Treatment Modalities

Milestones Ranch Malibu recognizes that “one size does not fit all” when it comes to providing effective and appropriate treatment. We pride ourselves on the development of individualized treatment plans to meet each client’s unique needs. Milestones has an abundance of on-site resources available and through the services our highly trained and experienced clinicians, offers a wider array of intensive and adjunctive therapies than most other residential treatment programs. After a comprehensive initial assessment by the clinical team, each client is provided with a customized treatment plan. Additionally, each client will participate in a core program, which includes:

Cognitive Behavioral Group

Clients learn how identify their cognitive errors and other thought distortions about themselves, the world and the future. Tools are taught to help clients identify and restructure their own maladaptive thought patterns. Interventions include role-play, psychoeducation, handouts, and weekly “homework” assignments to practice skills learned in session.

Dialectical Behavior Therapy

The bedrock of Dialectical Behavior Therapy is DBT skills.  The group setting is used to help clients address difficulties with emotion regulation, impulse control, interpersonal relationships and self-image.  DBT skills training helps clients change behavioral, emotional, cognitive, and interpersonal patterns associated with problems in living.  DBT combines the basic strategies of Behavioral Therapy with Eastern mindfulness practices.  DBT emphasizes enhancing dialectical thinking patterns in order to replace rigid, dichotomous thinking.  Research demonstrates that through DBT skills groups, people can learn healthy coping skills to support long-term healing and recovery from psychiatric and/or addiction issues.

Seeking Safety

Seeking Safety is an evidenced-based therapeutic model that treats the co-occurring diagnoses of PTSD and substance abuse. Statistics suggest that prevalence rates for a dual diagnosis of PTSD and substance abuse in addiction treatment facilities are as high as 59% in women and 38% in men[i]. Using the Seeking Safety model developed by Lisa Najavits, PhD., clients are assisted in developing a commitment to practicing safety, building of coping skills, use of planning skills to prevent harm, healthy responses to urges and cravings, and how to ask for help. This model offers twenty-five helpful treatment topics divided into interpersonal, behavioral, cognitive, and “combination” categories. The key elements of Seeking Safety designed to address trauma symptoms also overlap with traditional elements in substance abuse treatment, which are: education, a present time orientation, handling urges and cravings, attention to self-care, and a focus on relapse prevention. Client safety is the priority of treatment and there is an emphasis on practical solutions, which clients can apply in their daily lives.

EMDR

Eye Movement Desensitization Reprocessing (EMDR) is an evidenced-based treatment for trauma. EMDR can be used to complete a client’s treatment plan, since trauma-related stress is common in persons admitting to addiction treatment facilities. Symptoms that can be helped by EMDR include: severe anxiety, depression, distressing memories, difficulty trusting others, and unreasonable feelings of guilt and shame, to name a few. A central precept of EMDR is that – for some – distressing events are inadequately processed in the brain, and then become frozen in one’s neural network. Then, internal and external stimuli in the present trigger those memories, creating maladaptive responses and symptoms of anxiety. EMDR works – in part – by facilitating the adaptive processing of information i.e., distressing memories and experiences. The process of EMDR diminishes the power of trauma-related memories and teaches adaptive coping skills. Client and therapist work in partnership, guided by respect for and understanding of the client’s comfort level, in order to find relief from trauma-related stress.

Process Groups

This group is about relating feelings to the here and now, with the leader providing guided feedback and process comments. Clients learn how to identify feelings and emotions, discuss them, and move forward. Other skills include learning to stay present with feelings, and allowing feelings the space to exist. The core components of a process group is that each client brings their unique life experiences and coping mechanisms to deal with these experiences. More often than not,  these experiences and coping mechanisms remind other group members of significant people in their lives, past or present and they are able to work through feelings both positive and negative with the help of a “skilled” group facilitator.  The group facilitators role is to allow the process to unfold while drawing attention to the interpersonal dynamics within the group rather than to one individual.

Anger Management

Anger management group is an in-depth exploration of the factors that both determine and affect one’s ability to manage anger.  The group’s main emphases are on skill building and education. Topics include: identifying high-risk situations; creating a personal “tool-box” of skills; raising awareness of irrational thinking; reframing distorted cognitions; self-soothing skills; assertive self-expression (rather than aggressive); problem-solving and conflict resolution skills; and effective communication. Topics are introduced and explored, while clients are aided in making connections to their own experiences. This group also aims to raise client awareness of precursors and expressions of anger, as these relate to her/his own addiction process. Weekly topics are designed to create insight, stimulate reflection, and strategize about how to manage anger productively. Special attention is placed on providing a psychoeducational experience designed to raise client awareness, level of cognitive functioning, and patterning relevant to the different aspects of anger management.

