Resilient Teens How Mindful Healing is Transforming Adolescent Mental Health with DBT Ep.74
Episode Overview
About Guest: Lianna Tsangarides
Lianna Tsangarides is a highly respected licensed clinical social worker with over a decade of experience in the mental health field. She is the founder of Mindful Healing, a therapy practice in Connecticut that specializes in Dialectical Behavior Therapy (DBT) for adolescents. Lianna’s career began in intensive outpatient programs and residential care settings, where she developed a passion for working with high-risk teenagers. Witnessing the revolving door of crisis care, Lianna was inspired to create a therapeutic space that offered more than just immediate stabilization. Her goal was to provide long-term, sustainable healing for teens struggling with self-harm, suicidal ideation, and severe emotional dysregulation.
At Mindful Healing, Lianna has built a practice that is deeply rooted in the principles of DBT, integrating mindfulness, emotional regulation, and distress tolerance into every aspect of care. Her approach is both comprehensive and individualized, ensuring that each teen receives the support and skills they need to navigate their unique challenges. Lianna’s dedication to her clients is reflected in the structure of her practice, which includes both individual therapy and group sessions designed to reinforce DBT skills in a supportive, peer-driven environment. Under her guidance, Mindful Healing has become a beacon of hope for adolescents and their families, offering a path to recovery that is both compassionate and effective.
In addition to her work at Mindful Healing, Lianna is a sought-after speaker and educator in the mental health community. She frequently presents on topics related to adolescent mental health, DBT, and the challenges faced by today’s teenagers, particularly in the context of social media and post-pandemic anxiety. Lianna’s insights are informed by her extensive experience and her commitment to staying at the forefront of therapeutic practices. She also actively contributes to the ongoing education of future therapists, serving as a mentor and supervisor to interns and new professionals in the field. Lianna’s contributions to mental health extend beyond her practice, making her a vital resource for both her clients and the broader community.
Episode Transcript
Becky Coplen: Thank you for returning to mastering counseling. We are thrilled today to have Liana Lindsay with us, who has an amazing practice goes by Mindful Healing. And , thank you for giving us your time today.
Lianna Tsangarides: Yes. Thank you so much for having me on.
Becky Coplen: Yes, we’re glad to have you. And today her practice is open especially for teenagers and using DBT therapy. So we’re going to explore that in depth. And , just kind of talk about the type of clients that she’s helping and where how her practice has grown. So why don’t you go ahead and start us off about where it all began and how you were inspired to start mindful healing?
Lianna Tsangarides: Yes. So I started my career working in IOP and then residential settings for years, and while I absolutely loved and would never change my time working in those settings, it was hard seeing kind of the revolving door and feeling like you had such high risk clients and that they would get better, but then be coming back into treatment. And I really wanted to create a treatment option for teenagers who were high risk or self-harming, or really struggling with these intense big emotions where they could stay long term and you could really see the work where they felt safe and they could get actionable skills, and they could be whoever they were, and they could be their weird, sort of spunky and funky selves and get the treatment that they really needed. And that’s what Mindful Healing is all about.
Becky Coplen: That’s amazing. And as you’re describing some of the things that teenagers may need. I love your description. I have a couple of my own in my own home and as you know, most of the population recognizes it is such a time of trial and error and change. And I’m sure people say to you, and I don’t really like to say this because I love working with teenagers as well, but I’m sure you sometimes hear, you know, oh, how could you work with that age? It’s, you know, such a difficult time. But let’s actually talk about that, because to me, it’s such a special time and I’m sure you definitely value. But what would you say would surprise people about how amazing that group of kids are?
