As I interviewed Ranch therapists for this article, I was struck by a few common themes. The first was the importance of the relationship between the child and the therapist. Every therapist said the relationship comes first. Without that, nothing the therapist says or does will work. While each therapist has his or her own way of connecting to children, they all stressed that building a trusting relationship is their number one goal.
Another theme was the uniqueness of each child and how that plays into therapy. The children who come to the Ranch for residential treatment can't be easily described or put in a box. Every child is different. They have different stories, different personalities, and different dreams. A one-size-fits-all approach to therapy doesn't work. When our therapists meet a child, they aren't trying to figure out which of their three therapy methods to use with this child—they are piecing together individual strategies to work with this child only.
Every therapist profiled used the word, "resilience," when talking about our kids. Most Ranch children have stories that will make your toes curl. Yet they walk and talk and laugh and go to school and function in the world. Yes...they are here because they are struggling, but beneath those struggles are incredible strengths. They are survivors.
Finally, when we talked about the kids, their eyes lit up. They love these kids. They see through the behaviors to the awesomeness of each child. When I asked them to tell me about Ranch kids they used words like strong, capable, resilient, awesome, wise, loving, forgiving, and intelligent. Ranch kids are survivors and our therapists put their hearts and souls into helping them move through the world as their best selves.
I hope you enjoy learning about each of our therapists as much as I did.
Tammy Noteboom, Vice President, Communications
Dakota Boys and Girls Ranch
Sara Vetter has always wanted to work with teenagers. She started working in direct care at the Ranch 25 years ago as a graduate student in Fargo. After getting a master's degree in Counseling, she took a job as a therapist at the Ranch in Minot, and in 2001 she moved with her family to Bismarck to work on that campus.
Sara typically asks children two things when she starts seeing them in treatment. "Why do you think you are in treatment?" and "What can I help you with?"
"Some kids state they have no idea why they are here. Others tell me their diagnoses. 'I'm here because I have a conduct issue.' or 'Because I have ADHD.' They think they are in treatment because they are a problem. That's how it's been—they are always the problem everyone is trying to fix.
"When I ask what they want, some kids say, 'To be happy. To not be hurt by people.' Other kids come in really angry and don't know what they want—except to just be left alone."
Thanks to years of experience and training, Sara can meet kids where they are at and find ways to connect with them using techniques you wouldn't think of as traditional therapy. She has a quick wit and uses a lot of humor in her sessions.
"We were struggling to find common ground in an intake with one young man who was really defiant. He was determined to not agree with us on anything. So, just to break it up I stopped and said, 'Do you like cheese?'
"He's like, 'Yes.'
"Shredded or sliced,' I asked.
"'Both,' he said hesitantly.
"Oh good," I said. "I'm glad we can agree on something."
"He kind of stopped being defiant for a bit and we were able to have a conversation. You have to find something you can agree on. Sometimes you have to take a bit of a gamble to start building a relationship. It doesn't always work. I've joked with children before they were ready—I thought we had built a trusting relationship and they weren't there yet. Then I apologize. Apologizing is a big thing. Adults don't want to apologize. We worry it will shift the power to the child, but I've apologized many times and it almost always helps build trust. It also surprises kids because they've rarely had an adult apologize to them.
"Therapy is not just one thing. I came out of school with the mentality that you have very structured therapy sessions. You ask these questions and use these skills. I was surprised by how flexible and adaptive you have to be to work with kids. Sometimes it's the goofy things you do that start to build trust."
Sara believes in Ranch kids and their abilities. "People may think our kids aren't bright enough to do the work they need to heal. I believe they can. They need positive supports, nurturing relationships, and a little help figuring out a realistic definition of success for them. We are a starting point for some to learn skills they can use in the future, if they aren't ready to now."
Taylor Keller works with our youngest children in Cornelsen and Butt cottages on the Minot campus. Taylor, who earned her master's degree in Counseling, said some Ranch kids come from loving families, yet something just isn't working. Maybe there has been a crisis or a death in the family that triggered the behavior issues. Maybe the child has underlying behavioral health issues like bipolar disorder—things loving parents can't always address on their own.
