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Our Clinical Approach

A Proven Therapeutic Approach

Evolve’s therapeutic approach is evidence-based and behavioral. In our standard clinical model, we provide psychiatry, a strong DBT skills-training component, along with other evidence-based treatments such as Cognitive Behavioral Therapy (CBT), Motivational Interviewing, and others. The combination of therapeutic approaches in each treatment plan depends on the adolescent’s specific needs in treatment. We also offer experiential therapies such as equine-assisted therapy, art therapy, music therapy, yoga, fitness, hiking, and more. Experiential activities provide fun, healthy outlets for teens, expose them to new ways of expressing themselves, and help them discover what a “life worth living” looks like for them. 

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Evolve provides a safe and structured environment where teens develop valuable skills and insights, ensuring gains in treatment are maintained long after discharge. 

photo of an Evolve client being mindful
Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment that has shown to be effective at treating depression, anxiety, substance use disorders, and eating disorders. It is based on the belief that these problems are caused by unhelpful ways of thinking and behaving, and that treatment should involve changing these unhelpful thinking and behavioral patterns. In essence, once an individual starts to think about themselves and the world differently, they will then start to feel and act differently as well. For example, a client utilizing CBT for social anxiety would need to challenge negative assumptions about what others are thinking of them while also challenging themselves to not avoiding social situations. Over time, they will start to feel less anxious in social situations as a result.

Mindfulness

Mindfulness is something simple and practical: it means paying attention to what’s happening in the here and now. It means seeing the world as it is. Teens often have highly emotional reactions when they’re not focused on the present and end up behaving mindlessly instead of mindfully. Mindfulness helps replace mindlessness with awareness. We teach our teens that the first step toward positive change is acceptance of the moment, without attachment or judgment. When they learn to see their behavior through clear eyes, they can then learn to enhance their quality of life. Cultivating mindful awareness gets our teens out of a reactive space and into a neutral space, where they can approach a situation by taking facts and reality into account. At Evolve, a focus on mindfulness is incorporated into all aspects of treatment, including individual and family sessions, groups, and experiential therapies. 

Motivational Interviewing (MI)

It is not uncommon for teens to feel unsure about changing their behaviors that others find problematic. Afterall, the behaviors may serve an important function for them (mood regulation, managing distress, etc.) or they might just find them fun (drug and alcohol use). The goal of Motivational Interviewing (MI) is to understand a client’s personal goals and priorities in life and help them find their own motivation to change. This involves patience and “meeting them where they are at,” which is very significant for teen clients who may feel like they don’t have any control over their lives. Because internal motivation for change is such an important component of therapy and entering recovery, MI is considered an evidence-based treatment for substance use disorder.

Dialectical Behavior Therapy (DBT) ​

Dialectical behavior therapy (DBT) is an evidence-based, highly effective treatment modality that treats emotional dysregulation, self-harming behavior, suicidal ideation, and other mental health and/or behavioral issues. DBT is a structured, skills-based approach designed for individuals with intense emotions, strained relations and impulsive behaviors, and helps people change their ineffective behavior patterns.

While many treatment centers report that they use DBT in their programming, Evolve is unique in that great care is taken to facilitate these components of the treatment in a way that adheres to the structure and philosophies developed by Marsha Linehan, the creator of DBT.

In addition to Evolve’s standard clinical model programs with DBT Skills Training, Evolve offers comprehensive DBT residential programs.

Cognitive Behavioral Therapy (CBT)​

Cognitive Behavioral Therapy (CBT) is an evidence-based treatment that has shown to be effective at treating depression, anxiety, substance use disorders, and eating disorders. It is based on the belief that these problems are caused by unhelpful ways of thinking and behaving, and that treatment should involve changing these unhelpful thinking and behavioral patterns. In essence, once an individual starts to think about themselves and the world differently, they will then start to feel and act differently as well. For example, a client utilizing CBT for social anxiety would need to challenge negative assumptions about what others are thinking of them while also challenging themselves to not avoiding social situations. Over time, they will start to feel less anxious in social situations as a result.

