136. TEEN TREATMENT PROGRAMS: Tips for Parents & Teens on Finding the Right Treatment Program ft. Dr. Justin Mohatt

Feb 23

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Today's guest is Dr. Justin Mohatt— an internationally recognized, double Board-Certified Psychiatrist at Ohana, a program for child and adolescent behavioral health at Community Hospital of the Monterey Peninsula. In this episode, we discuss advice for both parents and teens on different types of teen mental health treatment programs. For parents, we share tips on how to find the right treatment program for your child, including how to start the search process, program must-haves and red flags, how to motivate your teen to seek treatment, and how families can participate in the treatment process. For teens, we share what to expect when starting a mental health treatment program and how you can benefit most from residential treatment.

Ohana's Website: https://www.montagehealth.org/locations/profile/ohana/

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🛋This week's episode is sponsored by Teen Counseling. Teen Counseling is an online therapy program with over 14,000 licensed therapists in their network offering support with depression, anxiety, relationships, trauma, and more via text, talk, and video counseling. Head to teencounseling.com/shepersisted to find a therapist today!

About She Persisted (formerly Nevertheless, She Persisted)

After a year and a half of intensive treatment for severe depression and anxiety, 18-year-old Sadie recounts her journey by interviewing family members, professionals, and fellow teens to offer self-improvement tips, DBT education, and personal experiences. She Persisted is the reminder that someone else has been there too and your inspiration to live your life worth living.

a note: this is an automated transcription so please ignore any accidental misspellings!

Sadie: [00:00:00] Welcome to She Persisted. I'm your host, Sadie Sutton, a 19 year old from the Bay Area studying psychology at the University of Penn. She Persisted is the Teen Mental Health Podcast made for teenagers by a teen. In each episode, I'll bring you authentic, accessible, and relatable conversations about every aspect of mental wellness.

You can expect evidence-based, teen approved resources, coping skills, including lots of D B T insights and education in. Each piece of content you consume, she persisted, Offers you a safe space to feel validated and understood in your struggle, while encouraging you to take ownership of your journey and build your life worth living.

So let's dive in this week on She persisted.

Dr. Mohatt: often I'll hear from young people, but I don't need. A therapist. I have friends. Yeah. And my response to that, is that friends are wonderful. They're really important.

I want you to have them and I want you to talk to your friends about the important things in your life, but. Your friends are just that they're your friends. [00:01:00] Your therapist is there to be supportive of you, but also push on you at times. And therapy may be uncomfortable at times. But you need an outside person who can tell you what it is

hello. Hello, and welcome back to She Persisted. I am so excited for this episode. This is one of my most highly requested topics.

It's something I'm constantly getting questions about via email and dms, and on the question submission form, which is parents that are looking for guidance on how to find their teen treatment, and then for teens what to expect from that process. So we've brought in an expert. Today's guest is Dr. Justin Mohat.

He is an internationally recognized, Harvard trained double board certified psychiatrist. He specializes in anxiety, O C D and TIC disorders in childhood adolescents and emerging adulthood. He's an expert in complex case formulation and medication management, and works heavily on the treatment side of things.

He works at a treatment program. So he answered all of my questions [00:02:00] about what to expect

and what to know if you are navigating this process, both as a parent and as a teen. So for parents, what to look for in treatment programs, what questions to ask them, what are the non-negotiables, what are the things that are nice? To have tips to get your teen to be an active participant and to be motivated to get treatment, especially when they're not necessarily motivated initially.

And how to approach the treatment process. So like what can you expect from quote unquote getting treatment? And then for teens, what can you expect when you are pursuing intensive treatment? What Justin wishes that teens were aware of when they start treatment. In a bunch of myths that he wanted to debunk.

So if there are any anxieties you have about this experience, we debunk all of those. So this is an amazing conversation. It really fills a need that I haven't touched on before, and she persisted, which are these questions that teens and parents have from an expert perspective. So I'm so excited about this.

You are going to love it. So with that, let's dive in

Sadie: thank you so much for coming on. She resisted today. I'm so excited to have [00:03:00] you on the show. We're gonna talk about some of my most frequently asked questions, and I know this episode is gonna be such a resource for so many people.

So thank you for sitting down with.

Dr. Mohatt: Yeah, I'm happy to be here. I'm very flattered that you asked

Sadie: me. Of course, of course. No, I am very excited to pick your brain about all things teen treatment and get the adolescent perspective and the parent perspective because it really does feel like a black box almost until you're within the treatment world.

You're like, I don't know what to expect. Like what's the difference between i o P and intensive treatment and residential, and there's no. Path. So hopefully with this conversation we can provide a little bit of clarity and less uncertainty for any families that are navigating this.

Dr. Mohatt: You said that so Well.

