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April 11, 2019

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The Art of Empathic Listening- Bill Miller

Dr. Bill Miller, expert in empathy, listening, and motivational interviewing, hosted a full-day workshop in Oahu this winter.  Six members of the Pacific Quest clinical team were able to attend. His presentation, titled “Listening Well: The Art of Empathic Listening,” focused on the interpersonal skill of accurate empathy, and captivated a sold-out audience at the University of Hawaii-Hilo.  Mental health counselors, substance abuse counselors, nurses, hospice workers, and other island residents all came together for this phenomenal event.   Below are the perspectives of three members of the Pacific Quest clinical team who were in attendance.

Mike McGee, CSAC

As the Adolescent Family Program Manager and Substance Abuse and Addictions Recovery Specialist, and having recently received the internationally recognized credential of Certified Substance Abuse Counselor (CSAC) from the state of Hawaii, I first heard about Dr. Miller’s workshop when I was invited to be part of the board organizing the event.  It was an incredible honor to receive such invitation, and to meet Dr. Miller in person.  I was especially struck by his patience, humbleness, and overwhelming sense of serenity and kindness.  I thought that I understood Motivational Interviewing well before this event, but I really appreciated the primary focus on empathic listening.  It seems well understood that listening is one of the most important components of therapy, yet it is easy to see how we can sometimes get in our client’s way with our agendas and definitions of growth.  I think we can easily focus on the technicalities of a therapeutic approach and miss what actually makes it work- compassion and understanding.

Dr. Elnur Gajiev, Psy.D.
Dr. Miller, a pioneer in his own right, highlighted the work of the late Carl Rogers and spoke to the tremendous therapeutic power of empathic listening and responding in kind. Though Rogers’ work is sometimes thought of as structureless in it’s advocacy of unconditional positive regard, Dr. Miller asserted just the opposite, noting how “Accurate Empathy” is as much a scientific and clinical approach as it is an art, and cited several empirical studies to support this point. He also noted how Empathic Listening is far more than simply a technique to utilize in sessions in order to build rapport or shift towards some predesignated therapeutic aim, but more so a way of being – a practice founded upon the principles of partnership, acceptance, compassion, and evocation – which changes us in seemingly all aspects of our lives as we continue to enact and embody it. To prove this notion, he led us through a number of experiential exercises in which his instructions fine-tuned our use of our empathic faculties (verbal and nonverbal alike) and understandings of one another. There were many moments of laughter, in which we noticed how often we may trip ourselves up through “doing too much” rather than tuning into what is already there; as well as moments of deep understanding and shared insights.

Dr. Miller’s lessons rippled far beyond the domains of Motivational Interviewing to connect to a foundational element within the art and the craft of what we practice on a daily basis. He imparted a greater appreciation for the role of Empathic Listening in our work and in our lives, and we are incredibly grateful for his visit to our wonderful home here in the Pacific Ocean.

Dr. John Souza, Jr., LMFT, DMFT

I first became aware of Dr. Miller when I was approached by one of his close friends and colleagues here on the Big Island of Hawaii, who invited me to form a committee with the goal of offering this workshop. I had no idea who Bill Miller was, nor did I necessarily think that a workshop on listening would be well received; I mean, who doesn’t know how to listen?! After 11-months of committee meetings, reading Dr. Miller’s book (Listening Well), and realizing how much research Dr. Miller had done on the subject of listening and empathy (including his work on Motivational Interviewing) I came to appreciate what this conference was offering: An opportunity to counterbalance the over-emphasis on specific models of clinical practice; to implement our outcomes data that overwhelmingly speaks to the importance of relationships in improving client’s mental health; and to learn that the art of listening well and accurate empathy can be learned if one is willing to first practice the discipline.

As part of the workshop committee, it was difficult to actually participate in the same way as my colleagues. However, seeing so many PQ therapists in the context of a much broader community of local practitioners, I appreciated that what we had done was bridged our PQ world with that of the larger population of providers in Hawai’i. We were all there to learn to improve our relationships. My hope is that this workshop will continue to inspire improved relationships across work environments, professions, and cultures, particularly here on the Big Island.

