E.25 The Most Popular Episode, Crisis Work with Cara Tirrell and Bill Dwinnells

The most popular episode turned out to be the most complex editing work I have encountered in this podcast. Who knew the episode on crisis work would end up the hardest to edit? Shoutout to Laura for her amazing editing work. 

It  is all about crisis work. Cara Tirrell and Bill Dwinnells will discuss their work on a crisis team. We share the ups and downs, the challenges, as well as all the lessons we have learned from that work from our combine 50+ years in that particular field. We also look at the effects on the clients and how we can create rapport in about 5 minutes during a crisis situation.


Bill Dwinnells can be reached for counseling at www.billdwinnells.com and if you want to know about his software for crisis team, go to 508tech.com

Cara Tirrell can be reached for coaching at www.caratirrellcounseling.com/

Transcript

Steve Bisson: 0:01

Hi and welcome to finding your way through therapy. I am your host, Steve Bisson. I'm an author and mental health counselor. Are you curious about therapy? Do you feel there is a lot of mystery about there? Do you wonder what your therapist is doing and why? The goal of this podcast is to make therapy and psychology accessible to all by using real language and straight to the point discussions. This podcast wants to remind you to take care of your mental health, just like you would your physical health. therapy should not be intimidating. It should be a great way to better help. I will demystify what happens in counseling, discuss topics related to mental health and discussions you can have what your thoughts I also want to introduce psychology in everyday life. As I feel most of our lives are enmeshed in psychology. I want to introduce the subtle and not so subtle ways psychology plays a factor in our lives. It will be my own mix of thoughts as well as special guests. So join me on this discovery of therapy and psychology. Welcome to Episode 25. Episode 25 is the most popular episode of season two. I do this every season and the most popular episode was probably also the most challenging episode. And that has nothing to do with the guests that I had. But all the problems afterwards with the recording the recording just did not go well overall. And there was a lots of difficulties but lots of lessons learned here. A lot of them I put in place now. But I want to give a shout out to my amazing editor Laura, I cannot say enough good things about her. She is just truly amazing. And for most of you that episode came out flawless because it turned out to be the most popular episode frankly, in this episode I'm meeting with build when ELLs and character L and we're talking about our work on the crisis team and how it impacts clients how it impacts us, and how we've carried lessons to this day in our jobs. So was probably the one I would have said that is going to be the most popular interviews tend to be most popular at this point. But I hope that you enjoy this replay. Hi, and welcome to finding your way through therapy. My name is Steve B. So if you haven't listened to Episode 20, I urge you to do so because it's going to be a great precursor to episodes 2122 and 23 for the rest of the season really on trauma and PTSD. So I hope that you have listened to it. If you haven't, go back, listen to it. And episode 21 will be here anyway. So episode 21 is about crisis work. And I'm meeting with character out and build windows, both crisis clinicians that I've worked with in the past, between all of us, we have about 50 years plus of experience with crisis work in it was an immense pleasure to set it up. And I'm hoping that the interview goes as well as just any conversations we've ever had in the past. I think we're going to talk about a lot of how it affects the actual crisis clinician, how it affects the clients, the complexities of it, and how it can be challenging, as well as very rewarding to do this type of work. So here is the interview. Hi, and welcome to episode 21. I'm very excited about this episode because I'm talking about a very serious subject. But at the same time seeing old friends is always very nice. So I'm sitting here with character L and build windows. We've known each other for about 20 years, but you know, maybe the audience doesn't know who you are. So how about we do a quick intro, how about we start with Bill?

Bill Dwinnells: 3:33

Hi, my name is build wells. I've been working in Crisis and Emergency Services for about the past 25 years. I've also helped develop software to help programs run emergency services, that software can be fine found at 508 tech.com. I also have my own private practice if anyone wanted to get in touch with me that way. That is that build when els.com Again, that's built when els.com

Steve Bisson: 4:03

Looking forward to hearing more about that and Kara, your turn to introduce yourself.

Cara Tirrell: 4:08

Hi, Steve. And Hi, Bill. Thank you for having me on. Well, recently I just opened up my own practice therapy, Terrell counseling. And I had been in crisis work for probably over 15 to 16 years I did elder protective services. So I investigated elderly abuse. And then I worked with both of you doing some psychiatric emergency services. And I did that for awhile. And during that time Bill was actually my supervisor during some of that time and I still appreciate some of the helpful things that he you know, supported me with. So that was helpful at that time and I've gone on to work with quite a few different populations. Working with municipalities, like I said onboarding Task Force, being a Director of Youth and Family Services. I worked at the Housing Authority I've worked at several senior centers, and I have my Master's in Counseling and Psychology from Lesley. So that's kind of where I am now.

Steve Bisson: 5:10

Welcome, Cara, and I can't believe we've known each other for this long, you have a great office. So that's kind of cool. I'm looking forward to hearing a little bit more about the work that you do. Tara Kara, so please, let me tell me more about it.

Cara Tirrell: 5:24

Sure. So I think that, like I said, it's probably been over 20 years that I've been in and out of crisis work. And originally, a lot of the work that I did was actually going into homes. So some of the crisis teams are different. And we'll talk about that a little bit. But usually it's based or has moved towards being based in local ers. So if someone's experiencing a crisis, if they're feeling like they're gonna hurt themselves, or someone else, their psychosis, substance abuse issues, they can go to the local er, but back in the day, we did a lot of homework, meaning that we went into directly into people's home after a call. And when I look back now on that, it's a little concerning, because I think at this point, you know, going into a home by myself, you know, it's probably not the safest idea. But at the time, I was young, that was very brave. And I felt like I knew exactly what I was doing. And I learned a lot too. And then I ended up at a local emergency service work. And I stayed there for about 15 years, and I worked there simultaneously when I worked for the town as well. So you know, why it was advantageous to me at the time was, it was very flexible work, you know, you could do it at night, or on weekends, we were 24/7. You know, there was a varied amount of work you could do there, you know, there's a work that you could do for triaging, you could do the actual evaluations, you could do, you know, facilitating the insurance piece of it, finding beds for people, that was a whole piece of the job, too. So I think it was probably the best place to learn something, I would recommend it to anybody starting out in any type of psych work? Well, I

Steve Bisson: 7:03

definitely know that we've changed how we do crisis work in general. And I know that just going back to some of my past episodes with Sergeant J ball, and how we now even call responding police in the house of people so that way, there is more safety doesn't guarantee anything, but we've unfortunately seen in Massachusetts, Illinois, Texas, and everywhere else that there's been, unfortunately, negative outcomes from people's houses. So it's very important to mention that. So I really appreciate that you said that. Even after doing this, like you said, You dated yourself too, right. But when when you really think about it, when you go back to what we used to do I sit there going, I had a lot of balls at 17 or 23 2017 years ago, that I probably go today. So

Cara Tirrell: 7:54

yeah, Steve, Well, I didn't have any balls at 17. I definitely had a lot of guts. And I felt very brave going into those homes. And I'm glad you know, and I think you guys would agree, the experience that it gives you, again, is unbelievable. And working with different departments, like you said, the police department, the fire department, we worked with doctors, nurses, EMTs, you run the gamut. And you really, really develop a skill set, that's second to none.

