In this week's podcast episode, Dr. Sam Himelstein speaks with Dr. Fleet Maull on his work with the Center for Adolescent Studies and his experiences with incarcerated youth.
The impact of having positive and supportive role models for incarcerated youth
The pros and cons of tech programs and apps for mindfulness
Authenticity and predictability as a foundation for trauma-informed mindfulness
Teaching from a space of presence, strength, and confidence (rather than ego/authoritarianism)
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Sam Himelstein, Ph.D. is a licensed psychologist and the founder of both Family Spring, a mental health company that leverages technology to serve teens, young adults, and their families who’ve been impacted by substance use disorder and related mental health challenges; and the Center for Adolescent Studies, an interdisciplinary training institute focused on trauma-informed care, mindfulness, substance use disorder, resilience, and related training for professionals. For over 15 years, Dr. Himelstein has worked with incarcerated, trauma-impacted, and substance-using populations and has had the mission to help adolescents and young adults thrive by becoming aware of the power of self-awareness and transformation.
A formerly incarcerated youth himself, Dr. Himelstein was privileged to change his life from a path of drugs, violence, crime, and self-destruction to that of healing and transformation. Learn more about his philosophy, work, and approach through his books: Trauma-Informed Mindfulness With Teens: A Guide for Mental Health Clinicians (Norton, forthcoming 2019),Mindfulness-Based Substance Abuse Treatment for Adolescents: A 12-Session Curriculum (Routledge, 2015), and A Mindfulness-Based Approach to Working with High-Risk Adolescents (Routledge, 2013), his professional training institute: https://centerforadolescentstudies.com, and his clinical work: https://myfamilyspring.com
Podcast Transcript
Fleet Maull:
Hi! Welcome to another session here on the Prison Mindfulness Summit. My name is Fleet Maull. I'm your co-host for this session. I'm really thrilled to be here today with a longtime colleague and friend, Dr. Sam Himelstein. How are you?
Sam Himelstein:
Doing great. Honored to be here.
Fleet Maull:
Yeah. Well, it's great to connect after quite a few years, and really been looking forward to this conversation.
Sam Himelstein:
Absolutely.
Fleet Maull:
So, I'm going to share a little bit about your background and work, and then we'll jump right in. Okay?
Sam Himelstein:
Okay.
Fleet Maull:
All right. Sam Himelstein, Ph.D., is a licensed psychologist and the founder of both Family Spring, a mental health company that leverages technology to serve teens, young adults, and families who have been impacted by substance use disorder and related mental health challenges, and the Center for Adolescent Studies, an interdisciplinary training institute focused on trauma-informed care, mindfulness, substance use disorder resilience, and related training for professionals.
For over 15 years, Dr. Himelstein has worked with incarcerated, commonly impacted, and substance-using populations and has had the mission to help adolescents and young adults thrive by becoming aware of the power of self-awareness and transformation.
A formerly incarcerated youth himself, Dr. Himelstein was privileged to change his life from a path of drugs, violence, crime, and self-destruction to that of healing and transformation. We can learn more about his philosophy, work, and approach through his books Trauma-Informed Mindfulness with Teens: A Guide for Mental Health Clinicians, Mindfulness-Based Substance Abuse Treatment for Adolescents: A 12-Session Curriculum, and A Mindfulness-Based Approach to Working with High-Risk Adolescents. His professional training institute, also the Center for Adolescent Studies, and his clinical work at my FamilySpring.com. All right.
So, I think it'd be great to start off with your background of having had your struggles as a young person and ending up involved with the justice system yourself. And then somehow transitioning through that to overcome some of those challenges and end up becoming a psychologist and returning to serve people experiencing similar struggles. So, tell us a little bit about that path if you would.
Sam Himelstein:
For sure. Yeah, absolutely. Just reflecting on my early childhood, I had some tough experiences. I struggled a lot in school and found myself kind of pushing back on authority figures, mainly teachers. And unfortunately, I kind of graduated from getting in trouble at school to getting in trouble with the law. And long story short, I was in and out of the juvenile hall.
I was really lucky and privileged for a number of reasons. I got in trouble very young. Like, when I was in middle school, I didn't mess up high school in terms of academics or anything like that. I had a couple of parents who were just, you know, rocks. As I reflect on it, they never gave up on me. They visited every time they could. I had some good mentors and therapists who really helped me start to build insight and self-awareness. And that's really where I got into mindfulness and meditation.
I was living in a group home, actually. One of the counselors there put me in a book that was kind of a mix between martial arts and meditation. That's how my journey really started with this work. I kind of got obsessed with mindfulness. Well, I got obsessed with meditation and learned a lot of different styles of meditation, and ultimately kind of landed on mindfulness meditation and kind of never looked back since.
I went back to high school. I went to college. I studied psychology in college. I found myself volunteering and working with youth programs. And then, I went on to go get a Ph.D. in Clinical Psychology, and I really oriented all of my work, all of my papers, all of my classes, all of my internships, all of my jobs, towards working with marginalized and incarcerated youth. Whenever I could, I would bring in mindfulness. I ultimately got involved in some programs where we were explicitly doing that. So, that's the short story of why I'm here today and why I do what I do.
Fleet Maull:
I'm sure you've learned a lot since and through your training and experience, but it sounds, though, like through your experience with your parents and some of the mentors you had that helped you overcome your challenges and kind of get your life back on track, that you probably learned a lot right then about what works and what's needed.
