E.72 Why Crisis Work Is A Great Learning Experience With Susan Roggendorf, Cara Tirrell, And Bill Dwinnells

In this episode, we discuss with three former and current emergency services for mental health and substance use issues, Susan Roggendorf, Cara Tirrell, and Bill Dwinnells. We discuss the highs and lows of the work we have done, how we got into the work, how it brought us closer to first responders, as well as some of the difficulties we all face. We also debate the word suicidality and how it is interpreted from a crisis clinician's point of view versus those who have never worked in the emergency department.

Susan Roggendorf is a Licensed Clinical Professional Counselor in Illinois and a Licensed Mental Health Counselor in Iowa. She's the LGBTQ+ owner of Coffelt Counseling Services in the Quad Cities. Susan works with folx living with anxiety in her LGBTQIA2s+ community. and with First Responders grappling with anxiety as well as other life issues. When not in her garden or busy annoying her adult kids, she's hosting and producing her own podcast, F*ck The Rules.

Bill Dwinnells has worked in the field of emergency services/crisis counseling for the last 26 years.  He has worked with multiple law enforcement agencies helping to educate the officers on how to interact with mentally ill people.  Bill has also created custom software for the management of emergency psychiatric service programs currently in use by multiple teams across the state.  He also has a private practice where he works with individuals. You can reach his website here.

You can Cara Tirrell's website here. 

Transcript

Steve Bisson: 0:02

Hi and welcome to finding your way through therapy. I'm your host, Steve Bisson. The goal of this podcast is to demystify therapy, what can happen in therapy, and the wide array of conversations you can have in therapy.I also talked to guests about therapy, their experience with therapy, and how psychology is present in many places in their lives, but also share personal stories. So please join me on this journey about there.Hi, and welcom e to episode 72 of finding your way through therapy. I am Steve Bisson. If you haven't listened to Episode 71, yet, please do so. A review a chapter in my book about the unique challenges of first responders talking about different things including stigma, so I hope you go and listen to it. But episode 72 is with three yes three returning guests. The first one is Bill Dwinnels, Bill Dwinnells is someone I worked with on a crisis team years ago. He is someone who is currently still working in what we call emergency services now, and always happy to have Bill on. Cara Tirrell actually works out of my office and is an amazing counselor and really enjoy talking to her generally outside of work. But we've done two shows with Bill two and couldn't wait to have her on again. And we added Susan Roggendorf, I think that you remember Susan, from Episode 58. And Susan works with folks living with anxiety in her LGBTQ+ community and also with first responders who grapple with anxiety as well as other stuff in regards to the work that they do. And her podcast which I will be hopefully a guest again very soon is the rules and I highly encourage you to go listen to that too. But here is the interview. Well, hi everyone, and welcome to episode 72 of finding your way through therapy. This is also YouTube channel number 16. And you're gonna recognize all these faces, but we've never actually all talked together. You've got Cara Tirrell and Bill Dwinnells. They've been on episode 21 and 55. And I'm gonna go what YouTube channel the episode 5. So we've been on there a few times. So welcome Bill and Cara. Yeah. And then Susan Roggendorf is someone who came on on Episode 58, YouTube, YouTube, episode number 8 And Susan is here also,

Susan Roggendorf: 2:34

hey there.

Steve Bisson: 2:36

And I wanted to bring all of us together because we have something in common. We all worked in the sorry, Bill, you're still working in it. But we all worked in emergency services. I was actually I had a friend of mine who worked actually in New York City doing this, but she was unable to join us. So it was a little too bad because that would have been fun to to have her point of view. But in case I've sent everyone back to the episodes and all that, but I would love for you guys to tell us a little bit about yourself. So let's start with you Susan.

Susan Roggendorf: 3:07

My name is Susan Roggendorf. I am a licensed mental health counselor for Iowa, and a Licensed Clinical Professional Counselor for Illinois. I have my own practice cofell counseling, and I am part of a collective called the med therapy collective. I was in the ER in the crisis stabilization unit in Illinois for seven, eight years, and then decided I needed to go into private practice before I flamed out.

Steve Bisson: 3:34

I'm happy that you're still very sane. I'm just joking.

Susan Roggendorf: 3:38

A meta point of view.

Steve Bisson: 3:40

Bill, how about you introduce yourself?

Bill Dwinnells: 3:43

Sure. Build When else can find me at Build when else.com I do maintain a private practice off to the side. I've been involved in emergency services in some way shape or form for the last 26 years. And I'm still involved. I do run one of the local races teams involved in that is also a crisis stabilization unit.

Cara Tirrell: 4:08

The software you developed

Bill Dwinnells: 4:10

Oh yeah. And the software, I developed some software to help with the tracking of emergency service cases that can be found at five away tech.com. That's now being used by multiple crisis teams across Massachusetts, and soon to have a couple more added to it. Thanks for having me.

Steve Bisson: 4:30

And how about you Cara?

Cara Tirrell: 4:31

Hi, I'm Cara Tirrell, and I've been lucky enough to work with both Steve and Bill for many years and glad to meet so I had left agency work and community work in 2021. So more recently, and did start my own private practice taking clients and I see people in person right now and telehealth. Some of my specialties are are a little unique. I had some experience with working with teens that have Tourette Syndromeor pans or pandas, which is somewhat unknown in the in the school system or the agencies. And it's very hard to find a clinician for that work with seniors or elderly caregivers and have had some work with hoarding, that we're not a hoarding task force in the community. So those things have helped me. And to just specify, you're not hoarding stuff, you're helping people with hoarding issues, I am helping, yes, I will help people with hoarding disorder, people that are living with people that are hoarding or cluttering. And it's pretty intricate disorder. And people really struggle with it in the community. And there's a lot of shame based experience with it as well. But I myself am not a hoarder.

Steve Bisson: 5:40

Okay. We'll talk about after the show. I, it's interesting, because I was thinking about when I've had all of you on the show before, and I've certainly talked to Susan on her podcast. And I'm so excited, because back going in December, I'm gonna do it again. Can't wait to do that, but one, that's gonna be a good time. Well, we're gonna have a great time. The thing that I realized, though, is that we've all done crisis work, and I don't have a clue how you started. So what I'm going to do is I'm going to start off with my story, and then I can turn to you guys. But for me, it was totally accidental, because I came from Canada to come and work in the United States and Massachusetts. And I was working with people with developmental disabilities, which was not the deal I thought I was getting when I first moved here. I'm going to leave it as vague as I can. There was issues at my program. And then the crisis work came up. And they wanted someone with developmental disability experience. And I told them, I was bilingual while French, but they didn't know that. So I started working as triage on you overnight for many, many years. And I just develop a passion from there, and really enjoyed it for 15 or so years. So that's how I actually started with crisis work. So I would like to turn that question to you guys. I'm gonna go into reverse this time. I started with Susan. So I'm going to start with Kara this time.

