Finding Your Way Through Therapy
Join Steve Bisson, LMHC as he unravels the complexities of therapy and counseling. Engage in straightforward dialogues, enriched with insights from special guests sharing a like-minded perspective. Each episode presents valuable, easy-to-digest information designed to help you perceive therapy, and those who partake in it, in a grounding, relatable manner.
Finding Your Way Through Therapy
E.172 The Mental Men Discuss The Hybrid Therapy Models And Its Flexibility and Effectiveness
The post-COVID era has brought unprecedented changes to community mental health, and our recurring guests, The Mental Men, are here to share their unique insights! Discover how mental health professionals have navigated the shift from in-person to remote practices, transforming the way they interact and support each other. We'll discuss the challenges and creative adaptations that have emerged, offering a window into the current state of therapeutic practices and the mental health landscape.
What has happened to the luxurious and reflective training environments of the past? Join our conversation as we reminisce about the good old days and contrast them with today's fast-paced, often less supervised training methods. Dennis Sweeney, Patrick Rice, Andrew Kang, Chris Gordon, And Robert Cherney share personal stories that highlight the importance of supervision, mentorship, and creating safe, empathic spaces for clients. From the evolution of clinical training to the critical role of team-based therapeutic approaches, we uncover how therapists are developing their skills in these changing times.
Hybrid therapy models are on the rise, but are they truly effective? We explore the pros and cons of combining in-person and virtual sessions, emphasizing the benefits of flexibility for both therapists and clients. Learn about the transformative impact of recording therapy sessions and the importance of focusing on clients' strengths to foster healing. Tune in for an enriching discussion that celebrates the resilience and adaptability of the mental health community.
Freed AI converts conversations into SOAP note.Use code Steve50 for $50 off the 1st month!
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Hi and welcome to Finding your Way Through Therapy. A proud member of the PsychCraft Network, the goal of this podcast is to demystify therapy, what can happen in therapy and the wide array of conversations you can have in and about therapy Through personal experiences. Guests will talk about therapy, their experiences with it and how psychology and therapy are present in many places in their lives, with lots of authenticity and a touch of humor. Here is your host, steve Bisson.
Speaker 2:Toujours aussi j'en suis. And this means basically always very nice and welcome to episode 172. If you haven't listened to episode 171, it's me rambling along about my work with first responders where it started, where it's at, how I'm developing different things right now. You know about the group. The group will be expanding. I've got a couple of other ideas I'm working on, so I wanted to share that. So please go back and listen.
Speaker 2:But episode 172 will be again a returning guests and I mean guests as in the mental men Again, the mental men coming back for more punishment, I guess, or they really enjoy my voice, I don't know. But in all seriousness, you know, I've always enjoyed talking to them. Those guys are amazing, always a great time when we're talking. So here is the interview, right after a word from our sponsor, getfreeai. Yes, you've heard me talk about it previously in other episodes, but I'm going to talk about it again because GetFreeai is just a great service. Imagine being able to pay attention to your clients all the time, instead of writing notes and making sure that the note's going to sound good and how you're going to write that note and things like that. Getfreeai liberates you from making sure that you're writing what the client is saying, because it is keeping track of what you're saying and will create, after the end of every session, a progress note. But it goes above and beyond that. Not only does it create a progress note, it also gives you suggestions for goals, gives you even a mental status if you've asked questions around that, as well as being able to write a letter for your client to know what you talked about. So that's the great, great thing. It saves me time, it saves me a lot of aggravation and it just speeds up the progress note process so well. And for $99 a month. I know that that's nothing. That's worth my time, that's worth my money, you know. The best part of it too is that if you want to go and put in the code Steve50 when you get the service at the checkout code is Steve50, you get $50 off your first month and if you get a whole year, you save a whole 10% for the whole year. So again, steve50 at checkout for getfreeai will get you $50 off for the first month and, like I I said, get a full year, get ten percent off, get freed from writing notes, get freed from always scribbling while you're talking to a client and just paying attention to your client. So they win out, you win out, everybody wins, and I think that this is the greatest thing. And if you're up to a point where you got to change the treatment plan, well, the goals are generated for you. So get freeai code, steve 50, to save 50 on your first month.
Speaker 2:Well, hi everyone, and welcome to episode 172 of finding a way through therapy and the return of a group. I cherish it was. You know, we've been talking for about seven or so minutes before the podcast and we always have plenty of things to talk about and I'm like okay, everyone, stop, let's record this so that everyone can have the insight that we're talking about. So I want to welcome again Robert Cherney Dr Robert Cherney, I do apologize. Andrew King, Dennis Sweeney, chrisris gordon, dr. I missed the doctor thing, dr chris gordon and, uh, pat rice, and welcome to the podcast, thanks for having us thank you, thanks.
