Confluence Welcomes Dr. Caitlin Wagner Kinnart, Ph.D. to Clinical Team


This August Confluence added Dr. Caitlin Kinnart, Ph.D. to its clinical team. Caitlin comes to Confluence with a diverse set of work experiences that have focused on helping adolescents, young adults, and their families through mental health challenges. She has provided counseling in community-based programs, at a wilderness program, and at a therapeutic boarding school. Her work has earned her a reputation for exceptional care and service among clients, their families and referring professionals.

Caitlin holds an M.S. in mental health counseling from Montana State University. In 2010, she returned to school at the University of Vermont, where she earned an M. A. in Developmental Psychology and a Ph.D. in Developmental Psychopathology and Developmental Psychology. At UVM her direct care work and research focused on the young adult experience, stress, emotions and relationships in college life, as well as coping within family systems. Dr. Kinnart’s academic research and work experience makes her uniquely qualified to help Confluence participants confront their challenges and develop the strengths and capacities to move their lives forward. Here she is in her own words.

What motivated you to study and eventually work with young adults.

Young adults today are facing entirely new and unique challenges that are complicating their paths to adulthood especially for those who experience a mental health challenge. The unprecedented use and effect of technology, the pervasiveness of drug and alcohol use and increases in the prevalence of stress can exacerbate an already tumultuous stage of life. All of which can contribute to and worsen underlying mental health diagnoses. At the same time a new body of research supporting an entirely new stage of development both on the psychological level and on the physical level is informing treatment and transforming how we think about the young adult experience and this stage of life in general. These factors make working with young adults extraordinarily interesting and rewarding because they in some ways have a unique opportunity, given the stage of development, to make dramatic improvements to their lives with the right help.

What strengths do you see in Confluence’s approach to working with young adults.

Traditional talk-based therapies at the individual and group level combined with psychoeducational and experiential approaches as well as the comprehensive health and wellness program deliver a holistic top down and bottom up approach to healing. It enables those who are at a pre-contemplative level of change and those who are actively seeking help to engage and participate and ultimately benefit. The clinical treatment coupled with various therapeutic approaches offers many avenues for healing, change and wellness. Lastly, I think Confluence has a unique capacity given its combined residential and wilderness experiences, which minimizes stasis during treatment, to help young adults improve life skills, build resilience and incorporate stronger executive functioning capacities.

What role do you see parents playing in supporting treatment and the path to wellness.

I have always been a proponent of incorporating family members into the continuum of care and I believe doing so betters outcomes and improves the durability of treatment gains. Working with young adults we strike a unique balance working to both maintain the integrity of the treatment relationships with participants while at the same time helping parents understand the program’s process, the specific challenges of each individual and ultimately how best to support their daughter or son’s treatment journey to increase the chances of long-term wellness. It can be a challenge but I believe it is integral to the Confluence approach and helping young adults make meaningful change.

Fresh from the Farm and Field

Fresh from the Farm and Field


Spring has finally come to Gove Hill. The last few days have been spectacular with temperatures reaching into the high 70s with bright blue skies. With over 40 inches of new snow in March alone, the arrival of spring is much deserved and appreciated by participants and staff alike. Although we are enjoying the sun and warmth now, we are prepared for all seasons and conditions and we certainly took advantage of what winter brought as well.

The participants and mentors at Confluence were able to enjoy three of the best ski days of the season. Twice we were on the slopes immediately after 24+ inches of snow fell. The group chased the powder at three of Vermont’s best downhill ski resorts and two cross-country ski areas as well.

In addition to ski trips, we spent time at yurts nestled in the shadow of Vermont’s iconic Camel’s Hump. The group had warm nights around a wood stove, cooking in the camp kitchen and restful nights on the yurts’ bunks. Their days were filled with snowshoe treks to backcountry cabins and shelters along Vermont’s Long Trail. The excursion culminated in summiting Camel’s Hump on a perfect blue sky day.

Confluence excursions are not only about fun and adventure. They provide a very real opportunity for participants to support their therapeutic work. Excursions, with their inherent challenges and opportunities for successes, foster confidence and help build resiliency.

“I was nervous. I didn’t think that I was capable of making my own shelter and sleeping in it. When I have these thoughts I usually just avoid doing it, but this time I did it. And it was awesome!”

These were the words of a participant after returning from an overnight excursion at a state forest. Participants were expecting to winter camp, but they weren’t expecting the 14 inches of snow on the final night. They set up shelters and thrived as individuals and as a group in a situation that in the past may have caused doubt, fear and anger. Instead they found confidence, excitement and camaraderie.