Unknown: 8:19

Let's call a very important to just for the record, just a very important to so I just want to go there. And I can't believe you don't think it's 17 I had any balls myself. But anyway, that's another story for a different day. Bill, how about you tell me a little more about your history with the crisis.

Bill Dwinnells: 8:35

For the most part, I got in crisis work right out of grad school, I had, I had also been working as a part time firefighter EMT. So I was kind of familiar with crisis work in general. And I really wanted to develop some skills to be able to work with first responders. That led me to find out about emergency psychiatric work. And I just sort of gravitated towards it because this really is psychology's version of the fire department. And when I got into it, I've worked for a number of different emergency service teams. You know, over my career, as I said, I've been the clinician, the supervisor, the director, I've been able to assist multiple police departments and setting up jail diversion programs. I actually have one right now that we're writing the grant for. So there'll be hopefully coming online soon. And, you know, I've just really worked at being the person who can walk into chaos and restore some sort of order, which I think is, you know, a skill that all of us develop during crisis work. You know, that's what I really like about it. And as I said, I've worked my way up and moved around to different teams that needed my help, and did what I could have done Usually now I've you know, I've kind of slowed down a little bit more, as you talked about, you know, things have changed. I'm not quite as quite as spry as I used to be. So I've slowed things down a little bit, and then got into private practice where I still work with first responders. And I've even worked with some former crisis workers, you know, helping them deal with whatever they have to deal with. So it's been interesting.

Unknown: 10:26

I do remember a time where we go into the emergency rooms, and there was beds just about everywhere. And with time, I think that would have changed and they put in certain areas. And just for the record your you forgotten important time because we worked all together at the same place. You used to be the Director of respite on the overnight. You used to be able to do that, if you remember those days, we were based out of Massachusetts, and I think we all worked together from what like in the like the early 2000s. So I don't want to date us too much. But I want to say like in 2000 to 2003. Yeah.

Cara Tirrell: 11:02

Yeah. And, Steve, just to add to that the craziness of and I use that loosely, of course, the environment was challenging. You know, we were all in one room. And like you said, in the other room were people in respite care, which means that they were basically temporarily living in our office in another room, while we were answering crisis calls 24/7. Again, that's a very unusual setup. And I think it made for, you know, a time stressful environment, environment. But also, you know, I think it's one of those things you do when you're young, and you do get that experience so that you can use it in your future work. But we also had a lot of fun. You know, I think there was a camaraderie there. And I think we all promote each other and help each other and not only going into the ER, as the home visits, we go with the police, we go into the prisons sometimes or the jails, you specifically worked closely with the jail diversion program. And we would work in group homes. So we saw so many different types of people from zero to 100. I mean, we saw children, we saw young adults, we saw teenagers, we saw elderly, we saw everybody in their crisis, Satan it, it was tough at times. And I wonder, you know, I'll put it back on you guys. I look back and think, you know, some of our coping skills had to be pretty stellar, because you know, we were dealing with trauma on a daily basis, deaths, violence, there's a lot of in crisis in itself is a high pressured environment. So I would say to you guys, I mean, I, a lot of times we'd use dark humor, you know, we'd make jokes. And you know, it's just kind of this environment where you couldn't really you had had to have tight boundaries. And you had to be pretty professional about things. But we also could laugh about ourselves, too. What do you guys think about that?

Steve Bisson: 12:53

I think that dark humor is essential for our work, as I think that it is for first responders. I always considered us first responders and a half, if that makes any sense. But the one lesson I learned is that mental health does not discriminate. One of the things that I remember is that mental health, whether whatever your so your socio economic status, your racial status, sexual orientation, what have you, it doesn't discriminate, and it goes from the youngest person I've ever seen was three years old. And the oldest I ever saw was, I can't remember, I want to say that they were in their mid 90s. But you know, what I've really learned is that it doesn't discriminate whatsoever. And that was a lesson that I remember really finding helpful in regards to the work that we do. And I'll turn to you guys, maybe you can help me out. What are your thoughts about mental health? And how it does not discriminate? And how it affects so many people in the work that we do? I

Bill Dwinnells: 13:53

completely agree with you, you know, I mean, it certainly does show how, you know, mental health doesn't have any boundaries when it comes to that. And, you know, to play off what both you and Kara had said that the skill set that you develop, as a crisis clinician, you have to develop the ability to interact with all of those people. You know, the way I interact with a three year old is different than the way I interact with a 93 year old, which may be different than how I would interact with somebody who's Asian versus Italian. You know, so you, you end up learning how to interact with people and build rapport in a very short period of time, with people of extremely diverse ethnic, and racial backgrounds. And in some cases, two, I know all three of us have had this experience, people with different developmental disabilities, you know, and how to interact with them, you know, because it is all slightly different. It's not one approach fits all. You have to be able to adapt and many times adapt on the fly, too. what the situation is, you know, 15 minutes ago, I may have been talking to a five year old. Now I have somebody who's completely opposite end of the spectrum. You know, I think in that you end up developing some really good skills that just makes you a much better well rounded therapist,

Steve Bisson: 15:17

and a better human being for doing the work that we do. I mean, a great stuff, we worked with a lot of different people with different types of issues. And one of the things that I remember is they wanted relief. And, you know, we learned how to meet people where they're at, and how they can really get some support from us, despite not bringing the full relief that they probably look for. But it was so important to play that role in what we've done in the emergency room and what you continue to do, obviously, you bill in the emergency rooms at this time. Yeah, Steve,

Cara Tirrell: 15:54

I could add to that, because when when Bill was talking about the different types of people you would encounter, and again, in their darkest days, too, and in a high stress environment, which is the ER, which is nonstop, almost everywhere you go. And we were pressured to do things in the time sensitive way to, you know, we always had to be mindful that a client had to be seen at a certain time, there are regulations that dictate that we see them within a certain amount of time, they can't be at the ER for longer than they can't be there too long, until they see somebody. So there's, there's regulations that we had to go by. We also, you know, when I'm thinking about it, Bill was sometimes people, they didn't speak English. Or we encountered someone, like you said, with developmental disabilities, for someone who was deaf, or we had to use an interpreter or a sign language interpreter. And we'd wait. Yeah, we would wait hours sometimes waiting for the interpreter. And we had to fill out 12 Page evaluations. And I know, thank god Bill has come to the rescue for that. And I don't think anybody other than someone who's sat there for, for hours filling it out, would have that sense of, of why it's important that it's easy, accessible, and I know they do everything on the computer. Now. Back in the day, we'd have to write everything out. And we had to make sure we checked in with the doctor, the nurse collaterals, we had to make contact calls, and then check on insurance, facilitate approval through insurance, which is always a nightmare. And then call to the different hospitals, like you said in the entire state, to see if there's a bed for, you know, a certain aged person who presented with these certain behaviors. We also dealt with people who had substance use disorders. And times if they were intoxicated, when they came in, or they had had a high BHEL or they had to wait for their tox screen. That was an added issue to look at.