Etiology of Addiction

Many factors influence the development and course of addiction. This psychoeducational group provides a forum for discussion on the biopsychosocial causes of the chronic, relapsing brain disease known as addiction. Based on the premise that education helps empower clients in recovery, this group provides information and opportunity for patient-relevant discussion of the causes and course of addiction. Education includes in-depth exploration of all the different factors that determine and effect the development of addiction.  Various models for understanding the development and stages of addiction are explored and explained. Through stimulating activities and discussion, clients are encouraged to connect information to their own experiences and understanding of their addiction process.

Brain Fitness Group

A group to motivate, encourage and stimulate brain health as it relates to overall wellness. Through therapist-led exercises, presentations, and discussions, clients are taught to improve their capacity for meeting the cognitive demands of everyday life. Attention is paid to identifying individual learning styles and ways to learn more efficiently, A variety of brain-related topics are taught, including: time management; memory strategies; attention/concentration; goal-setting; executive functioning; organization; problem-solving and metacognition; sleep hygiene; stress-reduction techniques; and physical exercise.

Shame, Guilt and Forgiveness Group

A group focused on shame, vulnerability, and developing the skill of shame resilience.  Shame is a universal emotion that is not often discussed in our culture, yet influences human interaction and recovery outcomes. This educational group uses the work of Dr. Brené Brown and The Daring Way™ program to help clients understand the role of shame in their substances use and how to overcome it long-term.

Skill Building through Role-Play

 Clients develop skills through the role-play of situations and events in their lives that would normally trigger emotions with which have learned to associate drug or alcohol use. Clients build the confidence to respond with new behaviors by recognizing that they can accept their feelings while communicating their intentions. Through rehearsal, clients learn to distinguish between unhealthy “defense mode” and a healthier, “intention mode” as it relates to their goals. Through the practice of intention – rather than learned reaction and defensiveness – change occurs organically. Through practice, group role-play, and the shared learning experiences created, clients learn acceptance, empathy, trigger awareness and management, and boundary setting.

Desensitizing Cravings

 Through biofeedback, clients can observe real-time measurements of the stress-response created while thinking about stimulus of substance use. Clients are then taught and guided through the practice of both self-regulation and state-changing techniques, as well as the technique of shifting focus. Clients also learn that they have conscious control over changing associations. Creative use of metaphors helps group members reframe their stress response, so they are more in control of their responses, reactions, and behavioral and cognitive alternatives. Clients build confidence (by observing through biofeedback) as they see their bodies’ new response to formerly activating stimuli.

Relapse Prevention

 This group is designed to increase client understanding of the emotional, physical, and neurological changes that occur during early stages of recovery.  As a client’s knowledge base builds, skills are taught to help clients progress successfully through the stages of recovery. Through the use of educational videos and handouts, plus group exercises and discussions, clients incorporate and practice new learning. Special emphasis is placed on recognizing – and managing – the struggles most common to all addicts and alcoholics in the early stages of recovery.

Codependency Group

Codependent relationships – a dysfunctional relationship where one person supports or enables another person’s addiction, poor mental health, or under-achievement – are ubiquitous in substance-abusing family systems. This group provides effective coping skills, along with psychoeducation about the many manifestations of codependency. Codependent themes are explored and creative coping skills are shared and learned as a group.

Popping Patterns Group

Patterns work uses written and experiential exercises to identify and diminish negative patterns of thought, emotion, and behavior, such as shame, displaced anger, people pleasing, caretaking, complaining, blaming, anxiety, and depression. Handouts and discussion are an integral part of the work as clients learn about the patterns that underlie addictive behaviors and govern their daily lives.  The ultimate goal of Patterns work is positive, personal transformation.

Building a Positive Future-self

Clients learn how to associate with a positive version of themselves; enjoying sobriety as well as achieving goals and living a life of purpose. Activities and discussions include recognizing belief systems that interfere with self-responsibility, understanding the power of intent, and connecting a resourceful state to a desired outcome. Clients are led in meditation in order to internalize newfound learning and goals. Special attention is paid to how to move toward their desires and break the cycle of preempting, defending and avoidance.

Art Therapy

Through the creative process clients can enhance their emotional well- being. Constructive ways are found to share their emotions, foster self-awareness, reduce anxiety and increase self-esteem through artistic self-expression. Clients use various art media and the resultant artwork to explore their addictions, history, mental health issues, reduce stress and triggers in our beautiful art studio.

Music Therapy

This group uses music interventions, which include creating, singing, moving to, and/or listening to music.  Through music therapy, clients are helped to connect with their feelings and emotions. Music therapy is used in a variety of ways to help accomplish treatment goals.  For example, sessions may include: song analysis, drumming, imagery to music, song writing, etc.  No musical skill is required to participate fully in the session.  And because sessions vary from week to week, clients are unlikely to have the same experience twice during their residential stay.

