Co-Regulation & Empathy are the keys with Dr. Rob Gent

A teen can be brilliant, funny, and “fine” on the surface while their nervous system is running on fumes underneath. That’s where we start with Dr. Rob Gent, Chief Clinical Officer at Pacific Quest and clinical psychologist with deep expertise in neurobiological development and family systems. We dig into why age and maturity don't line up with traditional expectations in adolescents and young adults with today's generations of youth. And target  the modern mix of ultra-processed food, poor sleep, chronic stress, and screen saturation can show up as anxiety, depression, ADHD symptoms, brain fog, and shutdown.

We also get concrete about what parents can do when home starts to feel like a daily negotiation with safety on the line. Dr. ob explains why reliable, predictable boundaries are not “tough love,” they are a loving structure that calms the nervous system and makes real empathy possible. We talk about the trap of micromanagement, the “behavioral hamster wheel,” and the shift to relational leverage, where trust and attunement start doing the heavy lifting.

From there, we go deeper into regulation versus dysregulation, Dan Siegel’s flipped lid, and why calm doesn't necessarily mean regulated. We explore integrative mental health care and functional psychiatry, plus experiential regulation tools like gardening, movement, and time outdoors. The thread tying it all together is shame, and Rob’s reminder that there’s no pill for shame, but empathy can dissolve it when it’s backed by consistent boundaries and co-regulation. If this conversation helps, subscribe, share it with a parent or clinician, and listen and follow Head Inside for more. 

Transcript

Welcome And Guest Introduction

SPEAKER_04 0:00

Hello, folks. Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment of experts, advocates, and professionals from across the country, sharing their thoughts and insights on the world of behavioral health care, broadcasting on WPVM 1037, The Voice of Asheville, independent commercial free radio. I'm Todd Weatherly, your host, therapeutic consultant, and behavioral expert. With me today is Dad Extraordinaire, clinician, neurobiology expert, Dr. Rob Jent. Dr. Jent is an accomplished clinician and expert in psychotherapeutic development with a distinguished career that spans over two decades. He serves now as the chief clinical officer for Pacific Quest, a residential mental health care program for adolescents and young adults on the Big Island in Hawaii. Dr. Rob holds a PhD in psychology with an emphasis on neurobiology and the science of relationship and development. His work is centered on the advancement and development of integrative health, where neurobiological, psychological, physiological, and relational development intermediate to create optimal healing and functionality. He remains deeply committed to innovating the science of integrative health and implementing research to enhance the effectiveness of therapeutic interventions and residential care. Dr. Jitt is a nationally recognized presenter, educator, and expert in the field of clinical therapy and treatment. His personal and professional journey reflects commitment to excellence uh in both his family life and his work. Dr. Rob, welcome to the show. Thanks for joining us.

SPEAKER_00 1:31

Wow, thanks, Todd. It's such a privilege to be here and uh be able to talk with you today.

SPEAKER_04 1:37

No, the privilege is mine. I'm just glad you uh took the six hour we we were able to navigate the six-hour time difference and make it work. Early morning for you, it's already afternoon for us. How's the big island going?

SPEAKER_00 1:50

Yeah, Big Island is beautiful. I feel very fortunate to be able to be at this place in my career, to be able to be here working with adolescents and young adults, and more importantly, with families and their parents. And there's this ongoing need, of course. Um, what does family systems work look like? You know, I just will say it really quickly. We see we're seeing this big gap between how old are these kids chronologically in years versus how old they are emotionally and developmentally.

SPEAKER_04 2:20

Yeah, and uh yeah, so it's that's been a topic in conferences lately. Um, yeah. I've gotten to see you speak, but I'm seeing others, and it's you know, we we you know, Ericksonian kind of logic doesn't quite fit anymore. It really doesn't. Um you know, you can't take a kid's age and look at it and say, hey, and you know, I I have to say, I'm super excited to have you as a guest on the show today because you are one of the most uniquely positioned people to speak to not only what's going on with families and adolescents and the stages of development and how we see it and the kids that are coming at us today, both in treatment and schools and everywhere else, but also, you know, you came, you were chief clinical officer at a large behavioral health company that owned lots of programs. I remember, gosh, five, six years ago, remember having you, you were jumping from you were running all around the country. You were, you know, Utah and North Carolina and California, you were going back and forth, you know, either reviewing a program or supporting a, you know, one of the clinical directors. And there were, you were just, you were seeing the span of treatment as it is delivered from from adolescent, you know, 13 to 28. I doubt there's anything in that age group, you know, from a treatment perspective, that you haven't seen so far. And then you you jumped across the the water to go over to what is ultimately a much smaller and intimate program. Um, in a in a and the big island, people don't think of the big island this way, but it really is kind of remote. Um, it's kind of a remote area. There's not a lot uh going on in the big island, there's a lot of tourism, but it's like a small town on a big island. Um, and uh having been there and having seen the program and everything, I I wonder how is it you compare the work you saw being at the helm of the behavioral health company with multiple programs in your view, down to looking at it from this, you know, a little bit more microscopic, like really getting invested in some of what it looks like for families and the clients that are referred to Pacific Quest and the kinds of problems you're seeing. Where do you see the contrast? What's the contrast in your view from a programming perspective? What's that what's that been like for you?

