Ann: While the number of adolescents suffering from one form of mental health disorder or another is higher than ever, parents are either crippled by a lack of knowledge about these issues or a lack of available resources to help. So, more and more teens end up without the assistance they need to get better.

The good news for you is – it’s not impossible to get them that help. But you have to be ready to educate yourself – to dig through the mountains of information out there to figure out the type of help they need, find the specific person or facility that’s best for them and then either fight your insurance company to provide it, borrow money to pay for it or beg your way in somehow. It’s not impossible but it’s a lot harder than it should be.

And because it is so hard, you can expect that the first, the second and maybe even the third or fourth thing you try, may not be the right thing…yet. Understand this is a process and it can take a lot of time and unfortunately, even a lot of money sometimes. And if you don’t have money, it can take a lot of tenacity and an unwillingness to take NO for an answer.

This is Speaking of Teens, the podcast that helps parents who are struggling to find peace and connection with their teens. My name is Ann Coleman; I’m an attorney turned parent educator and a mom who has been there - and I’m on a mission to help you build a stronger relationship and decrease the conflict with your kid so you can help them grow into the young adult they’re meant to be.

On today’s episode is a guest, who at 20-years-old, is a happy, healthy young adult and a junior in college. But from very early in her adolescence, she struggled with her mental health. And her parents, as you’ll hear, tried over and over and over to find her the help she needed to get well. They didn’t give up until they found the right place for her.

Sadie Sutton is also a podcaster. She’s the host of She Persisted, the appropriately named podcast that she started when she was 16-years-old after a year and half of intensive treatment for severe depression and anxiety. I’ve followed Sadie on Instagram and listened to her podcast for several years now and to say I’m impressed is an understatement. She built this podcast for other teens struggling to get better, to understand what’s wrong and to help themselves if they’re not getting the help they need. She’s had some major guests on her show and it’s definitely a podcast that your teen and you need in your que.

And what’s so great now is that Sadie has had a lot of time to reflect on her journey, to talk to all these mental health professionals both in treatment and on her show, to practice her coping skills and to see things from a more subjective point of view – even from her parents’ point of view.

Sadie: Yeah, so it's interesting, I think like a lot of parents come to realize that it wasn't like one day you just started being depressed, or there was one thing that caused these feelings or one argument and then you're struggling with self harm or suicidal ideation or whatever it is. These things really creep up very slowly over a long period of time. So I remember as a kid, like not being very great at coping with my emotions or feeling really uncomfortable when I had really strong emotions, or maybe not necessarily feeling like super secure or I was a perfect fit in every social setting. All these things that we experience as humans, and especially as teens and young adults.

But when you're not able to cope with those or you don't necessarily have the right mindset or even just thought process when it comes to coping with your emotions, you start to become really ineffective when you avoid them or you push them away or you distract yourself a lot. That's kind of what happened to me. I have a lot of clarity now from a lot of therapy and a lot of internal work. But when I was going through it, I had none of that. I was angry, I was confused, I was overwhelmed. I just knew that I was really sad. I felt really exhausted all the time. And I didn't ever feel happy. Like I remember the way that I would describe everything is I would be like, I'm too lazy. Like someone would say, Oh, why don't you do this? Or something simple? Like, why aren't you baking cookies? Or do you have an interest in joining this club? I'd be like, I'm too lazy.

That was what I would always say. Or people would say, how are you doing? And it was like, I'm tired. And it was like that all-encompassing lack of motivation and fatigue and unwillingness to do anything that I kind of just embraced as part of myself. And it's interesting because we have such blinders on when it comes to our own experience. And we're so caught up in what thoughts we're having and what emotions are arising that we don't think it's possible that anyone else has ever felt the same way that we have before. And that's really not the case.

Even though I was like, generally aware of mental health, I remember not truly realizing I was depressed until I was told I was depressed by the pediatrician. And at that point, I like, wasn't sleeping, my eating was a disaster. I don't, I was self-harming at that point. I had all of these different things were going on, and yet there really wasn't that clarity of like, oh, maybe there is something from a mental health perspective that's coming up here. And so...

What was interesting about my relationship with my parents and how we approached everything is that we had more conflict when I was in middle school. We would argue back and forth about certain things. I would talk back sometimes, typical back and forth. I have three younger siblings, so it's not like we're ever living in that household where everyone's just sitting there quietly by themselves. There's a lot going on. There's a lot of personalities.

Basically, I had been meeting with a marriage and family therapist on an outpatient basis for about a year. And I remember we were referred to that therapist by the school. And I think it was just like my parents, I would have to go back and ask them like, what was the exact reason we initiated that? But I remember like, we weren't doing great in our relationship, the communication wasn't as great as it could have been. I never liked talking to my parents about anything like from a very young age, the idea of being like, oh, I have a crush on someone or like this embarrassing thing. Full body hives, worst nightmare, did not wanna talk to my parents about anything at all. And still to this day, whenever it's like, I'm like, vulnerability is so uncomfortable with them for some reason. So there wasn't that like back and forth. And I'm sure that was one of the reasons why they wanted me to build those skills and work on that and therapy. And so I had a lot of like random drama with my peers in middle school, teen girls, like at that age, of course, the whole, and weird there is texting and Snapchatting and you're just learning how to use those tools. And so definitely just like everyday challenges. And so I started meeting with a therapist. I remember throughout that year, things were getting more challenging. I would go to the therapy sessions and I was just so frustrated to be there. I didn't wanna be seeing this therapist. It wasn't something I'd initiated. I remember at first I completely resisted, like I was like, I will not go, refusing to get in the car. I forgot how my parents eventually got me to go. Yeah. I wish I could, I'm sure it was something like, well, this is like a basic foundational thing that you do, like going to school. So if you can't do this, then that means that you're not at the place to be able to do something social or have your phone or like whatever those other secondary-

Ann: Yeah. I was going to say, how did they get you to go? Because that's always the hard thing, is getting them there to begin with. You don't remember how they did that.