Sam Himelstein:
Absolutely. Absolutely. I mean, from my parents, I really learned that showing up predictably, consistently, and authentically in a relationship is one of the three critical elements of doing this work. That was mirrored in my relationships with my mentors and counselors, and therapists. The one thing that I knew as a kid, even to some extent consciously but of course reflecting on it as an adult, even more so, was that I was lucky to have some really talented and authentic mentors and adults in my life who I knew were safe. I knew that they were going to show up and be consistent.
Everybody's a human being. Everybody has bad days, but I knew who they were, and I didn't have to tiptoe around them. I knew, ultimately, they were there to help me. That is one of the things that kind of continued to propel me forward. So yeah, I reflect on that a lot.
And even through all of my professional training, I kind of refrained from those consistent, authentic, healthy relationships. That's 80% of what I'm doing and what my staff is doing when we're working with young people who've been trauma impacted who've been incarcerated. And even when we're teaching mindfulness, we still refrain from the relationship because that's what helps people feel safe enough to try a practice, like mindfulness or other types of meditation.
Fleet Maull:
Yeah, absolutely. I think the social sciences literature is pretty clear on that regarding all kinds of change programs for youth and adults. It's the quality of that relationship. That authentic, consistent relationship has the highest impact apart from whatever interventions might be offered or any particular program content. It's that relationship that has the highest impact.
Sam Himelstein:
Absolutely. Absolutely.
Fleet Maull:
Sam, we first met when you were working with the Mind-Body Awareness Project, a great project in Oakland, Alameda County. When I was involved with them, they were offering programs in a very large juvenile detention facility there in Alameda County, and I think, maybe a little bit in some surrounding counties. And so, tell us a little bit about your work with Mind-Body Awareness. What have you learned there?
Sam Himelstein:
Yeah. The MBA project, as we usually call it, that's really where I cut my teeth in this work, I would say, early on. I got involved with them in late 2007 and early 2008. I was also a grad student. I was going through my Ph.D. at the time, so I was getting a lot of clinical training from my grad school and a lot of real-world experience from the MBA Project.
And yeah, like you said, the organization works at the time and for a long time worked in multiple counties in the Bay Area, San Francisco, San Mateo, and Alameda County, providing meditation-based and mindfulness-based emotional intelligence services to young people who were incarcerated or were out on probation but had touched the juvenile justice system in some way.
I got a lot of really amazing training experience there and amazing life experience there. I had some really good mentors, people you probably know, and a lot of people in this world who know Vinnie Ferraro and Chris McKenna. I had some really, really foundational, amazing relationships with the youth that I worked with. I used to run a program. I did my dissertation for grad school through the MBA project. That's what my research was on.
We created a 10-week mindfulness-based program for incarcerated youth. And at the time, there was nothing out there at least directed specifically to incarcerated youth. So, you know, I was running a group. I was running groups multiple times a week in those units in San Mateo County, for example, for years, and I had some youth because the unit we were working in was kind of a longer-term care facility. I had some youth that I was working with for a couple of years at a time and just grew really, really great relationships.
Of course, they were professional, but they're still very authentic and had some young people in there really opening up their hearts and going deep into practice. People ask me all the time specifically about meditation sometimes at work, and I always tell them, like, "You can do it. You just have to build a relationship and help the young people you're working with really apply it to their lives so that it's the real thing. It's not just a kind of abstract practice." I was working with youth where sometimes we would do a 45 minute sit, so it was really, really foundational there.
The last thing I'll say about it is, like I said, I really learned a lot about myself when I was with MBA because I had almost every job you could have there. I was a meditation instructor. I was a research director. I was a program director. For almost two years, I was the executive director. So, it was a really, really phenomenal time and a big growth period for me. I'll always reflect on that time positively. I'm still in touch with the organization and the person who runs it now. I was supervising him, so he could get his clinical hours. And so, I always kind of keep the ear to the ground with that organization. They're still doing a lot of really good work.
Fleet Maull:
That's a great, great, great project, great organization. I'll never forget when I was able to go into the juvenile facility there in Alameda County with Binney and Chris and some of the others, and just the way they connected with you, it was just really, really fabulous. And you could see what an impact it was having.
I know in your work with marginalized youth and youth that have been placed at risk and are challenged, a lot of that is focused on addictions and substance use disorder. So, I wonder if you could talk about that. Obviously, there are going to be all kinds of other contributing factors, but how does that play out in terms of how it sets us up for failure in life or real challenges or for getting involved in the justice system and so forth?
Sam Himelstein:
Yeah, for sure. I mean, for people who are in the field, this is probably not a shock. But I think it's still good to start with the basics. A lot of the listeners of the summit will have probably heard the term self-medication at some point. That's what a lot of the young people that we work with are struggling with.
Some people use drugs and alcohol recreationally. That's okay. That's a real experience. But a lot of the young people we work with are addicted to opiates, or they use cannabis daily, or they use alcohol daily. And oftentimes, they're using it to kind of mask an experience or a number of experiences they've had. The unfortunate aspect is, you know, to some extent, it works.
They've dealt with so much trauma in their lives. They've been shot. They've shot others. They've lost people in their lives. They've witnessed domestic violence, you know, all of those things. That's just scratching the surface. They turn to drugs and alcohol because it helps numb them or it gives them some type of escape. That's a lot of what we see in the work that we're doing.
There's an old guard in mental health treatment like substance use treatments over here, mental health treatments over here. And that is not really authentic to how to actually do this work, and the evidence base doesn't support it. It's all there. Substance use treatment is mental health treatment. It is trauma treatment, in many respects, at least for people who are trauma-impacted.