I think that so much of our field is exactly that, a black box and, yeah. . People spend days on the internet trying to search. They get word of mouth and somebody says, oh, this person is really good. You should go see them. But they have no idea if that person's good for what they need. And one person can be really good [00:04:00] at one thing and not know anything about another thing.

Yeah. And, and so you know, I think we've been working very hard in the places that. most recently been been at to try and create systems that are more transparent Yeah. And easy to navigate and to help families through that process.

Sadie: Absolutely. So in thinking we split this between advice for parents and advice for teens because.

The questions are very different. For teens, it's more like anxiety of what is this gonna be like and what is this process like? And for parents, a lot of the times it's like, how do I find a treatment program or what can I do to support my teens? So to start with parents, I'd love to get your thoughts on what the typical treatment trajectory looks like.

Obviously everyone's. Very different. I always am like my 14 months in treatment are probably something no one else will ever experience because everyone goes a different route. But there are some things that I think are similar with looking for programs and maybe going from a more outpatient setting to a more [00:05:00] inpatient setting, these common themes.

So I'd love to kind of understand what steps families typically go through when they are navigating teen mental health treatment.

Dr. Mohatt: Well, I think that families often start. Complete confusion and laughter, any idea where to begin. And then, you know, I, I think some families find their way to some sort of mental health provider, but I, I also think that the best.

resource for most families as a starting place is their primary care physician. Yeah. You have a trusted relationship with that person. Theoretically they know you, they know your family. They are essentially mandated at this point to be screening for things like depression and anxiety in kids.

And depending where you are. . Sometimes they are screening for suicidality and, and self-harm. So that's a really good starting place because even if they aren't going to be the people to deliver any sort of intervention or [00:06:00] care, they know the community and they will typically have trusted people that they know to work with in the area.

And they also will know things like how long does it take to get. typically to somebody. And, and frankly, a lot of primary care doctors can treat some things. And so you may not need to wait to get into a child mental health clinician to start something. And then you can move forward with things like outpatient treatment.

Yeah. Which typically that first step I'm gonna put a, just a plug in for kind of early identification of challenges the kids are having because the earlier we can get in there, and this is again, where pediatricians and primary care doctors can be so key the easier it is to intervene and, and make a difference.

And so, , you know, if you need outpatient treatment, then the next step is identifying a local therapist or psychiatrist. And that's I think, another place where families get confused. Like, do we need a psychiatrist? [00:07:00] Do we need a therapist? Do

Sadie: we need a psychiatrist who does therapy? Because that's an option.

Dr. Mohatt: Exactly. Yeah. And some people, by virtue of maybe their own history or just the community they live in, think that you. , you have to have a psychiatrist that does everything. And I think in different parts of the country there are different models of treatment. I worked for a long time in the Northeast where that model of one psychiatrist doing everything is more common and lots of the country that is not typical.

And, and I would say that, What's more important than somebody's credentials is their experience and how much time they spend doing this. You can have a highly trained psychiatrist who went to medical school, did residency, fellowship, worked somewhere, and

Sadie: you're their first patient. . They just, they on their own.

Dr. Mohatt: Yeah. Or you're not their first patient, but they don't really do therapy very much. Yeah. And you really want a therapist who does what you need them to do every. [00:08:00] A

Sadie: hundred percent. And even just the demographics of, do they work with teens or is their target demographic normally adults? Because those challenges that you're experiencing are probably really different.

Are they more experienced with navigating anxiety versus depression? Like all of these are different specialties and things to kind of keep an eye out for. And I love what you mentioned about pediatricians because that's exactly where I started my journey. I've said that on the podcast so many times.

Like went into my pediatrician appointment, they did the depression screening and. All of those, all of the above is happening. And then from there I went to a psychiatrist and worked with other people. But it really is a great first step. And like you mentioned, being able to be aware of things that maybe aren't, aren't going so well, really early on in the process.

And then make shifts and get resources and. . The other great thing about having your pediatrician clued in is every single time you go in for their annual, they're checking up on how things are going, how are things going with medication, or how are things going with meeting with a therapist? What are your responses [00:09:00] to these questions looking like compared to a year ago?

Whereas if you meet with a psychiatrist one time, but then you just. fall off that train and never go and and return to those appointments. The pediatrician is at least following up in a consistent way.

Dr. Mohatt: Absolutely.

Sadie: Yeah. So for parents that have received the recommendation that their teen might benefit from , An intensive mental health care program whether it's a residential or, a longer term program where they're looking beyond just their, their local psychiatrist and therapist or pediatrician, like we mentioned.

What things do you look for in a treatment program, whether it is non-negotiables, whether it's staff, whether it is different types of therapy things that are nice to. , but when you are looking at a program, what things are, are you keeping an eye out for? To make sure that it's a great fit for a patient.

