Empathy, Structure, and a ‘Tight Hug’ – Behind the Scenes at the Pine River Institute

Witness an encounter in deepest Mulmur. 

On a drizzly autumn day with fog playing hide-and-seek among a sea of cedars, Dan Ardis – middle-aged, pleasant and, in shirtsleeves, underdressed for the weather – encounters a passing youth wearing muddy sneakers and a dark sweatshirt.

I’m visiting Pine River Institute, an addiction and mental health treatment centre for youth, expecting stereotypes – loutish and sullen. The teen is neither. He’s big, his hair tousled, and his eyes brighten when Ardis stops to ask, “Is your day improving?”

Turns out it is. Apparently it had begun quite badly just a couple of hours earlier, manifested in frustration and rage. The pair greet with a fist bump and Ardis, leaning casually on the tailgate of a truck, listens to what the youth – who must remain nameless for privacy reasons – has to say. 

The kid, maybe 16, is a piano player and, as the drizzle increases, he respectfully notes that the instrument here is badly out of tune. Ardis commits to getting someone in to tune it. “Can I watch?” the youth asks. 

And faster than you can ask yourself, Where is this conversation going and can we get out of the rain? Ardis replies, “It depends on the repairman. I’ll ask. Are you keen?” – the kid is – “Let’s talk about timing.” 

Done. With that scant dialogue, a life lesson was being taught and learned. Therapy was in progress, beyond any textbook, with humanity, positivity and respect. A piano will be tuned. A youth who is troubled and troublesome – or he wouldn’t be here – may become less so.

“People are wrapped around him here and he knows it,” Ardis explains afterward in the dry of his office overlooking a playing field where the damp weather has not deterred the progress of a 20-person game of Frisbee football. 

Ardis, a former elementary school principal in Dufferin County, is senior director of operations and campus life at Pine River. He likens the program here to “A hug. A tight hug.”

A hug can be both comforting and confining. We all need them, but some, who are still in the developing, adolescent stage, need them more than most, and for both reasons. Which, implicitly, is why they come, voluntarily, to Pine River’s campus in Mulmur for what can be a tough program of indeterminate duration.

Kids in the neighbourhood 

Pine River Institute, its students and staff are our Headwaters neighbours. They have been quiet, unseen and almost unknown neighbours since 2006. The campus spreads over 220 acres of fields and woods east of Horning’s Mills on the site of a former outdoor education centre of the Toronto District School Board. Over the years, hundreds of students and their families have participated in the Pine River program.

Designated a Residential Youth Treatment Facility with charitable status, the campus best resembles a somewhat rustic summer camp, though it operates year-round.

Fifty-nine treatment “beds” are funded by the Ontario Ministry of Health, topped up by modest supplemental fees charged to parents or caregivers. Bursaries ensure no family is rejected due to lack of means. There are also a small number of private beds along with beds funded by other agencies, bringing total capacity to 65 beds. 

The government funding covers core program costs and staff salaries. Dorms, classrooms, and maintenance of bike trails, playing fields, campsites, gym and music cabins (far from as grand as they sound) are funded by, and some are named for, generous donors to the Pine River Foundation. 

Moffat House is one of them. It is a bright, new, two-storey, wing-shaped building pierced by many large windows offering views over acres of mowed fields out to seemingly endless forest. A minimalist IKEA-like ambience encompasses a large common room, classroom and four-person dorm rooms with elegantly integrated bunks. It is staffed by youth counsellors night and day.

Although Moffat House nearly doubled Pine River’s capacity, an increasing number of applicants has meant maximum wait times were reduced by only about 25 per cent – from nearly two years to 18 months. Depending on certain variables, the minimum wait is six months. Pine River offers a six-week online program of weekly support for caregivers of those on the list. 

The length of the wait reflects a steady rise in demand for mental health and addiction services for children and youth over the past two decades. A spike in most indicators of mental health stress during the Covid pandemic has fallen only slightly in its aftermath. In 2023, the Ontario Student Drug Use and Health Survey by the Centre for Addiction and Mental Health revealed that 38 per cent of students (Grades 7 through 12) rated their mental health as “fair” or “poor.” About one in five (19 per cent) reported purposeful self-harm. One in six (18 per cent) admitted to suicidal thoughts. 