Cara Tirrell: 7:02

Okay, I was actually trying to, I'm older. So I have a Rolodex of jobs that I've had in the past. But I think when I started, I loved crisis right away. Of course, we kind of referenced that before we started that kind of excitement, that fast paced environment. I liked working with lots of different agencies, the police, the fire department, all those things. So I think it really started I did an internship in college, I went to St. Anselm College for undergrad, and I did an internship with women's protective services. So I was trained as a domestic violence counselor, I did a rape press crisis line. So I started there, and then ended up with an elder protective services. So I investigated elderly abuse for probably three or four years. And then I was also on the best team, which was the Boston emergencies services team for my internship for my masters. So again, I kept I kind of kept going back to it, you know, it's like the mob, they just keep, they pull you back every time. So once you get a taste of it, you kind of love it. And I was young, I was very energetic. I was really looking for a lot of experience. And I would say to anybody starting out, start out in crisis, because you're gonna learn almost everything. And then I ended up with you guys at advocates, worked there for 15 years and then worked for the town running their food pantry and some of the community services there. Yeah, they it's interesting, because Susan, on the separate podcast and separate conversation, she asked about, why do people not recommend emergency service work? And then I always go in my head. I'm the I tell people start there. That's the best place to start. But that's just me. So thank you, Kara. And Bill, how did you start and stay stuck? And I mean, enjoy it there.

Bill Dwinnells: 8:43

It was really systematic, bad life choices

Cara Tirrell: 8:49

over and over

Bill Dwinnells: 8:51

Over and over again. No, I mean, I had, I think I got my Well, my first taste of any kind of emergency work is I had been working as a call member on the local fire department, and ambulance team. So that kind of got the blood racing. It was fantastic met met still no a bunch of great guys, and gals. But it wasn't quite for me. By while I was in grad school, I did get a part time job working for one of the local emergency service teams and the only thing I could say is for whatever reason that just clicked. And then once I got my degree, I went into being the clinician going out at the time, most of the stuff we did was in the IDI, then then slowly, it started branching out into community stuff. And then eventually we worked into putting clinicians into the cruisers, you know, with the police officers, which once that happened, I think that that's what really sunk the hooks in me. I was all good with that. And since that time, I've had the opportunity to work with a number of emergency service teams across the state probably at least a half dozen, if not more different police departments, helping them set up their duel what in Massachusetts anyways, it's called call response a dual response. It's given me the opportunity to present it statewide meetings on how clinicians can or should be used in conjunction with police officers. It's just kind of snowballed to the point where I just, I never got to help.The challenges were always there. So I just kind of kept rolling with them. Because I do think it's, it's, it's very needed, I think there's a very less serious lack of knowledge as far as mental health goes, and how it permeates all segments of society.

Steve Bisson: 10:47

Well, can you blink twice? If you just feel stuck there? I know people in listening to podcasts will not know, but the way that they'll have to go to YouTube to see if you blinked or not. Alright, I'm not telling anyone what he did. But we'll call 911. Later.

Cara Tirrell: 11:05

Oh, 811. We'll bring that up to actually.

Steve Bisson: 11:08

But thank you. Appreciate it. Bill. How about you, Susan?

Susan Roggendorf: 11:11

Well, unlike your youngsters, I'm 55. And I got started late in this game, decided I didn't want to be an office manager for the rest of my life. But for 20 years of it, I was bored being a calendar monkey. So I went back to school to do therapy to do counseling. And I got put actually into the ER during my practicum by the director of outpatient services at that time. And I actually fill in with a guy named Dan scritch field who has it actually, he is the OG of crisis in our emergency department where it was at the hospital. And we get along really well. And I really am so grateful he was my person to follow my mentor. And I just I fell in love with it. You know, it was like detective work. And I love that stuff. So that's what I started, I was in my 43-42, something like that, when I started that finished up my schooling. And I decided that I wanted to go back to the ER because even though with my practicum, I've done several different things, you know, you go and you do the in session you do group work was interesting, but it was a lot of dynamic going on there. And I didn't want to ride herd and all that energy. So I decided I didn't want to do that. So I decided to go back into er work, they had a position open the crisis stabilization unit and just sort of fell into it. And of course, you know, Dan was still there. So that and several other persons Chris yawns Ville Levy, they were also my mentors while I was there, Chris and Bill have gone on to do other things. But as far as I know, Dan is still OG of the CSGO. So that's kind of how I got onto it. And we talked before about being a cortisol junkie. Yeah, absolutely. And I miss it. I do miss that part of it. I don't miss the other stuff that you know, was threatening to fly me out. But that's that's kind of how I got into it. So are we just all cortisol junkies? I think so.

Cara Tirrell: 13:11

So I kind of have to be, I want to say what I took what Susan, I think she really defined something that I really love about working in the ER, like you said, when a case would come in, you do some investing. I liked that investigative piece of it, calling the police to get more information finding out about who the collaterals are, has this person been seen before, I'm going to talk to the doctor to get the medical, the nurse to get the vitals, I'm going to talk to everybody about so that I could put this together in a cohesive, you know, report which we're required to do, but it also helps for continuity of care. But I just really like I think that's how my mind organizes itself. And I think I lend that partly to that type of a job where now I hear people struggle with that writing progress notes. And I'm thinking I could blast out a 12 page, like piece of paper while I'm on the phone to the insurance company, talking to someone in the back and getting the medical, you know, I had that skill set, specifically because of that type of job.

Susan Roggendorf: 14:10

Yeah, I agree. And when you guys were talking in your previous episodes about filling out those six reams of paperwork, it was getting even more ridiculous when I left in February of this year, just more and more paperwork. Now I most people understand, at least those of us that work in at that arena is that a lot of our funding, we have to document the crap out of it. And that's why we have so much paperwork, but it just got to the point of ridiculousness where I'm spending more time on my paperwork than I am with my patient. That was just stupid. But part of it that I did like was being able to engage with my patient but like you said, care is that investigative part of it, just talking to everybody getting information, and then being able to pull the strings together and go that no, that doesn't sound right. What do you mean? Yeah, you're right. They pulled you off a bridge. No, you're not all right. We're gonna have a conversation about what this between voluntary and involuntary now. So it's just, that was the exciting part. I think that's where the the adrenaline comes in, and you're getting excited. Part of it too, is when I would walk into the unit at the beginning at least. And I'd see the board, and I'd see how many of them were for us. And I was excited. And I wanted to dig in. Of course, by year six or seven, I'm like, Oh, God, you know, especially when you're the only crisis clinician on duty. You're responsible for your four campuses of your hospital system, and the five counties in the eastern Iowa hospital ER rooms. At that point, you're like, oh, no, don't want to do this anymore. So I think at a certain point, you're right. I think you said it was one to two years, one to three years, people are in crisis where normal people

Steve Bisson: 15:46

the official average is a year.