Dr. Mohatt: Yeah. I mean, I guess my first thought, which doesn't really answer your question is just what are all those [00:10:00] different levels of care? Yeah. Because I think families don't even know that. But I, I imagine your listeners, have heard what these different levels of care are over time. So I, I think the first thing is figuring out what level do you need, right?

Yeah. So there's everything from regular outpatient care to intensive. outpatient treatment or intensive treatment programs, which might be like two to three days a week for a couple hours at a time up to. sort of half day programs to partial hospital programs that are essentially the school day, five days a week, to residential treatment, which is kind of longer term, but voluntary treatment and unlocked places.

And then inpatient treatment being the highest level of care. Mm-hmm. . But true question about what to look for. I have a couple big things that I really wish families would hear. One is, . Just because a place is the most expensive place doesn't mean it's the best place. And just because it's in the most beautiful setting [00:11:00] doesn't mean and has

Sadie: horses, doesn't mean it'll be the best.

Dr. Mohatt: Has horses, has an ocean view, has like, I think families can easily get. Romanced by some of that because it's so scary to have your child go away somewhere so to say, okay, well the place is really expensive. It looks really nice. That doesn't necessarily mean high quality care. Yeah. , the other thing I would say is be wary of programs that promise everything.

If you look at their materials and they say they basically treat everything under the spectrum with evidence-based treatments and it's highly unlikely that they really are that specialized in all of those different things. I much prefer to have a program that says We do this and this very well.

And this is our modality. You want to ask them what modalities of treatment they use and they should be able to answer. that clearly here's an easy example, which is I often see patients who say that they've been getting cognitive behavioral therapy for their anxiety [00:12:00] disorder, but it's not getting better and it's not helping.

And I ask them, well, , what are you doing in your therapy? And it turns out that largely what they're getting is supportive psychotherapy with. Some sort of instruction on how to do deep breathing and maybe some psychoeducation on not avoiding anxiety provoking situations, but not C B T , not getting full fledged C B T, and they're not getting the core key treatment to C B T, which is exposure therapy.

So you, you want to educate yourself ahead of these conversations about your kid's diagnosis and what the best treatments are for that, and then ask very pointed questions

Sadie: about it. What are those questions that you would ask if you could give like three to five that they could bring to their intake meeting?

They're on the phone, they're screening these programs. , what would you ask?

Dr. Mohatt: That's a really hard question to answer, simply because I think it's so dependent on what a particular young person [00:13:00] is struggling with. Mm-hmm. , what those questions.

Sadie: So what if we said like a teen is struggling, will you like use me?

A teen is struggling with depression. Self-harm has tried outpatient, inpatient. At home. The recommendation is residential care. History of self-harm and suicidal ideation and have tried outpatient D B T and then intensive outpatient. But as far as residential, what the recommendation is, we, no, we don't know.

Do we need a D B T intensive program? Do we need like a therapeutic boarding school for residential? So the next step is residential. The background is depression, anxiety, those behaviors. So what questions would you ask different residential program? . Well,

Dr. Mohatt: I think the first thing I'd want to know, given the history you're describing, is whether the program.

I, I would sort of start with an open-ended question, knowing what I want the answer to be. Yeah. And so my question would be, you know, what modality of treatment do you use in your program? Mm-hmm. and listen to what they say. And what I would want them to say is that they use a combination of [00:14:00] dialectical behavioral therapy and cognitive behavioral therapy, and that they sort of address safety concerns first.

And so the. treatment would probably be D B T. And then when, when safety is off the table, then you can work on the depression and the anxiety. Yeah,

Sadie: I think that's really helpful for sure, to kind of just have those exact labels of what to listen for and to ask that open-ended question because. I mean it's, it's so crazy that you even have to think about how these things are marketing and kind of see through when they're like, oh, we offer everything.

And it's like, well, what do you really offer? And when you said that, it reminded me of this marketing strategy where it's when things advertise themselves as like the Cheesecake Factory where they offer anything and everything you could possibly ever want to eat, but nothing on the menu is really that great.

And so you can think of treatment programs that way where if they're offering anything and everything to possibly Be treated, they're probably not gonna be that great at all of those different things. So to listen for those key terms is [00:15:00] super helpful rather than going in and being like, do you offer D B T?

Because my parents did that when we were looking for therapeutic boarding schools and the therapeutic boarding school was like, yes, of course we do. But then once I went there, they did not offer D B T.

Dr. Mohatt: Right. Well, you know, and I think specifically with D B T I would wanna know, and this is very kind of technical Yeah.