Speaker 2:So I I'm gonna forego the uh introductions because I think that we've done it enough times. So people who've known want to go back and listen a few episodes like and on, they can go and listen to it. But you know, we were having a good discussion, because one of the things is that what I love about this group is that I think that it would be. There's never going to be a time where we have nothing to talk about. I really think that that's the greatest thing about this group and we have unique perspectives. I want to say that I worked with four of these five men no, five of these five men at the same organization at one point in time, and we were talking a little bit about that right before we started the podcast.
Speaker 2:So let's talk a little bit about clinical settings, because I really think that we don't talk about that enough, and I think Pat was making good points and it's a little bit of what we talked about the last time. We talked about a little bit of healing and therapy and how it happens, but Pat was talking about and Bob was talking about the same thing about the clinical setting and how it's changed since COVID, the pandemic and quote over. It's not quite over, but I don't think it'll ever be over. But I'd like to talk about that clinical setting. So you know, bob, you brought it up first. I'm going to turn to you and go and talk a little more about how it's been in your experience in the community mental health setting since COVID ended, for lack of a better word. Okay, Thanks.
Speaker 4:One of the things and, chris, you certainly know this as well as anyone the clinic settings that I'm working in, community mental health.
Speaker 4:The atmosphere has changed since COVID and as I think about that, one of the things I realized is that it used to be everybody would come in every day day and then we'd all kind of get to know each other and we'd hang out by the coffee pot or the Xerox machine and we'd talk and we'd do what I called hallway supervision, where you'd walk into somebody's office and say, hey, do you have a minute, I'd like to just run something by you, and that is something that is less done now.
Speaker 4:It's still being done and I'm noticing some of the younger clinicians really starting to kind of gravitate toward that merged with some people, and but the one that I primarily am in is one where we've got a lot of, you know, newer clinicians and they are socializing and actually starting to form groups where they go out together and in one sense that is part of the camaraderie, part of the collegiality, part of you know what makes a clinic vibrant, and I really want that atmosphere to be a part of it, because I think the more a person feels connected not only to the clinic but to the other clinicians, the more effective they're going to be.
Speaker 4:But I do notice that there are. There is a tendency to kind of close your door, have your lunch, answer your emails and not come out. Have your lunch, answer your emails and not come out. And it doesn't mean not that's certainly not everyone, but I just think that we need to kind of be careful about that and try to really foster that whole idea of how are we going to bond together as a therapeutic team, because that's who we are. We're a large team and we see a very, very diverse clientele, which is wonderful, but it really does help to have some people you can just bounce ideas off of and get some advice from, and so I'm happy about that that is starting to happen.
Speaker 4:So the piece about this private I do private practice and the only thing I wanted to say was try to develop a therapeutic atmosphere. We need to hold people to some accountability. If somebody is laying in bed and they want to do therapy, usually I will ask them to please get up. Sit in a chair if you're going to do that, and you know it's only an hour. But I do notice that the whole idea of like has changed a bit. What's acceptable, going to therapy, instead of what it used to be, which is coming to an office, sitting there and you know, conversing in that sense, but that's my take.
Speaker 2:Chris, I'd love to hear from your point of view.
Speaker 5:Well, I think you're going into a very interesting other topic, bob, about people bending the environment in therapy. But before we leave this first point, I'd like to linger there. There's so much to it. I remember when I was in training it was incredibly luxurious. We had a tea group every week for a year. Pretty much all of us were in therapy ourselves at the time. We also had a lot of individual supervision.
Speaker 5:So, in addition to the wonderful camaraderie of being in a group of 12 trainees and we'd have dinner together, we'd do stuff together, that idea of taking the time to sit with a supervisor with the same kind of privacy that we had in therapy, where we could talk about our experience of worry and wonder and anxiety and insecurity and feeling like a fraud.
Speaker 5:Because you know, like I'm not sure about you guys, but like in my training, we were thrown into the deep end of the pool on day one. You know, day one we started acting as if we were psychiatrists. We didn't know our ass from our elbow, but you know. So what we did is sit in the chair and look serious. I grew a beard so I could look older than 12. And we acted as if we were psychiatrists and it took a lot of years to outgrow that feeling of fakery, but that environment of having supervision, time and time to stop and think what the hell am I doing here? It was just so great and I feel like what I think has happened is people have gotten the pace has gotten so fast that that time for reflection and sharing maybe has gotten squeezed.
Speaker 2:I tend to agree. I think that the other part too is I think that with COVID, we changed our philosophy in regards to making time for these type of things, and I think that that plays another factor. And you're right, you know, like you know, I worked on a psychiatric crisis team. I had, you know, one day of training for something called care track that I would like rest in peace, and then, after that, they gave me, like you know, three or four phone calls and then said all right, you're good, answer these calls, and it wasn't because they were mean or anything, but that was my training in 1999. You know, I think my fourth or fifth call was like someone who was suicidal. This 23-year-old kid from Canada trying to pick up a phone and solving this over the phone on his own was the deep end that I dealt with. And again, nothing against anyone, but that's how we learned. So there's a significant difference in our training process, I think, today. So I agree with you, chris.
