Latest / College Is Fine, Everything's Fine / #36 Sadie Sutton Tells You How to Put DBT to Good Use on Campus

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#36 Sadie Sutton Tells You How to Put DBT to Good Use on Campus · College Is Fine, Everything's Fine

all right, so. Some of you probably already know Sadie and some of you might not. So we'll do the introduction, but sure. Her BioD early is gonna speak for itself. So we have Sadie Sutton, who is a 19 year old psychology student at the University of Pennsylvania. And after receiving a year and a half of intensive treatment, beginning at 13 years old and fully recovering from severe depression and anxiety, she was inspired to share her story with fellow teens going through their own personal growth.Sadie, we're so excited to have you on.you so much for having me. I'm so excited to be here.And I think the thing that connected us really is that we are all lovers of, and speakers of D B T,that specific sort of language. I would say that that's something we all have in common, and it turns out that we know some of the people who helped you through that intensive time.which is crazy. It's such a small world and yeah, it's still feels like a smaller community. There's more and more people that now like know of D B T skills or they teach different principles like mindfulness, but like the true D B T community still feels small. And so it's so cool to have all these different touch points and in commonalities.It's really amazing.So I think it's become much more colloquial or common language, right? There are celebrities that have, gone through D B T professional athletes, so it's definitely in the Zeke heist, like everyone's kind of talking about it. But have you found, cuz it's, you know, um, even the word dialectical, I think for people it's like what? Have you found a common way or to kind of explain it to teens and college students so that they can kind of understand in a really snippet, uh, like what is D B T.there's kind of two Es I'll take. One is if people are familiar with the mental health field, I'll say it's kind of like C B T, but it's more skills-based because most people have heard some variation of C B T and like, okay, your thoughts, your behaviors, your emotions are all connected. That cycle's pretty similar.I know Marsha is like, we're not C B T, but even when I took D B T, people would explain it to me that way. So I feel like if you've been within the mental health, Taking that C B T intro is helpful, but for people that have never, ever heard of anything related to D B T, the way I explain it is that if you are living your life effectively, if your mental health is stable, if you feel happy and fulfilled and connected, you're probably doing most of these skills.But when you're struggling with your mental health and when you are. in a difficult spot with getting your emotional needs met. You tend to depart from this effective way of coping and this effective way of using your skills. You get really maladaptive in the way you get your relational and validation needs met. and the way that you're self soothing or you're coping with these intense emotions or urges. And so what DB T does is it like really effectively lays. every way to cope with any type of problem, whether it's most regulation or mindfulness or interpersonal effectiveness, just just tolerance. It's a how-to book to get back to that effective point of functioning.And so, , there's really comp things that seem more complicated, like how to immediately lower your heart rate when you're having a panic attack. And then there's really simple things like, how do I advocate for myself and set a boundary? And so for people that have really great mental health, they're like, why do these things need to be taught?and which is great. Like you are using these skills, you're being effective. And then we just have to remember that sometimes people, again have developed really ineffective ways. You have to get back to that baseline, that that way of functioning effectively. And the the last thing that I always mention is like, people are like, well, like D B T was developed for people that are extremely suicidal or struggling with borderline personality disorder.Like, how does this relate to me? And I'm always like, well, if it's working for. Then it will work for you. So if you're feeling stressed or overwhelmed or you're having issues in your relationships, these will work because they're working for people with much, much more challenging and complex and overwhelming, um, issues. This has developed for people that are really, really, really struggling, and so it will also be effective in what you're navigating as well.Well, and I can tell you that I first became aware of D B T when I was in graduate school and getting trained in it. And you know, when you are considered a D B T therapist, you do need intensive training, which we can kind of go into, but it's really something where you need to buy into these skills yourself.Be willing to practice them. But I remember in grad school thinking like, well damn, I wish I had learned these earlier. Because you know, some people have really great mental health, but there's a lot of reasons for that. There's obviously biologically they just have the right chemistry, right? But there's also that they might have had somebody who, who could model those thingsand maybe they haven't had a stressor that's significant.And so even if so far your life has felt like, oh, kind of on track and I