Alex Danvers (Host): Welcome to Behind the Miracle, the Sierra Tucson podcast, where we take you inside Sierra Tucson and behind the famous Expect a Miracle slogan we use when we talk about the benefits we see of residential mental healthcare here. My name is Alex Danvers. And today, I'm talking to the Sierra Tucson Chief Clinical Officer, Dr. Ryan Drzewiecki. Ryan, thanks for being on the program.

Dr. Ryan Drzewiecki: Hey, thanks for having me. I'm super excited to be here and talk a little bit about what we do here at Sierra Tucson.

Host: Yeah. So for those people who may not know a little bit about your background, you've been in clinical psychology and therapy leadership roles for a long time. You worked at Hazelden Betty Ford. You worked at A New Leaf in Mesa. You worked at All About You Behavioral Health in Arizona. You founded the Mara Psychotherapy Group in Arizona and Colorado. And you worked at All Points North in Edwards, Colorado. And all of those are actually very prestigious places that give a lot of high-end, high- acuity care. What made you want to go first into psychology and then into leadership for psychology?

Dr. Ryan Drzewiecki: Yeah, that's a great question. I've just started to say it found me and/or I fell into it on accident. When I first graduated from undergrad, I had no idea what I wanted to do with myself. So, I just started working and started gravitating towards leadership. I actually started as a special education teacher and became the co-lead teacher and then a lead teacher and started to realize this was something that I really enjoyed doing.

Host: Special education in like a high school or a middle school?

Dr. Ryan Drzewiecki: It was actually elementary school, ages like 5 to 12-ish. It was a big group of students.

Host: Oh, that's a real journey because now we're in a setting here where we don't deal with anybody under 18. Have you tried to move away from kids? Is it pretty tough working with kids?

Dr. Ryan Drzewiecki: You know, it'd be interesting, I think, to revisit it. I know at the time it was frustrating that when you see kids doing really well in one setting and you start to realize some of the issue is the family dynamic, I found that very frustrating back then. But yeah, you know, I fell into working with adults and just really enjoyed it. So, I haven't really looked at kids since I became a psychologist. I haven't really worked too extensively with kids.

Host: Yeah, it's interesting. You started that journey in schools, but then you went on to pursue a doctorate in psychology, right? So, you had to be going in a different direction here, or maybe it sounds like some of the stuff that was going on with the family was maybe driving your thinking a little bit of like, "Oh, this is a whole other issue that doesn't get addressed."

Dr. Ryan Drzewiecki: Yeah I mean, that concerned me. And then honestly, I think I was just running from my own imposter syndrome when I decided to get into grad school. Once I realized I liked leadership, I started taking on more and more leadership roles. I ended up as a chief program officer for a company in Phoenix, actually co-founded that company, and then realized I was surrounded by all these people with all this experience, and it scared me to death. And I thought I should probably figure out what I'm doing. And that's what got me into school.

Host: Cool. Yeah. That's great. I mean, I think that's a really common story for a lot of folks. My own decision to go to grad school, I was influenced by reading a ton of popular psychology stuff. It was kind of the height of Malcolm Gladwell and Steven Johnson, if you remember, who were kind of tech and science writers. And I was like, "Oh, this psychology stuff is great, but I'd really want to make sure I know my stuff. Maybe I should get a doctorate before I start doing science communication.

Dr. Ryan Drzewiecki: I think we're both overachievers. We really shot high, didn't we?

Host: Yeah, yeah, yeah.

Dr. Ryan Drzewiecki: Like, "I'm not sure I know what I'm doing. Let me go all the way for a doctorate degree." Yeah.

Host: Right, right. So, you've worked at a lot of these sort of top treatment facilities in the U.S. And one of the things we talk about in mental health is obviously this idea of common factors, things that cut across all the different modalities of therapy that people provide and tend to lead to success, right? So for example, no matter what modality some therapist is using, if they have a good alliance or a good sort of connection with their client, that leads to a better outcome. Because of your experience, I was wondering if there are any kind of common factors that you see cutting across treatment facilities. Are there any things that you think are just general good things to look for in a treatment facility?

