Grit defines what we ask of our clients, and what we ask of ourselves. It is in stark contrast to what we might refer to as “culture of convenience”. It requires us to prioritize direct communication, accountability, and honesty.
Our belief is that a “culture of convenience” can never be a safety-led culture. Safety requires depth, presence of mind and spirit, and shared norms and values. We see this manifest in our daily decisions. When a client wants their phone back but they haven’t yet completed their life story assignment and we have to make the decision to say no. When a client is best served by experiencing discomfort, rather than appeasement. It manifests in the decisions we make around admissions, how we market our services, who we hire and how we manage our staff and clients. When it makes more sense to scholarship a client for an extra month of treatment, even if it cuts into profits. Inconvenient, surely, but better.
A less challenging culture would require us to let everyone choose their own adventure, even at their own peril, rather than providing them with clinically led suggestions that challenge them just enough to their edge to allow for growth. When we started as a company, we had 2 therapists. Our team now consists of 10 therapists, plus a much wider collective of multidisciplinary professionals. With more opinions comes more labor in reaching consensus on the best way to deliver care — which means we must be as committed and dedicated as ever to our common goal.
Having an executive leadership board composed of people in long-term recovery, and sharing nearly 300 years of collective lived recovery experience within our staff at large, we know intimately the beauty that results from the shedding of old ideas, narratives and beliefs. And we know this only comes as a result of rigorous emotional, mental and spiritual work, without shortcuts. The temptation in growth is to scale by simplifying — to flatten clinical decision-making into protocol so everyone can move faster. We have tried to do the opposite. The slower path of conferring in real time about the right care for a specific person is harder. We believe it is also better.
So the larger questions become, are we “treating” our clients or co-creating a recovery experience with them? How can we continue to address the reality of emotional suffering through socioemotional skills and resilience? How does the external act upon the internal, and vice versa?
We expect miraculous growth and change, and often are witness to it. Not because we are forcing it, but because we consistently hone and adjust the program, culture and environment to apply pressure and support in the direction of positive, life-affirming change.
When our community is faced with staggering rates of anxiety, depression, personality disorders, substance use, loneliness, grief, existential concerns, lack of purpose, lack of belonging — our response must be more thoughtful than a xeroxed packet and a recovery movie. Treatment must ask something deeper of the providers; we must be willing to answer that call. Looking back on the past 10 years, we can reflect candidly on our successes and failures to live up to that greater vision.
This is part of why where the field has gone over the last decade matters — because we should examine the choices that distinguish good treatment from convenient treatment. We should start the conversation of where we fit in the greater landscape. Even in Arizona, experiencing a 40% growth in licensed centers since 2019, it’s hard to feel like we have begun to make a dent in the problem at large. There is still so much work left to do. When we first opened our doors, the concept of primary mental health treatment wasn’t even in the collective discussion. There was a sharp divide between substance use disorder treatment and primary mental health treatment centers. Dual-diagnosis or co-occurring treatment usually meant integrated psychiatry and not much more. It was a big differentiator if a facility understood or addressed trauma. Much of the available treatment consisted of a 12-Step-only curriculum. Only the most esteemed centers looked deeper.
Our decision in 2018 to expand our services to include primary mental health care and comprehensive dual-diagnosis treatment was our response to the complex realities our clients were carrying. Treating a client with both Substance Use Disorder and Borderline Personality Disorder with only 12-Step just wasn’t an option. We built out a full MH curriculum and split these groups for greater individualization. This was a newer concept to us but became our standard in short order. Inconvenient, surely, but better.
Today, the industry at large has changed. Most facilities offer psychiatry or medication management. Many facilities offer some level of trauma psychoeducation or process work. The industry continues to move in a positive direction of integrative and comprehensive care. 12-Step Facilitation is now viewed as a fundamental element of a greater treatment plan. Looking at the whole person instead of just the one piece that is manifesting in dysfunction is becoming more of a standard in the field. This is how we have been able to address such a diverse client population successfully.
Our clients have been our greatest teachers in this way. In the beginning, most clients were satisfied with some process groups, psychoeducational groups and 12-Step meetings. This was the standard 10 years ago. If you provided any level of individualization, you were really knocking it out of the park. Today’s clients are much more savvy and sophisticated. Not only are clients exposed to more psychological concepts and therapy speak in the culture, but they come into treatment with a higher level of agency and desire for how they want their treatment to go.
Our founder, Dan Nichols, LCSW, always likes to remind us that client self-determination is the most foundational principle, and that we also have an obligation to assist our clients using our best practices, skills and wisdom. And to do this effectively, it always comes down to rapport and relationship which is a byproduct of a genuine safety-led culture. Again, there are no shortcuts.
What the next ten years will ask of us, we suspect, looks a lot like what the last ten did. The willingness to say or do the harder thing when the easier thing is available. All practices with direct analogues to personal recovery. We are more clear about what good treatment demands, and we are more committed than ever to paying that cost on behalf of the people who walk through our doors. Providence began as a name we adopted because of the meaning “divine guidance or care”. We saw something miraculous in true change and healing, and have a relentless belief in it. Ten years in, our striving has become a discipline. Nationally, more than 1 in 5 adults are struggling with mental illness, and yet we are still witnessing the miracle of healing, and we are still doing the tough work to make it possible.
Learn more at https://scottsdaleprovidence.com
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