But are your, are your therapists D B T certified with behavior. Yeah, you know, are you really D B T therapists? Do you provide full fidelity D B T and. , anyone can say they do anything. Mm-hmm. . And they may do D B T informed treatment. And in some situations that might be appropriate. But if you're talking about residential care and you're talking about chronic sort of self-injury and depression, you really want that full fidelity treatment.

Sadie: Yeah. And it's also so helpful to remember that a lot of these. Evidence-based treatments are proven to be evidence-based under very specific conditions. So like with D B T, you're doing a very specific six week course [00:16:00] of learning a certain number of skills with your therapist working in tandem with a certain number of other therapists.

And you are approaching your challenges in therapy with a very specific hierarchy and you're also meeting with a psychiatrist. Like all of these details are very clearly laid out and that is what is shown to be effective. The idea of like me on the podcast when I teach you a D B T skill, it's not what's evidence based to heal depression.

Like it's just a fun thing that might make you feel a little bit better to accumulate some positives in your life, but it's that like super set criteria. That is shown to be evidence-based. So you have to make sure that the treatment programs are using that set criteria that has been proven to be effective and not just like pulling little ideas from here and there to, to try and support people.

Dr. Mohatt: There's a really interesting and important research study that was done several years ago now. Mm-hmm. looking at. comparing sort of psychoeducation, like providing education about cognitive behavioral [00:17:00] therapy. Yeah. To doing full-fledged cognitive behavioral therapy to medications. I'm trying to look at what's realistic for primary care doctors to do.

Right. They can't do a C B T session in their 10, 15 minutes with . Yeah, well,

Sadie: they're like also checking to make sure you can like bend your knee correctly, right? Like, let's check the nose, let's do some exposure therapy, pull

Dr. Mohatt: nuggets of information and does that move the needle? And unfortunately it was not.

As effective as, which is what you would expect. But but I think that that's often what happens. People provide a little education about C B T, but they don't really do Yeah. False CBT with exposure.

Sadie: Yeah. If there were two to three non-negotiables that you would want to make sure were at a treatment program for parents to look for, whether it's like a psychiatrist on staff or.

A certain evidence-based intervention. Maybe it's like a number of patients or how long the treatment facility has been open, a certain like accreditation. There's so many different potential things, but [00:18:00] if you had to choose some non-negotiables where you're like, at the very minimum a program should have this, what would that be?

Dr. Mohatt: Yeah. And, and you're speaking to some really tricky things because state by state, the regulations are on residential treatment are widely varying. So residential can be fully accredited or, or regulated, but depending on the state and the size of the program that can meet vastly different.

Yeah. And I'm sure this is making your listen. Very anxious as I'm saying it, but I know

Sadie: I just released, literally as we're recording this, the episode that went out this week is about the trouble teen industry. So luckily there's gonna be some time before this episode comes out. But like in that episode, an example of what accredited a program was, how many toilets they had and the ratio to students

So there's a. , there's some discrepancy here on what accreditation means.

Dr. Mohatt: Absolutely. I mean, hon honestly, I think the, the most important things from my perspective are that they involve family. Yeah. And that's for a couple reasons. One is [00:19:00] if you are a program that doesn't communicate with parents, that doesn't involve parents and family in treatment, and you're doing this sort of bubble of something, A kid and then you say, okay, we're done.

And you send them home and you've never done anything to change the environment, then you're setting everyone up for failure. Yeah. In that circumstance. So I think number one for me is that family is very involved in the treatment. Mm-hmm. in mm-hmm. in. , whatever way is possible that may be virtual because the family can't be where the kid is at.

But that it is built into the program and it's not just, we'll check in once a week for an hour or you call us if you have any issues. Right? Yeah. You'd be surprised what can happen out there. So I think that's really critical. I think that again, Evidence-based treatments, but not every evidence-based treatment under the sun.

Mm-hmm. . So, you know, for instance, for a kid who has depression, who has self-injury, has a lot of [00:20:00] emotion regulation difficulties, a no. go would be if they didn't have a true D B T program. Yeah. If you have a kid who has obsessive compulsive disorder or a severe anxiety disorder, you want a program that is an exposure based cognitive behavioral therapy.

Mm-hmm. program. And they should be able to talk to you about what that actually looks like and how they deploy that a hundred percent. So, you want evidence-based treatments for the thing that your. struggle. Yeah.

Sadie: And you can even ask them like, oh, can you send the, the research that supports this intervention that you're using?

I remember I asked my therapeutic boarding school that one time after I'd left and they sent me a paper talking about how nature can be good for mental health . And I was like, okay, but this is not what. I, my parents signed up for when they were like, we'd like a long-term transitional program that can help her, like maintain mental health, continue to maintain D B T skills and not be depressed and suicidal like they were [00:21:00] not optimizing for exposure to nature.