For us, what we're doing in there, of course, like we were just saying, the relationship is so critical, whether you're a case manager mentor or licensed therapist, that relationship is still so critical to get somebody to even have the thought of feeling comfortable of opening up about some of those tough experiences they've been through, and then really learning to start to develop insight on why am I using, you know, how is this getting in the way in my life.
I was in Alameda County Juvenile Hall just a couple of days ago. Somebody was talking about how they're really starting to have some big insights about how drugs and alcohol are really getting in the way of their relationships in their life, just with their family members. And so, we're doing a lot of interdisciplinary, integrative therapy. Mindfulness is a big part of that because, at a really base level when people are using it to self-medicate, as opposed to trying to have a spiritual experience or something like that.
When they're using self-medicate, they're in some way taking themselves away from themselves and putting up barriers to present-moment authentic awareness. You know, they're trying to get away. They're trying to escape in some way. So, what we do is we, you know, through our curriculum and through our therapy is, we try to help them step by step and a little bit at a time, of course, but be more present and learn to be with self and learn not to judge and to be less reactive.
And, of course, as you know, and as the listeners know, that's a practice, and it takes training. And so, that's mainly what we're doing there. At the Alameda County Juvenile Hall, that's the juvenile detention center that I was incarcerated in probably about 25 years ago at this point. It's a trip, and it's an honor to have a contract through our company, Family Spring, to go back there to that same facility and do this work. The work is challenging at times, for sure. But it's very rich.
Fleet Maull:
Wow. Quite a journey you've been on. It's wonderful that you're bringing everything you've learned back in to support the young people struggling in similar ways that you were.
You were talking about self-medication. As we know, our culture is really oriented in that way. We're all exposed to all kinds of messages around self-medication and pain avoidance, and so forth. The slightest discomfort really and were encouraged to involve some sort of self-medication, whether it's food or substances, medication, whatever it might be, digital activity.
And so, I mean, youth are all really set up for this today. And then there's so much overdiagnosis of conditions that have been labeled ADHD, things like that, and often overmedication there. So, a lot of youth or young people are set up to be involved with medication and self-medication.
And then, as we know, depression and anxiety are endemic in our society, endemic among youth. And so I wonder if you could talk a little bit about how these issues of anxiety and depression are, how they're intermingled with addictions. And then, the danger of this leading to suicidality and overdoses and the really terrible outcomes that can happen.
Sam Himelstein:
Yeah, absolutely. I mean, you hit it on the head. A lot of people, and especially a lot of young people who are struggling with substance use, there's usually something else going on. It's not happening in a vacuum. A lot of the youth we work with, that's trauma, complex trauma, some type of developmental trauma.
We also run programs in the community. We have private clients as well. Not everybody we work with is in the juvenile hall. And so, sometimes, it's not trauma. Sometimes it's depression. Sometimes it's anxiety, but there's usually some kind of core mental health issue that's going on. And substance use is kind of the behavior that they're implementing. They try to deal with it.
And you're absolutely right. I mean, anxiety, depression, trauma, ADHD, like, trauma isn't diagnosed enough, but ADHD is overdiagnosed because some of the symptoms overlap with what we're seeing and what people with post-traumatic stress disorder and complex trauma.
A lot of those diagnoses, when individuals start to dip in their mental health, continuously go down. For example, I worked with a lot of youth who, when the pandemic started, got more depressed, got more anxious, and their trauma got more exacerbated. When that happens, they are at risk for more severe behaviors.
Sometimes that can be suicidal ideation or suicidality if they did. And they're more kind of on the spectrum of self-harm. Sometimes it could be more violence in the community because I had one youth tell me not too long ago that when the pandemic hit, violence rose because everybody was allowed to wear a mask in the community. So, nobody knew who each other was.
And so as mental health symptoms get worse, oftentimes youth are at risk for those sorts of things, whether it be suicidality, violence, what have you. And oftentimes, drug use and alcohol use are rising in accordance with that.
Fleet Maull:
Well, I want to circle back to talking more about trauma and then trauma-informed approaches to this work and to teaching and offering mindfulness practice. You mentioned the pandemic. I'm curious, since the lockdowns began in the spring of 2020, how you have seen that impact this work. Many of the prisons and juvenile facilities have shut their doors outside from volunteers or even contractors coming in, in many cases.
Perhaps it's starting to open up again now, but I'm just wondering what you've seen in terms of this work and whether it's inside facilities or other ways in which we're trying to support at-risk and marginalized youth and others and how the pandemic has impacted that.
Sam Himelstein:
Yeah, absolutely. I was actually in the California State Youth Detention Facility, which is the state-level, the CDCR. I was in there on the day they shut it down for COVID. I was doing a mindfulness workshop. We were there during the day long, and they basically kicked us out in the last segment and said, "We probably shouldn't let you come in today." And that was the beginning of the shelter-in-place and lockdown.
And yes, a lot of people, a lot of organizations, had to just deal with either cutting services or shifting online to Zoom to Telehealth. That was a difficult move for us in our programming. There were a couple of COVID outbreaks in the juvenile detention centers we work in. We were providing services in person. We were compliant, all masked up and everything. Then when an outbreak would happen, we'd have to go to Telehealth. It's very difficult to facilitate a group in Telehealth when all the young people aren't physically in the room together and the facilitator is on camera. It's a little bit easier to do one-on-one work. And so, that's kind of how we manage it, how we kind of shifted and moved throughout it. Now we're back in person, but it was very difficult.