feel like I can manage most. Life throws you curve balls. I think that most therapy programs that do any sort of college prep are really based very heavily on D B T skills. So, I know you mentioned Marsha Lenahan. Marsha, Marsha Lenahan is the person who created D B T. She's like the queen be of the,We love her. Everyone. It's so interesting, like no one's saying this about the person that started C B T or. Psychotherapy. No one's like, oh, we love F Freud. Like no one is doing that. Or like, Skinners the best like, but Marsha, we loved Marsha. And I think part of it that's so cool is that she struggled with all these things that she created a treatment for, and she has so much empathy and compassion and has been exactly where all these people are. the providers that are, are teaching D B T to these newer generations and these newer individuals. Like there's that extreme level of compassion and understanding and embodiment of the principles like you were talking about.It's like maybe you didn't have people model these skills before, but in D B T treatment, Everyone is using them, whether it's your psychiatrist, your therapist, and it's so fun to, to be very immersed in that in this community where everyone is so shockingly effective with regulating their emotions and setting boundaries and in their relationships, it's a really, really cool thing.That doesn't happen in very many places in life, but it's very powerful to see, see modeled, and then be able to implement yourself.Well, and I think Liz and I can both speak to this. She. awesome boss lady. I mean, she was smart from a business perspective too. I think part of the reason we still say her name is she has said this is mine.And that's, that's that. And I think she was really very thoughtful about the way that she did that so it could go back and she could get the credit she deserves.Yeah. And I hear now she's still leading her little mindfulness groups. Now that she's retired, she is still teaching the skills, which is just so, so, so.Well, one of the things when I was getting trained in D B T that I loved was really, this idea of practicing what you preach and like we're all fallible and really I think you can see the adaptations of D B T, and I'm glad you're pointing this out when anyone Googles it. Any of my clients, even friends, when I tell them, they're like, wait, like that's type ofthey're always like, do you have B p d? And I'm like, okay. It's been used for so many other I know. Like that's the first question they get so concerned. And I'm like, well, you should be reassured that I'm doing this treatment because if it's working for this thing that is so challenging for people, then this is, this will workbut it's been adapted now. , it just keeps going down like lower and lower Age-wise, we know it's a primary intervention in elementary schools, middle schools, high schools, , and a prevention model. So I think that the. , any of our listeners listening that really when we think about D B T, they are life skills and they're just not taught as well as math and reading.And hopefully we're trying to affect change within the D B T community that the social and emotional learning that we get at a younger age to hopefully prevent. Some of the mental health outcomes that we're seeing in teenagers and young adults and adults So I'm glad we're on the , same page, all of us that we love. D B Tand we'll put a link in the episode on the New York Times article where Marshall Lenahan talks, , about her, history with mental health issues and the development of D B T. I think it's a good read for anyone that, wants to familiarize themselves more with the origin of D B T.And if anyone needs any last convincing, Selena Gomez does d b t. So you should do D BI know the list, just the list just keep, keeps getting longer.Yeah.but you know, I always like to ask, there are some fan favorites in terms of D B T skills. Okay. And I could even say even with my patients, I love when they finish skills group cuz I like to like survey. I feel like I should get like this like little survey like when everyone graduates from D B T, , like what's their favoritewe did that. We would do a little like, graduation ceremony, at McLean when you would like step down and you would either leave the program or you would go to the like lesson 10 side of the unit and you would say, what's your favorite skill? What have you learned? All of the things. And it was really fun.It was definitely a, a hallmark of the experience to like pick your favorite skill. You'd write it down in the notebook. It was a whole thing.Is your, is your favorite D B T scale the same as it was when you were at McLean?I feel like when I was at McLean, a lot of the skills I was pulling from were really distress tolerance and validation was so huge for me, especially from my parents. And I would say now the skills that I pull from most frequently are more emotional regulations. I love accumulating positives. I'm always using the Please scale.Um, building mastery is a huge one. . But I also feel like the goals that I now set with my skills usage, like this year, I'm like, I wanna do more radical acceptance. I wanna do more loving compassion. Those are the ones that I am kind of leaning more to, more towards. Whereas initially there was more resistance, like, this is stupid.I don't wanna do loving compassion towards people that I hate. Like this is not fun. Um, there. Whereas now it's like, okay, there's so much value to these and I've learned them once. Now