Scott Sells, PH.D., MSW, LCSW, LMFT - Guest
Scott Sells, PhD, MSW, LCSW, LMFT, is former tenured Professor of Social Work, Savannah State University, Savannah, GA and Associate Professor at UNLV in Las Vegas, NV. He is the author of three best-selling books, Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide (1998), Parenting Your Out-of-Control Teenager: 7 Steps to Reestablish Authority and Reclaim Love (2001), and Treating the Traumatized Child: A Step-by-Step Family Systems Approach (Springer, 2017). Scott is currently the founder and model developer of an evidence based model known as the Parenting with Love and Logic and the Family Systems Trauma Model that are being used by both juvenile justice and child welfare in over 14 states and in Europe.  He provides training and resources through the Family Trauma Institute, which can be found at familytrauma.com

W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations.  He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy.  The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning.  This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy.  Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners.

Keith Sutton, PsyD: (00:22)
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. Today I'll be speaking with Scott Sells, PhD, MSW, LCSW, LMFT, who is a former tenured professor of social work at Savannah State University, Savannah Georgia, and associate professor at UNLV in Las Vegas, Nevada. He's the author of three bestselling books, treating The Tough Adolescent, A Family-Based Step-by-Step Guide, parenting Your Out of Control Teenager, seven Steps to Reestablishing Authority and Reclaim Love and Treating The Traumatized Child, A Step-by-Step Family Systems Approach. Scott is currently the founder and model developer of an evidence-based model, known as Parenting With Love and Logic, and the Family Systems Trauma Model that are being used in both juvenile justice and child welfare in over 14 states and in Europe. He provides training and resources through the Family Trauma Institute, which can be found at familytrauma.com. Let's listen to the interview. Okay. Well, hi Scott. Thanks for joining us.

Scott Sells, PhD, MSW, LCSW, LMFT: (01:37)
Thank you for having me, Keith. I'm looking forward to this.

Keith Sutton, PsyD: (01:40)
Yeah. So Scott, gosh, I am familiar with your work for a long time now. My old supervisor, my internship and postdoc, recommended your book treating the Tough Adolescent and Parenting Your Out of Control Team way back. I don't remember what it was, 2006 or so. I just loved the book and just had such great kind of tips and techniques and a process to it. Then later you came out in a training Jim Keim and I were doing, and we got to a chance to chat. Then your book came out about working with families where one of the kids has trauma and just really enjoy that somebody is actually doing the work in that area because there is a lack of research, a lot of lack of writing approaches to work with children, adolescents with families in the family system, and the healing. Then we brought you out for the Association of Family Therapists Northern California Conference. Really excited to have you here today, and I want to hear about all the work. I always like to start off with folks by hearing about your story about how you got to doing and what you're doing and what your evolution of your thinking was.

Scott Sells, PhD, MSW, LCSW, LMFT: (02:51)
Well, it started on the first day of the job after my master's program in social work. I remember working at, they're gone now, but the old charter hospital system. I was the family therapist on the children's unit, and I can remember the first day on the job, having kids and families come in that had severe emotional and behavioral problems and did not know what to do. I was a deer in headlights. I can remember when one of my first kids starts swearing at the parent, the parent says to the kid, ‘If you say one more peep outta your mouth, you're grounded for a month!’ The kid says, peep again. ‘Now it's three months!’ And then before I could even blink, I lost control of the session. And so I'd come home from work with a lot of cognitive dissonance, like, ‘What am I doing?’And so I actually went back to get my PhD at Florida State, but the reason I did that is because it was an interdivisional program. And they had one-way mirrors. And I was scared to do it, but it finally got me to the point where people could watch me deliver it, the timing. And I finally got theory. And so long story short, I saw Charles Fishman, who wrote the book Family Therapy Techniques with Minuchin. And I was young and naive, and I just came up to him and said, I'm a Ph.D. student at Florida State, could I do an internship with you? But I thought he was going to say no, or ‘Yeah, like, maybe we'll talk’. But he invited me to his house. He interviewed me and for the whole summer, I got to stay and work with him. And he took me down to his basement and it was wall-to-wall boxes of videotapes. He and Minuchin had worked with in Philadelphia Child Guidance Center. He said, ‘We got this new technology from Sony where I want you to edit all these tapes for my workshops’. And so I was in his basement and watching tape after tape after tape to try to clip out moments of change. And it got me interested in this idea that it wasn't all a mystery. That there were patterns. And then I got ahold of a book by Greenberg and Rice called Patterns of Change, which actually shows you the method of process analysis of videotapes. And, gave me a step, a roadmap. And then through a mutual friend, I met Jay Haley. And he was gracious enough to say, I'm ready to go to the next level. I want to really take your work and put together a model. And he was really familiar with his early work with cybernetics, and how he would actually go to drive into work with Minuchin every day to the Philadelphia Child Guidance Center. And they learned from the families how to develop structural strategic. So he was familiar with it, but it never had anybody approach him with a formal process.