Why Integrative Health Changes Treatment

SPEAKER_00 4:37

Yeah, I appreciate the question, Todd. Yeah, it's it was an intentional shift for sure to go from this national big company. And a little bit of an anecdotal story is that it was presenting and traveling as you know, you saw me multiple places, and I kept seeing these common themes around nutrition, gut brain access. What are we seeing over and over again? We were wondering, you know, I would talk to clinicians, and you know, these kids were in a little bit of a brain fog, something was going on, and I would say to them, well, just ask them what they've had to eat in the last couple of days. And or the last hour, you know, in the last hour, and then I would get this response of like, oh wow, come to find out it was a bag of takis and a package of Oreos that they've had. And we wondered why they weren't had this fluid thinking and the vulnerability was tough, and there's ADHD, and there's all of this stuff, and so I we were seeing that pattern happening across the nation, and so I was very intrigued to look at it to to be able to refocus in a way where I wanted to really, really get down and understand. And Pacific West, I came here and spent a lot of time with them, and they have a very strong medical component to look at this principle of integrative health. So the psychiatrist, the the psychiatry, um, the medical staff here looking at how do we look at functional psychiatry, integrative health, and medicine, and tie that all into psychotherapy was this opportunity that I had not seen anywhere else and being able to prioritize it. I mean, you've been in this industry, you know how limited a psychiatrist's time is. You know that a true medical doctor looking at this relationship and then having professionals in a psychotherapeutic dynamic is very expensive and very hard to come by. Many people will say that, well, that's not the most profitable business model. That's true. But I I knew that coming here in PacificQuil was the ability to be able to really refine and seeing what the need is and how to treat that from uh even a looking at working with a psychiatrist. What medications are people on? Are are we seeing an accurate diagnosis? I mean, medications are so over-prescribed now. And absolutely essential, but this the medications need to be assessed in an ongoing environment where we could balance out. And this is what I knew Pacific Quest was very good at and why I wanted to be here. Um, is that you know, get them off the sugars, get him into you know, great unprocessed food, whole foods, get the right amount of sleep, the exercise, being outside. At this stage, too, when we talk about residential treatment, as you know, Todd, it's like I mean, who doesn't get a call or who doesn't struggle with? I don't know what to do about screens and my kid, they're addicted to their phone, they won't get off of it, and they're just locked in their room, or they're just absorbed by this stuff. So Pacific Quest for me was it was coming to the big island was a chance to get this population that was still occurring on the mainland, but get them into this very contained environment that we could really strip it away and do assessment and treatment in a in a much different way.

SPEAKER_04 8:19

But yeah, I was gonna say, in seeing the results, because I know you've had your hand in research, like what are the numbers, what are you seeing in the numbers? Are you getting to like do some comparative and get some other folks involved and colleagues and and look at what this re what from a research standpoint is looking like? What are the numbers look like right now?

SPEAKER_00 8:37

What do you see?

Outcomes Data And Faster Progress

SPEAKER_00 8:39

Yeah, so I've uh you know, we're we are part of the NATSA ongoing research project through the NATSAP. And thanks to Mike Petrie and R2D2 and all of that, yeah, we are we've been a gold member, PacificQuest has been a gold member contributor, so we can see lots of outcomes. It what's really been fascinating comparatively is to see the amount of getting out of clinically indicated numbers, clinical levels, into healthier, much healthier numbers in a quicker fashion. And when we look at like the SWL, we'll do the, you know, it's a measure of well-being. We see these rates are much faster than other programs. And I believe the correlation is to exercise, movement, nutrition, looking at the type of psychotherapy we are doing, looking at this from a developmental lens, working with the family systems, all of that together, I have seen compared to I was doing outcomes at this very large behavioral health company. We're seeing a much quicker um access to healthier numbers. And then I of course want to look at it long-term too. Um, so yeah, the numbers really reveal that there's more productivity to move these kids into healthier baselines quicker. Anxiety, depression, all of that's improving. We make sure that we do a family assessment device called the fad to be able to measure family interaction. And that's that's a huge piece because all of the physiological stuff we can do, Todd. I always kind of laugh at this, and we can put meds at it. There's still no pill for shame. Right.