The unfortunate thing is the people who suffered the most were the young people, the clients, and the people we were working with because they got their services cut at a time when their mental health system symptoms were getting exacerbated, and stress was rising. These are people who are incarcerated, so they don't generally at least have access to the same amount or types of drugs they would have on the outside to cope with it. And so, it was just kind of a recipe for a lot of chaos. I, myself and I would tell my staff that we kind of got to roll with it and show the institution, just like we would build a relationship with a young person, show the institution that we're going to be there, we're going to be consistent, we're going to roll with the punches, so to speak. That's what we did, but it was tough.
I'm a believer in Telehealth. I don't think it's as good as in person, obviously, as somebody who has done this work for a long time, but I think it's better than nothing. I do think it's going to be here to stay. I think with juvenile detention centers and adult prisons, we have to work a little bit better with the administration to figure out how this can actually work longer term to deal with, whether it's a COVID outbreak or whatever, you know, if something else comes along. So, it's not caught up to where Zoom is where me and you can just hop on right now because facilities just don't have the bandwidth or the tech setup to do it. But I do know that's changing, and I'm hopeful for it.
So, yeah, it's been a struggle, but we've still been able to do our work. My kind of message to my staff and to other providers and other volunteers is when things happen, you just got it. I know you know this, but like when you're working in a prison or juvenile detention center, a lot of the work is going in there having your agenda, knowing that you can go in and your group's just not there, there's somewhere they're not supposed to be, or they're doing some other activity and you just kind of got to roll with it and go with the flow. We did that on a large scale when it came to the pandemic and COVID and are still, you know, from time to time dealing with it.
Fleet Maull:
Absolutely. I think the Prison Mindfulness organizations and projects all over the country have been going through that same journey. I think you and I agree there's no substitute for in-person programming and for the ability to create that consistent, authentic relationship.
During the pandemic, through Prison Mindfulness, our executive director, Vita Pires, has been offering the Path of Freedom program over Zoom in maximum security, South Carolina prison, and in a New York County Jail for both men and women. First of all, we never thought they'd allow it. And then we thought it'd be really hard to do, but it is happening. And it is hard to do. There are a lot of challenges compared to being in person, but it's happening.
A lot of us are seeing coming out of the pandemic that there's going to be a kind of hybrid feature to how programs are delivered going back to in-person, but also a lot of online stuff. And also, what we're seeing in the world of corrections is our reliance on secure tablets, like these computer tablets, where there are some big companies marketing this to correctional systems, where they provide them with these tablets that the incarcerated persons can then use. In some cases, to do like FaceTime with their family, but they will have a charge for that. But also, to access educational programming and books and so forth. We have one of our programs, Path of Freedom, there. We actually didn't realize the reach of it yet, but it's reached 36,000 prisoners through one program like this, and now we're working with some of the other companies. So that seems to be a wave of the future.
I have mixed feelings about it because, in some ways, prisons and correctional facilities are so security-focused they don't like bringing in books because they're afraid things will be smuggled in with books. They're always a little bit allergic to the outside altogether, right? So, the more they can have secure tools, maybe it's going to create barriers to doing the in-person work or to get the good books in people's hands and so forth. So, I'm just curious about your feelings about where all this is going and what you've seen so far.
Sam Himelstein:
Yeah, that's a great question. Similar thing out here. Even in juvenile detention centers, they're moving towards tablets. A lot of adult prisons have tablets. Some people I grew up with, who are actually doing time, I've FaceTime with them because they have their tablets now. I feel very similar. I'm mixed about it. I think there are definitely some positives.
As somebody in our company, Family Spring, we're creating some technology and some applications that can be adjunctive to treatment and can help treatment. But the way we frame it, and this kind of sums up my mixed feelings about tech in general, is we're not creating an app to replace a therapist. We're creating an app that is backed by a therapeutic relationship, a real human-being relationship.
Do I think it's a net positive that there are 36,000 people who can access your program through their tablets and hear meditations by you and your instructors? Absolutely. I think that is a wonderful thing. I will vote for that any day of the week because there are going to be some young people and some adults in the system who are motivated enough to practice those meditations to gain insight and to have some transportation.
Would I choose that instead of you going in and running those programs? No, I would try to do both. So that's kind of my feelings about these applications and tech moving forward. We're really trying to develop tech that's backed by human relationships. You probably know this. Listeners probably know this. I have almost every mindfulness app that you can have on my phone, just because I like to experiment with them. If I recommend them to people, I like to have personal experience with them. And just like any other app, it just becomes background noise.
It becomes background noise and something you have on your phone that you don't actually use because it's just an app, and we know, as human beings, that it's a piece of technology. But when it's backed by a real person, when we're meeting weekly, and I say, "Hey, I'm going to assign you this meditation in the app, and we're actually going to talk about it next week. Let's dissect it and, you know, kind of unearth, you know, the pros and cons of it and if it was helpful to you." That's a real relationship. That's back into technology.
So, that's kind of my feelings on the situation. I think we're moving in the right direction. I think we need people like us, like actual service providers, who are in those boardrooms when that tech is getting developed so that we can ground the work and the relationship and ground it in that human connection because there is a movement, particularly in the mental health field, towards wellness and apps and AI that is in my opinion and this is for another conversation, but missing the mark a little bit, you know.
Fleet Maull:
Yeah, I actually have a colleague who is developing a kind of AI-driven database business that provides really wonderful practices. I mean, they're really cool, wonderful stuff, a big library of stuff. And, you know, it may be a good adjunct, but I think the important thing is seeing these things as adjuncts to in-person therapy. I mean, we've learned that we're negotiating with some companies now, but we may be able to get some of our programs in front of hundreds of thousands of incarcerated persons. And we can never reach that many people with in-person programming.