it'll be a little bit easier to implement. But yeah, I would definitely say like depending on where you are mentally, the skills that you gravitate towards really reflect that.Liz, what do you practice the most?I think more acceptance based skills. Like I think I, , naturally, even as a therapist, I probably am more on the dialectic of change oriented. Um, I'm always kind of focused on, okay, like what could I do differently to kind of manage my mood more effectively or challenging my thoughts when I notice that they're biased?and I'm really trying to like mindfulness occur, emotion or mindfulness to current thought. How to see if I can change my emotional experience without doing something. So I would say that's like my growth edge. That's like what I'm more mindful of. If I had to say like, my favorite skill to practice probably is opposite,for me.probably oppositeaction. Opposite action in general. I have to use it like all the time. It's like, Liz. Okay. You want to read or watch Netflix? You probably, your wise mind is telling you to do this.You probably should do this, right? Or I don't wanna go outside. It's freezing out. Okay. I'm gonna like bundle up and go outside. Like I, I'm constantly using opposite action.Yeah, I would say it's interesting because so many people, when I'm trying to teach the idea of radical acceptance, which in short just means embracing what's in front of you with open arms, and it's not the same thing as just sucking it up. It's saying, what are the things that I can change? What are the things that I can't?And let me see if I can just accept fully and act towards that acceptance too. What is in front of me. And for me, even though so many people fight against it and I understand that completely, I've found that, that that skill has been the most relieving for me. Cuz it just takes away this idea of constantly fighting things like, you know, I talk about this all the time.I live in the winter, I'm from the south. I mean, I live in the northeast. I'm from the south. I struggle with cold and there's a, just an acceptance that comes from okay, I keep, I would go through months of just fighting it and being frustrated and saying it shouldn't be this way. And what a relief. When I said, okay, this is what it is.What are the things people do who like winter, let me try that more. And it's, it's a huge help, but it can be hard. You have to sort of re like any skill. I have to kind of, I get off track, I get back on track. Um, Sadie, which one do you struggle with the most? Which one that you know is in your toolkit, but you're like, I don't wanna.Yeah. I love what you said about radical acceptance. I feel like as a teen, it's very freeing to realize that you always do have a choice. I feel like I especially was in that mindset of like, I don't have control over anything. Like my parents decide where I'm going to school. Everyone says I have to show up to these certain places at these different times.I have to be in treatment, I have to go to therapy. There was none of this. Like I have a choice in the matter. And to be able to realize like at every single opportunity I could like accept or reject reality and I could choose to be effective or I could like continue to be willful. Like that was so eye-opening to be like, I have control over everything.And yes, I could like lead myself down a path of being extremely ineffective and creating more problems for myself, but I still always have that choice. So that was. Really, really eye-opening and, and changed everything. For me, the hardest skill for me to implement, I mean, opposite action is always hard.I'm always struggling with that one, especially when it's little things like not watching Netflix or getting out of bed. Um, , but I would say I still like on a daily basis, am recommitting to plea skills. I think as a teen, our routines and the things that we're engaging in are not necessarily aligned, like with a balanced sleep schedule or with a really balanced diet, or exercising on a regular basis.And yet having that foundation is. So necessary. So those are things that I'm like constantly being intentional about. Um, wise Mind, I feel like was a skill that seems like it would be more challenging, but because it was something that was like drilled in so early on and you kind of cultivate that ability to understand.What your wise's mind is saying. And then you could just like continue to go back to that. It's not like every time you're like re-finding your wise's mind, it's like, okay, going back to that place that I've already established. But yeah, I would say it's like daily things like please skill, where it's like, I don't wanna do these things.I know that they're good for me. And it's like a more ongoing process rather than just like, I distract for this period of time and then things feel better. I ride the wave of this emotion and then I've moved on. whereas police skill, it's like every moment of every day. You're, you're implementing and you're going back to that foundation?Yeah, they always say that, please, skills, which essentially in short, d B T loves you pneumonic. It's like taking care of your physical health, you know, eating correctly, uh, being active, making sure your sleep is okay, not taking. A lot of substances so that you, or at least recognizing how they infect your mood.So it's essentially healthy daily habits. It's the easiest thing to teach in a class cuz you're like, okay, you should eat, you should sleep. Everyone's like, Uhhuh, Uhhuh, . And we