SPEAKER_04 10:26

Doesn't seem to resolve even though the person doesn't is has got less depression or whatever, right? Or less anxiety. The shame is still there.

SPEAKER_00 10:35

Yeah, and those are all integrated, right? I mean, it's we're seeing the shame, the anxiety, the depression, those things of the trauma. When we can talk about all of this stuff, significantly impacts the shame, and we can take medications to, you know, slow the brain down and treat the ADHD and do all of this stuff, which is really great. But as I say, there's no pill for shame, but we know the resolution to shame needs to be this empathetic process. We can talk, you know, boundaries, expectation rules, all of these things, and how to set up appropriate structure for a kid to thrive, adolescent, young adult. How do we calm their nervous system with the structure that we can then move into a place of resolving shame? That's that's been a significant piece for us for sure.

SPEAKER_04 11:26

I think that um, you know, you you stated this in the beginning. Some of the some of the issue that we deal with in in the world at large is one silos. You know, yeah. You got the you got the medical doc over here and you got the psychiatrist over here. They're not seeing the client for more than 20 minutes and they're not talking to one another. And, you know, to get an integrated approach, to get a team of people, especially in an outpatient version, where all the therapist and the doc and the people are talking to one another. Um, and then there's the other thing, which is I I heard some report the other day, it's like, well, you know, the problem is is that um nobody's like nobody's uh setting off fireworks and doing promos for broccoli. Like, because it's broccoli. It's you know, Whole Foods, they're it's not a it's not a sexy thing. It's you know, you make a lot more money on Takis, you know, you make a lot more money on video games and phones than you make on broccoli and solid proteins and stuff that's cooked at home and those kinds of things. I when you've got a family and and you see this, I'm sure, or you probably don't get to see it as much now because you get to, you know, exist in an environment where you're focused with an integrated team. But the rest of the world out there, for kids who can't afford to come to Hawaii and receive treatment, which I wish they could, um, and peak kids that are in communities, maybe they're not at a residential level of care yet. And they're, you know, they're having trouble in school, they're doing a lot of refusal stuff at home. Mom and dad are are struggling with like setting the limits on screens and setting the limits on bedtimes and everything else. And then they start to have this symptomology. They're having suicidal thoughts or they're having depression or anxiety. If you were going to say something to a family that's out there on this cusp of like maybe needing residential care, what's something that you would say to them with all the experience that you have? What what what advice would you give a family that's sitting on that right now?

Safety First With Predictable Boundaries

SPEAKER_00 13:27

Yeah, it's that's a great question, Todd.

SPEAKER_03 13:29

And I definitely the first thing out of my that I would express to this family is what's reliable and predictable as far as maintaining safety within the home? Oh, yeah, that's a really great way to phrase that. Wow.

SPEAKER_00 13:45

Say more about that. Well, we we talk about that what is the most loving thing that you can provide for a child? Reliable, predictable boundaries. Parents often these days, and I find myself saying this, if I'm doing talking to parents or doing a coaching or whatever I'm doing with parents, I'll often ask, Do you feel held hostage? 99% of parents say, I totally feel held hostage. The cart is pulling a horse around, we're afraid that you know they'll move immediately to self-harm or they'll move into a place of threatening suicide. So we don't feel like we can leverage anything. So it's great to come come up with all of these consequences and stuff, but you know, you I'm sure you've heard this from a lot of parents these days too. Gosh, I I don't even know how to set limits with the cell phone because they do everything through the through screen time, their school, they're everything is in this, and so it's hard to parse that out. So for me, it really is about I would say to parents, really look at what is all about maintaining and sustaining emotional and physical safety has to be number one. Can you do this in the home? My encouragement, if you can do this from home, do this from home. This is great. Can you provide enough system? But what are those basic boundaries? And let's talk about natural and logical and relational consequences. That's super important for parents to be able to say, okay, so I need to really look at how do I set a foundation. That's right. And that can be extremely hard to do, Todd, especially in this day and age where you're like, parents don't feel like they have a lot of leverage.