At the same time, we're wanting to do that, but our already existing strategy, which we're going to continue and try to do even more, is training as many people as we can around the country to go into the facilities with these programs. So, the ideal situation will be where we have volunteers or contractors going into a facility to deliver a program, and those prisoners have access maybe to a similar program on this tablet, and then the two can create a nice synergy. That would be the ideal situation.
Sam Himelstein:
Absolutely.
Fleet Maull:
Yeah. So, I want to circle back to trauma. A lot of the things you mentioned, whether it's substance use disorder, ADHD, obviously PTSD, but all kinds of other things, anxiety, depression, suicidality. It's all trauma based. I mean, we know that today. This stuff just doesn't arise out of anywhere. And even when people think there's a kind of chemical imbalance in the brain that's related to certain mental disorders. It's all trauma based.
And so, I know your work is trauma-informed, and you do research around that. So, I'm wondering if you could say something about the principles of bringing mindfulness-based programming into facilities or working with marginalized youth in a trauma-informed way.
Sam Himelstein:
Absolutely. Yeah, it's a big passion of mine. We've kind of covered, you know, I would say, the first pillar of that already, which is to do things in a trauma-informed way, is to hold the relationship in the highest regard. And to not over-focus or over-rely on any one technique. The base of the pyramid for direct service work from a trauma-informed perspective is the relationship.
What that really means is creating trust, creating emotional safety. As you know, and your listeners probably know, too, trauma is marked by chaos. It's marked by disintegration. And so, one of the remedies for that is consistency, predictability, and consistent and predictable authentic relating. It can be very healing in and of itself. So that's the basis in terms of the work.
But also, from a practice standpoint, too, it's oftentimes minor adjustments to the practice to make sure that you're not actively contributing to a possible triggering of somebody. These are things that probably a lot of people here already do, but it's just good to have a framework for it. Like, for example, inviting somebody to close their eyes when they meditate, but certainly not mandating it and literally telling them, "It's okay to keep your eyes open."
From a trauma perspective, it's very simple. How do we assess our environment to know that we're in a safe place? Well, biologically and evolutionarily, we do that by looking around to see. Is there a bear that is about to attack me? Is there somebody across the street who's about to attack me? Right? So doing something as simple as inviting people rather than mandating them to close their eyes but letting them know it's totally okay to keep them open is trauma informed.
And also, I think, really, the core of it is, the facilitator going in understands that when things come up when somebody is resistant to meditation, or they crack a joke right before you're about to do a meditation or something like that, to learn to interpret that type of resistance as protection. People are oftentimes trying to protect themselves and not take it personally. I teach my staff to really learn this. This, of course, is practice. It's much easier said than done, but to step outside of their ego and just meet people where they're at. And over time, you will be able to promote the practices a lot more.
But it's other things, too. It's making sure, you know, the first time you meet somebody, if you know they have or have a sense, they have a trauma background, you know, we're probably not doing a meditation for 10 or 15 minutes. We're probably starting with just a couple of minutes just to kind of assess just to make sure it's not triggering their physiology and their trauma responses. Because it's going to be very difficult for them to be present with self if their neurophysiology is telling them, "Don't be present with self. Go into fight, flight, or freeze because you're in a situation that warrants that."
So it's having that understanding. It's meeting people where they're at. It's holding the relationship in high regard. It's just some very minor shifts and practice in terms of what I like to call meditation logistics. Sometimes if you're going the more spiritual route, and you're learning meditation in a Zen temple, for example, you have a particular way to sit, and they have a very particular way of doing things which can be wonderful, right? But when we're delivering secular practices in a prison or in a youth facility, oftentimes, we're planting seeds and hoping to nurture those seeds over time.
So, we're not necessarily saying you got to sit in a certain way or doing anything that would, at least especially for teenagers and young people who are incarcerated, doing anything that might produce more resistance. as simple as, like, I don't want to close my eyes, and I don't want to sit in a certain way. And now I'm not going to listen to anything else you have got to say because that doesn't fly with me. So it's really meeting them on that relational level, and just kind of taking it step by step, taking it slowly with practice. I'm just talking about meditation. There are so many different ways to bring in mindfulness practice, as you know, that's even beyond the world of meditation. But that's what comes to the top of my mind right now.
Fleet Maull:
Yeah, it's wonderful. I love the way you kind of reframe the resistance as protection because often resistance can be a misnomer because what we're really seeing is somebody taking care of themselves and keeping themselves safe and kind of warding off a further sense of powerlessness or being disempowered, right?
And so, if we can learn to just see that as information. Like, this person is communicating something to us. And then also, even if we do think of something as resistance, well, what am I doing to contribute to that, right? How can I show what I'm doing that, and certainly not exacerbate it more, but not to create it in the first place? Right? So yeah, I think that reframing the whole concept of resistance is really helpful.
Sam Himelstein:
Absolutely. I had a staff once, a long time ago. Actually, this was when I was working at MBA, and that exact thing manifested. I was training them to think of it that way because he came up to me one day and said, "I'm getting disrespected as a facilitator in the group." I said, "Oh, tell me about that. What are you feeling as disrespect?" And he said, "They won't close their eyes?" And I said, "Well, would you want to close your eyes if you were in a group with 10 people, some of which were opposing gang members, that if they were out on the streets, it would not be a safe environment?
And so, I just started to get him to really think step by step of the resistance itself is that wired protection and exactly what you said. It's information. When you start seeing it as not just something to get rid of, but actual information about human beings, about how they're viewing the world and how they're trying to protect themselves.