Speaker 2:I didn't grow a beard for that. I just had no hair up here, so I grew up with it. That's the only reason. But that's a story for a different day. Pat, I know that you wanted to talk because you unmuted yourself.
Speaker 7:Oh yes, as Chris said, there's so many layers to this. But he brought me right back to the fact that what a luxurious training we had back in the 80s and how all of the grad students I had for 20 years we enjoyed that one-on-one, the individual supervision. Watch this, but they have a lot of them have and that's what they've often spoke to me about is that the ability to just process your own fear that they're making mistakes. And I know one thing is that in the beginning I was trained very, very firmly that being calm and being empathic and just listening is sometimes the most therapeutic thing you can do.
Speaker 7:Very often patients with the most amazing content, because it's finally they feel safe enough in the office or the environment, that sacred environment that we create just by being present, they heal themselves. The healing agent often is within them. I think it really is within them. We create an environment for that of which we are part. But still it's that God that was so perfect, it's that sense of being. If they really knew I didn't know what I was doing, this wouldn't be going well. That's the kind of side track. I had wonderful trainers, one of whom in this thing is right below me, dennis this thing is right below me, dennis and Dennis and Dick Fleck and others that you know. Arthur, in the day when we were, when he was leading a supervision group and some individual stuff it was it was just that I had faces that I could focus on and I mimic them. I mimic them as Dennis's group. I refer to a number of people into Dennis's long term group and I do a great dennis.
Speaker 7:They all agree because it was what got me through. When I didn't know what to do next. I I copied what and all of my students for the most part, while they were with me, they did their own therapy. I had people that I would refer them to as a part of the because I said you need to. You may not think you need this. You're wrong because you're in. You may not think you need this. You're wrong because you're in a very stressful time and you're learning rapidly and you're going to be dealing in the deep end of the pool in the ER many a day, but you're going to get to see a really seasoned clinician work every week with you.
Speaker 7:You're going to steal a lot of great material and great opportunity because it's just what you know're sponges.
Speaker 7:We all were sponges. We're trying to learn as fast as we can. And I went from this nice internship under bob and dennis and all of this and really all, and then I was basically in about a week and a half I was made a clinical coordinator of a public detox. That was the trenches you 1200 admissions in a 22 bed facility every year, 1200 admissions a year, and it was just so. You know you. But I had a team behind me that I could ask and I had an amazing training paradigm that allowed me to not feel it. And you know, the ultimate thing is the patients are in front of you. You just have to work. You just have to, and when you don't know what to do next, be quiet, be still, be empathic, you know, look like Dennis. And that worked because these people had the experience that I didn't have. I just sold it.
Speaker 7:And I think in the day of Zoom and everything, and the fact that clinicians today I learned this by teaching some classes and for with Andy, being a guest lecturer in Andy's classes at BC in the social work school is that once the laptops came into the classroom, the whole environment changed. People weren't making. I couldn't engage students anymore. They were sitting there recording the whole thing and doing. I don't know what they were doing. They were sitting there recording the whole thing and doing. I don't know what they were doing. But I think now the clinicians dive into their office and pick up their phone or whatever it is and get on, whereas I tried to get out of my office because the light on the voicemail machine was lighting up and I knew that was more work and I didn't want to answer a voicemail until I had time to do it and sit with it. But I was often looking for someone to speak with for a few minutes just to help clear my own head, and I think this format here is wonderful in so many ways.
Speaker 7:But in telemedicine and this is the last thing, is that I see it now because it's soliciting me even though I don't want to work is that so many of these sites have 25 or 30,000 therapists doing it like this, you know, so that a lot of new clinicians have 25 or 30,000 therapists doing it like this, so that a lot of new clinicians who are hungry and need to make some money are basically going into teleclinics, telehealth clinics, and I couldn't even deal with being in an office with masks on, because with a new patient you lose everything. If I can only see the eyes, I lose so much connection to what's being, what's attached, what the emotions that are being attached to the words. So I think it's changed a lot and it's nice to hear it getting back. You know, when I drove down Route 9 not so long ago and see this beautiful Advocates Clinic right in the corner of Winter Street, you know, beautiful, you know I'm going.
Speaker 7:Wow, that's a long way from Waverly Ave. I'll tell you, beautiful, you know I'm going. Well, that's a long way from Waverly. You know, it's just, it's just. You know we're getting back into what I think the community mental health of the 80s. We were like the envy of the United States and Massachusetts.
