September 8, 2025 • 43 mins
Bobcast! Patron emails!
This episode is sponsored by BetterHelp. Give online therapy a try at betterhelp.com/KIRK to get 10% off your first month.
00:00 When is physical touch in therapy OK?
18:19 'Zoey' OPP
20:36 Is transcranial magnetic stimulation (TMS) a treatment for ADHD?
28:36 'Margaret' OPP
30:08 Can trauma cause incontinence?
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Become a patron: https://www.patreon.com/PsychologyInSeattle
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September 8, 2025
The Psychology In Seattle Podcast ®
Trigger Warning: This episode may include topics such as assault, trauma, and discrimination. If necessary, listeners are encouraged to refrain from listening and care for their safety and well-being.
Disclaimer: The content provided is for educational, informational, and entertainment purposes only. Nothing here constitutes personal or professional consultation, therapy, diagnosis, or creates a counselor-client relationship. Topics discussed may generate differing points of view. If you participate (by being a guest, submitting a question, or commenting) you must do so with the knowledge that we cannot control reactions or responses from others, which may not agree with you or feel unfair. Your participation on this site is at your own risk, accepting full responsibility for any liability or harm that may result. Anything you write here may be used for discussion or endorsement of the podcast. Opinions and views expressed by the host and guest hosts are personal views. Although, we take precautions and fact check, they should not be considered facts and the opinions may change. Opinions posted by participants (such as comments) are not those of the hosts. Readers should not rely on any information found here and should perform due diligence before taking any action. For a more extensive description of factors for you to consider, please see www.psychologyinseattle.com
This episode is sponsored by BetterHelp. Give online therapy a try at betterhelp.com/KIRK to get 10% off your first month.
00:00 When is physical touch in therapy OK?
18:19 'Zoey' OPP
20:36 Is transcranial magnetic stimulation (TMS) a treatment for ADHD?
28:36 'Margaret' OPP
30:08 Can trauma cause incontinence?
Become a member: https://www.youtube.com/channel/UCOUZWV1DRtHtpP2H48S7iiw/join
Become a patron: https://www.patreon.com/PsychologyInSeattle
Email: https://www.psychologyinseattle.com/contact
Website: https://www.psychologyinseattle.com
Merch: https://psychologyinseattle-shop.fourthwall.com/
Instagram: https://www.instagram.com/psychologyinseattle/
Facebook Official Page: https://www.facebook.com/PsychologyInSeattle/
TikTok: https://www.tiktok.com/@kirk.honda
September 8, 2025
The Psychology In Seattle Podcast ®
Trigger Warning: This episode may include topics such as assault, trauma, and discrimination. If necessary, listeners are encouraged to refrain from listening and care for their safety and well-being.
Disclaimer: The content provided is for educational, informational, and entertainment purposes only. Nothing here constitutes personal or professional consultation, therapy, diagnosis, or creates a counselor-client relationship. Topics discussed may generate differing points of view. If you participate (by being a guest, submitting a question, or commenting) you must do so with the knowledge that we cannot control reactions or responses from others, which may not agree with you or feel unfair. Your participation on this site is at your own risk, accepting full responsibility for any liability or harm that may result. Anything you write here may be used for discussion or endorsement of the podcast. Opinions and views expressed by the host and guest hosts are personal views. Although, we take precautions and fact check, they should not be considered facts and the opinions may change. Opinions posted by participants (such as comments) are not those of the hosts. Readers should not rely on any information found here and should perform due diligence before taking any action. For a more extensive description of factors for you to consider, please see www.psychologyinseattle.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
So, Bob, we have some emails here. This first one
is about touch in therapy. Shall we go over it?
Let's do it. This is the Psychology and Seattle podcast.
I'm your host, doctor Kirk Khana. I'm a therapist at
a professor.
Speaker 2 (00:12):
Who are you, Bob, I'm surprised we're doing this. My
name's Bob. I'm your good friend from graduate school from
one hundred years ago and a therapist here in practice
in Seattle.
Speaker 1 (00:21):
It's right anonymous listener. She says, Hello, Kirk and Bob.
I have a question regarding physical touch in therapy. I'm
twenty five years old and I was diagnosed with borderline
personne I sorer by the way, I've been seeing my
current therapist for over a year now, and over time
we've we've been able to build a trusting and safe relationship. Okay,
(00:42):
I've been seeing my current therapist for over a year now,
and we have a good relationship.
