Finding Your Way: Resilience Development in Action

E.197 Mental Men: Trauma, Grief, and Healing

• Steve Bisson, Pat Rice, Bob Cherney, Andy Kang, Dennis Sweeney, Chris Gordon • Season 12 • Episode 197

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Trauma lies at the heart of most psychological suffering, yet our understanding of it continues to evolve. In this profound conversation with the returning "Mental Men" panel of experienced therapists, we explore how mental health treatment has transformed from psychoanalysis that sometimes minimized real trauma to approaches that honor lived experiences and their lasting impacts.

When Dr. Christopher Gordon underwent psychoanalysis in the 1970s, the prevailing theory suggested psychological problems stemmed from internal conflicts rather than actual traumatic events. "We paid really little attention to actual trauma," he reflects, noting how profoundly this limited understanding affected treatment. Bob Cherney captures the persistent nature of unaddressed trauma with the striking metaphor of "an infection in the soul that festers" when not properly addressed.

The conversation explores grief as a universal human experience that our culture frequently mishandles. We expect people to "move on" within weeks of significant losses, when truly processing grief requires much longer. As Pat Rice eloquently states, "If you live long, you'll have to say goodbye a lot"—pointing to how aging inevitably brings accumulated losses that need ongoing attention rather than quick resolution.

Perhaps most compelling is the discussion around strength versus vulnerability. "Strength is asking for help," challenges traditional masculine norms of stoicism. The therapists explore how protective parts develop to shield individuals from vulnerability but often prevent necessary healing. For first responders who witness what "95% of people never see," this conflict becomes particularly acute as they struggle to maintain professional composure while carrying enormous emotional burdens.

The Mental Men celebrate those breakthrough therapeutic moments when clients suddenly recognize patterns that have eluded them—what Andy Kang describes as seeing "the pilot light of hope come on again." These moments, as Dennis Sweeney remind us,  is why addressing trauma matters so deeply: healing becomes possible when we honor both wounds and resilience.


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Speaker 1:

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:

Alors, c'est le retour des mental men. It's the return of the mental men. Hi, welcome to episode 197. If you haven't listened to episode 196, please go back and listen to that, because that was my course that I did with Lisa Mustard. You can get a CU for it when you register with her website. It's on working with first responders and helping therapists work with first responders. So please go listen to that and then log into Lisa Mustard's pod course website and then you get your CU for those who need it, for LMHCs particularly, so that'll be available.

Speaker 2:

But on episode 197, the returning mental men you know these guys. They've been, we've been together for a long time. We've had, I don't know, seven, eight episodes. I stopped counting. They come in quarterly. They will not change. This will not change with the rebrand that we're doing. So here is Dennis, pat, chris, andy and Bob with me.

Speaker 2:

And here's the episode 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 justa 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 are you 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'll give you $50 off for the first month and, like I said, get a full year, get 10% off, get free from writing notes, get free from always scribbling while you're talking to a client and just paying attention to your clients. 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 getfreeai code Steve50 to save $50 on your first month.

Speaker 2:

Well, hi everyone, and welcome to episode 197. I told you they would be back. We were hoping to have another cohort, but we're going to push them next time to be here. But the mental men are back and very happy to have them all. We haven't had golf in a while because it's the winter up here in the Northeast, so we haven't had a chance to play together and talk. But Andy Kang, dennis Sweeney, dr Bob Cherney, dr Christopher Gordon and Pat Rice, welcome back to Finding your Way Through Therapy, thank you.

Speaker 3:

Thank you Thanks.

Speaker 2:

Thanks, steve. I was talking beforehand. We always do these pre-interviews and what I was talking about is the rebrand to Resilience, development and Action. So you guys know on the podcast already this, but maybe some of my fellow mental men here didn't know. So I was talking about how trauma has become one of the emphasis that I want to talk about, and Chris was bringing up an excellent point and instead of me saying, oh, let's ask a question, I'd like you to pick up, chris, where you were talking about, especially how, when you started as your own psychoanalysis psychoanalysis Okay, french-canadian talking, sorry, but yes, please go ahead, chris, before I humiliate more my language.

Speaker 4:

Well, I was sharing that when I was in I'm a psychiatrist and when I was in training in the 1970s, I underwent psychoanalysis, not as a part of my training, but really it was more like high-intensity psychotherapy is what I imagined it to be, and so I was experiencing this treatment modality at the same time as I was learning about psychiatry treatment modality, at the same time as I was learning about psychiatry, and what we were talking about was that back in those ancient times, there was a lot of the predominant model of therapy was psychoanalysis, and psychoanalysis was based on the idea that there were these deep conflicts in people's minds that often arose in childhood but arose out of like.