So ask them if they can send you studies that support this intervention in the adolescent population and show good results. And you don't have to read the entire study. We're not like, please spend all your time reading 12 studies. But if they can't provide that, that's immediately. red flag.

Dr. Mohatt: Yeah. And I think the other thing is you, you want transparency.

So if you're getting any sense that they're sort of skirting around questions and they're not giving you very clear answers, I would be really wary. Yeah. I, I think that this may be hard and you may not get a satisfactory answer, but it's worth at least asking what their internal. Quality kind of processes and if they have any data or statistics on the success of their program.

Yeah,

Sadie: absolutely.

Dr. Mohatt: And they should be able to produce something.

Sadie: Yeah. From the professional standpoint, should parents have to sign over their custody when their child gets mental health treatment?

Dr. Mohatt: Shit. [00:22:00] Sit. , Well, you can tell by my answer, . You're like, what? That's a thing. . No, absolutely.

Sadie: Not a standard of care.

And I have to remind people of that because like I, my parents found the most amazing D B T program in Boston, and then four months later I also went to a program at Montana and when they were like, okay, sign over 51%, my parents were like, okay. Like they're very smart people. They knew what they were talking about.

And yet some of these. again, it's a black box. Mm-hmm. , like from the outside you would be like, oh, well my kid is living there for a year. So maybe they would need 51%, but they don't . That's a uhhuh a myth.

Dr. Mohatt: not a thing. Or it shouldn't

Sadie: be a thing. Should not be a thing.

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Sadie: The last question I wanted to ask from the parents' perspective is, so many, and this is hard to answer because when I get asked this, I'm like, I don't even know what to tell you.

Because the question is, how can I get my teen to want to be motivated to make changes and want to get better when they're like not wanting to go to treatment, which was exactly where I was at. And I think my most recent response is just Be there to support your child, explain to them that you want to see them feel [00:24:00] better, and then the professionals are the one that can help cultivate that willingness and help provide some hope on how things can shift.

But that's a lot to ask of a parent to be like, let's get your kid from absolutely not wanting to make any changes, to be so motivated and engaged in treatment. But for a parent who's like, . I know my kid needs help, but they are just so not at the point of being motivated to do that. Do you have any advice or validation or wisdom that you can kind of offer because it's so common in this process?

Dr. Mohatt: I feel like I just wanna ask you the question back because I, I, yeah, I do think that, . If I knew the answer to that, I would be the the world's most famous child. . Yeah. I mean, I think ultimately where I see it fall apart is when it becomes a tug of war. And if, if parents can Brian try and not take the bait, so to speak, and, and not have it turn into a war about it mm-hmm. and come from a [00:25:00] place of compassion and validation. Yeah. And not that that's gonna be immediately successful, but you're going to start moving the needle if it Yeah. Just becomes no, you need to do this. And it, it becomes a sort of budding of heads, then you're not gonna get anywhere.

I mean, I, I do think that I've certainly been in situations where, for variety of reasons, a young person, often it's substance related, is just not in a place to make a good decision for themselves. Yeah. And so parents have had to make really difficult decisions to sort of send their kids away against.

Their will. And sometimes that ends up going well cuz they get clean and the kid gets perspective and, sees things in from a different way. Sometimes it doesn't. Mm-hmm. goes so well. Ideally you get to a place where it's a shared decision making. Process. Yeah, and I think as therapists we try and use [00:26:00] motivational enhancement, motivational interviewing strategies to kind of help young people and parents sometimes get to a place where they can see that the benefits of doing something outweigh the fears.

That they have. Yeah. To get the young person to realize that. Cause I often feel like when a kid is refusing to do something, it's not because they just don't want to do it. It's because they've, they've lost hope that anything. A hundred percent a difference. And so what you're really coming up against is hopelessness more and it comes out as oppositional kind of, or defiant behavior.

Yeah. Or

Sadie: even fear. I remember I was like tooth and nail. I will not do a sleep study like I was already in residential treatment. , I'd agreed to all these things, but it came to the sleep study. For some reason I was. And I'm like, this is where the, the hammer's coming down. I'm not going. And so it's kind of unraveling that and being like, what's behind that?

Because I mean, any kid who's really struggling, like if they knew that on the other side was happiness and joy and [00:27:00] stability, of course they would get to that point, but there's just not always a clear path forward. And so I love that perspective of trying to see what is going on beneath the surface and seeing beyond that like opposition.

If you. .

Dr. Mohatt: Yeah. I really believe in compassion and, and in that is sort of self-compassion. I think parents have to give themself sort of some grace and some sense of like, this is a really bad situation and I may not always have handled it well, but I. do things differently going forward and not just get stuck in a rut Yeah.