Lianna Tsangarides: , I think actually how resilient teenagers are. I think a lot of the population thinks of teens, and especially this generation is not being very resilient, but I think that they are facing much bigger Are challenges that our generation faced in a lot of ways, and I think a lot of the discussion around teenagers today is that they don’t have any challenges. You know, that they haven’t faced hard times, that everything is just kind of handed to them on a plate. And, you know, I think there’s a like in DBT, there’s a real dialectic to that. Well, you know, we have a lot of privileges growing up in the world of technology, and they have a lot of access to information. Growing up is the first generation entirely on smart technology is also a lot of challenges. And I think there’s a hidden sort of resilience in working with teenagers and a lot of what makes working with them very challenging. And why not everybody wants to work with teenagers is also what makes them such a wonderful population to work with. They are resilient and they are kind of fierce, sometimes a little oppositional and stubborn. But that stubborn kind of nature is also what inspires them to kind of keep going and find their independence and find who they are. And, you know, I just love working with teens. I wouldn’t really want to work with any other population.
Becky Coplen: . I love that perspective. And yes, definitely resilient. And you make a good point of their blazing the trail and we’re you know doing all the things wrong. Raising them in the first generation of technology and finding all the balances and how it’s helpful how it maybe hurt them. But that’s definitely a great approach that their challenges may not feel as physical, maybe as like people in the past, but like their mind going all the time. And how we often hear, you know, if there were issues at school with other kids, you could forget about it at home. And now it’s so much, you know, with social media and all of that that they can’t always unplug, which has its challenges for sure. So thank you for sharing that perspective. Let’s go back a little bit to the start of your practice. How long did you make the shift into it, and where did you think of the name and what is your practice look like? And I definitely want to talk about the groups you run too, because I saw that on your website as well.
Lianna Tsangarides: You know, the name just, you know, comes from how important mindfulness is to me and to DBT in particular, because we are a DBT practice and I love DBT and I find it very effective in working with teens. And so since mindfulness is, you know, the foundational skill set of, you know, it just kind of felt right to be mindful healing that that’s part of, you know, what is essential healing aspect of what we do.
Becky Coplen: I kind of started just rolling with all the questions. So yeah, I love always hearing about the names of practices. , where they come from. It sounds just like a soothing, calm name, so I appreciate that. And let’s talk about DVT in specifically how that would what type of teenager you might be able to help using that approach and just kind of the breakdown of the actual strategies in a session individually or in a group?
Lianna Tsangarides: Well, I’m biased. So I think, you know, DVT can help pretty much all teenagers, but specifically like a comprehensive DVT program is for like big behaviors. So we see a lot of self-harming teenagers, suicidal ideation, angry outbursts, and just really dysregulated emotions, like teens who are kind of like on an emotional roller coaster and feeling like, you know, whether it’s their anxiety or their thought process is, you know, bigger than they are and that they can’t control that. Dbt is really designed for them. The skills in general, if you talk more like DBT informed and kind of just weaving that into individual therapy, I find that helpful with just about any treatment plan. But a really structured like comprehensive DBT program is more of the first kind of client with like really big emotions. And when I say comprehensive that’s where they are in DBT skills group DBT individual therapy which is very structured, where they’re doing like their diary card and reviewing that at the beginning of session. And they’re like tracking their target behaviors. And, you know, they it’s very, very goal oriented. And you know, they have like access to DVT coaching outside of session. And so it has a strict focus and structure to it. .
Becky Coplen: All right. Good. In which often we’re hearing kids of all ages. That structure I think is a huge part of helping them feel comfortable even if they resist it a little. I think in the end it ends up being really good. So let’s talk about how you would differentiate if a teenager client would need the group, or the more individual sessions, or do a lot of them do both, as you kind of mentioned, but kind of talk about what things might be more helpful for them in each category.
