Dr Alex Danvers (Host): Hi, I'm Alex Danvers. Welcome to Behind the Miracle. At Sierra Tucson, we say that you can expect a miracle. And in this podcast, we're going to explore some of the stories and science underlying how we deliver these miracles for patients. I'm sitting here today with Kory Silva, our Associate Director of Resident Experience at Sierra Tucson.

Kory Silva: Hey Alex, how are you?

Host: I'm excited to do this. We're changing up the Sierra Tucson podcast format a little bit. We're trying to make it a little more fun and conversational while still getting all the expertise and wisdom of the many excellent care providers we have here at Sierra Tucson.

So Kory, I looked up your bio on the Sierra Tucson website, and you've got a ton of experience in mental health, in the startup world, and you also talk a little bit about your own journey of recovery. So, my first question may be a little broad, but what's your backstory?

Kory Silva: My backstory, I just started in my journey in behavioral health, because I fell flat on my face. And I was successful in some ways, but not in ways that were fulfilling or healthy, really. And I wanted to kind of take what I've learned in the startup world, take what I've learned in my own experience of recovery, particularly, trauma and substances and kind of turn that into something meaningful and worth having.

Host: Let's do the timeline, right? So, you are going through your bachelor's at University of Arizona. And after that, you started working in the startup world?

Kory Silva: Yes. We helped develop a logistics software where we were essentially trying to have like U.S. custom brokers or Mexican custom brokers, and our truck drivers and the companies that we're kind of using for the whole import-export business to kind of be able to communicate in a way that was really transparent and that people were held more accountable to get information, the paperwork done, and the shipments kind of processed much quicker.

Host: So, this is like a tech software startup for logistics for truck drivers.

Kory Silva: Yeah. A hundred percent.

Host: Yeah. That's a really big difference from Sierra Tucson.

Kory Silva: It is a really big difference, a hundred percent. You know, it's so funny it's like coming from a startup and like coming into this field, there's a lot of overlapping and I think that's what helps us make Sierra Tucson be as successful as it is. You know, I always tell entrepreneurs like if you were going to go down that road, you need to be extremely passionate and come into this field knowing that you know nothing. And that everything you know is probably wrong, and they're based on your assumptions and your experiences. And it really kind of allows us to develop a foundation where we are able to observe and see what is needed versus what we think is needed and kind of push our own agenda or push our own experiences onto others.

Host: So, from my point of view, actually, that's really interesting. Because I think for people who enter recovery, there's this idea that maybe they don't have great perspective on what their strengths and weaknesses are. They might have some cognitive distortions. These are the types of things they talk about in psych class, right? But it sounds like you're also talking about in clinical care, in leadership, right? You might come in with these ideas that are sort of preconceived notions or maybe a top-down frame, but you don't always think that's the right way to approach things.

Kory Silva: Of course not. You know, I think it's really interesting, particularly with like millennials and like Gen Z, they say that they are the loneliest and the saddest of generations, and I think it's because they were never really given the opportunity to really understand what gives them passion, what makes them feel connected, what makes them feel good about themselves. We really kind of start to see that disconnect or loss of self or even self-erasure because of being brought up in an environment where you are seen and not heard and kind of wounded themselves because this whole concept of getting help and mental health is still relatively new where we're actually being able to talk about it and not like be shamed about it. And I think that's what really makes that perspective very interesting.

I firmly believe that people who are unable to accept themselves are exactly who they are, people who are unable to kind of, I like to call, highly sensitive people, like, emotional hoarders, we pick up things that are not ours to pick up. And then, we turn these things into character-defining traits when they're not. You look at it from the perspective of like trauma, right? A lot of times, we're going to talk about, say, childhood and developmental trauma-- that tends to be my jam-- where say a caregiver was violent or sexually assaulted or whatever it may be, we're taking other people's behaviors and turning that into what that says about me. How does that make sense?