Keith Sutton, PsyD: (06:34)
Yeah.

Scott Sells, PhD, MSW, LCSW, LMFT: (06:35)
So that's how it all started, with me watching videotapes like an anthropologist and trying to find out artifacts and secrets of family therapy. So it was a fascinating process. 

Keith Sutton, PsyD: (06:51)
Yeah. Taking what they were doing and then looking for the themes and then creating something that might be replicable or something that you could help others learn.

Scott Sells, PhD, MSW, LCSW, LMFT: (07:01)
Yeah. The micro steps, that was the key. In the book by Greenberg or Rice, they said that most models or theories have generalized principles but they don't go into the micro steps. And for me, when I went to read Problem Solving Therapy by Haley, I read it in one night because it was the first book that actually had Step One - Social Stage. Here's what you do, Step Two, Problem Solving stage, I was like, if I could go even further with this, what would it be like for therapists like me to have scripts? Micro steps. And at first, I was like, ‘Well this will encroach on my style, I won't be as artistic.’ But Haley said, no, it's a paradox. You have to be structured first to be spontaneous. And he said, ‘You know, it's like the Karate Kid episode where Miyagi says to Danielson, paint the fence, sand the fence.’ And he is just like, ‘Why am I doing this?’ And then he finally realizes that when Miyagi then says, ‘Paint the fence’, and he gives him a great karate move. He does it unconsciously. Because he has been painting the fence for so long. And Fishman said  ‘You will hear the voices of therapy’. And I said, ‘What does that mean?’ He says, ‘When you are structured, you'll know what to do, and you'll be spontaneous’. And so that just stuck with me, and I've told that story to a lot of people who are like, ‘I don't know, Scott if I want to read your books and do your micro-steps’. I said, ‘Well, when you ride a bike, don't you have training wheels first? And when you shift the gears of your car, when you have manual, you first have to go first, second, third, fourth, and then pretty soon you just do it without even thinking.’ So that's why I think we need family therapy. I read a research article that said that all this research was outcome research, or who won? Did cognitive behavioral beat out another model? They said in the research, ‘well, we have to understand the question of how does it work first and that the basic concepts of family therapy haven't even really been operationalized’. So that just struck a chord in me that we have to answer the question ‘How does it work?’ before we can research ‘Does it work?’ And so we skipped that step in graduate school, we want to go right to numbers, which are important, but we have to do process research first. 

Keith Sutton, PsyD: (10:00)
So I think that's such an important piece too. I think that with cognitive behavioral therapy, you can buy a 120-page book that has the steps of Session One, do this, Session Two, do this, scripts, and so on. So it's a little bit easier to pick up than say maybe family therapy where there's theory and there's some concepts and so on. And then you're expected to take that and just kind of go for it. But what you've done in that process research is looking at those steps and stages. And particularly like you said, those micro steps, which when I'm talking to people about learning evidence-based treatments or following a protocol or something, oftentimes people follow it a few times first and then begin to improvise from there and work more from a principle-driven model. And I think it's like cooking. You might follow the recipe a couple of times, but once you've got the recipe down, then you can start to improvise and try different things and use this with something else.

Scott Sells, PhD, MSW, LCSW, LMFT: (10:59)
Exactly! And it mirrors Hollywood movie-making. Because the greatest movies go through scripts, scenes, and storyboards. And then the actors get in there like Meryl Streep and improvise along the way, but there's some structure to it. There's a clear beginning and clear middle and a clear end. And you know that you're in a good movie where the time just goes by. And that's a parallel process to family therapy where the family feels safe and secure with the guardrails. They're providing feedback loops to you that they're into this, and then you're free to improvise because you now know where you're going with the next transitional statement to the next technique. And it flows versus flies by the seat of your pants.

Keith Sutton, PsyD: (11:54)
But I think the therapists feel more confident because they know where they are on the map and where they're going, rather than feeling like every day they're kind of trying to figure out what's next or what to do.

Scott Sells, PhD, MSW, LCSW, LMFT: (12:05)
Exactly. You can lower that anxiety and just sit back and enjoy the ride.