Speaker 4:

The classic example is the Oedipus complex, this notion that the problems in people's lives arose from conflictual feelings about important other people in their lives, but not because anything bad happened or anything traumatic happened, but rather that it was a phenomenon of the person's own imagination. And as a result of this, we paid really little attention to actual trauma. You know, actual trauma was like a screen for the real stuff, which was an intrapsychic conflict, and I felt like this was completely off base for me in my own therapy, because my therapy, I have since learned has a lot to do with trauma, and every year that's gone by that I've been in practice, I've become more and more convinced that trauma is at the heart of most people's suffering, and if we don't open up space for people to appreciate and explore their trauma, we actually harm people. So I think you're rebranding Steve. That's very exciting and it sort of tracks along with the path my work has taken over the years.

Speaker 2:

And I think that that's what we were talking about too, because what I find, particularly with most of my clients, especially around trauma or even any type of relationship building, you got to start with the relationship building, to go deeper into the conversation and all that, and I know that Bob was talking a little bit of the changes as he goes along too. So I want to put you on the spot, bob, but you know like I would like to hear more from you on that.

Speaker 5:

Well, it's a wonderful idea and I think it's so valid because you know both personally through my own therapy and then professionally over the last decades, especially working in community mental health, I would say at least 90% of the people that we see have trauma and, as I have my practice, I think that that number still stands up with many people, if not all, and so I agree 100% and I think that, as we were talking before, people have a need to discuss some of the things that have happened to them earlier in their life, and I call it, you know, some of it's family of origin, some of it is abuse or neglect that happens as they're growing up and this forms a, you know, it's almost like there's an infection in the soul that festers.

Speaker 5:

If it's not if it's not I was going to use the word exposed but at least illuminated and brought to light so that people can actually discuss it and emote from it.

Speaker 5:

That's the thing that always strikes me is how much once you uncover, or once they allow it to be uncovered, they have. You know, facing it becomes very intense emotionally, and I think that part of it is so important in order to allow it to reduce some of the pressure internally, because otherwise, if it doesn't come out or if it doesn't get addressed at some level, it's like an infection that's going to get worse. And so I've been struck with it and I think some of the techniques like EMDR, which actually kind of goes right to the heart of it, are really valid and worthwhile. But there's many ways of doing it. But some of it has to do with, like Steve said, form the relationship first, because you will not have someone expose their trauma to you if you don't have a solid therapeutic relationship, you know, and the trust and the comfort and the empathy all combined to make that happen.

Speaker 6:

Section of the soul. What a phrase. Yeah, I completely agree. And I just to jump in here when you think about what a child understands when they're going through their childhood, it's, it's their picture of normalcy, it's it's what they, how they understand the world is how they've experienced it, and so they don't understand that maybe stuff was wrong.

Speaker 6:

Even if they felt that way at the time, did they still create their whole sense of normalcy around what their experience was? And so a lot of times it takes a while to uncover that, oh, that's where the infection was, or that that the origins of that were just seemed like the way things were and the way things were supposed to be. And so when you get to trusting someone or they're trusting you to reveal more of those details, that's when you start to have those kind of eureka moments about oh, that's why I've always felt this way, that's why I've always been so nervous, and it's it's really quite amazing to see that light go on, but I don't see how you could ever get to that without discussing what actually happened to your point chris right andy.

Speaker 7:

You know um, I'll jump in for a second. It's um. I was trained by half of this room as I got into re-education in my mid to late 30s and started working with Dennis and Bob and other really gifted people, one of which was someone we all knew and I talked a lot about because he was really my mentor, Dick Fleck, the chaplain at the hospital in which we worked, and he was remarkable because, and I think, as I recall, when we were there, there were two diagnoses given. I know I got into the field just as dual diagnosis was hot and taking off and we started the Metro West dual diagnosis task force and things like that. So it was really the hot button for everybody.

Speaker 7:

But defining what dual diagnosis was was very difficult in the beginning and when I started working with you fellows and the old Start Out program, Start program I remember they gave two blanket diagnoses before people basically were truly assessed. One was some kind of an access one, chemical dependency diagnosis, typically because it was an alcohol and drug treatment program, and the second was unresolved grief, and I'm not sure whether Dick was instrumental in that or somebody, but I was profoundly impressed by that. So when we talk about trauma. Trauma is the echoes of some loss of innocence and a form of unresolved grief. That's the way I was trained and when this mentor Dick he had a hip replaced, as we all know, originally, mentor Dick, he had a hip replaced, as we all know originally. And when he was out I took over his groups as just out of school and everything myself brand new, and he had about three groups and some of his caseload temporarily and I'd go visit him twice a week up at the rehab and he'd always say the same thing what have you learned this week, Grasshopper? It's an old reference that only the white hairs will probably get.