Back on the Farm, the group has been hanging Vermont’s iconic sap buckets to collect sap and boiled down nearly 100 gallons into 2.5 gallons of maple syrup. In addition, we’re planning out our new frisbee golf course and upcoming summer excursions. With anticipation we're awaiting mountain bike trails to dry out and the waters of the rivers to warm up so we can get out on our bikes and in our canoes.

It’s an exciting time to be here at Confluence. We look forward to connecting with new participants and wishing our alumni the best as they continue their wellness journeys.

- Foster

Developing Self-Esteem Is Foundational To Our Treatment Approach.

Developing Self-Esteem Is Foundational To Our Treatment Approach.

Self-esteem, it’s more than what you might think. Self-esteem isn’t simply how people feel about themselves. It is the vantage point from which they view themselves and others and how they experience the world around them. At Confluence, our approach broadens the understanding of self-esteem to encompass the whole person: a complete cohesive, enduring, internal core, or sense of self.

Although difficult to define, a sense of self is the bedrock of someone’s personality. It’s what helps people feel whole. A sense of self enables people to free themselves of anxiety, depression and other psychological symptoms. It also empowers people to be responsible, emotionally tough, resilient, accomplish goals, and truly care for others.

Clinical research tells us that someone’s sense of self is gained through relationships. At Confluence, we understand the importance of relationships. Our model of growth is based on the premise that people develop the capacity to live motivated, fulfilled lives not because of their current mood, accomplishments or their material possessions, but because of their core and healthy relationships with important others. These relationships become part of someone’s personality. Healthy relationships expand the capacity for how people experience themselves, others and their ability to successfully navigate the world around them.

Our clinical approach is based on developing self-esteem and a strong sense of self. The three relational ingredients required to improve self-esteem and develop a strong sense of self are: Idealization, Empathy, and Belonging.    

Young people who are stuck in their lives need to have people who can help them develop important life skills such as managing a schedule, cooking, budgeting, self-reflection, and taking responsibility for one’s self. We use backpacking, skiing, snowshoeing, rock climbing, painting, yoga, mindfulness, and other activities as a means to foster hard skills and develop healthy idealization. The role our staff teams play and the connections they develop with participants form patterns for future relationships with family and peers, at home, in the workplace and in school.

Additionally, we seek to appreciate each participant in a close, personal way. It’s our mission to deeply learn each participant’s strengths, skills, interests, aspirations, fears, and dreams while striving to realize their true motivations. If empathy is walking a mile in someone’s boots, then at Confluence we literally walk that mile together. Participants and mentors adventure side-by-side listening, thinking, feeling, understanding, and emotionally growing together as we explore not only the rugged outdoors but our equally complex inner lives and selves.  

Healthy self-esteem also requires belonging. When people are stuck in their lives, they often meet their need to belong in unhealthy ways. Unhealthy relationship choices can further complicate our lives and that much of the time our relationship patterns seem to endlessly repeat themselves despite our best efforts to change them. Sometimes, rather than having needs met by others, people choose to have them met through alcohol or other substances. Confluence provides a space where participants feel welcomed, build relationships and feel connected to a community. Participant-to-participant relationships built on shared experience and empathy are critical to beginning the healing process. In addition, relationship with Confluence clinicians and mentors create a sense of belonging and foster a new found sense of self that supports growth. The group dynamic of cooking, eating, adventuring, learning, feeling, and growing as a team builds community and connection. Teamwork is important and everyone is at their best when they are supported by a caring community.

Lastly, we use the term participant rather than patient, client, or student. The participants are team players, who join others to complete goals and actively chart the direction of their lives. One who is a participant allows us the experience to become part of them. Participating involves growing into the whole. When they leave, they carry parts of us with them.  

By fostering healthy idealization, approaching relationships with empathy and creating belonging, our program supports participants’ path in the creation of a strong, stable core. Through authentic, open and honest relationships lasting change can take hold. In doing so, we increase self-esteem, in it’s broadest sense, helping to liberate young people from their challenges and to encourage living a functional, independent, and successful life.

Dr. William Ketterer, Clinical Director

Three Branches To Mental Health

Three Branches To Mental Health

Last week a family visiting Confluence was seeking to better understand our treatment approach. They were well informed and prepared to ask discerning questions to identify what the program does and why the approach is effective. With the help of a referring professional they had whittled us down among a few other options and their task now was to see which of the programs really aligned with the support that would best benefit their son.

