How to Know If Your Teen Needs ERP Treatment for Anxiety or OCD
In this podcast episode, therapists Tiffanny Herlin, LCSW, and Mark Rainsdon, LCSW, discuss how WayPoint Academy uses Exposure and Response Prevention (ERP) therapy to treat teen anxiety and OCD. They explore when to consider residential treatment, how to evaluate treatment options, the role of medication, and family involvement in the recovery process.
Wondering if Your Teen Needs Anxiety Treatment? Call Our Team Today 801-491-2271
Being the parent of a teen who is struggling with anxiety can be challenging as you try to figure out how to best help them. The decision to consider residential treatment, while often a last resort, can bring a mix of relief and apprehension. We at WayPoint have created a podcast series to help parents like you find guidance and relief through this difficult time. Licensed therapist Tiffanny Herlin, LCSW, interviews fellow clinician Mark Rainsdon, LCSW, about his professional insights into adolescent anxiety treatment, focusing specifically on Exposure and Response Prevention (ERP) therapy.
This episode focuses specifically on how WayPoint Academy utilizes Exposure and Response Prevention (ERP) therapy for anxiety and OCD. This episode will explore the following key topics:
- Residential Treatment Indicators: Identifying when advanced care will be needed
- Selecting ERP Therapy Resources: Evaluating therapist qualifications and program effectiveness
- Medication in ERP: Integrating pharmaceutical support with therapeutic interventions
- Family-Centered Treatment Approach: Structuring therapy and managing family expectations
Whether you are considering residential treatment or simply seeking to better understand ERP therapy, this episode will provide valuable insights. Listen in or read the transcript for a comprehensive discussion on these critical topics.
Want to Learn More?
This is the second episode in WayPoint's podcast series focused on ERP. Be sure to check out the other episodes in the series to explore more about how ERP supports teens in managing anxiety:
Ep. 2: Exposure Response Prevention Therapy: What It Is & How It Works.
Introduction to ERP Treatment
Tiffany: Welcome back! Today, we’re talking about what to expect with ERP (Exposure and Response Prevention) treatment. When should someone consider ERP? We touched on this last time, but let’s revisit it for any new listeners.
Mark: Sure. As we mentioned before, ERP isn’t just for OCD; it’s also helpful for anxiety and other mental health concerns. If your anxiety starts interfering with your daily life, that’s a good time to seek help from an ERP therapist. ERP therapists are trained in cognitive behavioral therapy (CBT), which can also help with depression and other challenges. They’ll assess your needs and might suggest exposure work as part of the process.
Tiffany: Got it. Can you explain what ERP treatment looks like and what the goals are?
Mark: Absolutely. Let me give you an example. Imagine Jimmy comes to WayPoint after trying inpatient and outpatient programs, plus hospital stays. His parents have decided it’s time for a long-term residential program that focuses on ERP.
The first step is building rapport. ERP involves asking clients to face fears, which can be intimidating. Trust is essential. Once that’s established, we start exploring core fears. We often use a “fear hierarchy.” This involves identifying what the client avoids and asking “then what?” questions to uncover deeper fears. For example, if Jimmy avoids public places, we’d ask, “Then what?” He might say, “I’m afraid of getting contaminated.”
Tiffany: So you ask, “What’s the worst thing that could happen?”
Mark: Exactly. That helps pinpoint what’s driving the fear. Once we understand that, we build a fear hierarchy—a step-by-step list of challenges. Number 10 might be mildly uncomfortable, and number one is the biggest, most overwhelming fear.
Tiffany: For me, number one would be jumping out of an airplane!
Mark: Right, and for someone with a fear of heights, number 10 might be something safer, like standing at the top of a building with protective plexiglass. As they progress, they might tackle more intense scenarios—like going to the top of the Stratosphere in Vegas or eventually doing something like skydiving, if that’s meaningful to them.
The key is focusing on fears that matter to the person. If skydiving isn’t important, there’s no need to push that. The goal of ERP is to help people face fears that interfere with their lives in a way that feels safe and manageable over time.
Tiffany: Yeah.
Mark: If something like jumping out of an airplane is meaningful to you or your family, then sure, we’d work toward that. But if your fear of heights is just keeping you from renting an apartment on the 20th floor, I’m not going to push you to skydive—that’s unnecessary.
For example, in the last episode, I mentioned my fear of snakes. I don’t need to drape a boa constrictor around my neck—that’s not my goal. But I do want to be comfortable enough around snakes so I can hike and enjoy Utah’s beauty without panicking. ERP for me would focus on being near snakes, not handling them unnecessarily.
When working through a fear hierarchy, we start with small steps. Each activity is rated on a scale called Subjective Units of Distress (SUDs). Zero means you’re calm and collected, while 10 is the worst anxiety you’ve ever felt. Clients rate each activity, and we use this as a guide to decide where to begin. Sometimes we skip higher levels if they don’t provoke much anxiety and jump to the point that feels most challenging.
Let’s say your fear is heights. Maybe level 7 on your hierarchy is riding a ride at the Stratosphere in Vegas. Your usual response might be to back out entirely—say you suddenly have a stomach ache and refuse to go. For ERP, we’d work on breaking that avoidance. First, we’d get you in the van to drive to Vegas, helping you reduce your SUDs from a 7 or 8 down to a 3 or 4 during the trip.
Once we’re in Vegas, we might start small, like trying the zip line on Fremont Street—it’s just 20 feet off the ground. If you get to the top but don’t want to ride, we could simply sit there, dangle your feet, and wait until your anxiety eases. The goal is to face the fear and bring your anxiety down.
It’s important not to get fixated on completing every item on the hierarchy perfectly. If you skip the zip line but manage to sit at the edge, that’s still progress. Success isn’t about checking every box; it’s about reducing avoidance and building confidence over time.