Susan Roggendorf: 15:49

And here we are as reprobates, you know, although bill is still Bringing up the curve. So I mean, it's just, it's interesting. And you start off and I was young, but I was still excited about it. But you're right, that investigative part of it was really the big draw for me getting into it. Yeah. And I still sometimes look at cases like that. Not that they're cases, but clients that I'm seeing, yes, I can gather a lot of information very quickly to kind of formulate, and, you know, when we were asked to do diagnosis, and very quickly, obviously, sometimes within an hour, yeah, so I use some of that skill set, and then have the, I guess the luxury now to have a little more flexibility and room and, but but that that background really still assists me to this day. Oh, I agree. 100%. That's, in fact, I have to hold back sometimes. Yeah, that I can't just I can do more. Yeah.I got several more sessions. I can figure some more things out. Yeah, that 15 minutes. Yep.

Steve Bisson: 16:54

So what keeps you going bill?

Bill Dwinnells: 16:58

keeps me going, why keep going back to emergency services.

Steve Bisson: 17:01

You're not even going back? You'd never allow. I mean, Jesus Christ.

Bill Dwinnells: 17:06

Like I said,

Cara Tirrell: 17:07

a supportive wife. Yeah.

Bill Dwinnells: 17:09

And a very good damaged mind.

Cara Tirrell: 17:14

Just a personality for it, too, because you have a chill personality, I think.

Bill Dwinnells: 17:19

Yeah, I mean, I think that certainly helps I try not to let anything get to me too much. But I mean, you know, I joke with my coworkers all the time that I've just been doing this stuff. For too long. I'm too damaged to do anything else. And some of its tongue in cheek, but some of its true. I mean, anything I tried to do after this is gonna seem very boring. But you know, by comparison, you know, even with some of the, you know, the outpatient stuff, by comparison, it's like, oh, okay, well, this, this should be easy, or easier to deal with. And this point, I think, doing some of the outpatient stuff probably is what saved me. Because while those folks are certainly having problems, their problems are not as intense or as immediate as the folks I'm used to dealing with. So it's almost like I can take a little bit more well, like you were saying, I can take a little bit more time to formulate a really good solid plan as to how to help these people move forward. But I really have trouble seeing myself doing too much, too much of anything else, you know, I think I'm always going to be involved in emergency services, in some way, shape, or form, let's say until I retire, but I'm not going to retire. Who am I kidding?

Susan Roggendorf: 18:33

I don't think any of us.

Cara Tirrell: 18:35

Yeah, and and Bill, I'm gonna give you props that you don't give yourself I think you became the leader that you wanted to see. And in what we were lacking when we were all kind of in the we're on the front lines, I think you became the leader that we wished we would have. And now the your clinicians have somebody that kind of was there from the bottom up and has an understanding of how it works. And that makes a difference.

Bill Dwinnells: 18:59

Yeah, I mean, I think there is a big difference because I have seen agencies that don't promote from within, and they just bring I've seen people be brought in who have no background in emergency services. And quite frankly, the frontline clinicians pick up on that real fast. It usually doesn't go well. You know, I do think one of the one of the big things I got going for me as soon as they talked to me, they know I've got you know, the street cred you know, I'm not asking you to do anything that I haven't done that I haven't done myself and in possibly weirder circumstances, but we can all talk about it so I mean I I do think that's definitely helpful is like I do get a lot of respect just walking in the door because they know you know if they know my history

Susan Roggendorf: 19:45

it's gonna say Are you kidding me? I would have killed for someone like you bill is no know I'm being totally serious because we will have people that were promoted from other areas to come in and be our managers or be our leads. It's like, all of us, even if we OG, we are all looking, you know, into for you. Yeah. And they're trying to tell you how to do your job. It's like, Have you spent time with us because that was one thing that I kept bringing up over and over is like, if you're not part of our world, then you should be staying at least a couple of hours every shift throughout the week. So you understand including weekends and overnights. So you understand how this machine who grunts and what we have to deal with

Cara Tirrell: 20:25

how it smell, among other things? How yeah, there's so many variances that you don't have unless you're really doing it, like you said, and I want to say I did kill to get billed for my supervisor. I wasn't getting the leadership I needed. And I said, I won't be able to be my supervisor. We were all advocates. And they said, but he's on the night shift. I said, I don't care. I'll come here in the middle of the night. I don't care. I know. No one else is gonna,

Susan Roggendorf: 20:51

smart woman, you know, because it's hard because I don't know about y'all. But in my capacity as part of the our crew, we were also responsible for telehealth, in addition to people rolling into our ER physically. So not only are we doing our physical location, but we have our three campuses that were virtual. And then we acquired five counties of ers doing virtual. And then if we couldn't do it virtual because of whatever laws dictated, we couldn't do so like with minors, we had to go to another campus to do it in person leaving our original campus and then come back and when you're short handed, and if you've got a leader who has no idea how that runs, that that sets it up, like you said, Bill, walking on to the unit, knowing somebody like yourself with a background that you had mad respect immediately, and you would get it when we go. Yeah, I gotta go over there again. Yeah, I get it, get your ass over there and take care of it. We'll take care of it that when you get back that I would respect versus someone who think well, you know, it's just something to do with protocols. Like if there's a protocol, I'm over this, right. There's better ways to do this. You need to start listening to us.

Cara Tirrell: 21:57

And Susan, when we first started, we used to have to go to homes, people's homes. We went to, you know, facilities, we went to DCF. I remember going to Medfield state in the middle of the night. So scary. And this is literally when it's abandoned. And they had redone the juvie hall there and I'm like knocking on the door looking around and thinking Westboro by the way, let's borrow. But yes, Westboro. I think I've been to Medfield for something else. But yes,

Steve Bisson: 22:24

I've been on both actually.

Cara Tirrell: 22:25

But how scary was it? Like you're saying, there's safety issues, there's flexibility there's, you know, transportation, you have to get there? How do you get there? How do you you know, eat in between? Are you allowed to go the bathroom, you know, all these things? That complicated.

Steve Bisson: 22:41

So I'm gonna stop for a second and kind of turn to Bill to, because you've talked about the leadership stuff that Bill brought, obviously, I've worked with Bill on the overnight, and always enjoyed having him there. And when I worked with him, what I mean, I'm turning to bill, but I know obviously, Susan, and Cara has mentioned a few things, what's a good leader in an emergency service program?

