about that experience?

“I really enjoyed all the college racing. The collegiate circuit is the only one where you’re competing as a team and your scores are adding up so one team wins. It was so special to me, and the team of women I raced with in college was very healthy and supportive.

When I was competing, Dartmouth didn’t have a venue to host the national championships, so the University of Vermont hosted my sophomore year. So many people I knew were there cheering us on. It was great to be there with all the people I love and care about.

Dartmouth can’t give scholarships so we’re generally a bit of an underdog in athletics, compared to schools that can recruit with full-ride scholarships. We didn’t win the team championship, but we came close, and it was special to be working for a crazy huge goal.”

What did you consider for your career outside of ski racing?

“I liked racing and was good at it, but it isn’t a long-term career. I decided to attend Dartmouth and major in psychology. I liked a lot of the classes that were about inequity in the education system and specifically how financial status and poverty affect education and life outcomes.

I wanted to work one-on-one with people, specifically kids who needed it. I decided to go into social work and leave the door open to go into mental health or more of an advocacy space.”

How do you think your background as a high-level athlete helps you in the field of psychology?

“When I started learning more about therapeutic modalities like distress tolerance, it all felt obvious to me. Just doing the thing, basically, I could relate to that. As an athlete there’s a lot of in the moment pain for later gain. Like interval training for example, it’s putting your body in a distressing situation and learning to tolerate it. I think that mentality of working hard was helpful to me.

As an athlete, I also had challenges with anxiety. It was a constant thing where I loved ski racing, but anxiety sometimes got in the way of me enjoying it. I really related to Acceptance and Commitment Therapy (ACT) and the idea of making decisions based on what you value rather than what you’re scared of. I think that was the most important thing for me as I moved forward, really figuring out to prioritize how to make decisions based on what I cared about.

Ultimately that’s why I stopped ski racing. I realized to pursue that career, I had to live a pretty ‘me-centric’ life. It didn’t feel aligned with my values at the time. I wanted to learn and grow, as well as have my friends and family be my number one priority. Rather than worrying about missing training or worrying about getting sick, or whatever else.”

Katharine Call

How did you end up at Mountain Valley?

“I came to Mountain Valley literally the week after I got my master’s diploma from Columbia University. During grad school, I got experience working at a non-profit with people who have experienced domestic violence and sexual assault, in an advocate and crisis management role. I also worked at the VA in case management.

As school came to close, I was applying to every job I could find within reason. But I saw the clinician position at Mountain Valley, and it was immediately the one I wanted. I went on their website and saw everything that had possibly been a career interest of mine looped into one place. Adventure therapy, exposure response prevention, the adolescent population, it was so aligned with what I wanted to be doing. In fact, I thought the posting was a scam at first because it sounded so perfect, so I was surprised when Zack responded to me.

I do feel like Zack, Everett and the team took a pretty big chance on me since I didn’t have a lot of work history in mental health. But I think since Zack also completed at the collegiate level, he was able to see how some of my background would be uniquely beneficial in a way that I didn’t even see yet.”

Tell me about your work in Exposure-Response Prevention?

“With my personal experience doing ERP around my own anxiety, I have a lot of empathy for how difficult it is. I’m a strong believe in challenge by choice and I want to make sure the kids get to choose their exposures. It’s a highlight of my job.

One example that stands out is a client I had with severe contamination OCD. She was willing to do the exposures but would beat herself up after the fact. Like “Well if I was normal, this wouldn’t have even been an exposure.” She struggled to celebrate the fact that she was doing something hard.

For her ordeal we decided on a series of three different very challenging OCD exposures. We had all the community come cheer her on, chanting her name and clapping. I was bumping music and playing “This Girl is On Fire.”

For her first exposure she picked a strawberry up off the tennis court and ate it. Then she threw away all her soap, hand sanitizer and Lysol wipes while everyone cheered goodbye. Finally, we rolled out the compost bin, and she plunged both hands into it!

It was iconic, everyone went wild. I was sobbing and it was such a memorable day.”

Back to skiing for one more question. Your brother, Ben Ogden, recently won two silver medals for Team USA at the Olympics. What has that experience been like for you?

“I’ve been so stoked. It’s been so fun to see. The coolest part about it, from my perspective, is that when I raced, I really struggled with balancing it and making it healthy. Ben has done that. He is the most selfless person I know, and he doesn’t compromise anything he cares about. I admire it so much.

He has so many people in his life that love him and he makes sure he makes time for all of them. To be able to ski at such a high level and not give up your life, it gives me goosebumps to even talk about.”

MOVING MOUNTAINS

Resources

Staff Spotlight: Nathan Thoele

Nathan Thoele is part of Mountain Valley’s leadership team, serving as the Residential Director. He leads a skilled team of residential counselors who work directly with MVTC residents on a 24/7 schedule. Nathan has a unique background that took him from working in summer camps, to AmeriCorps, to five years at the Vermont Institute of Natural Science as lead bird trainer and environmental educator. Today, he’s using his coaching and listening skills to ensure that MVTC is a safe and welcoming place for everyone.