March 18, 2019

Written by:

Life Happens FOR You, Not TO You

Getting a student into wilderness therapy requires the effort of many dedicated and committed people. By the time students reach Pacific Quest, they’re in deep, open to at least giving it a try…until they don’t. Uncertainty and fear arise, and then questions emerge like, “Where will this journey lead me,” and the externalization we so often witness in the form of “Why are my parents doing this to me?”

This generation of student consistently shows up with applications to PQ that read, “I am depressed and anxious.” Why is this? Is it the environmental uncertainty, the current instability of our political system, combined with the gun violence in schools and messages they heard as children like, “you can be anything you want to be” until they find that they need to struggle much harder than they thought would be required while trying to flourish in a college setting without the support system grounded in their parents’ involvement?

The notion that “Life is happening for you, not to you” is a powerful reframe that can shift the sense of failure, and the fear of uncertainty to excitement and then hope.

Lately I’ve been running a group built around this topic of uncertainty and the theme of life is happening for you, not to you. I talk about the Yale University study (https://qz.com/1343503/a-new-study-from-yale-scientists-shows-how-uncertainty-helps-us-learn/) that says that the brain benefits from volatility and that uncertainty switches on the learning parts of our brain.

When I teach this to our students they experience a shift in perspective. Maybe this “not knowing” is a good thing, maybe I’m not failing or screwed up forever. Maybe I don’t have to complete college in four years. Maybe I just need to learn more skills to make it work out there. The shame falls away and the possibility that I am right where I need to be emerges. A significant shift occurs as the student moves from victim-hood to sovereignty.

I don’t know about you, but most of the really juicy changes in my life have not been planned, rather they emerged from my courage to embrace uncertainty and follow my heart, trusting that if I stay healthy, and do the right things and show up with kindness and compassion towards myself and others that great things will happen, and they have.

Students at PQ and their families step into uncertainty when they enroll with us, and it takes a collective effort to hold the uncertainty with confidence that what we do works, and it does. They begin to build small positive experiences that reinforce a belief in their personal agency, defined as the ability to set ones own course, and to be effective at reaching ones own goals in life. Stepping into the uncertainty, the mystery of life brings expansion of consciousness and disrupts old neurological pathways.  And as a student recently shared with me, “If you can’t get out, get in,” that’s when the magic begins to happen. 

March 18, 2019

Written by:

Clinical Spotlight: Andrea Sussel, MSS, LCSW

Andrea is a licensed clinical social worker with a wealth of experience; she has been a therapist at Pacific Quest since 2015.  Andrea received her BS in Health and Physical Education from the Pennsylvania State University and her Masters of Social Services from Bryn Mawr College Graduate School of Social Work and Social Research. She is a certified Gestalt Therapist from the PA Gestalt Center and has co-facilitated workshops at The Esalen Institute in Big Sur, CA. Andrea has completed Level I and II EMDR training and is currently working toward her certification in Sandplay Therapy.

Andrea has extensive experience treating students and their families who are struggling with a range of mental health issues including depression and anxiety, gender dysphoria, sexual orientation, drug and alcohol abuse, eating disorders, autism spectrum, and bipolar disorder.  Additionally, she enjoys working with general difficulties within relationships, including those within the complexity of the family system. She also has experience and success working with young people who struggle with self-harming, suicidal behaviors, and personality disorders.

Andrea worked as a psychotherapist for 8 years at a liberal arts college on the Main Line of Philadelphia where she founded The Body Image Coalition and led the initiatives to impact a culture shift at the college regarding disordered attitudes about body image and our dieting obsessed culture. Prior to that she worked as the eating disorder specialist on a DBT team and in inpatient and outpatient settings treating individuals with eating disorders, including those on a specialized dual diagnosis unit for LGBTQ people. Just prior to moving to Hawai’i, Andrea maintained a private practice for 10 years.