all know it. They're the hardest things to do. It requires a lot of discipline and a lot of boundaries in your environment and things can come up.We'd love to like hear more about, you know, maybe you started this podcast, which we haven't even introduced.You have apodcast, Haiti I do.called Sheep Persisted, and I think. , my understanding was that you felt like there really was a need for. , uh, people to hear from other people their age about mental health advice, experience, normalizing de-stigmatizing this therapy experience. And you probably have gotten some feedback now that the podcast has been up and running for several years about why that's been valuable to listeners.So from your perspective, why do you think it's important for people to hear advice or aspects about your experience from people like they're same age, like what do you think the benefit of that?Totally. I remember going through outpatient therapy, inpatient therapy, residential treatment, and I kept hearing from adults over and over again that like, it will get better, things will change. Some would even say, I've been in your exact position. There was like the logical, like there are tons of studies showing that D B T works and there were other.Adults, again, emotionally being like, I promise this, this will shift. And it was just so hard to connect with them. I think part of that was that I was letting my emotions and my thoughts control me. I just felt like I had no control over anything. And my experience with almost every variable in my life was very negative. So when I, um, went through D B T and when I went through intensive treatment, Really didn't initially believe that it would work, and I really think that's why it didn't.And so when I got to McClain, they were very clear that like you can't just kind of go through the motions. Like that's a very, um, participant based program, like, you have to be willing, you have to accept that you're there and you have to be invested in the process. And so I, for the first time, kind of made that mental shift. and I can trust people to try and help me and I can let them in and I can try and really go through this process. with my wise mind and, and being open to a, to a potential effective outcome. But as I went through this and as I started to see shifts in my, my mood, I was. Initially, so severely depressed, I'd been hospitalized four times. I had all these insane behaviors. I was intensive in intensive treatment for a year and a half, so my mental health got to a place that most teens mental health doesn't get to.And so I was very aware of how bad my mental health it was. And so for that reason I was like, I gotta tell everyone because if this works for me, then it can absolutely work for all of these other teens that are struggling and not doing well. But it hasn't necessarily gotten to this insane, crazy, challenging place I.never wanted anyone to go through emotionally what I did. So I was like, I wanna share everything possible that helped me so that no one else has to suffer the way that I did. Um, and I, a third was really, really aware of how lucky I was with the resources I had access to. And McClain is the, the best adolescent.D B T residential program in the world. They are the most phenomenal, amazing clinicians. DB T is the, the best program. It's the, the primary intervention for adolescents struggling with depression and anxiety. And so there was all of these different ways that I was being supported that most teens don't have access to, whether it's, there's crazy wait list for D B T in their area, whether it's their parents don't believe in mental health, whether they're not able to.Drop everything and take a semester off of school because that's just not feasible in their life. And so I was very aware of how lucky I was and again, how severe my mental health was and how effective these skills could be in a a different setting. And so I wanted to share those. And so it was really a combination of like, this is insane that this actually worked.I have never believed an adult in my life when they said it would get better. So as a teen, I have to tell other teens that it is possible, and I also would felt so lucky. I wanted to share the resources that I had gotten access to and share these skills That really changed my life. And then since I've been doing the podcast, it's really.evolved and become less of like, this is my story, this is what was helpful, and more like, this is the resource I wish I had, like all these conversations about every aspect of mental health, mental health, whether it's grief or anxiety or core beliefs or stress, or productivity. All of these things that were kind of adding to the picture of struggle, but I wasn't having conversations about it and have resources to really dive into, understanding these concepts.And so that's kind of what I've done with she.I think it's such a great, I way of course, of taking something that was really difficult and making some meaning out of it. At this stage have. Spoken. I mean, you're in college now and our, our audience, you know, we hope it's mostly college students at this point. So is there something different about hearing advice from someone like you?Have you had friends or other students at Penn or just friends from home feel like, okay, I can hear this because it's coming from you who you said, I couldn't really connect to someone older than meat certain points. How do you feel like there's a difference when a friend says it versus an.Yeah, it's