My name is Sonya Warga and I am the Clinical Director at Marymound. I’ve been with Marymound since the spring of 2016.
This is actually my second career. I worked as a dental hygienist for 17 years. I think reflecting back you start understanding that you’re the way you are and you operate and work in the world the way you do because of your history, right? Which really fascinated me. As time went on in dentistry, I actually made these relationships with my clients who would come in and you know, I’ve known some of them for 20 years. I’ve watched their kids grow up. I watch those people turn into adults. I just really was engaged with that and I became so much more interested in their stories and what they wanted to share with me than the dentistry side of it. I sort of started thinking, you know what? I think it’s time to take a leap and do something different.
I went to school at U of W for my Masters of Marriage and Family Therapy, and I studied that at the same time that I was still working in dentistry. I graduated in in 2016 with my Masters and I thought I had a plan. The plan was that I would eventually grow a private practice and I would be my own boss and I would do that style of work with my degree and my experience.
So, of course that takes time to build. I graduated and I was leaving dentistry and I needed a job. A friend of mine, who was my mentor in the program, was working here at Marymound, actually in the Sexual Abuse Treatment Program and with Sinclair Group Home. So I applied to Marymound for a position as a clinician.
I was successful in getting a position with Marygrove and Sinclair Community homes. I thought I would stay in the position and learn for a while until I got a private practice established. I started up the private practice and I was working. I was doing that in evenings, trying to build it up as I worked full time. And what I discovered was I really don’t like being a business owner. I really love doing therapy and I really love working with people. I hate invoicing. I hate trying to generate a client pool. And when you’re starting a private practice, you have to do that all yourself because you’re building a business.
So, coincidentally, with discovering that, I really was uncovering a passion for working with this particular population, with youth specifically. What I discovered here was I really, really connected and felt passionately about these young people. And the longer I stayed, the more ideas and hopes and imaginings I had about what that could look like. It’s kind of like finding your niche, you know, finding where you really fit.
Originally, I was working at Sinclair and Marygrove and then eventually Sinclair and the Sexual Abuse Treatment Program. As the clinician with Sexual Abuse Treatment Program, it’s more an outpatient therapy model, so it’s more what people would imagine when they think of going to therapy. Being a clinician in the group home is very different. You’re doing a lot of work with the team, maintaining a therapeutic environment. Because the environment is really critical, so in the group home setting, what we talk about a lot is that an hour of therapy in a week isn’t enough, particularly with the population we’re working with. What is really needed is an environment that’s set up to be therapeutic all the time and so everyone who interacts with the youth, and every interaction, ideally will be therapeutic and clinically-minded. Tucking a kid into bed is therapy, rubbing that child’s back is therapy, reading them a story is therapy, comforting them when they cry is therapy.
I think of my current role as the Clinical Director as two-sided, with two main components. So the first main component is supporting the programs and supporting the clinicians who work in those programs. That involves troubleshooting, problem solving, and lots of advocating. When I came to work at Marymound, I had no idea how much of the role would be about advocating. This includes advocating for best practice for kids, particularly to external systems and organizations. Trying to convey the importance of the environment or the importance of a specific service to a child and what that could mean for long term outcomes, what that could mean for their life is the advocating that we try to do.
Also, advocating for the organization and for how we are going to work as an organization out there in the community, so really advocating strongly for serving the needs of the child. How do we manage that and how do we work with other organizations and stand our ground on that, on what we believe to be in best service of the clients we serve.
And then that flip side is sort of the larger planning of the clinical framework of the organization. A big part of the role right now is creating that overarching framework that hopefully will continue to exist long beyond me, or exist and evolve appropriately so that there’s that continuity of approach and we get that consistency that then really generates solidity in the organization.
And so you do a lot of work with the team around creating that environment, around coaching the team to be able to work with the youth in that way. We talk a lot about how to respond to youth when they’re struggling, and how different responses either settle that or sometimes actually complicate it and make it worse if our response is not trauma-informed. And then in addition to that in the group homes, if the child is willing, you can meet with them one to one in a more traditionally therapeutic way. So it’s all therapy and therapeutic, but it looks quite different than what you would think of as traditional therapy in an outpatient model.
