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Welcome to another edition of Treatment Coordination and Advocacy's newsletter.
This month we explore the fine art of balancing confrontation and compassion. Dr. Seth Kadish of Milestones Ranch in Malibu, CA offers his expertise on the subject. It is so important to, as Dr. Kadish does, reflect on our philosophy about what supports real change in a client and work consciously from that model. We often develop our own style over a period of years and do not take time to articulate what our underlying belief system might be. After you have read this piece, you might take time write down your own philosophy. You may have the basis for a whole model of recovery, or, you may find that it is time for a vacation. Either way, the process will be fruitful. As for Dr. Kadish's perspective, I had to smile when I read it because, in my experience as well, he speaks the truth, and I certainly never learned anything like this in my training. Probably just as well...
Also this month, we broach the topic of sex offender treatment. You may be suprised what the research says about the potential for rehabilitation. This is a subject that is of great interest to me(Pamela) because, as I work in the field of sexual assault response to victims, I see the need is so great for appropriately trained sex offender treatment providers. There are only a small handful of treatment providers in my whole state. Interestingly, a rape recovery center in a rural county recently received grant funding to implement a juvenile sex offender outpatient treatment program. The grant included ATSA training for all clinicians. The Executive Director there said that when she was approached with the idea, she said absolutely not; her loyalty was with the victims and, in any event, she believed that sex offenders could not be treated successfully.
Then she did the research. She was so impacted by the possibility and, further, the great need on behalf of the offenders, yes, but also their innumerable potential victims, that she dove in to a pond she never thought she would be in.
Rape Recovery Centers are beginning to look at this issue more and more, because, frankly, no one else cares as much about sexual assault prevention than they do. I personally would like to pilot a mandatory intervention program for misdemeanor sex offenses that we are now learning are "gateway" crimes for budding perpetrators. I would be willing to bet that the measured rescidivism rates of a pilot program such as this would be much lower than people expect. This is just an idea for now, but I'll keep you posted.
As for the newsletter, it continues to grow. The "Employment" section has some great opportunities, and the conference section is larger than ever. Have a great month and don't forget to take care of yourself as you do your clients.
Amy Lashway Cisneros, MA LPC and Pamela Castle, MA LMFT
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Are all Sex Offenders beyond Help? |
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There is an enduring myth in our society that all sex offenders are untreatable and that they all re-offend until they are caught or die. It is interesting that I hear this both from health professionals relatively new to the field about as often as I hear it from seasoned clinicians. For newer folks, this is probably due to our pre-existing cultural preconceptions; For experienced treatment providers, I suspect it comes from seeing the impact of the victims of these repeat offenders day after day after day.
It is true that there is a percentage of sex offenders for whom "sex offender treatment" should give way to "sex offender management" in order to preserve both our treatment resources and the safety of our society.
However, there are also a percentage of sex offenders who will respond positively to treatment, who will not re-offend, and who, with the right type of treatment program, can be safe in society.
I am including a link below to a juvenile sex offender risk assessment tool. It is definitely true that juveniles sex offenders have a statistically higher percentage of success in treatment than do their adult counterparts. but I thought it might be helpful to examine some of the criteria specialists measure in order to assess their risk to re-offend.
"In all, 23 items representing 4 subscales were developed. These scales were intended to capture the two major historical (static) domains that are of importance for risk assessment with this population (Scale 1: Sexual Drive/Sexual Preoccupation and Scale 2: Impulsive, Antisocial Behavior), and the two major dynamic areas that could potentially reflect behavior change (Scale 3: Clinical/Treatment and Scale 4: Community Adjustment). The latter two subscales were of particular importance, because the original risk assessment protocol was developed to assess not only risk at discharge but change as a function of treatment."
This assessment tool has been found reliable over a period of many years. Their only caveat was that there was so few post-treatment rescidivists that they are concerned about drawing inferences about the causal factors of their re-offense.
Most people find this surprising, even for a juvenile study. Even more surprising, however, is that adult rescidivism rates are not nearly as high as most folks think.