About yourself

Sadie: and so much self-validation, because I can't even imagine what it's like as a parent to see your child struggle so much and feel like you don't know how you can help them. And whether it's guilt or shame or just its sadness. That's a lot to go through as a parent, let alone as a child.

And so I feel. , I, I completely, that was lost on me when I was going through this process, [00:28:00] how, how hard this was for my parents and how I wasn't the only one that was struggling in this process. That it really does take a toll on the whole family. And so resources for parents too, because it's not an easy journey.

Dr. Mohatt: , I also think that this process can go better. , this comes back to family focused treatment. Yeah. If treatment follow along the way isn't about a kid being in a room with a therapist and then getting a report out or not from the therapist afterward, like really incorporating family into everything that's done from a treatment standpoint, that's what we try and do at our center is have family at.

at the core of everything that we're doing, like in our partial hospital program, we have one day a week where the entire family is required to be there. Yeah, I love that. And it's not just a family meeting each week with a therapist. It's a whole day where the family's getting D B T skills and. . So

Sadie: yeah, no, I asked my parents a couple of weeks ago, I was talking to some [00:29:00] parents about like advice for teens and supporting your teen.

And before I gave the talk I was like, okay, parents, what are the advice? This is your chance to, to throw some advice for parents that are going through it. And the one advice was that this works so much better if the parents learn the skills alongside the teen because if anything, it doesn't hurt for you both to get more skillful and.

Both to be more effective in the relationship and that you also just are able to empathize on another level. You have this shared experience of navigating this and my parents and I are now big D B T nerds Whenever we're navigating anything or I have something to do, my mom's like, Hey, bring out the dear man.

And I'm like, I know I've learned this also.

Dr. Mohatt: Totally. Yeah. And, and the apple doesn't fall far from the tree, right? So if you're asking an anxious parent Yeah, to do exposure therapy with their anxious kid, and the parent is so anxious, they can't do it, you're not gonna get anywhere. So you have to teach everyone these skills to get any

Sadie: movement. A hundred percent. So for teens, I [00:30:00] think one of the biggest things that I remember is just how daunting of an experience this is. It's so anxiety provoking because a lot of the times you don't know what to expect. And once you get there, I feel like it's better because you're in it with other teens, like you're not alone.

They, it's a very, a lot of the times a very welcoming experience. Tons of teens have been through this process, so they know how to orient people and do the little tour and introduce you to other kids or teens, probably not kids. But it's very anxiety provoking to know that you're gonna be going to a program or an outpatient program or therapy session, but not know what that looks like or what to expect.

So if you could give just some basic. Pointers of , what to expect, whether it's like, you can probably expect to, on the first day kind of go through why you're here and, and what's happened thus far. Or maybe it's you'll orient to like what your family system is like. Or you, you probably will learn some skills, but just kind of providing a little bit of insight into what goes on again in this like black box of a world that teens oftentimes haven't had any [00:31:00] experience with.

Dr. Mohatt: Well, I think the first thing would be to say what it is not right. Yeah. I think. , A lot of teens are thinking that if they go to residential treatment, it's going to a locked hospital.

Sadie: I googled McLean and it was like asylum from the 18 hundreds and I was like, great. Perfect. .

Dr. Mohatt: Yeah. Terrified. Exactly. And that's not what residential treatment is.

Yeah. And it's not what intensive outpatient treatment is. Yeah. And there is a place for inpatient treatment treatment, but if. Family is trying to get you help in a voluntary way at a specialized program. It's going to be an unlocked unit, it's going to be everyone's there voluntarily. It's going to be again, if it's the right program, it's gonna be kids your age, right?

Yeah. So that's a thing. I mean, hopefully it isn't a program that. Commingled kids of all different ages. That's another that regulations should prevent. But yeah, I think you're not gonna be asked to strip [00:32:00] down, you're not gonna be asked to be in scrubs. You're not going to have all of your worldly belongings taken away from you.

Yeah. You know, they are going to wanna understand what's bringing you in. They. wanna understand if there are safety concerns, depending on why you're going into treatment, but even if you're going in for something that's not about self-harm or suicidality, they're gonna be asking you those questions.

They're gonna wanna know, yeah. They genuinely are gonna want to try and understand what the path has been to get you to that place and to come up with goals and targets for treat. while you're and if safety's a primary concern, they're gonna spend a lot of time on that first day assessing safety coming up with safety plans, and trying to sort of identify in the program, what are the resources that you can use when you're feeling

Sadie: unsafe.

There's so many questions that you're asked initially. Again, like you're emphasizing it's such a collaborative process. Not [00:33:00] like you're brought in and the, the treatment protocol is a hundred percent laid out. Like this is being adjusted based on what your needs are.