Speaker 2:So well, you know I can I'm not going to go there quite yet but I worked for a company that was like that, that had you know therapists across the country. But I worked for a company that was like that, that had you know therapists across the country, and I can go on about how it was impersonal at times, how it can also become a loss of connection. I connected with a few people that I'm still connected to today, not clients, but actually some clients, but mostly a couple of therapists. And you know what I miss and I want to throw that out because you mentioned it. You know the camaraderie that we had.
Speaker 2:I remember my first phone call to Chris for Section 12. And we have another doctor that I will not name, but everyone knows her. I had to do a presentation within 20 seconds as to why my Section 12 was valid or not, and she was always very yes or no kind of like. Get get to the point. I also worked the overnight, so you don't want to talk too long. First time I call Chris, I go with the same presentation.
Speaker 2:Chris is like two o'clock in the morning, chris goes. Steve, calm down, we're not in the rush. Explain to me what the hell is going on. And I'm like, oh my god, he's mad at me, medical director at the time. So I'm like, oh my god, he's gonna hate me. And I'm like, oh my God, he's mad at me, medical director at the time. So I'm like, oh my God, he's going to hate me. And I'm like so self-conscious about what I said. And he said again Steve, it's your first consult, calm down, talk to me. We're human beings. We want to connect.
Speaker 2:And that's where I realized that when you have good set of colleagues and you know there as a doctor he's the psychiatrist, the lead psychiatrist goes to Harvard. Everything else he was so down to earth. That made me feel so comfortable. And I worked at that crisis team on and off for like 15 years and when I had a consult with Chris, I needed to consult with Chris and Chris never made me feel like crap once about it. And I think that that's the stuff that we're kind of missing when we're not connecting with our colleagues. And I think me and Dennis had a private conversation in regards to that last week about that too, about connecting with our colleagues on a regular basis. This is what I look forward to. This is not an attack on anyone, but because I get to connect with people I love who also kind of like, treat me as an equal, and we have a great conversation because of that. So it's just a great group to have. But I don't know who wants to go off of this.
Speaker 3:But let me jump in if you don't mind. You know this podcast is is the perfect example of kind of that double-edged sword, I think, where it does offer this opportunity to get together you know I don't see you guys as often as I'd like and get some group wisdom going, which is always so useful. I just want to also give supervisor props my first supervisor, also dennis, and so you know we're all mimicking Dennis, all clinicians, I believe, are actually mimicking Dennis. But you know the question of of whether you, what, what you bring to a virtual session or not, it I find that it itreates the magic, but it's very fundamentally different. You know that there is a connection, there is a back and forth between you and this other person, but you do miss out, just visually, on over half of the information I would say. So I find myself having to work much harder in this medium, but you know my client does not have to take three hours out of the day to make it to the appointment either. Them clearly worth it, and maybe we need to do more sessions and maybe we fill it in a different way.
Speaker 3:One last point I wanted to make about the team approach is that we set up supervision groups. We set up lots of other mechanisms to let that happen. But I've also been working a lot with trying to and, steve, you and I have been doing this recently with clients is team approach, is on a client, on a specific client. So having a trauma therapist, having a psychiatrist on board, having coaches or other supports because one hour during a week is just not enough to hold a lot of people and to work with someone through all the things they're dealing with during the course of a week. So I've been finding connections that way as well, which I think deepens the work.
Speaker 4:That's wonderful. I mean I see that at the clinics, andy, where we'll have someone who has a significant trauma history, the therapist who has been working with that person wants to have some consultation and we often will refer to people who have been trained in EMDR within the clinics and that allows us to have the individual participate in EMDR, which is a wonderful trauma treatment in addition to the therapy they're having with their you know their, their general, you know therapist, and it's a really the adjunct with the EMDR or any trauma therapy frankly allows that individual to uncover stuff more quickly than perhaps they might've in their own therapy, because things will come to them once they start to uncover them, and I see this with EMDRs. Once you start to do that, the memories are basically connected through the neurons and you just trigger things and you start to uncover but also to experience, and that's where the team can come and help to support that person through that time period, which can be fraught with some pretty intense emotions. But so I appreciate that. My last comment is that I believe, and I've always believed, we work in an apprenticeship model and I think it's an incredibly important thing to be able to look, to be able to see, to be able to listen, to be able to see, to be able to listen, to be able to experience the right and the wrong, and I've always been blessed with being able to do that.
Speaker 4:And I'm, chris, I was so glad to hear you say you grew a beard. I grew a beard my third year of graduate school because of that very thing. You know, I'd be sitting with a 45-year-old person and here I am, maybe 28. And I just wanted to kind of like make sure that I had at least some gravitas and but you know it's a funny thing, but you know we all have to start somewhere and it's not an easy thing.