Lianna Tsangarides: You know, it depends on kind of what they’re coming in for. So if they are struggling with suicidality and self-injury, they are probably going to go into both. If they’re, you know, essentially have high risk behaviors, then we’re likely to recommend them to, you know, as I mentioned earlier, we would refer to as like our comprehensive DVT program because we want to make sure that they’re safe and so that they have access to therapy as much as possible, that they’re getting the DVT skills, that we’re tracking their behaviors. And part of tracking that behavior is that they’re not just identifying like triggers, because life has triggers like those don’t go away. Those don’t go away when we end therapy successfully. Like life is frustrating at times that we not only are learning what our triggers are, but we’re identifying through that. You know, in DBT, what I called like a diary card. But we’re identifying what are our thoughts and our feelings that we’re experiencing when we’re triggered. And then as we’re learning that and An individual therapy where simultaneously learning in group therapy and in like DBT skills, group the coping skills that line up and match okay with those different thoughts and feelings. So it’s how do I manage? Like what skill is appropriate for what type of thought and feeling and when do I use it? And then in group, it’s also giving us a chance to practice with our peers different skills. And in between the sessions we’re practicing and we’re talking about that in individual therapy.
Lianna Tsangarides: And we have homework and different things. And so we’re really learning that these skills work and we’re tracking that data. And we’re seeing maybe last time I experienced this type of feeling or thought or trigger, you know, I had this behavior or this emotion at a level like nine. And maybe I still had the behavior where, you know, maybe I still, you know, had an angry outburst, but it lasted, you know, three minutes instead of ten minutes or it took me longer to react than it did in the past. . And it’s one of the things I love about track it, it can feel really tedious and not everybody loves to do it but it gives in the end this really concrete data of. Right. Oh you know I didn’t realize I was making progress because I still have the feelings and I still have the behavior. And so I didn’t feel like I was making progress. But when we look at the past two months and I can see my chart, you know, I am making progress and I’m seeing, you know, my little color coded apps and code down. . And then they feel really successful and really motivated to keep going. And those moments I just I love to see in session, I love to see their face when they have that like aha, like, oh I didn’t know.
Becky Coplen: Right. They probably didn’t know how far they could get in making progress. So data is always so helpful. And in this world, in mental health world science data, it’s not as easy as you know, your math multiplication facts or whatever it is that you’re learning. It can be great. So that’s awesome that you can provide that. I know a lot of it is very goal oriented and everything. So would that be like a possible goal someone would have? You mentioned, , someone feeling success of having an outburst for three minutes instead of ten minutes. Would that be like a goal that they would maybe set? They know they are going to get really angry when X, Y, or Z comes in the room or they’re in this environment, but the goal is to shorten the outburst.
Lianna Tsangarides: The goal might be to shorten it. Typically, our goal is often to eliminate it depending on what the behavior is. So like if they’re self harming or they have angry outbursts. We’re really trying to have them feel in control. So they’re not having angry outbursts, that they’re learning an effective way to express their anger or, you know, an effective way to express, you know, whatever’s under the surface that’s causing them self harm. So we’re looking to eliminate self harm. We’re looking to eliminate the angry outburst, not the anger, but the outburst. Yeah. But as the stepping stones. Absolutely. Let’s decrease it. Let’s, you know, like, those are still successes. Yeah.
Becky Coplen: I see that the larger goal for sure. And then hoping for that. But knowing it might be the smaller steps. So thank you for clarifying that. What I’d love to hear about is kind of more from your perspective in running the practice, and especially the kids who maybe Need group and individual. How do you manage if someone runs a group, does that mean they see any of those people individually as well? Do you guys partner up or refer out? Talk to us kind of about the structure, especially for people who need the whole comprehensive plan.
Lianna Tsangarides: So if ideally if they need like comprehensive DVT, they are staying within our practice because of how structured that is. And the communication is really streamlined that way. Not everybody needs that comprehensive program. We definitely get referrals for our skills group from individual therapists. We just work on really communicating with them or vice versa, that we have somebody who’s in group and we might refer to an individual A therapist outside of our practice as well. Or family therapist outside of our practice. Okay.
Becky Coplen: So kind of changes depending on the needs of the family or the teenager. Okay. And when you say out how many people make up mindful healing at this time?
Lianna Tsangarides: Uh, currently there is myself, our parent coach, two clinicians. We have our intern starting in the fall.
Becky Coplen: Oh, cool. Will that be the first time you have an intern or.
Lianna Tsangarides: No, but we haven’t had one in a while, so. Okay.