SPEAKER_04 15:35

Well, I like this, but you know, you proceed at it like what's the most loving thing you can do for your kid? You know, it's it's hard to come up with a bad response that's the most loving thing. And I know that parents can be enmeshed and and can be boundaryless, and and maybe they come up with something that's not right about what's the most loving thing. I have a I have a cli have a family I'm working with, so I'm I'm just using this interview for free advice, is what I'm doing. I've got a client that I'm working with right now, and you know, it's a kid kind of in this position, be a kid that would be probably, in my view, very appropriate for your program. We'd get a lot of benefits for it. But um, one of the things that he, you know, you probably guess kind of on the spectrum, maybe, maybe some OCD, you know, OCD's been diagnosed, anxiety, suicidal ideation. The mom came up with something, and I just I I applauded her. She, he, you know, something happened, a limit was came up, and she needed to set it. He wouldn't do something. And so, well, I'm gonna take the phone. But she knows her knows her child well enough that you know, she said, I'm taking the phone. You don't have access to it right now. I understand that it makes you feel safe. So I'm gonna leave the phone right here on the table. I'm not taking it out on the room. I'm just telling you that you're not allowed to use it. I'll know whether you do, but it will be in your sight so that you're not it's not left and you know that it's there because I know that it's also a comfort. And that was the like, and he did go use the phone, which is amazing to me. But she came, she she knew her child well enough. So I the this piece about relational work, because I think we hear, you know, especially with the media that we've got today, like you hear what is supposed to be, how you set a limit with a child, or you hear what tough love is, or you hear all these stories and things like that. But and this is your field of expertise, something you focused on a lot.

Relational Leverage Over Power Struggles

SPEAKER_04 17:37

But what's your favorite? Give me a few one of your favorite stories on the use of a relational dynamic when you're working with these kids that are struggling with this stuff. Like, what's one of your favorite stories or approaches for that matter?

SPEAKER_00 17:51

Well, I I certainly think the uh the story about this mom illustrates some really wonderful principles. And for her, she understands the boundary that the phone is a no-go because what's the boundary? There's no self-inju, there should be no self-injurious behavior. If that phone is gonna heighten the anxiety and have some maladaptive, unproductive stuff. But certainly the mom does what? She sets some really clear rules and expectations around the phone, which is great. More importantly, because she that that boundary is reliable, that she knows that we could just turn off the phone, the phone's inaccessible. She feels like she has some control over that. She's actually freed up to do what? I love this. She's freed up to be then so attuned with her own kid that she says, What if he's on the spectrum somewhere? Boy, we could talk about spectrum brains, and they get very stuck in the left hemisphere and they're very logic-minded. And the anxiety, you know, it's gotta be there's some rigidity, and I gotta see the phone. I mean, I blind this mom, she's like, I'm gonna set it right here. But the expectation, the rule is very clear to help maintain his anxiety that that's terrific. So she's able to move into this place of having some relational attunement and sensitivity, and that's actually done because believe it or not, she has confidence in the boundary that can be maintained. And I think that's the problem. I tell this story a lot. Parents, if boundaries aren't, if there's not a clear path to follow through and maintain the boundaries, then we're always in this triage mode. We always held hostage. And how many parents have you spoken to, Todd, or or dealt with, where you can feel this like they're in micromanagement mode. They're killing themselves with micromanagement. And then they're getting into this pattern of the kid finding loopholes, and I call it the behavioral hamster wheel. They're on this behavioral hamster wheel trying to maintain all of this, and they miss the relationship because I like to talk about this principle. We want to move from physical leverage to relational leverage, and that's a developmental thing that most parents would love. Oh, great, I don't have to get all this physical leverage and threaten all this stuff or leverage all. It's really about developmentally, we're into relational compassion and understanding and regret and remorse, all of these pro-social developmental things that oftentimes I hear these kids struggle with. Does your kid have empathy? No, they're incredibly selfish. Let's talk about why and how to get there. Shame in itself breeds selfishness and being the victim. Shame strips us of real accountability.