Like other programs, Confluence offers a strong clinical foundation in a structured therapeutic milieu. Our clinicians bring expertise and sophistication to their work with participants. We have well trained staff that bring depth and intentionality to the experiences.

Unlike other programs our hybrid wilderness therapy and residential experiences combine the powerful impact of outdoor experiences with real world skills that help young adults better manage their day-to-day lives and launch into independence.

What is most unique, and what got to the heart of our visitor’s question, is our treatment approach. Confluence treatment model is rooted in three methods that help participants move forward. 

1. Reduce symptoms: Individual, group and experiential therapy help participants reduce and eliminate the negative symptoms they are experiencing and heal from the specific mental health challenges they are confronting.

2. Build the infrastructure of wellness: Structured activities, written assignments, and behavioral interventions support participants in developing the mindsets, communications patterns, practices and routines that support positivity, productivity and health.

3. Character development: Relational strategies and a focus on the exploration and development of the self support participants in building honesty, resilience, responsibility and connection.

This approach acknowledges a fundamental reality that is often missed in treatment programs. It isn’t enough to simply feel less bad. Conversely, it isn’t enough to feel better if it comes at the expense of relationships, capacities and integrity.

True health is dynamic and exists both within and between people. It requires the skills to engage actively in life, not just to mitigate suffering. Wellness is a process. It is an intentional act, and one that is strengthened by the support of others. By reducing symptoms, building the infrastructure of wellness and addressing character development, Confluence helps young adults build lasting change that is both profound and durable.

Each of these three approaches is an active and intentional aspect of Confluence’s treatment approach. This three branch model is integrated into daily life, the relationships and the activities in which participants engage. Together they form the clinical backbone of the program and bring together individual and group therapy, activities, experiences and milieu into a unified treatment experience.

- Bill

Combining Residential and Wilderness Settings

Combining Residential and Wilderness Settings

Milieu matters. It's where real change and personal development take place. Perhaps one of the most important aspects of the therapeutic milieu is the setting for care. The setting can be an effective mechanism for getting treatment at the right time, maintaining participant engagement in care and effecting positive clinical outcomes. But the treatment setting can also work against progress if it is too overbearing, not grounded in real world experience or too heavily reliant on metaphor. Confluence offers a unique blend of two different treatment settings – a traditional residential setting and a wilderness therapy experience. Alone both settings offer unique advantages that facilitate the treatment process, combined they offer a dynamic approach that brings together the best of both worlds. 

Full wilderness immersion treatment programs provide a therapeutic container allowing for intense levels of focus, which is remarkably effective in helping to break through resistance to the therapeutic process and also at revealing the consequences of maladaptive behavior patterns. Perhaps more importantly wilderness therapy offers the very real therapeutic benefits of natural environments and respite from more complex manners of living. Additionally, intentional activity, positive stress experiences and challenges help individuals grow, develop resilience and build self-esteem. 

On the other hand residential programs allow for a mix of comfort and support empowering individuals to be active in their own care. The setting creates an opportunity for individuals to focus on their treatment rather than worry about their environment and its latent consequences. Our home-like residential setting helps individuals by providing a healthy schedule, space for mindfulness-based stress reduction, nutrition and wellness practices, community connection, relationship development as well as time for fun and relaxation. The residential setting offers a more real backdrop to address life skills development and improve capacities for independent living.

Confluence wilderness therapy experiences are about using the outdoors to meet the prescriptive needs of participants. Those needs include the therapeutic benefits of the natural world, self-esteem building activities, creating patterns for healthy living and putting space in between the individual and the challenges experienced in everyday life. The wilderness allows participants to reset from the distractions and pressures of normal life and become empowered and more confident. 

The co-existing residential component at Confluence is designed to support treatment by lowering the threshold for participation in treatment. It cultivates a level of commitment or “buy-in” from those in a precontemplative stage of change, while not being too heavy handed for those already accepting of treatment or who are seeking treatment on their own accord. The program was specifically designed to support young adults and their families in these situations. 

As young adults who are experiencing challenges accept the need for treatment, the ‘buy-in’ created by our hybrid model helps deliver treatment when it is needed most and reduces the likelihood for more intensive intervention at a later time. 

It’s this blending of two approaches that makes Confluence effective and unique. Our approach to wilderness takes advantage of the inherent benefits of outdoor experiences and builds confidence while fostering empowerment. The residential setting increases participation and engages young adults in their care, while developing skills for life and independent living. The combination provides the setting where participants find both the capacity to achieve their clinical goals and the means to meet them. They find themselves hitting reset on their lives, becoming more engaged and developing new strategies for moving forward. Confluence's blend of wilderness and residential is a truly accessible process that readies participants for long term success.