Bill Dwinnells: 23:03

I think it's something that, you know, Cara hit upon, it's got to be somebody who's not going to react to what's being put in front of them. Even if it's something funny, horrible or whatever, because immediate, it could be anywhere on the gamut.But you need to be able to put the shock and awe of it to the side. And really think through what is it that needs to happen right now, it doesn't even have to be a perfect solution, it just has to be one that keeps everybody safe. And at least moves the client, patient consumer, whatever word we're using today for whatever it is that moves them in a positive direction. It doesn't have to bring about resolution.But it has to be something that the clinician involved can trust, that management can back up and moves the person in a positive direction. And as long as everybody's safe. And to be honest, we've done our job, because if there needs to be follow up tomorrow, then we'll do follow up tomorrow. But the big question is, you know, can you offer leadership that protects everybody? Staff, the client, you know, and honestly, the agency, because, you know, as a manager, that's part of my job to is to protect the agency. How do I protect all of these people simultaneously? Even if you want to second guess my clinical decision later, that's fine. But at the end of the day, we all go home. You know, that's, that's kind of my that's my philosophy. At the end of the day. I want everyone to go home with 10 fingers and 10 toes just like they arrived.

Steve Bisson: 24:48

Great. Well, yeah. And I think that you know, Susan, and Carrie, you've talked about what was missing and leadership, including people who've been there, done that. What else according to you guys As would make a good leadership and emergency services, because the one thing I want to add that I always liked, we talked about, like someone who's been there done that. Another person who can take something that's really difficult and go, Hey, it's just part of what we do here. Don't worry. And not we're not going to worry. But it just makes it so much easier than like, Oh, my God was three people in three different ers. What are we going to do? Those people I disike tremendously in when I was when I had leadership? A staff are kind of screwed. You're the only guy and there's three people at three different ers go with one at a time, if we can get you some help. Oh, get it? Yeah. And those are the leaders that I truly enjoy. But I'll turn to you, Susan, or Cara, whoever wants to go first in regards to that.

Cara Tirrell: 25:43

I agree with Steve and I agree with Bill. I think that what I really appreciated with when I had a supervisor that validated that we're coming with a lot of experience, even if you're new, you still have you've gone through a master's program, you hopefully have been trained. I wasn't. But hopefully you have some training, but you have some ability to be taught and learn and have something that you're coming with. And like you said, it might not be the right disposition in the moment. And that's fine, the supervisor could correct you last question to cite something different. But you're talking to a high level of a person that has a high level of education, and usually some familiarity with some mental health issues. So I like I appreciate someone who's allowing someone to learn and grow as they're also, you know, trying things out. And I think validating that they have some knowledge and that they can, you know, be confident with it.

Susan Roggendorf: 26:35

I have to agree advocating for your clinicians that are out on the ground and out in the field. Absolutely. That was often lacking. We also were responsible for doing in house devaluation sometimes if the psychiatrists couldn't get there. And it's just in it. And of course, the units are all up in arms, because they're not a psychiatric unit. And if someone is in need of psychiatric services, then they're freaking out because they've got security up there. Somebody's sitting on the patient and everything else is going on. And then they're upset with you because you're not up there pronto. And it's like, I have four people ahead of you. It's going to be at least four hours, but then you've got your leadership who's never been a part of this going, should probably go up there and take care of them. Great. Who are you going to bring in to take care of these fours, then I've got two physicians, two pas and an NPA that are screaming up my skirt because they need to be taken care of. But we got one of them that's tearing apart one of the rooms because they really need some help. You want collaboration. I think you know what you said, Bill, it is about keeping people safe. Absolutely. Never felt that. And like you said, Cara, it's about being advocated for. It's all of those things that all of y'all have said that was missing. And I and I know contributed to my flaming out at the end and saying, I've got to get out of here before I really hate everything that I've done here, which is a shame because I love the work that I did there did not love the BS behind it did not like the lack of leadership didn't like the way we were thought of the secondary citizens didn't like the fact no one treated us as actual providers. And like hello, I haven't NPI, government seems to think I am. So maybe come on board. So all of what you little have said has been missing in my experiences. And yet, I still love the work. So I don't know if that answered your question for you, Steve.

Steve Bisson: 28:23

Bill wanted to add something it actually did. But I see Bill wanted to say something.

Bill Dwinnells: 28:27

Well, I was gonna say the I've worked with agencies that their executive leadership had absolutely no experience doing emergency services whatsoever. And the way I explained it to them is you need to understand that your emergency service team is basically like your SEAL Team Six. Okay, because we handle what no one else in the agency can handle.There was one agency I worked with that they would send you to a safety training class. And you go through the whole safety training class, and at the very end, it says if none of this works called emergency services,like okay, well,

Cara Tirrell: 29:05

we are service I always love when a psychiatrist left that if you have an emergency, as you're calling them call 872-3333, which is our number. And I'm like, Wait, who are we supposed to call? Yeah,

Susan Roggendorf: 29:19

exactly.

Bill Dwinnells: 29:20

So So I mean, where are your last line of defense? And okay, that's fine. I get it. I understood that when I signed up for the job. But then if you have no other answers, why he's criticizing the way I did it.

Susan Roggendorf: 29:33

Not offering support.

Bill Dwinnells: 29:35

Yeah, you're not offering support. It's important. Fix this. Yeah.

Susan Roggendorf: 29:39

I don't need I don't need a pizza. What I need is another staff member. I need some additional resources here. I need something to help me out as an overnight clinician when everything is closed. Yeah, you're right. I just Yeah,

Steve Bisson: 29:52

but we'll take the pizza. Anyway. That's right.

Bill Dwinnells: 29:56

We will always take you through in Chinese

Susan Roggendorf: 29:59

And Tacos.

Cara Tirrell: 30:00

Yeah. And Bill, I think you have a good point is if we are the people that you're looking to, but the expectation is to fix it, or to do something like you said about the the behavioral health person about someone actually acting out. That's not really our role. Our role is to do evaluations and designate level of care.

Bill Dwinnells: 30:24

Well, no, I mean, I would say,especially now with the with the way the models changed a little bit. Yeah, our job is to deal with that person who's in a heightened state, whatever heightened state, that may be, okay. But if you're gonna say, Well, I want I want you to make my kid not behave this way anymore. That's not going to happen. All right, I want you to make this client more agreeable to taking their medications. That's not what we do. That's long term stuff. And I respect the people who you know who do that. But you need to understand that's not my role. You know, it really is like, I'm the paramedic, I'm here to patch them up, to keep them alive, to get them to long term care. And then the long term care people are supposed to take them from there. I'm just here as an Emergency, emergency backup, when everything else goes to help. I'm here to keep everybody safe and alive. So they can get to that next level. Or at least set them up. So they're, you know, they're pointed in the right direction. But my job isn't to do the long term therapy, you know, whatever kind of therapy that may be mental, physical or whatever. Yeah, we're just here to kind of patch them up and go, then

Susan Roggendorf: 31:36

you guys said something in one of your episodes. And I can't remember which one it was. But you said something that I was driving and ahead, actually, and I do this very rarely pull over the side of the road, because it was really It hit me,

Steve Bisson: 31:51

We might have to bleep this out.