So in terms of our clinical framework, what we’re really trying to move towards is a Two-Eyed Seeing Model where Western therapeutic interventions sit alongside culture and traditional healing. So both of those in the ideal model are equally valued and incorporated into healing plans for the clients that we work with, in a way that makes sense to the client. In the past both at Marymound and in other spaces and places, the primary focus has been on Western therapeutic interventions, so you’re talking about cognitive behavioral therapy or solution-focused therapy, different pieces like that, but coming from a very westernized lens and lacking cultural components and richness
The majority of the kids we are working with are Indigenous, in part because Indigenous families are overrepresented in child welfare. And we want to be mindful that we’re working with our clients in a way that makes sense to our clients, not in a way that is about us, right?
With Two-Eyed Seeing, the root of our Western side of the model that we’re creating is the Neurosequential Model of Therapeutics or NMT. This is a model that was developed by Dr. Bruce Perry and essentially provides a tool to understand how developmental trauma has impacted brain organization and development.
Adverse events or difficult events in childhood, well really right from the prenatal and intrauterine periods, and even transgenerational factors, really influence how the brain develops.
What’s considered by the NMT model is adverse events and relational health. So how many of these adverse events are at play and how many positive relationships or what kind of positive relational experiences have also been experienced to help buffer the impact of those adverse events; this is what helps us to understand some of the reasons a child may present or respond in a particular way.
The impact of developmental trauma really results in a diversion of sorts in terms of brain organization, so the system itself alters brain organization to best serve the survival of the child or of the individual. So with lots of adverse events, the focus goes to survival: fight, flight, freeze and those kinds of ideas, and less so to the development of perhaps relational competency, if you will, or speech, language, or abstract thinking. Those things sort of fall to the backburner because they’re not required for survival in that moment
With the NMT model, by inputting information about history and current presentation, you can focus in on where to begin the therapeutic process. NMT provides a starting point that reflects the developmental stage of the child, which may not match their chronological age, and identifies what regions of the brain to target and in what orders. It helps us know where to start working so that interventions are most effective. It also tells us that we can’t move forward unless we first address the foundation. It’s like building a house – you can’t build this second story if you don’t have the foundation. And the NMT shows us where to start strengthening the foundation, making sure that it is strong so that the child can progress in their development.
Currently, I think the biggest challenges we face are connected to child welfare system in general. I think there’s lots of folks out there doing their best and with great intentions. The systems that we’re working in can be challenging for a variety of reasons. There are competing priorities. For me and thinking about our organization, our priority should always be the kids and what’s absolutely best for them. The difficulty is that the structures external to us that we interact with aren’t always built in a way that make that easy or achievable.
I think if I was talking to somebody who didn’t know about Marymound and trying to explain what we do, I think I would say that we are an organization that is striving to provide a variety of services primarily for kids who are involved in the child welfare system currently and also children and youth who are struggling with mental health in some way or another. I think the public probably largely identifies us as being connected to child welfare in some way, and I think one of the things I would say is that we’re working to support many children and youth who are involved with the child welfare system, but we’re not CFS.
I think I’d want them also to know about the wide range of services at Marymound: everything from the Youth Addictions Stabilization Unit to the Crisis Stabilization Units to our Treatment Foster Care or Independent Options Program, all of which are amazing.
We’re guided by a set of values that I personally feel are very important. We try and work by those values consistently. With my own team, if they are struggling with a decision, I try to encourage and say let’s think about this: you know, we say we’re working with compassion, respect, courage, collaboration and spirituality, so if what we’re proposing doesn’t fit that, then we shouldn’t be doing it, right?
So there’s that piece, as well as being not only trauma-informed, but trauma-responsive. Responding to our clients and working with our clients and understanding our clients from a trauma-informed lens and recognizing that as people, we all get to where we are because of our history and because of what has happened in our lives.
The reality is nobody chooses to have difficult times and they don’t choose to present in what other folks perceive as difficult ways. I think it’s really important that our community understands that. We experience these kids in a very different way than they sometimes are experienced in other places. I think that’s really an important piece of what we’re trying to do and an important piece to convey: we don’t see the kids we’re working with as criminals, as bad kids, as delinquents, you know some of those words that have been used in the past. We see them as smart, savvy, funny, loving kids who have learned to get their needs met in a certain ways, because there was no other option.