Category: Therapy

Over-Control: When Self-Control Becomes a Problem

During a recent CERTS Parent Education Webinar, Robbi O’Kelley the Executive Director of La Europa Academy presented on the topic, “Over-Control:  When Self-Control Becomes a Problem.”  Robbi explained that at the CERTS Programs and specifically at La Europa Academy we are seeing more and more students admit with over-control issues.  Students with over-control issues often need a different type therapeutic support than students with under-control issues.  Many of the evidenced based treatments are designed for under-control individuals.  Many treatment programs for teenagers suffering from depression, trauma and anxiety deal specifically with emotional dysregulation, poor distress tolerance, and poor impulse control.

Over-control is a problem of emotional loneliness, secondary to low openness and social signal deficits, whereas under-control is a problem of emotional dysregulation secondary to poor distress tolerance and lack of poor impulse control.  The chart below demonstrates the different dynamics between a student who presents with under-control issues and over control issues.

Under-Control Dynamics  

Over Control Dynamics

 

Difficulty regulating emotion Difficulty showing emotion
Allow mood to dictate actions Rigid rule governed behavior
Difficulty self-soothing Bitterness, envy
Poor Impulse Control Lack of Openness
Relationship difficulties Distant relationships
Use of external items to manage emotions—substances, food, etc. Hyper-Perfectionism
Low Distress Tolerance High Distress Tolerance

Defining Over-Control–Four Core Deficits

Receptivity and Openness:  Manifested by high risk aversion, hyper-vigilant for threat, avoidance of novelty, and automatic discounting of critical feedback.

Flexible Responding:  Manifested by compulsive needs of order and structure, hyper-perfectionism, compulsive planning/rehearsing, rigid rule-governing behavior, and moral certitude.

Emotional Expression and Awareness:  Manifested by inhibited expression, and/or disingenuous expression (e.g smiling when distressed), and a minimization or low-awareness of stress.

Social Connectedness and Intimacy:  Manifested by aloof/distant relationships, high social comparison, envy and bitterness, and low empathy and validation skills.

Helping Over-Control Clients

The focus of treatment is the correcting the over-controlled coping style. One of the best treatment options is Radically Open Dialectical Behavioral Therapy (RODBT). Radically Open Dialectical Behavior Therapy (RO DBT) is a new evidence based treatment targeting a spectrum of disorders characterized by excessive self-control, often referred to as over-controlIt is supported by 20 years of clinical experience and translational research that parallels established guidelines for treatment development (e.g., UK Medical Council, 2008; Rounsville & Carroll, 2001; 2006).   Treatment that focuses on changing this style and “becoming part of the tribe” ameliorates the symptoms.  Therapists need to teach radical openness rather than avoidance.  They can teach clients to embrace emotions as an important system of information for making decisions.  Therapists also need to focus on teaching and modeling flexibility in thinking and actions.  Parents can also model this type of flexibility to their children with over-control struggles.  Therapists can also target social signaling as a primary intervention.  This is important because a teen with over-control issues often find that they are “on the outside” of social interactions.

To learn more about Over-Control, you can watch Robbi’s entire webinar on the CERTS Parent Education Channel at:  https://www.gotostage.com/channel/certsparenteducation.

 

 

 

 

Equine Therapy Where The Co-Therapist is a Horse

Maren Hirschi, who is one of the primary therapist at Kolob Canyon RTC is a gifted Equine Assisted Counselor.  Recently she wrote this article about her experiences with Equine Therapy for the NATSAP Newsletter.

When I was 16, my grandfather told me, “A horse can really learn to love a girl.”  It’s a powerful love.

A few weeks ago, our Equine Director, Anndi, and I were doing an Equine Therapy session with a family who was on campus visiting their daughter.  At the end of the session, Mom said, “It brings everything out into the open because it’s obvious.”

Adolescents in treatment are a tough and often closed off crowd.  Okay, anybody who is in residential or inpatient treatment probably falls into this category.  Regardless of how they look on the outside.  In the years that I have been doing this work, I have seen many treatment weeks and months spent breaking down the walls built by the masterful architect of hurt.  While we of course have a lot of tools in our toolbox to help us break through these walls , ie the therapeutic relationship, DBT, CBT, journaling, art, music, etc…, I have discovered a masterful co-therapist capable of crushing those walls in just a few sessions; sometimes this happens in just a few moments.