An article on the APA website:
http://www.apa.org/monitor/julaug03/newhope.html
says that "psychologists face challenges in convincing law enforcement authorities to take treatment seriously given the obvious public concern about sex offenses. One major obstacle is public misconceptions about recidivism, Hanson says. "Even when we're talking with law enforcement officials, they'll guess demonstrated rates to be in the 70s or 80s, so real rates of 10 to 20 percent surprise everybody," he notes."
Of course, the only rescidivism number we can track is the number of re-arrests, so the number of times offenders re-offend without getting caught is a source of speculation. However, criminals who move through the system one time are more likely to be caught again, especially sex offenders on the registry.
The article goes on to report a significant difference between the rescidivism rates of treated vs. untreated offenders(This refers to psychological treatment, rather than medication-based treatment)
I encourage you all to take a look at the links provided and assess the data for yourself. One of the ways we can stay fresh as trauma professionals is to continue investigation of a variety of topics that impact our work. Also, in a subtle way, what we think about the potential for change in any arena can insidiously negatively impact our view of human nature in general.
I look forward to your comments...Pamela
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The Art of Carefrontation |
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The Art of Carefrontation
By Dr. Seth Kadish
Malibu, California
As Clinical Director of Milestones Ranch Malibu, I have implemented the strategy of �carefrontation,� an almagam of the words �caring� and �confrontation.� We have noticed significant success with our clients using this approach.
Carefrontation is not an exact science nor is it a specific technique, but rather an attitude or approach. The hallmark of carefrontation is speed. This strategy is designed to transform clients in as rapid a way as possible. We may have as few as 30 days to help the client make a radical shift in his/her negative patterns of thinking and behaving. In the recovery field, we are often called upon to make as profound an impact as possible on the client in the least amount of time.
How do we do this? By telling the truth. We do this in a loving way, or at the very least, a neutral way, though sometimes I know I can be rather blunt. Look, I�m from Brooklyn � we were born and raised on bluntness.
In addition to my Brooklyn upbringing, I worked with Probation kids for years - tough customers, who would run over therapists without a qualm, or overindulge in emotion without real transformation. After that I went to work for the California Department of Corrections in a maximum security prison. These inmates could manipulate you from here to the moon if you weren�t onto their stuff. I realized that a carefrontational approach was the only way to get through to these guys � caring enough to engage their support, interest, and cooperation, but firm enough so that they knew I wouldn�t take any nonsense from them.
While learning to work with difficult, sometimes violent clients, I also served as a supervisor at a local clinic, training doctoral candidates. These folk were smart, caring, and dedicated � but not always very effective.
I understood. I had been just like them at an earlier point in my career.
Why weren�t they effective? Because they had been taught that therapists should go slow, take clients� histories, join with them, be sensitive to them, be kind, empathetic, and loving-an approach that didn�t always bear fruit.
Like inmates or Probation kids, these �ordinary� clients would also defend, resist, manipulate, or overindulge with their therapist. This gentle approach, taught in many schools and clinical settings, struck me as rather soft and not compelling or bold enough in many instances. If the approach did work, it often took an excessive amount of time.
Now, lest you think I�m an ogre (though I am known to be pretty tough on clients), I am caring. I want to save my client�s life � the drug user who�ll return to heroin without a hard look in the mirror, the inmate who will kill himself or another inmate unless he gets a measure of help, or the �ordinary� client who will continue on in a spiral of erroneous thinking and maladaptive behaviors.
So, what is carefrontation?
- Caring confrontation
- Both a technique, and an approach or attitude
- Addresses the client�s negative patterns of thinking and behaving by pointing out those self-destructive patterns and holding the client accountable for choices
�� � � Consists of
rapid joining (which can be done in a matter of minutes)
assessment based on observation and clinical experience
ensuring the client�s buy-in (we need the client�s permission to tell the truth)
explaining the reason underlying the carefrontation (assure the client of your desire to help)
practicing rigorous honesty
providing solutions (interventions and/or assignments)
giving positive reinforcement (catch the client doing it right)
Carefrontation is designed to be a lightning strike; in war terms, a blitzkrieg; in sports terms, a fast break. I repeat � it�s a strategic intervention. Carefrontation may be particularly fruitful with the �therapized� clients, who expect our history-taking and sometimes predictable questions.