Dr. Ryan Drzewiecki: Yeah, I think there's really something to be said for the overall kind of holistic environment and how it all comes together. That's a very right-brained answer, I'm sure. But as a clinician, as a psychologist, I think it's less about like which modality you use to treat what. I do think that expertise in a wide variety of modalities is fantastic. But to me, I think it starts with being a trauma-informed community and what that really means. A treatment center has to be a safe space. It has to be a safe space for the people that work there, and it has to be a safe space for the clients that come there. And that's really the starting point for any successful treatment. If people don't feel safe, there's not going to be a lot of great work that gets done.

Host: Yeah. So, I'm hearing this kind of idea of integrative treatment and trauma-informed treatment. And I think I'd like to pick up maybe on both of those aspects. Sierra Tucson, what I found when I came here has a really integrative model. And by that I think about, "Oh, physicians collaborating with primary therapists, collaborating with specialty therapists." But I think there's probably a lot more that kind of goes into the way you think about this. What do you think about when you think about good integrative care?

Dr. Ryan Drzewiecki: I think about, number one, I mean, the importance of good communication. But yeah, in a residential setting and part of the reason that I love residential is that you do have the opportunity to really be integrative and collaborative, work together and put together a great integrative and holistic package of services. When you see somebody outpatient for your mental health, one hour a week, that person's really confined to doing things in one way. If it's a therapist, they're confined to one modality or at the outpatient level of care, you have a much more prescribed way of approaching things. Whereas in residential, we can put together a lot of different approaches from the integrative and body focus kind of approaches to psychiatry and the wide variety of different clinical modalities that we can put into play. You know, here in residential on the clinical side of things, we try to really expose people to an array of different approaches from the behaviorally-oriented, solution-focused approaches to more insight-oriented top-down approaches. And then, we try to figure out where that person's at and what they need in this moment. And residential gives us a really great opportunity to do that.

Host: Yeah, I think that there's something really nice about being able to kind of find a modality or an approach that matches with the individual patient, right? So somebody who comes in might be in a frame of mind where maybe the sort of motivational piece doesn't connect with them as much, but sort of something about processing trauma or something that's more body-focused might be a better way in for them. And I think, yeah, we're lucky that we have experts in a lot of different modalities here.

Dr. Ryan Drzewiecki: Yeah. And we can give people an exposure to a wide variety of different things and then also work while we're here to figure out what works best for them, both for while they're in our care, but also to inform their continuing care. One thing I think we really try to drive home here is that residential treatment is about getting to the starting line and not the finish line. If you're here for maybe 28 days, give or take, we're not going to solve every mental health challenge that you have. But hopefully, we equip you to understand what that journey is going to look like. And then it's something that you have to do every day. Mental health, it's a lifelong journey and that's what we try to do in residential, is just prepare you, help you to understand the trajectory towards wellness and get you to that starting line and, hopefully, take a few steps with you, but really help people to get set up for a long-term success.

Host: Yeah, I really appreciate that. I know you've brought that up in several of our kind of like internal meetings at Sierra Tucson. This idea that you're getting to the starting line, right? Mental health is this journey. And it's something that a lot of people will be dealing with throughout their lifetime of like finding their way through ups and downs. That's the normal human condition. And I think that there's something about maybe getting taken out of your normal everyday environment and plopped down in a beautiful place surrounded by a lot of people who are experts in healing, experts in trying to help people out of these holes. And it really does feel sometimes like a summer camp for healing out here. We've got horses, we've got walks around the track, beautiful mountain views.

