Listen to the audio of this interview with Ann Smith.

In the Pennsylvania Countryside, atop a peaceful streamlined hillside in Wernersville, you’ll find a quaint Victorian home known as the Breakthrough Mansion. On its porch, you’ll see people enjoying the comforts of rocking chairs or inside, chatting in a cozy lounge. Are they on vacation? Not in the traditional sense. Rather, they’re on a five-day retreat in this safe family residence to get away from the chaos of their normal lives in order to rebuild happier lives for themselves. They’re participating in a residential group therapy program called Breakthrough at Caron — a unique treatment program designed to help people “break through” old defenses and destructive life patterns to improve relationships and personal growth in an atmosphere similar to a healthy family. And it’s making a difference. Consider these testimonials from past visitors:

"The individual therapy I was doing was just not getting me there quick enough. Breakthrough pushed the door open; it was the catalyst that helped me get going and put it all on the table."

- Lisa, 32, newly married, administrative assistant
 

"You sure did make a difference in my life and I will always be grateful. I am no longer the victim and [am] no longer feeling any guilt. The road to recovery is long and painful, but oh so worth the destination.

- Rhonda, 64, married, retired business owner
 

"Thank you for providing a safe place to discover and explore. I have been free of my compulsive behaviors for seven years and credit Breakthrough for being an important part of that recovery."

- Charles, 52, married, Principal in a national healthcare consulting firm
 

Ann Smith, MS, LPC, LMFT, is the Executive Director of Breakthrough from Caron. She is best known for developing innovative residential treatment programs for adults from painful family backgrounds. She returned to Caron earlier this year with her patented Breakthrough program. She is a licensed professional counselor and marriage and family therapist, and has authored two books: Grandchildren of Alcoholics: Another Generation of Co-dependency and Overcoming Perfectionism: The Key to a Balanced Recovery.

BHC Journal recently interviewed Smith about the program.

BHC Journal: This is Robin Jay with BHC Journal and today I am speaking with Ann Smith, Executive Director of Breakthrough, a revamped program at Caron’s Wernersville campus that’s going to be reopening in a new facility in April. Breakthrough at Caron is an adjunct to therapy for people who need personal growth to get over issues that are keeping them back from moving forward in their lives. Ann, thank you for joining us.

Ann Smith: Thank you.

BHC Journal: Ann, give us a brief synopsis of who Breakthrough at Caron is for and how it’s uniquely tailored to help these patients.

AS: Breakthrough at Caron is really meant for people who are possibly in the midst of a crisis, but often people who have been working on themselves for quite a while, either through their own efforts, through self-help groups, or through the therapy that they’ve been in. Although they’re really motivated and they’ve tried very hard to change some things in their lives, they find themselves stuck. They’re usually stuck in patterns in their relationships, in how they feel about themselves, possibly in career choices; they just don’t feel like they are able to move forward. They know intellectually what they want to change in their lives, but they haven’t been able to do it, even with the help of skilled therapists.

BHC Journal: What are some examples of specific issues that people can come to Breakthrough at Caron to receive help?

AS: Abusive relationships would be one of those issues. Also, people who find themselves getting the same feedback in relationships over and over again. Men will often come to Breakthrough when they are being told frequently by people they’ve been involved with, maybe marriages, maybe different relationships, that they’re shut down and are unavailable and they don’t know how to open up even though they want to. Sometimes they need a jump-start. Sometimes they need to be in a more intensive therapy where they’re able to really get to the bottom of what it is that’s causing them to hold back and how they can change that.

BHC Journal: Ann, you’ve mentioned that this is an adjunct program to therapy. Why is it important that this is part of a long-term therapy process?

AS: It’s very incomplete. Breakthrough would be incomplete without people working on things in a practical way; working on their problems over time in therapy. Breakthrough does not deal with the specific details of the problems in their lives. We don’t try to solve every problem they have. We try to help them get underneath the problem to the pattern and the process that’s going on for them so that they can then be better problem solvers. This helps them be able to work with their own therapy to make the changes to integrate whatever it is they’ve learned. That is why the combination is so important. Breakthrough by itself would just be a really nice, neat experience for them to remember, but it wouldn’t really take hold without being part of the longer process.

BHC Journal: Breakthrough at Caron is normally a five-day residential process?

AS: Yes it is. It’s from Sunday to Friday.

BHC Journal: What types of activities and experiences will participants find when they’re in this program?

AS: Breakthrough is unique. It’s like nothing people have ever experienced before most likely. What we try to do is create a learning lab for people to step out of their lives, but to step into a world where they are in a very small group. Usually there are about 10 people in a group with two therapists.

We create a family atmosphere in that we filter out all outside influences and distractions and allow them to build a closeness with strangers where they can actually take risks more easily than they can with the people in their own lives. And we do that by having a very deliberate structure to the program and we move very quickly into emotional areas that they don’t expect to be able to do [on their own]. But they are able to do it because it’s very safe. I insist that it’s non-shaming, that there’s nothing about it that says we need to blame someone or we need to be confrontational. It is safe and it gives people a chance to really feel their feelings and to experience a closeness that resembles intimacy in a small group and to take risks that they are not able to take out in the world.

BHC Journal: Ann, please expand on the tools that are used to help participants achieve some of the goals that you mentioned.