Steve Bisson: 17:51

Blood alcohol level.

Cara Tirrell: 17:53

Thank you. Everything in crisis work is an acronym. Everything.

Steve Bisson: 18:00

Absolutely. And I agree. Just a reminder, we're listening to finding your way through therapy. I am Stevie. So I'm sitting here with Kara Terrell and build when else we're talking about crisis work. And yes, you're talking about all the acronyms IOP, AND C bad and pH and you know, those are all acronyms that we needed to know, intensive outpatient partial hospitals, children behavioral programs. But finding the right placement and getting approved was such a hard process and sometimes was very daunting to get everything that we needed. And what would happen is that we'd have to tell people like until we get the beds, you will end up waiting in the ER and we didn't have a timeframe, right. And even though it was difficult for us, we weren't professionals, we were trying to be the best we could, in regards to letting them know what was going on. We really didn't know how long it would take. And to me that was a very hard part because you never had a real answer. And you know, people again, looking for relief, looking for what how to feel better, is what was going on. So you know, what I want to turn to you guys and ask you is what do you think was the hardest part for you in regards to those moments and how to deal with them? Because it happened very often. It's not like it happened once or twice. I would say that it happened weekly. And I think about Saturday nights, I think about Friday nights. And sometimes even Mondays where we would end up having that. So what was the hardest part for you

Bill Dwinnells: 19:26

guys? In my experience? It's always been tough to have somebody who's in the middle of a crisis and telling them they have to wait. And sometimes you have to tell them that they have to wait really indefinitely. There are multiple factors that go into why the wait, I mean, Kara did a fantastic job kind of running down the whole list of everything that we have to do from checking the insurance talking to the doctor talking family talking to everybody, but I think you know the one thing that she forgot to say A that can complicate all of this is that's assuming nobody disagrees with us. You know, we've had that sometimes we had the doctor disagree with us, or the insurance company or the family or whoever, any anywhere along the line, there could be a disagreement, and that slows everything down. Whether they are young, old, hard of hearing, or blind or speak a different language, the option for us to not serve them is not there. And I think that's one of the other things that you learn in crisis work is that failure to a certain extent is not an option, we have to find a way to serve these people. Unfortunately, sometimes that does mean long waits. And sometimes it means telling folks things they don't necessarily want to hear. But the long waits can, you know, impact people, I've certainly had people who had to wait days, some people have had to wait weeks. And then er, you know, while trying to find them a suitable either a suitable placement, or a suitable alternative to placement. Because we do that, too. We always, you know, when I'm working with my clinicians and my staff, I tell them to go in with Plans A, B, and C, to see what we can have happen. And, you know, the clients and their families become very frustrated over the waiting. They don't understand because, you know, they're not with us, we know what's happening, because we're working on it. But I think it's important for, for clinicians to keep that in mind, that we know what's going on. So it's not as frustrating to us still frustrating, but not as frustrating to the family who feels like they're not being told anything. We just need to be mindful of that.

Cara Tirrell: 21:46

Yeah, I think I agree with Bill that some of the issues that come up with someone, usually people weren't, they were at first happy to see us because they thought that, you know, they'd get an answer, or have some movement. But when you've been sitting like Bill said, for days in the ER, and you know, one of us comes on as a new person on the next shift, we have to take over for whatever the whatever has happened, you know, I did for years, the Sunday shift, seven to one, so I would, you know, the call would come in at 630. We have someone over at this er, they've been sitting there since Friday night, they came in intoxicated and making statements that they might hurt themselves. We've done a bed search every shift, we you now have to go in and figure something out. And just like we had regulations that we couldn't keep people just sitting at the ER with cert without services, we also can't just let people leave if they've made statements of safety issues. And that is, you know, a pretty big responsibility. And and like Bill said, we we do several consults with every client that was, you know, the regulations and the requirements and the policy. But that's a tough responsibility, because it always was, you sign that evaluation, and you put your bought your name and your professionalism down. And you just tried to do the best you can. We all saw like hundreds of clients.

Steve Bisson: 23:07

And I know that I was there on Sundays with you, I used to be your buddy. Yep. And you know, one of the things that I realized is that in being a new situation, it was very frustrating, not only for the clients, but for us. And we would do our best to kind of Calm down everyone. And what I mean by that is we're also really affected the hospitals, it affected so many people, you had all the resources that you could find, because we create good relationships and a community, we had an agency that had good relationships, but sometimes it was hard to find those beds, especially on the weekends. And finding an inpatient at anytime is hard. Yeah,

Bill Dwinnells: 23:43

there's a very serious lack of resources for people who are who are in need of that level of care, it becomes very problematic to get folks in there. And I think there are multiple factors to that. I mean, one physically, I just don't think there are enough beds, to one thing I do think happens is a lot of people have this magical thinking about what happens when they go to an inpatient psych unit. And they think they're gonna go there, they're gonna get magically cured, I can tell you in the statistics will back me up on that, that very rarely ever happens. What really happens on the inpatient psych unit, and believe it or not, I'm not trying to say anything negative about them. But the patient goes there, and is able to stabilize, really in an artificial environment. They're given meds and they're very, and then they become very well adjusted, again, to an artificial environment, not where they live, which is what caused them to go into crisis in the first place. One of the things we find is probably 80 to 90% of the people who are on inpatient psych units could have just as effectively been treated, if not better with community providers, who would then show them and it's struck them on coping skills to work and live within their community that they're going to be returning to, as opposed to this, you know, artificial, you know, in some cases sterile environment of an inpatient unit. It's always been my mission, and, you know, my team's mission, to work with people in the community in where they live, how they live, and really embed ourselves in that to get folks to where they need to be. And so they can function on their own, again, in their own home communities. You know, I think that's one of the things that's very important. One of

Steve Bisson: 25:35

the things I remember also is that inpatient was the goal for some, and especially for some of the clients and the families. But for us, it was always about diversion and keeping him in the community and finding those resources, which is so important for them. And I really appreciate when we would find something in a community versus sending him an inpatient, but I know that that frustrated a lot of people.