Speaker 7:

And finally, one day it hit me, and it hit me in conjunction with my own therapy, which I had an extraordinary therapist who specialized in all of this, an EMDR pioneer and other things, EFT. But one day I left her office and we'd connected the dots, as we did periodically, and I remember walking out of the office and over the tea and Newton, thinking to myself no wonder I did all the things I did, no wonder I needed sedation, no wonder it all made sense to me. I started to make sense and I stopped being that heartbreaking riddle to myself. And that's, I think, what trauma does more than anything, and as a therapist in dealing with it. And I remember saying to him, virtually in that same place, he said what'd you learn today? I said it's all grief work, isn't it? And he said, ah, it's all grief work, isn't it? And he said, ah, yes, it's all. He never told me. He made me discover it, as most of you did. You know, it's all grief work and the worst part of the more pervasive the trauma, the more dramatic the trauma, the longer the grief work sometimes. So the more tricky the grief work is because it's very difficult.

Speaker 7:

And I remember Mike Elkins, in the training a million years ago, said you know, if you're not careful, people that have been deeply traumatized will hypnotize you to despise them, because it's how they feel. They'll invite you to treat them the way they feel about themselves. You know, and kind of in the quantum aspect of it, you know, we know that the observer of any reality changes the reality you observe. And so we, as professional observers and assistants, you know, we have to be very careful of that and that's most of our work is around learning ourselves well enough so that we don't muck it up, you know, and well-intentioned harm. I'll end with this is most of the lessons I taught my grad students for many years were the mistakes that I made, and I remember I've said this before co-leading groups with Dennis when I was a student and I'd make some blunder and something would go wrong and I'd look over.

Speaker 7:

He'd be grinning because he knew that we were going to in his own way, which was subtle, but because we'd have a lot of grist for our mill of processing afterwards and he told me that you'll learn only from your mistakes. Everything you do intuitively well, you really don't learn from, and I didn't. I showed up intuitively well. The rest of it was quite a learning process and I learned quickly because I had great teachers, so unresolved grief, and so we talked in the beginning about trauma and grief. I don't think that they're. I think they're the same thing, just different stages of it, in a way. So what do you guys think?

Speaker 3:

One of the first things that I was taught and learned in my early training, way back in the 70s, was that it's just critically important to respect both people's health, but also to respect what you can understand is either pathology or woundedness.

Speaker 3:

Respect what you can understand is either pathology or woundedness, and I think that the woundedness is really a reflection of the trauma.

Speaker 3:

That's an extraordinarily sensitive area, along with being extraordinarily important, and I think it's important to be able to give people permission permission to be able to go to the trauma, but also permission to not go to it if they're not ready.

Speaker 3:

I think it can get pushed too quickly and people actually get re-traumatized. And people can re-traumatize themselves partially well, it's a defense, but partially as a way of both punishing themselves but also protecting the people who may have perpetrated the trauma, because that's what they know, that's what they were taught to do. So I think being able to sit with somebody and be able to tell them directly you know, we may need to go into this in more detail, we may need to understand it and look at it more closely, but we don't necessarily have to there is a way of being able to work it through. I don't know what the answer is going to be right now, but there is potentially a way and we'll do that together and I think that speaks to the establishment of the relationship also and I think that, the whole establishing of the relationship.

Speaker 2:

there's a couple of you here who've sent me people to do EMDR. One of the things I refuse to do as an EMDR clinician is if they're not in therapy with someone. I know they got to establish a relationship with me prior to doing that work so that they don't run away because it is difficult work to do the EMDR stuff. And I think that some people like give me EMDR and solve me. And there's some other places where they just do EMDR and then they come back and there's a little difficulty that wasn't quite related but it triggered other stuff and because they didn't develop the skills or relationship with a therapist, it becomes very hard for them to like, oh I thought I was cured and then get to the other side because they didn't have that priming of a relationship with someone. This is my experience.

Speaker 5:

Excellent point. I have two brief comments. One is the ability to pace the exploration of trauma. Dennis, you were alluding to it. So first you have to recognize that it exists, but that comes out of the client, that comes out over time as they are talking, because they'll say something and you'll see either a disconnect or something that a choice keeps on being made that's wrong or unhealthy. But the pacing is really important because you're exactly right, really important because you're exactly right. You're going to.