So even the safety plan, like what has been helpful for you in the past with coping with urges or when you get anxious, what skills do you like to use and really making sure this is gonna be effective for you. And I would say other. , random things that that come to mind is like, there's lots of activities, probably lots of arts and crafts, like lots of different ways to express what you're experiencing.

It feels very much like being at a new school because you're thrown into a new environment with other teens and you're all just kind of like getting to know each other and, and introducing. yourselves. So much TV watching and movie watching, most times you don't, there's not a lot of time like scrolling on TikTok or on your phone.

So when you're doing an activity at night, you're watching a show together or doing a movie. And so it's not all just therapy 24 7. It's lots of normal activities routines that, again, would transfer after you leave treat.

Dr. Mohatt: and you're, you're reminding me that one of the other big barriers I hear from some kids [00:34:00] about going to residential treatment is falling behind in school.

Yeah. And, and trying to reassure kids that school is a part of treatment when you're in residential care. So you will be doing school and you don't need to worry that you're gonna come out and have to repeat a

Sadie: grade. Oh no. Yeah, a hundred percent. And even me, I took a medical leave of absence for one year, but I did the summer semester, caught up on things.

I was on track. I was able to apply to college. The world continued to go round, and I think it's such a reminder that without your mental health, you really don't have anything. You're not able to pursue your education or these interests or a career because your mental health is such a foundation.

And so, . Yeah. Very, very important reminder. Is there anything you wish that teens would be aware of when pursuing mental health treatment? Any myths or things that they knew going into treatment that people want them to get better or that it's a very collaborative experience? Anything that you were like, I wish they came in day one and this was just an understanding.

Dr. Mohatt: I, I mean, ultimately I wish, and this is really for kids [00:35:00] who are maybe not sold on treatment. There are, there are young people who come in asking for treatment, like mm-hmm. have that first appointment and ask the parents, you know, like, why are you

Sadie: here? And they're like, the kid brought me here. .

Dr. Mohatt: Yeah. They asked to see a therapist.

But for the kids who aren't at that place, I a wish. understood that I am not an agent of their parents. Yeah. Yeah. I think their parents are really important partners and really important people in their lives, and we're gonna want to involve them, but I'm not here to do the bidding of your parents.

I'm here to help you and figure out. What's causing you suffering and struggling and trying to affect change so that you can lead your best life? And I often say to kids if I think they have a sense of humor, that in the first visit that my real main goal is that I never see them again.

Yeah, yeah. Like, I'm not here to take your money. I'm not here to sort of see you forever. I'm not here just to put you on medication. In fact, I'm [00:36:00] only gonna put you on medication. is really indicated and necessary and that your best interests are sort of like the guiding light, the true north of of treatment.

I think it's really hard to. , understand that and feel that when you're in a dark place. Yeah.

Sadie: Sometimes I also love the, the way of thinking about it, of like if you have a therapist or a psychiatrist who's in your corner and truly working with you, you would suddenly have this highly trained professional to help you advocate and get things from your parents.

If you're like, I want them to validate me more, or I wish that they would stop getting mad at me for not cleaning my room. You have this person who has been highly educated and can be like, From a therapeutic perspective, we really do think that asking about the room being cleaned 12 times a day is not great

And you have someone in your corner, you have someone helping you make these changes in your family relationships. And it's kind of funny to think about it that way because in a lot of ways it's true. You have someone helping set those boundaries and advocate and it's a, a lot more of a skillset than you on your own

Dr. Mohatt: you have, you have an [00:37:00] objective outside professional.

Yeah. Who is not there to do anything other than try and improve your life. Yeah. And often I'll hear from young people, but I don't need. A therapist. I have friends. Yeah. And my response to that, I have many different responses to it, but one of them is that friends are wonderful. They're really important.

I want you to have them and I want you to talk to your friends about the important things in your life, but. Your friends are just that they're your friends. Your therapist is there to be supportive of you, but also push on you at times. And therapy may be uncomfortable at times. But you, you need an objective outside person who can tell you what it is when it's happening.

Yeah. And, and that you can develop a rapport with that is a true back and forth and trust. Yes. .

Sadie: Absolutely. I love that. When you have patients come in, are there any mindsets or approaches or [00:38:00] questions asked that you're like, this is great, we love to see this.

I know when I first got to residential, I was like, I don't wanna be here. My parents said I have to be here. This isn't gonna work. And then before I actually began, there had to be that shift of like, okay, I. You guys to help me. I know that there's evidence, support, this, and I, I want to get better and I hope I can get better and let's see how this goes.

So is there anything like that that's helpful to kind of like do that internal work as you're kind of cultivating that willingness and entering the, the therapy world?

Dr. Mohatt: . I mean, honestly, , I think. What I love to hear is an openness to just exploring opportunity and possibility.