The result of our carefrontation is that the clients gain awareness of their faulty thinking processes and the way in which those negative, or distorted, beliefs have driven their behaviors. The clients feel empowered, and make conscious changes in their behaviors.
At Milestones, we encourage the clients to use the therapeutic milieu as a place to practice a new way of being in the world. The milieu allows for immediate feedback from staff and peers as to how these new behaviors are working, and to make any necessary adjustments.
We have trained our staff, including psych techs and therapists, in this approach, and have witnessed marked improvements in clients� commitment to their own recovery, hope for a better future, and interpersonal relationships in a relatively short period of time.
The question is, why don�t therapists do carefrontations?
ignorance. We don�t know how to do it. Therapists are untrained in this approach. To the contrary, we are taught to be soft, compliant, warm, and patient with clients.
Fear. Of alienating the client, who will discontinue therapy;upsetting the client, who will cry and howl;angering the client, who will verbally or physically attack the therapist;and confrontation itself - the therapist lacks a family or personal history in rigorous truth-telling, and giving and receiving feedback.
Self-image. The notion of carefrontation shoves against our self-image � we see ourselves as loving and kind, and never overpowering, or inducing emotional pain. Pain is sometimes a necessity on the road to healing, however it can be difficult for us as therapists to be the ones who potentially cause them further distress. The thing to remember is it is a temporary condition that will pass as soon as the client begins to experience success.
To discuss questions or training opportunities, please contact Dr. Seth C. Kadish, Clinical Director of Milestones Ranch Malibu at 818-321-3076 or drsethck@aol.com
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Treatment Center Profiles |
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We are continuing our Treatment Resource list again this month, starting with a highlight of TC&A's contract intake and aftercare services. We highly recommend seeking further information on the other programs listed by calling each program or accessing their website from the link provided. Be sure to tell them that you saw their profile here in the Treatment Coordination and Advocacy Newsletter.
Treatment Coordination and Advocacy
People engage in self destructive behaviors and struggle with mental health issues for a variety of reasons. The path that got them to where they are now was unique and profoundly personal. As such, their path to recovery and healing will be equally unique and personal.
The Mission of Treatment Coordination and Advocacy is to aid all clients in their pursuit of the proper treatment program and professionals for their personal recovery needs. Each client possesses different desires and goals for their individual healing process. This must take into consideration their specific addictive behaviors, mental health diagnosis, medication needs, unique personality traits, family histories and logistical concerns.
No single program or therapist can be all things to all people. Our commitment is to get to know our clients on a deep and meaningful level, to understand those core issues which underlay their current difficulties and to locate and evaluate those treatment professionals that are best suited to provide the recovery needs of each of our clients. Further, we facilitate the development of the therapeutic relationship between such client and their treatment professional and the communication amongst all members of the therapeutic team.
If you have a hard to place, complex client and are not sure where to refer them or if you need help finding the most clinically appropriate extended care for someone getting ready to discharge from your facility, call us! We have an extensive network of national treatment centers and providers of the highest caliber.
Austin Recovery
Austin Recovery offers affordable detox and residential care in gender specific programs for men and women ages 18 and above. Our not-for-profit agency has provided effective and compassionate treatment since 1967. We are under the medical direction of John Luker MD, a Board Certified Addictionologist. Lengths of stay are 30 to 90 days with men receiving treatment at our Recovery Ranch (a rural 40 acre campus) and women served by an 8-acre city campus (previously a Charter Hospital facility). Treatment is 12-Step oriented coupled with individual, group, and experiential therapies. Services offered: Alcohol, Drugs, relapse prevention
Treatment Type: Residential & Outpatient, Alumni & Aftercare Age Range: 18+
Payment: Self-pay only. Detox: $300/day / 30 day residential: $150/day / Extended Program: $125/day
Contact: Dennis Barkway, Admissions Coordinator
or Bill Wigmore, Chief Executive Officer
8402 Cross Park Drive
Austin, Texas 78754
E-mail: info@austinrecovery.org
Admissions: 800-373-2081
Administration: 512-997-0101
Hanbleceya
Hanbleceya is an intensive outpatient program for severely mentally ill adults in a therapeutic community setting that includes a semi-residential component. We treat both acute and chronic cases in addition to dual diagnosis. Hanbleceya is highly structured and believes that healing is optimized when the patient also participates in the healing of fellow patients. This support base is an essential element to the Hanbleceya culture. Our treatment program consists of three main components:
1) Intensive Psychotherapy;
2) Semi-Independent Living Support;
3) Vocational and Educational Support.