– Foster

A Parent's Guide To Knowing When To Seek Care

A Parent's Guide To Knowing When To Seek Care


Families considering treatment options away from home are faced with a difficult challenge. Many parents wonder if out-of-home treatment is “too much” or they may worry about “sending their kids away.” Parents may be concerned that introducing the idea of treatment will compromise an already tenuous relationship with their young adult child. Thoughts such as “we made it this far” or “it isn’t that bad (today)” often battle with a real sense that things are out of control or just not getting any better. There is so frequently a dilemma between waiting too long or acting too early. Beneath this, a nagging belief that “we should be able to help him here” may create further uncertainty and hesitation.

These are common and valid concerns. This is not an easy decision. Encouraging a young adult child to take a break from their daily life back home and devote some serious energy to getting back on track may feel like one more daunting argument in the works. Our team at Confluence can support you in working through these dilemmas. We can help you determine if Confluence is an appropriate intervention and we can provide some strategies for introducing the idea to your daughter or son.

But how do you know if an out-of-home treatment option is right for your son or daughter? Here are a few questions to consider:

  • Has your son or daughter been involved in other home-based treatment approaches with limited or no success?
  • Has your son or daughter not met some of the typical developmental accomplishments of their peers?
  • Have you noticed significant regression in their capacity to cope or handle challenges?
  • Has your son or daughter stopped being a problem solving partner in addressing the mounting challenges that are building up?
  • Does your son or daughter commit to changes that sound promising but not follow through on these commitments?
  • Are there mounting risks that exist in the home environment that are not being addressed?

If you’ve answered yes to any of these questions, we think Confluence could be an option for your son or daughter.

Confluence offers impactful wilderness therapy experiences with residential treatment that teaches real world skills directly applicable to home life. We are an emotionally safe, positive environment that nurtures behavioral, emotional and relational growth. Confluence is appropriate for a wide range of participants experiencing mental health, substance use and life adjustment challenges. We work with young adults who are looking to get “unstuck.” Our participants are voluntary and agree to participate in the wilderness excursions and are active participants in their own therapy.

Confluence helps young adults get back on track. We work with participants and their families to prevent things from spinning further out of control and to help establish healthy strategies for moving forward. Treatment at Confluence is short-term. During this time, we help unlock participants’ potential and build the infrastructure required to re-engage with life. The strong clinical focus, positive peer culture, and active lifestyle offer a dynamic treatment experience unlike that of other settings. The mix of experiential therapies, shared living, and talk-based treatments propels participants in a new direction towards health and wellness.

If your son or daughter is struggling and unable to move forward, we’d be happy to talk with you to determine if Confluence is a good fit. Parents can speak directly with our Admissions Director for further information by calling 802-727-0019.


Tributaries To Our Process

Tributaries To Our Process

This month Confluence hosted our first mentor training. Six individuals began getting to know one another, hesitantly sharing goals and life stories as they slowly became part of our team. I remember the feelings I had when I arrived at my first wilderness therapy job training. I was unprepared to open my emotional landscape, share my thoughts and participate as was expected. Mostly I was unprepared for the vulnerability I would let bare and the deep connections I was to develop with my co-workers and participants.

At Confluence, mentors are key to our program. They create a place of belonging, where each individual, mentor and participant, is a part of a greater whole. They challenge, support, teach and engage with  participants. They are the tributaries, bringing their strengths to Confluence’s current. mentors offer their empathic understanding derived from their diverse experiences.

Mentors understand the struggles faced by young adults coming to Confluence and are ready to listen, guide, laugh, work and play together to allow healing and growth to take hold. mentors are able to help because of their passion for the program and helping others. Mentors give and receive feedback about how they interact with co-workers and participants. It’s the same process we use with participants. We believe this is essential to healthy relationships–both professional and personal.

Mentors are skilled at identifying primary emotions and pushing participants to notice activating events and the emotions that arise. Mentors practice these skills because they know how hard it can be to change, to hear what others think and to accept emotions. They have felt the fear and difficulty of openly sharing hard truths so that they are better able to appreciate the participants struggle to do the same. This is true empathy–it’s the ability to not only wear someone’s shoes, but to know how difficult it is to put them on.

Mentors are actively involved in each task, each assignment and each part of the daily routine. Mentors and participants join together in the common goal of building strengths, honestly addressing emotions and forming relationships.