definitely interesting. I've had a lot of teens. Message me or leave reviews or say that it's been really helpful to hear different tips or that it's really validating or they've been exactly where I was. And so that's been really amazing and fulfilling to hear.And it's something that's also really interesting that I didn't necessarily expect was parents who have no insight into what their teen is going through. And so to hear another.Talk about it and be like, oh my gosh, like this is what's going on inside their head. These are the emotions they're struggling with. This is what they're, they're grappling with on a daily basis and they're not talking to me. But now at least I have some kind of insight of what they might be experiencing.So that's been really cool because I know for me, I didn't talk to my parents at all about what I was struggling with. So to be able to help other families kind of have some line of communication has been really cool. As.I have, I've had some friends listenAwcollege students, teenagers, and a lot of them have said, have said to me, I did not realize how thoughtful this generation was. . I didn'treally, you know, and I'm like, Yeah.I think they were expecting just a bunch of people. I, who knows. But it's been nice to debunk some of those,Yeah, we don't have a good reputation when it comes to mental health that we're like, gen Z is so dramatic. They are like struggling with all of these things. It's like, okay, we, yes, we do struggle a lot. The statistics show that, but I think there's also so much willingness to educate ourselves and try to improve and implement skills and, and feel better.So it's just about kind of walking the walk. Getting that, that across to other people. Like, yes, we're complaining a lot, but we also wanna do somethingright, exactly.So sad. It seems like we're on the same page about, both our podcasts. I think our efforts are to reach a wider audience and to account for people that don't have access to mental health treatments. For a lot of reasons, evidence-based mental healthMm. And it seems like you're this, uh, listen to your podcast.There's some hopefulness that you can kind of give to people that might be in places that you've been in before. What are some other, like myths that you've kind of noticed just about therapy in general that maybe people your age have and through your experience, like what, what happened? That kind of challenge maybe in your own myths that you had about treatment.You know, that now that you're kind of on the other side.Yeah, I think one of the biggest. Pieces or kind of types of resistance I see is like, well, my mental health isn't bad enough, or it's not at that point yet. That's one of the most common things I hear, and every time I hear it I'm like, that's just wrong. Like, nope, this is objectively not how this works. Because I always, whenever I hear those things and with most mental health things, I always check it against physical health. And that's a really effective way to be like, is there stigma here or is there some like personal resistance to asking for help? And so, . If you had like a fractured leg, but it wasn't a broken leg, you wouldn't be like, well, it's not bad enough.Like I don't really need to go to the doctor because all these people have a broken leg and mine's just fractured. Like what? Like that doesn't make sense. And it's the same thing with mental health. If you're like, I'm anxious on a daily basis, but I don't have anxiety so I shouldn't get help like that doesn't make sense.I think if anything, the way to approach that is I'm so lucky that my mental health hasn't gotten to that crazy severe point, and what that means is that these skills will be more effective, it'll be easier to recoverand so I really do feel like we need to shift that narrative of like, oh, my mental health isn't bad enough, so I shouldn't. utilize these resources and it's like, oh, my mental health hasn't gone to a terrible point. So this is the perfect time to intervene. Prevention is amazing. I can absolutely use these skills and prevent myself from suffering more.Beautifully said. I love that we have been known to use the fractured leg versus broken leg idea ourselves.Oh my God, I love it. I love it. But one thing that you have mentioned, if you look at your website or listen to your podcast, you're saying things like evidence-based treatment.Now you know, Liz and I know what you mean, and we know why that's important to say evidence-based therapy versus therapy. That would be, we'd call kind of treatment as usual, and it's not to. , it's bad, right? And people have had a lot of support and helped through it. But how do you explain evidence-based therapies to, to your friends?And then why do you feel like it's important to distinguish the work you promote?So I had a really interesting experience in treatment, which is that the first intensive program I went to was at McLean. It was a Dialectal behavioral therapy program. It was to a t evidence-based. They'd worked with hundreds of teens and seen really effective results. They have highly qualified clinicians that have done research for much of their lives and or like, Fully immersed in this D B T experience and D B T as an intervention is also very evidence-based and broken down in a way where there's not a lot of deviation from what was proven to be effective.Like you learn the skills in a certain order. You address things in therapy in a certain way. There's a hierarchy of what you're talking