Program Cost: Starts @ $5,500 per month (includes housing)
Contact Info:
Kerry Paulson
619-466-0547 (office)
619-261-4508 (cell)
email: Kerryp@san.rr.com
New Hope Recovery Center
New Hope Recovery Center in Chicago, IL offers comprehensive addiction treatment for adults. Located at Lincoln Park Hospital, New Hope provides detoxification services within the hospital for a smooth transition into treatment. New Hope treats both men and women with a dependency on any drug including alcohol and prescription medications. With a range of service levels including outpatient treatment, residential treatment and independent living, patients are able to make a smooth transition from treatment into a stable, sober environment. New Hope is twelve-step oriented and works with community volunteers to integrate patients into the recovery community while in treatment. Our staff is available to answer questions twenty-four hours per day.
Costs: Extended care is $2800.00 - Scholarships are offered. $13,412.00 for Residential and $4500.00 for IOP.
Contact: Greg Simpson, Program Director
Phone:773-883-3906 (direct line)
773-935-1830 general 24 hours
email: info@new-hope-recovery.com
New Life Centers
New Life Centers is located in Salt Lake City, Utah and is JCAHO accredited. This program provides comprehensive treatment for adults and adolescents with eating disorders. A range of clinically intense treatment options are offered, including residential, day treatment, and intensive outpatient. Each program offers highly individualized treatment plans and evidence-based interventions. New Life Centers has staff with extensive experience in a variety of therapeutic approaches, including Dialectic Behavior Therapy, Cognitive Behavior Therapy, Interpersonal Therapy and Exposure Therapy. These interventions are also used to treat other issues that are commonly associated with eating disorders. In addition, each treatment program incorporates an Exercise and Movement Education Program as well as the nutritional philosophy of Intuitive Eating. New Life Centers has a multidisciplinary team dedicated to the field of eating disorder treatment to help those struggling with an eating disorder achieve a new life worth living.
Program Cost: Assessment: FREE
Residential $837/day
Day Treatment $627/day
Intensive Outpatient $297/day
We work with most insurance providers
Contact: Carol O�Brien at (888) 281-3353
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Industry News and Current Events |
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Here is a list of several conferences/trainings available in 2006. I encourage each of you to seek further training in those issues that are unfamiliar to you. If you would like to submit a conference or training to be listed in our next newsletter please forward the information to: amy@treatmentcoordination.net
Conference Title: The 20th National Conference on The Family in Stress and Crisis
Sponsor:The Institute for Integral Development
Date(s): April 10-13, 2006
Location(s): Santa Fe, NM
Phone:800-544-9562
Training: Somatic Experiencing
Date: April 14 - 17, 2006
Location: Santa Monica, CA
Instructor: Raja Selvam, Ph.D
Local Coordinator: Stacey Pachter 310-319-1904
Email:smpsep@earthlink.net
Notes: LEVEL: Beginning I
Conference Title: Mastering Counseling Skills-Anger, Abuse, Trauma
Sponsor: FACES
Date(s): April 19-22, 2006
Location(s): Santa Fe, NM
Phone: 877-633-2237
Email: info@facesconferences.com
Conference Title: 64th Annual ASGPP Conference
Sponsor: The American Society of Group Psychotherapy and Psychodrama
Date(s): April 27-May 1, 2006
Location(s): San Francisco, CA 94102
Phone: 800-795-7129
Fax: 415-391-8719
Conference Title: Why do I Keep Doing this? The etiology and treatment of compulsive sexual behavior
Presenter: John R. Giugliano, Ph.D, LCSW
Sponsor: New York State Society for Clinical Social Work � Westchester Chapter
Date: Saturday, April 29, 2006
Location: White Plains, New York
Telephone: (914)720-0262
Email; mlowery@,maryknoll.org
Conference Title: 19th Annual Northwest Conference on Behavioral Health & Addictive Disorders
Sponsor: The Institute for Integral Development
Date(s): May 4-6, 2006
Location(s): Seattle (Bellevue), WA
Phone: 800-544-9562
Conference Title: 37th Annual Medical and Scientific Conference
Sponsor: American Association for Addiction Medicine
Date(s): May 4-7, 2006
Location(s): San Diego, CA
Phone: 301-656-3920
Fax:301-656-3815
Conference Title:12th Annual Conference, Science and the Human Spirit-Changing Lives of Adults with AD/HD
Sponsor: Attention Deficit Disorder Association
Date(s): May 4-7, 2006
Location(s): Orlando, FL
Contact Information: Vin McCampbell
Phone: 484-945-2101/404-591-3211
The Myth of the Resistant Client: Change Without Force with Maci Tater, LPC, CHT
Date:May 5-6
Location: Atlanta, GA
Times: Friday, 9:30-5:30 and
Saturday, 10:00-5:00
Cost: $195 if register by 4/14/06; $225 thereafter.