The Journey of Exposure Therapy
Tiffany: So it’s not about “curing” someone or completing a list. It’s more about gradual exposure and gentle progress, right?
Mark: Exactly. Think of it like a road trip. The goal might be to get to Vegas, but along the way, you can stop at Zion National Park. You’re still heading toward your goal, but those side stops matter too.
Sometimes, as clinicians or clients, we focus so much on finishing the list that we miss these meaningful moments—like pausing to reflect on why you’re afraid to get into the van in the first place.
Success doesn’t have to mean riding the ride at the top of the Strat. It can be getting to the top, looking over the edge, or even just riding the elevator and feeling your ears pop. Maybe you take a break, come back, and try again.
Tiffany: That makes sense. It’s about staying in that uncomfortable space longer and responding differently to triggers.
Mark: Exactly. Let me share an example. I took a group to the Ogden Mall for social exposure. One student had a huge fear of rejection. On the way there, he decided he’d approach some girls his age at the food court.
When we arrived, he went over, introduced himself, and sat down. After a moment, they moved to another table, but he stayed calm. When he came back, I asked how he felt. He said, “Honestly, it wasn’t as bad as I thought. It was uncomfortable, but I survived.”
We talked about how rejection isn’t failure—it’s part of life. If those girls had stayed and given him their numbers, it might’ve been cool, but it wouldn’t have been as meaningful. By facing his fear and realizing rejection wasn’t the end of the world, he grew. That’s success.
Tiffany: Ultimately, success is teaching students that it’s okay to be uncomfortable. It’s about becoming comfortable with discomfort.
Mark: Exactly. That’s something I emphasize to my students all the time—you can’t avoid discomfort. Life is discomfort. The goal is to find a way to thrive even when things are tough.
But I also tell them that I don’t want them to become cynics who think, “Life is just miserable.” I want them to enjoy the fun moments—like going to Disneyland—but also learn to embrace challenges. When things start to get tough, it’s an opportunity to ask, “What can I learn from this? How can I grow from it?”
Tiffany: That resonates. I’ve had my own experience with ERP therapy. I have a fear of heights, probably because I fell out of a two-story window when I was two. I wasn’t hurt, but my dad had a fear of heights, so it felt like a mix of nature and nurture.
To challenge it, I started small—standing near the edge of a cliff, for example. Eventually, I hiked Angels Landing. For those who don’t know, it’s a terrifying hike with sheer drops on both sides. I was on all fours at some points! It was emotional and challenging, but when I finished, the adrenaline and endorphins were incredible. I thought, “That was so hard. I’m never doing it again, but it was awesome.”
Mark: And that’s exactly what we’re talking about. You weren’t training to climb Everest or become a canyoneering expert. You were just challenging your fear enough to do something like stand on a tall building—even if it’s still uncomfortable.
The truth is, we all do ERP in our daily lives.
Tiffany: Absolutely.
Mark: Think about it. Anyone listening to this podcast has probably done some form of public speaking or had to address a group at a picnic, like tapping a glass and saying, “Hey everyone, I’d like to introduce someone.” That can create a lot of anxiety.
But that’s ERP at its core—exposing yourself to a situation that makes you uncomfortable and working through it. Instead of avoiding it or delegating it to someone else, you step up and say, “I can do this.” That’s the essence of ERP: facing discomfort and learning to respond differently.
Tiffany: So, for parents who realize their teen is struggling with anxiety and need to find an ERP therapist—we talked about how to find one in our last episode—what questions should they ask a mental health professional about ERP?
Mark: Great question. It ties back to what we discussed last time. One big question is: “Are you going to make my child do something they don’t want to do?”
How the therapist answers this is crucial. If they just say “yes,” I’d be cautious. ERP isn’t about forcing someone to do something they’re not ready for.
Tiffany: So it’s not like pushing a kid into the deep end of the pool and saying, “Alright, you’re going to swim whether you like it or not.”
Mark: Exactly. The kind of ERP therapist who metaphorically throws a kid off the high dive? You don’t want that. That approach can cause trauma and lead to treatment-interfering behaviors, like avoiding therapy sessions or refusing to do therapy homework.
A good ERP therapist works with your teen in what we call the “Goldilocks zone.” That’s when the teen might feel some resistance, like, “I don’t want to do this,” but they’re still willing to try if supported. The timing has to be just right.
Another important question is: “Where did you get your training?” Unfortunately, it’s easy for someone to call themselves an ERP therapist without the proper background. They should have formal training in ERP, whether that’s through programs like the BTTI (Behavior Therapy Training Institute), online courses, or other credible sources.
Tiffany: So they need actual, structured training—not just something they picked up casually.
Mark: Right. You don’t want someone who says, “Oh, I saw something about ERP on TV, and now I’m giving it a shot.” That can lead to poorly executed therapy, which risks creating more harm than good.
It’s also worth asking about their experience:
- How long have they been practicing ERP?
- Do they consult with a team of other therapists?
These questions help ensure the therapist has the knowledge and support to provide effective treatment. Properly trained ERP therapists are careful to avoid pushing too hard too soon, which is critical to success.
Evaluating Therapist Experience and Fit
Mark: I think another important question for parents to ask is about the therapist’s overall experience. Now, I want to say—shout out to all the new therapists out there—that doesn’t mean you need 10+ years of experience to be a good therapist. But it’s helpful to understand their background beyond just their therapy training.
For example, did they go straight from undergrad to grad school to becoming a therapist? Or did they gain other experience along the way? Maybe they volunteered, worked in different programs, or spent time in residential or wilderness settings.
A good example is a therapist I recently hired. She hasn’t had specific ERP training yet, outside of me supervising her, but she has a wealth of experience from working in residential and wilderness therapy. I trust her completely with any of my clients because I know how brilliant she is, even though she doesn’t have years of credentials or letters after her name.