Keith Sutton, PsyD: (12:10)
Yeah. So tell me, you talked with Hailey about trying to kind of operationalize or work on these processes. Where did it go from there? How did we get from there to the PLL work?

Scott Sells, PhD, MSW, LCSW, LMFT: (12:23)
Well then, once I had done an iterative process where I looked at an idealized model based on the research of what should happen. Then I looked at Haley's videotapes with Neil Schiff, who was the therapist. Neil and Haley worked on weekends and they videotaped everything. And Neil is the protege of Haley, who said he was the greatest therapist he ever worked with. So when you watch people at a master's level do great work, then you really get some of the jewels of the crown. But then I had to go and I worked at UNLV as a professor. Then I had to field test the model. So where it went from there, is I got a lot of graduate students with me. We built a one-way mirror and we started interviewing the clients to say, ‘is what we're seeing working in terms of the steps, the sequencing?’ And sometimes they were out of order, like one body of clients would say, ‘You're introducing nurturance and attachment way too early before we first get structure’. So that resulted in the first book Treating the Tough Adolescent. In chapter 13 of the book, I fought with the publisher to write out the process outcome research study so that people could actually thread from beginning to end the evolution of research and clinical practice together. Which I think is a great contribution. But often most people don't know about it. But, Doug Sprinkle said, we need to map out how the clinician and researcher aren't on two separate planets, but they're together so that research isn't scary, it's very user-friendly. After that first book, it really took off because people were so hungry for the step-by-step. And then it gave me the opportunity to do a lot of outcome research, to answer the question, ‘Does it work?’ And that evolved to Parenting with Love and Limits, where I had seen what Scott Hanger was doing, and Jim Alexander. They were taking some of the concepts of family therapy and putting together an evidence-based system of care. And where the defining line of that is, with their work with multi-systemic therapy and functional family therapy, you then went to the next level, you manualized your work. But then you had to figure out how to do fidelity checks, to make sure that people were using it with model adherence. Anybody can say that they're using the model correctly, but if you don't have any regular clinical check-ins, they may not even know they're not delivering it right. Because we're one of the only fields where I can get my degree, go behind closed doors, and totally mess up the delivery and not even know it. And mess up the client! Where you would never see that in the medical field. I mean, could you imagine taking your child in and talking to the brain surgeon? So the brain surgeon says to you, nobody's ever watched me work, but trust me. So that's where it led me to parenting with level limits because I wanted to ensure that people were doing this life's work with fidelity. And so then Haley gave me the idea that we needed to do videotaped supervision, and the technology was just emerging through one of the first platforms, WebEx, where people could, you could edit the tapes. You could develop a video supervision manual where you could, on a Likert scale, evaluate the tapes on content and process. And you could develop a computerized dashboard to look at some of the pre and post-measures and utilize that in supervision. It was really amazing to start to see the therapists come alive where they now had a manualized micro-step model with videotaped supervision with a computerized dashboard. And their skill level was shooting up quickly and you didn't have to go to a university with a one-way mirror. You could do it over technology like a flywheel. And so for me, I did it. I quit my job at the university to go for it because it was like I had achieved my dream. I was in Savannah, Georgia at Savannah State University. I had tenure, I was a full professor. I was just doing speaking, and I was like, ‘I'm coasting here, this is great’. And I was like, no, I'm only reaching 10 to 15 master's students in my classroom. What if I could reach thousands? And so I sold my property that I had bought off my first book, because I didn't have the money for a bank loan, and, my family was like, ‘Are you nuts? You've got the American Dream, tenure and full professor’. And I'm like, ‘No, if I don't try to do this, I'll never do it’. Because before Haley died, he took me out to dinner, and we're up at a restaurant overlooking the ocean in La Jolla, California. He turns to me with tears in his eyes and he says, ‘Scott, we did it wrong’. I said, ‘What do you mean?’ He says ‘We were like rock stars, we had all this momentum, but we didn't do our research, like publish it. And we had become an endangered species.’

Keith Sutton, PsyD: (18:45)
Mm-Hmm. Family therapy,

Scott Sells, PhD, MSW, LCSW, LMFT: (18:46)
Family therapy is on the endangered species list. And he, ‘Will you carry the torch?’ And he's right because, in the early eighties and even early nineties, I'd say, ‘How many in the audience know who Jay Haley is? Salvadore Minuchin?’ like in the eighties, 90% of the hands go up. Now if you go out to a workshop and you say, how many people know Haley and Minuchin's work, you might get 10%. And that's just one decade. Yeah. So I felt like I had to do this, for the betterment and not just for my own coasting.