Motivational Interviewing

It is not uncommon for teens to feel unsure about changing their behaviors that others find problematic. After all, the behaviors may serve an important function for them (mood regulation, managing distress, etc.) or they might just find them fun (drug and alcohol use). The goal of Motivational Interviewing (MI) is to understand a client’s personal goals and priorities in life and help them find their own motivation to change. This involves patience and “meeting them where they are at,” which is very significant for teen clients who may feel like they don’t have any control over their lives. Because internal motivation for change is such an important component of therapy and entering recovery, MI is considered an evidence-based treatment for substance use disorder.

Family Therapy

Conflict within the family system can contribute significantly to a teen’s presenting problems, making family therapy an essential aspect of treatment. At Evolve, all clients participate in family therapy, typically with their parents and/or other familial caregivers. These family therapy sessions occur weekly at all levels of care. While there are many approaches to family therapy, our Primary Therapists typically take a solution-focused, skills-based approach.  

Group Therapy

Group Therapy is a powerful therapeutic tool at all levels of treatment. During group sessions, therapists help adolescents develop and explore interpersonal relationships and work on specific treatment goals. 

At Evolve, teens participate in several group sessions per day, which may include Dialectical Behavior Therapy (DBT) Skills Training Groups 

Research supports the use of adherent DBT skills training on its own as an effective intervention for reducing emotion dysregulation, self-harm, suicidal behaviors, and other challenges our teen clients face. 

Each Evolve programs include weekly DBT skills training groups that focus on each of the four skills training modules: Core Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. All DBT skills groups are facilitated as designed by Marsha Linehan, the developer of DBT, which means that they stick to the following format: 

  1. Mindfulness practice 
  2. Homework review
  3. New skill lesson 
  4. Assign new skill practice homework
  5. Check-out 

Goals of Skills Training

GENERAL GOAL

“To learn how to change your own behaviors, emotions, and thoughts that are linked to problems in living and are causing misery and distress.”

Skill Acquisition  Skill Strengthening  Skill Generalization 
Clients learn a new skill during each of the Skills Training Groups   Clients practice the skills with the support of staff, and discuss what worked and didn’t work  Clients learn how to use the skill when they need it in real life 

Problems to Decrease  Behaviors to Increase  Goal of DBT Skills Training 
Reduced awareness and focus; confusion about self 
(Not always aware of what you ore feeling, why you get upset, or what your goals are, and/or have trouble staying focused) 
→ Core Mindfulness Skills → • Reduce suffering and increase happiness 
• Increase focus and control of the mind 
• Experience reality as it is 
• Be present to your own life and to others 
     
 Emotional Dysregulation 
(Fast, intense mood changes with little control and/or steady negative emotional state; mood-dependent behaviors) 
→ Emotion Regulation Skills → • Understand your own emotions 
• Decrease the frequency of unwanted emotions (and stop them once they start) 
• Decreased vulnerability to emotion mind 
• Decrease emotional suffering 
     
Impulsivity 
(Acting without thinking during a crisis; escaping or avoiding emotional experiences) 
→ Distress Tolerance Skills → • Survive crisis situations without making them worse 
• Accept reality as it is in the moment 
• Become free 
     
Interpersonal Problems 
(Pattern of difficulty keeping relationships steady, getting what you want, keeping self-respect; loneliness) 
→ Interpersonal Effectiveness Skills → • Ask for what you want or say no effectively 
• Build and maintain relationships 
• Maintain self-respect 
• Reduce anger and conflict in relationships 

Seeking Safety

Trauma and substance use often go hand-in-hand. After a traumatic experience, many people choose unhealthy coping mechanisms, such as substance use, to escape their pain. Seeking Safety, a relatively recent evidence-based treatment model that treats co-occurring post-traumatic stress disorder and substance use disorder, helps our teens recover from their traumatic past so they can regain the footing they need to move forward in life. Through the structured group curriculum, teens work towards safety in their relationships, thinking, behavior, and emotions. 

Relapse Prevention

Relapse prevention therapy is a type of cognitive behavior therapy that treats alcohol and substance use disorders. Research shows that relapse is common after recovery. Among other factors, difficult emotions (being lonely, depressed, or angry) and environmental triggers (e.g. witnessing friends using drugs) can trigger a relapse. At Evolve, we use Relapse Prevention to help our teens limit relapses by teaching them how to anticipate, identify, and cope with high-risk scenarios that can lead to relapse. For clients without a history of substance use, relapse prevention strategies are also used to address relapse on other problem behaviors, such as self-harm, food restriction, etc.  