Tuition discounts for full-time students and Hakomi graduates
Contact: Sean Caffyn at (404) 375-0058 or
Cherie Lyon at (404) 735-9631
email: Hakomiatlcl@yahoo.com
Training: Somatic Experiencing
Date: May 5 - 8, 2006
Location: Boston, MA
Instructor: Maggie Kline, MS, MFT
Local Coordinator: Holly Burns
Phone: 617-277-9007
hburns@gmail.com
Level: Beginning I
Conference Title:Introduction to Neurofeedback Sponsor: EEG Spectrum International Inc.
Date(s): May 13, 2006
Location(s): Raleigh, NC
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title: Mastering Counseling Skills-Anger, Abuse, Trauma
Sponsor: FACES
Date(s): May 18-20, 2006
Location(s): Washington, DC
Phone: 877-633-2237
Email: info@facesconferences.com
Somatic Experiencing
Level: Beginning I
Instructor: Steven Hoskinson, MA, MAT
Date: May 19 - 22, 2006
Location: San Francisco, CA (Belmont)
Local Coordinator: Karen Ouse
831-331-6956
healing-heart@comcast.net
Anya Lynn 707-295-9282
Conference Title: 26th Annual NAATP Addiction Treatment Leadership Conference
Sponsor: National Association of Addiction Treatment Providers
Date(s): May 20-23, 2006
Location(s): Palm Beach, FL
Phone: 877-850-6463
Conference Title: Building the Movement
Sponsor: National Mental Health Association
Date(s): June 8-10, 2006
Location(s): Washington, DC
Phone: 703-838-7505
Email: dlooney@nmha.org
Notes: Mental health advocates and thought leaders gather to share best practices and develop the tools they need to advance education, advocacy, research and service in their local communities.
Somatic Experiencing
Level: Beginning I
Instructor: Diane Poole Heller, PhD
Date: June 16 - 19, 2006
Location: Silver Spring, MD
Local Coordinator: Crossings, Alaine Duncan
Phone: 301-565-4924, ext. 101
aduncan@crossingshealing.com
Conference Title: Introduction to Neurofeedback
Sponsor: EEG Spectrum International Inc.
Date(s): June 17, 2006
Location(s): Woodland Hills, CA
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title: The 23rd Annual Conference of the International Association for the Study of Dreams-Dreams Building Bridges
Sponsor: the International Association for the Study of Dreams
Date(s): June 20-24, 2006
Location(s): Bridgewater, MA
Phone:508-531-2249/866-373-2612
Email: clhoffman@bridgew.edu
Conference Title: Neurofeedback in a Clinical Practice
Sponsor: EEG Spectrum International Inc.
Date(s): June 22-25, 2006
Location(s): Washington, DC
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title:Intro to Neurofeedback
Sponsor: EEG Spectrum International Inc.
Date(s): July 15, 2006
Location(s): Philadelphia, PA
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title:Mastering Counseling Skills-Anger, Abuse, Trauma
Sponsor: FACES
Date(s): July 19-22, 2006
Location(s): Seattle, WA
Phone: 877-633-2237
Email: info@facesconferences.com
Conference Title:Neurofeedback in a Clinical Practice
Sponsor: EEG Spectrum International Inc.
