"Clinical Community Psychology: A New Approach to Treating Complex Mental Health Conditions"
with Dr. Melita Stancil
Season 8, Episode 5

Dr. Melita Stancil is a Clinical Psychologist whose expertise is in treating children with complex psychological needs, helping them as well as their families to thrive. She is the founder of Dr. Melita Psychological Services, PLLC and has worked in mental health for over two decades. She has developed a unique, interactive, ecological framework called ATILEM designed to alleviate distress in individuals, coping with complex mental health conditions by integrating clinical, social, cultural, and environmental influences with targeted therapeutic modalities, such as cognitive behavior, therapy, social cognition, intelligence, training, and others. Dr. Stancil is a prolific writer and frequent speaker at Industry Conferences. She has been a guest lecturer at the division of Child and Adolescent Psychiatry at Columbia University Medical Center and York College. She previously served as a clinical psychologist at the Child Mind Institute here in New York, and the lead clinician at Ellenhorn. She received a Master’s of Arts and a PhD in Clinical Community Psychology from the University of South Carolina.

In this Episode you will learn:

  • How clinical community psychology, which integrates social, cultural, and environmental influences with clinical work, is used to treat complex psychological conditions
  • The role of assessments in helping parents determine how best to meet the psychological needs of their children
  • The surprising signs that a child might be self-harming
  • The importance of partnering with your child’s school to understand the narrative about your child in that environment
  • The ramifications of not addressing or denying that a child might have complex psychological needs
  • The importance of parent coaching in treating children with complex psychological needs

Petal Modeste: According to the Centers for Disease Control, depression, anxiety, ADHD and behavioral problems are the most commonly diagnosed mental health conditions in children between ages 2 and 17, affecting nearly 20 million children. When we add learning differences, eating disorders, computer and gaming addictions, The number of children and adolescents with complex psychological needs is staggering our guest to day. Doctor Melita Stancil is a clinical psychologist whose expertise is in treating children with complex psychological needs, helping them as well as their families to thrive. She is the founder of Dr. Melita Psychological Services, PLLC and has worked in mental health for over 2 decades. She has developed a unique, interactive, ecological framework called ATILEM designed to alleviate distress in individuals, coping with complex mental health conditions by integrating clinical, social, cultural, and environmental influences with targeted therapeutic modalities, such as cognitive behavior, therapy, social cognition, intelligence, training, and others.  Melita is a prolific writer and frequent speaker at Industry Conferences. She has been a guest lecturer at the division of Child and adolescent psychiatry at Columbia University Medical Center and York college. She previously served as clinical psychologist at the Child Mind Institute here in New York, and the lead clinician at Ellenhorn. She received a master’s of arts and a PhD In clinical community psychology from the University of South Carolina. Welcome, Melita to Parenting for the Future. I am so pleased to have you here.

Dr. Melita Stancil (She/Her): Thank you so much for inviting me. I am so excited to have this conversation with you.

Petal Modeste: So I always like to start by asking you to tell us a little bit about your early life, Melita. What values informed your upbringing? And which adults did you most admire as you were growing up?

Dr. Melita Stancil (She/Her): Such a great question. I was brought up down South so originally from Atlanta, Georgia, and then we bounced around to Texas and to Virginia, where I went to high school, and then also attended Undergrad at Norfolk State University and you know the adults that I guess most admired when I was young definitely was my grandmother. She was always present in case you needed anything. And so what I learned from her, I think, is that it takes a village. So there was my grandmother, but she kind of was the center of, my small universe, and whereas my mother, my father, all kind of revolve around her as a matriarch in the family, and so it taught me at a very early age that you could balance like family and career as well as you know, that it wasn’t about relying on one individual in order to accomplish anything that it was about having the community as a whole, and you could make your own community of individuals that you felt like. We’re trustworthy in different ways in order to help rear children.

Petal Modeste:  So you’re a mother. Did this shape your parenting -this example that your grandmother set?

Dr. Melita Stancil (She/Her): 100% I was a military wife and so in and of itself is his own little special community.  Other military families are going through what you’re going through. What I also found was, it was important for me to diversify, because I also was independent, and I had on my own career goals and aspirations, my own educational aspirations. So the moment I had this baby I took some tips from my grandmother as I tried to set up various opportunities that were flexible enough to allow me to be present at home.

Petal Modeste: And so you ended up getting a PhD in clinical community psychology, as I mentioned in the introduction. You chose to put family and community at the heart of your study. Why?