Anger Management

Increased anger is common during adolescence. For some teens, anger can result in verbal or physical aggression as well as intense conflict with family and peers. In anger management groups, teens learn how to control their temper without resorting to yelling or aggression. They learn productive and healthy ways to process their frustration and techniques to calm down when they feel the first signs of anger. 

Meditation

We teach simple breathing exercises, relaxation techniques, and focusing strategies to ground and center the chaotic jumble of thoughts and emotions that adolescents experience. From simple belly-breathing to full-body progressive muscular relaxation, a calm mind helps give our teens the freedom to see their behaviors clearly and make healthy choices. 

Life Skills

Many of the teens that seek treatment at Evolve have missed out on developing key skills for “adulting” due to being engulfed in depression, anxiety, substance use, or self-harm. They may, do their own laundry or other household chores, let alone more complicated tasks like budgeting money, writing a resume, or applying for college. Life Skills groups at Evolve provide guidance on all these tasks in a way that is hands-on and applicable to today’s generation of teens. Discussion and education around how to navigate the internet and social media safely is also incorporated. 

Experiential Therapy

Drama Therapy

In drama therapy, teens participate in improv, storytelling, theater games, group dynamic games, or role-play exercises that help them learn empathy, self-confidence, and relationship/communication skills. The process of acting out a specific role during drama therapy can be cathartic and trigger real change in a teen. It can help adolescents solve problems and explore their personal feelings about a specific issue that’s bothering them.

Surfing

Our surfing program at our Southern California residentials are all about taking therapy into nature. The National Surf School and Instructors Association accredits our surf instructors, who specialize in using surfing as a therapeutic tool and transformative experience. Surfing helps teens practice social skills, learn stress management techniques, develop executive functioning skills, improve muscle tone, and develop spatial awareness, all while having fun and learning a new skill. Surfing also releases endorphins that increase positive emotions and wellbeing.

Art Therapy

Research shows traumatic memories are stored in the right hemisphere of the brain, while speech is located in the left. Because art and music are right-brain activities, it’s often easier for those with past trauma to draw or paint about their experience rather than talk about it. For all teens, though, art therapy improves self-awareness, reduces stress, and is a peaceful, relaxing activity they enjoy.

Equine-Assisted Therapy

Horses have a unique sensitivity to human emotions, which makes equine therapy an effective and widely accepted therapeutic tool, especially for adolescents. Teens can address and break down barriers and resistance toward the therapeutic process through their connection with these majestic, powerful, and loving animals. Through their interactions with horses, adolescents develop caring and nurturing behaviors. They also uncover aspects of themselves previously inaccessible in their relationships with peers, family, and society. Teens are required to be fully present, watch for and respond to subtle signals on multiple levels, and solve problems in the moment in ways that trigger deep learning and emotional maturation. Equine therapists use horses in this context to guide and support positive change. Our equine specialists hold certifications in the use of horses in a therapeutic setting and specialize in working with teenagers with substance use and mental health issues. Equine therapists are present during the therapeutic process and work collaboratively with our clinical team in the development and implementation of the individual treatment plan. 

Hiking

Studies show nature improves mood and decreases symptoms of depression, anxiety, and stress. In fact, many teens become calm down as soon as they’re outside in the fresh air. How does this work? One theory is that spending too much time in an urban environment causes our minds to work hard to overcome our stimulus-rich surroundings. This hard work results in mental fatigue. When you gaze at nature – trees, lakes, flowers, or any other sort of green space – your mind gets a break from constant, intrusive stimuli. This is one reason why our residential treatment centers feature large backyards with ample green space. This is also the reason why many of our residential treatment centers are located in scenic areas – near forests, state parks, creeks, and the ocean – and why we offer hiking as a weekly activity. Our therapeutic hiking groups provide our teens a unique opportunity to connect with the natural beauty around them. Nature hikes offer opportunities to develop a new self-image, a new way of relating to others and the environment, and new ways to respond to the challenges of daily life.