Sadie: Yeah, so something like that, I'm sure they said at that time. I ended up going, doing it for months at that point. It got to the point where I just really didn't feel like it was working. I didn't like talking to this person. Looking back, I'm like, how were these sessions even possible? We were like working on a presentation. I was on my laptop in the middle of there. Like what was going on? Yes, it was the craziest thing. Yes.

Ann: No way, that's what the therapist had you doing? Okay, that's interesting. Oh Lord, yeah.

Sadie: Like it was so odd. I was doing sticker charts in like in eighth grade. Like it was so odd. So needless to say, I didn't feel it was helpful. My mood kept getting more and more like worse and progressively I was struggling more. And so it kind of escalated to the point where I was either going to the therapy sessions and running out the clock. So I wouldn't talk about running things. I would just sit there, stare at the ground and wait till the hour was over or I would drive there with my mom, sit in the car and refuse to go in. And I remember one time she went into therapy and I was just like really mentally struggling with like how I saw myself, how I felt about myself, the emotions I was having. And I was like writing all these sticky notes, like these really terrible things about myself and just putting them up like as a way to like express what I was experiencing. And I think that was one of the first times where she was like, okay, something internally really isn't great and something is not as it should be and there was more insight into those emotions that I was having. And so she ended up taking me to my pediatrician halfway through my eighth grade year. And yes, we had been seeing the therapist and I'm sure she was like, this isn't great because I had one incident of self-harming and they knew something was going on, but there was no diagnosis or treatment plan at that point. And so I went to the pediatrician and he did the typical screening. Funny, it was actually my sibling's pediatrician. Mine was not there that day, so I met with him and he was really nice. And it was the first time that anyone had ever put words to what I was experiencing with not having any interest in anything. Low energy, really intense emotions, feeling sad for no reason, all of those things that had been like swirling around in my internal experience, but I couldn't describe and I didn't understand. And so...I remember crying and he was like, you're really depressed. Like that's just going on here. And he was like, your mom made an appointment with a psychiatrist and you're either going to go to the psychiatrist's appointment or you're going to go to the hospital and you're going to spend the time in the hospital because it's really clear that there's not any insight into what you're experiencing. That's really important that you go to this appointment. There was already that resistance to talking to your therapist. There was no insight to what I was experiencing and I had been self-harming. So it was...

Ann: Let me ask you though, this is what kind of blows my mind, is that how long had you been going to the therapist by this point?

Sadie: A year.

Ann: So you've been going to a therapist for a year and you walk into the doctor's office, the doctor has this little 12 questionnaire, you know, 12 questions or whatever that they ask you and he knows immediately, why wouldn't a therapist do that? I wonder. Have you ever thought about that? Why would your therapist not have known that you were depressed and that you needed specific help for that depression.?

 

Sadie: Yeah. Like a year, a year. Yeah. I'm sure she knew and I'm sure there were things she was trying to do because my mom would come in at the end of sessions and then we would try and have conversations together and she had been looped in about the self-harm thing, but there had never been that formal diagnosis so I'm sure there was some awareness, but at that point I didn't want to talk. I literally, genuinely hated her. I never went back again and so there was no willingness to talk about what I was experiencing. There was so much resentment that I had to be there in the first place. I never had a time that I can remember during that year where I was like, oh, maybe this is helpful or this is working. And no fault to her, like if you're not in the right mindset and if you're just completely hell bent on not wanting to be there, it's not gonna work. And so that was really the case there, which was unfortunate. But I also think I was already past the point of like, let's solve these everyday problems with everyday solutions. And I needed something a bit more, yeah, exactly.

Ann Yeah. You were on the downhill slope at that point. What do you think? I mean, that's the problem. You know, as a parent, you want to get your kid to go to therapy, and then if they refuse, you know, you can't force them. It's not like you can pick them up and put them in the car to take them. And then how do you get them in the head space to want to go? I mean, it just, that's why I think residential treatment is, or hospitalization is such a go-to for parents because they don't know what else to do. If you can't get your child to open up and go to therapy, I mean have you thought about that? I mean what would you tell people to do if they can't get their kid to go to therapy and they know that something's wrong?

Sadie: Yeah, it's really tough and I was that patient for a really long time. Like I didn't want to go, I didn't want to be there. I didn't know what I was experiencing. So, it wasn't like I know I'm depressed and I'm just not telling you. Like there was just so much resistance when it came to feeling my emotions, thinking about them, being willing to talk about them, having any ownership or acceptance that I might be part of the problem. Like it was just blame and anger and frustration and confusion. And so.