Dr. Ryan Drzewiecki: We've got a lot of great amenities out here. And I also like to have some unstructured time as well. I mean, people are in a safe environment, and this is a great time to actually experience some stressors. You know, we always try to balance what does having a safe environment look like? How do we maximize a person's potential for growth and safety? Residential setting is all about leaving your home, going somewhere else, going somewhere with a lot of safety and a lot of containment. But then while you're here, we try to balance keeping people safe and helping them feel safe, but also allowing them to experience challenges and frustrations and figure out how to deal with that while they're in a safe environment.

The unstructured time at the end of somebody's day is just as important as the group psychotherapy session or the individual appointment from earlier, because that's where people learn, "Hey, what do I do when I don't have something on my schedule? How do I manage? How do I connect with other people or find peace in being alone? You know, How do I find acceptance and stillness and aloneness?" So, we throw together all those ingredients to try to get a great outcome from treatment.

Host: Yeah. I'd like to shift a little bit to this idea of a trauma-informed community. And I think this is sort of in keeping with the idea of this kind of integrative model, but I think in some ways it feels like a buzzword a little bit in mental health. But I also feel like you've done a lot of work here at Sierra Tucson in thinking through specific ways that we can be more trauma-informed. Do you want to talk a little bit about some of the things that we might be doing here or some of the ways that you think the staff and the clinicians here talk about trauma that's helpful for residents?

Dr. Ryan Drzewiecki: Yeah, I think even before we talk about the treatment of trauma, like I alluded to earlier, we talk about just creating a trauma-informed environment or a safe space. And that to me is more of an ongoing, active process of keeping a good balance versus just checking off a bunch of check boxes and saying, "Yay, we're trauma-informed." You know, we need to constantly ask ourselves like what creates safety? What creates safety in this environment? And how do we contribute to that? Because on the one hand, we're a controlled environment. We want to limit certain things. We need to have certain rules, because we have a lot of people here, but also understanding that having rules and exercising that kind of a control also detracts from a feeling of safety.

So, how do we create an environment where we can have appropriate rules in place that support safety while also really promoting autonomy and respecting that people are adults and that they've probably paid a lot or sacrificed a lot to be here. So a constant balance for us. And anytime we say, "Oh, you know, we saw so and so was doing this and we're concerned about it," we really just try to dive in and say, "Well, okay, let's talk about what it is that they're doing, what need they're meeting and trying to do that, and how we can best react to that," and really go from there. So, it's like an ongoing conversation to me in terms of what is trauma-informed care? It's keeping a balance.

Host: Yeah, I really liked that answer actually. And that was not where I thought you were going to go. I thought maybe you would talk about making the signs nicer, trying to change the language that we use around things. But I think the way that you're thinking about it feels a little bit more holistic and it feels like mental health and ongoing process, you know, how do we understand people meet them where they're at so that when we're telling them, "This is something that we think will be helpful for you," it's not seen as just kind of an arbitrary rule, but it's seen as something that's maybe setting a natural boundary or something that is going to be helpful on their journey.

Dr. Ryan Drzewiecki: Yeah, you mentioned the signs. That's kind of our current trauma-informed initiative, is looking at every single sign everywhere on campus and making sure that it is trauma-informed in the way it's worded. Um, you know, just to the, it makes such a difference. Language makes such an incredible difference. If you have a sign that says, "No smoking here" versus a sign that says, "Please smoke in the approved areas." It's a difference. I never want to be punitive. I never want to approach a treatment center as though it were a kindergarten. Like I said, like people spend a lot of money and make a lot of sacrifices to be here and they're adults. And so, at the same time that we want to create a safe environment by having approved smoking areas, we also don't want to wag our fingers at anybody. So, that's a big initiative we're doing right now. We go around, we take pictures of every single sign. We come back to a committee. We talk about the optimal wording and we go from there. So, that's one of many things we're doing to have that ongoing conversation about how are we creating a safe environment here.