"Sometimes just loving your child isn't enough," Taylor said.
On the other end of the spectrum, Taylor said we have kids who have endured severe sexual and physical abuse, trauma, neglect, and abandonment.
"These kids often don't have any family or anyone who cares about them. I've been seeing a lot of kids with severe psychiatric issues...psychosis, disassociation, attachment issues, and lots of trauma."
In either case, "treatment begins the moment a child steps on campus. A therapist meets with each kiddo within an hour of admission. Therapists need to get a good grasp of where they are at and create a safety plan."
I tell kids, "We want to make your world on this campus as large and as full and as meaningful as possible, while also keeping you safe."
One of the boys Taylor is working with now has been abandoned by virtually everyone. His dad chose to terminate parental rights and told him it was because he was a bad kid.
"At the beginning of therapy, I spent a lot of time learning about this young boy. What kind of trauma is he bringing with him? What are the underlying family issues? What is he good at? With this child, there is a lot of suspected abuse. He came to us in a very antagonistic place and was in constant fight or flight mode. This is a kid who has had no safety, no security, and no nurturance. We spent a lot of time getting to know him and showing him we cared. We gave him the space he needed to trust us.
"Most people think about therapy as talk therapy but talking about feelings is hard and it's not natural for a ten-year-old. Interacting through games and art, that's a very ten-year-old thing to do. Now we are at the point where we can have some of those higher-level conversations. You can see that the safety and security the Ranch was able to provide gave him what he needed to make positive changes in his life.
"Our goal for most kids is to stabilize them, start the therapy process, and get them into a home setting where they can continue treatment. While we are building trust, we have lots of things to work on—social skills, identifying their feelings, relating with others...
"Really small things, like making eye contact, can be difficult when you've experienced a lot of trauma," Taylor said. "So, we practice making eye contact. We also do a lot of frustration tolerance through games and art. If they get frustrated because they are losing or something isn't turning out the way they'd like, we start building coping skills.
"We want kids to succeed at home and in the community. When we start talking about discharge, some of our kids start acting out because they don't want to leave. This is their home. It may be the best home they've ever known.
"The difficulties we're helping kids overcome are really, really hard. But the kids are worth it. It's really fun to show kids they are able to provide joy to other people, and that they can experience joy in a way they haven't before."
Jesse Lamm loves trauma work. "I don't think we understand how much trauma affects people," Jesse said. "When you look at anxiety, depression, and other mental health issues, so many of those things can be traced back to a trauma of some sort. I love being able to go in and process the trauma and help kids make connections between the trauma and the way they feel and behave now. You can see a slow progressive change in kids when they start to work through some of that stuff."
Before joining the Ranch, Jesse earned his master's degree in Clinical Mental Health Counseling.
As a fairly new Ranch therapist, he has been most surprised by the resilience of the kids.
"If I went through what they have, I don't know if I could continue doing my everyday activities. But these kids, they still go to school, they still do their normal stuff. They still put a smile on their face. They still have friends. Just seeing the resiliency of these kids every day is pretty incredible."
One of the kids Jesse counsels now avoids talking about his trauma. When Jesse asked him why he is so resistant to talking about it, the 15-year-old said he wants to hold onto the bad memories so he can avoid those types of situations in the future.
"He wants them as a defense mechanism or reminder," Jesse said. "If a child is resistant to therapy and resistant to change, it's going to be hard to go through the therapy process with them. To be successful in therapy, you have to try. You have to implement some of the things we talk about. "I've told him, 'If you keep going this way, you're probably going to end up in jail. If that isn't what you want, what can we do to change things?"
"I suggested he could have those memories without such a harsh negative reaction."
Like this young man, many of our kids are pretty quick to anger. One way we can help is to tap into the root of the aggression. Where does that aggression come from? Past experiences? Family history? We also teach kids body awareness. We help them notice little signs like clenching their fists, getting hot, having a knot in their stomach. Jesse pairs the new awareness of their bodies with coping skills. Hopefully, with time and patience and Jesse's guidance, this child can overcome his own resistance and healing will come.