Students at Pine River, ranging in age from 13 to 19 (average age is 17.3 years), are struggling with mental health and addictive behaviours characterized by some combination of self-harm, eating disorders, depression, suicidal thoughts or attempts, low self-esteem, family conflict, truancy, running away or involvement with drugs, street life, police, courts and the medical system. They come from across the economic spectrum, and though they tend to skew urban, many are from rural communities. The student body is currently about 62 per cent male, 35 per cent female and 2 per cent gender diverse.

Typically, students have already experienced psychotherapy or medical interventions, often at multiple outpatient or short-term residential treatment facilities, without success. They go through the motions – “Holding their breath,” in the words of Dan Ardis – then go back to whatever they were up to. In the minds of their parents or caregivers, Pine River might be considered “the end of the road,” although therapists and counsellors working there never use that term. 

One of the things that distinguishes Pine River Institute in its stated mission – “To work with youth struggling with addictive behaviours to get their lives, relationships and futures back on track” – is the length of the program. There is no set term of stay. The average is 19 months and is dependent on a student’s emotional growth and maturation. 

Pine River is also unique for its “parallel process,” in which parents or caregivers must be willing to participate in their own lengthy therapy process. It’s not simply a matter of dropping kids at the door and coming back to pick them up, problem-free, a few months later.

 “We are rare,” Pine River’s clinical director Anne Tong says earnestly, and with pride. “In the continuum of care, we would be at the heavy end of it in the length and intensity of the program.” This is evident in both the quantity – students undertake both individual and group therapy sessions multiple times a week – and the quality of therapy. The place is awash with therapists and counsellors. Even the cleaning and kitchen staff have been schooled in how to act within what Pine River describes as a “therapeutic milieu … accurately attuned and empathetic.”

Underpinning it all is the “maturity model,” by which Pine River students are admitted and grow according to their individual timelines. The John McKinnon Maturity Model, referred to at Pine River simply as The Model, is based on principles outlined by American MD John A. McKinnon in his book An Unchanged Mind: The Problem of Immaturity in Adolescence. Tong explains, “There is typical adolescent development in maturity, and life sometimes gets in the way: a death in the family, multiple moves, divorce, mental illness, learning disability, autism, substance abuse, trauma, fetal alcohol syndrome …” 

The Model assumes adolescents are not smaller adults, but humans in development, their brains still growing and plastic, with the ability to replace negative neural pathways with new ones that allow for emotional growth and produce healthier behaviours. 

Is the notion of a “bad seed” – a child irredeemably born a problem to themself, their family, and society – bad science? Tong makes clear: “That is not how we see it. Things got in the way of what the child needs to mature effectively. The work here is to understand how those things impact them so they can say, ‘I’m not bad. Things happened in my life, but I’m empowered to make different choices.’ A lot of our kids have had that experience – ‘Bad seed! I’m a bad kid, so if everyone says I am, I’ll just be so!’” 

But how does The Model, defined by “reality, empathy and regulated emotion,” combat a society inundated with dangling lures of unreality: lotteries, social media, impossible lifestyles flaunted in film and music lyrics, cults, pornography, legal marijuana and the like?

“That is why the program here at Pine River is physically isolated,” she responds. “It lessens distractions. (Cell phones, cigarettes, candy, caffeine and soft drinks are prohibited on campus.) We are helping them with a realistic future orientation, helping them recognize the things they want. If they talk of being rich or being famous, we help them break that down. ‘Is that really what you want? What are you actually looking for? What would be fulfillment?’ It is not that they want fame, it is that they want connection, they want someone to validate their existence.”

Outdoor initiation

The open-ended treatment program at Pine River begins with six to eight weeks (sometimes more) of camping, canoeing, trekking and snowshoeing in a small group. This takes place year-round, deep in and around Algonquin Park. Pine River calls this preliminary phase the Outdoor Leadership Experience, or OLE.

The OLE program is run by outdoor enthusiast, wilderness counsellor, now wilderness therapist (the latter have advanced university credentials) Melanie Fowler. She visits the park regularly to check in with the three counsellors who stay and live with the group, three staff to eight students, round the clock, rotating with alternative staff on eight-day shifts. 

Imagine it is November, late in the day, surrounded by forest. The light is going, the temperature is plunging and you have a flint, steel and a pile of sticks. Make a fire …

“Making a fire without matches takes persistence and resilience. It can be finickity. It can take time. It’s challenging. ‘It’s not enjoyable – but can you get through it?’” Fowler and the counsellors ask their charges. They support. They encourage. Fowler explains: “The woods simplify. You work with the weather. You work with the land. There are natural consequences. If you don’t go on a firewood run, you don’t have a fire. You work as a team or you might not cook dinner that night.” 