Speaker 5:

There's times, as we've all seen, where people are. Literally you know they'll be shaking their head or they'll say you know you can tell you have to read the client as you're sitting with them in a way that is holding and nurturing, but also knowing when to back off a bit and when to continue exploring. The second thing is that grief work. I just smiled because I have several people that are grieving their animals right now. I mean, and I've seen people grieving dogs in particular because they're so wonderful companions and they provide such consistent love. But I'm also realizing that our culture does not tolerate grief very well. People don't want to, you know, okay. Okay, maybe you'll go to a service when somebody loses a relative or another person. But it's all right, now we go home and we live our lives. But it's all right, now we go home and we live our lives. But the people that are losing get some resilience so that they can start to, you know, live in a different way.

Speaker 2:

that's healthier different way that's healthier. I think that you know I do talk about grief a lot in the Kubler-Ross stuff and there's definitely been some people who said it's been disproven. But what I always say is there's truth in what they say and there is. You know, I think that when I work with a lot of first responders which is something you all know one of the things I some of the guys like what can I do? What can I do? I said go check on them 14 days after the service. Don't, because everyone's going to be there for the first 14 days.

Speaker 2:

But there's this you talk about our culture. I think our culture is like oh you, you, you lost someone. It's been 14 days. And I say 14 days, you get the point, you're good, now you're all set. And I think that what I kind of pursue a lot of people to, if they have losses in their families or whatever check on them 14 days down, 30 days down, and so on and so forth. Because that's sometimes where the grief actually does occur, because sometimes, especially if it's a family member or whatever, you have to do the service and all. You're so into it that you don't have time to go through your own grief process service and all you're so into it that you don't have time to go through your own grief process.

Speaker 4:

So a little bit of what you're saying. I feel like I'm hearing so much wisdom in this conversation. It's just one pearl after another and I want to share that. For me, one of my great teachers was Aaron Lazar. I don't know if you guys had much to do with Aaron, but he was a marvelous, marvelous psychiatrist and he was a person who centered the idea of unresolved grief in his practice.

Speaker 4:

And the beautiful, beautiful thing about centering unresolved grief is it's so unpathologizing. You know, grief is a universal experience of being a human being and the idea that you have somehow incarnaled this experience. You were not able to face it, for whatever reason. Fully. You know, andy, as you're saying, you know, when you're a kid you're sort of doing the best you can with what you've got. So this unresolved grief stays inside. But when Aaron would talk to people in the patient role, it was so non-pathologizing, so humane and so much of what psychiatry, like the downside of it, is. It can be so toxic, it can make people feel damaged or broken or other, and unresolved grief is something that brings us very, very much together as human beings in the human family.

Speaker 7:

As I look at this crowd here of seasoned individuals, the fine print of the aging gracefully. Now, we spend so much time and energy in our culture trying to live long and somewhere in the aging brochure graceful aging brochure in the fine print there's an asterisk that says be aware that if you live long you're going to have to say goodbye a lot. And one of the specialties that came upon me in my practice and is going to bring me out of retirement, I believe because of the need, is specializing in helping parents scrape children when they lose children. The unspeakable hole that happens is mostly because one of my best friends lost a son six years ago and we spend hours every week together and we talk about it and it's kind of this mystery that he and he is an excellent person to help other people as there's such a network, especially in 12-step recovery, of parents who have survived children. The nature of the generational disorder is that there's an expectation and you alluded to it earlier that it's going to get old, will be done with quickly, you know. Or if you give it a year or two and then it, no, it never. That hole never goes away. You just have to fill it with.

Speaker 7:

I heard a wonderful phrase, for it is that the ache you feel from losing someone close to you is the knowledge that you have so much love to give them that you can't in the way that you're most familiar with. So what are you going to do with the love it's a heart thing, not a head thing your heartbreak. You heal your own heart by finding another source of love, which is what dogs and cats and other animals serve for a lot of people. As they lose people in their life, they sometimes collect animals. For a lot of people, as they lose people in their life, they sometimes collect animals. I'm guilty. I've been told I've evolved now into being able to handle a cat. So you know, I was a dog guy for many years.

Speaker 3:

I'm going to interrupt here and take on an old role of grenade tossing, if you're strong enough. None of this is true. What do you mean? Please explain Well everything that you're talking about. It's just a form of weakness. If you're strong enough, then this is just something that you get through.

Speaker 7:

How about missing a two-foot putt? I've seen it, I've seen it, I've seen it, I've seen.