Host: Yeah. I think that's a great point because I think we do like talk about patterns that we develop. Maybe they were adaptive for getting us through a traumatic situation, getting us to survive something that was really not healthy. But then, if we kind of allow that to linger on, if we allow those patterns to kind of become part of our identity or maybe we don't develop a strong identity in kind of the way that you're talking about, then we end up stuck, right?

Kory Silva: A hundred percent. And that's when we become like a victim of our own circumstance and become a victim of life. This might sound quite silly. I'm a big Tupac fan. You know what Tupac is?

Host: Yeah, sure.

Kory Silva: Tupac has this phrase called like thug life. And what a lot of people don't know is you see on TikTok or whatever that thug life is like the cat with the little like Cholo Locs or whatever, pushing a cup off the table. And that's not what thug life actually means. It's actually an acronym that stands for "The Hate You Give Little Infants F's Everyone." And it talks about people do what they know, people do what they see. Like a perfect example of that is like, when have you ever seen a child at like the store at Walmart or something and have the child be like, "Hey dad, please don't buy me that because I'm worthless and I'm undeserving." You don't. And why do you think that is?

Host: Because they haven't learned that message?

Kory Silva: Correct.

Host: Yeah. I think if I did see that, I would just be devastated.

Kory Silva: A hundred percent, because it'd be really sad. But we don't learn these things. We're not born with these beliefs of ourselves. We're not born with these titles and these labels and personality characteristics or whatever that is. It's like, we're not.

Host: Yeah. I think, maybe just to dive in a little bit more about your story, right? So, there's certainly one way to learn about things, which is go to some kind of schooling and learn what the proper thing is for a therapeutic point of view, or learn what a psychologist is supposed to say. But it's another thing to maybe experience it from the other side.

Kory Silva: A hundred percent. Not to brag or anything, but my ACEs score is eight, right? So like, let's talk about that, right?

Host: Oh, we should start and say what an ACE is, right?

Kory Silva: All right. Adverse childhood experiences. There's like this scale where things are kind of listed, you kind of write down if that fits for you or not. But it's all about from the ages of, like, when you're born to 18, and just family dynamics and dysfunction and violence and all of the things, you know.

Host: And just because I'm the stats guy at Sierra Tucson, we do the ACES for all of our patients. We see that on average, most of our patients have a score above four. A score above four is, according to the research, the point at which childhood trauma is affecting your adult mental health, right? You're carrying that stuff forward.

Kory Silva: I'll be a hundred percent. Again, if it's what you know. And it's really hard to overcome because in order for us to survive, we need to really either make ourselves invisible, hide our feelings. I mean, if you look at even how deeply enrooted it is in us, look at it from the perspective of like passive-aggressive communication. Do you know how that's developed?

Host: I don't know always how it's developed, actually. I know that I sometimes do it.

Kory Silva: I mean, who doesn't? Welcome to being human, right? But it's like when you're brought up in an environment where it's not safe to express your feelings, so you're angry, you're internalizing it, you have all of this energy and it needs to come out somewhere, and that's where we really start seeing those passive-aggressive behaviors because expressing my feelings could be dangerous.

Host: This is exactly those patterns we're talking about. You learn these patterns and then you go into what should be a healthy workplace or a new relationship with somebody who is also trying to find psychological health and you're like, "Hey, I'm passive-aggressive."

Kory Silva: Right. And I think that's something that we do really well here, is that we are really able to kind of de-shame behavior by really kind of seeing everything that we do as a coping skill. Now, whether or not that coping skill serves us or is working for you or is healthy, that is a different conversation, right? But at the end of the day, it's a coping skill, because there's nothing fundamentally wrong with anyone. I remember my therapist told me once, "Abnormal reactions to abnormal events is completely normal."

Host: That's a great saying.