Tiffany: I get that. I worked in residential programs for several years before earning my master’s, and when I started grad school, I felt so much more prepared than many of my classmates.
Mark: Same here. I worked in wilderness therapy for a few years before grad school, and sometimes in class, people didn’t understand basic concepts, and I’d think,
Tiffany: “Oh, that’s easy.”
Mark: Exactly. It was stuff I’d already been doing in the field.
It’s not just about the credentials. Parents sometimes ask me, "What letters should we be looking for?" And honestly, the letters—LCSW, LMFT, CMHC—don’t matter as much as their knowledge base and experience.
For example, I know LCSWs with a deep understanding of marriage and family therapy, and LMFTs who are skilled in systems theory and leveraging community support. It’s really about vetting the therapist, asking the right questions, and making sure they’re a good fit.
Also, it’s important to know that sometimes therapy just doesn’t work with a particular therapist. I’ve had cases where I didn’t connect well with a student, and despite my best efforts, progress wasn’t happening. In those situations, I’ll recommend the student switch to another clinician. And often, they thrive with someone else. It’s not about doing something wrong—it’s about finding the right match.
Tiffany: It’s kind of like finding the right doctor, right? A doctor can have all the right credentials and be great at their job, but if their bedside manner or personality doesn’t work for you, it’s okay to look for someone else. It doesn’t mean they’re a bad doctor—they just weren’t the right fit for what you needed.
Mark: Exactly. And when it comes to working with adolescents, it’s important to listen to your kid, but also take their feedback with a grain of salt.
For example, a couple of months ago, I had a student come to me saying, “I want to work with you instead of my current therapist.” So I sat down with him as the clinical director and asked, “What’s going on?”
He explained a few things, but it boiled down to, “I just feel like it’s not working, so I want someone new.” I asked him, “Well, let’s look at why it’s not working. Are you doing what your therapist asks after sessions?” He said no. “Are you being open and sharing during sessions?” He admitted he usually just says everything is fine.
So I said, “Can you do me a favor before we even think about switching therapists?” He asked, “What’s that?” I said, “Try engaging more in therapy. Be open and see where that takes you.”
Three months later, he’s doing well with the same therapist.
Tiffany: That’s such great advice for parents looking for an ERP therapist.
The Role of Medication in ERP Treatment
Tiffany: Let’s touch on medications and how they work with ERP.
Mark: That’s an interesting topic. Now, I’m not a psychiatrist, so if any psychiatrists are listening, they might be thinking, “You don’t know what you’re talking about.” But here’s my perspective—
Tiffany: Let me pause real quick to explain something for parents who might not know the difference. I often hear, “What’s the difference between a psychologist and a psychiatrist?” A psychiatrist can prescribe medication, while a therapist or psychologist cannot.
Mark: Exactly. We don’t have the training or board certifications required to prescribe medications.
Tiffany: Right. Okay, go on.
Mark: From my experience, there isn’t a specific medication that cures or directly treats OCD. That’s not to say there aren’t medications that can help with symptoms. Anti-anxiety meds, for example, can take the edge off while someone engages in therapy like ERP (Exposure and Response Prevention).
For many, once they get a better handle on their therapy, they can start to wean off the medications. But as far as a “magic pill” for OCD—if anyone finds one, let me know! Right now, it comes down to engaging in ERP therapy.
Tiffany: So, the general idea is that medications like anti-anxiety meds can help, but they’re not a cure.
Mark: Exactly.
Tiffany: Medications can help the brain release neurotransmitters, making it easier to function. But you still have to learn the skills through therapy. Medication and therapy have to work hand in hand.
Mark: A good example I’ve seen at WayPoint is the number of students who arrive on high doses of medication. Often, the family and their psychiatrist are just trying to keep the peace. But as we work with the students here, we’re often able to reduce or even eliminate their meds.
For me, this highlights a skill deficit that needs to be addressed. That’s why I often share a phrase I learned during DBT training: skills before pills. There are no side effects from using skills. If anyone can name one, I’d be impressed!
Tiffany: You might just end up coping better.
Mark: Oh, that’s a terrible side effect! But think about all the side effects students experience from being on multiple medications. To be clear, I’m not on some anti-medication crusade—medications are awesome when used appropriately.
At WayPoint, we have a fantastic medical team that ensures we address both the skill deficit side and the neurochemistry side. But when you think about it, mental health medication is still a relatively new science. Look at how they treated mental conditions in the past—using things like horse tranquilizers! It’s wild.
Tiffany: Yeah, that’s true.
Mark: We’re just beginning to scratch the surface. So often, I see students taking one medication to manage the side effects of another, and then another medication to handle the side effects of that one. Meanwhile, what if we just taught them how to manage their anxiety and even learn to befriend it? There are no side effects to that approach.
That said, I want to be very clear: there’s nothing wrong with needing medications. If someone takes insulin for diabetes, no one judges them.
Tiffany: Exactly.
Mark: Yet, in mental health, there’s this stigma. If someone is on Zoloft, it can feel like a black mark. But why? That doesn’t make sense. Some people simply don’t produce the right amount of certain chemicals in their brains and need that little boost. It’s no different than someone needing insulin to manage diabetes.
Tiffany: I completely agree. There are pros and cons. Let’s move on to the next step.
When to Consider Residential Treatment
Tiffany: Let’s say a parent has a teen with anxiety. They’ve tried outpatient therapy and found an ERP therapist, but it’s still not working. How do parents know when it’s time to consider residential treatment, like WayPoint, which specializes in anxiety and uses ERP?