Susan Roggendorf: 31:55

No, it's not one of those settled down, Steve,it shook me to the point because it I don't want to say triggered, but it brought up so many memories of we were the ones that were the last resort, because nobody knew what to do with this person. And I felt that was so unfair for us as clinicians to get that, and not have the support or like build the leadership, to advocate for us so that we could do that for those persons we were seeing when you guys said that and, and I'm not ashamed to say I was crying, because it's so many times that happened. And it was so incredibly difficult. And they were really complex cases. And they took hours and had to turn it on from overnight today. And sometimes they were still there when I came back on the ship that night. So we are there to do these things for people. But then we get those cases, everybody's hands off because they don't want to deal with it, or you don't know what to do with it.

Cara Tirrell: 32:54

I always thought that like you don't want to deal with it. You don't want to deal with you. You don't want to deal with it. But you want me to deal with it. Even though I told you these are the this is the option. And that's it. I think when you talk about like triggering, I think one, I always had a hard time with people. Because it included knowledge of, I guess, knowing the substance abuse piece of it when parents would call about their adult children. And they'd have sent them to the ER or there was an incident or there was something that happened. They knew something bad was gonna happen. And that's true. You know, the person could drink for five more years and be in a car accident could kill themselves could you know, there's all these varieties, but I couldn't do something in the moment. And it was so hard to explain to someone you can't hospitalized someone against their will, because they might have made bad decisions. And it's not that it wasn't true or imminent, but I can't hold them against their will. That's pretty powerful. Well,

Steve Bisson: 33:54

and I think that I go back to I think it was one of our episodes, I said, we're not quite first responders, but we're first responders and a half. Because we do deal with that population sometimes that no one else wants to deal with, and sometimes not even the first responders. He's all yours. She's all yours. And I mean, again, it's not to deny anything that first responders do, obviously, and it's not to glorify us either. But the truth is, is that that's who we deal with. And I always thought about it as a first and a joke that I was thinking about too. And it's not a joke. But you know, like, I was trying to think about like, you know, how many of us have seen people live smear feces against the wall. I mean, that's one of the things that I come up with all the time. And at the end of the day, we talked about leadership. If someone wants to go into this job, we've done a great job scaring the hell out of them and say this, but how do we kind of identify someone who's going to be able to work in this field? I'm going to turn to Bill first for this one because Bill is someone who does hire people every day and no, I'm still not willing to go work for you yet.

Bill Dwinnells: 35:01

Alright, maybe Susan will come work for me.

Susan Roggendorf: 35:05

I can relocate to Massachusetts, we'll talk after.

Bill Dwinnells: 35:11

How do I do I do identify those people? Well, I mean, I'll be very honest with you, if you come for an interview with me, the first thing I'm going to try to do is scare you away.Because I don't want you taking this job and being like, Oh, you didn't tell me.I tell people straight out in the interview, if you've never ever in your entire life, ever even thought about being a firefighter, EMT, or COP, this is probably not for you. Because having interviewed people who I also then put into cruisers with the cops, because I had the cops asked me the same question, how are you going to know who's going to do all right in this cruiser? I said, because I look for the same kind of mindset that I've seen in firefighters, police and cops. Are these people, first responders, you know, yeah, their site, their social workers, psychologists or whatever. But do they have the mindset that they run towards danger.bAnd they're okay, seeing the ugly. And we've certainly seen plenty of ugly,you need to make sure that somebody really understands that that is what they're signing up for.Now is that like that all the time, of course, not nothing ever is. But you do have to be prepared for it, you are going to see things that are going to bother you, you are going to see things that you are going to have to talk to your supervisor, or at least somebody aboutthese things will just happen. I'm sure we all have various stories, and the public may or may not find them interesting, but they're damaging stories. And these are thoughts, situations and images that we have to learn to live with.Some of them are not coming out of your mind is going to learn how to work with them. You know, for that I refer you to Steve as EMDR practices. You know, this is what happened. So that's usually what I first look what I usually first do, and what I look for, I look for people who tell me they get easily bored.If they happen to tell me they have ADHD, that's a plus Come on, in.You know, things like that. But really, I'm looking for people who are not afraid to have the conversation of Are you suicidal? You know, or maybe even more direct? Are you thinking of killing yourself? Right, that's the first

Cara Tirrell: 37:30

that's, that's a really good point Bill. Asking that in using real words. And what it really means because the person who was suicidal knows what it means. And to ask someone that is very powerful. You know, and there's a couple of different ways you could do it. But really, I always thought to be honest and to be genuine, because of a person, you know, people say oh, you trigger them know, if a person is going to kill themselves or plan to kill themselves. Nothing you can say is going to affect that or prompt that. Now to ask someone, and after a while you do it all the time. But but the beginning and even now in my practice, it's very powerful. Because, you know, it's tough. No, I just gonna say and I don't know, where if I ever got specific training about it, or just evolved into my own style, but I just thought honesty and very specific, I know how to assess it in my own mind, you know, a plan and intent, likelihood to deal with past history, all those things that you do assess, but to think to look someone straight in the eye and say, Are you planning to hurt yourself or to kill yourself or to hurt someone else? And it's hard to hear an answer sometimes to write.

Bill Dwinnells: 38:50

And I think that's, I really think that's the crux of it. I always use the word kill.Because it's unambiguous. What you're what you're referring to. Okay, it's unambiguous. And for the client, sometimes that can be triggering for them. And it should be, because maybe they didn't realize that's what their thought process was going towards. And it kind of shocks them into the moments like, this is what you're signing.It also pulls away all the pretty language that people can hide behind, when really what you mean is this.Additionally, I think the other thing it does is it makes it clear to the person I'm talking to, I am not afraid to have this conversation. I am not afraid of the answer you're gonna give me all right. I may not necessarily you know, as I said earlier, I may not necessarily know how to resolve your issue that may take somebody else, you know, with some other training, some other resources, but I'm not afraid to have this conversation with right here and now and convey that I sincerely am going to do whatever I can to help youbecause people always telling me oh, well, you know, I'm afraid of saying the wrong thing. Or if you approach the situation with sincerity, and a genuineness that you want to help the person, I promise, they are not going to remember a single faux pas that you make, while trying to convey to them that you're trying to help them. They're not going to notice it. See, that's huge.