Kory Silva: Listen, I bought him a beach house. You know what I mean? Like I'm in therapy for a long time. And it's amazing to kind of really see that into fruition. I always look at them from the whole process of recovery. It's interesting because even looking at it from the basis of humanity, we were taught that human beings are the top of the food chain, that's actually not true. We did not become to the top of the food chain until we developed a tribe, which helped us survive our environment, because before we're just getting picked off by saber-toothed tigers or whatever was out there at the time and just getting eaten. And we start developing the community, we start being able to develop safety, develop being seen, knowing what your role is in that tribe, and like feeling good about what you're bringing to the table, and having that connection. Because healthy human connection is really what's the answer to everything, from my perspective.

Host: This makes me think of a lot of stuff that I got really into in grad school in terms of like how humans evolved, where did we come from, and there's a psychologist at the University of Arizona named Dave Sbarra who's written about this idea that, for humans, baseline is being around other people, being connected to other people. And if at any point we get away from that baseline, we feel isolated, we feel disconnected from other people, we're going to start having negative reactions. We're going to start having pathology. So, this guy is a relationship researcher, but he's making a broader point about how we find happiness, how we find that connection at an instinctual level.

And then, there's evolutionary biologists who say, you know, why is humanity so successful as a species? Because we work together, because we are hypersocial, because we can kind of come together as a family, as a group, as a community, as a tribe.

Kory Silva: That was a very insightful loaded thing, but it's like a few things came into mind. It's like, when have you ever heard of somebody attempting suicide at the breakfast table with their family? You don't. You don't. Why? Because like being connected is hope. Just even looking at it from the perspective of like how we are able to kind of track if someone's going to be able to overcome trauma, your chances increase dramatically when you have a connection to talk about it, to not be judged about it, to not be scared about it, right? Because that's what trauma does, is that it silences you, makes you feel like nobody would get it, nobody understands, which is why you isolate. When we isolate, things like suicidality become much more plausible, and the solution, that's why I always like to say it's like human beings, we might be the problem, but we're also the solution, because we need each other to kind of get over whatever happens.

Host: I just want to repeat that human beings might be the problem, but we're also the solution. I love it.

Kory Silva: Because we are.

Host: I think one of the things that I really admire about you here at Sierra Tucson is that you run the RT team, and that is our residential therapist program, and those are the people who are oftentimes running out to deal with people in crisis. And I know you've responded to those crises, you've talked to a lot of the other residential therapists and sort of managed them and coached them through how to deal with these. What do you find that you've learned from doing that at Sierra Tucson?

Kory Silva: I mean, listen, thank you, trauma. Because of trauma, I can deal with really big feelings in a way where I'm just completely unfazed by them, because I understand going back to like seeing whatever it is that they're doing, which is related to behaviors as coping skills and not seeing them as, "Hey, what's wrong with you?" It kind of really allows us to be empathetic, and empathy is a superpower. Empathy, I believe, is earned. And you earn that through suffering, because through suffering, you're able to understand emotions at a much deeper level, which allows you to make more organic connections. So by being able to flex the empathy, you're able to really re-regulate people quite quickly.

Host: Yeah, I love that connection that you're making here, because we're talking about these crises are often coming from a feeling of disconnection. And so then, what do you do in the moment to kind of get people out of the crisis? You reconnect. You use that empathy.

Kory Silva: There's a lot of data to even back that up, right? Like when you're dysregulated, going to a group of people who are regulated will regulate you. And it's all about that. It's all about maintaining ourselves regulated through the empathy, which makes it safe for them to have that connection to talk about it, and then you start to develop the buy-in. The buy-in is one of the hardest things to get. But it's also one of the simplest things as far as a concept goes. It's all based on safety and authenticity and we're also modeling what is like conflict resolution, which for a lot of us may have never experienced that at a young age and you cannot have a healthy attachment without undergoing conflict resolution, because conflict is necessary in life.