 

I think there's a couple of things that can help. And it's definitely, it's a really tough thing to do. And I'll kind of share also my story of starting at residential, because I think that is a good example of getting teens to buy into the process. But I would say one of the easiest things that parents can do is have their child help choose their provider. And when I've talked to peers who have gone to therapy, or they've tried working with a therapist, and I hear these, I'm like your therapist told you that they had to research like, how to deal with this thing or like, they said what to you? Like, where did you find this person? And so the biggest determinant of success in therapy, regardless of age or what you're, what you're experiencing is the relationship with the therapist. And that's true across any modality. And so if your teen hates the therapist, like I did at various times, it's going to be really challenging for them to be vulnerable and ask for help and want to put in the work and be willing to invest in themselves. I think another thing that's really confusing as a teen is that your parents are choosing your therapist and telling you, you have to go to therapy. And how it works based on medical laws is that the therapist is the teen's therapist. Like they can't tell the parents what's going on in the sessions. The parents can't send an agenda with regard to what to talk about or what to cover. Like it's your child's doctor, psychologist, therapist, whatever it is. And so as a teen, that's not always clear. And a good therapist will make that abundantly clear as soon as you get there and say, maybe they'll be like, your parents said this, but I don't wanna talk about that. Like what's going on with you? But a good therapist will say, yes, your parents are the ones that want you here but I want you to know that I'm in your corner and I'm your therapist and we're here to do the work that you wanna focus on. And a lot of the times, since you have that relationship, the teen then does wanna work on the things that are also causing you stress as a parent, which is probably related to school or relationships or the conflict you're having. So giving your child like a pre-screen list of providers, you don't have to be like, go on Craigslist and find yourself a provider, but be like.

Sadie Yeah, here are three options. And so my mom did this when we left residential and she was like, here are a couple of names, I'm pretty sure she did this at least, or at least she had me do this when I came to college. And it was like, you know that DBT is evidence-based, you know you have a history of working with a DBT therapist, you've liked that in the past, so go find one. And if your teen is younger, you don't have to give them that whole project of researching who takes your insurance and...

Do they do telehealth and how are you gonna get there? But give them like three or four options and maybe they want a younger therapist. Maybe they want someone that's older and it's so dependent on the person. I remember talking to a friend and I'd always had really young therapists that were females and he had like an old man therapist and I was like, what? I was like, who are you talking to about your problems? Like it was just so disorienting because I knew what worked for me thus far. And so it's like giving your team that autonomy and that option. Just like you would if you were choosing who to spill all of your deepest darkest secrets to.

Ann: Yeah. Right. very personal.

Sadie:  Yeah. Exactly. What do you think about getting that diagnosis too? Like is that, was that a significant thing for you know it to kind of kind of name it to tame it you know validate in your head that this was what was wrong and now you felt more maybe motivated to talk about it and resolve some of the problems? 100%. I remember having such a sense of relief and also really like identifying with that diagnosis. Like I remember we had this project where we were like drawing out parts of our identity in the IOP program I did. And we'll circle back to like that whole story and all the in-betweens. But they were like, draw the parts of you that make up yourself and who you are and how you see yourself. And it was a lot of the teens would put like depression and anxiety on that piece of paper that they were drawing on. Like it was just as much a part of them is where they lived or the fact that they like to draw or their favorite TV show. Like it really is something that depending on how long you've been struggling, you really do see that as a part of yourself. And that can be even harder because then you're like, this is just how I am and who I am as a person and I can't change it. But it was very relieving. And I think so much of mental health goes unacknowledged. You aren't - no one else is privy to all of your thoughts and emotions and urges. And when you feel like crying or you're so overwhelmed or you don't want to do something. And so, you know that you're showing up and trying your hardest to just continue to be there every day. And no one else has that appreciation. And so these things like getting a diagnosis or being in treatment or being on a medication, it was very like externally validating of like, okay, this is real and this is a problem and other people also see that and this isn't normal and this isn't okay because it does get so normalized when it creeps up on you because you're like, this is how it's always bad. This is just how I'm supposed to feel. And that might not necessarily be the case.

Ann: Oh yeah, yeah. Well, I mean, and that happened to me too. I mean, later in life, I looked back 20 years and thought, oh my God, I was depressed. That's what that was. That was depression. So you're so lucky that you did have that, you know, acknowledgement and that validation early on and got treatment for it because people go for, you know, decades without even realizing. They just think it's the norm.

Sadie: Yeah.

Ann: Do you think that, and your parents aren't going to listen to this, so it's okay. But do you think that was there anything else that your parents could have done or any mistakes that they made along the way that maybe you would warn other parents of? Or do you feel like they did everything they should have and right along the timeline that they should have?