Jesse said a parent told him the other day that other therapists have said her son's mental age will never progress past 15. "That really irritated her," Jesse said, "so she was asking my opinion. I told her I don't know. I don't know how far he can get. But I do know there is a special place in this world for every one of these kids—a place where they can succeed, where they can thrive, and where they can be happy."
Monica Olson believes faith is a critical piece of healing. "A lot of places minimize the importance of faith. The fact that the Ranch is a Christian organization made it a good fit for me. Clients ask, 'Why me?' 'Why is this happening to me?' They often say they hate God, but as they process through their experiences, coming to a belief in something greater than themselves give their experiences meaning."
Monica, who earned a master's degree in Clinical Counseling, feels as though God brought her to Dakota Boys and Girls Ranch. She was working in Denver when the Ranch posted the therapist opportunity in Minot. She felt led to apply and accept the position.
One of the things Monica likes about residential work is the team approach. "Therapy doesn't stop once a child leaves my office. It continues in their interactions in the cottage and at school. We have regular meetings where we all get on the same page. Everyone comes in with their own set of expertise and perspective and that can help in terms of these kids being successful."
The "teams" Monica refers to are the "Core Teams." Every Ranch cottage has a Core Team that meets weekly. The Team includes the therapist, along with staff from direct care, nursing, occupational therapy, education, wellness, and spiritual life.
The therapist and cottage coordinator complete a Child and Adolescent Needs Assessment (CANS) at the beginning of treatment.
"The assessment consists of several different modules to assess things like life functioning, family functioning, strengths, culture issues, developmental needs, risk behaviors, barriers, caregiver support, and more," Monica said.
After they complete the CANS, they meet with the Core Team, the child, and the family if possible, to create treatment plan goals.
"One of our young women, she is 15, endured years of physical, sexual, verbal, and emotional abuse by a family member. She struggles with flashbacks and becomes dysregulated when memories surface. Her initial CANS assessment showed so much to overcome. So many people who have experienced significant trauma in their youth block those memories and then don't know why they are acting the way they are. But this young woman can recall those memories, make the connections between her past and her behaviors, and still remain in the room with me. There is something inside of her that is so strong. I see her on a path towards healing because she is addressing, not running, from her past.
"Ranch kids are survivors. Some of them are so incredibly insightful and wise beyond their years. They may not even realize how intelligent and strong they are. I hope I can help them see that so they can realize the depth of their strength and resilience; and then use those strengths to move forward."
Lucas Mitzel counsels Ranch kids from a foundation of honesty. "I don't lie to kids, ever, and I will always be a straight shooter. If they ask me a question, no matter how uncomfortable the answer is going to be for me to share, I'm going to share with them. If it's something I can't answer, I tell them that. If a child can trust me with every word I am saying, then they're going to trust me a little more when I ask them to try something."
Lucas, who earned a master's degree in Social Work, knows he must prove himself to kids—prove to them he's not going to leave them or judge them.
"One of our recent residents had been lied to over and over," Lucas said. People told him he was going to have a foster home, but it never turned out. He didn't trust anything. If I'd have made even a hint of a fib with him, we'd have lost everything.
"One day he got super upset in my office. He started to tear my office apart, throwing things. I just sat there and watched it happen. And then I remember sitting on the floor with him while he was in tears and he told me his story.
"His mom and dad were both abusive. He'd had tables thrown at him, been hit at and screamed at, and been locked out of the house. He reported it again and was placed in a treatment center where he wasn't understood. From there he bounced through foster homes—15 in all.
"That moment on the floor in my office was the moment he changed things. He was still mad at the world, but he was handling it. Once he shared what happened in his childhood, he could work through it. He worked hard and he got to a new home because of it."
Lucas fights hard for all Ranch kids, and once a client, always a client. "I give my kids my office number when they leave and tell them they can always call if they want to say hi or to share an update. Even if they don't call, they know they can.
"These kids are the best. They are sometimes the most wise and loving and caring and forgiving people you will ever meet. I've worked with kids who've had awful things done to them who then turn around and give that person a hug and say, 'I forgive you.' I learn more from these kids than they'll ever learn from me. The fact that any of them can get up and go to school, be in therapy for an hour, go back to school, do occupational therapy, have groups every single day, and still get up and smile is amazing to me.
