Treatment-resistant youth therapy with Riley Cochran

[0:00] Dan King here, as always, very much looking forward to a conversation with Riley Dan King: [0:05] Cochran, the founder and executive director of Resolute Counseling Center. Welcome to the show, Riley. Really, really happy to have you here. We'd love you to just start out telling the audience a little bit about yourself and the basics on Resolute. Riley Cochran: [0:19] Yeah. Hey, Dan, thanks for having me here. I'm Riley Cochran. I've been working with youth since for the last 15 years now in a variety of different settings and places. And Resolute is really the cooking pot, I guess, of all my experience and putting something together that is really intentional about working with youth specifically. So our specialty is 12 to 25 and really working with youth and young adults that people describe as like treatment resistant or treatment avoidant. But our whole philosophy is quite literally and logistically meeting people where they're at. So we do in-home work, we do community-based work. We have an office to do trauma and grief work and really try to embody the concept of therapy is appropriate for almost anybody and the belief that it's our role to help people find the right approach, right person, Riley Cochran: [1:12] right even setting that's going to work for them. Dan King: [1:14] It's a very distinct specialty that you picked. I'm curious what inspired you to specialize in working with youth? You know, there's so many sub-dimensions of that work from anger to trauma. What inspired you to pick youth and deal with these challenges? Riley Cochran: [1:29] Yeah, definitely my own personal experience. I think so many people in this field have some sort of personal connection to doing this work, working with youth specifically for me and specifically kind of quote unquote treatment avoidant, treatment resistant. My specialty is young adult males that have had some sort of fatherhood abandonment and attachment trauma and how that impacts our emotional intelligence, our interpersonal communication, even the behaviors that come to the surface. I think as a young person who my dad did the absolute best that he could, but generationally, you know, the stereotype of not having a whole lot of emotional intelligence outside of anger and happiness and finding non-traditional places that helped me move through my own youth experiences. And unfortunately, I wasn't the therapist. I went to rehab in an inpatient program for 18 months when I was 17 and really took a deep reflection. That's what birthed this work for me. And it was really taking a step back and looking at, hey, what worked for me? What worked and didn't work for other people that I knew at that time? How can I put together a program and a practice that's creative and meets youth where they're at? Dan King: [2:44] That's such, such important work at a high level because it's a bit, you know, beyond the scope of this to spend 10 hours delving into it, which we could. How would you summarize some of the fatherhood wounds and the general sort of systemic context in which these issues are birthed? Riley Cochran: [3:00] Absolutely. I think we could talk about it for 10 hours, so it's even hard to know where to start. I think in general, knowing that a lot of the work that I do now with young men, anger is the safe emotion. Anger is the emotion that is modeled and taught and shown and has familiarity with. And that shows up in society and in different places, school, sports, extracurriculars, where the emotion that's safe, that's comfortable, that's been normalized to express as a young man, also is the emotion that leads to problems, that leads to labels, that leads to judgments, and how deeply that can impact. Teen development is massively focused on sense of identity, and so when how we interact with others around us, especially as young men, where anger has been normalized as being okay, but then has responses and reactions from day-to-day interactions that place judgment and shame and response and reaction, I think there's so much guilt, shame, and confusion that young people hold. And it's really connected and correlated to how safe or how normalized anger and the role anger has in comparison to other emotions is. Dan King: [4:16] Yeah, the power of anger can be so all-consuming that even a society in an upbringing that disincent us from emotional awareness, we can't escape anger. It's there. It's often beneath the surface. Often it's just right in front of us. So even a society that especially for men disincentes emotional expression, anger at least you got to admit that exists. You got to have some relationship with it, right? Riley Cochran: [4:40] Yeah. And it's such a, it's an emotion that I think gets a bad rap because of often the behaviors that come with it and are associated with it. But it's such an important and valuable emotion. And I think that's a lot of my work with young men is helping them recognize and realize, hey, where is this anger really coming from? And then where is it spilling over into? And how do we reconstruct it so that it can show up where it needs to in a way that is healthy for you to engage with it? And then when can we also recognize, well, this isn't anger, this is shame or guilt or sadness or all these different things, but anger is what I connect to, so it's spilling over here. Dan King: [5:19] As men, for so many of us, our emotional range is so limited, right? So, so limited. And so I think for development, our identity can evolve so much when we get in touch with it and just see, man, there's so many different possibilities. I can feel so different when I'm in touch with that emotional range. And I don't think men have a support system that really encourages that. Riley Cochran: [5:40] Yeah, yeah, absolutely. And then, you know, I mean, if we want to look at like systemic systems, right, school and things like that, like unless there is intentional training in those spaces, often