Sadie: Mm-hmm. We were both disasters. It was like the blind leading the blind, except for they were blind because I wasn't telling them anything. I was blind because I didn't know what I was experiencing and was so angry with the fact that I was experiencing it to begin with. So I think that was really challenging on both sides of things. I went to that initial pediatrician appointment and ended up going to the psychiatrist appointment. It was a tough day. I just remember just like completely shut down, wasn't talking. I think at one point she was like, well, can you like draw a pie chart of your feelings? And I was just like, I'm sad. Like that was all I was experiencing, like really physically struggling with feeling like lethargic and unmotivated and all of those kinds of things. So I ended up being hospitalized for the first time at that point. I was 13. I ended up being in the hospital for about a week, maybe 10 days. And to give you like the really brief Cliff Notes version of until I got to residential and my mental health started actually improving, I was hospitalized three more times, so four hospitalizations. I did two rounds of intensive outpatient, two rounds of outpatient at Stanford. And within that was like DBT, CBT, group therapy, family therapy, individual therapy, medication management, all of the things. And so, yeah. So it was like we really truly tried everything and...my parents tried as hard as they could for as long as possible to keep me at home because it can be really disruptive to take a kid away from their family and move them across the country or to another state or whatever it is. And the clear messaging from the, my treatment team was just like, this isn't working. Like we can't keep her safe, you can't keep her safe and things aren't changing. It would be one thing if she was super open and vulnerable about like...I'm having these urges or things aren't improving. And that just wasn't what was happening. There was no improvement in mood or urges or self-harm. And there was also not as much openness as there could have been with me as a patient.

And so you asked earlier about like...finding a therapist and getting your kid to go to therapy. I had an interesting conversation with a podcast guest and she is like a parenting expert. She runs a center on parenting at Mount Sinai and she was talking about how she's less worried about kids that already have a diagnosis and are in the treatment world than she is about the kids that fly under the radar. And that's really true.

And so if you're like, how do I get my teen to be motivated to get better? How do I stop them from being depressed? If you can get them to that first appointment with a good evidence-based provider like that, they will take it from there. And so I think that's really clear and when I got to residential, and so I knew I couldn't be at home. It was like an option of like, do you want more help? I did not wanna go to residential. I was terrified. We brought it up one point, probably six months before that. And I was like, please do not make me go. I really do not wanna go there. There being this some strange place where I was no longer living at home, but working on my mental health and I was no longer allowed to do outpatient DBT because it wasn't working and I wasn't staying safe. And I'd already done the intensive outpatient program at the hospital twice, and it hadn't worked. And so there were no other options. And so at that point, my parents had done the research and we can go into like the details after what that was and what they look for in programs and all of that.

But we flew across the country, I packed all my stuff, both my parents went with me, we got to Boston, we got to McLean Hospital in this program called Three East, we did my intake meeting. And so it was probably like around 10 different clinicians, whether it was social workers, psychologists, postdocs, psychiatrists, educators, everyone who was going to be working on this case and working in the continuum. And the first question that they asked me was, do you want to be here?

Ann: Wow.

Sadie: I was like, no, I was like, well, I have to be here. Like, I'm not allowed to go back to my outpatient program. I like that therapist, but they said I can't do it anymore. And no, like I this is the next step, but I don't want to be here. I've already done DBT. It doesn't work for me. Like I tried this twice already. I it's not possible for me to recover. And in the nicest way possible, they were like, that's not how this works, because this is where people go when they don't have any other options. And when they're really struggling and when there's these really intense overwhelming symptoms that are not going away. And so they, I remember one of the doctors said to me, he was like, you are the poster child for this program. You're depressed, you're anxious, and you're a teenage girl. And we have seen hundreds of people just like you. And we have helped hundreds of people just like you no longer be depressed and no longer be anxious, but this isn't going to work unless you want to be here. And you saw the other girls that are here and going to group and getting ready for the day today and they all want to be here. They've all made that decision to do the work and be committed to choosing recovery. And you have to find in your wise mind if you can do that. You have to see the wisdom in this. And so that's a DBT principle where you have like the rationale, which I'm a very logical person. I love that, which is that DBT is really evidence-based when it comes to depression, anxiety, self-harm, and suicidal ideation in teenage girls.

 

And then there was the emotional side of things, which was trusting therapists enough to be vulnerable with them and be truly honest about what I was experiencing. It meant having like a little tiny itty bitty shred of self love or self care, whatever you want to call it, to want a better life for myself. And maybe not believe yet that it was right around the corner, but like maybe like 45 years from now it could be possible because before then that was just like written off as an option like there's no chance and so and then it was like being willing to do the work and actually participating groups and like all those other things was part of seeing the wisdom in it and he also was really clear that that's not how all programs work and a lot of these programs the parents sign on a dotted line and you're there whether you want to be there or not and that scared me I was like I want to be involved in my treatment and I want to have some level of autonomy. And they were really nice. They let me ask my questions. They were so compassionate. And so while I was really anxious about going to residential and staying there, it wasn't like I was scared to be there. And I was like, okay, I want to do this. I want to be here. And they were so understanding. And they, I said, I don't want to be here. What you do doesn't work. And they took it like champs. They were like, we hear this every day. And so I thought about it. Yes, I thought about it. And I started...

I'm residential the next day. And so that was the first time that I think anyone had ever really given me that choice. Like it's here or it's something much worse. Like this is the better option here. And sure, we'd love to have you, but you have to want this. I'd never been in that position to make that choice and been backed into a corner like that. And I'm so lucky that I was backed into that corner instead of a different one. But I mean.

And you asked about like what my parents have done and what they could have done differently. And so that was really the turning point in our relationship and in treatment in general was that time at residential. And so prior to that, there was a lot of things that weren't going well. There was a lot of miscommunication. We weren't able to communicate. I wasn't able to be vulnerable and they weren't really able to validate what I was experiencing. And so I like to tell this story about my dad because I think he had like a really substantial shift in the way that he approached things because it was just very black and white. So before I was sleeping on their floor for like six months on this little pullout mattress, they didn't trust me to be safe and sleep in my own room. So every day they would wake up and get ready for work and to drop my siblings off at school. And I would just like lay there comatose at being like, it's not happening today. No, I will not be going to school. Like I'll be laying here and doing nothing. And my dad would come in and be like, okay, Sadie, it's time to go to school. And I'd be like, nope.