Speaker 5:You know I'd like to share. I have an interesting I hope it's interesting an interesting perspective on this in-person versus virtual meetings, because I've been seeing a therapist for the last five or six years and we started off and now that we're post-pandemic we can kind of do either one and I noticed that my experience of being with my therapist especially in the beginning of when I started seeing her, because I was experiencing a lot of psychological, emotional, psychiatric turbulence at the time it was extremely comforting to sit in the room with her and just experience the calm environment in her office and being near her and it was really good. Then, when we went virtually, I was in a better place by that time and also there wasn't as much need. But I felt like I could draw back on my experiences of having been with her in person and remember that that. And so now, looking back at the whole thing, I agree with Andy that there's something about being in the same physical space with the therapist that just is not present in a Zoom environment.
Speaker 5:But I wonder if it is a good idea to think about doing a hybrid, because the point that Andy was making about the three hours versus 50 minutes is huge. I mean for me to see my therapist. I got to schlep all the way to Cambridge, find a frigging parking space, which is easier than like trying to get a rich man into heaven and then drive all the way back. So you know, I think maybe the hybrid has a lot to offer.
Speaker 2:Well, having done telehealth before, it was cool. Before the COVID stuff happened, I think I got a call from every single one of you except for you, chris, of how to do it when we went to COVID and I never stopped face to face. I stopped for about four months during the COVID pandemic and I went back to the office for those who were comfortable and all but maybe three or four went back to some sort of hybrid model. Like my clients like oh, I have a doctor's appointment at St V's so it's too hard to get to. St V's is in Worcester Mass. I'm in Holliston but I live in, we'll say, marlborough I'm just making it up here because I don't want to identify anyone. So can I just do zoom or, and then I can get to my appointment much faster. And I think that there is some value in that too for a client, because now you're listening to them, you're valuing their time, they're valuing your time and they get to get their medical stuff done. So I think the hybrid model is the key and having someone like Pat to talk to, or Dennis and I like to look back to, all of Andy, bob, you, chris, anyone who could help me with certain things. Because, again, as you talked about, hybrid is also the therapeutic process.
Speaker 2:When people come in and say to me, oh, I want CBT and I'm like I can't promise that, I don't know what's going to be needed for you, and sometimes it's like, oh, this is not a good match. But you know who's a good match? Dennis would be a good match for you or whatever. It's also thinking about it that way, because I'm not a match for everyone, and that's okay. Because I'm not a match for everyone, and that's okay. But a lot of people are very afraid of saying those words because they think it translates to I'm incapable. Dennis, you've been awfully quiet for the last half hour. I need you to talk, man.
Speaker 6:I know that that's your way of doing things, but I still need you to talk.
Speaker 6:I've been processing a lot listening to what people are saying and I think you know, chris, when you talk about getting thrown into the deep end early on in my training I'm not sure that I did feel thrown into the deep end, but never by myself that there was always somebody there, always somebody there, and but the the thing that I remember is that the sort of the process was that we're going to throw you into the deep end, you're not going to be alone, but you still got to work on figuring it out.
Speaker 6:We're not going to tell you and I think that from a therapeutic process, that's one of the core elements is that what we're doing is working with people to help them to figure out how to figure it out. As you talk about, you know, the shift to the hybrid, we're, in that process again, sort of gotten thrown into some chaotic dynamic here in that learning that the way it once worked well, it worked, it was great, but it doesn't necessarily work the same way anymore and we've got to figure out different ways to work with new things. And it's just. I think it's a model of the therapeutic process.
Speaker 7:I'd like to say one thing about I was just thinking back of one of the first clients that I had that traveled from New Hampshire to see me every about once a month on a Saturday morning and it would be like a seven o'clock session that we agreed that we'd do two hours because he needed that kind of time. And what he suggested, and it became a paradigm shift for me, is that do you mind if I record this on my? He had a recorder, a little, you know, like those dictator recorders, and he listened to it in his truck as he was going places and every every the next month he'd always listen to it on the way back down, you know, and which I did. Patients started asking me that and I said absolutely so that for those hybrid sessions when they're actually in the office those times. So I did phone sessions for people that were. I did a lot of remote work, but I don't know why, but I did, and it'd be phone sessions often with college kids and things like that to support them in between the um, the uh, the in the office session.
Speaker 7:And then that's the one thing that zoom is really useful for. Is that very often my patients, you know I'm still seeing some of the following up and terminating, but is that they record the sessions? They say, do you mind if we record this and I send it to them and then they can watch it and, you know, they get themselves too, which is really interesting. They're seeing themselves in context. I think it's a richer environment than it may be.
Speaker 7:The one thing that this hybrid model allows is another dimension of how they see themselves in the session and see us, and don't have to, because they used to have people taking notes all of the time so they wouldn't forget things that were important, and I just think it really lends itself. Zoom lends itself. I know when I do my meditation practices with a facilitator, I record them and she'll send them to me as well so that I can then use them for the basis of another meditation or a process of meditation. So there's a lot to this. Really, when you think about it, is that the paradigm shift that we're on in this watershed, or actually it's now it's gaining a lot of traction?