Mark: This is where my brain goes off on a tangent, but it’s important to understand the question you're asking—essentially, "When is it time to take that next step?" It's a huge decision, right? Sending your child away can be a financial burden and a lot to manage emotionally.
Tiffany: Exactly, it's a big step.
Mark: For sure. I’ve had situations where I’ve thought, "We should have brought this kid in months ago." And then, there are times when a child arrives, and I think, "Wow, they’re doing a lot better than I thought." Parents sometimes second-guess themselves—wondering, “Should we have waited longer?” The key is really how things are going at home. Have you tried outpatient therapy, ERP, and other treatments? Is progress happening?
If things aren’t improving, that’s when you start looking at residential treatment, especially if family dynamics are being affected. For example, if other children in the family feel neglected, that’s a sign you may need to look into more intensive treatment options.
Tiffany: So, it’s about considering how the whole family is being affected?
Mark: Exactly. You also need to ask, “Is my child able to function normally? Are they attending school, holding a job?” If school avoidance or other issues are taking over for an extended period, then that’s when residential treatment becomes something to seriously consider.
At WayPoint, part of my role is helping with the admission process, and I don’t accept students unless I’m sure they need this level of care. I don’t want to put families through that financial and emotional toll unless it’s necessary.
Tiffany: That makes sense.
Mark: Right, and if there are other things we haven’t tried, I’ll suggest those first. If that doesn’t work, then we can explore residential treatment.
Tiffany: I imagine if the family is having to make major accommodations to keep things running smoothly, and the child is at the center of everything, that’s another sign outpatient treatment might not be enough.
Mark: Absolutely. And if outpatient therapy has been ongoing for a long time with little to no progress, that’s a good indicator that something more intensive might be needed.
Sometimes, kids just refuse to go to outpatient therapy. I’ve had students who get so anxious on the way to their appointments that they jump out of the car at a stop sign because they’re afraid of what will come up in the session. When that happens, it’s a safety concern. If they’re not showing up at all, or their anxiety is causing major disruptions, that’s when it’s time to consider outside help.
One key benefit of residential treatment, compared to outpatient therapy, is that we can ensure your child’s safety. If a teen is self-harming or considering suicide, we can manage those risks in a controlled environment. At home, you may have other responsibilities—like a job or other children—and it can be hard to manage the safety of a child who’s struggling.
If you're constantly worried about your child’s well-being and can’t leave the house because of that, it’s a clear sign that you need outside support.
Tiffany: Right, residential treatment is helpful because it removes those uncontrolled variables that you typically have at home.
Limitations of Outpatient Therapy
Tiffany: In outpatient therapy, a big challenge is that the child may not fully open up to the therapist. They might withhold information or even refuse to go. But with residential treatment, there’s a whole team and support system. Parents often feel overwhelmed, guilty, and in survival mode when they’re trying to handle things on their own. However, in residential treatment, I can check in with a student and immediately see any issues through reports from the school and staff. I can approach the student directly about things like school refusal or conflicts with peers, which I wouldn’t have access to in outpatient therapy. Residential treatment offers a more closed system with more oversight to keep the student safe and ensure they follow through with things like school and therapy.
Mark: Exactly. When parents are transitioning their child home, I remind them that, as a therapist, I have a whole team backing me up. They have one or two people at home supporting them, and that makes a big difference. I have access to a lot of data from the school and home, which is something outpatient therapists often miss. My brother, who's an LCSW, works in outpatient therapy, and we’ve talked about how difficult it is for him to work without all that information. He’s part of a consultation team, but it’s still not the same as having everything integrated.
Tiffany: That’s right. I’ve told parents, "Go talk to your child’s therapist and make sure they understand your side of the story because your child might not be sharing everything." Many parents don’t realize they can do that, but they absolutely should.
Mark: Yes, it’s important to share all the relevant details.
Tiffany: Another important point for parents considering treatment is to know that educational consultants can be a great resource. They specialize in residential treatment programs and can help parents navigate the options. They develop relationships with different programs, understand what each one offers, and can guide parents to the right fit for their child. For example, if a teen is struggling with OCD or suicidal ideation, an educational consultant can point you to programs that specialize in those issues.
Mark: Right, because if you just search for programs that treat OCD, you might find a lot of them, but you don’t know if they use effective treatments like ERP. Many programs say they treat anxiety disorders, but they might not be trained in the specific approaches that would help.
Tiffany: Exactly, all you can do is look at what’s listed on their website.
Mark: That’s why consultants are so valuable. They know which programs are truly equipped to handle specific issues, whether it’s a residential treatment center or a therapeutic boarding school. It’s an added cost, but it’s worth it to make sure your child gets the right care.
Evaluating Program Credibility
Tiffany: It’s worth it.
Mark: 100% worth it. In the last month, I’ve had four or five educational consultants come to WayPoint. They’ll ask me a lot of detailed questions to make sure they know what they’re talking about. For example, they’ll ask about how we handle self-harm or suicidal ideation. If I just say, "Oh, we work with them," they won’t be impressed. But if I can show them our policies and explain exactly how we handle those situations, they’ll feel confident talking to parents about it.
One thing I like about WayPoint is that our students lead most of the tours. It’s a great experience for them—talking to a random person, showing them around, and hoping their room is clean! But it also gives the consultants a chance to hear from the students directly. They can ask questions, and the students can tell them about the program from their perspective. I don’t even go on the tour with them, so the students can speak freely.
Not every program does this, but at WayPoint, we work with students who are often more anxious about getting in trouble. So, I can trust them to show the consultant around and not cause any issues. Then, the consultant can report back about what they’ve learned from the students themselves, like, "They like it, but Mark tells too many analogies," or whatever else they might say.
Educational consultants are worth the investment. There are so many programs out there, and it’s not hard to make a website look appealing, but an educational consultant can help you find the right fit for your child.