Cara Tirrell: 40:24

I really liked that. Being genuine. I really liked that. And people said, well, they could lie, or this people lied, lied to us all the time. I mean, that was not a that was not an unusual, we expect them to lie. Yeah, that was almost like, yeah, that's not the big deal. It's really more about how you with that evaluation process with the questioning whatever your style is, is connect with a person so that you can find out what's what's happening, and likely to happen. And then there's, of course, people who were vague. That's a whole other thing. But I would say 90% of the time, people said, Yes, I will or No, I won't, even if they have said, you know, and this is why. And another piece I always ask is why wouldn't you? They said, Well, I'm not sure. versus saying well, because I'm Catholic, and I would never do that I know my mother would be devastated. I have two children at home. You know, there's some protective factors that you look at too. But there was a such a small amount of people that were actually had the intent and plan, I think over 15 years to do it. I knew when someone was, was going to act on it,

Susan Roggendorf: 41:33

to build on what was built, what Bill was saying, in looking for people, because I've been part of those interviewing groups, you know, they would come in and meet with a manager, but then they'd have to meet with a bunch of us who worked in the ER because they'd have to work with us. First of all, it's about having that conversation. Is it that they can build rapport in that room with us? Can you connect with us? If you can't fucking connect with us? How are you going to connect with someone who is very resistant to being an error? Er, who has had said or done things that make them something of a danger to themselves or someone else? Secondly, how do you ask someone if they're going to kill themselves? Every time I've asked that question, one of two things would happen when we would go well, first, and they would talk about how they would you know, start talking to them and basically say, and then what were you planning to kill yourself? Because this is what I heard. Or they would get this look of like, I wouldn't say kill, I would say, you know, like, no, no, dun, dun, you know, and that is actually something I took into my practice with me being trained like that, is that's the first thing I talk about my first session with every single client is part of informed consent. That's the number one thing people are worried about when they read that about suicidal ideation plan, intent, and compulsion, the complaint. And when we talk about what that means, and it's like, I want you to tell me if you're feeling suicidal, I want you to tell me if you're going to plan to kill yourself, because I want to know, is this part of the chronic si you've been having? Is this different? Or is this brand new, and what the hell has happened that this set this off for you? Let's talk about where this came from. And you guys talked about it in another episode where it's about let's D stigmatize talking about suicide, we need to talk about this, there are people walking around with chronic si that are passive. But that's something also that people when we've interviewed them have to understand too, is that if they say they have Si, but they don't plan on doing something, and then they're like, Oh, well, they're lying. Not necessarily, let's find out why they said it and where they came from, which goes back to what we said before about investigating what's going on for our clients. So and it's when we talk to these people were coming to interview. All those things come into play when we're looking for someone to come in. And like Bill said, do you get bored easy? If you get bored? Easy? You're in the right place?

Cara Tirrell: 43:48

Yeah, it's never the same. It's always different. They're same scenarios, but it's always different.

Steve Bisson: 43:53

Yeah. And then well, I was hoping is one of you would say, you know, you grab the skin and see how thick it is. And then judge from there. But no one said that.

Susan Roggendorf: 44:02

No, that's your that's your kind of method there. Steve.

Steve Bisson: 44:05

Your skin. Let me see. Let me see how thick it is.

Cara Tirrell: 44:08

Because I think that is a misnomer that you would say you have to be tough. You have to be unfeeling or you have to be you don't care, because I think that's really the opposite. I think you care very deeply. But with training and a skill set, you have appropriate boundaries. That's very different.

Bill Dwinnells: 44:28

You also need to know how to put youryour emotions to the side for the moment. I learned a long time ago while working on the ambulances. I had a mentor of mine first serious call I went to he's like, are you alright?Yeah, yeah, I think he goes, Okay, he goes, pull it together. Now. We can freak out later. And the same is held true for the s work and the EDS or community stuff. Go take care of Business, as Bill Belichick says, do your job.And then we can put you back together afterwards. But there's somebody out there that needs your help right now. Go help them. And then we'll help you.You know, it's kind of the way, you know, the way we look at it.

Susan Roggendorf: 45:20

I've only had it twice where I actually had to step out of our room, because it was just too overwhelming. For me, I just, it was too fresh off of a personal experience that had happened that was very deeply affecting to me. And I was the only fucking overnight clinician and I had to call for a backup. So I basically said, you know, I gotta go check on something. I'll be right with you in a few minutes. And at that point, I walked out and I grabbed my nurse that we'd have a nurse back in the CSU that when we bring people back to our section, they were doing the medical part of it for them, the psychiatric part of it, and just sat down and said, Oh, shit, this is what's going on. And I would just probably cry, get mad, and then pull up my shit together and go back out and do it again. Only twice it's ever happened. But it was hard. It was very difficult. But that is part of the game, you have to get there to do your job.

Steve Bisson: 46:15

Right. And I think that I ended up maybe I've talked about in the podcast, maybe you guys know the story. I had a pretty bad negative outcome happened when I worked at a jail doing the suicide watches, and one of our medical director, and I'll always give credit where credit's due Dr. Chris Gordon, took me to lunch, maybe three or four days later, I brought my pager This is how long ago it was. And my computer because I'm like, Well, I'm probably getting fired. So I might as well bring my stuff. And Chris is like, well, you don't need that. So we have a decent lunch. We never talked about it. And then we're about to leave the restaurant. And he says, Oh, where are you going now? So I'll go back to the crisis team. And so where are you going? He's like, Well, I'm gonna go do see a few clients in my outpatient office. If I make it.I'm like, what? Like, and if you make it to the crisis team, like, what? What we don't know, maybe we'll get stuck in traffic, maybe we'll get into a car accident, maybe we'll have to answer to an emergency somewhere else? I don't know. And then like, is he threatening me? And that's the first thing that

Cara Tirrell: 47:17

neither of us will make it out.

Steve Bisson: 47:20

Geez, what's gonna happen here, he turned to me. And he says, You can't predict what's going to happen in 15 minutes, how you can predict people's behavior 15 minutes later, is unheard of. And that was probably the most grounding story I've ever heard. And I give credit to Chris Gordon, because it was tough. I had, I literally thought I was getting fired. It was a very tough situation. And I tell people all the time that you know, if you can predict human behavior in five minutes, nevermind 15 minutes in five minutes, you are a better person than I am. And so being able to get that's the question and the stuff that I always found would be helpful talking to crisis teams, because that's the stuff that really works with and how are you? And the other thing that I want to throw in we, because we were talking about it just a few seconds ago, you said go to go see Steve does EMDR but how do we deal with the vicarious trauma? And I know Bill, you've answered that one before in a different way. But is there anyone who wants to offer some suggestions because whether you hear story number one, Story number 27, or story number 2700. At one point, we start getting affected by what's being said, I know I do. And, you know, I joked around about the thick skin but ultimately, how do we deal with vicarious trauma?