"I just love seeing these kids every day and can't imagine myself any other place."
Boni Simonson starts talking to kids about discharge as soon as they arrive at the Ranch. "Preparing for discharge is different for every child, but I want them to tell me what they are worried about," Boni said. "What are they going to struggle with? How will they answer when people ask where they've been? I show them ways they can be honest without getting specific. 'I was having a hard time. I made some bad choices.' There might be rumors about why they left, so it's important for them to have a return plan."
Boni, who earned her master's degree in Clinical Counseling, has learned and applied many therapeutic techniques in her 28 years at the Ranch. With discharge planning, she likes to walk kids through potential situations. "I throw out scenarios and then we brainstorm."
"Part of preparing a child to leave is getting them adjusted to being back in the family, if they are returning. And the family adjusting to having them back." Surprisingly to some, when kids start getting close to leaving the Ranch, they often start to sabotage their treatment by acting out and regressing.
"I believe it's because they've developed close connections with staff and other kids and don't want to leave," Boni said. "I really don't think it's related to not loving their family, or not appreciating their new foster parents. They are just torn about leaving. If they've been successful here, it must be as terrifying to leave as it was to arrive."
While they are at the Ranch, Boni sees the kids individually at least once a week. They also have group three times a week. One of Boni's groups is at the barn so they use the horses to work out problems.
"Most of the time we do a problem-solving activity in group. This week we had an activity called Life's Little Obstacles. The barn was set up as a huge obstacle course that looked impossible for a horse to get through. Their instructions were to get their horse through the obstacle course without touching them or using a rope. Eventually, they figured out I hadn't said anything about re-arranging or changing the obstacles, and they were able to get through the course. The obstacles represented bullies and bullying. We discussed how problems like being bullied can look so big, but if they take it apart, step-by-step, they can get through it."
First and foremost, Boni focused on her relationship with the child. "The research shows that the relationship you build with them is the biggest factor in change and success. The more I've done this work and the older I am, the more I believe that is true."
Christy Wilkie believes kids don't want to hurt. And she believes with her whole heart that every one of the4m has the capacity to move beyond the pain.
Christy, who earned her master's degree in Social Work sees the resiliency of Ranch kids firsthand.
"That's why I do this work," Christy said. "Everyone has the potential and the power to heal. I am privy to seeing the capacity of the human spirit in a way that I don't think other people have glimpses into.
"Ranch kids are often defined by the things that happened to them and that's part of their story. But it doesn't have to be who they are. I have a kid right now who at her very heart and soul is an artist. Art embraced her and makes her who she is. I could choose to see her as an abused and traumatized kid, or I could choose to see her as an artist. I'd rather see her as an artist and then help her use her art as an outlet for all the stuff that happened to her."
"People forget our kids are all sorts of people. They are video game players, artists, friends, daughters, musicians, Christian kids who love to go to youth group. They are bright and creative and athletic. They're like every other kid who, most of the time, have just had the worst circumstances. But they are outrageously amazing kids. Every single one of them."
"I tell kids it's my job to take some of their burden and carry it around for them because I'm in a better space to do it than they are. Sometimes just downloading that and putting it on me to carry makes them feel a little lighter. Eventually, they learn to let more and more of that go and the road is a little bit easier than it was before."
One of Christy's clients was in treatment at the Ranch before moving into a foster home. The foster family adopted her, "but as you know, adoption doesn't undo childhood trauma," Christy said.
"She ended up at [the psychiatric hospital] and Tom, our treatment manager, and I were the only people she'd talk to. We went there and she was yelling at us and calling us every name in the book. She was a very angry kid and I adored her."
This young woman worked hard to heal, and her parents did a lot of family therapy with her. Now, at age 19, she is a high school graduate and a college student. Through it all, she continued to see Christy through Dakota Family Services, the outpatient clinic founded by the Ranch.
"She is one of those kids who likes to touch base and know the Ranch is here," Christy said. "I think a lot of our kids feel that way. When they leave, they know this is always a place they can come back to. There is a comforting feeling for kids who know that this was the place they healed."