Host: Yeah. I mean it does seem like there's this pattern at some point, as an adult, you hit. You know, "Hey, there's conflict with my partner, there's conflict with my close friend. And I guess maybe I have to push through it." Or you can just keep dropping out of relationships whenever they get hard.

Kory Silva: Hey, listen, how about conflict with yourself?

Host: Oh, yeah.

Kory Silva: That's a really big part of that, right? Because I think the conflict within yourself is what drives the conflict with everybody else. If our goal is to get our needs met, and we have learned ways to get our needs met by acting out, by being angry, by being violent, by self-sabotaging, by all of these things. The conflict is not really with them, is it? It's a conflict within yourself. Some of us here at Tucson does, and I feel very passionate about recovery, because to me, recovery is the ultimate love story. Recovery is all about falling in love with yourself again. Falling in love with your empowerment, with your abilities, with your mistakes, flaws, and brilliance, because that's where the brilliance comes from, the mistakes and the flaws. And being able to encompass all of that. And I think that's something that we really do well here, is we embrace the messy.

Host: Yeah. I love that idea of recovery as being a way of falling back in love with yourself. Because I think, it's so easy to, In this modern world, doubt yourself, doubt your worth. "Oh, I don't have the things that I'm seeing other people have." And oftentimes we're seeing distorted messages. Maybe we're looking at our Instagram feed or whatever. And we're saying, "Oh, this person has got a perfect life. This guy's got a perfect life. This is a perfect life. What's wrong with me?" And we're not sort of appreciating the struggle, you know?

Kory Silva: I mean, listen, Facebook theory, right? Like, it's a thing. It's always funny. I teach a class, where we talk a lot about identity and how we compare ourselves to other people and need to see without actually knowing what's really going on. And there was a story I read about this guy who was always posting his amazing life. His 1.5 kids, and the little corgi, and the two-storey house, and the boat. But it's like I tell the residents, like, "What you don't know is that behind that picture, that boat is getting repo'd tomorrow. That relationship is in the middle of an affair." Things happen. And we can't take things for face value.

Host: Because in some ways, these platforms become kind of a way of curating our experiences and presenting a version of ourselves that we wish were true as opposed to dealing with the immediate of what's going on. I feel like for coming to Sierra Tucson, right? This is a residential mental health facility, so people are literally disconnecting from their lives. They're coming out here, living in the mountains on this like campus, a bunch of other people who are all trying to go through the work together. And they don't have their cell phones all the time.

Kory Silva: It's interesting because I think what makes residentials so necessary is that it's really hard to get out or gain perspective of your environment if you're in it. I think that's what the beauty and like the magic that is here in Tucson, is like you're walking around campus and there's literally deer like that just walked past you on your way to a lecture. So, there's like this fairy tale surrealness aspect to it that kind of helps people feel at ease and comfortable, because it's about to get really uncomfortable and really messy, because that's what therapy is.

Host: It's going through the work. I know I told you one of my early drafts for a name of the podcast was The Work, right? Like, that's what this place is about. It's not about, "We're going to give you the magic bullet or the special pill that's just going to take away all your problems." You're putting in work too.

Kory Silva: If there was a magic wand where I would just go, "Boop! No trauma for you," it doesn't work like that. I probably wouldn't be here. I'd probably be on a boat, actually, with my 1.5 kids. But the way that we recover from trauma is not changing the past, but changing the way that we feel about it. And that's all it is. Simple concept, difficult to do. But I think that's why understanding distorted thought patterns and how they have helped us in the past versus how they're not right now is really where it's at. It's understanding how we got here and radically accepting how we got here in order to change it.

Host: I think one of the things that we sometimes find with patients here is that they hit a wall and they worry about, "Should I just go home? Is this like too much? Am I overwhelmed?" And I think one of your big focuses in the last year has been thinking about how do we help people through these moments to recommit to therapy.