When you start seeing it that way, then there's a huge opportunity to work with them over time to help them develop that insight and self-awareness and then be able to choose, "Is this how I want to show up in life?" This is my superpower, but it's a double-edged sword. Sometimes the sword is facing outward. Sometimes the sword is facing inward. That is some of the deepest mindfulness and kind of insight-oriented practice that I've personally done with clients and with adults and youth.
It's just that simple shift of this "resistance." It's protection, and it's not about me. If another facilitator was here, this would most likely be happening as well. While, of course, at the same time, I can contribute to it, and I can do things to exacerbate that resistance, so I want to have that kind of awareness of self when I go in and try to kind of look at things from a minute perspective and step out of my own ego, as much as possible.
You know this, and probably a lot of your volunteers and folks in this field know this. Especially working with incarcerated youth or with youth in general, it's very easy for an adult to go into an authoritative mode. I'm the facilitator. I'm the adult. I should be listened to. That's really a position that's solidified within the ego that we got to step out of sometimes because it's easy to get in those resistance traps. I'll stop. I could talk about resistance all day.
Fleet Maull:
Well, no. I think this is so important because if we're talking about doing trauma-informed work, there are all kinds of techniques where you can adjust to the more invitational language and use present participle and permission. There are all the kinds of things we can do as well as our understanding of trauma and sensitivity but making that fundamental shift to get off our own agenda, and to really shift into deep listening, and really seeing everything that's coming from whoever we're working with, is just human beings communicating to us how we can be helpful to them. Right?
And instead of interpreting things like resistance or getting our own ego involved, I think that's really the deep ground that you're pointing to in the trauma-informed work. While we're on this topic, I just want to go just a little further with this. So, working with young people, you know, yes, I think most of them have experienced powerlessness so much their whole lives. So, if we step into that authoritarian kind of parental role, we're liable to create all kinds of resistance, right? And we're just going to do that out of our own defensiveness anyway. Right?
That can happen to any of us. We're not sure what to do. It's not working. What's going on here? At the same time, we need to be in that really agenda-free listening, trauma-informed mode, right? We do need to show up with something. I don't know what the right term is. A certain kind of strength or presence or competence, or you're not going to get young people to even pay attention to you, right? If you come in a really passive way, you're not likely to get their attention. So sometimes, it's not like becoming authoritarian, but sometimes, you do have to bring in a little bit of strength or presence and something to get their attention. I wonder if you could speak to that.
Sam Himelstein:
That's very, very true. I think as somebody in my training business, I'm training people to do these types of programs. The word that comes to mind for me that you said was confidence. And you probably know this from experience on both sides of the wall and people you've trained, going, particularly into detention settings, youth and adults do not want to work with people who they think are scared of them. And so, they can smell that out, whether that's passiveness or just being intimidated, or whatever. So, confidence is really, really critical.
I tell people confidence comes from two places. It comes from doing your work and your training, and your prep. The best people who run these programs, whether it's my MBSAT program or you or your Path of Freedom program, they've done their homework enough to where they don't have to continuously go to a piece of paper and be like, "Okay. What am I supposed to do next now?" They've done that, right?
And then the other place is the experience. They go in. They see the people they're working with as human beings. They're not afraid to project confidence. I think presence and strength are other words that you've said that I relate to, as well. Particularly for young people. We work with young men and young women, but of course, in the juvenile detention center, it's like 90% young men. And particularly working with young men, they really gravitate towards that kind of authentic presence and strength that's not domineering, that's not too authoritarian, because that's what they're getting with the guards, right? But somebody who there's a consistency to it. I do think that comes from confidence.
I tell people all the time, you know, it's okay if you're starting. There's a difference between "I'm not confident" versus "I don't have a lot of experience in this work." If you're just starting off, for example, and you've never gone into a juvenile detention center, it's okay to say I don't have a lot of experience, and I'm about to learn new things. But if you go in there and you start acting non-confident, and you're too passive, you're absolutely right, like part of it is we do have to get their attention, we do have to show them that we're serious in the sense that we're going to show up consistently over and over and over again, and we're not babysitting. We are not just going to do nothing, you know. That comes through as you project that confidence.
There is a little bit of an ineffable quality around it, but one of the things that I think is happening is when you do that, you again, going back to the consistency and the authenticity, if you're showing them, hey, you're looking them in the eyes, so to speak, and you're showing them, "I'm here, and I want to know you." You know what I mean? I want to get to know what's up with you, who you are, what your life is about, and what's in your heart. That's the type of confidence where it's like, wow.
For some youth, of course, that's intimidating. That's where the resistances come up, right? That's normal. But for other people, and even for that, you know, for the youth that gets intimidated, over time, dang, this person has given me the time of day. When is the last time an adult has done that for me? You know, coming from the youth perspective.
And so, that type of experience, when you have that over and over again, will lead to more and more confidence and your confidence in the ability to know. This is one of my favorite experiences but somewhat difficult too. When I work with a young person, sometimes I meet people for the first time, and the vibrations are already there, and it's like, you know, handshake, hug, great to meet you. We're going to have a great working relationship. But other times, you know, and this is an experience I value even more to some sense, they are like, "Hold on. I don't know. I'm not about to open myself up to you."
In my mind, I'm telling myself, "Okay, this is where we are." That's totally normal. It's totally okay. The individual is going to have their protection up for a while because they need to assess and figure out if I actually am what I say I am, which is an emotionally safe, consistent, predictable adult in their life. And for me, knowing that that's a process and having that confidence that that's a real human being, they're protecting themselves. I'm here to stay. I'm here to build this relationship with them, which will look different for everyone. That's the piece for me that helps me go in every time I go in with kind of that confidence, that strength, that presence of really at the end of the day, like the meta-communication is, "Hey, I want to know you." Whatever it takes to know you, I'm willing to sit in that fire with you.