Susan Roggendorf: 48:36

I see a therapist. I've been seeing a therapist, somebody who is specific to working with therapist, if they've got a background in ER crisis work so much the better. But if not, then I look for those that are working with first responders, law enforcement, hospital staff. And that just happened to be the cohort that I see now in private practice. It helps to have somebody who has been in that situation or understands that situation that is not going to sit there and negatively react when you bring up the story of this is what happened and I can't shake it right now. So for me, that's the first and foremost is like go see a therapistand then go to yoga, and then eat a lot of tacos.

Steve Bisson: 49:23

What about you guys, Cara Bill, whoever wants to go.

Cara Tirrell: 49:27

I started boxing. Yeah.That really gets it out. I've therapy, you know, I have cat therapy, dog therapy I foster. So having a robust outside life is very helpful. And I think the camaraderie with the team when I was working was helpful. I mean, to know that you had other people that were going through the same thing and that you weren't alone. I think that was a big piece of it. And that you know, we talked about how the use of you know, the dark humor and not always feeling in crisis, even if it was a crisis. I Guess you know, you get into this like mode? I think you were talking about all these things happening at once Susan, and you're just almost just manage it one thing at a time, and maybe that's why I'm kind of good at that. And other areas, too is the I can divide and conquer. What's the most pressing thing? What's the priority? Let's go through that first. And then let's get through it. So, you know, usually de escalation. That's another skill that I think I've taken away from that. And I think it's priceless. And a lot of situations, your instinct is to blow it all up. But de escalation gets to what you want in the situation, usually,valmost anywhere.

Steve Bisson: 50:39

What about you, Bill?

Bill Dwinnells: 50:40

Well, I know you want me to say I drink heavily.

Steve Bisson: 50:44

Please, please, please isolate that I want to do a drop.

Bill Dwinnells: 50:50

No, I actually do use a lot of mindfulness techniques, I do a lot of meditation. I've tried going to therapists. And that usually works for me, because, in my opinion, they're just much more interested in my stories than helping me through my stories. So I've really, you know, I've really relied on colleagues I've met through emergency services who, you know, know what I'm talking about, in general, if, in some cases, they even know the specific people that I'm talking about that this happened with? It's like, oh, yeah, I remember Joe, we Joe did this. It's like, Yeah, well, this happened to Joe now. So I think I rely on that. Fortunately, I have enough longevity in this field that I know a number of clinicians who either I've worked with trained or whatever, that if I'm, you know, having a difficult problem I have, you know, I have a nice supportive community that I can reach out to and just say, hey, somebody helped me process this. I think that's usually what helps get me through a lot of the stuff.

Susan Roggendorf: 51:56

Okay, well,

Steve Bisson: 51:58

as we wrap up, again, we went for an hour just went by, again, fairly fast. One of the things that I we've talked about how the clinicians and all that but you know, we talked about me, we've never really explored, I think maybe once we talked about the experience of a client, a consumer, a patient, whatever they're calling it this week, as Bill said so nicely earlier. And I agree with him 100%, I don't give a crap as a person.But I think that it might be interesting for like, maybe for us to just kind of like, what's kind of the advice you would give to someone who actually shows up to an ER and is looking for the help and how to get the help they need. And I'm going to go again, I'm going to start off with Cara on this one.

Cara Tirrell: 52:43

First of all, I would say do not go on a Thursday, Friday, Saturday or Sunday.

Bill Dwinnells: 52:51

Don't go on any day ending in y.

Cara Tirrell: 52:55

Seven o'clock or three o'clock. But I think I have done this before. I've talked to other people. And I said this is the best way to get these resources that you're looking for. But I also sometimes say to people, what are you looking to get out of it. Because if you're looking to get tons of services at that time, it's sometimes unrealistic to say go to the ER, wait for five hours. You know, it depends what's going on as well. So I mean, to be fair, and then you expect to go into inpatient unit, that may not happen. So sometimes that kind of stuffs out what people are looking for. And if they genuinely are saying, you know, my daughter is saying they, they're under 18, they want to hurt themselves that she has been scratching, she has a history, to cut herself today has an intent and a plan, I would say, call the crisis team first, I would let them know that you know, you have a couple of options. If you don't feel like you can keep them safe at home, then arrange to meet, say that you're gonna go to the local er, get the medical clearance, and then really advocate to the clinician who you want them to call. Because I thinkin our day, and this was a while ago, you know, it was really important to talk to the original reporter, whoever brought them in, or whoever made the original call, get the medical stuff. And if a police officer was involved, or police get that information, and if there's a therapist or psychiatrists get their information, so I think those pieces are really important. I know that, as you said, Susan, and Bill, I know it's a tough place right now. It's everybody's doing a lot with with no support. But the ideal would be to advocate for as much information as possible to get the best disposition for the client. That's what I would recommend.

Steve Bisson: 54:46

Thank you. And, Susan, you want to add to that or

Susan Roggendorf: 54:49

Well, I agree with Cara, it depends on where you're going. We have actually had doctors offices refer their patients to us because you can get your meds through the er What No, we don't do that, if you're having significant issues that put you at imminent risk, meaning you want to kill yourself, you want to kill someone else, you have a plan, you have compulsion to complete, get your ass to the ER, we can help you with that. If you're looking to bring your child in to put them in patient to teach them a lesson to behave themselves, no, you need to do outpatient work as a family and maybe individual therapist for you, as a parent to handle what's going on with your child. I just think there's this unrealistic expectation when people roll into the ER, they're gonna get triaged, they're gonna go right back to psych, and there we go. But like everything else, we're understaffed, we may not have beds, you know, if you truly do need an inpatient bed, as you guys have explained in previous episodes, we might not have it, I know that I have called between the two states of Iowa and Illinois, and gone as far out west and east as possible and north and south to find a bed and found nothing. So, spending days in the ER to get what you need. My best advice is, get into outpatient services before it becomes a crisis. If this is something that's chronic for a person, get on your meds, stay compliant, go to your therapy sessions, go to your group sessions, talk to your sponsors, talk to your mentors, talk to people who are part of your support system, obviously, if it's an emergency contrast to the ER. But there's so much we can't do because we just we either were prohibited by law, or we just don't have the resources or the staff to do it. Or we don't have the beds for people again, if you're an emergency situation, absolutely come in. If there's a question about I don't know if my child really is suicidal or not, but they've been cutting and this looks worse than before. Bring them in, we'll do the assessment will talk to our psychiatrists to figure out what they want to do for orders. We'll go from there. But if you're looking to get your meds refilled, because they've lapsed, and your doctor says that's not gonna happen. So I agree with Cara, it depends on what's going on.