Speaker 3 (00:46):
We have.
Speaker 1 (00:47):
We have a very close therapeutic bond, and it's new
to me. I still often struggle with intense feelings of
shame and sometimes fear, but I'm now able to talk
more and open up. I have strong warm feelings towards
my therapist and eventually gathered the courage to tell him
about these feelings. We've talked about transference and also discovered
(01:09):
that for me, feelings of love are closely linked with
shame and guilt. When I feel that way, I sometimes
long for comfort and want to hug him. For the
past few sessions, we've occasionally sat next to each other
and he has held me for a while and gently
stroked my arm or shoulder. The past few sessions, we've
(01:29):
occasionally sat next to each other and he has held
me for a while and gently.
Speaker 3 (01:33):
Stroked my arm or shoulder. Okay, I'm trying to envision
that a while. What is that? It says five minutes,
ten minutes, so I don't know, I don't know.
Speaker 1 (01:43):
This feels very soothing and comforting, and it has helped
reduce my self hating thoughts. However, I'm afraid to move
during those moments because I don't want to do anything wrong,
and I often feel very dazed afterwards. I also worry
that my fear feeling of love might intensify and that
I could become too dependent on him. I don't want
(02:04):
to want too much, and I don't want to be
too much. My question is when is physical touch and
therapy okay and when is it not? What are the
potential benefits and especially the potential risks. Thank you so
much for the amazing work that all of you do.
End of email, Bob, what do you think?
Speaker 2 (02:23):
Yeah, this is a great email, a bit prevocative to me.
So one of the things that you're talking about that
I really appreciated is that you guys are deliberate in
the way that it sounds like you're deliberate in how
you use affection in your session. And I don't know
(02:45):
this is true, but it sounds like your therapist is
really mindful of their impact on you, and you guys
have what I think is a good basis to keep
talking about this. So what I hope you'll do is
you'll say, you know that you freeze when you feel
your therapist arm around you. I'm presuming that you want
(03:06):
to have their arm around you, and that you guys
are clear that this is part of what's in part
of what's therapeutic, like a corrective experience of affection and care,
and you're having what I would call probably a pretty
typical response if you've got a trauma and abuse history
(03:26):
of freezing, So talk about it. Definitely talk about it,
and you guys might actually play with moving, like let's
just move, we can just move, we can come back
to this, we can also just move again right to
kind of help you, you know, shift your nervous system
maybe a little bit, or teach your brain that it's
actually safe to move. Just because someone's arm around it
(03:46):
doesn't mean he got to be frozen in still. And
I'm guessing, though I don't know if this is true,
that your therapist is managing their feelings that are arising.
So the chances of you being too much aren't maybe
not that great though the fear of being too much
is probably pretty pretty typical for those of us who
have this kind of stuff. And so let's see. And
(04:11):
then there was one more thing.
Speaker 1 (04:14):
Well, would you ever do this kind of work as
a therapist.
Speaker 2 (04:17):
I get scared, I think because my own stuff. I
get a little bit scared. But I've done some small
amount of that.
Speaker 3 (04:25):
Yeah, like what I think.
Speaker 2 (04:27):
I held hands with the client once who was going
through some really hard ship. We talked about that that's
what we were, that that was what was going to do,
and I sat next to them and they were immersed
in some pretty heavy duty trauma exposure.
Speaker 3 (04:43):
Was it a woman, yes? Were you afraid of being
sued or something?
Speaker 2 (04:49):
No, not being sued?
Speaker 3 (04:50):
I was.
Speaker 2 (04:51):
I think I was afraid of like would my colleagues
think I was, you know, fucking up? And I was
afraid that I might be seeing by my client as
having some kind of you know, motive beyond care for
her well being. Yeah, which I mean that client was
very important to me. I cared a great deal about.
Speaker 3 (05:12):
Her, But you are in a purf for her?
Speaker 1 (05:13):
No? Fuck?
Speaker 2 (05:14):
No?
Speaker 3 (05:14):
Yeah, did you address that at all directly?
Speaker 1 (05:18):
Yeah?