Bill Dwinnells: 25:58

Yeah, I mean, we definitely want to keep people in the community, it is an absolute last resort, for a couple of reasons. One, like we said that that just aren't enough resources. You know, there are also, you know, what I was talking about, you know, in my opinion, better treatment in the community. And it's just changing the mindset, but a lot of people have this mindset of like, Oh, I'm sick, I go to the hospital, which is true. However, instead of thinking, I'm sick, I should go to the hospital, you know, I would like to see the change become, I'm sick, I need some assistance, that maybe your hospital and if it is, we'll find you a hospital bed. But there are many, many steps and many programs prior to hospitalization, that can happen and can be just just as if not more effective, than, you know, going to inpatient unit.

Steve Bisson: 26:51

I certainly agree with you that we have to work our community resources. And also make sure that the clients know that the inpatient stay is the last resort, this is actually never going to be the first resort. It's really keeping them in the community, because inpatient is so artificial, as you stated earlier, Bill, and I agree with you wholeheartedly. So how, you know, I always tried to make sure that they knew that before we got to where we got if it was inpatient?

Cara Tirrell: 27:20

Yeah, I would agree with that. And, and I think, Bill, you know, the original thought was going to the ER, was to get medical clearance, too, because that was a big part of it. But what's become problematic about it, I think, that you're talking about is kind of this backup where, where you'd have all the psych patients, you know, not even having rooms or, or any privacy or confidentiality, because it's so, so false. And that's, that's really a tough, tough place to be for us treaters and for clients.

Bill Dwinnells: 27:49

Yeah, you end up having clients sitting in a hallway. You know, then as a clinician, I'm called in, and I need to do a pretty intense psych evaluation, while this poor person is sitting in the hallway, you know, so confidentiality is out the window at that point, you know, we're just doing our best to help the person hold on.

Steve Bisson: 28:13

And I think it's important to mention that it's hard to hold on for them. But it's also, you know, there's a hard part for the therapists and managing these situations, whether they are on the, they're not in their room, they're in the hall, or managing how they're feeling, and really being able to sit there with them, and making sure they're comfortable. While we're asking them that very tough questions. It's never easy to be in that position for anyone. But I certainly think that they really, you know, this is something that we need to think about how difficult it is for therapists to because it's managing how we ask these questions, and how do we make sure our clients feel comfortable enough to answer these questions? You know, if you're a male, asking a female about sexual abuse or assault, I mean, that is obviously difficult. We obviously have more females that work in the crisis world than we do males, but thinking about the comfort level of our clients, to make sure that they're able to open up and being able to talk to us, is very important. And sometimes, you know, really the biggest challenge that we have,

Cara Tirrell: 29:16

and I think the other piece that's challenging as someone you know, you talked about coming out, you know, you do have to have a level, you have to have a master's to do this work. So you have to have a high level of education, and you have just come out of school or maybe you've been in the workforce, but you go into crisis work and you're limited to a half hour to an hour with the client and has have to like you said Build, develop rapport. You know, it's not natural because we, you know, learn so much in school about developing are a poor supporting person, providing with them support. So you have to do all those things while you're getting trauma history, substance abuse, history, information about a person that's It's tough to talk about, and you're doing it in a really short time. So you do have to develop those skills very quickly to do it in a time pressured way, as well as recording everything I got to the point where, after 15 years, I could take notes. So easily, I only had to put down four words or something. And then I'd go into we had a little tiny room that we'd all crowd into, to do our, our work afterwards. And right next to the bathroom, and write it all down in coherent, high level clinical information presented to a psychiatrist, which oftentimes had to be within like, a minute or less. But with all the pertinent information, then present to the insurance company, again, with high level information and clinical information and describing the client's diagnosis you we also had to diagnose people. And I think that's an important part to know that this is a very high level, expectation and responsibility. And I don't know, if we were always given the support that we probably needed.

Bill Dwinnells: 31:09

I think one of the important things that you you touched upon Kara, and I don't think it can be emphasized enough,

Unknown: 31:17

is the education.

Bill Dwinnells: 31:20

You know, the folks doing this work, as you said, have a very high level that level of education. At the same time, none of us were trained to do crisis work, that's not part of the curriculum have a graduate level course. Because at a graduate level course, they're talking to you about how you develop rapport over the next two to three weeks. In crisis work, you have about five minutes to develop some sort of working rapport, at least enough to get through to this person, you know, and I mean, let's keep in mind that the questions you're asking these people aren't, Hey, how's your day? It's telling me about your sexual abuse. So I know you only met me 15 minutes ago. You know, so it's, how do you get around that? You know, I've always thought there should be some sort of required course, at, you know, in graduate level education that goes into crisis work, something more beyond? Hey, it's there. In the graduate level courses, they tell you, Oh, yeah, you should take two to three weeks before you diagnose somebody. No, in our work, we get to diagnose them about 20 minutes after I made report within five minutes before that, you know, so I mean, when we say all of this is done on a intense time crunch, this is what we're talking about. And I think this is why as clinicians, sorry, yes, emergency service crisis clinicians. You know, I think this is why we just become laser focused on diagnostics. You know, I mean, I've never met a crisis clinician that couldn't diagnose anybody walking into the room, which is why we don't get invited to a lot of parties. I think.

Cara Tirrell: 33:07

That's my party trick.

Steve Bisson: 33:10

But I think that we are thinking about the insurance companies and diagnosing and, you know, I gotta tell you, I hate diagnosing even an outpatient, and how it's a disservice to our clients sometimes, because we're really working on symptomology. And sometimes we're that intense, especially in emergency rooms, that's a lot more important than getting the right diagnosis. But I'm getting off the topic here, finding your way through therapy, this is the podcast you're listening to. I am your host, the B cell sitting here with Kara Terrell and build when als which is to crisis clinicians, either in the past or currently, right, I want to go back to the challenges. And we talked about partly about the challenges that we have as clinicians, but I want to go back to the experience that conditions go through in general. For me, it was always staying awake on the overnight. But of course, I never fell asleep. You all know that. I've always been a very big professional, I have a good story for that, if you ever want one, but you need to contact me offline. But what I would like to talk about more is what are the challenges for the clinicians? I think that there's so many things that are a challenge for clinicians that we need to address. And they're not very easy to address. But I think that that's something that we need to do. So going to you guys, what are the challenges for clinicians?