Speaker 6:So I think of hearing a comment that Thich Nhat Hanh made in a conference that I was listening to and he said you know, you Western therapists, you get it backwards. First question you ask is what's wrong. And he said really, the first question you should ask is what's going right. Because if you figure out, if you can get a sense of what's going right, then you might have a better chance of being able to engage and work with what's going wrong.
Speaker 2:My old favorite saying of Thich Nhat Hanh was the way out is in. I think I've changed it now. Thank you, dennis. I think that's a great one to think about and I certainly talk about, you know. I think that doing things differently that's the other part, too, about doing therapy. I think the therapeutic process is, you know, thinking about what's right, the strength-based stuff, which, you know, I give credit where credit is due.
Speaker 2:The person who really taught me a whole lot about that is the man here, dr Chris Gordon. He's the one who made me think about those things because, again, I remember a consult in the ER and I told him all the problems. He's like Steve, what is going right in their life then? And it wasn't those exact words, but something to that effect what's the positive in his life? I think is a pretty good quote and it really changed my perspective of, even in a crisis situation, still looking for what's right.
Speaker 2:And I think that I want to give credit where credit is due. And, chris, uh, I feel like I always throw flowers at you because I don't get to see you face to face all that often, but it's all true. Stuff like does my progress, notes probably 95% accurately and creates a letter for the client to send it to them in order to they know what they talked about. To me has also been a very big game changer in the past year or so in my work, but I don't want to get too off on subject here, but the AI stuff is another way to add another layer to our work.
Speaker 6:I do want to make a comment, though, about this idea of looking for what's right, that one of the core elements that I was first taught was also to respect whether you want to think of it as the pathology, respect the pain, respect what's wrong, that that balance needs to be there, that we need to be able to be open to and sit with, whatever the war is, whatever the chaos is, because that's also a major part of being able to get the whole picture.
Speaker 4:Yeah, well, I agree with you, Dennis, and I believe that the core of the therapeutic alliance is the relationship and it's just, it's a matter of basically building that relationship, that trust that you know, collaboration over time. Because of many of the people who come to us, one of the issues is trust. One of the issues is that they've been hurt or betrayed or whatever. But once you have that core, you can go into not only the, I think, the strength-based stuff you can kind of help them to, you can help reinforce that and to expand it, but also to go into those darker places where people are afraid and people are are, you know, they're basically they're, they're humbled and they're humiliated and they feel ashamed. All those places. Like you said, that's the war that people are fighting within themselves.
Speaker 4:I agree with you about Thich Nhat Hanh. I read his writings quite a bit. If we can take the time to actually slow down and to listen really intently, that's, that's healing all by itself, but it's it's not enough. We have to also, you know, become more active and try to help people and facilitate how they can take themselves to a different place.
Speaker 3:I think Dennis is the, is the modern Thich Nhat Hanh, Dennis, you're, you're the. You're the modern version of that. You just coined a new T-shirt or bumper sticker and we help figure out how to figure it out. My son's got a recent ADHD diagnosis which explains a lot of different things that have been happening for him, and I've been saying to him recently don't worry, we're going to figure it out, we're going to figure it out together. And when I saw the relief on his face, I started taking that into session with people Don't worry, we're going to figure this out, we're going to figure it out together. Figure it out together.
Speaker 3:And you know that that goes such a long way to helping people stay with trying to do it. You know they're coming in with with the attitude of that it's, it's impossible or you know this is a monumental task that I don't know if I can really do. But just breaking it down into a simple concept like, yeah, we're going to work on it and we're going to, by doing that work it out, is really helpful. You know it really calms people down and I know it did that for my son. So I'm a firm believer. I think I'm going to make those shirts, yeah, You're providing hope, andy.
Speaker 4:I mean I. There are many times I've said I'm going to lend you some hope, because right now I believe more in you than you believe in yourself. And you're right. It does cause people to wait a second. This person's really thinking I might be able to do something, and that by itself is is very, very important.
Speaker 5:I'd like to share a couple of thoughts about the idea of strengths too. You know I have been supervising psychiatry residents at the Mass General McLean program for I don't know 40 years and I still am doing that. It's a great source of joy to me, but one of the most fundamental precepts that I teach the residents who my supervise is to start with the strengths. You know, the young psychiatrists are so well trained to sniff out psychopathology and they've got you know a million terms for different kinds of problems.
Speaker 5:But there's no similar catalog of strength and what I teach them is, you know, it's the good stuff about this person that's going to be the fuel of your work with them. And the more you can find to admire, like, celebrate, recognize in a way that the person feels like you see that about them, the more comfortable they're going to be at dealing with the things that are troubling them. So it's it's really like a light bulb going on over a lot of these young docs heads when I say let's just take, take some time and enumerate all the strengths you can think of, and when we start out they come up with two or three socially skillful, hard worker, accomplished a lot in school, and then I think come on, let's really go for it. And before you know it, we've got 15 things including they're good looking, they're a good dancer, they're a good bowler and if they're a good golfer, that's like you want to make an appointment to see them.