about, what you're doing. You have a very specific team you're working with. Like there's no question of like, okay, well what are we doing today? Like, , it's very clearly laid out because it's that way that is proven to work, and so that's what you'll implement so that you can get the results that D B T promises.So that initial program at McClean through East, it changed my life. It saved my life. I started to no longer be depressed. I started to be able to cope with my anxiety. I was no longer suicidal. When I lefted, I had a foundation of a relationship with my parents, like all of these amazing, insane, crazy shifts took place.And then after McClean, I went to a therapeutic boarding school for 14 months, and it was a really different experience to be in an evidence-based program versus just a a treatment program. And what's really unique about teens specifically is that there is a lot of programs that are not evidence based.I, you guys would know more accurately on whether this is true, but I feel like this doesn't happen as much in adult treatment. Because they're not as vulnerable, a vulnerable as a population with teens, you're not consenting for yourself. Your parents are consenting for you. And so it's a really different experience because you're not able to do all this research for yourself.You're not the one making the decisions, someone else making a recommendation to your parents and then them signing off on your behalf. And so, The therapeutic boarding school that I went to, while it was effective to maintain the progress that I'd made, kind of have that stability, have that long period of time to practice my skills and get good at them before I moved home and went back to that original environment.There were a lot of things that were not as effective. It wasn't an evidence-based intervention.It was just kind of like, what are we gonna talk about this week? And then there was other things also that are, Common in this thing called the Trouble Teen Industry, which is just a nickname for these programs that are not evidence-based and are not regulated as much. So not talking to your parents at all or maybe talking to them only once a week.Um, really no expected length of stay or timeline on how long you would be in treatment for. Um, needing to meet qualifiers of not being depressed or not being anxious to graduate and leave the program, and really questionable education and, and classes that are not at the, the level that they should be at, um, because it's not being regulated.So all of these different things, um, that take place at these programs, but when you get down to. , you're going there for mental health treatment, and so when there are no psychologists on campus, when the psychiatrist is only meeting with kids every three months, all of these things are red flags because at the end of the day, what you're going for is, is evidence-based effective treatment.You want some level of guarantee that things will shift and things will work.And so that's kind of what differentiates evidence-based treatment and non evidence-based treatment, um, kind of from my experience.I love Sadie that, you know, when I'm hearing you talk about it. Um, although, you know, teens don't necessarily, they're not in the driver's seat around their therapeutic, choices, I still think there is a room for them to be more educated andadvocate for themselves. You know, I think parents I've worked with.You know, tons of parents that are navigating more intensive kind of treatments, and they're lost too. They're kind of shooting arrows in the dark. They'relooking for so unfortunate is that they are also very vulnerable and these different programs are like, yep, we can solve this. And the parents aren't like, okay, how? Like, what is the fi You're not gonna go read 10 different studies about like, why this is gonna work. Like if I, as I, as a parent, I can't, I'm not actually a parent.So I'm like, I probably wouldn't do that. I'm sure if I was a parent I would, but like, I'm like, that sounds like a lot of work. Like that's like really dense material to get through.right. When you're in a crisis and a traumatic period of time. But I think like now there is this possibility, like you're saying, like look research. Right? Kind of look into it, understand more like what your options are. And like Sarah said earlier, I'm always amazed. Some different types of therapies work for different people.And I hope, and it seems like through your podcast, more teens and young adults can advocate and research for themselves and maybe can communicate with their parents or other kind of adults in their life that are, that are assisting them in the decision about their treatment.And.One thing I think is really helpful, especially cuz sometimes we're talking here in some part about bigger intensive programs, but what about the person who finally, Sadie says to you, okay, I'm willing to. Go to therapy, even though I only have this fracture , you know, I always am encouraging everybody, including the teen who I'm seeing at the parents are calling me.I'm saying like, let them vet me. Here's some questions that they can feel really free to ask. Here's how I do treatment. This is the method that I use. This is how I conceptualize how I'm gonna get them better. And typically when they're coming into my therapy session, after they've said, okay, we're ready to go, you're gonna hear me ask pretty quickly, okay, how are we gonna know when your, when your therapy is done?And if they're not