Andrea has been spending time on the Island of Hawai’i for the last three decades and draws upon her connection to the land and culture to promote healing. She brings a compassionate and relational approach to her work, along with her strong belief that each person has an innate ability to heal when given the proper “soil.” She values patience and listens deeply to others as they access their inner wisdom and voice. Andrea’s use of bibliotherapy, poetry, music, humor and the life force of creativity to meet her students where they are, while creating a safe space for them to open at their own pace is what makes her approach gentle, effective and ultimately sustainable.  Andrea was drawn to Pacific Quest because, as she expressed, “I feel incredibly synchronistic with all the essential practices that are promoted and I believe PQ has illuminated the core elements of a healthy life for all people.”

In her spare time Andrea enjoys hiking, swimming, paddle boarding, yoga, and silent meditation retreats. She also teaches at the Insight Volcano Vipassana meditation group, volunteers in the ancient forest at Niaulani Art Center, and worked as a Red Cross volunteer in the recent Volcano relief efforts. She was featured in the recent documentary, Fire and Sand, winner of the 2019 Santa Fe Humanitarian Award. She experiences great joy in her 28 year old son who is currently working in the field of recovery in Kona and is teaching English online to Chinese students.

Parent Testimonials:

Our therapist, Andrea, was outstanding and had a wonderful connection with our daughter.

Every part of our work with Andrea was super.

Andrea did so much for our son and our family. We are incredibly pleased. She is absolutely amazing- actually beyond amazing!

March 7, 2019

Written by:

What’s in your Treatment Pie?

Mental health disorders are on the rise, and consequently, so are medication prescriptions.  Polypharm, the prescription of multiple medications, is rampant, as doctors and parents scramble to mitigate the distressing symptoms they witness in their patients and children.  This is especially problematic in the United States, where the rates are nearly double that of other Westernized countries. Zito says, “Concomitant drug use applied to 19.2% of US youth, which was more than double the Dutch use and three times that of German youth.” (Zito, 2008. Child and Adolescent Psychiatric and Mental Health.)  Increases in polypharm manifests concerning side effects, and can be quite debilitating to patients.  Many doctors, clinicians and parents are seeking to expand their “treatment pie,” by utilizing a diverse toolbox for treatment beyond that of medication.

The US is distinct in that prescribing psychotropics medications to young people often is the first line treatment for mental health concerns.  When the first medication is not effective, the next move is to add an additional medication in hopes of some amelioration. Let’s take the example of ADHD psychostimulant medications such as; Ritalin, Adderall, Vyvanse, Concerta, and Focalin. A child is struggling in school- unable to complete their school work, acting impulsively, and seemingly ignoring school rules. Doctors too often resort immediately to medications, and in turn, psychostimulants have the common side effects of suppressing appetite, inhibiting growth, increasing heart rate, causing anxiety, and contributing to sleep issues.  When these side effects occur, doctors will often add another medication to help these symptoms. This is what we call polypharmacy; the simultaneous use of multiple drugs by a single patient, for one or more conditions. This is a slippery and dangerous slope.

A recent study, the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA Study) examined the efficacy of stimulant medication. The study initially showed promising conclusions, which were widely shared and used as a justification for increased production of stimulants and marketing by pharmaceutical companies.  Looking more closely into the MTA longitudinal follow up studies, it was the concluded that longitudinal data did not support the use of stimulants.  At the National Association of Therapeutic Schools and Programs (NATSAP) conference in January 2019, Keynote Speaker, Dr. Robert Foltz, presented on “Psychotropic Medications in Youth: Challenging the Assumptions that Guide this Practice.” And demonstrated the lack of longitudinal safety and efficacy studies for the most commonly prescribed psychotropic medications. “We had thoughts that children medicated longer would have better outcomes. That didn’t happen. There were no beneficial effects, none. In the short term, medication will help the child behave better, in the long run it won’t. And that information should be made clear to parents.” The MTA findings only support the short term (12 weeks) use of medication treatment, as there was a scarcity of data beyond that time frame. (Foltz 2019).