Speaker 7:I would just say that I have gained over the years great respect and it was something that I remember with students that would come back having done an intake in the emergency room and wanting to talk about it, and it was such an opportunity to mine their skill set of the student. But we both would mutually decide. I think many, many times that the most remarkable thing about the patient they just saw is the fact that they're alive. The survival skills and I taught them because it was taught to me in my own work with an extraordinary therapist for many years that the label that I wanted to use for myself, the description of myself, wasn't victim, it wasn't beat up to a pulp, it wasn't whatever, it was survivor. It's the survival skills that they bring in and one of them is knowing enough or being open enough to start therapy, which can be terrifying to so many people. So you know, I was taught, and then taught it to many, that this is sacred space and the opportunity for someone that will come in on the worst day of their life. Maybe you may see someone and they're willing to tell you about it. You must be giving them some hope. Your presence must feel safe. So these are your strengths, strengths, and. But you know, we, we create an environment where they show us their strengths and I think that's brilliant. Uh, chris, that that's the way. Let's enumerate that first. Now you know what toolkit is that you're going to use to help these people fix their, their problem, you know, or fix their situation, and that's basically the basis that everyone knows.
Speaker 7:I've been in 12-step recovery for half a lifetime, but you know, the one thing that everyone in there says is you're not the first one, god. There's a half a room here of people that have experienced something like this. You're not alone. We'll figure this out, because it's really hard to do something unique as a human being, and we hear awful things, but often we don't have a lot of sense of mutuality in that in the, in the community, because these things go deep.
Speaker 7:You know, I forget who it was that said might have been chris gordon that said never underestimate the power of repression. I heard that really early, you know. I think it was a. It was a conference room thing in the fair building that you were talking about. The repression is what keeps people alive. They may not remember it, you may have to tease it out, you may get a sense of it, but they're alive because of it and we have to be very gentle when we try to bring up our wonderful you know advanced empathic techniques. Did you ever think that possibly you could have blah, blah, blah, blah, blah, you know? And because that can eviscerate someone's sense of security and safety. So, yeah, it's really a rich environment sitting with people that are sitting alive and wanting to get better.
Speaker 5:I'd really like to meet this guy, Chris Gordon.
Speaker 7:We'll record this and send it to you.
Speaker 2:One day you'll get to meet him. If you go after this, if you go check in the mirror, you might see him just just saying you know that you're right, and I think that one of the things that is so important to do and I can't tell you like I work with you know first responders, people with trauma, and me starting off with strength-based stuff isn't going to fly all that well and sometimes it's really working with the people that you have, working with someone who's so desperate, that is on borderline, going to the hospital and talking about their strengths and what they have. Even the first responders do respond to that type of stuff. But if I start off with what's right and like why, why am I here if everything's right, you also have to know your audience and I think that that's another thing to keep in mind, because you know I had a call yesterday or monday last week, actually not about a client who was, like you know, talking about their kid, saying can you help him? And he's like 19 or something.
Speaker 2:Well, I like him to call first and they said, well, he's not doing anything. He just came back from rehab a month ago. I'm like, yeah, he won't do anything for five months His brain's mush, and sometimes it's also thinking about the circumstances. That's so important too, because if we only go strength space or we go only one thing, there's also kind of like a pro that could be problematic in certain, uh, therapeutic alliances. My thoughts, well, everybody agrees with me. That's rare, um, but no, I'd like to hear other people talk about that too, because I think that that's, you know, like I. I, if I talk to andy about certain things, I think I will have a different tone and intonation. And if I talk to pat or dennis or chris or bob or joni or frank or helen, or because it's all different people and I think that that plays a factor, unless you guys like I'd love to hear your feedback about that, because there is a little bit of adaptation to what the person needs that's in front of you.
Speaker 4:But I think you've got a great point that some people are. They see themselves as so damaged and their shame and their guilt and the remorse overshadows everything else and at some point trying to uncover some of the more positive aspects of themselves. At first they don't believe it, they will reject it, and now it's a matter of trying to see if there's enough stability in the relationship to be able to continue that small you know, progress Because progress isn't like this.
Speaker 4:Progress in therapy is often like that and at some point you know I always use at some point, you know, the needle does start to change. But the whole idea of am I worthy of even considering myself? You know that word self-compassion gets used a lot now, but many people don't have that. You know that word self-compassion gets used a lot now, but many people don't have that. And survivors, part of the pride that they take in themselves is that I can go through hell and I'm going to be, I can survive it. And yet they start to expect hell and you're not.