Sadie: And he would be like, okay, Alexa play symphony music on volume 10. And he was like, if I physically make it uncomfortable enough, she has to get up. No one likes an alarm. And I was like, just you watch, like I can listen to this for hours. I just am not getting out of it. Literally. And then, um, he would come up next to me to be like, okay, so you're like, you know, school's really important. If you don't go today, you're going to fall behind on things and you're not going to do well on tests and then you're going to be able to get into high school. Then you can't get into college. Then you can't get a job. And like totally catastrophizing the situation, as if I hadn't already done that in my own head. And so, yeah, he's like, today makes or breaks your future. And I was like, it's broken. I'm staying here for the day, thanks. And so it was just, it was a mess. And then after the way that he would approach things is he would, he didn't have empathy for what I was experiencing because he had never been that depressed. Like he just couldn't even understand. And so how he would try and sympathize is he would ask me on a like number scale how I was feeling that day and if you're like on a scale of one to 10, how anxious are you? How depressed are you? How suicidal are you? And especially in the early days of residential I was like I'm like a 9 out of 10 of the most depressed I've ever felt and for him to understand like that was just my baseline of functioning was being that depressed and that anxious and really not wanting to be here at all was really eye-opening and allowed him to appreciate that and just understand how much pain I was in and then he learned the the skills of validation and creating space for emotion. So we'd say like, I can't understand what you're experiencing, but if you're not getting out of bed, you must be in a lot of pain and you must be going through a lot. And I know I can't change that and I know I can't understand exactly what's happening, but I just want you to know that I see that. And for that, there just to be that acknowledgement. Yeah, after years of not being seen or heard,

Ann: Oh, that’s huge, huge.

Sadie: …and not feeling like anyone even appreciated how much pain I was in. It was really a game changer and then approaching interactions from that perspective going forward as well.

Ann: Yes. Yeah. I mean, that's one of the things I tell parents, you know, you've got to validate those emotions and even if you don't understand them, and it is hard. I know it's hard for people to understand anxiety or depression if you've never felt it. I mean, it's just, it's hard to even explain it unless you've experienced it just to, you know, a teeny bit. So I get that. But even if we don't understand it, we can at least empathize and say you must, like your dad said, you must be feeling really horrible for not to be able to get out of bed. So it's funny, we just did an episode yesterday on school refusal. So was that a big issue for you? Did you stay at home a lot?

Sadie: Yeah. I stayed home a lot or I go to school and be like mom come pick me up. Like that was something that was really a big problem for sure. Yeah.

Ann: Yeah, I did that too. Eighth grade actually, did a lot of “mom come pick me up.” Yep, all the crying and all that good stuff. Yep, remember it. Well, and the thing, way back then, nobody paid any attention to that stuff. It was just like, well, that's just, you know, she's just a girl and it's, you know, she's that age. So nobody really acknowledged what that was or anything else. So you're extremely lucky to have somebody.

Sadie: Yes. Oh yeah, oh yeah, 100%. Yeah. Mm-hmm, to realize it and acknowledge it.

Ann: And I'm assuming, so you stayed at McLean for several months, right? Was it two or three months?

Sadie: Yeah, their typical length of stay was six to eight weeks and I was there for 14. So we were lucky that we were seeing so much progress that we were able to really do a lot of work at that point and not only like get me out of that initial like fog of depression and anxiety, but then work on things like getting up and going somewhere during the day. So I'd go to the IOP program like I was practicing going to school and having a routine and figuring out sleep issues and starting exposure therapy and continuing the DBT skills and working on relationships. So we were able to do a lot of work in that initial period. And then I went to a therapeutic boarding school for 14 months after that.

Ann: Right, right. Well, so get when you went to McLean, I mean, was some of it at least maybe the change of not just change of scenery, but the change in environment and kind of opening your eyes up to what was possible. And I mean, I always when I reflect back about my own son going off to residential treatment, I mean, I look back at all the horrible stuff that was going on in our household and how sad and depressed and anxious and all the arguments and all that stuff. It just seemed that just getting him out of that environment and kind of starting fresh with therapy and with someone else and all that, it seems like that was almost as good as the actual therapy and being in residential itself. Do you see that at all? Maybe that's just from a parent's perspective.

Sadie: Yeah. Yeah, I definitely think it was a big game changer. And I think about more recent appointments of therapy where I'm like, I need to get more movement in, I'm going to work out this many times this week, and I'll come back next week and be like, that's what I was working at. Like, I completely forgot about that. And so you can imagine how hard it is to learn these skills and truly implement them in a lasting way, when you're still in your day to day routine. And there's all these stressors or triggers or you're in that place where you used to function so ineffectively. And so of course it's hard for teens or anyone of any age to make such dramatic changes and how they feel their emotions and how they talk to themselves and how they cope with all these things. And so it definitely, it makes sense why that environmental shift makes such a difference. I also think being able to almost like work independently from my parents on these skills where we separately learn them and then together we're able to implement them was really helpful. So there was a lot of components that did make a difference there, but I mean, I'd also been hospitalized. I'd spent like shorter times away from my family before, and there was never a shift in mood or coping or anything of that nature. So it was really the intensity of what we were doing. It was the team and doing that evidence-based work in that really rigid evidence-based way.

