Diagnostics: Importance of Isolating Variables to Seek Root Cause
by McKay Deveraux, LCSW, Executive Director @ outBACK
Have you ever seen the Tom Hanks movie, “Money Pit”? For me, I consider it a documentary of the earliest parts of my marriage. A few months after we were married, my wife and I purchased an older home that we planned to fix up and sell. It did not take long to realize that neither of us knew as much as we thought about anything, let alone fixing up an older home.
At some point in our remodeling, I noticed some mold in the ceiling corner of our basement bathroom. The first thing that came to mind was the exhaust fan not working well enough to remove the moist air from a hot shower. I took the fan apart and discovered that I was right about the fan. So, I fixed the fan, cleaned up the mold and planned to fix the drywall after the corner had dried out. When I returned later that week, I discovered that the area was still quite wet. This time, I cut into the drywall and exposed a waterline going to my icemaker upstairs. While I could not see the leak in the line, it had water running down it and was obviously the culprit. This was a more difficult repair, but with quite a few holes in my basement ceiling and walls (and some guidance from my contractor father-in-law), I was able to successfully replace the waterline and planned a time the following week for the now extensive drywall repairs. When I returned to the area, I was shocked and frustrated to see that the area was still quite wet. After a lot of thought and exploration, I finally discovered that the evaporative cooler on my roof had developed a small crack in the water line that ran through my attic insulation, down through the upstairs walls and into my basement ceiling where it connected to the main waterline. The water from the leak followed this same route until it crossed paths with the icemaker waterline, where it changed course and went into the walls/ceiling of my basement bathroom. What seemed to be a small patch of mold caused by a dirty fan was a much different problem that affected far more than I could see.
Too often, mental health issues can be like this water leak. We notice a symptom, draw a reasonable conclusion, and attempt to fix it. Sadly, it is far too common for these initial attempts to fix the problem to fail. In some cases, we may even find ourselves spending substantial amounts of money, cutting holes all over our house, unnecessarily replacing icemaker water lines as we try to fix the “leak”. This process taught me about the importance of good diagnostics.
When it comes to mental health, diagnostics is pivotal. For example, it is easy to look at a teenager who is displaying oppositional behaviors and diagnose them as–well, a teenager. In all seriousness, we understand from our own experience that adolescence is synonymous with raging hormones, complex social pressures, desires for autonomy and so much more that can result in teens behaving poorly. We may dismiss their oppositionality as a phase and prescribe the treatment of long-suffering. However, what may be missing with this approach is that their oppositionality could be a manifestation of something else. Oppositionality can be manifested as a sign of anxiety, depression, ADHD, autism spectrum, trauma, oppositional defiant disorder, or several other diagnoses. To find the source of this opposition requires us to follow the “leak”. As we do so, we can begin to isolate variables and rule out potential contributors. This sounds easy yet can be difficult, especially with adolescent clients who are struggling to know how to identify and acknowledge feelings, communicate with parents, and/or are resistant to receiving therapy due to fear and shame.
The process of diagnostic assessment is where wilderness therapy shines. outBACK provides an unparalleled opportunity for a teen to be unplugged from their phones, substances, games, social media, peer pressure/peer influences, and junk food. This simple act of reducing overstimulating and unhealthy variables provides a glimpse into what they are like without these influences. When coupled with the addition of positive factors such as consistent sleep patterns, a healthy diet, regular exercise, fresh air, and sunshine you begin to see a “baseline” for what they may really be like.
This “baseline” allows their wilderness therapist to follow the “leak” more readily to the source. Despite what some parents and professionals may think, teenagers do not act out because they want to disappoint us. They do so because they do not know how to deal with the complexities of their own lives. They avoid the pain by using diversion techniques such as drugs, sex, games, risky behaviors, etc. They begin blaming and cutting off their loved ones to justify their coping mechanisms. They regularly engage in self-sabotage and begin to alter their identity development. What starts as a small and simple leak becomes something that impacts the entire home.
Wilderness therapy is not a “cure all” or some magic pill. However, part of the magic that does exist in wilderness therapy is found in the incomparable diagnostic process that guides a more accurate course of treatment.
McKay Deveraux, MSW, LCSW
outBACK Therapeutic Expeditions