Evoke's Team Approach to Treatment
Often when I am working with a new family the fact comes up that I (and other therapists at Evoke) spend two days of the week in the field. At this point I can usually hear anxiety and concern in their tone, "You only see my daughter or son for two days? What happens the other five days of the week?"
While this question seems like a challenge to our way of doing things, it’s actually one of my favorites to address because it allows me to talk about one of my favorite parts of the Evoke experience; that there is truly a treatment team.
Let me break it down. Each student has a therapist whose group they are assigned to. Our clinical team has a variety of graduate degrees and backgrounds and each week we meet together to consult, brainstorm ideas, discuss program improvement, and staff cases with each other. I love the varying approaches of our clinical team and hearing how different people address similar concerns is an ongoing source of creativity and checks against stale thinking. One of the (few) positives of Covid is that we are also now doing joint Zoom meetings bimonthly across the Entrada and Cascades locations. Being able to discuss clinical concerns across both branches has been an unexpected and valuable resource that has only added to the joint brainpower of our meetings.
But the key piece of our treatment team that parents are less familiar with are our field staff. These humans are our boots on the ground in terms of clinical support for our students—they are split into two shifts that both live eight days at a time in the backcountry and overlap with each other on Tuesdays. Before going into the field each Tuesday our field staff attend clinical training. They learn about various modalities, styles of intervention, how to facilitate and process different therapeutic concerns, practice program groups, and learn about different relevant clinical issues.
Our staff frequently return for multiple weeks to the same group. This allows students to have some continuity and it also helps us as clinicians utilize what different field staff offer in different ways. Each week, students are assigned a DAPS (a shorthand based off a type of clinical note that over the years has become just another piece of wilderness lingo). A DAPS is a staff member that is a student’s primary support physically and emotionally. This looks like them consistently processing and supporting the student emotionally as well as helping them therapeutic assignments. They take notes about behavior, important pieces of processing, interactions with other students or staff, and other clinically relevant pieces to share with their therapist. Physically, field staff monitor and document any health concerns as well as touch base with our medical team if needed. At the end of the week, each member of staff prepares a clinical report (or Milan report) to present to the student, the clinician, and the incoming staff team about what occurred during the week.
Over time, as we clinicians get to know our staff and the types of student they work well with, the field staff themselves become a part of the intervention. For example, I’ll deliberately pair a certain staff member as a DAPS with a student based on how I want to support and challenge that student throughout the week. Pairing students with certain field staff can bring out interesting clinical issues. Students tend to project onto staff different dynamics from home—at times reacting to a member of staff as they would to their mom or dad, to a sibling, or other important figures in their life. Staff at times can take the brunt of this projection, and are trained to hold space and process through it in a healing way with our clients.
When I refer to the idea that our staff are our clinical boots on the ground, I’m also referring to the powerful and complex processing they do minute-to-minute out in the field. They offer coaching and in-the-moment feedback on interpersonal dynamics, communication styles, maximizing and minimizing emotions, how to effectively use our program tools, pushing deeper into processing, calling out patterns of behavior and how they evolve, processing the metaphors of busting, hiking, chores, packing up belongings, and so much more. They also offer ideas for therapeutic assignments that will allow and challenge the student to press into what’s coming up for them based on their day-to-day experience.
Our staff also contribute clinically by being in session, which is an element that’s unique to Evoke. Sitting in on a therapy session is a rare opportunity in the mental health world, and it’s so valuable to my process with a student to have a staff member who has been living with them to contribute their observations and perspectives on issues we are talking about. When a student is talking about something that happened during a week, it’s often powerful to see the contrast in their perspective with that of their DAPS. Sometimes the student is being much too harsh on themselves and it’s an opportunity to process through their critical lens. Sometimes they are trying to frame the scenario so they look a certain way and it’s an opportunity to process manipulation. Or sometimes we are discussing a pattern at home and the staff can name how that exact pattern played out during the week.
Sitting in on session also gives staff the opportunity to observe how clinicians tailor each session to different clients; through watching the therapeutic process in session staff learn different methods of processing, affirming or challenging a client, and how to tie together parts of the week back to home. Furthermore, not only are staff observing how clinicians tailor each session, but it also allows us to observe them and then provide coaching. As a therapist, having field staff in session allows me to see their style, how they relate to my clients, their therapeutic skills, their insights about their week and process. It also allows me to make it clear to my student that we are working together to support them.
So, while I can understand parents initially being concerned about the amount of face time their child is getting with a therapist, I can’t say enough about the support that our staff provide between my weekly sessions. They are a critical extension of our clinical team in supporting our students and we’re grateful for the incredible work that they do.