What brought you to Mountain Valley?
I thought I wanted to be an ecologist, so I went to Prescott College to get a degree in something related to that. While on that journey, I realized that my favorite part about ecology was teaching it to people. I switched to an environmental education degree. After graduating, I moved to Vermont to put that degree into practice. I worked as a camp counselor, a conservation assistant, and an educator. After a couple of years of that, I landed at VINS and became one of their live bird show presenters, their primary bird trainer, and their volunteer trainer.

I got really into training people and learned that I liked coaching people to do specific and complex things. My job at VINS was to train people to train birds, and I enjoyed helping my co-workers make sense of the confusing parts of the job.

After being there for a while, I realized I wanted to work with people more than animals. I started looking for the next step in my career and found Mountain Valley. I specifically came here with the desire to practice my skill of listening. At VINS, someone pointed out that I seemed to have a profound desire to listen to people. I thought that seemed true, and when the job at Mountain Valley popped up, I took a leap of faith to try something new.

Tell us how your position has evolved over the last five years.
Originally, I was hired for an overnight residential counselor position. Everett Logan knew I was interested in more adventure- and outdoor-related activities, so he kept an eye out for a day shift position for me. Once it opened, I slid over and started some module facilitation. I created the Nature’s Classroom module, which is still very popular with residents today, though it looks a little different now. I also created a module about interpersonal skills that residents loved. After that, I moved up to a supervisor position, and then the Residential Director position opened. I applied and got it.

I’ve worked on every shift the residential team has—days, evenings, weekends, nights. That experience made me feel confident that I could serve Mountain Valley well as the Residential Director. I have a good perspective on what the residential staff are expected to do and how they do it.

What does a typical day look like for you?
I have 21 people on my team and directly supervise the supervisors for each shift. When I come into the office each day, I check to make sure we’re on top of any incidents and review my email to coordinate parent visits. Then it’s a lot of bouncing around—a lot of my job is checking in with other residential counselors and meeting with the supervisors multiple times per week. I also spend time with residents, and they’ll frequently ask me logistical questions about what is or isn’t allowed on campus, how home visits work, whether they can move their assigned laundry day, and so on. I answer them and try to have some deeper-level conversations as well.

Back at my desk, I spend time planning trainings for staff, coordinating with parents of residents, reviewing documentation, answering emails that ask complex questions, and handling a myriad of other clerical tasks. And, of course, I attend several routine meetings each week, in addition to impromptu meetings designed to address incidents as they arise.

What qualities do you look for when you’re hiring a new residential counselor?
I want residential counselors to have the impulse to trust residents rather than doubt them. In psychological terms, that’s unconditional positive regard and client-centered thinking. Beyond that, I want our staff to have good empathetic listening skills—listening geared toward empathy, not just cognitive understanding.

It’s important for our staff to balance setting firm boundaries with being flexible. We want our staff to engage with residents and be willing to embrace some discomfort alongside them. I can train some of this, but it’s important to be a people person.

What’s the most rewarding part of your job?
The time I get to spend with residents and the breakthroughs I witness. Just a few days ago, I was walking through the woods with one of our residents, who tends to avoid all emotional topics. I broached that subject with him and asked him why. We ended up having a very emotional conversation that ended with him kneeling on the ground in the forest and crying. He told me some things that I and other MV staff knew indirectly but that he had not said to anyone face-to-face before. It was a first for him and a profound moment for both of us.

I see the members of my team grow as professionals, and that always brings me joy. I’ve spent many afternoons having hard and crucial discussions with some of my staff as they grapple with the tough work we do. Witnessing them make sense of the work is truly special.

And finally, I am compelled to grow constantly. After five years, I am still challenged. Sometimes the challenge feels like too much, sometimes not enough. But overall, I like that I can look at who I was even just one year ago and see how much I have changed for the better. What I find most rewarding about this job is growth. We’re all growing all the time, and I love that.

MOVING MOUNTAINS

Resources

Understanding the Subjective Units of Distress Scale (SUDS): A Tool for Managing Anxiety

Anxiety can often feel overwhelming, especially when it surfaces unexpectedly. At Mountain Valley, we understand the importance of equipping individuals with effective tools to navigate these intense emotions. One such tool we regularly employ is the Subjective Units of Distress Scale (SUDS). Before our group and individual psychotherapy sessions, we often ask participants to share their SUDS levels. This practice not only promotes self-awareness but also fosters open communication about one’s emotional state.

What Is the Subjective Units of Distress Scale?