Tiffany: Yes, I’ve discussed this with another executive director, and we both agree—when you’re looking at a residential treatment program, it’s important to visit and see if they do what they say on their website. If they say they offer equine therapy, for example, do they have an arena and a qualified equine director? Do the kids talk about it? Those are the things you need to look for as a parent.
So, if a parent is choosing between programs, why should they pick WayPoint?
Mark: That's a great question. The main thing that sets us apart is our focus on anxiety, especially anxiety and OCD. A lot of programs say they work with anxiety, but when you ask what they do, they might say something like, "We have them fill out worksheets." But how does that help someone with social anxiety? They’re just sitting in a classroom, feeling safe, but not addressing the root of their anxiety.
Tiffany: Right, or they just talk about it.
Mark: Exactly. It doesn't make sense. The founders of WayPoint, Mike Bullock and Jared Ballmer, realized that a lot of programs try to be all things to all people, which doesn’t work for kids with anxiety or OCD. If you put a kid with anxiety or OCD in a program with kids who have more severe behavioral problems—like former drug users or partygoers—those kids will just fly under the radar, keep quiet, and try to stay out of trouble. They won't get the help they need.
Tiffany: It's kind of like the example we discussed earlier—where a kid does great at school but is struggling at home. The same thing could happen at a program, right?
Mark: Exactly. And on top of that, the staff is so focused on the more disruptive kids that they may overlook the anxious ones. They think, "Oh, Jimmy’s fine," but Jimmy isn’t getting the support he needs.
Tiffany: Yeah.
Mark: So, we realized we were doing a disservice to these kids. They were going to therapy but weren’t in a therapeutic environment that matched their needs. At WayPoint, we focus specifically on anxiety and OCD. We’re very selective about who we admit because we don’t want to accept kids with issues like substance abuse or extreme behavioral problems. If we did, it could affect the treatment of other students.
Tiffany: So you accept kids who primarily struggle with anxiety or OCD, but you’ll also work with those who have co-occurring conditions like ASD, ADHD, or depression, as long as their anxiety is the main issue?
Mark: Yes, that’s right. We focus on creating a safe environment where students can talk about their anxiety and do exposure work without the fear of being ridiculed. Of course, being a teenager means some fear is always there, but we try to keep it minimal.
Tiffany: So, you're not turning them into perfect, fully functioning adults?
Mark: Sorry, that’s not going to happen, even if they’re 18 or 19. But what we can do is create a space where students can focus on managing their anxiety. The constant discussion of exposure, ERP (Exposure Response Prevention), and distress tolerance among the students shows that our program is working. They talk about it so much that I sometimes have to remind them, “That’s not an exposure!”
Tiffany: So, it becomes part of the culture.
Mark: The peer culture at WayPoint is a huge part of what makes our program work. It’s cool to see how it evolves. Sometimes, the group dynamic isn't as supportive, but right now, we’ve got a great group. For example, I was on a camping trip last week with one of our students who was struggling. He asked me if he should talk to his therapist, but before I could answer, the other kids on the bus immediately said, "Yes, for goodness' sake, talk to her!" And he got the message. That’s the kind of environment we have here, where the kids understand how important it is to support each other, face their anxieties, and talk about them openly.
Tiffany: That’s one of the most powerful aspects of residential treatment—studies have shown that group therapy is often more effective than individual therapy. When teens see their peers going through the same struggles, they realize they’re not alone.
Tiffany: It’s funny how often, as a therapist, you’ll give guidance to a client, and they ignore it. Then they talk to their peers, and their peers say the same thing, and suddenly, it’s a great idea.
Mark: Right, they’re like, "I should go do that!"
Tiffany: Exactly! You’ve just told them that an hour ago, but it feels different when they hear it from someone who’s going through the same process. Their peers hold them accountable in a way we can’t because they know exactly what they're experiencing.
Mark: It’s hilarious! As a parent, you probably experience the same thing. I’ll be on the phone with a parent saying, "Yeah, I told them this," and the parent will be like, "Oh, that sounds great. I should try that." And I’m thinking, "I’ve been telling them that for years!" It’s all about development—teens are trying to find their identity and sometimes don’t want to listen to their parents or the old therapist in the room.
Tiffany: Right!
Mark: I joke around with the kids because they always say I’m older than I feel, but the positive peer culture at WayPoint is huge. We often say that if we had a program based on individual therapy all the time, the kids wouldn’t engage with each other. Honestly, 90% of the issues I deal with would disappear. My job would be so much easier! But there's something powerful about the group dynamic—the community aspect works for these kids.
Tiffany: Absolutely.
Mark: One thing that sets us apart is how we don’t use a level system like other programs. We use a citizenship system instead, where kids are measured by how well they contribute to and engage with the community. It’s not about being a good person—it's about being a helpful, active part of the group.
Tiffany: Yeah, it’s more about participation.
Mark: Right. And when they come to me with concerns about their citizenship level, I remind them that’s a community issue, not a therapy issue. I want our sessions to focus solely on them, not on whether they helped clean their room. Over time, they start to see the value in being part of a community. They realize that helping others is not just about getting rewards—it’s about showing appreciation and creating a positive environment for everyone. And that mindset transitions well when they go home. When they start helping with chores at home, it’s not just about getting something in return. They begin to understand how their actions can free up time for their parents to do something fun or have a date night.
Tiffany: And that makes parents happier, right?
Mark: Exactly! And when parents are happier, they’re more willing to support and help their kids. It’s all about building a symbiotic relationship where everyone helps each other out.
Understanding the WayPoint Treatment Timeline
Tiffany: What should families expect if they come to WayPoint? What does the treatment timeline look like?