the reaction and response those spaces have to forms of maladaptive expressions of anger come with a whole internalization experience that if we don't work on or talk about it, that doesn't happen. Dan King: [6:03] Yeah. Yeah. That's a gateway to trauma. Yeah. Dan King: [6:06] So incredible that you have picked this as a specialization, that you've been focused on it for so many years. How has that evolved in the group practice setting? Because now you're working with other clinicians. It's not just your own work, right? Riley Cochran: [6:18] Absolutely. You know, that's a really good question. I think as a group practice owner, I've had to learn the importance of cultural alignment, I think. And like, because we are such a niched practice, those presentations come with their own barriers and challenges and, you know, being intentional about finding people that want to work with that stuff and training and developing them into being effective in that space. And I'll be honest, as a group practice owner, like there's been times where we've diluted away from that just by, you know, someone not really wanting to work with an angry, pissed off teen. Okay, what do you want to work with? Let's support that. Let's grow that. And then all of a sudden that's unintentionally kind of pulled the group practice in different directions. Dan King: [7:05] And they can be very tricky questions around, so I've got a specialization, how much is this going to be of the practice's work? If someone else comes in, they want to do something else, and I think they're broadly a fit, should we evolve the practice to do that? Or in doing so, are we diminishing our brand, right? Are we becoming something else that perhaps we don't want to become? And I can see how so many clinicians would struggle with this work because it is extremely challenging. Even as I heard you talk about it, I could feel a weight in my own stomach. Riley Cochran: [7:38] That's good awareness, Dan. I think part of new clinicians that I bring in a lot of the first work is helping people be aware of how this stuff activates and triggers us, right? We've all had relationships with anger and maladaptive presentations of anger. And so in order to hold that space for clients, are we at a place where we can hold that space and cope with it ourselves? Dan King: [8:00] How did you navigate that question of, hey, we're going to evolve and we're going to maintain this specialization. We're going to include clinicians that want to do other work, but only in a limited way. Like how have you gone about navigating that question? Riley Cochran: [8:13] Trial and error, I think, is the authentic answer there. I think specifically through that trial and error, we have learned that Resolute is a good place for two types of clinicians. Ones that love our niche and really want to become effective and have an immersive experience in working with those presentations and those trauma wounds. And then people who are pretty self-motivated and independent and are willing and wanting and ready to put themselves out there and learn how to establish themselves as a niche clinician in maybe a different niche or a different specialty. So where it's where it was challenging was, I think we've had to learn, unfortunately, you know, people aren't a fit at our practice if they're not within our niche, but they're also not willing and wanting to take an active role in establishing their own niche. I can coach people all day on like, how do you establish yourself as a niche clinician and how do you, you know, connect and network and trainings and set yourself up with a professional profile that can be niched down. But I can't go do that for you because Resolute is over here in this niched area, if that makes sense. Dan King: [9:24] If you're a clinician that's niching, you're trying on an identity. And if that identity doesn't fit, you can't fake it because the clients will know, probably even in the marketing, it will come through. So that identity, it's got to fit you. Riley Cochran: [9:38] Yeah, absolutely. Absolutely. And, you know, I think we've had that where it's a field where I would say most people have a big heart and really want to help people. And so this idea of helping youth that are struggling is like something that can show up in an interview and connect with people in different ways. But then I think it's as a group practice, it's trying to normalize that it's okay if you start working with this population. You're like, whoa, this is hitting so much stuff of me. Like, I don't want to do this. Like, that's okay. Let's name that instead of continue to, like, try to make it work if it just isn't going to work. Dan King: [10:14] Do you have a process for helping people answer that question? Because I can find it can be such a difficult question initially. You feel what you feel, right? Yeah. But it's possible that you can evolve into the person that can do this work. How do you help people make that decision? Riley Cochran: [10:29] I think it's a lot of conversation of what fills your cup, right? And if the barriers and presentations of our niche population are draining and demoting and like leave you just moving closer and closer and closer to burnout and that like there is a in i think this niche specifically like those breakthrough moments they they don't happen as frequently as maybe someone who's like self-motivated to to engage in therapy or an adult who's ready to do their own work right and so if the process of like engaging kids and building for and working through those barriers that are presented. If that process isn't fulfilling for folks, it's probably going to be a really Riley Cochran: [11:13] difficult niche to work with. Dan King: [11:15] Imagine. And picking up on this idea of filling your cup, I definitely want to delve in a moment into what fills your cup as a practice owner, because that's something you and I have talked about offline. But before we do that, just to play devil's advocate a