Host: Right. I feel like there's also a kind of movement at Sierra Tucson, a kind of like forward momentum, always be learning about new approaches to treatment, new modalities. And so, to shift gears a little bit here what types of things do you look for when you look for what type of modality might work here at Sierra Tucson? What are you trying to evaluate?

Dr. Ryan Drzewiecki: Right now, our biggest push is to really focus on the approaches that are emerging out of this trauma-informed paradigm, trauma-sensitive kind of treatments. And these approaches that focus on retelling the story and reclaiming mental health and reconceptualizing mental health from a positive perspective. That could be something as similar as , acceptance and commitment therapy, or narrative therapy that talks about retelling your story in a way that's positive. What we find, and especially at this level of care and with this length of time, reducing shame around mental health is huge. That's one of our number one tasks. You know, IFS is another great approach that we're incorporating as much as possible. The idea that these parts of yourself--

Host: IFS, meaning internal family systems, right?

Dr. Ryan Drzewiecki: Yes. Yeah. Internal family systems. And the idea is that, you know, the parts of yourself that you hate, that you're trying to do away with are parts of yourself. You should realize they're there to protect you. You learn those for a good reason. They work in some circumstances and you can both want to change a part of yourself or a behavior, but also embrace that that part of you has kept you safe. And those are the approaches that we're really looking at right now.

To your bigger question, I think when I look at an approach, I just want to know that the people who are developing the approach have a real good sense of, I think, the different schools of thought in terms of the whole history of mental health and that they understand their place in that. I'd say that we're in the midst of kind of the fourth wave of psychotherapy, but I like an approach that knows what it is and knows its own place in terms of the context of what it is that it's trying to do.

Host: Oh, okay. Do you mind? I'm curious here, when you say you were in the midst of the fourth wave of psychotherapy, what you mean or what you think this kind of wave is about.

Dr. Ryan Drzewiecki: That's a great question. I have a presentation on this. And what I realized when I was doing the research is that everybody has a different model of what wave we're in and everyone is completely different. I learned the way that I think about it from grad school, I assume, but I realize not everybody defines the waves in this way, but I think about the initial wave of dynamic and analytic approaches that are very, very insight-oriented that really say the path to recovery is to learn things about your behavior that you're not aware of.

Host: So, that would have been like coming out of Freud and psychoanalysis.

Dr. Ryan Drzewiecki: Exactly. Yeah. Coming out of Freud and psychoanalysis. And there's still a lot of place for that. I think it's indisputable that we all have unconscious processes and learning about them can be helpful. But then, you get like the second wave to me, where the really humanistic and relational therapies that said, "That's all well and good." But what seems to me most important is developing a relationship and therapy is a vehicle to have and explore a healthy relationship, and therapy can revolve around that person's relationships with others.

Then, we had really the behaviorally-focused wave that said, "At the end of the day, change your behavior if you want to feel better." You know, if we're talking about a solution-focused kind of therapy, we need to just work on getting people to change their behavior." I think the current wave is this trauma-informed, shame-reducing kind of wave where we're really talking about embracing mental health and understanding that these mental health challenges are also gifts. You know, that anxiety poorly managed might be very, very overwhelming and cause a lot of functional impairment and distress, but anxiety well-managed can make you highly successful and different things like that. It's reconceptualizing mental health from a really positive perspective.

Host: Yeah. I mean, that certainly resonates with me. When I was starting graduate school, the positive psychology movement was still relatively new. I think was kind of hitting its stride and that was started by a clinical psychologist, Martin Seligman, who was really arguing that we've thought about psychology from the perspective of taking someone from a negative place back up to sort of baseline or going from negative to zero, but not from zero to that kind of positive place of flourishing or thriving. And I think that argument really appealed to me at the time.