AS: People would expect to find that it would be educational or a lot of discussion with people getting feedback. It is not that. We are not doing talk therapy per se. Instead of talking about something, they actually re-experience it. I’m not referring to severe trauma, but if a person is talking about a relationship that they’re in, what we would have them do is actually use role players in the group setting to actually show us and to demonstrate what that relationship is like. It’s an amazing process where people very, very quickly get into those roles, so that in the end, it helps both the person we’re focusing on and the people who are helping by way of playing roles in their work. Each person gets a period of about an hour or so of specific work just on their issue about their relationships. They also do group work in experiential ways where people touch on things like losses they’ve experienced in their lives, relationship difficulties, their own self-esteem. Some issues in childhood might come up that are relevant to the things that they’re going through now. But all of it is done by experiencing it rather than just talking about it.

BHC Journal: So when a patient goes through the five-day residential program and they’re ready to go back into the real world, how is it that care is transferred back to the therapist? Is there still some interaction in that transition?

AS: Yes, there is interaction — as much as is needed. In some cases, it’s quite a bit; in other cases it’s very smooth. If people regularly refer patients to Breakthrough, they’re very accustom to the process and we don’t have to interact quite as much. But what happens is we give them a report.

The most important thing is we prepare the client for re-entry, as we call it, into the “real world.” The world doesn’t change while they’re in there and so we make it very clear about what we know from dealing with thousands of people for many years that they will experience when they leave. We urge them not to leave confrontational or to go out into the world and think that they’re going to change everything quickly. Because they’re not. They need to return to their therapy. If something new comes up that their therapist is not aware of, we make sure that they know what occurred and what might be significant about that. Then they go back to their own therapy as quickly as possible and they start working on it at a different level. The therapists will normally say the change in them is absolutely visible and remarkable, but it won’t stick unless they continue therapy. It really is important that people understand that it is an ongoing process. For some people, just a few months longer, for other people maybe a few years. It really depends on how much experience they had before they came and also how deep and extensive their trauma might have been in the past.

BHC Journal: Is there anything that I haven’t asked that you think is important for the behavioral healthcare professionals to know about Breakthrough at Caron?

AS: There are a few things that seem to be misunderstood in group work like this. One is the notion that what is done is blaming someone else for your own problems. It is not about that at all. We make it clear that although you may visit areas of your life where you felt traumatized about a particular relationship, we need to always look at it in a different context of what was going on before that. I call it the back story. What was going on with parents that put them in the position to be the way that they are? There is no one to blame and each individual ends up totally responsible for the quality of their own lives. That’s a big, a big misunderstanding. About every time a person works on childhood, that [would mean] that they’re blaming someone.

What I try to do in Breakthrough is to help people identify what I call their survival decision. This is something that they’ve figured out as very young children about a way or style of functioning that would work for them in that family. It may be things like they decided to be very, very good or they decided to be very vigilant and take care of other people or decided to run away in an emotional sense all of their lives. And in that decision is the reason they’re at Breakthrough. So we get at the pattern. We don’t focus on who did it or who’s at fault. What we focus on is how you can change that and to change it permanently over time. That is very different from blaming.

We also focus on how they can take very good care of themselves after leaving Breakthrough. We treat it kind of like emotional surgery — that you need to give yourself a couple of months of not making big decisions and not doing anything too dramatic to change your life. Certainly not confronting people and saying that it’s your fault or you have to change for me, but they understand that self-care is a very big part of it.

BHC Journal: It sounds like an amazing program. You mentioned that the origin of the program started in 1983?

AS: Yes.

BHC Journal: Do you recall the circumstances that led to the development of the program. Was it that Caron, through the business that they’re in, was able to see that there was a need for a specific program like this? How did that come to be, do you recall?

AS: Some of it was intentional and some of it was accidental. The intentional part of it was that Caron really was one of the first treatment centers in this country to focus on the effect of addiction, alcoholism in particular, on the family. So they started to work toward educating family members on how they, too, might have been hurt by living with addiction.

We started the program just trying to serve the families of people going through rehab. Within no time at all though, because of the programs nature of doing something unique, experiential, and more intensive, it started to attract adult children of alcoholics. People who grew up in alcoholic families who had never been able to talk about it or get specific help on the things that were left over for them as adults from childhood experiences. As we attracted those people, in time, no time at all really, we ended up with a waiting list longer than we could manage. We expanded and expanded and expanded because the demand, even including professionals themselves wanting this kind of help, was so great. It spread to anyone who ever grew up or experienced a painful family in their childhood. Those were never addressed before. People would go to therapy and they would stay on the surface and they would talk about their circumstances in the present, but they never got to the bottom of it. So the need was much greater than we ever thought it would be. We just went with that and the program mushroomed. We were, in fact, having 60 people a week, every week for the five days and a waiting list of 1,000 people. That demand was because of the void that existed at the time.

BHC Journal: Ann, how can the professionals listening today find out more about the program and get information to people they think would be good candidates for it?

AS: The easiest way is to go to the website, which is brand new. It is www.breakthrougatcaron.org and all the information they might need is there along with phone numbers. There is a section there for professionals to look at to consider who might be appropriate to refer and they can also call 800-268-6259 to speak with me personally or to get additional information for their clients.