little bit, I mean, some work is just inherently going to be more draining than other work, right? And so, is it the case that certain kinds of work that just, you know, as an industry, we need to do that work, that kind of work is more likely to induce burnout, right? Certainly, I'm imagining not having done the work, but I'm imagining very few or no clinicians are truly energized by it. Could we say that, hey, there's just a certain amount of burnout that doing enough of this work, it's going to be there? Or is there a different way, just to push you a little further, is there a different way we can measure whether this work is really a fit for a given clinician? Riley Cochran: [12:07] Yeah, I think that's a great question. So I try to... Normalize and name that this is, you're right, like this is a hard field and there's definitely a component of burnout that like there's a reason it's so prevalent in this field because the work is hard. And I would say like being able to become more aware of what does fuel us, what does fill our cup, like that resilience builder. And my experience has been probably my biggest protector against burnout is like the hard days are hard and I'm never going to like minimize that and take away from that. But have I built, am I connected enough to the things that truly fill my cup and how much of that is in the clients that I work with? And then helping clinicians on my team identify that as well of like, do the things that our clients present, are there aspects and components of that that truly fill your cup or not? And if they're not, or if it's really few and far between and hard to find. Have you had experiences working with other types of clients or other types of settings and situations that do fill your cup a little bit more, a little bit differently? And I think for me, that's at least the approach I try to take with supporting people. How do I help them navigate and become more connected to what fills their cup? Because that will be the resilience against what's just hard about this work. Dan King: [13:30] It's a beautiful reminder that a lot of it is going to be hard regardless. And still, even within that hardness, you can find silver linings, right? And so I know, I know for me, that's interesting. I mean, I'm not a clinician. I'm very aligned with the work I do. And sometimes in part, because it's just other health stuff, I feel quite tired. I feel the weight of its importance. And I think any of us that take on work that has a burden like that. We need to be super sensitive to which elements of it, are, you know, at a very, very deep level of draining. And yet someone has to bear this burden. And if I'm able to bear it, I'm going to keep bearing it so long as I can find some examples of, oh yeah, this, just give me this. Dan King: [14:15] So I think we're aligned on that. And so let's go now to filling your own cup. So you and I talked about offline, how, you know, you came to a space where you started to see some misalignments, some burnout within this journey of group practice ownership. Take listeners into that journey because I think there'll be some helpful insights. Riley Cochran: [14:36] Yeah. So I always knew that I wanted to have a private practice and kind of do my own thing. I've definitely been entrepreneurial and kind of independently motivated. Riley Cochran: [14:46] When the group practice actually started to grow, there was definitely this like new, very excited energy behind it. But I think after, you know, bringing and getting to a certain point where the more clinicians and the bigger the practice grew, the further away from actually working with clients, I had to start to shift and become right. And I think painfully, I had to take a pretty honest look at why do I feel so burnt out and so tired in the last six months now than I was when I was seeing 30 hours of clients a week? Like, what is so different between then and now? And really being honest with myself that, like, I hate managing people. I absolutely despise it. It, like, eats my soul away a little bit. I, you know, I love supporting people and I love getting to know people and I love understanding, you know, what does fuel people's cups and what do people care about and how can I support them? But as a group practice owner, there truly is like a systems oriented piece and component to it that if it's not set up and operating and running smoothly and clearly and kindly to people, I think it really starts to impact. Like that is, I think that I was unintentionally taking away from people's cups because I wasn't good at creating systems and sticking to them. I'm not a systems person. And people need that. People need grounding. Riley Cochran: [16:15] People need clarity. People need consistency in life in some senses, especially where they're working at, especially when the work that we do as a practice is so far away from that, right? Like the kids that we work with, there isn't consistency, there isn't predictability. And it was hard. You know, I love doing the work. I love connecting with my team, but I hate running a group practice. It's really been a difficult shift that I've had to be honest about. Dan King: [16:42] Thank you for seeing it, for naming it, for having the courage to talk about it. Dan King: [16:46] That is a rare gift, and I'm very confident it speaks very strongly of your clinical skills. So having seen this, what did you decide to do about it? Riley Cochran: [16:55] Try to hire and bring people in that do that stuff well and do it way better than I ever could imagine doing it. You know, one of the best things I've done in the last eight months is hire an admin person and hire an operations person and let them work together because they're both very detail-oriented. They love audits. They love insurance stuff. They love documentation, like all the things that I'm like, let's just do what we need to do and move on to the creative, fun stuff, they love those things. And I think it's, I've been