asking those questions or if they're not able to conceptualize, here's how I see the issue, here's what we're gonna actively work on. We both understand the goal. We're gonna work on that together. Then I'd wanna know more information. They might have a different rationale, a different methodology, but they should be able to explain that pretty quickly.Mm-hmm. . Mm-hmm. a hundred percent. And I think it's also. addressing like what a reasonable outcome is. Because if you never have struggled with your mental health before, you're not like even like, okay, what is the result I'm looking for? So I think that's something really tough for parents is if a treatment, a program has all these graphs on their website and they're like, a hundred percent of our participants leave no longer depressed.And it's like, no, you don't let your participants leave unless they no longer meet the criteria for being depressed. It's like, we gotta check that. And so many people live with depression on a daily. You can function through life in a really effective way and get resources on an outpatient basis and continue to work through towards that goal of recovery without being in a program 24 7 like that is so possible and in a lot of ways probably more effective because you're implementing and using the skills and the real environment that you'll have to independently.And so it's really like understanding, okay, like what is the outcome that I'm looking for? Because like that's also another different thing you would never even be aware of. And so for any teens or parents like one Google search, just look up the program name. in breaking code silence or program name trouble teen industry. And very quickly you'll see people being like, this was such a terrible experience. And I think what's also interesting is like, as teens. There's also this element of like when you leave these negative reviews, like, oh, they didn't accept it.They didn't wanna get better. They're just still struggling. And so we have to remember, like a lot of these kids that are writing about these experiences, they were there for like over a year. And if you did not see shifts or changes or generally positive outlook after really truly investing in something for over a year.Especially on that level of intensity, like all day, every day. It's probably not necessarily a reflection of the kid, especially if multiple kids are like, this really was not effective.Yeah. We, no, it's, it's important to pay attention to that and, and we can also share in our episode notes some of these resources that you're mentioning for sure.a hundred percent. How do you generalize your skills to your environment and college? Um, you know, it's the ultimate dialectic I think of It's like time of your life.So much independence and autonomy. It's really hard. So what are some of the things, Sadie, that you are stressful in college for you, even somebody, a skills master over there, you and your friends. What are the things that you guys are struggling with?, I mean, it's so hard. It's such a huge transitional period. I think relationally. It's really, really difficult because you're likely not going into college with a lot of people that you know, and you're building a whole new community from the ground up. You're building new best friends, you're building new acquaintances, you're building new teachers that you can lean on for support.Like all of these relationships have to be completely. restructured from the ground up. And that's really challenging because it's also such a big transition. Like you wanna be able to lean on relationships. So it's like you're building the relationships and trying to lean on people at the same time, which is really challenging. I would say on a secondary level, which for some people, depending on their priorities, becomes their, their biggest challenge is like the stress of school and the amount of work that you have to do and the pressure of performing, especially with your peers.I think what's interesting about high school is that everyone has to be there. Like legally you gotta graduate. Like that's just kind of how it works. Whereas in college, you now have all of these really driven. Academically oriented kids, and it's no longer like, okay, if you do the work, you perform really well.And so I think for a lot of people, you have to kind of reevaluate your expectations, especially if a lot of your identity has been impacted by that academic performance. Um, or even your extracurricular curriculars in high school. Like if you're like the kid, like, oh, like my identity is these clubs that I'm in.You probably wanna have the same clubs at college. So what are your other interests? How do you spend your time? So that's another thing. I would say that, that identity shift and understanding where you fit in the context of your life, especially as you're comparing yourself to other people. But I would say really just on a day-to-day basis, there's a lot of stress with getting everything done, maintaining that level of productivity and output.Classes are really hard and the semester can feel really, really long, especially when you're having exams every single week. And it feels like there's a lot writing on every exam. Like every exam is like, oh, it's 50% of your final grade, and then the next week it's like this one, 60%. It's crazy. So, um, there's just a lot of stress and pressure with, with what you're expected to output, which means that you just have to do more to establish a, a healthy