Dr. Ryan Drzewiecki: Yeah. I still love that line of thinking and try to apply it both to managing the team here and then to how we deal with our clients as well. Like you're saying, if we take somebody and we say, "Here's what you're not doing well. Let's focus on that." It might see some growth, it might see some recovery. But if you say to somebody, "Here's what you do really, really, really well. Let's lean into that. Let's understand the areas where you're not as strong, but let's lean into your strengths. You see a whole lot more growth." So, that speaks to how we try to develop our staff here and then how we try to help our residents as well.

Host: Yeah. I really like that. Building yourself up around your strengths, because everybody has their own unique strengths. They have their own unique path that they've taken through life that's led them to develop certain skills. And we need to find places that allow us to express those skills, allow us to express those unique kind of gifts that we have. And I think it's easy maybe for my generation or maybe for a lot of people feel this way when you're young to be like, "I can do anything," right? You kind of get this message of, "Yeah, those sort of, "The world is open. If you just try hard enough, you can go out and do anything." And then, you sort of get into the world and you're like, "Oh, maybe not." But that doesn't mean there isn't something that you can find that you can really excel in and be proud of. And so, you might think, "Oh, well, yeah, I guess probably even if I trained really hard, I wouldn't have been a professional athlete." But I was able to find things that I was really good at and really passionate about, and I was able to make a contribution by finding that sort of intersection of innate interest and talent and desire and focus.

Dr. Ryan Drzewiecki: I think that's the way to successful change. I think that's the heart of change management. You know, the example I always give is you might have a client come in and say, "I want to quit smoking" and that's great. And you set that as the intention for your work together. But if all of your work together revolves around, "Stop smoking, stop smoking. What are you going to do to stop smoking?" You're not likely to have a lot of success. Whereas if your approach is, "Hey, what else can you do? What can you start doing? How can you start doing new things or leverage your strengths? Like, what are you going to do instead?" You have so much greater chance of success. You know, you don't lose sight of the fact that you're trying to stop smoking, but you don't focus on doing less of the bad thing. You focus on doing a whole lot more of the positive things that are going to satisfy that same need as the bad thing. As human beings, we just don't like to be told no, even if it's us telling ourselves no. We don't like to decrease negative behaviors, but increasing the positive is something that you get a lot more buy-in and a lot more success.

Host: I want to pivot for the last little bit here and just talk a little bit about some broader issues. You know, right now, it feels like we're in a cultural moment where there's a lot of negativity. There's a lot of issues with mental health and with loneliness. And here's where I lean into the Ted Lasso bit. You have chosen this as kind of a rallying point for some of the clinical staff of a shared love of Ted Lasso. Can you speak a little bit to why it appealed to you?

Dr. Ryan Drzewiecki: I think it chose me. Ted Lasso rose up and grabbed me. My team started calling me that because we've got this back office here and there's about five of us. And each one of us kind of corresponds to a Ted Lasso character. You know, Dr. Kincanon has a big beard and Elaine's got a lot of Rebecca characteristics and Kory is some mix of Dani Rojas and Roy Kent.

And my leadership style is very much about team building. It's very much about trying to-- like we've been talking about, just bring out the best in people and encourage others. I try to take a very lead-from-behind kind of stance and build other people up and help the people that report to me to flourish. And I think that's very Ted Lasso-esque. And that's how I ended up earning that nickname here.

Host: Yeah, I think it's really nice to see actually the positivity and maybe I'm leading a little bit here in my question because there's one line that I remember Jason Sudeikis giving about the success of the show. And he said, "It was a real surprise to us because we made a show about two things we thought Americans hated, soccer and kindness." And it just feels like Maybe right now we're in a cultural moment where there's not as much compassion and building each other up as there could be.