Dr. Melita Stancil (She/Her): Community psychology is a burgeoning field – it’s kind of a baby compared to clinical and other forms of psychology.  Early community psychologists had a set of values to define what treatment, what interventions, what communities needed to actually go in and to ask individuals what do you need? It aligned a lot with how I was raised, as far as there was a community and there was also a need, for clinical services for individuals going through a little bit of a hard time.  And so there’s this whole field of specified solutions to problems that come up psychologically.

Petal Modeste: So let’s turn to your work now. You work with children who are diagnosed with an extensive range of psychopathologies or mental health conditions, and they include anything from anxiety to depression, to anger, management, antisocial personality, mood disorders, dissociative disorders, self-harming, trauma, PTSD, you name it. What makes all of these conditions so complex?

Dr. Melita Stancil (She/Her): What I find in individuals that I see is that, when we, as scientists, research practitioners study a disorder like, for example, anxiety and a lot of ways in the research it is sanitized. So an individual comes on. We exclude other individuals from a science point of view. It makes perfect sense because we want to see if this treatment is going to impact anxiety in a way that decreases anxiety and also provide support for the individual and other areas associated with anxiety. But in my work what I found was that individuals will come in with anxiety and depression because anxiety, let’s say in that example was not controlled, and so then the person became hopeless. So it would be anxiety and depression. and maybe there was some intergenerational trauma that happened  the grandma who was pass down learn behaviors to Mom, and then also to the child. And so what the evidence base as far as therapies, we’re focused a lot on this works very well for anxiety. Clean. This works for depression has shown out outcomes this works for generational trauma. But when the person walked in with all 3 and sometimes hadn’t had the results. they’ve been through a series, sometimes of intervention, psychologically got there that there was a complexity to them that was also colored by their demographics. You know their station in life where they were in the world and their own identity development. so complex sounds like Oh, my God! Like these children may have a million things going on. But in reality I think most of us are pretty complex as individuals

Petal Modeste: So, what makes your framework so effective? You integrate several forms of therapy. DBT – Dialectical Behavior Therapy. But you also use acceptance and commitment therapy attachment based therapy, prolonged exposure. Tell us a little bit about some of these therapies and how you utilize them especially if your patients are children.

Dr. Melita Stancil (She/Her): So, there are two general schools of thought. There are manualized. So, for example, you talked about acceptance commitment therapy right? And so acceptance is about an awareness and acknowledgement of my reality.  We all have various coping mechanisms to not actually accept the reality and acknowledge what is going on in this moment. So it starts there and then there’s a commitment  to move towards yourself in a way that is aligned with who you truly see yourself to be. When I use DBT, for example, another therapy that I’m also trained in. It starts with understanding the dialectic. So what is the dialectic? It means that two things can be true at the same time – So I hate my family, and I love my family. Both things are true. Instead of saying it has to be one or has to be other. DBT. Says that the reality is most things are bittersweet and so that it is about understanding that it is not one thing that is happening all the time. It is oftentimes two things, and the inability to merge those things and balance those things towards your values and your goals, causes you stress.  I’m trained, in short-term therapies, meaning that each therapy in and of itself has a set number of sessions. So let’s say 8 to 20 sessions. You have this problem  and we set the goals upfront. We have check-ins along the way. So, for example, if you walk in and there is any thought about self-harming or suicide I cannot talk to you about how your boyfriend is getting on your nerves. First, we have to make sure you’re alive, right? So from a manual. You have to do these things to get this outcome and we can measure how we are working towards that.

The other school of thought is more cycle dynamic. And that’s why I came to New York because I was seeing a lot of people who had 2 or 3 things happening at the same time. And so what I learned very quickly was that if I was able to talk to an individual from a psycho education point of view, and say, Listen! From a manualized therapies will be most effective for you, however, based on what you’re telling me when you walk in the door. So I learned that had to be adaptable. And coming to New York helped me to learn the psychodynamic way of thinking, So in my model, what I do is I do what works with an eye on fidelity to treatment in order to address the complexity.

Petal Modeste: What about  the social, cultural, and environmental influences in the lives of your patients? How do you in this model integrate those as you treat them?

Dr. Melita Stancil (She/Her): That’s a good question. So, I start from where a person is meaning that if a child comes in or a parent calls me because the child won’t go to school, for example, I start with is the school a good fit. So I use the environment of the school. I work with the school. I work with the community around the school, because sometimes maybe the school is a good fit, but based on what the child is presenting, the Upper West Side is a place where they’re getting bullied and maybe the kid needs a different location.