Becky Coplen: Yeah. That’s great. A lot of people I talk to on here have had various interns, and usually it’s such a positive thing. A lot of them end up working as part of the practice. And it’s just it’s always fun, right? To train people in what you love to do and then see more people want to do that, or at least have that as their starting point. So, . Cool. Can you talk about the parent coach role a little bit, as I imagine they kind of have a different skill set than the other clinicians.
Lianna Tsangarides: Yes, absolutely. So our parent coach is actually my mother.
Becky Coplen: So literally when you said parent coach, I felt it like is your parent. But then I was like, absolutely not. They’re just, oh, there’s.
Lianna Tsangarides: Some good intuition.
Becky Coplen: In you. Wow. Yes.
Lianna Tsangarides: And so she has lots of experience on like, both sides of that desk, because my brother and I were pretty difficult teenagers, and it’s really.
Becky Coplen: Hard to imagine, I have to say, in my short time of knowing you, but.
Lianna Tsangarides: Oh, good thing this is recorded because I’ll be happy to share that with her or she’ll get a chuckle. Okay. , you know, she obviously again, I’m biased, but she is a wonderful parent coach and really guiding the parents through adjusting their approach, because I think a lot of times, you know, parents are nervous to come in and participate because they’re worried that they’re going to be blamed. And, you know, helping them to understand that it’s not about blame or it’s not about you doing anything wrong. Like, there’s no perfect parent. And that sometimes if a teen is struggling like the family system breaks down, like what might work before they were depressed or before they were anxious, or before they experienced a trauma is not going to work anymore. So your approach may be healthy and appropriate, but it’s no longer appropriate for your child. And then the more you get frustrated with how your teen’s reacting, the more that communication system is breaking down. And I think that sometimes parents are very worried about being told that, like you caused your teen’s behavior to be like this, and that’s not the case. You know, there’s lots of factors and it’s just about shifting. Like, how can you change your current approach and how you’re responding to your team that’s going to help your teen change their responses to you or their responses at home because they’re not in a vacuum , right? You know, they spend, you know, 1 or 2 hours a week in therapy and they spend, you know, all their time with you except for when they’re at school and sports. Right. And, you know, teens may not let their parents know this, but parents matter. Their parents opinions matter, their parents responses matter, their parents approval matters.
Becky Coplen: Yeah, yeah. That’s amazing that you have that connection there. And and you know, I’m a school counselor. And even in elementary, we have to make, you know, the hard calls to parents to say this is what your child is saying and they are suicidal, and we need you to have them seen or whatever. And of course it’s a bigger conversation than that. But when to have to see the grief or surprise, shock, whatever it is the parents are feeling, it’s so immense. If a child is, you know, caught up in this and struggling so much. And so I’m sure the parents are really glad to have the support and be able to talk it through, because my experience is a lot of the parents had no idea. And granted, the kids are younger in elementary and it’s the first time they’ve ever experienced this and it feels like everything they’ve done could possibly be wrong. So I think it’s awesome that you guys have this as part of a whole family thing. And as you said, we’re not living in vacus and this affects the entire family structure. So yeah, and that’s amazing that your mom is part of it. And you guys, it sounds like you took some of the things you dealt with when you all were younger and are trying to help people maybe do it a little different, or at least try some strategies. So very cool. Can you talk about are there some future plans or developments for the practice that you see in the next year or five years?
Lianna Tsangarides: I should that are just getting started. You know, we’ve just added our ADHD assessments and our school avoidance group that’s, uh, you know, starting this fall. And so we’re really excited about those. But I think some of our parent programing is expanding. I’m really looking at adding like a DBT group for parents. And I spoke about how much I love the, you know, group for the teens and the camaraderie that comes with that. And like seeing the skills work from, you know, kids who are further along in the group And you know, I love having the parent coaching, but I think being able to offer the camaraderie to the parents as well, to hear from each other and, you know, in addition to having like their own private space is something that we’d really like to be able to offer. Yeah.