Dr. Britta Zimmer recently presented at the Hawaii Syncopate Doc Talks conference for physicians, and focused on the management of patients prescribed multiple psychotropic medications and how to discern medical necessity and improve safety within an outdoor behavioral treatment program. Dr. Zimmer did this with a series of case discussions while speaking to over 200 physicians on the topic. The core of the issue is that our children need an expanded scope, treatment providers who are willing to look beyond the use of polypharm psychotropics.  As an Naturopathic Physician and Medical Director of one of the leading Integrative Psychiatric programs in the country, Dr. Zimmer suggest that doctors and parents examine their “treatment pie,” a range of treatments for enhancing mental wellbeing.  Examples include improving nutrition, exercise, sleep, relationships, and mental/emotional health. A successful treatment plan is the sum of the parts of a whole. Britta Zimmer, ND, encourages people to read the MTA study and to diversify their treatment pie.

March 1, 2019

Written by:

Michael McGee- Certified Substance Abuse Counselor

Pacific Quest is proud to announce that Michael McGee, Family Program Manager and Clinical Support Specialist, has received the Certified Substance Abuse Counselor (CSAC) accreditation from the state of Hawaii.  This is an internationally recognized credential and will allow Mike to further support Pacific Quest clients.

In addition to his work leading our adolescent Family Program workshops, Mike has been meeting with clients in our young adult program that have demonstrated a need for recovery coaching.  Mike utilizes a unique blend of motivational interviewing, psychoeducation, and personal experience to work with individuals with histories of substance use, addictive patterns, and compulsive behaviors.  Mike states, “My goal is always to meet people where they are at, help them create a model of recovery that works for them, and help plan a strategy that will make their recovery goals a reality.  I’m really looking forward to gaining more experience in this area and excited to assist our students on their individual journeys.”

February 26, 2019

Written by:

Clinical Spotlight- Camille Bourcier, MSW, LCSW

Camille is a licensed social worker, psychotherapist and behavioral specialist who received her Master’s Degree in Social Work with an emphasis in Mental and Behavioral Health from the University of Hawai’i at Manoa. With over ten years experience working with adolescents, young adults, and families in outdoor, educational and therapeutic settings she brings a dynamic style, utilizing a strength-based approach.

Camille began her journey with Pacific Quest in 2011 as a guide for the Adolescent Program where she become passionate and skilled in horticultural therapy and our holistic approach. Camille’s hard work in the field propelled her into a supervisory role for both the Adolescent and Young Adult Programs, which eventually developed into her role of Staff Manager, for which she received a company excellence award.
In 2015, Camille pursued her Master’s Degree in Social Work, with the goal of returning to Pacific Quest as a therapist. Since that time she worked with military families facilitating individual, group and family psychotherapy, utilizing Parent-Child Interaction Therapy. She also worked with a local behavioral health organization where she supported young people with learning differences and emotional challenges in the development of improved esteem, study habits and communication skills. Camille has provided home-based wraparound for youth at-risk of school failure and has also spent a decade working with a non-profit foundation that makes it possible for youth from different backgrounds to enjoy the Sierra Nevada backcountry.

Building strong relationships with students, Camille provides a foundation to address challenging behaviors and interpersonal issues. With experience from field to management in the mental health field and family support services, Camille brings a confident, calm and deliberate approach to her work with students and families.

The use of Hawaiian culture, the integrative wellness approach and the focus on experiential learning through horticultural therapy are what originally drew Camille to Pacific Quest. Many of the activities that are incorporated into the PQ student program directly reflect Camille’s passion outside of work. In her free time, you will probably find Camille at the beach with friends, hiking to the closest waterfall, or practicing yoga with her sister.

Parent Testimonials: Camille was OUTSTANDING! The communication was outstanding at every level – goal setting, regularity, insightfulness, and helpfulness. Camille made such a difference in the life of our son.

PRIMARY THERAPIST
Camille Bourcier, MSW, LCSW
camille.bourcier@pacificquest.org

February 20, 2019

Written by:

Reflecting on 15 Years

Aloha Friends!