Cara Tirrell: 34:31

Yeah, sure. I think that one of the things I reflect on now, you know, years later after working in crisis is we were there often two shifts in a row we were there 24/7 sometimes like you talked about even sleeping there while you were awake. But it was it was called an awake overnight. And basically the expectation is you stay up all night long, basically in a quiet room and expect to get through it and it was tough, but I think that, you know, thinking about the trauma that we would encounter, we talked about, you know, having to talk to people about their horrific violent trauma history, we saw people in, you know, the worst of the worst situations, very sad, sad cases, people in situations that really, were not going forward in a positive way. And so we saw those things, and just how it impacted us, you know, we were we had to cope in some way, you know, and I think you were gonna mention, Steve, that the average is one to three years in crisis. And I think I laugh at that, because all of us are clinicians. And all of us, I think, have exceeded 15 years or more. And Bill, I think you're even longer. I can't believe that. But there's something that draws us to it, too. And I think the challenge, you know, the challenge is to take care of yourself as a clinician and be a healthy person. Well, you're encountering major crisis. And, you know, it's also exciting, but it's also exhausting. So you get that real, up, you know, you're, you're at a high level, you know, energy level, very quickly, like we talked about, and you're dealing with the police, you're dealing with the fire department, you're dealing with, you know, if we went out to houses or group homes, it was very high level, excitement, slash energy, and then all of a sudden, like, a crash, because then you're, it's over, and then you go home, you know, so it's, it's tough. And I think we had to do a lot, you know, we had supervision, Bill was my supervisor for a while, thank you. And we relied on each other, you know, and I said, the dark humor, but you guys might, you know, talk about something else. And we became very good friends and colleagues, with the nurses and the doctors we worked with, I think they were great support. They called me the closer on Sunday mornings, because I'd always find a solution no matter what. And they were very grateful, because they've been taking care of these clients all weekend. So I put it to you guys, you know, what do you what do you look back and think about just a little side, when I first started working there, you know, the ER has a lot of different smells, let's just say. And I thought, Oh, I could never eat here. That's disgusting. If that would make me sick, you can smell you know, poop, you could smell you know, someone's puking. Within a week, I was having, like my lunch there, right in the middle of the ER with the grossest things going on. Because we were, you know, there was also medical patients do. So how did you guys cope?

Steve Bisson: 37:30

And my answers, but I want to turn to Bill, before we were recording, he had a great response to this.

Bill Dwinnells: 37:37

I just said to drink heavily. I don't actually recommend that. But, you know, it always gets a chuckle out of people. You know, I think one of the things you develop as a crisis clinician is, you know, a car I think you made a reference to it, is compartmentalized. You know, really being able to compartmentalize, you know, when I'm at work, I'm at work, I'm doing what I need to do. And then when I go home, I try my best to be at home and not be thinking about work, it doesn't always happen that way. But that's the goal. Anyways, you know, I can also say that I, you know, personally, I also do a lot of mindfulness meditation, and I find that helps me relax and sort of reset, sometimes I even do it in the middle of a shift. If I really feel I need it, you know, that that's, that's kind of what I do.

Steve Bisson: 38:30

And I then to go with Bill here, and I agree with you, I've done meditation, you know, mostly on a daily basis to ground myself, especially do it before bed, because I really need that exercise, obviously, really helps me I've done a lot of that stuff. But the problem that I always had was that you can't talk about it, you know, we have HIPAA, and that's that health information, Privacy Protection Act that we couldn't violate, we can't talk about our cases. My ex wife is a social worker, but I still couldn't share the stories with her. The way that I reframed it for myself. And sometimes it wasn't the healthiest thing in the world, not only for me, but you know, possibly costing me some relationships in the long term, but was to use dark humor, but that's a very bad party trick. Because I think that a lot of people don't really want to hear that stuff. And they don't really they you know, I remember getting, you know, saying some very dark humor, I still do to this day, and in parties, and I don't get invited for my party tricks. Because it's not only about, you know, diagnosing someone, but I would say some very dark humor stuff and I would have the look from other people. So really doing some self care really ended up being the healthiest way for me to do it. And like I said, exercise, yoga, meditation, you know, and that's not always easy, especially when you're a new clinician and you're learning how to do all that while working a new job and all that so I know that I struggled with doing that on a regular basis. He says, and like I said, friendships got a little strained when I started sharing a little bit too much about my dark humor slash thoughts about different things.

Cara Tirrell: 40:12

Yeah, I think, Steve, you reminded me, you know, the self care is important. And if I was ever to go into crisis again, which is not likely, I would say, I know, Bill, Bill, would you hire both of us?

Bill Dwinnells: 40:26

I would hire both of you right here. And now,

Cara Tirrell: 40:29

I thought, I was just gonna say, you know, you talked about talking about it to other people or keeping it just at work. I mean, I couldn't come home and talk about it to my husband, because I almost felt like he's normal, or he goes to a normal job and to hear things that I had heard, is traumatizing. And I wouldn't put that on the other person. So you really can only talk to other people that are kind of in it, I know that police and fire have that same experience, which can be very limiting, and it makes you feel very isolated. So that's a tough piece of it. And conversely, as a woman, you guys talked about being a man, you know, encountering women, we were we had to have security, every time we go into and everybody did not just just me. But the setup was that we would have security because oftentimes people were coming in, they could be aggressive, they could be violent, they could be intoxicated, we've had, you know, nurses were assaulted while we were there, you know, so you're also thinking about your own safety. And that's a tough position to be in.

Steve Bisson: 41:29

And questionable security sometimes, right. So that was very difficult, whether it's new, people who are security, the numbers were low for that you get a new client, you weren't sure how to deal with that. And it was uncomfortable at times, just to ask for support or even look, go in with, you know, sometimes a security when you're going into those programs, those rooms,

Cara Tirrell: 41:48

you know, who could have your back when you went into it went into a room, and oftentimes, you had to make sure that you know, they teach you, you know, originally, you know, some protective qualities where you know, you don't put your back to the door, you're not in a place where you can't get out all those things. But we've, we were in an environment where people had to be searched. But if they weren't searched properly, and they still had a weapon on them in the room, then you go in and close the door, you're in stuck in that room, and it could be really safe. So, you know, I think that we all learned everybody men and women learn to either keep the door open, have a talk with the security before you went in. And we'd have to kind of assess the situation very quickly. And, again, going into homes where their guns or their knives, or their children or their dogs, you know, we'd have to do those assessments, because I've had, I remember times where the police said You go in first. And I'm thinking, Wait a second, don't you have a gun, though, but we'd see those, you know, scary situations.