 

Ann: Right. Yeah.

 

Sadie:  and having everyone be really motivated and really engaged in the work that we were doing. And I also think the other thing worth mentioning there is that as a teen, these skills that you learn in residential, it's only worth doing all that work if you actually can implement it at home. And if you can actually implement them in the environment that was so stressful to begin with and that got you into this mental state. And so...at McLean, they were really great about keeping us in different environments.

So Friday, Saturday and Sunday, we'd go on an outing to like the aquarium or we'd go and see a movie. On Friday and Saturday nights, we'd go get ice cream or go out to dinner and then your parents would visit you almost once a week and you would spend the day with them to actually be in person because the skills you use in person are different from a five-minute phone call.

 

Ann: Wow.

Sadie Exactly. You would do visits home and practice using the skills and have check-ins and call the unit and be like, hi, I'm on my home visit. Like, here's how it's going. Here are the skills that I'm using. Yeah. So it was...

 

Ann: Oh wow. That is wonderful. Oh, I wish all programs were like that because they're not, they're just not. I don't know that there is another program like that in the country because most places, the kids don't get to go home and the parents don't spend all day. They come visit for an hour and then you leave and you visit there and then you leave. And something you said too, just reflecting back for a minute on those hospital stays because what maybe 10 days was probably the most you stayed. And a lot of times the most they'll even let you stay is like five to six days. But would you say that the hospital is a good midpoint, I mean, to send someone to the hospital to get, I know it's for stabilization, that's really about all it is, but could you have gone straight to the residential in the state of mind that you were when you ended up in the hospital all those times, do you think?

Sadie: I think it just depends on the-  you only want to do these things when you really need them because going to residential meant taking a Leave of absence from school like I took fall semester or freshman year of high school off because I Physically and mentally couldn't be a student and so you don't want to just be like, oh, I guess I could probably perform a bit better Mentally, let me take six weeks to go live in a mental hospital type of thing and so it's like it's a last resort and especially because girls and the kids that are being admitted to those programs again, it's like you've tried everything and these kids are really struggling suicidal ideation and self-harm and really extreme depression and anxiety and so It definitely could have been introduced earlier and what was interesting about the hospital. It's like you mentioned it's for stability. You only go and are admitted to the hospital if you're a harm to yourself or someone else. That's the only reasons that you should be admitted. They hold you for 72 hours by law because you're not safe to yourself or others. Then once you're safe, you're able to go home or you can check yourself out after those initial or your parents would check you out for the initial 72 hours. So, you can check yourself out after those initial 72 hours. It's meant to take you out of that environment temporarily so you can calm down enough and stabilize those urges. And there's not a lot of therapy going on. You're doing your craft. Someone's talking at you for an hour. You're doing lunchtime. You're listening to an AA meeting, which I was like 13 and had never touched a substance in my life. And I was like, do I have to do this? And they were like, yes. So it's like…It's not treatment. It's literally just stabilizing in a short-term way. And there's not a lot of work done to set up next steps. That really has to be something that's initiated by the teen or the parent. And so it's definitely, what became interesting was that going to the hospital became a really reinforced cycle where I would feel like no one was understanding how much pain I was in. I would be coming to harm myself and then go to the hospital.

Ann: Right.

Sadie: And then I'd be like, oh my gosh, are you okay? We're see you're not doing well, let's express all this care and concern, and that was not a healthy way to get those needs met um and feel validated. Not until a therapist told them, they'd be like, okay we won't visit her for every meal while she's in the hospital, got it. But yeah.

Ann: Right. And your parents didn't realize that. They didn't realize that because, yeah. Yeah. Well, and that's the sad thing about it. And I don't know what else you could do. I mean, and most parents don't know that the hospital is a temporary thing. And when they initiate it, and when these things come up, and they, you know, either child is self-harming or something, you know, they call the eat, they call the hospital or they call the, the police to come get them and take them to the hospital and think, Oh, well, this is going to resolve everything. You know, they're going to be fine now, they're going to fix them and they're going to, you know, do therapy and all the things. And then you're right. There's, you know, I think my son played a lot of Yahtzee or Uno when he was there. I mean, it's basically babysitting behind, you know, locked doors is all it is. So I think it's important for parents to know that, you know, the hospital is not the be all end all. It is not going to resolve things. You have to have a plan.

Sadie: Oh, I did puzzles, I colored Hello Kitty, like that was about what I have to show for that.

Ann: After that hospital, after the hospitalization. And what we were told, I mean, our psychiatrist and psychologists were like, you know, after the hospital, he's got to go to residential. I mean, that's, he just needs to go straight to residential. And I was all freaked out because I didn't have a residential to take him to. It was a couple of weeks in between, so it was really hard. But...

Sadie: Yeah. And that was what I had a couple of peers that also had that and then you're in this really strange in between where you either just stay in the hospital until your bed opens up or you go like, it's a really challenging thing and it speaks to how ineffective our mental health care system currently is. I hope so.

Ann: Oh, so ineffective. Maybe you could do something about that. As a matter of fact, I wanted you to mention that, that you are, where are you at school and what are you doing in school?