Mark: WayPoint is a 10 to 12-month program, and we don’t say it’s an “average” because for exposure and response prevention (ERP) therapy, it's important to be consistent and repeat the work until the behavior becomes habitual. Sometimes, we get asked, "My kid's doing great—they're able to go to school now. Can we bring them home?" And we're like, "Let’s hold off on that for a moment."
Tiffany: Would it be harmful to bring them home too early?
Mark: Yes, it can be. If they go home before they've fully completed the program, they may do well at first. But then, they’ll start to make mistakes, and because they haven’t learned how to deal with those mistakes, they’ll end up back where they started. They might have only gotten used to doing well, not to making mistakes and recovering from them.
Tiffany: So, they haven’t built those new neural pathways yet, right? They need time for the behaviors to become a habit.
Mark: Exactly.
Tiffany: So they need that full 10 to 12 months?
Mark: Yes, they do. Interestingly, when students stay for the full program, we see them take on challenges, like tests or honors classes, where they can experience failure, learn from it, and then come back stronger. We talk about that in family therapy. Then, when they go home, we still have them do exposures—practicing what they’ve learned.
Tiffany: So, home visits are like a test, where they get to practice what they’ve learned at home?
Mark: Exactly. I don’t like it when home visits turn into just vacations. It’s great to spend time with family, but it’s also a chance to practice real-world challenges.
Tiffany: It’s like a testing ground.
Mark: Yes! It’s like going to Disneyland and only riding the teacups every time. If you’re a Star Wars fan like me, you should be experiencing the big rides, like Rise of the Resistance or Indiana Jones—not just the teacups.
Tiffany: The teacups would be my worst nightmare. I’d stick to the Dumbo ride.
Mark: It’s like going on the Dumbo ride over and over but never trying the bigger rides. It’s about stepping outside your comfort zone and pushing yourself.
Mark: Going home is great, but we want our students to keep practicing what they've learned. We send them home with exposure exercises to continue working on. Sometimes, we even talk to schools and ask if the students can sit in on classes they missed. When they return, classmates might ask where they’ve been, and the student has to explain, “I’ve been at WayPoint, a treatment center for anxiety.” They have to face that social situation and work through it.
Tiffany: Yeah, that’s important.
Mark: That’s why we have a 10 to 12-month program. Some students, especially those with OCD, might need up to two years. It's all about what each individual needs to truly heal.
Tiffany: Parents need to understand that a quick fix isn’t always possible. Many of the issues our students face have been ongoing for years. So, creating new pathways in the brain to change old habits takes time.
Mark: Exactly. Another part of the program involves addressing obsessive avoidance, especially when it comes to technology. Any parent knows what I’m talking about—kids obsess over phones, computers, or tech in general.
Tiffany: Wait, kids are obsessed with technology?
Mark: I know, crazy, right?
Tiffany: I didn’t realize.
Mark: Here’s the thing: parents often tell me their kids are “addicted” to technology. But when I dig deeper, I realize it’s not technology they’re addicted to—it’s avoidance. They use tech to avoid their feelings or situations that make them anxious.
Tiffany: Yeah.
Mark: Right. They're not addicted to technology itself—they're addicted to avoiding their feelings or the situations around them. Once we address that, technology just becomes a tool. Here's an example: I had a student come to WayPoint, and they begged me, "Please, Mark, give me my phone." Part of our program involves reintroducing their phone, but I used to hold off giving it back for weeks, sometimes months. I wanted to be sure they had other ways to cope with anxiety.
Mark: At first, when I gave the phone back, it was like Christmas for them. They’d use it for hours, then maybe 45 minutes the next day, and so on. Then, I’d ask them, “How’s phone time been?” And they’d say, “It’s not as fun as it used to be.” They’d realize, “I’d rather go play soccer outside or play Magic.”
Mark: This shift shows how compulsive avoidance works. They were avoiding life to escape anxiety. Now, they’re happy to engage with life, play games, and connect with people. The phone becomes less important, more of a tool to pass time or talk to family—but it doesn’t control their life anymore.
For some students, this is a freeing moment: they realize, "If my phone dies, I don’t die too. I can leave my phone behind and be okay." Of course, this isn’t the case for every kid, but for many, it’s a big breakthrough.
Therapy Structure and Family Involvement
Mark: When students first start at WayPoint, therapy involves two individual sessions per week with their therapist, one family session per week, and three group sessions.
Tiffany: Do parents need to attend family sessions in person, or can they be done remotely?
Mark: If parents are local, we can do in-person sessions, but most of our parents are out of state, so we do them via video conference. For family visits, we often do a live visit where parents pick up their child.
Mark: About a year and a half ago, we made some changes to how we approach therapy. We started to reduce therapy sessions toward the end of treatment. Initially, students get two individual sessions, three groups, and one family session a week. But when they leave, they might only have one individual session and one family session every other week. That’s a big shift, so we begin to taper off the sessions gradually to prepare them for that.
Tiffany: That sounds like a lot of therapy.
Mark: It is, which is why we start reducing it slowly. By the end of treatment, students typically have one individual session and one family session every other week, plus three group sessions. Individual therapy becomes more as-needed. The goal is to transition them smoothly, so they don’t feel lost when they leave with less support. We work with parents to create a transition plan that includes rules, boundaries, expectations, and privileges, just like the structure at WayPoint.
Mark: The transition plan is a "living document," meaning it should change as needed. If it’s the same after three weeks at home, something’s wrong. The goal is to adjust the plan based on how the student is adjusting. After three weeks, you might realize they need more autonomy or different boundaries.
Tiffany: Do you help families find a therapist when they go home, or is that something an educational consultant would handle?
Mark: The consultant can help with finding the right support. For example, if we have a family from New York City, I don’t have connections there, but the consultant does. They can also help with finding an intensive outpatient program or a boarding school if the home environment isn’t ideal. We don’t directly choose the placement or therapist, but we can help narrow down options.