able to witness the positive impact on my team and my clinicians because there's clarity, because there's understanding, because there's predictability. And I've had to, you know, I've had to work on my own control issues too. Like at the end of the day, it's my group practice, it's clients that I love and care deeply about. It's my niche that fuels my soul. And so I've had a hard time even with making those hires, stepping away and letting them do what they can do way better than I can. Dan King: [17:58] Again, beautiful recognition of how to build something in which everyone is more aligned. And so how does then this knowledge, how does it impact what you want to build in the future? Because, you know, you could take a very devil's advocate position and say, well, yeah, the founder can outsource a lot of that. But if the founder doesn't ultimately want to create systems, should they be running a group practice and should they be growing that group practice. I can see some counter arguments to that, but how does this affect the future? Riley Cochran: [18:27] Yeah, absolutely. I think it's being intentional about that piece right there, right? So like, I do, I like numbers. I like knowing how the group practice is doing. I like knowing like, what's the impact? What's our engagement as a team? You know, what's our retention as a team? Like, can we put things and supports in place? I like solving problems. I just don't enjoy Riley Cochran: [18:49] The systems follow-up that's necessary for things to be implemented consistently and so i think for me you know growing the group practice really looks like having more leadership and management roles put into the group practice and then staying one thing i'm working on is like having those people present to me the solutions and place me in a role of like when there is people coming together trying to solve the solutions and it's still unclear about what direction are we going I think that's where my role really steps in but like from the actual fundamental application and follow-through that's that's something that who I am as a person and my skill set really doesn't align well with and so being okay putting other people in those roles and from a hey where's the group practice where does it go I cared very deeply about families that are struggling with teens that have big behaviors and plan to focus my energy and efforts on creating more and more ways to connect with those types of families. Riley Cochran: [19:53] And knowing that that is how I directly grow the group practice is like the more creative I can get in that space. Now, what's the purpose of the group practice to help youth and families that are struggling with big behaviors find healing and hope in ways that works for them? And so when I can focus on that question and then trust, And this is my control issues, like trusting that the people I have in play now are going to work on the operational side and come to me when when there's a gap or a barrier or something that we're missing. And we can have conversations around, hey, you know, there's this hole in the practice right now. What can we do? I think for me, that's that's kind of where I feel. Resolute is right now. Dan King: [20:34] Last couple of questions as we come towards the end of our time together. How have you interviewed for these systems people, knowing that you need them to fill the gaps? Is it natural for you as less of a systems person to be able to tell when you've met the right systems person for the practice? Dan King: [20:50] Or has that been a journey? Talk to me a little bit about that. Riley Cochran: [20:53] Great question. I interview people for cultural fit right now. And then I have people that are So like Alex and Melissa do our systems and admin stuff like they interview the people that will be doing those roles specifically because they know how to ask the questions that tell them if they're organized and systematic and all that stuff where I'm like, hey, what what type of person are you? Is this going to be a good fit for us culturally? Let me do that type of the interview. And then you guys interview for the skill set that's needed for this role. Dan King: [21:24] Makes perfect sense. And it's beautiful to trust the people that share in the mindset and have a similar philosophy to screen for it, right? They're probably going to be quite natural for them to do that. Riley Cochran: [21:35] Yeah, they're way better than I am, for sure. Dan King: [21:37] When you're not building this group practice, when you're not exploring your mission and how to help youth and families, what do you do for fun? Riley Cochran: [21:43] I have a seven-year-old and a four-year-old boy, so we are an outdoor family. I live in Colorado. Hike, run, snowboard, bike, whatever we can kind of do. It's summer now, so I think the water where we can find it will be calling us for sure. I've got a big old Rottweiler that we like to walk around and just be in nature, honestly. Dan King: [22:10] You are privileged to have some phenomenal nature where you are. So take full advantage. Riley Cochran: [22:16] Absolutely. Dan King: [22:17] Riley, great, great to be with you today. Thanks for delving into some hard territory. You know, these are some thorny subjects, but I think going in there holds all kinds of insights, both intellectual and emotional for practice owners and clinicians and group practices. Dan King: [22:32] So thank you for being willing to dance into the fire a little bit. Riley Cochran: [22:35] Yeah, I hope it helps. I know I felt like I had to figure it out and held on to things probably longer than I needed to, knowing that there was misalignment, but feeling like it was just a wall I had to push through or whatever. So, you know, I hope I hope this conversation helps someone that's maybe stuck in that same spot. Dan King: [22:54] There's made very well. I know I've definitely seen past versions of myself in there as well. And I think others will too. So thanks.