Becky Coplen: That’s amazing. Very cool that you’re starting with that. And yeah, the school avoidance group, that’s a new thing too. And yeah, they’re I don’t know exactly what schools you’re associated with. I know in our the school system I’m a part of absenteeism is off the charts for many reasons. It’s not always some of the kids even want to come. And there’s other factors, but there are definitely a lot of kids pushing to not come. So I assume you’re seeing a lot of that around you.
Lianna Tsangarides: We are. I mean, obviously after Covid, the anxiety of like being back in the classroom, like, you see, again, like the dialect, like a lot of people wanted to get out of their house and back in, but a lot of kids went the opposite direction and the increased like social anxiety and test anxiety spiked. And so I’m hoping, you know, those teens, you know, deal with like any safety behaviors that they put in place.
Becky Coplen: Right, right Yeah, whatever. , you know, certain grade levels, you know, if you will, the seniors of 2021 or whatever, everyone lost things. But it’s like no matter what age you are or how big the whatever is supposed to be special. That year, everyone lost some things, right? Like the two year olds lost speech, the one year olds lost expression, the ten year olds lost, I don’t know, gaining their independence. Whatever it is, it’s like something was lost and then coming back from it, I just think it will be in my mind. It’s always like at least a ten year thing. I feel like, because there’s just so many challenges coming out of that But I’m glad that you guys are doing that, and I’m sure it will help a lot of kids. Let’s talk for a little bit about the kind of behind the scenes of mindful healing, because we love to talk about the business side of practices. How much are you running? You know, the insurance communication, the scheduling, the meetings with the other clinicians and your parent coach. Are you managing all of that? Do you hire that out? , any apps or programs you really like that you would like to talk about?
Lianna Tsangarides: Okay. So let’s run significantly less than I used to. Learning to delegate was and is a challenge. Definitely. I do love the business side. Not every therapist does, but I do. I do enjoy it. We are out of network.
Lianna Tsangarides: And we work with risers. We use the riser app. I’m not sure if you’re familiar with that, So I’m not actually, uh, you know, speaking of, uh, apps or programs that we like, Thrizer is a program that helps you work with added network benefits, and it offers different ways so that clients don’t have to worry about, like submitting the super bill or dealing with appeals or, you know, if understanding the process or kind of just takes all of that off their plate and it helps take a lot of it off our plate. And so we use that and collaborate with Thrizer to make out-of-network billing smoother, ensure that they’re getting proper reimbursement and that that is a, you know, seamless process for our clients.
Becky Coplen: Yes. Okay Very good to know I like that and that’s good that you are delegating. But I get it. Like if it’s your practice and you kind of like knowing more of the behind the scenes and payroll and all of that, you know, I could see how some people would enjoy that, and it seems like you do so, but I’m glad that you aren’t doing all of it because it sounds quite overwhelming.
Lianna Tsangarides: Now I doubt so. That was a challenge. And learning, you know, when you’re first getting started, like when to start delegating and hiring support staff and, and what to delegate first and how to delegate. Those were definitely initial challenges. The first support staff I hired was my intake coordinator to help me with phones and scheduling.
Lianna Tsangarides: Which was hard. Like it was wonderful to let go of and very hard to let go of.
Lianna Tsangarides: You know, that’s the face of your company to the outside world. It’s the first point of contact.
Lianna Tsangarides: And.
Becky Coplen: Oh. Go ahead. Keep going.
Lianna Tsangarides: No, no, please.
Becky Coplen: I was going to say it’s like whenever you hire someone, it’s like also finding That you can’t read each other’s minds at first. So how much communication do you have to have with them before you know what I mean? Like you have to know all of the things, but then how much do you really have to know? And you can just count on them that it’s going to happen. You know, it’s definitely has its challenges, but I’m glad that you were able to do it. What would you want to share with someone who is just about to go out on their own and begin their own practice?