Date(s): July 20-23, 2006
Location(s): Raleigh, NC
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title:Clinical and Counseling Advances 2006
Sponsor: The Institute for Integral Development
Date(s): August 2-4, 2006
Location(s): San Francisco, CA
Phone: 800-544-9562
Conference Title:14th Annual Convention of the American Counseling Association
Sponsor: American Counseling Association
Date(s): August 10-13, 2006
Location(s): New Orleans, LA
Phone: 202-336-6020
Email: convention@apa.org
Conference Title:Neurofeedback in a Clinical Practice
Sponsor: EEG Spectrum International Inc.
Date(s): August 17-20,2006
Location(s): Woodland Hills, CA
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title:Neurofeedback in a Clinical Practice
Sponsor: EEG Spectrum International Inc.
Date(s): September 14-17, 2006
Location(s): Philadelphia, PA
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title: American Psychotherapy Association 2006 National Conference
Sponsor: The American Psychotherapy Association
Date: September 21-23, 2006
Location: Walt Disney World Hilton, Orlando, FL
Come together to learn, earn CE credits, and share experiences with your fellow professionals. Keynote Speaker is Dr. William Glasser. Also offering 15 other speakers and workshops.
Phone: 800-205-9165
Fax: 417-823-9959
Conference Title: American Association of Integrative Medicine 2006 National Conference
Sponsor: The American Association of Integrative Medicine
Date: September 21-23, 2006
Location: Walt Disney World Hilton, Orlando, FL
Come together to learn, earn CE credits, and share experiences with your fellow professionals.
Phone: 877-718-3053
Fax: 417-823-9959
> Conference Title:Neurofeedback in a Clinical Practice
Sponsor: EEG Spectrum International Inc.
Date(s): October 19-22, 2006
Location(s): Chicago, IL
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title:64th AAMFT Annual Conference
Sponsor: American Association of Marriage and Family Therapy
Date(s): October 19-22, 2006
Location(s): Austin, TX
Phone: 703-838-9808
Fax: 703-253-0505
Somatic Experiencing
Instructor: Nancy Napier M.A., SEP M.A., SEP
Level: Beginning I
Date: October 20 - 23, 2006
Location: New York, NY
Local Coordinator: Lynn Bourbeau
Phone: 212 477-2004
Email: leapb@aol.com
Conference Title: Neurofeedback in a Clinical Practice
Sponsor: EEG Spectrum International Inc.
Date(s): November 16-19, 2006
Location(s): Portland, OR
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
Conference Title:Neurofeedback in a Clinical Practice
Sponsor: EEG Spectrum International Inc.
Date(s): December 7-12, 2006
Location(s): Woodland Hills, CA
Phone: 818-789-3456/800-400-0334
Email: training@eegspectrum.com
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Employment Opportunities |
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TRAUMA COUNSELOR needed
Cottonwood de Tucson is a highly acclaimed treatment facility specializing in effective inpatient dual diagnosis, chemical dependency and behavioral health programs. Join us for an outstanding career experience.
The Trauma Counselor we seek will be Masters Level with state licensure. Three to five years full-time, professional experience in direct clinical practice with mental health populations who present with chemical dependency, trauma, depression, eating disorders or personality disorders are also required.
Along with the opportunity to contribute to the well being of others in an atmosphere of caring and support, we offer a competitive salary and benefits package. For consideration, send your resume, in confidence, to:
Human Resources Director
Cottonwood de Tucson, Inc.
4110 W. Sweetwater Drive
Tucson, AZ 85745
Fax: (520) 743-2133
E-Mail: john.simmons@cottonwooddetucson.com
Program Manager / Therapist Needed
Therapist with experience in treatment of Eating Disorders and Substance Abuse needed at adult (18 years and older) residential treatment facility located 50 miles west of Nashville, TN. Responsibilities include developing and updating individualized treatment plans for clients, providing individual, group and family therapy, as well as defining community resources for after-care planning. Duties also include management of residential unit with caseload of up to 9 clients and supervision of staff of resident assistants. Must be licensed LPC, LCSW or PhD. Please send CV to Toril Newman, LCSW, Clinical Director, The Ranch. 1-800-849-5969, Fax 931-729-9632, toril@recoveryranch.com, or PO Box 38, Nunnelly, TN 37137
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