Petal Modeste: Now you work with the families, you work with the parents of your patients. You have coaching for them, you help them make family treatment plans.  What is the goal of parent coaching in this context, what are some of the key skills needed by parents of children with complex psychological needs.

Dr. Melita Stancil (She/Her): So a lot of times parents will come in and they will say, without saying it this way, but the sentiment is, fix my child. Sometimes it can be my child won’t come to dinner, or my child’s not launching in a way that I want my child to launch. I want my child to engage in this high school or college process, right? And they’re just simply not interested. Or they’re not doing the things that line up with the family values. I believe that it is not the most responsible thing to simply have a child or a young adult in therapy, when it is possible for the family system to actually have intervention. And one of those interventions is parent coaching. The goal of parent coaching is, how can you be the most effective parent for this specific child?

Parent coaching is directive.  It assumes that the parent, from a coaching perspective, is well and what  they are seeking is to thrive. They are seeking to be the best at a specific thing. And so in this context, it is very much directed and interactive. And 99% of time. I say to  the parent, You need your own therapist. You need to have a space to talk about your feelings.  You also need to know. How to maximize your skills in order to show up for your child in this moment.

Petal Modeste: What about these family treatment plans. What do they look like? Maybe you want to use an example from your experience, respecting confidentiality, as you will, of course. But what are some of the key elements of a family treatment plan?

Dr. Melita Stancil (She/Her): So, the family needs support, not just the identified patient. Yes, Johnny may have come in right, and Johnny’s going to get what Johnny needs – sometimes that’s an individual therapist, skills coaching to regulate my emotions or effectively communicate. Sometimes there’s a psychiatrist involved, and that is the kind of emerging adult team, whatever that child needs. There also could be mentorship, an old Nanny, a coach, anybody in the village that the child respects and has a relationship with. What I do is, I say, let’s bring everybody together And we’ll coordinate and be align in the message to Johnny. On the family side there’s a family therapist who is helping the family to use what Johnny is learning to be able to interact with the family system. At the same time, the parents are receiving coaching.  I’m usually like the center, sometimes it’s me coaching the teachers on how to be most effective in teaching that  child in that environment. In some situations it could be a little army around the family to support them for a time-limited intervention which can scale up the kid.

Petal Modeste: So it sounds as though you are indeed the center because you’re working with people from the life of the child, but you’re also working with other professionals, It could be an educational consultant.

Dr. Melita Stancil (She/Her): Yes.

Petal Modeste:  An executive functioning coach, so part of your role is to be this sort of hub.

Dr. Melita Stancil (She/Her):  And sometimes it’s a therapist that maybe has been with the family for a long period of time, or Mom and or dad. And I’m taking in all the information in order to inform the case. I’m working with an interdisciplinary team of individuals.  We are all independent providers. Because, we want expertise, right? So when we work in certain systems, we may have, an amazing expert at XYZ, but it might not be the right fit for this family, so what is easier to do is to get together people from different walks of life, different disciplines, different personality, different demographics, that are important to this family system, and have them inform me from their point of view. What does this child need? What does this family need? And then offer their own opinions about how we create a treatment plan.

Petal Modeste: How can families who need your services, but don’t have the financial means to access them still benefit from those services? I think you have a nonprofit of some sort that perhaps might offer scholarships. But tell us.

Dr. Melita Stancil (She/Her): I usually tell the family that finances matter. They’re also a component of intervention, because they have to have retirement. They have responsibilities. So, price point is important, and I ask families when they come in to always be upfront and to think about what spend is a reasonable spend for this  child? I developed a nonprofit for this reason. How do we compensate professionals for what they are worth and also give families what they need. And what I found is that if I created a nonprofit, what I could do is make sure that professionals were paid, as well as provide the services to the families. Another way, though, is we could do is look at the spend that the family can reasonably afford and then all the providers make a decision together to reduce by say 10% or we can do this for X number of weeks And then we can re-access. So there are times when providers are asked to slide and then there are times that what we really need is a little bit of augmentation for the financial resources of the family. And I try to provide that through Turn the Sails, the nonprofit.

Petal Modeste: What are two  common obstacles that you face in your treatment of children and their families and how have you overcome them?