Speaker 3:

Again, I'm grenade tossing in here but unfortunately, that's a counter argument that I think needs to get understood. Is that you know we're talking about? I mean, potentially we're talking about boy. You guys are just sort of padding your own nest. You're giving yourself lots of work to do, aren't you special? But I think that there is this, and it's a Western theory of what is strength. It's a matter of addressing, too, that strength is about being able to engage and tolerate the stuff that you're not really strong at, and it just as I hear all of this today, I mean I truly believe everything that's being said, but there is the counterpoint of well, no, you just need to be strong.

Speaker 6:

I find that what underlies that particular idea of toughness as in the, the grenade lobbed, you must always be strong and and macho is basic fear. It's, it's basic fear underlying, underlying that that's telling us that, oh we, we shouldn't trust the actual feelings, we should just put on a face or behave a certain way because that's what other people expect, slash, that's what's going to make them comfortable. A lot of we're reacting to other people, reacting to us, in grief mode. You can see the fear in other people's eyes just from the concept, from the concept of loss or the concept of that level of pain. It's terrifying, and so toughness is such a great wallpaper for all of that. Oh yeah, just suck it up, you'll be fine.

Speaker 4:

No, it's been exhilarating to me over the last few years to learn about the IFS model internal family system and the idea that we have these different parts in ourselves. So if the person is experiencing this toughness, that's a part of themselves, that that it deserves to be heard, empathically understood, and I love that model because that way there's this sort of this maxim. In IFS there are no bad parts. So even the storm trooper, super ego guy who's saying don't be a pussy, fuck ego guy who's saying "'Don't be a pussy, suck it up and be a man". That part has something valuable if we can open ourselves up to it. It's very exciting to me. It's sort of anti-pathologizing.

Speaker 7:

Well, it speaks to intent. I think that part the stormtrooper is well-intended to protect you. Basically go back and inform them. Thank you so much. We don't need you now. You can take a break.

Speaker 4:

Or maybe you'd be up for a different job. A different job Because actually you took this on when you were like 12 years old and you were looking at the world, as andy said, through your 12 year old eyes and you know you've got a lot of energy. Maybe we could. You'd want to do something else with it rather than be the stormtrooper one thing exciting it's I just want to say one thing.

Speaker 2:

There is someone in this room that has said to me that strength is asking for help, and it's not the grenade launching person, but rather chris gordon, who had said to me at one point reach out for help if you need to. And that's actual strength. So I just want to jump jump in and give credit to Chris for that. Please go ahead, Pat. I'm sorry to interrupt.

Speaker 7:

Well, that's a hard thing for men to do initially and that's what most of the mutual self-help groups do is teach people how to be very you know. They're invited to more easily ask for help and it's rewarded. It was the whole idea I was thinking about in our culture. I was working as a part of a pain management team with people that worked in hospice and you know it used to be that death in our society, especially in Western medicine, was treated almost as you wanted to de-ex-ex. Machina, offstage and you know. And then it sedate people. The grieving mother would be put on terpenhydrate or Miltown or something back in the day and sedated until all the dust settled and that two-week period the medicine stopped, the people left and then they implode. So I've known people that work in hospice and so there's much more of an honoring of the death process, being a part of it and having an active role in it and normalizing it and not pathologizing it.

Speaker 7:

And I think even in the best medical schools for many years, chris, you probably could attest to this is that that was seen as a loss. That was the enemy. Death was the enemy. Death was the enemy. Yes, the enemy is disease. Can we do something about disease and prevent it. Ultimately, we learned that the best thing you could do about treating COVID is not to get it. You know so it was. So again, grief is inevitable. It's we're just, I think, just getting better at normalizing it and showing people what, as you said, steve, and what Chris had said, is that the strength is in learning how to deal with it effectively. Then you have the superpower of being able to really be effective at helping other people with it, and that's when the humanitarian aspect of all of this healing really kicks off, and I think that's a real deal changer in our society and in the world today.

Speaker 5:

Yeah, I think grief has been stigmatized, and I think that we're seeing some of that just in terms of the relationships we're forming with other countries, that, for example, gaza and Ukraine. The losses that they have experienced, it goes beyond traumatic, it's catastrophic, and we're expecting people to just keep on going on and at some point point you can't, and so now it's a matter of how. Now, what do we do? And I think part of our role, as in the helping professions, is to try to, you know, allow people to be who they are at the moment and work through to something. On the other side, you know, I really see a lot of this. You know, chris, you used the word toxic.

Speaker 5:

I see a lot of things that have to do with grief or loss or abuse. You develop, you being the child or the young person, or whatever. You develop survival skills. Right, I can get through this, I will. You know, I'll get through it. This is normal, and he said it's.