We are humbled and grateful to be celebrating Pacific Quest’s 15th year with you.  To honor our roots, we wanted to reflect on our story through the lens of our Stages of Growth – Nalu, Kuleana, and Ohana, and to speak to our own rite of passage.  We are proud to share where we have been, how we have found success, and aspects that continue to put us on the clinical frontier in Outdoor Behavioral Healthcare.

Nalu: Reflection

The first stage of growth, Nalu, is perhaps the most powerful right now on this 15th anniversary. We look back to our humble beginnings; clearing one piece of choked land, a few students in a tent, a few dedicated and exhausted staff.   The particular steps were simple – clearing, tilling, sowing, and yet the vision was grand.  The goal was to create a safe and healing outdoor therapeutic program that encourages students to seek internal change through rites of passage. We quickly learned that caring for and honoring the land was our path. Students would heal the land and themselves simultaneously, and this would start the process of lasting transformation and connection to something greater.

Kuleana: Personal Responsibility

Kuleana is about recognizing one’s personal responsibility in the world, and anchoring positive and valuable tools.  An early lesson in our process of growth was that of flexibility.  Just as plants must not remain rigid in the wind, one of our core tenants is remaining flexible and adapting. From the transitions our students experience between the stages of growth to the physical moves and program shifts over the years, we know that this is key to success.  We thrive on being one of the most progressive programs of our kind, and we welcome challenges as opportunities for growth.  Adapting the Neurosequential Model of Therapeutics and leading in Integrative Psychiatry and have been important steps, and even in year fifteen we continue to welcome change and we are thrilled for new chapters.

Ohana: Family

Ohana is what we are most grateful for along this journey.  We want to express gratitude for the families and professionals who have trusted Pacific Quest over the years, for the Pacific Quest family of staff, and importantly for the ohana of the island- the culture, history, people and the land of Hawaii Island.  We are humbled and strengthened by countless stories of struggle, transformation and success from our current and alumni students and families. We are thankful for the positive, caring staff over the years, and the challenging work they do. This island and its power continue to be awe-inspiring.

With our clinical prowess, our impeccable safety record, leading integrative psychiatric team and continued desire to evolve, we have developed into a leader in the Outdoor Behavioral Healthcare field.  Throughout our fifteen years, PQ has sought to provide the best care in this field, and we will continue to strive to be an industry leader into the future. We are thankful for the support of each and every one who has had a hand in making Pacific Quest who we are today.

Mahalo Nui Loa,

Your PQ Ohana

January 10, 2019

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Teresa Bertoncin earns highest level of EMDR certification!

Teresa Bertoncin was recently awarded EMDRIA (Eye Movement Desensitization and Reprocessing International Association) consultant status.  An EMDR consultant is recognized as an expert in the field.  It is no small feat to gain consultant status in EMDR.  In addition to being a Certified EMDR Therapist with six years of experience, Teresa conducted several hundred clinical sessions utilizing EMDR and received more than twenty hours of consultation from an approved consultant.

EMDR is an integrative psychotherapy that has been extensively researched and proven effective for the rapid treatment of trauma. EMDR therapy aims to reduce subjective distress and strengthen adaptive cognitions related to the traumatic event.  EMDR is recommended by the World Health Organization, The American Psychiatric Association and the Department of Defense for the treatment of Post Traumatic Stress Disorder. Additionally, EMDR has also been proven effective in treatment of panic attacks, complicated grief, dissociative disorders, disturbing memories, phobias, pain disorders, performance anxiety, stress reductions, addictions, abuse (physical, mental and psychological), body dysmorphic disorders and personality disorder.

Her extensive experience with EMDR allows Teresa to provide regular consultation support for her fellow Pacific Quest primary therapists who have completed an EMDR training program. In turn, the majority of the PQ clinical team is able to apply this powerful and effective treatment in the field. The Pacific Quest treatment team is a leader in outdoor behavioral health, and especially in trauma work with adolescents and young adults.