Amber Nelson said the most difficult part of her work is seeing kids come to the Ranch with no outside support. "I have two kids on my caseload right now who have no family support. One has some contact with his siblings, but the child has no one."
In these cases, Amber asks questions to find someone in the child's life who has been supportive. Did they have a favorite teacher, a favorite youth group mentor, a pastor they felt comfortable with? She tries to find someone they can reconnect with, creating their own definition of "family," so they have a support system when they leave the Ranch. Sometimes it is a new foster family.
Amber says family therapy, however "family" is defined for each child, is so important to a child's healing.
"We do lots of really cool things with families. We'll bring the family in and help them process through issues with their child right in the cottage. If they struggle at home, we'll go to the home and do a walk-through to point out things they can change in the home environment to be more supportive and less chaotic for the child. We try to be creative with the family by using the whole team approach. We've had some families that visit their kids daily and just hang out with them. We welcome families that want to involved to the best of their abilities. The more we can join with the family, the better."
Amber, who earned her master's degree in Addiction Studies, said, "Part of being able to be with others, and with the people we care about, is about handling our own emotions. Much of the work kids do in therapy is related to emotional regulation and distress tolerance. Emotional regulation focuses on changing the emotion. Distress tolerance is being able to accept that, in this moment, you can't change your situation."
One of the techniques Amber teaches kids is "Wise Mind ACCEPTS." ACCEPTS stands for Activities, Contributing, Comparisons, Emotions, Pushing Away, Thoughts, and Sensations—all tools kids can use to distract themselves from the reality of a situation they can't change, and to cope with it.
Another important aspect of a child's healing is spirituality. Amber said, "A lot of our kids come here very angry with God. I've seen quite a few kids repair that relationship while they are here. Spirituality is an extra source of support for kids."
Matthew Baumgartner wants to be a part of the solution. He was working in Criminal Justice and saw what happens when people don't get the help they need.
"I've seen a bit of that darker side. When people don't learn social skills and how to regulate their emotions, things can go back quickly. I wanted to be part of the intervention with kids—getting them the help they need to live better lives."
So, Matthew returned to school where he earned a master's degree in Clinical Counseling and is the newest member of the Ranch therapy team.
At the Ranch, he quickly discovered that our kids come to us with a wide range of experiences. "We've all got histories and different ways of looking at things," Matthew said. "Especially our kids..they have so many life experiences and so much complexity. They are such a diverse population.
"Sure, there are some common threads," Matthew continued. "We see a lot of depression, anxiety, and trauma. But that's not who they are. It's something they are working through right now."
Cognitive Behavioral Therapy (CBT) is one of the techniques Matthew uses. Using CBT, Matthew helps kids discover unhelpful thoughts. Once they discover their unhelpful thoughts, they can learn to counter them with more realistic ones.
"For instance, maybe they got really angry at someone and when I ask them why they are angry, they say, 'Because they are messing with me.' We can challenge those thoughts. 'Are they really messing with you or are they just doing their job? Maybe you are taking things out of context.' We help them go deeper where they may eventually realize that not everyone is out to get them."
When residents start examining their emotions and the trauma they've faced, it often gets worse before it gets better.
"These guys have relied on aggression to get rid of some of their emotions. Now we are taking them to a deeper level. With a trauma-focused model like we have at the Ranch, we often work on building their coping skills before we touch any of the deeper stuff," Matthew said.
One of these coping skills is deep breathing, which Matthew likes to call tactical breathing. "The gentlemen I work with in Seegers cottage can latch onto that better than when we call it mindfulness. I talk to them about how focusing on their breathing can help them bring down their respiration rate and heart rate. When the body slows down, they are able to think more clearly in those moments."
Sometimes kids come to the Ranch with little or no hope. "A lot of our kids are already burnt out, and they are so young. I want give them hope for the future.
"Therapy is never going to be 100% effective," Matthew said. "But it is cumulative. Even if we don't see a lot of change in a kid while he is here, down the road if they're getting therapy or making life decisions, they can build on the work they did here. Eventually, you're part of the solution. Maybe not right away, but there is always hope."
This article was originally published in Ranch Voice: Winter 2019.
Read more stories like this and explore other issues of Ranch Voice here.