I kind of went on a tangent there, but I think what you're saying is really true. And that's the paradox, right? It's like, we're not trying to be authoritarian or too authoritative. We're not, like, "Do this. Don't do that." Right? But we're also not going in there with a meek attitude of, you know, whatever you guys want to do is cool, right?
I tell my staff all the time. It's a dance. There's a paradox, but we do want to teach those skills because proficiency comes through practice, and we want to help them move along so that they can have the experience of going from, like, "I don't know about that mindfulness stuff. I don't think that works too." Wow, I actually have been trying it in. I'm getting some real-life experience from it and some results. So yeah, it's very, very important to have that kind of inner strength and that confidence.
Fleet Maull:
Wow. That's incredible. If it was a tangent, it was an incredibly valuable one because we're getting a masterclass in here on how to do that work. This is so valuable for anybody doing the work. A lot of it applies to working with adults as well or incarcerated.
And a lot of this we've learned through experience. And anybody who has been doing prison work for a long time, you know, is learning things to experience. If they're a learner by nature and have that kind of humility, we're going to be learning. We begin to understand what works. We see what works. And, you know, a lot of times, people in the field, whether volunteers or professionals in the field, don't really feel like they need somebody to do research to show them what actually works. They kind of know what works. On the other hand, research is really important to support programming to create buy-in for programs to get the system to open up to more programming. So, research is really important. And also, we can learn things about doing what we do better through research. There's no question about that.
I know you've published quite a few papers on your work. I remember quite a while back. You published a kind of review of the literature summary of the current state of meditation research. That was way back in, I think, in 2010. And overall, there's been nowhere near enough research done on mindfulness in prison, whether with youth or adults. And so, I'm curious about your thoughts about the current state of the research and kind of where it needs to go, what we're learning, and what more we could learn. And just the value of trying to support getting more quality research done on mindfulness-based work with youth and adults.
Sam Himelstein:
Yeah. I mean, generally, I would say research in the mindfulness world has continued to grow just in terms of working with youth and adults, particularly in clinical populations. Unfortunately, I don't think it's grown that much, particularly in the incarceration and detention world.
The paper you're mentioning that I published in 2010. I did that when I was in grad school because I was so interested in just meditation in general. I did everything I could do to write this review paper on the current state of what was going on in prisons.
I hesitate to say, but it's not a great paper in the sense that there are a lot of limitations to the research, right? Like, I wish it could have told us more. I review that by going over some of those studies. I haven't stayed up to date with every single paper that's come out, but I know that there's some good work happening in different Research Labs.
I know Amishi Jha at the University of Miami, she's done a lot of research, and some of it has been on incarcerated youth with some of her partners. But in terms of mass scale, there's still not a lot happening. And part of it is because—I think I even mentioned this in that review paper. I definitely mentioned that in my dissertation when I did my real-world experience of doing research in an institution. It's just difficult to do research in an institution.
The gold standard is still in empirical research, which I could go on a tangent about how this is not the only way, but still, it's a randomized clinical trial or a weightless clinical trial. And so, a lot of administrators in prisons and juvenile detention centers who don't have the research background will ask very logical questions like, why would you want the weightless group or the control group to not get the service, though, they always say, I know all those kids in the control group. They need treatment. They need the service. So, you run into these very real-world kinds of grassroots issues when you try to take research into a prison. And so, what we need to do is kind of step out of the paradigm of this post-positivistic randomized clinical trial-only type of mindset.
I'm not saying we shouldn't design high-level studies. We should. We should try our best but partner with the institutions in a way where we can get the best data and have the best relationship and still keep clinical ethics in the highest regard. Or if you're not a licensed clinician, like me, still keep the program and the service in the highest regard. The first aspect and the first intention here is to help people. The second intention is to look at the results of the studies.
I think if more researchers took that approach, and I would say people generally, in the qualitative side of research, have more experience with partnering with gatekeepers and saying, "How can we do this, and let's come to some kind of middle ground." Whereas people who just think of things in post-positivist terms, and it's got to be the randomized clinical trial or nothing. They don't get as far as some institutions. We got to have some middle ground.
I think there'll be more research, and we need more research because incarcerated youth and incarcerated adults who are coming back into the community, we want to be able to do long-term studies and see, "Hey, if somebody really develops this practice and they're proficient, and they have a practice, you know, and they say it's impacted their life, does that help them stay off drugs? Does that help them stay out of prison or stay out of jail? Or stay out of the juvenile hall?"
That's the next level of evolution that I think we need. Because even the research that I've done for all of my programs, whether it's been MBA or my Mindfulness-Based Substance Abuse Program, they're all limited. I mean, it's great in the sense that we can show that the programs had an effect in 10 weeks or 12 weeks or something like that. But what about the longer-term effect on their life? That's where I think the research really needs to go.
And like I said, in the adult and youth world, mindfulness and MBSR, there's been a lot of studies on them. And even in the clinical world, there's been a lot of studies on different types of dialectical behavioral therapy, Acceptance and Commitment theory therapy, or other types of mindfulness-based therapies that interact with therapy in general to help clinical populations. But we're still not that much farther along than we were in 2010 in terms of working good quality research with incarcerated populations. So, that's where I think it really needs to go.
Fleet Maull:
Yeah, Sam. You made so many good points there. It's the longitudinal research that we really need to do to understand the long-term impacts of mindfulness-based programming. And it is really challenging, really hard. And you're right, the research has exploded in the outside community, the mindfulness world of mindfulness-based therapies of all kinds, but unfortunately, with the prison work, I mean, we've made several attempts, like four or five attempts to get an NIH grant to do a randomized clinical trial on the Path of Freedom program using some really good university teams that have been successful in getting grants.