foundation for your mental health and, and habits that you can lean.lean on and kind of go into autopilot almost rather than on a daily basis, think, okay, how am gonna cope with this? It's like, no, you have your routine of getting enough sleep, having a balanced diet, interacting with these people that make you feel good, getting these things done for your classes on a recurring basis.And then you also deal with it added stress of like an exam or, or conflict with a roommate, whatever it is.I you are somebody who's out there with knowledge. We also know that there's so many people that we see in our office who, you know, they've learned a skill and so they've shared it with a friend. In fact, Part of the reason we started this podcast is we wanted to help the people who were helping their friends by saying, Hey, listen to this podcast.You know, I gotta go study. So, you know, when you have had an experience and you've shared it with others, oftentimes what happens is people will come to you for advice, or they're sh, they'll perhaps share more with you than they would someone else. Cuz I know you've been through it. How do you set boundaries around helping other people and then trying to.Also give yourself time to study. Have fun, reflect, eat.Yeah, so I feel like people will treat you the way that you show up in your relationships, and for a long time when I was initially struggling with my mental health, Whether it was like a coping skill or a way to deflect. I was like, I am the treatment coordinator for all of my friends. Like everyone was like suicidally depressed, and I was like, crisis manager coming in.You will use this skill. I'll get you through this panic attack. I'll call the therapist. I'll get the parents involved, like, let's go to the guidance counselor right now. It was a disaster. It was so incredibly stressful. It was so ineffective. I tell every single. , please do not ever do that. It is the worst thing you could possibly do because you are not equipped to be able to support your friend effectively.You can instead kind of shift the way that you show up in relationships. So if you are showing up and being like, oh my gosh, tell me all the graphic details about this insane mental health crisis you're having. If that's how you're showing up, that is exactly how they were will interact with you. But for me, when I left Treat, and I was very aware of like, I'm no longer defined by these mental health challenges, this isn't what I'm thinking about. 24 7 all day every. . So I'd like to have relationships that reflect that.And so when I would introduce myself or make new friends, I'd be like, hi, I'm Sadie. Like I, um, I love my dogs. I like to snowboard. Like this is what I wanna do for school, blah, blah, blah, blah, blah. Like things that were not related to my mental health. And so, It's interesting. Even though I am having these mental health conversations on a daily basis and I'm constantly creating content and my like friends are liking all the post on social media, no one is coming to me and being like, oh, this is this insane problem I'm having with this person.Of course, my friends come and talk to me when they're stressed or they're feeling overwhelmed. I like to think I'm a good validator and I implement all my skills, but I. Set myself up in a position where it's like, I'm your person to come through, come to when, when you're struggling in a really big way.And that's been really, really effective for my own mental health. And I also have really strong boundaries around that because I know how bad it was for me to be everyone's crisis coordinator and treatment coordinator and take on all this. And so, . If someone ever were to mention those kinds of things, I would be like, I am so here for you. Like these are the resources, but like, you can't talk to me about that. Like, this is like from my own experience, like it's not, it's not effective for me and I won't be able to support you as a friend.Like we won't be able to have a healthy relationship if relationship at all. If I'm acting as your therapist, and I think the last thing anyone wants to do is like lose a friend because friends can be so effective in supporting you in your mental health. They can be a. a break from what you're experiencing.They can be an amazing distraction. And so if you kind of laid out that way and not like a, if you talk to me about this, I won't be your friend, but like, I wanna be your friend the way that I have been, which is that we, we laugh together. We have fun together. We, we study together, we make sure we get our work done.And that's how I can support you. And I'm not gonna now step into this role of being your full-time therapist because that's not what works for us. . So it's a process of setting boundaries, but also really showing up in your relationships and the way that you wanna be treated, which is so easy to do. Oh, that's, the proof is in the pudding too. And I love that yousaid, you know, you learned by having to go through it to set a boundary. And a lot of times, you know, that's what happens is you do it, you realizewhat happened, and then you have to work your way back. But you cannot set yourself on fire to keep others warm. And a lot of people, I think, are in the position of feeling like they're, they're sort of in the flames. So, well, good luck with all of it.Thank you. Thank you. I appreciate it.All that. Um, we have loved having you. I know we both know you're so busy. So this has been fantastic.I'm glad weThank you.