The Subjective Units of Distress Scale, commonly known as SUDS, is a simple self-assessment tool used to quantify the intensity of distress or anxiety an individual feels at a particular moment. Developed by psychologist Joseph Wolpe in the 1960s, SUDS assigns a numerical value—typically ranging from 0 t0 10 (or 0 t0 100)—to represent one’s current level of discomfort. A score of 0 indicates complete calmness, while 10 signifies the highest level of distress imaginable.

How Does SUDS Work?

SUDS is inherently subjective, relying on personal perception rather than objective measurements. Here’s how it generally works:

  1.   Identification: When an individual begins to feel anxious or distressed, they pause to acknowledge these feelings.
  2.   Assessment: They assign a numerical value to their level of distress based on the SUDS scale.
  3.   Reflection: This number helps them—and the MV team—to understand the severity of their symptoms at that moment.
  4.   Action: Based on the SUDS score, appropriate coping strategies or therapeutic interventions can be applied to manage the distress.

Why Is SUDS Important for Managing Anxiety?

Promotes Self-Awareness

One of the first steps in managing anxiety is to recognize when it’s occurring.. By regularly assessing their SUDS score, individuals become more attuned to their emotional states. This heightened self-awareness can lead to earlier interventions and prevent anxiety from escalating.

Facilitates Communication

Articulating feelings of anxiety can be challenging. SUDS provides a straightforward way to communicate distress levels to therapists, caregivers, or peers. At Mountain Valley Treatment Center, sharing SUDS scores before group sessions helps create a common language that enhances understanding and fosters effective support.

Guides Therapeutic Interventions

In therapeutic settings, SUDS is often used during exposure therapy—a treatment commonly employed for anxiety disorders and phobias. By assigning distress levels during exposure to anxiety-provoking stimuli, therapists can tailor the intensity and duration of exposures to optimize treatment outcomes.

Research Supporting SUDS

A study published in the Journal of Anxiety Disorders highlighted the efficacy of using SUDS in exposure therapy for patients with obsessive-compulsive disorder (OCD). The research found that patients who consistently used SUDS to report their anxiety levels experienced a more significant reduction in symptoms compared to those who did not use the scale1.

Another study in Behavior Research and Therapy demonstrated that SUDS scores could predict treatment outcomes in cognitive-behavioral therapy (CBT) for panic disorder. Higher initial SUDS scores were associated with greater improvements by the end of treatment, suggesting that SUDS can be a useful prognostic tool2.

Implementing SUDS in Daily Life

While SUDS is often used in clinical settings, it can also be a valuable tool for personal use. Here are some tips for integrating SUDS into daily routines:

  • Regular Check-Ins: Set aside moments during the day to assess your SUDS score, even when not feeling particularly anxious. This practice can help track patterns and triggers over time.
  • Journaling: Keep a log of your SUDS scores along with notes about situations or thoughts that may have influenced your anxiety levels.
  • Coping Strategies: Use your SUDS score to determine when to employ relaxation techniques, such as deep breathing, mindfulness, or physical activity.

How We Use SUDS at Mountain Valley

At Mountain Valley, the SUDS scale is an integral part of our therapeutic approach. Before group sessions, we encourage participants to share their SUDS levels. This practice serves multiple purposes:

  • Encourages Open Dialogue: Sharing SUDS scores helps break down barriers and promotes honesty about one’s feelings.
  • Tailors Group Dynamics: Understanding the collective distress levels allows facilitators to adjust the session’s focus to better meet the group’s needs.
  • Monitors Progress: Regularly tracking SUDS scores provides tangible data on an individual’s progress over time.

The Benefits of Using SUDS at Mountain Valley

  • Personalized Treatment Plans: By consistently monitoring SUDS scores, our therapists can customize treatment plans to address specific anxiety levels.
  • Empowerment Through Self-Monitoring: Patients learn to take control of their anxiety by recognizing and addressing distress as it occurs.
  • Enhanced Peer Support: Sharing SUDS levels in group settings fosters a sense of community and mutual understanding among participants.

The Subjective Units of Distress Scale (SUDS) is a powerful yet simple tool that empowers individuals to understand and manage their anxiety. By quantifying distress, it transforms abstract feelings into concrete data that can guide personal coping strategies and therapeutic interventions.

At Mountain Valley, we are committed to providing evidence-based approaches like SUDS to support adolescents and young adults dealing with anxiety and OCD. By incorporating tools like the SUDS scale into our programs, we help individuals develop the skills they need to navigate their emotions and lead fulfilling lives.

If you or someone you know is struggling with anxiety, don’t hesitate to reach out. We’re here to help.

References:

  1.  Kircanski, K., & Peris, T. S. (2015). Exposure and response prevention process predicts treatment outcome in youth with OCD. Journal of Anxiety Disorders, 36, 45-51.
  2.  Meuret, A. E., Rosenfield, D., Seidel, A., Bhaskara, L., & Hofmann, S. G. (2010). Respiratory and cognitive mediators of treatment change in panic disorder: Evidence for intervention specificity. Behavior Research and Therapy, 48(8), 698-706.