Keith Sutton, PsyD: (19:28)
Yeah. Yeah. Definitely. And so can you talk a little bit about the PLL model and an example of micro steps? When I was a brand new clinician just starting on my internship, it was so helpful to have. To actually have ideas of the specific things that you could be doing in session. Can you talk about PLL model?

Scott Sells, PhD, MSW, LCSW, LMFT: (19:54)
Yeah. The term Parenting with Love and Limits came from Jim's work. Jim Keim’s work around the soft side and hard side of hierarchy. You have to have a balance of love and limits. Because oftentimes the symptoms are a byproduct of an upside-down hierarchy. The child just basically controls the mood of the whole household. And so parenting with level limits started out, where I got the idea from research and talking to families that good therapy was both psychoeducation and application. And so I started looking at work around group therapy. I said, what if you could take the principles of the model from treating the tough adolescent and put together what came to be a six-week parenting group? This was based on core skills that were missing. Because families we found would do well if they had the tools and skills from generational trauma. So what Haley would emphasize is that you have to give the families the tools. They're not going to wake up one day by osmosis and say, ‘Gee, I need to be more nurturing with my kid’. They just don't have those tools. So the group came about where it would have six core skills. The first class was having the family vent their 10,000 defeats and discover why kids misbehave. The second one was button pushing, how to stop that. The third skill set was how to write an ironclad contract without loopholes that was actually written. The fourth class was teaching them how to do troubleshooting and dress rehearsals. And the fifth and sixth classes were on how to restore nurturance. And that was working great. And then we did family therapy as an afterthought. And the families were like, ‘we don't want to, we'll take the path to least resistance. We'll just do the group!’ The problem is that they wouldn't know how to take the tools home, customize them like a cocktail. Now timing and sequencing, they had to have a coach. And so then we made it where it was standard operating practice where they got a participation, graduation agreement, from the get-go, that said that this was a package deal. They would do one of the groups and they would immediately be going into coaching or family therapy whether it be a home-based or in the office. And so that was a cocktail.

Keith Sutton, PsyD: (22:46)
Oh. So it's like that, it was like a, the groups were like a primer for the family therapy.

Scott Sells, PhD, MSW, LCSW, LMFT: (22:50)
They were a primer. And then they helped each other. So what happened was is they would be taking each other out to coffee. They would be helping one another out. It normalized everything. They were like, ‘we're not alone’. And so I have not seen many models that blend group therapy and family therapy together as a continuum of care. They're either bifurcated or it's really not clear what the touch points are. And so that's what was very unique, and then of course after a while, a decade goes by and I start to see that, when you stop the extreme behaviors the trauma sometimes would heal on its own, but a lot of times the trauma would come up to the surface, like, uncorking a bottle. And then I moved into trauma work, and have give step-by-step for that from a systems point of view and not just do behavioral work, with, you know, issues like conduct disorders, opposition defiant disorders. They're often a byproduct of the trauma. So Parenting with Love Limits became an evidence-based system of care, where it was not just the manualization of group and family therapy together, but also the videotaped supervision and the computerized dashboard, which allows you to see in real time things like if the therapist has high attrition rates, whether the family is really going off the charts on the child behavioral checklist, whether graduation rates are tanking, where they're going up. And then we can correlate with the videotape of you delivering this part of the model because we're suspicious from the dashboard that you're weak in this area. We don't say that, but we look at and try to self-correct it quickly. Because the therapist most of the time doesn't even know they're doing it. 

Keith Sutton, PsyD: (25:10)
Yeah. They don't even realize maybe that things are going off track there.

Scott Sells, PhD, MSW, LCSW, LMFT: (25:13)
Yeah. Yep. So that's how Parenting with Love and Limits was born and really, I think had a unique contribution in that way. 

Keith Sutton, PsyD: (25:22)
Yeah, because a lot of Treating the Tough Adolescent of course was a focus on the acting out and the running away and the drugs, and alcohol. And that's where the book comes in so well because it has so many different things one could do and lots of really great creative strategic interventions like the Gandhi intervention, and these kind of things where the family goes on strike and, and all these kind of different aspects, or the parents showing up to the classroom when the kids are skipping school to take notes for them in their curlers or nightgown or things like that. There were all these really interesting ways of addressing some of these issues of things that were out of control. But then yeah, like you're saying that there was then the nurturance and such. But I think it, it seems like in the next work you did with trauma, you kind of took that even further.