Steve Bisson: 42:51

Yeah. And, you know, everyone that we saw had stuff going on, right. And sometimes their fight or flight would be kicking in. And whether it was psychosis or dementia, them feeling unsafe, having struggles with withdrawals, and all the difficulties that they were having. There was a lot of unpredictability that occurred and made us eat them feel that way certainly made us as clinicians feel that way. And certainly you became buddy with the security or the police officer, because you never knew what else would be going on. And sometimes even the best searches in the world does not detect everything on the individual. So certainly very difficult for

Unknown: 43:29

us. Yeah,

Bill Dwinnells: 43:31

I mean, I certainly, I can tell you, in my own experience, I've been called to scenes to work with folks who, you know, what I was told on my way there turned out to be completely different from when I got there. You know, I've been told that oh, this person is, you know, losing their mind. And they're crazy. And they're dangerous. And, you know, I get there. And it's like, it's Joe. I know, Joe, I've worked with Joe before. Joe was not dangerous. Give me a few minutes to talk to him. And I'll see if I can get him to calm down. And sure enough, I was and, you know, we got to avoid the whole situation. And we Joe got moved on to, you know, whatever level of care it was that he needed at that time. I think what happens is the three of us, you know, in our colleagues and stuff, we understand mental health on a different level than the general public. So the general public just sees someone and turns them crazy, without really understanding what that term means. And they also don't understand the implications that they're making. And not that they necessarily have to, but I think because of that they tend to dramatize a situation, you know, much more than it really needs to be. We know we were able to get there and you know, in some of these cases, were able to de escalate everybody, get everyone to calm down. Take a nice deep Rath and work it out. Have I been to situations where things went sideways and we had negative outcomes? Sure. But I can say that those situations are fewer and further between, than what people probably think of when they think of the job that I do.

Cara Tirrell: 45:18

Yeah, I agree, Bill. And I think we were specifically called in to do that. So whether we had that experience or not, we quickly learned that because de escalating a situation where, you know, like I said, we had got, we go to the local jails sometimes to assess someone, we had to go to homes, group homes, where it's very chaotic. And we were the only people that you know, staff or the ER, Doc's or someone is looking to, to kind of calm the situation, assess it quickly, find a solution and make it happen in an hour.

Steve Bisson: 45:54

Yes, exactly. And that's in an hour, and sometimes even less, because you had a lot of people in the emergency room, just want to remind you, Joe is not a real person, but I have encountered Joe, and it's sometimes helpful to have that relationship. And that's so important in the work that we do. Just a reminder, you're listening to finding your way through therapy, I'm Stevie. So she's scared Terrell, he's built when else we're talking about crisis work and the stuff that we've done in the past, you know, I really think about ourselves as first responders and a half. And you know, there's no classes for what we've done and what you know how to handle certain situations. You know, I don't know about you guys, but I wasn't present for the class where they talked about how to handle a pandemic. And I certainly wasn't in every, you know, as I joke around with, and not joking, really. But I talked to my first responders and they say, you know, there's no class to explain what every possible scenario could occur. And it's the same thing for us in the emergency world. And I think it's, it's hard to really predict everything that could happen on a crisis team. And there's no possible way. All right, well, I

Bill Dwinnells: 46:59

think that goes back to the, you know, the building the rapport stuff, building the rapport, five minutes, being able to look at the situation. Hopefully, we're given a little bit of information before we get there as the crisis clinician, but being able to walk into this situation. And, you know, as you said, Steve, quickly assess what's the best approach for me to use with this person? You know, do I need to take a soft approach? Are they not going to respond to that? Do I need to take a little nuts, let's not say harsher, but a little stronger approach with this individual? What do I think they're going to respond to, and being able to quickly switch it up? If I pick the wrong one? I think that's a crucial skill. only being able to go in to the situation with one way of building rapport is going to quickly shorten your career.

Cara Tirrell: 47:48

Yeah, I totally agree with that. I remember lots of times where I thought, Oh, this is gonna work. I'll try this with someone. And you know, within seconds, I knew that wasn't gonna work. So you kind of delve back into your bag of tricks, quote, unquote, and just come up with something else. And you try and try because your goal is to de escalate, support, provides resources and find a solution. And you stick to that goal, no matter what, really, you know, and it was oftentimes left just to you because again, staffing was always an issue, and we would be the person in duty. And that was it. And there wasn't really another option. And I think that's part of the excitement, too. I wanted to add, like the flip side is that, although we would see someone maybe repeatedly, or we'd see certain presentations that were very similar, often, there was always something different about some about each case. And I think that's what drew us all in. Because we do love people, and we do like interacting with people. And we always want to help people. And I think that's important.

Steve Bisson: 48:58

We absolutely do. And that's why we do it. And it's a difficult job, but we love it. However, you know, one of the things that I've learned throughout all the years of doing this is not everyone can do this job. As we said, you know, there's no class although you know, I'm sure Bill can find a job writing these classes for different colleges. So I hope colleges across this country is listening to what we're saying, Bill, the analysis, his name, but all seriousness, we make a very quick report, we make a quick judgment, and we need to make a quick assessment of perhaps what the outcome should be and what we need to do for that client. So sometimes that can be very stressful, that can be tiring, we talked about a little bit of the self care we need to do. We also talked about, you know, short staff and how things are sometimes with, you know, staying for doubles, staying for an overnight when there's no staffing and going to three different ers in the same night. How do we last in this field? How do we keep ourselves from burning out or leaving the field at you know, because we can't handle it, or how do we keep it so that we can manage it on a daily basis.

Bill Dwinnells: 49:58

I think it's really important And to know your own limitations, you will not last long at this job. If you don't have any personal insight, you know, you need to be able to take some time and think about how things are affecting you, or how they may affect you. And then work on and then we all have different ways of working on it. You know, some people like doing meditation, some people like doing yoga, which is meditation, running exercising, Steve, I think you've done all of that stuff. Yeah, and some of us go to, you know, some of us go to therapy, you know, we have one of the things that I think is nice, as we develop, like you said, a camaraderie, we develop colleagues, you know, I can come to these two, folks, if I have something that I really need to get off my chest, you know, or others to other people that we've, you know, made connections with. For me, it's really just being mindful for the client, so that I can best serve them by being mindful for myself, so that I can best serve me to continue best serving them.