You know, the idea that, and this is really hard as a teenager, I remember well, even though it was a long time ago like that, that maybe you don't know everything and that it feels like you do, but it, it definitely feels like you do. But when a young person comes in and says, , I'm really miserable, I'm unhappy, or I'm really anxious.

I don't want to feel this way [00:39:00] anymore. And want to do whatever it takes to sort of feel better. That's obviously ideal. But just an openness to exploring what might be possible is sort of music to the ears of a

Sadie: therapist or a psychiatrist. Absolutely. And it's also just such a helpful reminder to have that, how many times in your life are you gonna have an entire team of people that are just there to support you and care for you and want to see you thrive?

Like there's not many positions that you're put in where that's the only goal is just to help you be more effective and happy. And so that's something that is really amazing about treatment that sometimes gets lost is everyone's just there to support you, and it's a really unique experience in that way.

Dr. Mohatt: the caveat to that would be that support doesn't always feel

Sadie: good. Oh, a hundred percent , right? Yes. Yes.

Dr. Mohatt: A good therapist isn't always going to just say, oh, I'm so sorry. , you feel

Sadie: that way. They're gonna be like, well, you got yourself in this situation. So [00:40:00] P party is little, sometimes there's

Dr. Mohatt: tough support, right?

Yeah. But a good therapist is gonna deliver a message to try and shift your thinking in a, in a way that doesn't lead you to feel bad about yourself. Yeah. But may challenge you to think about things differently.

Sadie: Absolutely. Any last advice for parents navigating this process and then for teens as.

Dr. Mohatt: I think on both fronts the biggest thing is just ask questions. Lots and lots and lots and lots of questions. And if anything doesn't feel right, ask more questions. Mm-hmm. until it either feels right or until you say, you know what, this is a no-go. I don't like this. And you know, I think. , at some point you also have to trust, right?

So once, once you get to a certain place where you feel like, okay, this person is good. where I, I find a lot of struggle is when, if we've got a good rapport, but then we come up against something and it feels like. , that trust isn't really [00:41:00] there. Yeah. And then we can't take the next step around the treatment because maybe it takes some risks around some sort of exposure.

I mean, I'm an anxiety disorder O C D person, so I, I think a lot about kind of how to help anxious people, including parents tolerate distress, distress, yeah. Those situations. Yeah. . So but questions lots and lots and lots of

Sadie: questions. Yeah. I remember writing down, like literally on a napkin. We went to go get lunch before, I officially started at three East and I was like, what will my typical day look like?

Which therapist am I actually meeting with? When can I call my friends? Like those were my questions. My parents were like, so how does D B T work? Are you actually doing D B T? What. The different ways that were involved and mine were just so simple, but having that clarity was really, really helpful.

And so there's no bad questions. These are things that probably tons of teens have had questions about before. And you can even ask the other teens as well. I remember that was one of the biggest things on the first couple of days, whether it was [00:42:00] at i o P or residential or therapeutic boarding.

asking them questions and think, okay, but like, what is it like when we start going to school? Or what is the routine on the weekends? Or what are your favorite things to do? And just getting a real feel for what the community is like and what to expect. And everyone has been in the same position before and so they'll be more than happy to to answer those questions.

Dr. Mohatt: Absolutely. And if they're not, then that tells you something about the program. A hundred. .

Sadie: Yeah. Yeah. If people want to learn more about Ohana or continue to follow along with all the amazing work you guys are doing, where can they do that?

Dr. Mohatt: Yeah. So , we have a website. So if you go to the community hospital of the Monterey you can navigate to the Ohana website.

If you were to Google Ohana Monterey, California you'd get a lot of information there. You'd get to our webpage. The webpage is under construction cuz we're very much under construction. We're a new program that's [00:43:00] being built. Both literally and figuratively are building. will not open until next summer.

So our services are still small right now but growing quickly.

Sadie: And so if anyone is planning to have a mental breakdown in about. A year or so, you're gonna have a great place to go too .

Dr. Mohatt: Yeah, we're, we're providing outpatient treatment and i o p and pH p level of care right now. And when the new building opens, we'll be doing all of the that and in a larger, expanded way, plus have residential adolescent treatment.

That will be in a couple different tracks, but one of those tracks will be a D B T based residential program.

Sadie: So amazing. I found I o P and PHP programs to be so helpful to really solidify those D B T skills and really just practice the, these skills in the context of having routine, getting up and going somewhere rather than just being in like the residential setting.

And so, It's amazing to hear that that's a resource. So if anyone is in Monterey, the links will be in the show notes. And thank you [00:44:00] so much for answering all my questions. I know this is gonna be so helpful.

Dr. Mohatt: No, it was. It was great. It was so nice to see you. Yeah,

Sadie: of course.

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