Scott Sells, PhD, MSW, LCSW, LMFT: (26:20)
Yeah. It was interesting because in my first book, you'll see like the Gandhi consequences are like shocking the pool with chlorine. But when you add the emotional warmups and the trauma piece, you don't have to go that extreme. Here's a concrete example. You'll have a kid that's extremely disrespectful, and a classic behavioral contract will be like, ‘okay, we're going to set limits, we're going to tie it to your currency, which may be your iPhone.’ And it's very hierarchical. But when you add the trauma piece, you can do an emotional warmup where you can do a positive child report. So you get the parents to give their kid a certificate every day for catching them doing something (good). And I want to show you through role plays, how to do it in a soothing way, as Jim says, in soothing sequences of communication. And so the kid just laps it up and the parents start to see that rules without relationships lead to rebellion, and that, when you can be soft with the love and limits going on at the same time then you don't have to use these extreme techniques to shock the pool. So, you know, obviously, in my early years, I had the more strategic creative directives, like if the kid doesn't go to school, go to school with him, sit in the classroom, and you still may have to do that, but when you're also doing what's called hybrid limits and trauma playbooks where it clarifies everybody's roles to be nurturing. It's an anti-venom to trauma. And a child is so bone dry, metaphorically the soil is bone dry. That when you put an eye dropper of water, it spreads like wildfire. And so the trauma pieces really kicked the more structural piece into another gear. So that's been kind of cool to see.

Keith Sutton, PsyD: (28:49)
Well, I'm wondering too, I was just rereading some of the book and one of the case examples you were talking about where learned from the “failures”, right? When oftentimes there might have been the first order change, things got better, the acting out decreased, but then there wasn't really the second order change, those shifts in roles that change within the system and so result in relapses later. It was interesting because one of the examples you brought up was particularly where the trauma was not necessarily with the child, but was with one of the parents and had never been discussed with her husband. It was a heterosexual couple and that part of what was happening as the daughter was getting better, as we know in systems,  then the attention was taken off of the couple and the trauma went back onto it. And all that stuff started coming up and the daughter was feeling like things were supposed to get better if I got better. And, she was beginning to relapse because things were actually getting worse. Can you talk a little bit about that? Because it sounds like it's not only the trauma in the child but also the trauma in the system.

Scott Sells, PhD, MSW, LCSW, LMFT: (30:03)
Yeah. I mean, that, that case is at the very beginning of the book treating the traumatized child. And that was a failure in that the family was doing great until the daughter got better. And in many cases, Haley calls this the function of the symptom, and that sometimes kids will sacrifice themselves consciously or unconsciously for the betterment of their parents. So this was a failure, but it spurred me into this whole idea of family systems trauma. The mom came in after we had done all the behavioral interventions to get the daughter under control. But then she revealed something very profound. She said, “my daughter's getting better, I'm getting worse. And I thought once things got better, we'd be on easy street. But now that my memories of sexual abuse are coming up as a kid, it's also spurred me on to stop physical relationships with my husband. Which is making it worse because I dragged him to therapy to begin with under the auspice that this was going to be great for our marriage. And now I can't even tell my husband what's going on or my daughter.” And so the daughter came in and said, I want to see you individually. And she said, “What the hell? what the heck? I'm better and my mom's more depressed. What's the deal?” And she's like, she had enough insight to say, “I think what I did is I distracted my mom from her pain. And I love my mom.” So this particular child said, “I'm just going to get worse.” and she did! And the mom was no longer depressed anymore. And so what happened was that the mom asked “Can you deal with my trauma?” And I was like, “I don't know how to do trauma work, so let me refer you to some people that do”. And she's like, “No, I have a relationship with you. I don't want to go metaphorically re-break my leg again and get it set.” 

Keith Sutton, PsyD: (32:20)
She's feeling safe with you and not wanting to go through with a whole new person.

Scott Sells, PhD, MSW, LCSW, LMFT: (32:24)
So all I knew how to do was catharsis. So she went through like two or three Kleenex boxes and she said, I felt better, but then there was a lot of diminishing return because she's like, now what? And that's what I got. That was an epiphany. Like, if I'm going to do this I've got to give people answers to now what? It can't just be catharsis. And I was shocked, Keith, because at this point now I have two kids, one who has special needs. The last thing I want to do is write another book. You know, it takes a lot out of you. And so I go, there's got to be literature and books and manuscripts that give you the step-by-step so I can just basically reference that and I'm good to go. But I was shocked. I was like, there's nothing. So what am I going to do here? And then I had another cognitive dissidence moment where I realized that if I don't do something who will? So that began another 10-year journey of writing this book, treating the traumatized child out of that treatment failure. That's why that's the first thing in the book.