Lianna Tsangarides: I would encourage them to get a business coach. , when I first started my practice, I was really nervous about spending money on my practice to help it grow. And when I got past that fear is when my practice actually started to grow. And when I had the time to really focus on my clients, and I was less nervous about the business, and I could be fully present, and things really shifted at that point. And so, you know, that’s not an easy anxiety to get past as a like a new person in solo practice. But you know, being able to sort of work on that anxiety and find the right coach for you to help you because there’s so many things you don’t know and you don’t know what you don’t know about the business side and specifically the business side of a therapy practice, like having like someone in your corner who can help walk you through that is, you know, an invaluable tool.
Becky Coplen: And just curious on that. Did you hire someone as a business coach specifically who helped in the mental health business, or was it a general business person? Business coach sorry.
Lianna Tsangarides: A therapy business coach for a short while. And what was really helpful for me was some of the coaching Courses that I took at the time, specific to growing groups and some of the mastermind like online programs and like co-working spaces where I could collaborate. You know, I love group work. And so I could hear from therapists who are further along in their practice than me and, and have, you know, advice from people at different stages in those kind of co-working spaces and. Right. That was a really important part.
Becky Coplen: Very cool. Thank you for giving us the details about that. I was going to ask when you because you have other clinicians on your staff. At what point was it a business coach or did you yourself decide I need to hire other people to work with clients? Like, what was that rub that pushed you to be able to do that?
Lianna Tsangarides: No I Decided and, you know, honestly, I just wanted to do more on the business side and something that’s very important. Part of mindful healing is the client care and small caseloads. And so if I wanted to keep writing the blogs and doing some of the marketing and the ad work and some of that, I wasn’t going to be able to maintain a full caseload and give them the standard of care that mindful healing. Marcus. Like. Right. You know that I was writing in our marketing. I wasn’t going to be able to call parents on a regular basis and contact primary care providers and contact the school and things that are in our SOP. And I didn’t want to skip out on either end.
Becky Coplen: Yeah, yeah, I think that’s amazing that you recognize that. And absolutely, you know, we have so many ethics in this field, and especially if you’re marketing that kind of full practice. And I know you work with the families and not just the teenagers, that it’s good that you’re able to structure the time and let other people do that amazing work as well.
Becky Coplen: Is there anything else that you’d want us to know about Mindful Healing that we didn’t hear about, or any topics we didn’t get to touch on yet today?
Lianna Tsangarides: I mean, I’m sure I could probably talk about my practice all day long. Yeah. .
Becky Coplen: Oh. Go ahead.
Lianna Tsangarides: Yeah. I think those are the overall basics of, you know, what we offer.
Lianna Tsangarides: And yeah You know what?
Becky Coplen: We didn’t get to talk about how much you’re doing online or in person or some of both. So what is the space situation that you guys are using that works best?
Lianna Tsangarides: Actually that is I should have thought of that. That’s super exciting. So we just moved into a new space like two weeks ago.
Lianna Tsangarides: Wow Very to expand that. So we outgrew our old space for to have a much larger group room. And so my clinicians can offer in-person or online sessions like every day of the week. So they’re no longer sharing, have to worry about sharing any office space. And so my parent coach is entirely online.
Becky Coplen: Okay All right. Yeah I had a feeling it maybe it was a little bold, but I figured the group was in person the way you described it. But that’s great. Congratulations on a whole new area. I’m sure everyone is re-energized and excited. Everyone always loves new spaces, so especially when you don’t have to share a viewer. So yeah.
Lianna Tsangarides: So we’re really excited about that and having yeah, more space for sessions, more times available. And so we’re yeah we’re very excited about the new office.
Becky Coplen: Yeah I’m excited for you. Well thank you so much, Liana, for giving us your time this afternoon and all the insights that you gave us on DVT and your healing or mindful healing practice.
Lianna Tsangarides: Yes. Thank you so much for having me.
Becky Coplen: Thank you to our listeners for tuning in today. I hope you got a better picture of DVT, and definitely learned some great insights into starting a practice and how it evolves and changes. Feel free to leave us questions or comments. Have a wonderful day.