Cara Tirrell: 51:08

Yeah, I agree. I really see it as a very high level of professionalism, because putting up boundaries, you know, and people would say, well, I could never do that, well, probably not if you if you went home every night and cried about it, and thought about it, and agonized about it and thought, you know, I could help them more, there's more to do. And I remember, I was a single person, when I started doing crisis, got married, and, you know, had two young children at the time. And I think that's when it hit me the hardest when I would see young kids, or that struggle that that was tough to see, you know, that certainly weighed on me. And it's a job, but it's an important job. And if we didn't want to help or do the work, there's a lot better paying jobs, and you know, easier jobs to do. But we also loved that work. And I think we were all, and we are and Bill still is very good at it. You know, our skill set was flexible enough to interchange with all those different level, you know, different levels of people, from the client, to the police, to the nurses to whoever we were interacting with our colleagues and, you know, encountered lots of different situations and be able to deal with it. You know, again, that's, that's a high level of professionalism, I think. And again, it was hard, you know, I wouldn't tell my husband who's in quality assurance or something like that. Nothing was nothing with people. But like, the closer you work with people, you know, that that's a tough, tough thing to do, you know, and I did elder protective services where we investigated elderly abuse. And again, people said, I couldn't believe you could do that. And I thought, well, I probably couldn't do you know, work for DCF, Department of Children and Family, because that would be challenging to me. You know, it's not that I didn't care. It's that, say, for example, on that Myers Briggs test, I'm a thinker. So doing the work, I could still separate it from the emotions, but it does wear on you. And I think in the end, I was probably had some burnout from from doing it for so long.

Steve Bisson: 53:10

And I think that's an excellent point that you're making, being mindful of how it affects us and how we are reacting to it. So it's something to keep in mind. And you know, one of the things I remember is knowing how when we trained individuals who came to this environment and wanted to work as a clinician, you'd get to know who's going to last right? We had clinicians who struggled with making a decision about the client, because they didn't want to do the right, no wrong one. And they would consult and they would always like flip flop about that. Or you had people who want to take the clients home, or they were all very involved. And when there's kids involved when you have your own kids that also affects you, obviously, like you said, Cara, but I also think that when you're new to that, it's you know, I think that having kids while you're in this work is a lot different than when you have kids after, but you always need you always know who's gonna last and who won't.

Cara Tirrell: 54:00

Yeah, and sometimes we were called dame's, we were verbally abused, we were at risk of being physically abused. I don't know, a lot of positions other than, you know, you talked about, you know, the, the frontline workers, and teachers, I think there are another group that's, that's in a tough situation. But that's not a lot of jobs, that you go into your job and get verbally abused, or critiqued or told, you know, whatever someone's going to tell you because they're in crisis, or they're, they're, they're very unwell or they, you know, you talked about someone who might be at a psychotic state, and those are really concerning, and to not personalize it, and to be concerned about someone and care about them, but not take it home and, and not be able to let it go.

Steve Bisson: 54:44

So when we started this job, one of the things that I've learned is that we had to be very good at learning something almost daily. We need to be open to that. With time I think that I've learned more lessons from the crisis team than I did in any other job in this field, frankly, But turning to you guys, as we're trying to wrap up here, what is the most important thing you learned that you can use even to this day in your work on a daily basis,

Bill Dwinnells: 55:11

one of the lessons I learned very early on in my crisis work was really the power of presence. And what I mean by that is, you know, I was called to a scene where, you know, a woman's house was burning down. And so we got there, the, you know, the firefighters are trying to put up the house, the house was a loss, that wasn't going to work, you know, so now they're just kind of keeping it from spreading. So in my younger days, I tried to be, Hey, my name is Bill, and I'm here to help you. And this woman who is standing there where their house on fire, turns to me and says, shut up. And I said, Okay, well, this job's not going well, all right, I'll leave you alone. And she said, No, don't leave. So for the next 15 to 20 minutes, I stood there, in total silence, with this woman, watching her house burned down until her husband arrived. Once he arrived, she turned, you know, and fell into his arms, turned to me and said, Thank you,

Unknown: 56:21

and then walked off with a husband.

Bill Dwinnells: 56:24

And that's where I learned that just the fact that, you know, I, my colleagues, you know, other ies clinicians are willing to show up. During these darkest days, these these tough times that people are going through, just by virtue of the fact that we're willing to shut up, show up and shut up to if the case calls for it. You know, but just by virtue of the fact that we're willing to show up, that alone can be on some level therapeutic, that these folks know that they're not alone. Someone's trying to help, maybe not in the most graceful way. But you know, somebody's there, and they're trying to help. And if you can convey that to the individual, they're going to forgive almost any faux pa that you make.

Steve Bisson: 57:16

What a powerful story, Bill, we're very hard to follow. You want to try to do that, Kara?

Cara Tirrell: 57:21

Yeah, I really liked that description, the Shut up, but you're showing up. Because I think that's almost illustrating some of the times what was most important, and if you think you're going to save someone or rescue them, you know, from a horrible trauma, I think that's the reality is that's not going to happen. But what you can do is be there. Concretely, one of my best skill sets from working in crisis is that I can write up notes in about two seconds flat, flat, I'm very good at that. The other piece, I think, is I do feel confident working with a whole variety of different people and making that personal connection. I think that's a strength of mine, that I that I really value. And I think that's part of what what I learned through crisis work. And

Steve Bisson: 58:09

I appreciate that care, because that's good to have. And it's a good skill that we all develop, I think, because we had 12 pages to fill out. What I've learned is that we need to offer relief in regards to the clients and what they're going through, even if it's a little bit because you know, when people are coming into the emergency room, they're very activated, even if they're in their own house, and maybe they got a section to police were called what have you. I mean, what happens is that they don't know they want some relief from what they're feeling or what's happening. And the biggest thing that I think that I do on a daily basis, even today, in outpatient in my private practice, is when someone comes in, I do some retrospective stuff with them, but really not much. Because I want to know what's going on in the here. And now in order for them to feel even just a little bit of relief when they're leaving. Because you know, what happens is that, you know, you're coming to counseling, you're already stressed, probably you don't know the stranger, you come in you want. You've been struggling with something for six weeks, six months, six years, depending on the person. And you want to be able to have someone who's going to say it's okay, or give you some relief in regards to a little bit of the stress that you're having, you know, even if it's just a little tidbit and here's a little trick, and here's something you can try. It really is what people really want out of counseling and they finally can breathe, they said I can breathe. And that's so powerful.

Bill Dwinnells: 59:35

I think that's a really important thing to remember Steve.

Unknown: 59:39

You know, I think that

Bill Dwinnells: 59:42

too many times and I see this, you know, with the newer clinicians, because they don't know yet they haven't experienced it yet. But people become so concerned with the paperwork. They become so concerned with the process that If they lose the individual in it, you know, where's the individual? What, you know, what does this person need for me right now? The paperwork, the insurance, how how I get paid, we'll figure that out later. That that's, that's secondary, obviously, you know, we do need to get paid stuff like that. That's the only way we keep the services open. You know, so I mean, somebody's going to pay the rent, so to speak. But, you know, that, to me, has always been secondary. You know, and I think, you know, that's what I try to convey to other people is, look, take care of the person first, you know, any kind of paperwork or anything like that, that we, you know, maybe don't quite get right, or screw up, we can fix it later. help fix the person first.