Keith Sutton, PsyD: (33:49)
Yeah, and can you talk about kind of what you are doing with these families? Because many people would lean towards individual therapy, play therapy or trauma-focused CBT and things like that and, and kind of work with the child, separately from the family. Can you talk about how you conceptualize or use the family in the healing of trauma?

Scott Sells, PhD, MSW, LCSW, LMFT: (34:11)
Yeah. I think it's oftentimes both. And, or it can be the family first and then see how much you need the individual treatment as an offshoot. Because the whole is greater than the sum of the parts. So the best example I can give is when you have anxious children, you also have anxious parents. And so, there was a great study in the New England Journal of Medicine on cognitive behavioral therapy as the go-to treatment for anxiety. And the study found that over 60% of children that received cognitive behavior therapy got better with anxiety. That's an incredible success story. And what the study also found, which is the metaphor and pragmatic parallel to this work, is that they found the parents were not actively involved in the treatment. And so it didn't stick, the results. It was first order change. And the kids would go back to the status quo. And it would often make it worse because the parents then had this false sense of like, you're unfixable. You know, you did all this treatment. What they found was that there was a dance going on between the parent and the child where the parent was over-accommodating to the child. So if the child was anxious and there was no imminent danger, they would come rush in to save the child. So if the child didn't want to go to school they took them to school every day. The child didn't want to, sleep in their room then they over-accommodated by letting the child sleep in their bedroom. And so there was this unbelievable missing blind spot in mental health where the parents were just as anxious as the kids. And unless you treated it interactionally, you didn't get to second-order change. And so that's when my work comes in where we also coined the term interactional trauma. Drama equals trauma. And so if found was that in many families there's so much lecturing, nagging, conflict that if you don't stop that, you can't even get to the trauma. Like an emergency doctor saying, stop the bleeding before we get to the shrapnel. So through that one case study around anxiety, you can really see the need of both ends. The cognitive-behavioral, changing the thoughts around anxiety. But if you have an over-accommodation dance, there's no reason for the child to stay changed. Yeah. So,

Keith Sutton, PsyD: (37:08)
Yeah. And there's been such great research too. I for the podcast I interviewed also Ellie Lebowitz and his work at Yale.

Scott Sells, PhD, MSW, LCSW, LMFT: (37:14)
Oh yeah. That's incredible.

Keith Sutton, PsyD: (37:15)
Addressing parental accommodation. And I interviewed Lynn Lyons on her book Anxious Kids Anxious Parents. I think that oftentimes maybe in the families that I work with. When there is anxiety, there's trauma, sometimes it's trauma on the parents' part, sometimes it's trauma on the kids' part. All these things make it hard to create that lasting change. There's these things that sometimes the parents can learn through skills of nurturance or the limits or so on. But oftentimes their own trauma stuff comes up and gets in the way and so being able to work with that. And sometimes if the parent has trauma, sometimes even helping to explain that to the kids in a way that's hierarchical, and not like, “take care of me”. But rather, “this is some context of why I react in these ways sometimes, that is in part due to you, and in part not due to you.” With the trauma, helping the kids turn to the parents and the parents be able to hear it. But sometimes that's hard. Like in one family, I was working with the mother would start crying and say, well, what do you want me to do about it? And would just walk away when her daughter was talking about the sexual abuse she had experienced, she was not able to soothe her or stay there. Or what Jim talks about, with the soft side of the hierarchy, being able to handle the hottest topics to be able to help contain and, and have that kind of attachment.