SPEAKER_04 20:47

Well, in limit setting, you know, when a kid gets in trouble, shame's part of it. It's like, hey, you've got something wrong. You, you know, why you should feel ashamed of that, do something else because you don't want to feel ashamed anymore. But I, you know, I see the dynamic that exists for families at times when it's, you know, they they they chafe at chase after limits and they chased after being smarter, being more clever than their child, which I mean, almost universally the child wins this race. Because they're just, you know, they've got more free time, really, in the end, to kind of figure I can get out the window this way or out of the house this way, or get these substances, or whatever it is I'm after. They're very clever at going after one thing that they want. And when they feel like the thing that that causes their anxiety resolve, even if it's unhealthy, is being taken from them. It's just like you say, you've stripped them of safety. They don't know how to be safe without that phone, drugs, you know, some you know, indulgent relationship, whatever it may be. They don't know how to feel safe about that. Figured out a way to feel safe doing this, it's unhealthy. Yes, we see that. And they that you're going to go in it from trying to take it away from them. And it's like, you know, they they talk about this with people with kids on the spectrum as well. It's like you you've got to you've got to go at it from a safety standpoint. Like, what is it that causes this person to feel safe? And I and I, the other thing I think that that kind of gets us past some of the game, which is, well, you want your kid to be safe. Your kid actually wants to be safe, even though what they're doing is not safe, but they they want to feel whether it safety may be belonging, you know, it may be that they there's an effect, there's a feeling they're getting out of the thing they're doing, and that causes them to relax or abate anxiety. And you know, if you can ask a really good question, it's like, how do you and I both get the need met that we're looking at? Then you can be relational and you might, you know, involve your child for you as a clinician, and you're over the whole team, so you get to see all these, you know, clever new clinicians trying new things and all the cool stuff. Like, what are the cool interventions that you're seeing for that your treatment team comes up with and that your direct care staff and therapists are coming up that? What are the cool things that you're seeing out there that are really working with kids from a relational and safety standpoint?

Regulation, Detox, And Nature-Based Tools

SPEAKER_00 23:25

I really appreciate you talk about safety and uh I might I'll just throw a little bit of neurobiological stint to it. Why not while we're at it? If that's okay. But yeah, so I like to talk about this principle of regulation versus dysregulation. A lot of what we throw these terms around what's regulated versus what's dysregulated. When we're not safe and our nervous system is on high alert, we call it high hypervigilance or whatever that looks like. Believe it or not, that's unsafe. When we're when we're out of our window of tolerance, and our I use Dan Siegel's hand model of the brain, and our lid is flipped, our cortex is not attached, the firing is not happening between the rational brain and the emotional brain, and the nervous system is targeted.

SPEAKER_04 24:16

It goes through the toilet, you know?

SPEAKER_00 24:18

It goes right into the toilet. Yeah, we call this lid flip. This is dysregulation. And I often tell parents, and I I love that we we as a program understand this that we often get fooled that calm equals regulation. And that is not true. Calm does not equal regulation. How many kids with a proverbial hoodie and they're just isolating and they're tucked away and they they're in a an overwhelmed dopaminergic system. They're so overflowed. Yeah, they're dysregulated, but they can present as calm or they're shut down or whatever that means. And so for us, back to your your question is it's really wonderful to get back to this place. Now we have the luxury of there's no cell phones, or they don't bring them to treatment. So we've created an environment that has removed. Now, do they need to go through this detox period? Part of this thought is you understand, is that we have the luxury as kids come to us, they get off the sugars, they get off the carbs, they get off the screens, they do a full detox, believe it or not, and there's a relational piece to this. They're immersed into what I call the secure base. And developmentally, that means they're immersed and surrounded by people who are committed to doing what's developmentally best for them. So instead of timeouts, they get time ins. We're transforming, we're creating neuroplasticity in a way to help that regulation. They have to go through this process of recognizing what does it mean to be regulated. Now we have done some wonderful things. I can think of an anecdote. We we had this young man, an adolescent, who is very high IQ, high anxiety, super smart kid, has been through lots of treatment, seen all these outpatient therapists, very dysregulated. But showing up every day and being able to go into the gardens and take some ownership, put his hands in the dirt, be able to look at, hey, I gotta water plants, I gotta care, and being able to see some growth, doing that with some staff for us brought him to a point of regulation that we knew we had a foothold for him. So whenever he would start to lose it and get dysregulated and become really in a state of maybe wanting to slip into a sympathetic reaction, fight or flight, or get super defensive, going in. So an intervention for us is using some gardens that will go into the gardens and do some horticulture stuff. There's an ability to hop in the water, let's get in the ocean, let's do those things. But more importantly, it's about this relational context. What's reliable and predictable with the relationships that I'm having in the structure that I'm in. That's the number one thing to help these students move from a place of dysregulation to a place of regulation is really starts with relationship. What's reliable and what's predictable? That's we know that's the biggest thing. So we we talk a lot about shame. I mean, it it sounds like a little placating, but you know, Todd, our goal is shame causes dysregulation. If you've got ADHD, there's a strong correlation between ADHD. Uh are you familiar with the work of Robert Sopolsky out of Stanford?

unknown 27:45

Yeah.