Kory Silva: The fight, flight, freeze, right? And some of us are runners, man. Listen, some of us run. That's how I ended up living in South America for a year and a half. You know what I mean? I tried. I tried, right? And, you know, something that I'm very proud of is having a chief clinical officer who really has mentored me a lot and gives us as clinicians like the space to be able to develop ways around that. Something that was kind of my baby for the past year or so has been like a grit model where we are taking different aspects, clinical and customer service and things of that nature and kind of molding it into like this therapeutic baby where we're able to re-engage people who are engaging in that running response, like if people talk a lot about AMAs.

Host: So, AMA meaning?

Kory Silva: Leaving against medical advice or advisement. And I always like to say that a treatment center, depending on what their AMA rate, is going to tell you how good of a program it is.

Host: I mean, this is something we hear from our CEO too.

Kory Silva: Oh, yeah. Dr. Price, right?

Host: Dr. Price. Yeah.

Kory Silva: And ours is incredibly low, and we've seen a dramatic shift in that percentage. It's because we're able to meet people where they're at, and also kind of fine tune these tactics to kind of help them regain power. Because why do we run? Because we get scared. Why do we get scared? Because we feel like we don't have autonomy. So, let's give them autonomy.

Host: For me, it's like, is this the place where you're finally going to feel comfortable enough to put in the work, right? And I know even on an outpatient basis, there's, you know, like, oh, you do therapist shopping or something, or you would try different places, and you're waiting for that connection that's going to be able to make you feel comfortable enough to dive deeply into what's really going on with you?

Kory Silva: A big part of change and being able to come to a place like this and face all of these things is that gift of desperation.

Host: Yeah, that's great. I think the gift of desperation is not something you normally hear.

Kory Silva: Listen, I always tell people, "If you're comfortable, you're doing it wrong." Be comfortable with the fact that you're going to be really uncomfortable. And I think the gift of desperation and that humility, because, I mean, you can't be desperate and still come in knowing, like, "I know all of these things." Desperation is, "This is not working for me, and I'm going to die if something doesn't change. Someone please help me."

Host: Yeah. And I think that is a place where a lot of people, there's a point of resistance, right? And I think the humility, you said it briefly, but I feel like that's the fruit. The gift is the humility that can come from it.

Kory Silva: Life has a way of humbling you. People talk a lot about my approach being all about life experiences, and just holding space for the things that normally people perceive that are cringeworthy, shameful or whatever. And it's like, I tell people, "Listen, I've been out of trash cans before. Who the hell am I to tell you what's wrong, what's not wrong, or anything like that? I am not that person. I'm not here to judge you, just like our staff is not here to judge you. We're here to kind of normalize your experience and also help you see that you are not these experiences.

Host: That's a really good point of connection for a lot of folks here. There are certainly a few people at Sierra Tucson who are working who have gone through their own recovery journeys, and I think that's a great way to connect. And it also kind of offers some hope. You went from being in this low point in your life to actually having a lot of your stuff together and making moves, getting stuff done here at Sierra tucson.

Kory Silva: When I sold my first startup, if anybody's an addict like me, I was an IV meth user, I have no shame behind that, and having a large amount of money to a person who is an active addiction is the most--

Host: Oh, boy.

Kory Silva: Oh, yeah. And you know, six years ago, I was homeless. And this is why I love this industry so much. And this is why I'm so passionate about what we do. And the team and Sierra Tucson as a whole, we're always evolving, and we are that center of excellence, because so much can change if people are just given that break and are able to find their footing. And we want to be that for them. That's why we tell people, "Expect the miracle. You are the miracle," because that's it. One thing can change someone's life trajectory dramatically.

Host: And take you from, "I'm selling a huge company as part of a startup" to "I'm homeless" to "I'm back to helping people through their own recovery," and, you know, managing people and coaching people and teaching people again.

Kory Silva: I think that's what post-traumatic growth is. And that's the importance of post-traumatic growth. It's not necessarily being thankful for the hardships or being thankful for abuse or things of that nature. But it's understanding that even though you have gone through these things that might be unpleasant, you have also gained a lot of skills that can help you change it.