And every time, we didn't quite make it, and they said, "No, we want you to apply again." but it's very competitive. And as it turns out, really, the only kind of NIH is a whole collection of Institute, as you know, and the prison funding mostly goes to the one having to do with substance use disorders, right? If you want to get prison programming research done, it's almost got to be related to substance use/substance abuse, right?
We hope we'll get around to having the bandwidth again today to maybe create a path of freedom relapse prevention program and try to get the research done that way. But it is really challenging for so many reasons. We did get a couple of brave brief clinical trials done as part of those grant applications. We were able to show, even just in a one-month follow-up, that there was a lessening of substance abuse and so forth. But, you know, the funding to do the longitudinal studies and then finding out how when people are released from prison to stay in touch with them, and yeah, I mean, so many challenges going into prisons.
And also, there are a lot of difficulties that are barriers that should be there. Because in the past, there has been very abusive research done on adults, and probably youth, too, in the prison setting. So, there are a lot of controls around privacy and protection these days. It's a challenging area, but it just really needs to happen because I think in order for policymakers and funders to really get behind Mindfulness-Based prison work with adults and youth, they want to see the evidence. And so, somehow, we got to get there. And you are pointing us in a really good direction there.
I think we're kind of near the end of our time, but you kind of pointed to this with this need for longitudinal research around what happens when people are released. I wonder if you could talk a little bit about post-release work. Now, there's very little successful post-release work of a mindfulness nature in this country. I mean, I know there's a wonderful Zen teacher, a woman in St. Louis who has a kind of a post-relief program of break Rishi started and brings people who are practicing mindfulness and Zen into working in a bakery. But there's, there's been very little.
I'm curious. You're probably seeing youth go in and out of the system in lots of different ways. I'm curious, even at a local level where you work, what do you see in terms of post-release? What's needed to help? If young people are learning about mindfulness in a facility, how can we help them continue when they get out? Because there are so many barriers when they get out? I mean, people get out there at survival. Right? They're just trying to survive and get a job. They're getting back into their neighborhoods, back into their families. They are back in all the influences that are different. And often, the places where they might practice mindfulness or geographically distant or culturally distant, or, you know. So, I'm curious if you have any insights or way in some directions around all this.
Sam Himelstein:
Absolutely. I would say the best thing that gives us a shot is having relationships that continue from the inside to the outside. And so, for example, we have some clinicians that do reentry work in Family Spring that, you know, you're working with a young person, you know, a 20-year-old who was incarcerated for a couple of years, something like that. And then when they get out, that same clinician, that same relationship is extended. Whether they continue the mindfulness work is really going to depend on how into it they are, but that clinician is still going to be there to give them those opportunities.
That really is one of the pluses, one of the pros of the kind of the new Telehealth Zoom world. Whereas before, it was hard to stay in touch, and it was hard to maintain that relationship. Now, at the very least, it's easier to stay in touch. We still try to do it in person when they get out, but if they move to a different city because of safety reasons or gang reasons, or something like that, we can actually still stay in touch with them.
So for us, that's the biggest continuation of that same authentic relationship. That's the biggest shot we have to continue that work. For us, since we're delivering treatment, if part of their treatment
plan was mindfulness or mindfulness-based programming in some way, then we would continue that on the outs. And so that's where we found some success.
It's still very difficult, though, for all the reasons you said. We've worked with people that we've had very high hopes for. They've gotten now, and they've gotten shot and killed. That's a very tragic situation when that happens. Did they make choices that were probably not in their best interest? Yes, some of the time. And some of the time, they're just back in survival mode. They're back in that same neighborhood where there's all that violence happening. It's so difficult not to get caught up in it, so it's very hard. There are a lot of issues.
That opens up the public health issue of violence in the communities, drugs in the communities, and all of the things that we're dealing with when we're trying to continue services. But we're still there to do it. We're still there to give it a shot because whatever happens with those young people when they get out, whether we're saying it explicitly or implicitly saying it, we're here, we're present, and we're showing up because you're worth it. And that's what we're trying to transmute to them.
Fleet Maull:
Wow. I'm so glad you are. It's so easy, I think, for those of us doing this work that sometimes, you know, start to feel a little hopeless and, you know, the general cultural, social, societal situation, sometimes you're not sure if it's getting better or worse. You're meeting people, working with people, but they're still dealing with this big system you have no control over.
I think we have to keep reminding ourselves that those human touches that we're making with each other are priceless regardless of the ultimate outcomes, but those human touches that we make with each other in this work are priceless. We can trust that, on some level, that's having a deep impact on our fellow human beings we're working with.
I'm so glad you're doing this work. This has been so incredibly valuable, really a masterclass on how to do this work. I just really appreciate you and what you're doing and reconnecting with you. Thank you so much for being part of the Prison Mindfulness Summit.
Sam Himelstein:
Absolutely. It's been an honor. Yeah, anytime. I'm happy to have these conversations. It's been great to reconnect.
Fleet Maull:
People can find out more about your work. Again, it's MyFamilySpring.com.
Sam Himelstein:
MyFamilySpring.com is where our clinical organization is. And CenterForAdolescentStudies.com is our training institute. We have a bunch of free online courses that folks can take and learn more about this type of work for sure.
Fleet Maull:
Great. Well, I encourage people to check that out. So, Dr. Sam Himelstein, thank you so much.
Sam Himelstein:
Absolutely. Have a wonderful day.
Fleet Maull:
Be well.