“Discomfort motivates us to change,” she continues. “The wilderness is a great place to regroup, to get yourself present. Portaging a canoe, building a fire, are things they have never done before and are succeeding at. It builds confidence. Our hope is by the time they are ready to move to campus (in Mulmur), they’ll have learned to regulate their feelings. They won’t be perfect, but they’ll have started that work.”

The therapeutic rationale behind OLE is to separate arriving students from the distractions and coping mechanisms (drugs, alcohol, defiance, aggression, etc.) they are caught up in. “To slow everything down and get clarity. To engage with life and peers in a more healthy way,” Tong says. “It is grounding.” 

Grounding, but is it harsh? Is it a boot camp, as one might be tempted to surmise from the comfort of a couch? The power dynamics in OLE, Fowler explains, are quite different from the authoritarian regimen of a boot camp. “It is a very supportive environment. The kids have positive adults who care and are curious about who they are. It is never just barking orders. 

“We have high expectations, but it is never a ‘forced march.’ When they first come in, it is, ‘Let’s start with a light backpack and work our way up.’ Accomplishments are celebrated. When they portage a canoe for the first time, it is celebrated. OLE is about building up, building up a sense of confidence, a sense of self. It is not about breaking down.”

A decade after learning how maturity looks and feels following 21 months at Pine River, Amy (not her real name) adds a personal perspective on OLE. She arrived “lost,” a suicidal and self-harming teen. “I wasn’t ready to be an adult yet,” she recalls in a telephone interview. 

Now 27, Amy is in college studying child and youth care with a dream of returning to Pine River as a counsellor herself. “OLE was hard, I won’t lie. It was physically and mentally exhausting. It is meant to be. Outdoor life is therapy. It gets you back to basics and appreciating the little things like a chair … a mirror … music. 

“It taught me my strength, my resilience, can be built back over time. You don’t just get things because you want them. You have to earn them. You have to earn your spot in the world too.

“By my last week in the woods, I really enjoyed it. I was proud of myself and looking forward to going to campus.”

Healing together

Through windows of the Neal dining hall, the Mulmur woods, not unlike those they left behind in Algonquin, serve as a backdrop to a group of eight teens, among those earlier engaged in Frisbee football. Finishing a midmorning snack (today, veggies and dip), they rise almost as one.

They are connected, self-monitoring and move as a team – a team carefully and clinically chosen for the right mix of group strengths and weaknesses. They return chairs in an orderly fashion, clear trays and litter, grab laid-aside ball caps (prohibited indoors), and as if on cue, file out together, heading across campus for class. 

Days at Pine River are structured, and then some – that “tight hug”: 7:15 Wake up, self-care, gym uniform on, initial room clean. 7:45 to 8:15 Breakfast. 8:15 to 8:35 Medications. 8:45 to 9:45 Gym. 10 Snack. 10:30 to 12:30 Academics. 12:30 Lunch (the menu is varied, wholesome and junk-free). 

Afternoons are devoted to individual and team therapy, and clubs. Evenings to study hall, team time, dorm time (self-care/shower/hygiene), journals and letters home. Quiet self-reflection may happen any evening but is scheduled for 4:30 to 5 p.m. on Thursdays. Lights out at 10:30 (10:45 on Fridays, team movie night).

“They have some free time, club time – equine, rowing, music, etc., but not a lot of ‘down’ time,” Ardis comments.

He leads a tour of a classroom – close, cluttered and portable-like – first asking students if they mind if we look into “their” room. Eight students work at eight computers to personalized curriculums. Each group is supported by one teacher, from the Upper Grand District School Board, an educational assistant and a youth counsellor. Students with poor academic records may work on catch-up in different subjects at different grade levels. 

They can earn creative hybrid high school credits incorporating Pine River activities – an environmental science credit, for example, structured around outdoor pursuits in the woods and ponds of the property, including beekeeping and fishing. 

With the support of their family, the students at Pine River are there voluntarily. But at times, when things get hard, when frustrations mount, a kid may sometimes “walk” – literally. They take what might be a contemplative, angry or confused walk into the fields and woods of campus. Or they leave the property and walk down a Mulmur backroad to clear their head. This is not a common occurrence, but neither is it unexpected. 

