1. + Welcome to the Open Sky Webinar We will begin at 6 pm- see you soon!

2. + Stages of Change: Understanding Your Loved One’s Process in Wilderness Therapy Presented by Dr. Paul Case, PsyD Open Sky’s Assistant Clinical Director Clinical Psychologist Clinical Therapist, Team D

3. + Agenda Introduction to the Transtheoretical Stages of Change Model The Stages: Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse The Stages in wilderness therapy Supporting loved ones in change outside of wilderness

4. + Transtheoretical Stages of Change Model Developed at the University of Rhode Island in 1977 by James Prochaska Based on analysis and use of different theories of psychotherapy, hence the “transtheoretical” This is one measure Open Sky uses in our outcome research with both adolescents and young adults. Our research shows all students leave Open Sky with a stronger readiness to change their problem behaviors.

5. + The Stages: Pre-contemplation Entry Point to the change process Individual doesn’t see that there is a problem to be changed, it is beyond their awareness Often it is the people closest to the pre-contemplator who have the greatest awareness that something needs to change “I don’t have a problem” “It’s not a big deal” “I don’t understand what the issue is”

6. + Contemplation Individual begins to consider the possibility of change This stage can be rather long lasting and is characterized by ambivalence May attempt to reduce the frequency of the behavior or make resolutions to address it at a future moment Individuals in the contemplation stage may act out in increasingly problematic ways “Maybe I do have a problem” “Maybe there is something I can work on” “Maybe this has something to do with me”

7. + Preparation Individual has reached a point where they want to make a change Committing to getting treatment, researching Demonstrate an openness to help and support from others Problem behavior is still exhibited, but addressing it is actively pursued “I can’t go on like this” “What do I need to do?” “I need help”

8. + Action! Commit to a plan and actively engage in that plan Sometimes action is externally motived; the individual is required to engage in treatment as part of their probation The hope is that the motivation to change becomes internal Internal motivation produces more sustained motivation to change and to sustain that change over time. “I’m checking myself into rehab” “I commit to attending 90 AA meetings in 90 days” “I am going to Open Sky”

9. + Maintenance Realistic plan for relapse prevention The change is not yet part of the individual’s internal way of being in the world and is vulnerable If returning from treatment, much support is required to re-enter the “real world” “I’’ve got a plan” “I need support”

10. + Relapse Generally part of the process Does not negate gains made Re-enforces importance of support and maintenance Important to minimize shame while maximizing responsibility “I slipped” “If I relapse, what’s the point?” “This doesn’t work; I’m a bad person”

11. + ACTION Pre- Contemplation Preparation ACTION Maintenance Relapse Permanent Exit Enter

12. + Stages in Wilderness Therapy Pre-contemplation: This stage often takes place at home, unless an adolescent student comes in with still no awareness of the challenges they are facing. Contemplation: With Young Adults, this is often experienced at home, leading an the individual to Open Sky. With adolescents and sometimes young adults, just being at Open Sky opens a space for students to begin contemplating., i.e.: “If I am at Open Sky, there must be something to look at”.

13. + Stages in Wilderness Therapy Preparation: This stage can be characterized by an individual’s commitment to coming to Open Sky or choosing to go to a next phase of treatment. Once in wilderness, we see preparation when a student begins to actively engage in therapy and positive relationship with their field guides and peers. Action: Coming to Open Sky for many (especially young adults) is a strong action. Once here, students in the action stage are diligently involved with their treatment plan and utilize the Open Sky treatment resources to the fullest.

14. + Stages in Wilderness Therapy Maintenance: This often involves developing an aftercare treatment plan, which can include everything from a therapeutic boarding school to a supportive living environment to home therapy. Relapse: For some students, we see relapse happen even while they are at Open Sky: a student struggling with dishonesty or manipulation can exhibit these behaviors while in the field. For others, relapse may be tied to a substance or other stimulus available only away from Open Sky.

15. + Supporting Loved Ones In Change Outside of Wilderness  Educating and understanding where your loved one is in the cycle can help normalize what they are experiencing.  It’s important to remember that the stages of change can be cyclical and it may take many revolutions before an individual is able to leave the problem behavior behind.  Support is needed in all the stages!

16. + Thank you for participating! Dr. Paul Case drpaul@openskywilderness.com 970.382.8181 Please keep this browser window open. When the presentation is complete, it will take you to a short survey for today’s webinar.