Steve Bisson: 57:02

But my Ambien and my Ativan, and my Percocet all ran out today. Yeah.

Susan Roggendorf: 57:12

And they were just filled four days ago. So 30 days worth of stuff is gone. Boy, they're the most unlucky personal life.

Steve Bisson: 57:19

I thank you. And I appreciate you writing that prescription. Thank you very much. I'll finish what I want to hear from you. And I'll add a little bit myself. I think the best advice I could give somebody don't lie to us. Don't embellish. Just tell us what's going on. I've seen people come in and either they their families, loved ones, whoever they kind of embellish the story make it sound more dramatic. Just to make it sound more dramatic thinking that that's somehow gonna get them you know, better care or faster care. It's not anything, it might take you down a road you did not intend to go down. Especially to you know, you came in and through after three days of waiting in the IDI for a psych unit. You say, You know what, I'm not suicidal anymore. It's like, well, so were you lying, then? Are you lying? Now, just because you want to get other what would which is, it brings up a lot of things. So I would always say just just be honest, I don't care about your drug use, in that I'm not pressing legal charges against you. I just need to know what what you have inside you. You know, what are you dealing with that that's what I need to know, you know, I'm not going to judge you for you know, your drug use or whatever else brought you to the IDI. I'm not judging you for that. But I do need to know. Because knowing that helps me decide, or at least helps me recommend to you different avenues we can go down. But the just like these other two ladies said, the less knowledge I have means the less options I can give you. Right. And I think that I go back to a lot of what has been said, I thought you were going somewhere with this, Susan. But the other thing too, is be realistic with your expectations. And what the one of the things is that you're not going to go to a psych hospital. And in five days, you're going to feel like a new person, even if I have the bed on a Sunday at

5: 59:15

13pm which will never be a miracle. But the point is, is that I think that I hear a lot of people like oh, they're gonna help me at the hospital held to it and no, we've we've talked about this before. That to me is the best advice is start prevention. Reach out the therapists don't wait till it gets as bad. And sometimes it does get bad and absolutely go to the emergency room that is perfect and be truthful. And look for the services that you can get. Because what I tend to, I've had family members I've had a lot of people in the community asked me questions and they say, What do you recommend? Steve? I said there's the CSU beds. There is partial hospitalizations. There is a bunch of services that are intermediary that youwill not need to go to the emergency room. And those don't need interventions from the emergency department, this is something you can reach out to. So for me as much as it is sometimes hard for people, I don't wait till my arm is falling off to go to the ER and say, All right, well, though, put it back together with a couple of like screws, no, I my, my arm hurts and it's been clicking for a while. So you go see your you see a doctor, you see a an orthopedic, you're gonna see someone who's going to do some prevention or help you before your arm is falling off. And I think that that's the advice I would give to people is that mental health typically doesn't show up out of nowhere. It's a progressive thing. And so getting those prevents preventive. And I think they they call it the sequential intercept model in the community justice programs. I think that that's what I would recommend. Absolutely. Agree with me. Yeah,

Bill Dwinnells: 1:00:57

we want to take care of this stuff. upstream.

Susan Roggendorf: 1:01:01

Right? Right. Right. Guest don't let us get don't let it get to crisis mode. There's no reason to I mean, of course, you know, I'm sitting from a position of privilege being a white chick, and I have a job. And I'm not at the lower end of the socio economic status, do a lot of things get in people's way, there's a lot of obstacles that they have no control over.But there's still some way to get help before it becomes crisis. As far as I know, every community across the state, even if it's poorly funded, still has some way to get people connected. Try it before it becomes a crisis.

Steve Bisson: 1:01:35

And I have Bill as my emotional friend, so I he helps me out if I'm going into a crisis and there's emotion.

Cara Tirrell: 1:01:42

My emotional Canadian friend,

Bill Dwinnells: 1:01:46

was emotional. motional, Iowa,

Cara Tirrell: 1:01:50

we have an Iowan emotional friend, right? You gotta get one over, we'll eat tacos and talk about it.

Steve Bisson: 1:01:59

So where do we reach all of you? I know you said at the beginning, but what's the best way to reach you? For example, Susan,

Susan Roggendorf: 1:02:06

um, you can get a hold of me at COFA counseling services.com. On the internet for any kind of in person services or telehealth services, you can also find my podcast rules. It's on just about anything that has podcasts on it. And you can also find me on Instagram as the story therapist, imagine that. Right?

Steve Bisson: 1:02:26

And just just for the record, your daughter did not mention my podcast is one of her favorites. So I have a beef with her right?

Susan Roggendorf: 1:02:34

I'll get the two of you on together and you can chat about it.

Steve Bisson: 1:02:37

Bill, what about you? How do we reach you if we want to reach you,

Bill Dwinnells: 1:02:40

I can be reached at build wells.com is just my name, because I'm not that creative. You know, I'm available for private practice counseling, you know, or if people are interested in software that I developed for helping to run emergency teams, that's at five, awake tech.com. But I should be able to be reached either one for consultation for whatever you think I might I might be helpful with.

Steve Bisson: 1:03:08

The bell is going off. So I think we're about done. Cara, what about you,

Cara Tirrell: 1:03:11

you can reach me through my website, Kara Terrell counseling.com or 508-834-7742 is a business line. And I offer probably just like everybody else about a 15 minute consult for free and just see, you know what's going on. And if I am a good fit, or, you know, I could maybe refer you to someone else. I just had a call from someone yesterday. And they said they call it a bunch of people. And I was the only person that responded back and, and she was looking to use insurance, which I don't take. So I referred her to another clinician, and just that little hand holding, because there's enough people for all of us to be sharing and you know, referring to each other and saying, you might like you know, Susan style, you may like Steve style, or Bill style different it's different than mine, or they have something that could support you in a in a more positive way. I think it's enough for everybody.

Steve Bisson: 1:04:05

And I do appreciate everyone. This was a great conversation. I must say that this was my first time doing a four way interview for the podcast. And it went really, really well. So I want to thank you guys very much, I guess. Yeah, thank you. I'll see you guys soon. Well, that concludes episode 72 of finding your way through therapy. Thank you, Susan, Cara, and Bill. It was a great conversation about emergency work, as well as the stuff that goes on in the unique challenges that we have. It seems like a theme this season in regards to unique challenges. But episode 73 will be about another chapter in my book called A Beautiful Mind needs to be nurtured. So I hope you listen to that one. Please like, subscribe or follow this podcast on your favorite platform.glowing review is always helpful. And as a reminder, this podcast is for information, educational, and entertainment purposes. If you're struggling with a mental health or substance abuse issue, please reach out to a professional counselor or therapist for consultation.