Speaker 5:

You only understand. You only understand it's normal when you start going to other people's houses and seeing that their father doesn't throw the pizza against the wall when he gets pissed off, you know, when you bring them into your adult relationships and you keep on asking yourself why is it that you know these, these women keep on, you know, leaving me, or why is it that this and that it's? There is a dynamic that happens and you know, I'm not sure if it was Pat or whoever, but they said we own, we train people how to treat us by, you know. You know we're basically externalizing our self-concept and people respond to that, but it's just. It's such an interesting thing. I've done a lot of addiction work over the years and you know children of alcoholics if they can get by, they can get, they can get through but there's often a real relationship damage that has happened that they need to address, they, they should address if they want to have healthy relationships. And so that's just one aspect of it. But those are my thoughts.

Speaker 3:

I think it brings in another really complex piece to the trauma issue, in that, yes, I fully agree that it's important to be able to address the actual fact of the trauma, to be able to name it when possible and to give that its due.

Speaker 3:

But still, the dynamic of experience and how you experience and what you do with that experience is all critical too in terms of people being responsible that, yes, you did experience this and yes, this is a part of what your life has been. This is why you've developed patterns that you have developed. What do you want to do with it now? Because you don't have to change that if you don't want to, but you also don't have to live that way if you don't want to. So it's about empowering people to be able to, giving them some agency to be able to make a decision about. I can do this differently, and I think that that's also maybe another definition of being resilient is being able to say I have a choice as to whether I can change or not. Given what's given, I can make a change.

Speaker 4:

I'd like to introduce an idea here. If it takes us too far down another path, we can put it on, do it in another podcast. But one of the ideas that I've found very valuable in teaching psychiatric residents over the years is this idea that when a person is caught up in a recurrent pattern like Bob was describing, very often the person cannot see the pattern. It just feels like life is unfolding itself. And you know why are all these women leaving me? You know, the constant in that equation is you, but that's not how it feels. It just feels like you have bad luck in finding bad women.

Speaker 4:

And one of the ways that I try to get this across to sometimes with patients and sometimes with residents, is the idea of the problem has no edge. And the way I like to illustrate this is are you guys familiar with the idea of the magic eye pictures that just look like blurs and if you can unfocus your eyes, the thing jumps out in three dimensions. Well, you know I think Andy was talking about eureka moments that's a eureka moment when you suddenly realize, holy shit, that's what's going on here, and I feel like you know that. For me that's a very vivid idea that if we're working with a person on a problem that has no edge in the addiction world. That would be their pre-contemplative. They don't even see the problem. But when they start to define that edge, then it gets so exciting and different things become possible. So I just wanted to share that Excellent.

Speaker 6:

I'll take that one deeper, chris, on that example, if you've ever sat in front of one of those photos or pictures and not been able to get it, it's very frustrating, very frustrating you start to squint, you try really hard to get it.

Speaker 6:

Yeah, it's very frustrating, very frustrating. You start to squint, your try really hard to get it. The harder you try, the further the picture goes away from. Exactly exactly. So we often find people right in that exactly, and you know we have to. You got to pull them back Exactly. And I said you know, buying more guns is not going to make you feel safer. And it was this idea of what's the edge, where's the what's enough? Yeah, what do you think you're protecting with your armaments? You know, and it's just an amazing metaphor, metaphor, but he's also living it and creating a whole arsenal around himself that is ostensibly protective but that also then completely distracts him from what the real fear is. We had to go through that. This is more along the lines of the grenade concept too, I think of just, you know, how do we protect ourselves and what skills do we have to make everything okay day to day? For this guy it was yeah, arm up.

Speaker 7:

I think that one of the reinforcing things, certainly for me, and I bet you guys can identify at some level is, chris talking about that eureka moment. Oh, when, when you get the person, they finally I the first time I tried those was in a room full of other people that had the same one and that was the last one to get it. You talk about increasing pressure, but when someone actually has that moment in front of you where you start to see the realization of self-awareness or a reconnection to their sense of who they really are, whatever it is the moment, it's like you see the pilot light of hope come on again. Yes, and there's nothing in my entire life, personally and professionally, that is more reinforcing than that. That's when I think you start to realize my God, this stuff can, this really matters, it really works and someone is coming back into the human race. I think at that moment and that's why all of this due diligence and work, both as individuals and as helpers and facilitators, to me is so incredibly worthwhile.

Speaker 5:

Amen.

Speaker 7:

The pilot light of life, that's a great term. I had to get away from it, to miss it.