Music and Dance

It’s no secret that most teens love music and dancing. Expressive therapies like these improve self-understanding and teach productive ways to cope with uncomfortable feelings. Singing along with a song provides a healthy context to release painful or difficult emotions. Discussing song lyrics can help an angry adolescent articulate the tangled knot of angst they feel inside. Our therapists aren’t afraid of delving into genres like rock, punk, rap, or metal to meet teens where they are and where they feel comfortable. Playing music has a magical way of simultaneously soothing and releasing emotions. Teens benefit from all the therapeutic positives of music therapy, learn to transform their experiences into art, and feel the satisfaction and sense of accomplishment that comes with creating something from beginning to end. Dance, like music, has an amazing capacity to unite mind, body, and soul in a single moment of pure joy and self-expression. Dance and movement therapy help our teens express feelings and tell stories while boosting self-esteem and increasing self-awareness and understanding. Research shows dance therapy can increase general wellbeing, positive mood, and body image.

Yoga

Adolescence is a time of radical physical, emotional, and social change. Hormones flood the body, while the brain struggles to keep up as the urge to seek novelty and identity outpaces the ability to regulate emotions and control impulses. Teens riding this emotionally charged roller coaster need help to learn how to slow down their thoughts, notice their emotions, and make effective choices. During weekly yoga groups at Evolve, our teen clients utilize mindful movement and breathing to achieve this. Like the recovery process itself, yoga takes time, repetition, and practice.

Physical Fitness

We show adolescents that living a healthy and well-balanced life can be fun. Every Evolve residential treatment center is equipped with gym facilities that our teens can use when they have downtime or free time. Physical activity is built into the schedule every day. Our goal is to offer our teens the option of making healthy, life-sustaining choices, and teach them that regular exercise is an important part of stress management and emotional stability. Through exercise, teens can develop coping skills and find healthy outlets in their lives that are productive. In treatment, this enhances recovery and limits the rates of relapse. Exercise has a huge effect on a teen’s emotional wellbeing and mood, and even improves cognition. It also has a host of physical benefits: it increases heart rate, reduces stress, improves sleep, lowers blood pressure, and increases energy. In many instances, exercise has been shown to reduce depression as effectively as traditional approaches like CBT or medicine.

Outings

We take weekly trips to the beach, movies, special hiking trails, museums, miniature golf courses, and more. If we think an activity is appropriate and beneficial, we include it as a special bonus for hard work and achievement. We use outings to model how to experience the world without the use of addictive substances, how to interact with society in enriching and sustaining ways, to enjoy the benefits of nature, and for the same reason everyone else in the world does – to get out and about, have fun, and shake up the regular routine.

Family Therapy

Family Therapy

We believe our teens cannot be completely understood in isolation from their families. When possible and practical, we require family members or caregivers to participate in family therapy sessions at least once a week. While we prefer families to attend sessions in person, we can also accommodate sessions by telephone or remote conferencing. This is particularly beneficial for families who live out of state. We believe parents need to learn recovery skills right alongside their kids. Many of our therapists are parents themselves, and we all agree that giving parenting advice was easy – before we had kids. We understand, empathize, and know from experience that when we’re parenting, all our weaknesses are revealed, and that’s okay. It’s not about giving stock advice and canned answers. We want our parents to learn as their kids learn, and our goal is for everyone involved to get on the same page and move forward together.

Multi-Family Support Group

In addition to the family therapy sessions, families in our Intensive Outpatient and Partial Hospitalization programs participate in multi-family parent support groups every week. These group sessions allow for families, teens, and therapists to meet all together in a large group (and at times in small, intimate groups) to collaborate and share their treatment experiences. In these sessions, families can learn from one another, recognize they’re not alone, and get support from others going through similar experiences. We conduct group sessions in a variety of formats, depending on specific family needs and circumstances. Weekly times for these groups vary from facility to facility.

Parent Support Groups

Parents need support, too. And sometimes, they need to talk to other parents without kids around. We offer support groups designed to teach parents a new set of skills to help them cope with their new normal. These groups help during and after treatment.