December 5, 2018

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Kalsched and Freedle present “Trauma and the Recovery of Lost Innocence”

Trauma can result in brokenness and lost innocence. Dr. Donald Kalsched, Jungian Analyst and author of Trauma and the Soul notes that innocence lies at the core of our sense of aliveness and spirituality. The recovery of innocence is an important and complex process that leads to renewed vitality and embodied living. Dr. Lorraine Freedle, PQ Clinical Director presented at the Sandplay Therapists of America (STA) national conference with Dr. Kalsched. Together they took the audience on a powerful journey of lost and recovered innocence featuring the sandplay process of a young man, “Howard” (pseudonym) from Pacific Quest.

In attendance were helping professionals from around the globe, including Theresa Hasting, PQ Clinical Supervisor and Hannah Mariotti, Boston-basedEducational Consultant. Theresa stated, “The presentation illuminated how sandplay and the Pacific Quest approach are used to help students access and reprocess past traumas, and also showed a real world application of Kalsched’s model.”

Hannah Mariotti stated, “I’m very grateful to have had the opportunity to learn from Dr. Lorraine Freedle and the other inspiring sandplay therapists at the Transformation in Sandplay conference last week. Lorraine is a wise and compassionate guide in sandplay therapy. Being a part of this community has inspired me to begin my own process and to pursue sandplay therapy certification this winter!”

Mariotti continued, “One of the most powerful moments of the conference was watching Lorraine’s mentor and co-presenter, the legendary Dr. Donald Kalsched, as he wiped away tears, praising Lorraine’s skillful work with her deeply traumatized client. I returned from this experience with a deeper understanding of how, ‘the hands can solve the riddle that the mind cannot.’ Sandplay therapy resonates for me on a personal and professional level as it centers on the development of an authentic relationship. The clinician and client co-create a new, and ultimately healing narrative, which challenges the stories written by their protective yet destructive Self Care System as defined by Kalsched. My hope is renewed for clients who carry unexpressed trauma; and that as clinicians we can plant the seeds of growth and healing through sandplay. As clinicians we can encourage them to access their innocence, live in the reality of their painful feelings, and be present with them in their authentic suffering.”

November 28, 2018

Written by:

Clinical Spotlight: Mark Storey

With a passion for finding a student’s authentic self, Mark Storey brings dynamic long-term wilderness therapy experience to Pacific Quest. Since 2005 Mark has worked in outdoor behavioral health. Mark worked as lead field staff and as family program guide at a wilderness therapy program in the Blue Ridge Mountains . After completing his Master’s Degree he worked as the sole clinical therapist at a residential facility in Puerto Rico before finding his home at Pacific Quest.

In addition to his experiential family-focus work, Mark worked in both individual counseling and equestrian therapy. As a Seattle native, Mark earned his B.A. from the Comparative History of Ideas program at the University of Washington after completing his thesis in Creativity in Wilderness Therapy, and would go on to earn a Masters Degree in Counseling Psychology from Washington State University.

Mark’s work pulls from more traditional styles such as CBT and Reality Therapy, while simultaneously incorporating newer models such as DBT, Sandplay Therapy, EMDR, and Positive Psychology. In issues related to communication, Mark teaches Cognitive Interpersonal Therapy (CIT), a type of therapy focused on empowering the individual to be accountable for the type of relationship they are creating. CIT focuses on building trust and understanding through reflective listening and assertive communication. CIT helps students re-consider themselves and their own value, while restoring the student’s own ability to establish healthy connections and build self-efficacy, motivation, and self-confidence.

Mark has a genuine curiosity that keeps him both amused and humbled. Staying true to his last name, Mark lives in a way that creates the best ‘Storey’ while living by his core values of compassion, gratitude, and exploration. When away from work Mark is excited to explore what this amazing land has to offer while working to develop a greater understanding and appreciation for Native Hawaiian culture.

Parent Testimonials:

Mark Storey is a Jedi Knight, a rock star and an intuitive genius all in one. Truly a gifted therapist and offered a wonderful platform for our child to grow. Thank you.

We love Mark Storey!! From the very beginning, we felt Mark understood Jesse and Jesse felt understood by him. He was both incredibly supportive and very direct and effective in his interventions and communication. And he’s been very responsive in (our son’s) transition to his new school.