Dr. Ryan Drzewiecki: Yeah. I think that's totally true. I think we as a culture could probably be diagnosed with some sort of a trauma-related diagnosis here. We don't feel safe between COVID and politics and just an awareness of all the international conflicts going on between different forms of discrimination. I think a lot of people don't feel safe. And when we don't feel safe, we fall back on some of these less evolved defense mechanisms. Right now, culturally, there's a lot of black and white thinking, "I'm good, and you're bad." There's a lot of labeling and splitting and a lot of just defensiveness and a lot of orienting toward the danger. And I think that that lack of a felt sense of safety has impacted us in that way. And that's why I think a show like Ted Lasso really resonated, because we need some of that. We need a lot more Ted Lasso and we need a lot more similar shows and similar focus in the media to remind people to be kind to each other and to relax and not think about everything in terms of, "Are you with me or against me? Are you my ally or my enemy?" There's a lot of shades of gray out there and we've lost some of that nuance in the current climate.

Host: Yeah, it seems a little bit like we could all use a trauma-informed community or a trauma-informed approach to our daily lives, especially the way that you describe it.

Dr. Ryan Drzewiecki: Yeah. We all need to sing Kumbaya or something. I think we really need to find ways to reconnect. Also, and it's a completely separate tangent, but the internet's made us able to share frustrations in a way that we never have before and still remain anonymous. And that's really fueled the fire as well. We can say nasty things to somebody when we're not in front of their face. And that's really caused a lot of issues as well. I think it's different if you have to communicate more directly with people. But the internet's certainly been a double-edged sword in terms of having some great benefit and some incredible challenges and risks.

Host: Sure. Yeah. In grad school, there was a lot of talk about the different emotions that fuel engagement. And I think a pretty consistent finding for the literature is that anger tends to fuel longer engagement, and longer engagement tends to fuel certain kinds of ad-driven business models. So, I think part of the antidote to that might be the kind of stuff we've been talking about today, which is finding some safety finding some people who are willing to hold space for you and be accepting of kind of the positive and the negative and the complexity of the journey.

And also not having people tell you to do things because I think it's funny when you talk about those signs. I was just thinking about, I have a lot of friends who, if you tell them no, they will have that knee-jerk reaction. That might not be their last reaction and they might be willing to modify it. But encouraging the good, I do think works a lot better than saying, "No, don't do that." That's the bad thing to do.

Dr. Ryan Drzewiecki: Yeah. I think we all kind of have that knee-jerk in some way. You know, if you tell me the sky is blue, I'll say, "Well, I saw the sunset last night and it wasn't totally blue." So, I think I certainly naturally have that rebellious streak. But I'm also glad you mentioned connection too, because I think we've talked about a lot of different things and so much of it boils down to connection. And so much of this larger cultural problem you're talking about has resulted from us losing some of our connection with others. And that's something here at Sierra Tucson, we definitely try to lean on. At the end of the day, it is all about connection. It's about connection with the team here. It's about connection with the other residents. And it's about creating healthy connections with your family and with the world at large. And that's really the number one key to success, you know, and the number one predictor. I think all the research says isolate all the variables and the best predictor of your ongoing mental health is the number of strong connections you have. Or actually, it's not the number of the quality of the connections that you have.

Host: Yeah. We could go on, but there's a ton of research on loneliness and how bad it is for your health. And I think hopefully the coming wave of research is about connection and how restorative it can be.

Well, I think we're coming up against time here. Is there anything else that you wanted to mention before we go?

Dr. Ryan Drzewiecki: No, I don't think so. It's been really great just coming on and talking to you. It's been a lot of fun. And I'm always happy to talk about what we're doing at Sierra Tucson. I've been here about two years and still have a lot of big dreams for where we want to go. But I think this is a great place to come and a great place to heal. And I'm always happy to get some awareness out of what we're doing here and the model that we're kind of embracing and the direction that we're going.

Host: Yeah, you too. It's always great to hear your clinical wisdom, to hear your approach. I do think, like you, we've got a really great program here. But, you know, we've got big dreams. We're always trying to make it better. So, thanks so much. And yeah, hopefully, we'll keep working on making those dreams come true.

Dr. Ryan Drzewiecki: Awesome. Well, thank you, Alex. This was great.