Dr. Melita Stancil (She/Her): The first obstacle, more commonly than I would like is, I will do anything for my child. And then, when I say, Okay, hey, mom, you know it seems like you may have had some childhood trauma, for example. Will you work with this trauma therapist on this? And how I’ve overcome it is, I tell parents when they come in, “I’m going to ask you to do things that are counterintuitive. I’m going to  ask you to do things that seem completely opposite of what you would want to do.  I’m going to make sure that you have the skills to be able to do it.  There’s a lot of conversation, a lot of talking about it, and I also let them know that there’s a limit to what I can do if they choose not to address certain things. So, it takes all of us working collaboratively in order to make change. Another common Issue that I see is parents who are well meaning in what they want for their child, but who cannot see the individual they have in front of them. So they had an idea of who their child was going to be. I am going to raise the next President of the United States, and they are going go to boarding school, and then they are going to go to an Ivy League school right? And they’re going to start out making $250,000, and then they’re going to get married.  Although they love their child, they are actually processing the grief that’s associated with the life they thought they were going to have, And so they are unable to actually be honest with themselves about who the child is; to realize that either your child has some complexity, and or the individual that you have in front of you is not the individual that you imagined you were going to actually raise.

Petal Modeste: You know, parenting or becoming a parent in a way, is, could be an extension of our egos. I mean you bring this this beautiful being into the world, but you sometimes forget they are their own person, they have their own mind, they have their own challenges, their own strengths.  And we do have very clear stories we write in our heads about who our children are supposed to be. I feel like it happens kind of subconsciously.  I really think that’s a very important point, and that I could see being one of the hardest obstacles that you probably face in your practice.

So you know, Melita, this podcast is about this underlying belief that we parents are the architects of the future, and that if we understand the world as it’s evolving and we acquire cutting edge scientific tools and  knowledge around raising our children to thrive and to be their unique selves, that we can actually impact what the world looks like for them, the world they come of age in. And so, of course, I don’t think there’s a parent who will disagree that every child needs a chance to thrive, even children who You might want to discount because of their abilities, or where they might have grown up, or the  economic circumstances in their families or their complex psychological needs.

And so, my next set of questions to you are around recognition and acceptance, and the willingness as a parent, to say, whatever the story has been in my head about my child, I am going to go the distance. I’m going to make the sacrifices. I’m going to do what I even need to do myself to make sure that my child thrives. So, at what stage do many of the conditions we touched on today tend to manifest?

Dr. Melita Stancil (She/Her): So you know, I will say when I go back and take history with the families, what I will hear is that this child was difficult to sooth, for example, or, you know, I had to drive in a car for 2 hours every night.  They start by telling me this story which begins with the child being different in infancy. And then how they responded.  So I think that temperament plays a big role in things. A match between the temperament of the child and the parent is also very important. So meaning, that you could have a very sensitive child but say, the parent is not as sensitive by nature. So the parent may not  understand why Suzy is reacting to Disney world and wants to go home. Maybe this is sensory overload. So I see historically that there’s usually a story where the child has been different, and they struggled to figure out how to support their child. You know, from infancy, sometimes to school age. Usually what I see is that the conditions manifest themselves when they are a pre-teen to a teen. Most of the families that walk through my door, are high school age freshman to senior year or launched to college. They went off to college, and they just couldn’t get out of bed or started having panic attacks. The kids will tell me that these things existed before. But the parents just weren’t aware that these symptom clusters were there.  Usually, when the functioning is impacted the grades, the attendance, engagement, extracurricular activities, that’s when they’re willing to look for intervention or walk through the door.

Petal Modeste: And that is what we should do If we suspect our child is grappling with a mental health condition of any kind? We should seek help immediately get them tested. Whatever it might be. We might be wrong. but it’s better to know that you’re wrong, correct?

Dr. Melita Stancil (She/Her):  100%. It starts with a comprehensive evaluation. If there is a suspicion that something is going on, I typically advise a neuro psychological exam that can say to you more definitively, this is normative behavior or we need to pay attention to this. So testing is essential. There are people who have all kinds of feelings about testing, and I understand that, as far as the fears of where is this document going to go.  What I find is that most individuals that are trained in neuropsychological assessment are very sensitive to privacy, very sensitive to, you know, addendums to reports or shorter reports for the school system. So I always say assessment, assessment, assessment.

Petal Modeste: What role might the schools our children attend play in both identifying these conditions and alerting us to it. And then how can we partner with them to make sure that they are consistently sharing their observations or experiences with us, because sometimes again, you might be seeing something at home. But you’re not sure, is it me right like you said. It might be showing up in a different way in school.