Speaker 5:

I'm ready to go back.

Speaker 7:

It's true. How can I miss you when you won't go away? That country song, you know, I saw such a funny cartoon the other day.

Speaker 4:

This doctor is talking to this really decrepit, like 90-year-old guys, you know, barely alive. And the doctor is saying to the guy you know, when you were young and you did all that exercise so you could live 10 more years in your life, this is those 10 years.

Speaker 7:

Thanks a lot.

Speaker 4:

All that jogging, all that jogging for this.

Speaker 7:

Yeah, my dad said he was going to take up jogging as soon as he saw one laughing you know what I was thinking, steve, that that the first responders.

Speaker 5:

I just shook my head because the amount of stuff they see and they encounter and they deal with and they have to absorb, it's unbelievable and I think you have done a lot of work with them and I did some work with folks who were first responders, but it's we have. Really, I think most of us and then the general public doesn't really understand the amount of pain and suffering and angst and anger and just whatever you wanna. There's a lot of emotions, but they are dealing with it on a regular basis and I really hope that they can come in more often to unload some of that. And I give you a lot of credit for working with that population because they, when I've worked with them, it takes a while to get some some trust going. That's exactly what I was going to say.

Speaker 2:

I think that one of the things that's you know, first responders want to know how you can handle that. That's the first and foremost thing that I find, and sometimes it takes six months, a year to two years to build that relationship of oh, this person can handle me, so to speak, before the actual great work, so so-called worker I know that was all a lot of work to build that relationship, but I was going to talk about that because that's exactly what it is. It's like those therapeutic aha moments with them is to realize that when you have eight to 12 major events throughout your career, 20-year career, nevermind the 3,000 small events that you had during your career the strongest person in the world will be affected slightly, if not a lot, and some people handle it well and that's you know. We don't want to pathologize every single first responders in the world, however, what's wrong with getting help when you have something that most people like, I think, my favorite sentences? They deal with the 5% of the world that 95% of the world doesn't know about, and when you're dealing with that type of environment, you have to show that you're able to handle it, because it's very hard.

Speaker 2:

My work with first responders and I appreciate Bob for bringing that up is really about, like you know, what I've started doing is I do CIT training here in Middlesex, massachusetts, for the police departments, and one of the things I do is I do the trauma part and I say, okay, let's do the ACEs.

Speaker 2:

If you're not, if you're not aware of the it's a adverse childhood experiences and I leave it up there and just say, hey, look, maybe when you, when you meet children, that's what's going to happen.

Speaker 2:

I don't throw it up there and if you guys know, if you guys are listening, sorry, I put it out there so that they start scoring themselves and they score themselves and I always say afterwards I'm like, all right, just for the record, over four is usually you gotta have some sort of trauma, ptsd, but typically first responders have eight and you see them all drop their eyes and they they like oh gotcha, so to speak. And I think that that's why, when you talk about what you don't know as a child, you grow up. A lot of first responders go into this field to help people, just like we do. And yes, therapists, by the way, I'm sure their numbers are in the six, seven, eight, also for the record, but I think that I want to throw that out, because the ACEs stuff has been part of what, in the last six months, two years, has been a very transformative work that I do with my clients.

Speaker 4:

That's really great. I was just reflecting when I retired from Advocates and I had been doing that work for like 25 years and my first love at Advocates was the emergency service and I love doing psychiatric emergencies. People are you know, they're.

Speaker 4:

They're in a crisis and a little love goes a long way and it's really really great work. But I know I was feeling and I would tell Julie about it I feel I was feeling like an odor eater. You know the thing you put in your sneaker that soaks up the odors. I felt like I was sort of like an odor eater, like I just was. There was so much suffering and it was. It was kind of it was a heavy weight and when I, when I retired, it felt like I could kind of exhale in a way I hadn't in a long time. I imagine first responders experience something similar. They respond and they don't have any idea what they're walking into and very often it's a horror show.

Speaker 3:

I think the application of the container theory works there too, because we are all containers, yeah, and you know we take in so much and it's important to know that we can only take in so much um and uh.

Speaker 3:

Then it's important to find ways to be able to let that container empty yes, and uh, that's critical, I think, with, with, for all of us in our work, but first responders, because in some ways I think in many ways we are also experiencing a first responder dynamic in many circumstances, but an understanding that we get filled up and when we get filled up it gets very heavy and it gets very hard to maneuver.

Speaker 5:

I see that First responders move toward.

Speaker 4:

they move toward the fire, and that's what we have to do a lot of the time, too, is move toward the fire that other people want. We just want to get the hell away from it.