Scott Sells, PhD, MSW, LCSW, LMFT: (38:38)
Yeah. We've got a real crisis now, which I call the perfect storm. And one is we have a whole generation of kids now that are born with technology, and that one of the greatest predictors of success in adulthood is not IQ social skills, self-esteem but self-control. And so a lot of our kids are not born, but taught this sense of entitlement. And that everything is open for discussion. Everything's about choice. And so the parents are buying into that. And so they're not getting the tools to set boundaries and limits. And Covid was a pop quiz for people because you saw that kids just fell apart. There was no resiliency. Like if you took the same kids from the Second World War, they plowed through it. There was a sense of love and limits. And so now you've got these huge waiting lists, I think I watched in the 60 Minutes documentary, of over 50% of our adolescents are either unhappy or anxious or suicidal post-pandemic. And you've got a whole workforce of mental health therapists who aren't trained in family systems work, or structural strategic family therapy to give the parents the tools around setting limits. And they've never been set limits when they were a kid. So you have three things going on. A generation of kids that don't have self-control. A generation of kids that have a sense of entitlement. You add gasoline on the fire with an over-reliance on social media, you add a pandemic in there. And you've got a workforce that's not trained in family systems trauma work and does individual treatment or medication.
This means you've got a real problem on your hands. And by the way, we've got the great resignation. So you got all these therapists that have had secondary trauma, and they're like, I don't need this. And so they don't have the tools to get the change happening, so they're just walking off the job and taking a job at Amazon - metaphorically. So yeah, that's five things. So now we come to a point in our history, we have something called the rise of self and a lack of community. And we are in a role as an unprecedented innovation around family therapy that has to come off the endangered species list. And so I'm hoping podcasts like this, like you're doing, and I thank you for this, will help people go, “Yeah, that makes a lot of common sense, Scott - You better do something about that.” So, and even what's incredible is it's a time also for innovation of people thinking paraprofessionals can do great work, like support advocates. If you read Mnuchin's first book, he would teach families in Philadelphia to be family therapists. And he said that a degree doesn't always equal competence. So you could teach people, like parent support advocates, to do good family therapy work. We've got to get out of our offices, out of the traditional 50-minute session. And we've got to be able to do brief strategic work and get people through the system; have what's called tuneup sessions, just to keep this change happening and move. Rather than having the luxury of kids on our caseload for three, four months, doing more extensive individual treatment only to find, like the anxiety study, that it won't stick. 

Keith Sutton, PsyD: (42:56)
Gotcha.

Scott Sells, PhD, MSW, LCSW, LMFT: (42:56)
So we've gotta re-look at the way we're delivering services today. So, sorry, I got on my soapbox.

Keith Sutton, PsyD: (43:04)
No, no, but that's, that's, I, that's my soapbox too. I think it's so tough because cognitive behavioral therapy or play therapy, I think is a bit easier in ways you just have one person in the room or the child or so on. And, the family therapy can be very overwhelming for folks. And I think too that a lot of folks in grad school aren't really prepared to do family therapy, based on, as you've talked about, these theories but not necessarily the steps of what to do. And then, you know, there's not much training sometimes once one leaves grad graduate school and their internships or postdocs or so on. So it is kind of a whole specialty area, but it's so necessary because the research shows right that there may be similar change at the end of therapy, in both approaches, but oftentimes there's much more relapse in the individual approach.

Scott Sells, PhD, MSW, LCSW, LMFT: (44:02)
That's a great point too. And that's what led me before Covid and I didn't know Covid was going to hit, is to take this book treating the traumatized child and break it down into a digital course. You know, where I went to people who were in that digital space, like Jeffrey Walker, Stu McLaren. And I said, it kind of paralleled Haley. Like go to the experts and say, “Yeah, how, how are we learning today?” And Stu McLaren, he's really great at putting together digital courses. And he said, “If you're going to put a course together, Scott, it's got to have three things.” One, we're drowning in information, so you better make sure that any lesson is bite-sized piece, quick, video based, and it's got to be entertaining and exciting. And then number three, the outcomes have to be immediate. Like once they try them and they work, you have to have a community with office hours. So I was a professor, so I thought, “why not try this?” So I took the 12 core tools out of the book and I put them into 12 modules and then I drip it out once a week, a technique a week. And people go in, they go into the course, 24/7. They watch the video lesson, they have the textbook there, they get to watch questions, and then they have community with other students. They don't have to go back to graduate school. And to me, that's an innovation that we should look at as a field of how can we bring the school to the person and make it easy on them without having to go back to school, so that they can walk in there and say, “Hey, I can do family therapy. I got the tools. I've watched the videos. I'm ready to go.” And I don't know, to me, that's kind of working smarter, not harder, I guess.

Keith Sutton, PsyD: (46:06)
Yeah. So kind of taking it beyond a one-time workshop and, and not necessarily feeling like they have to go all the way back to a graduate school. Instead, kind of being able to get that information, try it out, get some support along the way, and also look at its effectiveness as they go along. 

Scott Sells, PhD, MSW, LCSW, LMFT: (46:23)
Right, right.

Keith Sutton, PsyD: (46:24)
Great. Well, that's wonderful. I'll link to your website where the training is and where that information is and, also to the books. What's next on kind of your horizon?