Sadie: Yes, I am now a junior at the University of Pennsylvania and I study psychology. Yeah. My bio is definitely wrong. I'm 20 now, so I'm no longer a teen podcaster. I'm having identity issues with that.

Ann: Junior. Oh, I was still thinking sophomore. So you're are you still 19? Are you 20? Okay, so you're 20. All right. Wow. Oh So you're so this is you just don't wait when did you start your junior year? You're just starting your June Okay. So you're just starting your junior and you're majoring in psychology. Did you say?

Sadie: A couple weeks ago. Yeah. Majoring in psychology, I definitely want to go back to that same like clinical setting that I was in and work with teens on that level. And then I think at some point, I'll end up doing something on a more outpatient basis. But I really love the idea of like general education and making resources widely available through social media in some way. So maybe some happy mix between the two.

Ann: Yay. Oh, yay. Do you think you're going to go on, I mean, will you do masters, doctorate, all that? Do you think or do you think you're going to stop at the bachelor's and try to do something unique or what?

Sadie: I want to get my PhD in psychology. It's just a lot of, yeah, it's just a lot of, it's an interesting path. You do a lot of research. There's a lot of like different interesting steps you take to go down that road. So right now that's the plan, what I want to do. Someone last week was like, you have to be a psychiatrist. Like don't be a psychologist. And I was like, I am not going to medical school. Like you don't understand that like that would be my worst nightmare from an academic perspective. So it's like.

Ann: I knew you were going to say that.

Ann: Yeah. Oh. Yeah, no, no. Yeah. And then really, if you ask me, I think what you're talking about is gonna help more people. And I mean, I know psychiatrists, obviously, they do great work, but I mean, literally they're more or less like 15 minutes and here's a script and go try that. And then, you know, tell me if it doesn't work and we'll try something else. That is what's so frustrating. And it is, maybe you'll go into politics with your degree because that's what's so frustrating is we just have getting the qualifications. Yeah.

Sadie: Yeah.

Ann: Too few people to help the adolescent community and really the adult population, but way too few to help the adolescent community and too few people who understand it. And the general education piece I think is so important. It's so important for teens to understand. It's so important for parents to understand. It's important for teachers to understand. Pediatricians who still don't really aren't up on everything and don't know.

 

Sadie: Yeah.

Ann: And you know, they're your first stop. So they need to be more aware and more educated. So I'm gonna keep my fingers crossed that you do some of that with your degree because that would be awesome. Is there anything else you can think of? Any other, you know, tips or, you know, for parents dealing with their teens who may have an issue or anything? And it's okay if there isn't. I'll cut my part out of this.

Sadie: Yeah. Yeah, 100%. Yeah, no, they're definitely. Yeah, no, you're so good. I definitely think that the biggest thing is finding an evidence-based program with qualified individuals, because not all treatment programs are created equal, even if they are both residential, so they're both offer quote unquote, DBT, or they're quote unquote, CBT experts, or they work with kids with depression and anxiety. There's this really interesting web of programs in the United States called the trouble teen industry, which is really under regulated. There's no regulations in most states. There's currently no federal regulation overseeing these programs and they're completely for profit. And so they're not based on what is the literature show works for depression and anxiety. What is the literature show is effective when it comes to interventions. And if this teen is struggling with this specific thing, let's kind of introduce that as an intervention. I think we talked about how the skills are only as good as your ability to implement them in the original environment. And a lot of the times what you see with these other programs is they're a yearlong or you're there for months at a time and then you're referred to a second program and you just never leave the industry and you're no longer equipped to live at home. And like you mentioned, if you never visit your parents, if you never go home and practice these skills, when you quote unquote graduate, how are you supposed to go back home? And be stable and maintain that progress because you've only practiced it in the middle of the woods or the middle of nowhere in whatever state. And so there's a really phenomenal resource, it's a nonprofit called Breaking Code Silence. And they have a ton of resources for parents about what programs work. So what programs and types of interventions work for depression versus anxiety versus eating disorders versus OCD other programs that you can look for that are not, unfortunately a lot of these programs can be abusive and really cause a lot of long-term damage. And so the kind of names that you're looking for is wilderness programs, no research backing those. And a lot of times there's no psychologists on staff. Therapeutic boarding schools have yet to come across any therapeutic boarding schools that are evidence-based or not.

 

Ann: That are actually therapeutic. Yeah.

 

Sadie: Mm-hmm. Some residentials, if they're not tied to a major university or hospital, they're probably not using evidence-based interventions. And then there's a lot of things like conversion therapy or religious programs. A lot of those are not offering evidence-based resources or support. And so, if you're looking for like, what questions do I ask these programs? What do I need to look for to make sure I'm finding my kid a great program? BreakingCodeSilence.org is a really great place to start. And there's so many resources there that, like again, we talked about my parents found the most incredible program at McLean, and then there was no next step available. And so they found the best option possible, which did end up being in the troubled teen industry. And it was a better program. It definitely wasn't anywhere near what some of these kids go through, but it still wasn't evidence-based or effective. There was no psychologists on staff, no psychiatrists. And so not all programs are created equal. And so it's just about finding the right one and then you can trust them to take it there and guide you on how you can be involved and keep the progress going.