Diagnostic & Medication Group

Psychoeducation is provided on the etiology and outcomes of mental health and substance abuse conditions, as well as the medications used to treat them. This type of psychoeducation allows for the debunking of common myths and misinformation, as well as supporting client self-determination through relevant knowledge.

Somatic Experiencing

Somatic Experiencing, a method developed by Dr. Peter Levine, is a form of therapy used to treat trauma. Guided by Dr. Levine’s concept that trauma – once endured – remains trapped in the physical body, clients are guided through sessions to help them release and process past trauma, thus allowing healing to begin.

Family Therapy

The treatment team at Milestones Ranch Malibu works with clients and their families, providing psychoeducation, skill-building, and modeling of healthy interactions to help the entire family system effectively transition into  healthier relationships.

Family therapy at Milestones Ranch is individualized for each client that comes in the program as everyone has unique circumstances leading to them seek treatment.

We strongly encourage as much family therapy as possible as well as individual therapy and Al-Anon for the family members  so the client’s and their families can grow together.

We begin family therapy as early as the first week of treatment, again based on the clients unique set of circumstances. It’s a collaborative process between the family therapist, client and their families. As long as the proper consents are in place, families members are kept abreast of their loved ones progress throughout their treatment.

Family therapy is preferred to be conducted in person, although can also be done via HIPPA compliant Skype or conference calls.  When a family member is traveling a distance for family therapy sessions we provide a minimum of three days of intensive family therapy programming which would include:  daily sessions with the family therapist,  session with the psychiatrist, adjunct therapists sessions as well meeting with the internal medicine physician if there are any significant medical issues.

Cinema Therapy Group

Clients use cinema as an innovative medium for relating to their emotions and experiences, communicating their thoughts and feelings, and reconnecting with the world around them.

Stages of Change Group

Using the transtheoretical model of behavior change (TTM), interventions are tailored to a client’s unique readiness to change. With the understanding that clients are at different stages of thinking about changing substance use or making changes in their substance use, this group aims to motivate clients along the continuum of behavior change.  Examples of intervention techniques include psychoeducation, problem solving, discussion of roles, effective communication, managing stress and criticism, and healthy ways of rewarding successes.

Motivational Interviewing Group

Group is conducted using a guiding, client-centered style of conversation in order to identify, awaken, and support a client’s own motivation for behavior change.

Stress Management Group

Clients learn to identify sources of situational and/or chronic stress in their lives and find healthy alternatives to cope with and manage them.

Meditation Group

Clients are guided in meditation practice in order to find inner peace and tranquility by focusing their energy inward and practicing this ancient art.

Trauma Group

Clients walk through their past trauma and discuss and process how trauma has affected roles, relationships, and their quality and experience of daily life.

Acupuncture

Clients may elect [if deemed appropriate by their treatment team] to receive acupuncture services to aid in pain management, relief from discomfort, the stimulation of nerves, muscles and connective tissue, or simple relaxation. Acupuncture sessions can serve as a functional complement to the mind-body work done during their stay at Milestones. Traditional Chinese medicine explains acupuncture as a method for balancing one’s life force, or flow of energy. More modern, Western practitioners understand acupuncture as effective through the stimulation of neurohormonal pathways and/or pro-inflammatory markers. Before treatment, clients can discuss their specific needs and expectations with the practitioner to help ensure a positive outcome.

Fitness Group

Led by a credentialed personal trainer, clients will strengthen the connection between mind and body, as well as bond with their peers in fitness classes tailored to the group’s collective needs, and designed to be fun and invigorating.

Exposure Therapy Outings

Residential technicians accompany clients off-site (as a group) for supervised, structured outings multiple times a week. Clients learn how to thrive, find joy and experience life without substances. Outings focus on either acts of service, continued adult learning, and/or arts and culture. Under the caring supervision of staff, clients have real-world experiences and learn to respond differently and healthfully to everyday social and environmental cues.

Yoga and Martial Arts GroupsClients further the mind-body-spirit connection by engaging in groups centered on yoga and the martial arts.

In addition to the core program, individualized components – determined by the client’s needs – may be added. These options include:

  • Nutritional Assessments
  • Life Skills
  • Dialectical Behavior Therapy (DBT)
  • Eye Movement Desensitization and Reprocessing Therapy (EMDR)
  • Psychological Testing
  • Neuro-psych Testing
  • Additional physical activities such as Pilates, work with a private trainer, power hikes, swimming, kickboxing, etc.
  • Massage & Acupuncture
  • 12-step meetings and Exposure Therapy Outings
  • Spiritual Coaching
  • Gardening classes
  • Cooking classes

 

 

 

 

[i] Najavits, L.M., (2002) Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: Guilford