When it happens, they are followed at a distance or walked alongside of and spoken with, until the situation settles and they choose to return. They are never “hauled back by the ear.” On the road, if it is nighttime, if the weather is extreme or self-harm is an issue, local OPP will be called to assist, but not to apprehend, as no crime has been committed. 

When someone “walks,” or when a kid is defiant, disengages, creates a “reportable incident” (which must be officially logged, such as a tantrum, physical or verbal confrontation, or hiding contraband), or wants to leave, Dan Ardis allows, “We just wrap around them a little tighter, therapeutically. 

“It’s not ‘What did the kid do?’ It is, ‘What does the kid need?’ That is the dialogue. Questions, not demands. ‘What’s going on? What can we do?’”

Ultimately, some students find Pine River too arduous, too enveloping, too long, or just too much. They can, and do, leave, but it is neither encouraged nor easy. Paperwork, time, care and psychology may change minds, encourage second thoughts. “What are you going back to? What are things like back home? Could you try another week and revisit things?” The alternatives to Pine River are often worse.

Measuring “success”

Pine River has an average 52 per cent program completion rate – students who progress through all four phases: OLE, Campus, Transition (students are allowed increasingly longer home visits), and Aftercare (a check-in program supporting students reintegrating into the community).

But do not make the mistake of equating completion rate with success rate. Completion is only one measure of success. While Pine River operates within a rigorous code of ethics and standards of care, there are no government-mandated criteria for “success.” However, Pine River carefully tracks and publicizes outcomes in an annual evaluation report (available on its website), using the information to make adjustments and improvements to its clinical programs. 

Kids completing Pine River’s program do demonstrably better across all metrics: school attendance and achievement, substance abuse, hospitalizations for drug or mental health issues, police contact, and so on – but even partial completion of Pine River’s unique, open-stay program fosters healthier outcomes. 

Of the youths entering Pine River, an average of 57 per cent report daily substance use. One to two years after leaving, that figure drops to 10 per cent for those completing the program, 42 per cent for partial completers. Academically, 17 per cent of students entering Pine River have failing grades. After Pine River, the failure rate is 3 per cent for completers, 9 per cent for partial completers. Likewise, the number of missed school days decreases on average from about 50 per cent to less than 9 per cent for completers and 30 per cent for partial completers. 

However, statistics reflect only part of the story. Sometimes the difference made by Pine River is saving life itself. “We were desperate!” one mother tells me in an interview. Her daughter Robin (a pseudonym) “was struggling to make it. The wait list was the worst time. I was afraid we would lose her.”

Maureen (also a pseudonym) was watching Robin battling – and losing – life-threatening personality and eating disorders. Repeat hospitalizations and shorter-term therapies weren’t helping. Pine River did.

Over an 18-month stay beginning in 2019, “they gave Robin back her life,” Maureen says. Pine River’s Parallel Process for parents also gave Maureen the tools to restore her relationship with her daughter.

Parents of Pine River students must commit time and effort to this parallel process. First they must disabuse themselves of the idea that “My kid is the problem. Fix them! Nothing is wrong with me!” Regular parental workshops, a three-day weekend intensive (“It sure was!” says Maureen), plus therapy sessions both with and without her daughter “were daunting, but they were freeing. I learned when stressed, when challenged, what is your coping strategy? Mine was blame. Robin’s was avoidance. Once you identify your coping strategy, it opens more space to be empathetic. To understand there are two views.” 

Robin is now healthy, Maureen says. “She struggles sometimes, but she has the maturity to give herself grace if she goes off the rails and to practise self-acceptance.” Now 22, she is currently completing a BA in psychology, and plans to apply for a master’s program in social work on a path to becoming a therapist. “She wants to pay it back.”

Maureen’s advice to parents of a troubled child? “Don’t let shame get in your way. Ask for help.”

Under drizzle, bright skies or gently falling snow, life at Pine River Institute takes place to a rigid schedule, under tough rules and to high expectations. Unspoken within that structure is simple human compassion. 

 “I was having a bad day, a hard week, dealing with emotional stuff that came up in therapy,” Amy recalls. “I was crying a lot. I sat at my desk and my team leader gave me an origami sailboat. “It was a small boat, a small gesture, to show she noticed, she cared. She said, ‘This is for you. Open it.’

“Inside was written out how I had the tools not to let emotions take me under. ‘They are waves,’ it said. ‘Ride the waves.’”

“Hope is a place” is the motto of our neighbours at Pine River Institute.

That hope is realistic.