Speaker 5:

I'm hopeful that first responders can get some training in how to prioritize your own self-care or as self-compassion or understanding that there's a connection between your past and how things are affecting you now.

Speaker 5:

I mean, I see it at the clinics with younger clinicians. See it at the clinics with younger clinicians. There's more pressure right now because there's a tidal wave of need, but it's a matter of trying to figure out how do I set limits and sometimes say no or sometimes delegate or sometimes basically decide that you're going to take a little bit of a break for yourself and, frankly, on a regular basis it helps because you need to unload. You know it's almost like when the garbage gets picked up. You know once a week we get, you know the cans are empty and it's. I think it's important for us to do that and I've. What I see with a lot of younger clinicians is that you know, if you're only in the field a couple of years and you're already feeling like you're getting burned out, this is something to really be cautious about and we I think first responders probably encounter that, but I don't know if the culture of first responders is a welcoming kind of place to unload that.

Speaker 6:

That's a really key distinction, isn't it? It's this we have the ability to sit and talk and use words to reason stuff out, and I can call any of you at any time with a question or a concern if I'm freaking out. I think in that culture it's rare to find that. I think in that culture it's rare to find that. I'm sure it exists, but that's the overlay of how tough we are, you know, tends to obscure their ability, I think, to do that. But they might whisper it in the bunk after you know, or just I'm sure they're finding places to release that.

Speaker 2:

But maybe something more programmed and intentional would be very useful and help dismantle some of these ideas of toughness that get in the way in the community is that you know, if you address whatever happened, the event that occurred within the first six months, it can remain in an acute stress disorder environment and not necessarily become PTSD. And I talk about asking for help is actually helpful for you in the long term to keep your career going. But you know, the sentence I hear all the time is you know, one of my least favorite sentence I heard is from veterans in the first responder world. Well, I survived 20 years of this stuff, a little bit of that grenade. I've survived 20 years. Why would you need therapy? I survived 20 years without therapy. Why wouldn't you? And that grenade that occurs even within the stigmatization of mental health. I mean, I can talk for hours as to what goes for first responders and what they go through.

Speaker 7:

I actually developed. It found me especially. The first responders that I worked with were people that were paramedics and emergency room people who had suffered death despite their best intentions or their expectations. There was death there, and often the supervisor or someone, because I was always in the emergency room for the psych stuff. It was an intimate, small enough place where I would spend a lot of time just debriefing them quickly, and if there was a suicide on the unit, I was one of the people that would go in and just debrief people, just get them talking and normalizing this.

Speaker 7:

The fact that, well, I've seen it before, yeah, okay, what'd you do about it the last time? And it's not about surviving 20 years of survival. It's living well while you're being affected, and that's the difference. And again, I remember my mentor used to do the you know. I remember his seminars on care for the caregiver and all of that. Are we taking our own advice? He was a specialist in the silver rule, not the golden rule. The silver rule is treat yourself as nice as those you truly love, and if you're doing that, then you're you're going to keep yourself in the game and in a good, healthy place so you can then be a good partner at home and a good friend and whatever, and and uh and good company. You know, um on the golf course is all you guys well as we up.

Speaker 2:

We're going to wrap up here because we're getting close to the hour already. This is an amazing conversation. Like I said, we're going to bring a colleague hopefully, next time on, and I could talk about all this stuff every single time. That's why the mental men are so essential, and I think about the years of experience in this room just sitting back. This is my favorite part, not that I don't like my other guests on the podcast. I sit back and listen to you guys. I put in my two cents just to be the hoax and pretend I know something, and you guys are just absolutely amazing. I think that if we talked about trauma, grief and first responders, we'd have 24 straight hours and we'd still have a conversation. So thank you, guys. I really truly appreciate it. Thank you.

Speaker 7:

Thank you, Steve.

Speaker 4:

Thank you for having us Great conversation.

Speaker 2:

Yeah Well, we'll continue. You guys, you know you're coming back right. It's not a question of if, it's a question of when. So don't worry, I've got you on the books already.

Speaker 4:

Great, so long guys.

Speaker 2:

Well, that concludes episode 197. Again, the mental men. Thank you guys. I can't say enough of having, like I don't know, 200 years of experience in one room and being the kid in the room, which is perfect for me, so really enjoy that. But for episode 198, we're going to talk about therapy process. A lot of first responders might know how therapy works.

Speaker 1:

It doesn't do what it does do. So we're going to do that in that episode and I hope you join me then. 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.

People on this episode

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Steve Bisson

Host
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Courtney Romanowski

Co-host