Speaker 4:You're basically saying, all right, I don't know where it is, but I know it's bad, stuff's coming at me and I just gotta, you know, keep, keep vigilant, keep scanning the environment and it'll come. And, as we all know, if you, if you, if you think that way, you often it will often materialize. And um, the whole idea of like, how do we shift the attitude of maybe I will see if I can make this a different day, a better day or a better relationship, and that takes, that can often take a long time.
Speaker 7:There were. The old Serenity House in Natick used to have a gift shop and they made things which was, you know, a lot of gifts and recovery oriented things. And their two most favorite little plaques, the most popular, were I have outgrown my need to suffer. And the other one was, oh, dane Bramage. The other one was I can't remember the other one, it'll come to me.
Speaker 3:Take my advice. I'm not using it. No.
Speaker 7:That's a bad rice one, that's a bad one, but it's the the over identification with your uh, your in, you know your past and, being being a survivor, you can take it both ways is that I can endure most, most everything, but I don't need to anymore. And being able to, I can. Can remember Dick Fleck, who is a chaplain and a psychologist himself in his own right, but he was famous for talking about spirituality as a process of rediscovering qualities of yourself. The quality of your opinion of yourself is spirituality and the quality of self-feelings. And sometimes they have to sit for a long time patients did because they couldn't really identify the connection of how they felt to the trauma. You know it was an experience, but you get your thick armor on after a while and you feel safe within the armor. But the armor is a prison in and of itself.
Speaker 7:You know, I'll share one thing that just occurred to me is that I used to co-lead a group, the growth group, at the old start when I was an intern, with Dennis, and he would watch me make mistakes. He just gave me free reign to do what seemed right for me. I'd feel an energy in the room and I'd look over and he'd be smiling, knowing that we had a lot to talk about after the session. But I said so, what the hell is going on? Why do I do that? And this is what Dennis told me.
Speaker 7:He said, pat, I detect I'm going to do Dennis. Now, pat, I detect that there is a deep narcissistic injury here. I don't know what the nature of it is, but as you discover it, we will be able to utilize that as a strength here and not a liability. That was one of the most profound things. Yeah, he never cries, though. I just slept out of Dennis and back into Pat Rice. I just slept out of Dennis and back into Pat Rice, but it was that moment when I realized that there was hope. I could overcome my past to be able to be useful to people.
Speaker 6:Wow, there you go. One of the things that I try and identify with people is a distinction between sitting with something and sitting in something, and that's really critical in terms of past wounds. The past pain is that I'm willing to sit with you with this, but I'm not going to sit in it with you. I'm going to do everything I can to help you not sit in it.
Speaker 7:Yeah, you're pretty good at that from my experience. Thank you for your tears, bob. One of my favorite therapeutic things is a little boy that I knew. I saw his mother and he would come in, little Oliver. He'd come in the session and he said once when she was having a meltdown on the edge of the car he put his hand on her knee. She told me and said it's okay, mommy. Pat Weiss says it's good to cry. So that's my mantra. We have it in my household. Everything pat white says it's good to cry I always say that um I, I from the podium and a lot of public speaking I've done.
Speaker 7:It's just you get tearful and I said I don't apologize. I just say I work very hard to have access to these tears. This is a gift, so thank you.
Speaker 6:Over the years I've threatened to write a book, and if I ever do write a book, the title is going to be too many tears you're going to start with the title.
Speaker 2:That's great all I figured out now is we all have merch opportunities.
Speaker 2:Now we got to write uh shameless commercial division yeah yeah, I think everyone has got a merch in them right now, and that's great, although dennis may have a few months to write his book. So, um, but that would be, uh, you have free to one office that I know of, uh, whenever you need it, uh. But I need to wrap it up because it's been almost an hour. We got to be respect for everyone's time. I really appreciate all of you guys. I, I do love you all again. I said I say this after every one of them, but you know like I've worked with all of you there's, you know I, I this podcast is not an obligation by any stretch. It is from the bottom of my heart. I will not cry, but I can't tell you how much I love every single one of you and how you've really made me grow as a therapist, and I really want to thank you for your time.
Speaker 4:Thank you, steve. Thank you, thank you, steve, for facilitating this, for really getting us together.
Speaker 2:It's an honor. Yeah Well, that completes episode 172. You guys, thank you so much for listening, and thank you to the mental men. I mean this is always an interesting conversation going on. I have an idea for them I'm hoping they agree to. I'm going to bring that up to them a little later on, but episode 173 will be with Abby Westgate. Abby Westgate used to work in the UK as an officer, and so she has plenty of stories to share there and other hopes and dreams and things that she does right now. So I hope you listen to me then.
Speaker 1:Please like, subscribe and follow this podcast on your favorite platform. A glowing review is always helpful and, as a reminder, this podcast is for informational, educational and entertainment purposes only. If you're struggling with a mental health or substance abuse issue, please reach out to a professional counselor for consultation. If you are in a mental health crisis, call 988 for assistance. This number is available in the United States and Canada.