SPEAKER_04 27:45

Oh yeah, yeah.

SPEAKER_03 27:46

Yeah. Um it gets brought up a lot in with guests that come on the show.

SPEAKER_00 27:50

So Sopolsky's work talks about some of his research, says our physiological states are correlated to our social emotional states, meaning that as we're filled with cortisol, it has a distinct relationship between states of cortisol and actually states of shame. Wow. How many of these kids have lib flips, are filled with all kinds of cortisol, stress hormone, all of that's going on with them? Dopaminergic system, adrenaline fatigue because they're always seeking this input. All of that produces a certain state is correlated to this principle of shame. And what's the only antidote to shame? Thank you, Bernay Brown. Empathy.

SPEAKER_04 28:34

It it brings me to a

Shame, Cortisol, And The Role Of Empathy

SPEAKER_04 28:36

story. So I'll I'll share a little personal story. Yeah, please. I um so I I've been married almost 30 years. So I I I share the story to talk about how slow I am, really. But you know, my wife was a was a military kid, you know, like jumped around, moved to all kinds of places, which also meant that, you know, suddenly you strip away from your friends and you go to a whole new environment. Hawaii was one of them. She's she lived on the island of Hawaii and and and experienced in Hawaii racism because uh she was not Asian. Uh you know, she had a teacher who was Asian, and you know, she has these trauma stories that are associated with school. And a lot of them, as you might imagine, revolve around shame. Revolve around, you know, you're not you're not good enough, or you know, you're not including the social group, or these friends are not, you know, her her her story is not different than so many others that are out there. And so, you know, anytime we've done the we've gotten in the the the heated debates or the quibbles or the whatever else, uh a lot of the way that we approach conflict, I think, at least, you know, having looked at it as a professional, having experienced it as a person, a lot of the way that we approach it, conflict with a person, if you've done something and I don't agree with that something. And I want to go to you and tell you about the thing that you did and how it's wrong. And and there's a conflict, there's a disagreement. It's like, well, you wouldn't want to be wrong with you. A person would be ashamed to be wrong. And we approach it from our our approach to conflict is shame-based in society, largely right now, I think, at least from what I'm seeing. And I'm not, and I can't say that I was ever necessarily different. It's like, well, you know, you do it the right way. You don't do it the wrong way. That's the wrong way. Who would do it the wrong way? You should be ashamed of that. Anytime I would approach my wife this way, I got into trouble. And I realized about 25 years in, I'm like, my wife hates to feel ashamed. And I if I want her to do something, you know, for me differently, I just need to talk about the thing that I need, not her being ashamed of something. Because when I do that, it triggers the response that's like, you know, from childhood long ago. And and I'm like, you know, and then I was like, you know, I think I actually do the same thing. If somebody tells me that I'm the terrible person because I did something wrong and I should feel ashamed, I'm like, who the heck do you think you are? I could, you know, like the reaction, just the the base reaction, I feel like that is humans that we we are, you know, we sit in the midst of. Um, and the reason why we use shame as this mechanism is because, thank you, Brene Brown, we forget to be empathic. We forget to have empathy for the person that we're working with. It's like, where, why would they do that? I, you know, maybe I felt this way about this, but maybe it wasn't about me. So, what is it about that we're actually dealing with? And you go that you one, you come up with far more sophisticated ways to deal with problems, first of all. And two, you end up in a relationship that's deeper and more sensitive and more, you know, more attuned. I love this word, more attuned, so that you can actually be with one another in ways that are effective. And that sounds like what you're teaching these kids, you know. I, you know, are you teaching that to families? I guess that's the question now. I know that you are, so that's a trick question, but like, how do you teach how are you teaching this to families? Because kids get through with treatment, they go home, and then they've got to land all this stuff back in the environment that they came from. How's that like, how does that look for you as a clinician, seeing these kids go off and return?