Mark: One thing I often do is have the family find three or four therapists in their area. Then, I can check in with those therapists to make sure they understand ERP therapy and help the family make an informed decision.
Mark: The same applies to programs like boarding schools. If they choose one, I can reach out to them to ask how they handle tech use and make sure it’s a good fit for the student. I can also help prepare the students by discussing what to expect and even connecting them with staff at the school before they leave.
Tiffany: That’s great. Now, let’s talk about the start of treatment. Do students ever call home saying, “This isn’t the right place, get me out of here”? What should parents expect during those first calls home?
Mark: It’s very common for students to try to pull on their parents' heartstrings early on, especially anxious ones. They know how to find the path of least resistance, so calling home and asking to leave is something we see a lot. But parents shouldn’t be alarmed—it's part of the process, and it’s something we expect.
Tiffany: I like to call those "emotional bombs." They’re good at it!
Mark: I often get calls from parents like, "What are you doing with my child?" Just last week, one parent said, "He says you're not helping him at all at school." The therapist was quick and smart about it. She went to Jess Hartman, our academic director, and asked, "How’s he doing?" Jess responded, "He’s getting B’s and one C, but he’s pulling it up." The therapist then called the parent back and said, "I talked to our Academic Director, and here's what’s going on."
Mark: It’s all about staying calm and working with the parents. I tell parents, instead of reacting right away, take a breath. Practice responses like, “Thanks for letting me know. I’ll check into it and get back to you.” By staying calm, it shows your child that you’re in control, not reacting emotionally, and that you’re there to support them.
Tiffany: You’re validating their feelings but not overreacting.
Mark: Exactly. Then, in the next family session, we can address the issue with the child: “You’re saying you're not getting support, but we’ve heard that you’ve been working with a special educator and getting good grades. Can you help us understand what’s going on?” It’s not about blaming the child but about showing that we’re united and will support them together.
Tiffany: Kids can try to create conflict between parents and staff—triangulating, right?
Mark: Right, and we don't get angry. I always tell parents, "Don’t be mad at your kid." This is a natural part of what they do. They’re trying to survive in an unfamiliar situation. They see WayPoint as a threat—away from family, friends, and technology. It's their way of saying, "I want to leave."
Tiffany: It’s a survival instinct.
Mark: Exactly. So we address it calmly and ask, “Why do you want to leave? What discomfort are you feeling? Maybe we can help with that.”
Tiffany: And what fears do you think might be behind it?
Mark: Right. For example, a couple of years ago, I was walking down the path with a family and their child, and the child said, "I just can't sleep. My roommate snores." I looked at him and said, "Really? That’s what's causing all this stress? Your roommate snoring?" He said, "Yes!"
So I took the kid across the hall to our residential director and said, “This kid needs a room change because his roommate snores.” The director said, "No problem." We went back to the family session, and I explained to the parents what happened. I also talked to the kid, saying, "Look, you could’ve dealt with this by stressing out and making it worse, but by telling us what was causing your discomfort—your roommate's snoring—you allowed us to help. We didn’t accommodate you by ignoring the issue; we simply fixed something that could easily be fixed."
Now, you’re learning how to communicate your needs effectively with us, your family, and your therapist, instead of just white-knuckling through the anxiety.
Tiffany: It’s about addressing the issue rather than just enduring the discomfort.
Mark: Exactly.
Integrating Therapy and Education
Tiffany: What about school? Do the students attend classes? You mentioned it, so what does that look like?
Mark: Yes, we’ve got a fantastic team. Jess Hartman is our Academic and Associate Executive Director—she's amazing. We’re also a jointly accredited school. Our teachers focus on specific subjects like Science, Art, History, Math, and English.
Tiffany: So, they’re not just doing online classes?
Mark: No, not at all. And that’s intentional. For kids with social anxiety, online learning might seem appealing, but we incorporate in-person learning too. For example, our English teacher has students do presentations, and our History teacher does the same. We blend therapy with school, and it creates this seamless experience. We meet as a treatment team to discuss each student’s needs, and we adapt accordingly.
Sometimes, a student who’s floating through might be placed into an honors class. If a student is struggling, we make adjustments like providing sensory breaks or teaching them coping skills they can use in class.
This also helps during home visits. Students can still engage in school while at home. If they need to, they can attend Zoom classes with their teachers or therapists from here in Utah, and they’re still responsible for their homework.
Tiffany: So it’s a team approach, which is different from outpatient therapy, right? You’re bringing teachers and therapists together for these meetings.
Mark: Exactly. “Multidisciplinary team” is a term often thrown around, but we make it happen. When I was a primary therapist, I’d often meet with Jess or the teachers to discuss how we could push a student. There was even a student who, when he first arrived, couldn’t go into a classroom. So, I sat in the back of the classroom with him, just to help him feel comfortable enough to join. Over time, he was able to start attending class, and eventually, he even held up a sign in the student union building.
Tiffany: I love how hands-on you are. It’s not just talk therapy—you’re in there, working with the students directly to help them face their issues head-on.
Mark: That’s the key. We also keep our caseloads smaller, which makes a big difference. It used to be eight students per therapist, but now it’s six. This allows therapists to spend more time in the classroom, meet with teachers, and handle case management. We’re making sure all sides are covered before the student moves on to the next phase of their life.
Finding Hope in Treatment
Tiffany: For parents who are just starting this journey and feeling hopeless and scared, is there hope? And what does the end look like?
Mark: There is absolutely hope. I feel for parents who are going through this. When parents come to us, they often feel like they’ve tried everything, and they’re at their wit’s end. But I can tell you that ERP (Exposure and Response Prevention) is effective. Treatment works for anxiety and OCD.