Unknown: 1:00:44

Oh,

Cara Tirrell: 1:00:45

yeah, I really love that. I think that's why both of you are great clinicians. And I think you're great supervisor, Bill. I'm still plugging that. But I just was gonna say I think that, you know, as clinicians, there's not much that could surprise us or cause us to judge somebody, because we've seen almost everything, in lots of varieties. And we know that the pain that someone is in, is usually it's universal, no matter what someone is presenting with, the pain is where they're at, and to be mindful in the moment to be present to be there for them. Those I think, are our greatest strengths. And I think that's what's important to a person seeking help.

Unknown: 1:01:28

Absolutely. And

Steve Bisson: 1:01:29

I agree fully with that. I really like your interventions, both of you what you talked about, about what you've learned, just a reminder, we're listening to finding your way through therapy. My name is Steve Kerr is sitting here with Bill. And I can't believe it's been an hour. You know, I said earlier, we're going to wrap up, but I guess now being very serious, that we're going to have to wrap up this conversation. But I can't tell you how, how important this conversation is for so many people who have been to the ER or clinicians where people who are in this field are looking to maybe expand their horizons or learn more. I've certainly always enjoyed our work in crisis. And obviously, I've enjoyed my work with both of you. So maybe right now, maybe you can tell everyone how they can reach you. I'm gonna start with Bill.

Bill Dwinnells: 1:02:11

Yeah, I started a private practice, it is the moment, you know, COVID kind of helped it along. But its primary is primarily telehealth at the moment. But you can read me more about me or schedule an appointment if that's what you're interested in that build when ELLs and my last name is spelled D wi n n e ll s.com. That's built on els.com. And happy to talk with anybody who wants to know more about crisis stuff. Or if you want to come see me as a therapist, or any other way that I can help just you let me know.

Steve Bisson: 1:02:47

And you mentioned your software a little earlier. But can you tell more people about the software that you create?

Bill Dwinnells: 1:02:52

Oh, yeah, I had a one of the things that we had developed, one of the problems that we have is that in some cases, there are so many clients that an emergency service team has to deal with simultaneously. And for a long time, this was tracked on paper, or whiteboard that we'd have to erase things from, or things would get erased from, but that was just inefficient. So I had a friend of mine, we actually founded a company called 508. Tech that you can see at five away tech.com. And we developed a an emergency service database that tracks all ongoing cases, it tracks previous cases. So we could actually look up and see exactly how many times a client was seen by the emergency services. And what exactly happened during those encounters. It also has bed search functions, so that I can do a bed search for any level of care. And keep a track of it and keep a log of it so that I can, you know, later pull up and say yes, on this date, we did a bed search. We call these places. These were the responses, you know, and it's really been very helpful. We've, we've been able to sell it to I think, four or five of emergency teams. Already all of them have reported that, you know, they love it and find it absolutely indispensable. One team told me that they were getting a new electronic record. And one of the specifications they had for the company that was going to provide the electronic record is it had to function around my software, or they weren't interested in it. So we're very, very proud of that.

Steve Bisson: 1:04:42

And you absolutely should be proud of that. I'll definitely add it to the show notes both your websites. How about you anything you want to plug Kara?

Cara Tirrell: 1:04:50

Yeah, I can't believe you guys used to use pen and paper and whiteboards. You know, as a millennial, wink wink. I know all about software and all the updated stuff just Okay, yeah. So for my like, like Steve had shared my office is now within his office, you know, we're alongside each other. And that's Kara see Ara Terrell T i r r e LL. counseling.com. And so, you know, I think this is one more point is that, you know, the, when I started to think about my own practice, and I think Bill has done this too, and Steve has done this, the expertise that we've developed and the specialties that we develop are very unique. So some of the things I've done work in our very unusual, you know, working with people who are dealing with hoarding disorders, you know, I work with the elderly caregivers, working with kids who might have Tourette's or pans or pandas, you know, some things that are very specialized. I also see people 14 And over, I provide home visits to seniors in the area that that we live in close to my my office, I am seeing people in person and accepting new clients. And I also do telehealth as well. And I certainly see people that are dealing with everyday stress, parenting difficulties, post COVID, or during COVID issues, I think that's been a real challenge for a lot of teens and seniors becoming very isolated. And anxiety and depression are also very common right now. And those would definitely be people that that I'd be happy to talk about, and see if I could be a good fit for them.

Steve Bisson: 1:06:35

And you obviously know you have your spot here. I'm so happy to be here. But just remember, rent is late. But in all seriousness, thank you so much for your time, both of you, it was such an awesome thing to reconnect. And one of the things that I already see in all of us is that we just have such a passion for crisis work. And I hope everyone found this as useful and as helpful as it can be. And I certainly really like to rekindle my love with the crisis work. So thank you very much to both of you. We will see each other soon. And let's go out to dinner. Right. That's the time for them.

Cara Tirrell: 1:07:11

Thank you, Steve. Thanks, Dave.

Steve Bisson: 1:07:13

This concludes episode 21. I want to thank Bill and Cara for this great conversation, truly enjoyed it. You know, rekindled my love for something that I've done for many years, and truly am very grateful for all the experiences that I've had there. So thank you to Bill and Cara for having that great conversation. If you have more info. You want more information on Karen bill. It'll be in the show notes. So hopefully you can look at that. Well, this concludes episode 25. Again, thank you, Kara. And thank you, Bill. Thank you again, Laura, who did the amazing editing job. I don't know if people caught it on the replay. But let me know if you did just send me a note or something like that. Episode 26 will be my personal favorite. And I've already decided that my personal favorite this season was the truly touching story of Maureen man. Not only is she a holistic trauma healer, she also shared a very, very touching story about her son, which I hope that you listen to in the next episode. So thank you very much. And I will see on the other side at the next episode is the season and I'm feeling very generous. So let's go with a contest. Here's the contest, you will be writing me an email to my email address. It's my full name Steve de sol lmhc@gmail.com. I'll put it in the show notes and write contest in the subject line and why you liked the podcast. What what are the prizes? Well, let's start with the most important prize obviously, which is my book. So finding a way through therapy so one person will win my book finding your way through therapy. Another prize will be blight. Landry's book trauma intelligence and that will be another person will win that. And the grand prize will be someone who wins both books. So remember to email me with the word contests, and write down what you've enjoyed from my podcasts. And I will also add you to my mailing list. So please do so before December 31. That's when I will close it down. And you can go in and participate in the contest once a month. So you can do one in November one in December and we'll announce it in January. So looking forward to hearing from you and good luck. Please like, subscribe or follow this podcast on your favorite platform. A glowing review is always helpful. And as a reminder, this podcast is for information, educational, and entertainment purposes. If you're struggling with a mental health or substance abuse issue, please reach out to a professional counselor or therapist for consultation.