Family Change That Holds After Discharge

SPEAKER_00 32:32

You're you're bringing up the most critical piece, really, Todd, is how do we create the change within the family system? Because I mean, how many families have you seen good, good, good, great treatment and you plop them back right into the same environment that they were before? You know, and when it comes to substance abuse, uh, how many times I I'm forgetting if it was SAMSA or somebody did this research, but how many times do people go into substance use treatment before it starts to take root and their environment changes? Eight times before it they be they recognize, gosh, I have to change my environment. I have to change my supportive system to be able to make sure that this these are long-lasting changes. Eight times on average before it starts to take root. Can you imagine that? I mean, that that's a lot of treatment. And the point is is to really work with changing in the environment. So back to your question, how do we work with parents? Yeah, the parents are so critical to be able to move them into a place of they have to practice empathy, and that can be very hard because we'll talk about the nervous system. When we're on when we're on high alert or we're in triage mode, the luxury of empathy, empathy is a higher order thing. If we're in the moment and we're ourselves in the sympathetic and we're just worried about keeping our kid alive and doing this, we're on triage mode. We're not set for empathy. So when we can get parents to a place of recognizing that their kids are safe in the moment, it actually calms their nervous system. This is the work of parents. They can actually get back online, they calm their nervous system, and then they're in a place to actually evoke empathy. But here's one key thing that we don't often talk about. Empathy, Dan Siegel, Dr. Dan Siegel, if you guys are familiar with Dr. Sam Siegel's work, Louis Casolino will tell you. Empathy is the most efficient and effective mechanism for healthy development. Empathy. Brene Brown talks about it's the only antidote to shame. That's great. But here's the big piece empathy is only as effective as the person's boundaries are reliable and predictable. Let me repeat that. Somebody's empathy is only as effective as they are reliable and predictable. And I'll say to parents, have you ever been given empathy from somebody you don't trust? What does that feel like? I mean, you're like, what do you want? It feels disingenuous, it feels placating, it feels yucky, like you don't want it. And what's fascinating is quickly we then transfer it into mom and dad. Are you so reliable? Does your child trust you? Well, you don't have boundaries, we're actually enmeshed. Uh my I I don't know how to individuate. And if you're okay, then I'm okay. And we get into this, that actually it's what's interesting is foundationally there's not a reliable and predictable structure in place in order to have a real profound sense of trust. So the empathy actually then becomes less effective.

SPEAKER_04 35:46

I refer to it for with parents as standing still. Oh, I love that term. Learn how to stand still because you're running after them, you know. They're they're they're going all over the place, you're running after them. You're also they're okay, you're making your okayness dependent on their okayness. Yeah. And they're taking that out to the track and running it around. And you don't you you don't even know where you stand. So what I what I want you to do is I want you to be able to stand still and feel like you're not chasing after your kid. And yeah, I realize is a hard exercise, you know, if you feel like your child is in danger, but it's also you I know that you're probably familiar with this, it's neurodendritic, neurodendritic hypersensitivity. Oh, yeah, yeah. I love that term. Yeah, which is you know, all pain is too much pain, basically, for you know, opiate addicts. They they they so develop the nerve the sensitivity, or in that you get like five times the dendritic endings around a particular pain area. And it's like I think that parents develop this with like they have a they have an emotional neurodendritic hypersensitivity, like they all potential risk is too much risk. All potential fear of your child being in trouble or all potential anxiety that your child is experiencing is more than you can handle, and you do whatever it is to make it go away, and it just continues to make it worse. And you get to the end of that, you get into the end of the like a developmental phase of the of this kind of stuff, and that's when your kids are ended up at Pacific Quest because parents don't know how they're in and they're they're stuck, they need help, the kid needs help, maybe some separation from the environment's a good thing, and then all of a sudden you walk in, you start supporting them. It's like I, you know, I'd love to see the lights go on for parents who are like, oh wow, I'd have to be stable, empathic, reliably empathic, establish trust before we can get anywhere on this. Is that what you're telling me? Like the brand, the aha's that come out of that must be pretty, pretty incredible.

Co-Regulation, Oxytocin, And What’s Next

SPEAKER_04 37:57

Um, what is next for you? Like, I'm not talking about a job or anything else. Like, I know as a person having seen you present, having read some of your work, um I know that you've got a vision for where you want to see not just Pacific Quest, but the work of working with adolescents and young adults go somewhere. What is on what is on the horizon for you in that regard?