This Equine Therapy co-therapist of mine is a horse.  When I was trained in equine assisted counseling techniques under the Pegasus Model, the first thing I remember hearing was “The horse gives you what you need every time.”  Sure.  And, what other magic tricks does the horse do?  They talked of the horse being a mirror of a human’s experiences and emotions.  My co-worker, Craig, and I were paired together for an equine session demo during our training.  Our job was to get Lady through a track drawn in the dirt of the arena without touching her (only the lead ropes) or talking to each other.  She couldn’t step on the line of the track or we’d have to start over.  Lady, Craig, and I did this really easily the first time.  Lady walked through the track while looking back and forth from Craig to me.  Craig and I barely looked at each other and kept our focus on Lady and the task.  And that was it.  No big deal.  So I thought. Until the next pair tried do the same thing and couldn’t.  Lady was reflecting the great team that Craig and I are.  She knew she could trust us because we trust each other, and she and sensed that.

Okay, a horse acts as a mirror.  But, going so far as to rat a kid out who had been self-harming?  What other magic tricks does the horse do?  Then, one morning in February – after my team and I had been tubing on icy tubing hills at a local ski resort with our students and parents, I went to visit my equine buddy Hollywood.  I might get a little bit…playful when I’m on the tubing hills with our families.  While tubing, I hit my knee a time or two on the ice while diving onto my tube but didn’t really think anything of it; I just got up and went again.  Because it was fun.  When I approached Hollywood in his stall that afternoon, he got really antsy.  His eyes got big and he was doing this little prancing dance.  Hollywood had never acted like this for me before – he was my tall, lanky snuggle buddy who always acted pleased to see me.  So, of course I stepped into his stall.  What else would I do when my equine buddy who weighs at least 1,000 pounds more than me is upset?  The second I did, he calmed down and put his head next to my knees.  In the moment, I still couldn’t figure out what Hollywood’s damage was.  He was acting bizarre.  When I got home and changed out of my work clothes, I discovered my knees were black and blue from the morning’s fun.  Hollywood knew.  Now, I fully believed.

When I first started using equine assisted counseling, I did so because I love experiential therapy, I have always loved horses, I love being outside, and I hate sitting in my office.  I quickly saw it for what I thought it was: an opportunity do experiential therapy, with a horse and outside (not in my office).  AND, I got paid for it.  While these are all good reasons to use equine assisted counseling, it didn’t take long for me to realize that equine assisted counseling is so much more than those things.  It is a powerful, powerful approach.  It’s the backdoor approach that a client can’t ignore or pretend isn’t happening for a variety of reasons including:

  1. Horses really do give me what I need every time.
  2. Horses always live in the moment. They don’t hold grudges, don’t get stuck in the past, and don’t future trip.  They aren’t worried about what I did 10 minutes ago or what I might do in 10 more minutes.  They care about where I am at right now.
  3. You can’t bullshit with a horse. You just can’t.  They see right through that.

When I find myself struggling to help a kid start being open, honest, genuine, and sincere with themselves, me, their peers, parents, etc…, Anndi and I take the kid to the arena.  I have witnessed magic happening over and over and over and over.  The horse speaks to the kid in a way I can’t and nobody else has been able to either.   Just today, I watched Princess refuse to be ignored by a kid who was trying to be determined to not make a connection.  Princess literally wrapped herself around the kid.  The kid didn’t have much of a choice besides making a connection in the moment.  Princess’ willingness to give us what we needed in the moment opened the door to some important work that I’m fairly sure this kid was determined to not do.  She started the work because it was obvious in the moment.  I have dozens of stories like this.

Besides the individual sessions, Anndi and I do family and group sessions.  We do family sessions as often as we can when we have families on campus.  The dynamics that play out during family and group equine sessions are both eye opening (because it’s obvious) and powerful.  One of my favorite groups happened a few weeks ago.  At first, all of the group dynamics from the milieu were playing out, and it was chaos.  We gave them an opportunity to try the task again after having had a chance to process the chaos.  Once again, it was magic.  The group was able to immediately go back and correct the chaos in order to complete a task that initially seemed impossible.

In her book, Harnessing The Power of Equine Assisted Therapy, K.S. Trotter said, “Not enough can be said about the power individuals feel when they are successful in getting a 1,200-pound horse that could easily overpower them to respond to them.”  When we start having more safe experiences of doing the impossible such as getting a horse to do something you ask it to, accomplishing the unimaginable work of things along the lines of loving oneself and maintaining solid relationships with family and peers becomes imaginable enough that we stop avoiding that work. Or, at least, we slow down our avoidance of the work.

I no longer use Equine Therapy (solely) as a way to get out of my office (although, that perk is still strong).  I now use equine assisted counseling for the powerful tool it is.  Even though I have witnessed the power of equine assisted counseling, I continue to be awed by the work that happens in the space that horses willingly share with us.