Working at Confluence carries a great responsibility. mentors work here because they have joined together in a common goal. They are passionate about the participants and the path they have chosen towards health. We look up to and admire mentors for their dedication to our participants. They understand how difficult this journey can be and have demonstrated patience, confidence and encouragement. When participants begin their journey here at Confluence the mentors make it abundantly clear that we are in this together, we all belong at Confluence.

As our training wrapped up hesitancies and uncomfortableness waned. None of the trainees wanted to leave. They felt closer to one another. There was a palpable sense of community. They had been through something together and emerged as stronger and more connected people. They were excited and ready to get working. It’s with this same approach we meet all of our participants. Come to our farm, experience the wilderness, change through therapy, heal relationships, grow as a person, emerge more confident and return to a better life and a stronger future.


Creating the Space for Growth

Creating the Space for Growth

Confluence offers a place where young adults have the room to heal and grow. It is our mission to develop the conditions where participants feel safe to explore their challenges and find the tools to develop the changes they need. That space is created by our dedicated staff including our clinicians, mentor team and leadership.

Confluence staff have a deep commitment to aid others in their development towards self-worth, autonomy, compassion and resilience. As a new program we took great care to bring together an enthusiastic, caring and driven team. Our clinicians, mentors and leadership have diverse professional experiences in psychotherapy, teaching, wilderness therapy,  permaculture, yoga instruction, adventure outfitting, and authoring therapeutically informed curriculum for public schools and much more. The common thread, it seems, is a true desire to better the circumstances of others.

Staff at Confluence are enthusiastic about sharing their expertise and incorporating their passions into experiences that help participants heal and grow. But it is more than our collective desire to help that establishes a culture where participants are supported in their growth, challenged to unlock their potential and, ultimately, better the conditions of their experience. Confluence relies on four pillars of respect to build the space participants need to begin the journey towards wellness.


All individuals are given a safe space to embrace who they are, apart from who they wish to be or whom others think they should be. Participants are encouraged to assertively share their authentic self and can do so free from judgement and shame. Confluence participants focus on their individual health and healing. We use in-the-moment emotion statements, journaling and mindfulness as ways to develop and engage a renewed sense of self. We encourage habits of positive physical wellness, such as, learning to cook and prepare healthy meals with fresh produce from our garden, daily exercise and intentional rest.


Confluence recognizes mental health challenges are often accompanied by strains in relationships within the family. We also believe successful treatment includes helping repair and improve relationships. Lastly, we know family support and involvement in the treatment process increases the odds of positive and prolonged success. For those reasons, our family approach integrates parents, siblings and others close to participants and encourages the whole system to work toward wellness together. Written letters, parent visits, weekly calls and parent support from therapists and staff helps those who are part of the participant's support network stay involved, which in turn builds stronger families and relationships.


Community is an important part of being connected and invested in life beyond your immediate circle. Often connection to a community, allows one to feel a sense of purpose, confidence, belonging, support and higher self-worth. Confluence fosters a sense of belonging between therapists, mentors and participants. The Confluence community engages in both the easy and difficult parts of daily life together and in emotionally-safe and supportive ways. We give each other feedback to build each other up. We challenge and support each other on hikes, bike-rides, skiing, canoeing and in yoga. We actively listen and share with each other in daily therapeutic groups. We share in each others excitement and provide support in each other hardships. We have fun at the farmhouse during game, story and movie nights. We go on weekly wilderness excursions together, exploring the beauty of New England. And beyond all of that, we complete community service projects around the Confluence community. In this way, we connect ourselves to others and begin to love getting outside of our immediate circles to enjoy new people and experiences, which help us grow and gives us passion.


Building stewardship for the environment is an expression of participants’ connection, belonging, respect and increases self-worth. Everything we do is done with intent to preserve and protect the environment. While in the wilderness and on the farm, residents and staff use standards which promote sustainability and connection to the earth. This connection may come from harvesting vegetables for the day’s meal, tapping Vermont sugar maples for syrup, practicing primitive camping and orienteering, or summiting a mountain for a beautiful view. This is our world. We act and interact in ways that help us be more connected to ourselves. Which brings us closer and more connected to the whole. When we are more connected to the whole, we have the support to freely be ourselves, exploring and creating what we want to become.

Through the four pillars we create an honest, open and safe space for individuals to begin to explore who they want to be and where they want to take their lives. It is an empowering culture, positively affecting the very well-being of each individual immersed in it.