Scott Sells, PhD, MSW, LCSW, LMFT: (46:38)
To work with agencies, and, communities. To use the course as a catalyst to bring about, quick change, but lasting change. Where it's not a one-and-done training, where they take the training, everybody speaks the same language. I also am going about bringing a scalable version of the course more to bachelor's level folks, and paraprofessionals. They may not have all the in-depth clinical, techniques, which they don't need. But they have the psychoeducational pieces so that they can feel empowered and everybody can speak the same language. So my role is to be a systems irritant, in a good way. Like with families, but with communities and say, use the courses at callous to get everybody on the same page, just like families. Let me come alongside of you to help move to second-order change, versus not one-and-done training. And so far the preliminary results are very promising. I think, there is an element that can do evidence-based practice, but it is a huge commitment and time and resources and money. And that's fine, but there's a bigger contingency that can't do evidence-based practices, but they want to be able to master the tools and techniques in a proficient way, in a very fast way. And I think that we have to adapt to that need and also stem the tide, the red tide of the great resignation. Because guess what? Inspired people stay on the job. And when you get therapists who can use these techniques and suddenly engage a parent, their secondary trauma goes down and they want to stay on the job. So that's, that's my role as I'm going to be doing research on seeing that the course is correlated with what the anecdotal evidence is saying - that it's stemming the tide of resignation.

Keith Sutton, PsyD: (49:13)
Yeah. I think that's so important because I think that is the difference between family therapy and say, CBT, where with CBT, you can get a book from treatments at work, it has the step-by-step methods and it's not much time and money, versus say, multidimensional family therapy, I was talking with Howard Little, it's thousands of dollars. And evidence-based is a huge commitment from the organization. And of course, you need a lot of that to have fidelity, but is there something in the middle that can help people to gain some of those skills and grow? So it's great that you're now hitting that even on a larger systemic level and the different agencies that are providing services. And I think, just like you're saying, one of the things that really I think decreases burnout is competency.

Scott Sells, PhD, MSW, LCSW, LMFT: (50:00)
Competency, yeah. As an anti-venom to burnout.

Keith Sutton, PsyD: (50:02)
Exactly. 

Scott Sells, PhD, MSW, LCSW, LMFT: (50:04)
And I'd say it's “CC” confidence and competency.

Keith Sutton, PsyD: (50:07)
Exactly. Totally. Yeah. And, and I think, even if you're having a rough session or it was a rough session, if you know where you're going, why it's in the state that it is, it's much less anxiety provoking than if you're a new therapist and it just feels out of control and you feel like you have to do something right away and you're not sure what to do. So, I think that that's definitely a huge part and it'll have a great effect on burnout and not only treatment, but also helping therapists.

Scott Sells, PhD, MSW, LCSW, LMFT: (50:39)
Yeah. And the final thought is: I think we as professionals have to get away from the fiefdoms that we used to have of like, “my model is better than your model”. Or “I've got top secret information I can't share with you.” We've got to break those walls down and say, “let's be strategic, let's partner”. Let's stop being worried about the finances, that'll take care of itself. So now I've grown up and matured to the point where I'm going to give a lot of this stuff away for free. Because the bigger mission is, we are in, we are in code red right now. Okay? And it doesn't take a rocket scientist to see that. So we have got to unify otherwise we won't be able to make the biggest impact. So I hope that people listening here will call me because I'm even doing a retreat once a year in Montana for self-care, but also to bring people together and say, let's be think-tankers. Let's come together with all of our ideas. And be forerunners, instead of doctor sell, it's the idea, it becomes a movement. instead of “the family systems trauma model” Woo!

Keith Sutton, PsyD: (52:10)
Yeah. Yeah.

Scott Sells, PhD, MSW, LCSW, LMFT: (52:11)
Who cares about that? It's more about like multiplication and empowerment of our workforce. So that's, that's why I've totally come 180.

Keith Sutton, PsyD: (52:23)
Great. That's wonderful. Well, thank you so much for Scott for all the work you're doing and coming and talking with me today. And I'm sure it'll be very helpful for our listeners to hear about the work and we'll link to all the resources. Thank you so much.

Scott Sells, PhD, MSW, LCSW, LMFT: (52:38)
Yeah, thank you. And thank you listeners for everybody's listening. And, and what I want to say is you can do it, you can do family therapy, we need you.

Keith Sutton, PsyD: (52:51)
Yes, definitely. Definitely. Well, thank you so much. I appreciate it. Thank you for joining us today. If you'd like to receive continuing education credits for the podcast you just listened to, please go to therapyonthecuttingedge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists in-person in the Bay Area, or throughout California online, and our employment opportunities, go to sfiap.com. To learn more about our associateships and psych assistantships and low fee treatment through our nonprofit Bay Area Community Counseling and Family Institute of Berkeley, go to sf-bacc.org and familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACC’s website at sfbacc.org. BACC is a 501(c)(3) nonprofit so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.

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