Dr. Melita Stancil (She/Her): I think the school is essential because the child spends the majority of the day with this institution and these individuals. And you said it beautifully that there’s a story that we tell ourselves a lot of times. There is an informal story that’s being told about our child in these systems. What is key is to put yourself in a position where you are collaborative with the teachers, with the school.  it’s not friendship. We’re very friendly to invite conversations, so you can learn, if possible, the narrative about your child because you may see behaviors in one classroom that you don’t see in another classroom, which is teacher specific. And then ask questions. I think we have to be open. I think we have to be willing to listen, and I think that we have to be very collaborative, and have expectations of other trusted adults who are in the lives of our children.

Petal Modeste: What are some of the ramifications of not addressing or even denying that our child might have a complex psychological need.

Dr. Melita Stancil (She/Her): You know, worst case scenario, self-harm, suicidal ideation. So unfortunately, a lot of young adults. And self-harm can take many different forms. It could be what I call extreme self-sabotage, risky, unprotected sex; It can be passive suicidality: if I don’t wake up, my family would be better off. On a lesser level, it can be underachievement. And they don’t know why. When you start to see more problematic behaviors, functional behaviors where your kid is staying out later, drugs and alcohol dopamine chasing is what I call it, It could be social media – they are distracting themselves for hours  gaming whatever is stopping them from being able to thrive, not just survive.

Petal Modeste: Having worked in this field for so long, Melita, how important is it that more mental health professionals adopt an approach to the treatment of complex mental health conditions that that draws upon the collective expertise of various health care, professionals, that looks at the environment in which, the child is living or existing. How important is that, it is not often that you hear about this sort of holistic approach. Are we moving into a time where it is becoming more and more important that more mental health professionals adopt this kind of approach.

Dr. Melita Stancil (She/Her): I think so. In my perfect world, you know, everyone, young adults and kids would stay in their community and get the support that they need towards their goals, and if you need to come out and go to a rehab it would be very time limited, with the goal of always reintegrating into your community and family and actually applying those skills. I think we work in my field in silos, which is what you’re describing. So everybody has their own expertise in their own system in a way to do things that work for them, and if I do the same thing, which is where I started all day, every day, right, I will be competent in that right? And for some people that works, that’s the truth. What I tend to see, what a lot of professionals nowadays are saying, because of the influence of social media kids are very psychologically minded. So they are able to say, I’m having some depression. But also look, I got a little panic. Maybe I’m borderline personality – they very much over diagnose themselves. Well, how old are you? you know, like your personality still in flux.  You asked me how important is. I think it’s essential. I think that we have to look at these. human beings wholistically and we need to meet them where they are, and then help them to be the whole individual that they want to be. And that’s going to take some case collaboration, some case coordination, some case management. In some situations we have to know ourselves too as individuals. Right? So if I don’t want to do that work then I’m going call Doctor Stancil and she’s going to  make sure that you have a rabbi or a nutritionist on the team. So it’s either bringing in somebody that you know is willing to do that work, and or being willing to have an open lens yourselves as a professional.

Petal Modeste: So, of course, any parent of any child, especially a child with complex psychological needs will attest that there are good days and bad days, and sometimes the road ahead is just unclear.  So for a last question. I would like you to respond by sharing with us a word, a quote, a phrase, something that helps keep you not just optimistic, but actually energized to really address these complex psychological conditions; to work with, other professionals to work with families who were struggling. What keeps you going? What helps you keep Stay the course

Dr. Melita Stancil (She/Her):, I would like to say that it is some profound statement from a saint, That has shown us the way in the darkness.  But I find what keeps me going on the hard days is the Lemony Snicket quote and it is “people aren’t either wicked or noble. They’re like chef salads with good things and bad things chopped and mixed together in a vinaigrette of confusion and conflict.” And that’s all of us. We are all a little bit of all of it, good, bad, right, like all the things that make us who we are, and what I want for individuals is that they see their super powers – While honoring the fact that you have some challenges? The bad will change and the good will change, that. It is all seasons, and it’s not all in our control.

Petal Modeste: Thank you, Melita, for joining us. Thank you for what you do in the world. It was a really wonderful discussion. I hope you’ll come back and visit us.

Dr. Melita Stancil (She/Her): Thank you so much for having me. I appreciate what you’re doing in order to make the future better and to support the parents. It is truly profound and I hope that you can receive that it is a game changer from my perspective.

Petal Modeste: Thank you so much. That means a lot.

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