The most important thing is to hold on to hope. Keep looking for that silver lining, that light at the end of the tunnel. We talk a lot about responding versus reacting, and your child is watching you. If you’re feeling hopeless and stuck, they’ll see that and think, "If my parents have given up, then I have no chance."
Tiffany: They’re probably already struggling with self-confidence as it is.
Mark: Exactly. But here’s the thing—feel your emotions. I’m not saying to hide them. If I told you to just bottle it all up like Elsa from Frozen, I’d be a terrible therapist! But when you’re around your child, show them that you’re still hopeful. Let them know you haven’t given up on them. That’s going to boost their confidence.
I’ve had parents come into my office in January, feeling lost, and by the time they leave, a few months later, they’ve seen a transformation in their child and themselves. They start to understand how to support their kid, and it’s amazing. The best part is seeing parents say, "We’ve got our kid back."
Your child wants to get better. It may seem like they don’t, but it’s not that they don’t want to improve—it’s that they don’t know how. They’re scared, unsure if therapy will actually help. Keep that in mind when they seem resistant.
OCD and anxiety are very treatable, but it takes time. It’s not a quick fix, and it’s not something that can be solved with a couple of pills or therapy sessions. But with time and effort, you’ll see progress.
And here’s the most important thing I’ve seen over and over: going through this struggle will strengthen your relationship with your child. If you push through and keep working together, your bond will be stronger than ever. Adversity brings you closer.
Tiffany: Growth doesn’t come from comfort; it usually comes from struggle.
Mark: I can’t think of a single time in my life when I learned a valuable lesson during an easy, smooth period. All the life lessons I cherish came from the tough times when life was really hard.
Tiffany: And parents need to know they need to take care of themselves too, not just their kids. It’s easy to focus entirely on your child, especially when they’re struggling, but remember—you're in crisis too. Take time for your therapy, self-care, and anything else that helps you recharge. Am I missing anything? What else should parents be doing?
Mark: I can already hear some parents thinking, "Yeah, right, I don’t have time for that."
Tiffany: Exactly. They’re probably thinking, "I’m just trying to keep my kid alive and safe!"
Mark: Right. But you’re correct. Even if your self-care is as simple as putting your kid to bed, then listening to a mindfulness exercise on YouTube, or calling a loved one—like your parent or someone you trust—that’s still important self-care. If you can, seeing a therapist—whether for yourself individually or with your co-parent in couples counseling—can be incredibly helpful too.
One thing I always encourage parents to do when their child is in treatment is to make sure they get their therapist. When a kid enters treatment, it’s easy to think, “Okay, they’re safe now, I can relax,” but that’s actually when you should start talking to a therapist. The feelings are still fresh, and it’s an opportunity to work through them. It can help you become more resilient and a better parent, partner, and individual.
Tiffany: Yes, it’s about starting your healing journey, because what these parents are going through is tough.
Mark: Exactly. And here’s something else to consider: When you start going to therapy, your child sees that. They see you—someone who is capable and strong—choosing therapy not because you’re broken, but because you want to grow and improve. This can help them realize that therapy isn’t a sign of weakness or being "defective." It’s just about wanting to do better. I’ve seen parents mention this in family sessions, and the kids often react with surprise, saying, "Wait, you’re going to therapy?" And when the parents respond, "Yes, because I want to do better," it opens up a new perspective for the kids.
Your kids may not admit it, but you’re their role model—their superhero. And when they see you taking steps to improve yourself, like going to therapy, it can make therapy feel less intimidating for them. It shows them that it’s okay to seek help and that therapy is just another step in the process of becoming better.
Tiffany: You’ve shared a lot of success stories throughout this podcast.
Success Stories in Overcoming Anxiety
Tiffany: Is there anyone that comes to mind who you want to leave with the parents listening?
Mark: Yeah, there’s a few stories I could share. Let me tell you about a success story that wasn’t one of mine, but it’s a great example of what’s possible.
Back around 2018 or 2019, a student named Zach came to WayPoint. He was struggling with social anxiety—things like avoiding social situations and school. He started working with our executive director, Brian Wild, who introduced him to Exposure and Response Prevention (ERP). Over time, Zach began to gain confidence and turned things around.
At the same time, one of our former students had a family member working for NBC’s Today Show, and they reached out to us. They asked if they could do a spotlight on one of our kids. Of course, we said yes, but we weren’t sure who would be comfortable on TV since many of our kids struggle with social anxiety. We asked the group, and Zach volunteered!
The Today Show came to film him, and if you visit our website (WaypointAcademy.com), you can see the video. It features Zach doing some of the exposure work he did during treatment, like holding up a sign on a busy street in Ogden. He did it successfully, and it was incredible to watch his progress.
Last I heard, Zach is home, going to college, and living his life. His story is powerful because it shows that when typical approaches aren’t working, there’s hope. Zach came to WayPoint when things weren’t going well at home, did the ERP work, and now he’s thriving. It’s a great reminder that with the right treatment, kids can overcome anxiety and achieve their goals. You can watch the video and hear Zach talk about his experiences, including panic attacks and how he worked through them.
Tiffany: That’s amazing. And what a powerful thing for Zach to share with others—helping them realize they’re not alone in their struggles.
Finding Hope and Healing
Tiffany: And parents, if you're listening, remember—you are not alone. As overwhelming as anxiety and OCD can be, especially with your teenager, there is hope, there is healing, and there are ways to work through it.
I'm so grateful, Mark, that you joined us today and shared your expertise. I hope this episode provides some answers and hope for parents who need it.
Mark: Thank you for having me. It's always a pleasure to talk about this topic. It's something I'm truly passionate about, so I really appreciate the opportunity.
Tiffany: Thanks again for coming.