Clinical Methodology

Cascade Crest Transitions (CCT) uses an integrative, evidenced-based, and relationship centered approach based on Motivational Interviewing and Dialectical Behavioral Therapy. In addition, our clinicians often utilize Eye Movement Desensitization Reprogramming as a means to address trauma and negative cognitions. See below for more information on each of these approaches.

MOTIVATIONAL INTERVIEWING

Motivational Interviewing (MI) is a client-centered directive approach used to create space for individuals to tap into his or her intrinsic motivation to overcome the ambivalence and increase the self-efficacy that keeps them from making desired changes in their lives.

Motivational Interviewing Principles:

 

  • Express Empathy
  • Dance with Discord
  • Avoid Argumentation
  • Encourage Change Talk
  • Support Self-Efficacy

The belief adapted by CCT is that direct confrontational or prescriptive techniques tend to increase a student’s resistance and do not support CCT’s belief in joining with the student from a non-judgmental perspective. The goal of motivational interviewing is for the student to work through dissonance and increase self-efficacy while moving towards personal goals identified through intentional reflection.

 

Staff at CCT are trained in the following motivational interviewing techniques: Reflective Listening, Dancing with Discord, Asking Open-ended Questions, and to Confirming and Supporting Self-Efficacy. Motivational interviewing allows a therapeutic relationship to develop that is non-judgmental and accepting of the student. The principle is to meet the student “where he or she is” instead of where each student “ought to be,” as defined by an authority figure. Beyond the specific Motivational Interviewing skills, the CCT teams works to embody the spirit of MI by maintaining an ardent belief in each student’s potential while holding a safe container for exploration and reflection.

Dialectical Behavioral Therapy (DBT)

Dialectical Behavioral Therapy (DBT) is based on a cognitive-behavioral approach to therapy. DBT is an empirically validated treatment used in a wide variety of settings and shown in research to be successful in treating substance abuse, trauma, eating disorders, and depression. The emotional regulation, interpersonal effectiveness, and distress tolerance skills are useful for any individual seeking a healthier, more balanced lifestyle and is especially valuable for our students who have often lacked the skills to persevere through challenge.

Basic Focus of Dialectical Behavioral Therapy at CCT
  • Increase students’ capabilities to manage emotions
  • Using mindfulness skills to stay in the present moment
  • Regulate emotions
  • Improve motivation
  • Ensure generalization to relevant contexts

The staff at CCT are trained to teach the students to use DBT skills in many different contexts and throughout the students’ daily schedule. Over the first three months students participate in DBT skills group twice a week to build the following foundational DBT skills:

 

  • Distress Tolerance Skills: Skills to manage a crisis without making it worse
  • Interpersonal Effectiveness Skills: Learning effective communication skills to communicate one’s wants and needs while maintaining strong relationships
  • Emotion Regulation Skills: Understand emotions; identify the effects of emotion on the body; balancing feelings to reduce reactivity and increase intentionality

Dialectical Behavioral Therapy integrates mindfulness skills to help students learn to stay in the present moment and to manage emotions and thoughts more calmly. Mindfulness includes developing a path to a wise mind where one can utilize interpersonal and emotional regulation skills to manage the dialectic of both self-acceptance and a desire for change.

 

Diary cards are used for students to record their emotional fluctuations on a daily basis. The cards are then reviewed with the student, staff and student’s therapist to determine triggers to emotions, skills used to manage emotions, and the effectiveness of those skills. As CCT students are increasingly exposed to more and more stressors and challenges through intentional scaffolding (such as college, work, as relationships) they are able to practice the distress tolerance skills acquired through DBT.

 

DBT teaches students to generalize the skills to a variety of life experiences to avoid relapse or other acting out behavior. The utilization of a DBT based Chain Analysis gives students the opportunity to explore old, dysfunctional patterns of behavior and develop a step-by-step plan to examine the thoughts, feelings and actions that triggered the old pattern of behavior. Examination of the behavior allows students information to manage dysfunctional behaviors more effectively in the future.

EMDR: Eye Movement Desensitization and Reprocessing

When appropriate, CCT therapists often employ Eye Movement Desensitization And Reprocessing (EMDR) as an established, integrative approach to addressing trauma and negative cognitions through an information processing approach. Successful outcomes are well documented in the literature for EMDR treatment of many psychological disorders, mental health problems, and somatic symptoms.

Eye Movement Desensitization And Reprocessing Steps At CCT:

 

  • Psychosocial interview to include treatment plan conceptualization to EMDR and other psychotherapy modalities and interventions
  • Client readiness including stability, teaching affect management, and coping skills
  • Develop EMDR specific plan for targeting disturbing memories and experiences

 

The model on which EMDR is based suggests many problematic issues present because of maladaptive encoding or incomplete coding of disturbing circumstances that prevent the ability to integrate these experiences in an adaptive manner in the present. For example, the young student who was made to read in front of the class when he was not prepared continues to process the pain and perhaps humiliation of that experience throughout much of his school days, thus, not liking school and not being successful. CCT offers EMDR to students, as do many other programs addressing mental health challenges, as a way to access an individual’s entire brain; accessing relevant material from the whole self, i.e.: emotions, sensations, cognitions. Often individuals who have not addressed trauma will shut down when facing threatening stimuli or triggers. EMDR has been particularly successful in addressing the triggers, or traumatic recall, that can lead to regression.

View more information on the Clinical Team at Cascade Crest Transitions.

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Choose Cascade Crest for the strong clinically and academic components as well as the incredible location in Bend, OR. The blend of these elements along with our ongoing services help young adults deepen their understanding of a healthy lifestyle while learning and practicing the skills necessary to live as an independent and successful adult.

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