I'm a firm believer, it's like, you hurt, you heal, you help others. Like, that is the blueprint to humanity, that is the blueprint to life, that is why we get a bigger dopamine hit when we do nice things for other people versus receiving the nice things. We're hardwired.

Host: To want to have that kind of community.

Kory Silva: Right. It's fulfillment.

Host: Do you have any other thoughts about the future of Sierra Tucson? What are you looking forward to?

Kory Silva: What am I looking forward to? You know what, there's so much that we offer. We work with some amazing people. One of the programs that I haven't brought up, but I would really like to talk about something that is a big force of why I choose to work here, and something that I have never experienced in both working at other residentials and as a resident myself. It's our ability to really help people identify who they are and having that space. You know, I remember going to treatment. I wasn't in a place where I could afford a place like this. I went to more of a state-run facility. And being a gay man myself, it was like, "Oh my, God. What is the rooming situation going to be like?" like, "Oh my, God. Am I just going to be ostracized for being queer, this, that, or whatever," which, again, reinforces the shame, right? So like, it's all part of the sickness and then coming to a place like Sierra Tucson where we are so accepting of everybody. We have people here trying out new pronouns, dressing differently, changing their names even, and like figuring out how to become authentically themselves. And that is something that you don't get to see everywhere.

Host: And because we're able to hold space. And maybe not have the same kind of experience you had where there isn't that same type of shame, right? There isn't that concern about, "Oh, Am I going to be accepted here?"

Kory Silva: Because listen, at the end of the day, we're all 12-year-olds, okay? We all have attachment wounds to some degree. "Will they like me? Will they not? Where am I going to sit during lunch? Oh my, god." To quote Cher Horowitz from Clueless, "The wounds of adolescence take a lifetime to heal." And I think that is so true! And you see that even in adulthood. And I think something that's here at Tucson has always done well, and particularly now, and something that I'm hoping to continue and even expand on is all that inclusivity piece. Being able to figure out who you really are, not who you were told to be.

I think that's one of the things that this is why I work here, because we do that for residents. We do that for staff and that's what allows us to do it for residents, is because in order for residents to be able to see that it's okay to be themselves, we need to have staff that are okay being themselves.

Host: I think that's great. That kind of brings it full circle, right? One of the things we first started talking about here is this idea of humility. As a staff member, I'm kind of like, I'm always here learning. I don't know necessarily what I'm going to walk into. I can't make any assumptions that I've got the answer right away.

Kory Silva: And we need to have that compassion for ourselves, that compassion for others. And it's so important that Sierra Tucson, and we do this fairly well, is that we're able to give our staff like, "Hey, you know what? Go take some time off." Something that I do with my staff all the time. "Hey, you're looking a little toasty. I need you to go home. Okay? I need you to go home."

Host: Somebody's had that conversation with me.

Kory Silva: I need you to go home, because if I cannot support you, then how are you going to be able to support somebody else? Because something about residential, and if people have worked at residentials, we're always visible all the time even behind closed doors.

So by being able to model a healthier work culture, and by being able to take care of clinicians and doctors and all the things, all the people that are here, we're able to show them what it's like to be in a harmonious, or to be in an environment that is safe, that cares about well being, de-shames burnout, has like self-compassion, and that's what we're modeling for them.

Host: I think that's a great message maybe to wrap things up on. Kory, thank you. It's been a pleasure. Kory Silva, thank you for being on Behind the Miracle, the Sierra Tucson podcast where we go behind the miracles that we try to create here every day.

Kory Silva: Awesome. Thank you for having me.

Host: I'm Alex Danvers. Thanks so much for listening. If anybody wants to learn more about Kory Silva and the work that we're doing here at Sierra Tucson, please visit sierratucson.com. Thanks again, and see you next time.