SPEAKER_00 38:22

Yeah, I appreciate the question, Todd. Um for me, really moving towards focusing on we've begun to do a PacificQuest, really elevate what I call our family intensives. Um, time that we actually come, the parents will spend multiple days with us. We've got pre-calls, we've got postcalls, follow-up, but it's looking at medical psychiatry, really and interweaving it with the psychotherapy piece. But I'm a big believer in everybody setting their phones aside for a second. Let's calm your nervous systems, let's create this space. And I'm gonna go back to the hand model of the brain for a second. I'm really intrigued by it, and I know that the research is really clear about this. The emotional system, our limbic system, subcortical system, and our nervous system, where our neurosception is, our autonomic nervous system, our central nervous system, has no capacity for words. We do not learn and grow our emotional system and our nervous system through words. So this is why interestingly, I always talk about if our lid is flipped, has anybody in our field or parent ever tried to talk our kids out of their shame? I mean, they've tried many times. We we've all tried, and it's ineffective. The emotional system and the nervous system only grow and learn through experience.

SPEAKER_04 39:52

The the amygdala also has long-term memory, yeah, like yes, right? You know, it's like, oh, that it stores like long-term information. So if it doesn't have any reliable experience of non-libed, non-lid flipped state, it doesn't know what to do, you know.

SPEAKER_00 40:13

Very well said, yeah. Well, no, no, it's great. Well, so this is where it's so fascinating to me. And then, of course, you know, a lot of my expertise is an understanding development, neurobiological development. That when we create, and this is not age-dependent, when we create this experience of what we call co-regulation, this comes from the work of Dr. Stephen Borges. You can read about polyvagal theory, is that we move through this place of dependence through co-regulation, which leads us to healthy self-regulation, that we get these parents in a place and these kids in a place where they're actually in the moment, it's called intersubjectivity, where they're co-regulating together. They're not talking to one another necessarily, they're not relying on the verbal exchange, but they're having these interactive experiences with eye contact, safe touch, congruence of affect, this wonderfully amazing developmentally healthy thing called co-regulation, where there's eye contact. All of this in the moment where they both intersubjectivity is even defined of we co-create meaning together. This is where this beautiful thing called oxytocin begins to take place. Oxytocin then is the resolver, it dissolves cortisol and it becomes the love drug and increases our bonding and increases this meaning and rewarding experience to be in a relationship, and that is where we get hardwired for self-worth. It's such a beautiful thing, Todd. So, what's next for me? Oxytocin, but getting them, getting these families, I want to do it nationwide, creating an experience where parents and children and even couples are together with each other and interacting with each other in a way that transforms neuro neuroplasticity in a beautiful way that they create patterns and a sense of neurobiological safety with each other, where this sense of self-worth can take place. And that's where we get resiliency and all of these wonderful attributes. So, how is that for what's next? That's I mean, I'm with you.

SPEAKER_04 42:26

Yeah, I'm with you on this charge. There's a the you know, if you I'm I'm a you know, armchair um armchair quantum mechanist. Um I I love reading about quantum mechanics, and there's some guys out there like, you know, I think eventually we're gonna boil the universe down to a couple of lines of code. And I think you kind of just did that to a certain extent. Like it might just be the this the dissolution of cortisol and co-regulation that's the answer to just about everything that we're that everybody's dealing. But we just have to create an environment where people can have an opportunity to experience it now. And in the water in Hawaii is not not a bad spot. Dr.

SPEAKER_00 43:09

It is a beautiful it is a beautiful place to do that, I will admit. Yeah.

Closing Thoughts And Farewell

SPEAKER_04 43:14

Yeah.

SPEAKER_00 43:14

Um, Dr.

SPEAKER_04 43:15

Jen, I I love hearing you talk and talk about the expertise. I can't wait to see you back out there in the the conference world again. I'm sure I'll catch you at some point in time, but it has been a real pleasure for me and an honor to have you on the show. Um, it's good to see you well. Um, it's good to see you and your family well. I've seen the pictures of you guys out there on the island. So um I hope that you will return to the show and we'll talk a little more about this this future worldwide goal that you have. Great. Thank you so much, Todd, for having me on. Absolutely. This has been Head Inside Mental Health with Dr. Rob Jet. We'll see you folks next time. Take care.

Post-Show Music

SPEAKER_01 45:28

I feel so lonely, you lost in here, I skill me. I feel so lonely, you lost in here, I skill me on need to find my way on the I feel so lonely, you lost in here, I scalp me, I need to fama way home, oh bamboa we're home.