Ann: Oh, I'm so glad you said that because I have never heard of breaking code silence and I cannot believe I haven't. I mean, and I have not gone down the whole trouble teen industry road. I really wanted to a couple of years ago and when Parks, got out, my son got out, I really wanted to look into it because we weren't totally thrilled with all the things that happened where he was. And you know, as programs go, it was, you know, better than being at home.

Sadie: Ugh, it's so good. Yeah.

Ann: And, but then we did not bring him straight back. We didn't go straight home out of residential. We couldn't afford therapeutic boarding school. And he only had like six months left of his high school experience at that point. We brought him to my mother's house in Alabama. And so that we would not be going back to the same environment with the same people, with, you know, where we had been all fighting and fussing and all that stuff for two years. So yeah, there is.

Sadie: Yeah.

Ann: Definitely something to be said for a program that lets you step down and experience life like it's going to be, you know, after you leave. I mean, that you would think that's a no brainer, but you know, but most of these places…

Sadie: Totally, totally. And it's also just so, yeah, it just shows the compassion that they're treating their patients with versus some of these other programs. I remember they would be like, okay, staff members, you cannot leave the hospital campus with anything that shows that you're from McLean. Not only is it a HIPAA violation, but there is a respect of letting us go out and get our ice cream and not feel like mental hospital patients versus like...

Ann: Oh, yeah, that's right. Now that's a good point because that does not happen at all the residential's. They all wear their little shirts and their little, yes, I never thought about that. Oh God, the vans, the whole thing, that's right.

 

Sadie: Yes! You can spot them from a mile away. The white vans, you're like, oh, those are the treatment kids. Yeah. It's a little thing.

 

Ann:Oh my God, yes, I never thought about that, but that is a darn good point. You know, but the profit, and it just occurred to me when you were talking about this that, yes, so McLean does not take insurance. It is expensive. All families cannot afford it. The places that do take insurance, they'll do anything to get you there to get that insurance money on a daily basis and try to keep you there as long as possible. Although insurance is very reluctant to do that, but McLean and the places like them that don't take insurance have more of a, they have more buy-in into the actual mental health of the patient because they're being paid is not based on filing insurance. So that does make sense.

 

Sadie: Yes, it's so interesting and the whole business model of these wilderness programs and therapeutic boarding schools is to keep you there. They have no financial incentive to let you graduate. There's no reason for that. Another month means more money whereas McLean has like such a long waiting list of all these families that do want to go and being able to get these patients through and refer to these other resources allows them to continue that. And I also do want to mention that McLean does have scholarships for certain patients and so because they do get investors because they're tied to Harvard or these research universities, they do have the option to provide scholarships or financial support when you do need that, which isn't going to happen at these other for-profit programs.

Ann: Oh, that's good. Yes, yeah, you're absolutely right. Well, that is that's really good to know because I mean, I have looked at McLean myself and I know it is the best in the country and I have told I don't know how many people I mean, I wish that everyone could afford it. But knowing that they have scholarships, that's great. That's great for families to know. And I know there are also programs out there where you can borrow the money and you know, finance the money to send your kids I have seen that too. So all of that is good to know. And I'll tell you, Sadie, one of these days, I think it would be, I think you need to start a really nice big program for adolescents yourself and you know the whole because I mean it's just so needed and we need more people doing it and we need more people with a heart for it that understand what the families go through and what teenagers go through. So I'm going to look for that.

Sadie: That would be so cool. Yeah. Totally. Yeah, totally. And I do think. Yeah, a blessing of COVID is that virtual resources have become a lot more widely accessible. So one of the cool, I love Selena Gomez, we love DBT, she did DBT at McLean actually. And so her makeup brand Rare Beauty, they have this fund, the Rare Impact Fund. And so they not only have McLean clinicians on the board of that overseeing where they donate, but they've also donated back to McLean. And one of the initiatives is so many webinars for parents, for teens, and it's about everything. Like How do I deal with self harm? What do I do if my kid is depressed? What's normal, what's not? And so those are on YouTube and on their website and they bring in all these clinicians from all their different programs to give these speeches and provide these resources for free. And so there's a lot that they do on the public education front, which is really widely accessible. And I'll be honest, I haven't checked the website for probably a year at this point, but I remember seeing at one point that their IOP, which is what I went to during the day after I'd kind of was a little bit more independent at residential, that was moved virtually. So they do have options that thanks to COVID are now more accessible, especially depending on where you're from. But that would definitely be something to recommend as well, checking out.

Ann: Right. Awesome. Yeah, well, we'll get the links to all this stuff. I want to get that. So that's Selena Gomez, that's her makeup, her company that sponsors all that stuff. Okay, so you will get all the links to that and that Breaking Code Silence for sure too. Gosh, Sadie, this has been awesome. I'm so excited that you finally got to come on the podcast and we finally got to get together. So yeah, absolutely. Well, thank you so much and I will see you soon, for sure.

I’m sure you agree that Sadie is quite an impressive young woman, and I can’t wait to see what she does in this field. I’ll have the link to Sadie’s podcast, She Persisted, in the episode description where you’re listening, along with the link to the show notes where you’ll find all the other resources and programs mentioned in the show.

That’s it for Speaking of Teens today. Please come join us in the Speaking of Teens Facebook Group - The link is right there at the very bottom of the show description in your app.

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Speaking of Teens is produced and edited by the best golfer I know - Steve Coleman; researched, written, and hosted by me, Ann Coleman – not a golfer.

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