Speaker 2 (05:18):
I think one of the things that I said to
is that I didn't know if I wanted to do
this because it was making me uncomfortable. Not because there's
anything wrong with what she wanted, but I think it
might just be my own limit for whatever reason, Like
I don't feel comfortable with touched like that, and then
I probably wouldn't do that.
Speaker 3 (05:33):
Again. Who initiated it? We talked about it, but who
initiated it? I don't recall.
Speaker 1 (05:38):
Okay, it could have been you. It could have been
like do you want me to hold your hand?
Speaker 3 (05:43):
Is that?
Speaker 2 (05:43):
Yeah? It could have been It could have been that.
Speaker 3 (05:45):
Yeah.
Speaker 1 (05:46):
Yeah, So in response to your email, anonymous listener, I
believe you are. What I'll say is that, yeah, as
Bob was saying, it sounds like you have a really
good therapeutic situation happening here and there isn't any overt
sign of anything bad happening. Touch can accelerate therapy and
(06:09):
healing in a way that talk can never do. Well.
What I'll say is that what we hope for for
people with relational traumas, like people with borderline personality, that
they have significant time spent with their therapists experiencing corrective experiences,
(06:30):
and that can be sometimes accelerated by physical touch, physical warmth.
But there are risks, right, and that's what you're asking about. Also,
if you presented this case on the internet, then everyone
would assume that your therapist is a creep and has
(06:51):
already sexually assaulted you, if not grooming you for more predation.
But it doesn't mean that. It could mean that, but
it's that's not my assumption because that's not common.
Speaker 3 (07:03):
You know.
Speaker 1 (07:04):
The more likely scenario is that he is on the
up and up, and he has a style where he
does that sometimes, and it has been found to be
helpful and he knows that he's not going to cross
the line. That isn't to say that this isn't some
sort of grooming situation, but that's not my assumption.
Speaker 3 (07:27):
You know.
Speaker 1 (07:27):
It's sort of like if someone said, I had this
friend that likes to hug whenever we meet up, and
I'm not familiar, I'm not very comfortable with hugs, so
I don't really know. I wouldn't assume that the friend
is a rapist, you know. It's kind of in that category.
Could the friend be a rapist? Yeah, but it's not.
But here's the thing is, when it comes to touch
(07:49):
and therapy, especially at this level where he's holding you
for a while, as you put it, there are ethical
codes that are a help in this situation, and guideline
and our general professional ethics don't address this directly for
a variety of reasons that I won't go into. But
we do have an organization called the United States Association
(08:11):
of Body Psychotherapy and they do provide a code of ethics,
and it has been vetted for a long time and
it is researched. But I will look to this sometimes.
But the general guideline is also just present in the
other professional organization ethical codes, but they just don't really
(08:32):
orient it towards the body and the physical and the.
Speaker 3 (08:35):
Touch in therapy.
Speaker 1 (08:36):
But just to go over those principles, one is consent
is making sure that the client is consenting and that
there's ongoing explicit discussion of.
Speaker 3 (08:47):
It, like the way you were talking about with that
one incident.
Speaker 1 (08:51):
There has to be a fair amount of odd because
you know, if you have a friend that is grieving
the loss of something and you just held their hand
or hugged them, you wouldn't have a three minute conversation
about the hug before hugging them. But in therapy you
have to have that conversation and there's a lot of
corrective experiences that can happen just from that conversation. It's
(09:12):
not an impediment, it's a part of the therapy. It
can be therapeutic. Also, the therapist needs to be competent. Well,
what constitutes competency in using touch and therapy. Well, on
one of the spectrum, you have a therapist who has
never looked into it and maybe never even done it,
and suddenly decides to use touch significantly. Now I would
(09:33):
say holding hands is not really in that category, as
you were saying in your story, because I would say
that holding hands is pretty low grade. But if you're
going to be hugging your client, then I would say
that you need to make sure that you can demonstrate competence.
Then there's various different ways to demonstrate competence. I would
(09:55):
say that if you sat next to a client on
the couch and maybe your sides were touching and you
were holding hands, or or you were side by side
and you had your arm around the client or something,
I would say, maybe that wouldn't require a ton of competency,
but probably we're getting in that direction. But if you're
(10:22):
embracing a client for a while, like the way this
therapist is, then I think ninety nine percent of therapists
would say that you have to demonstrate some sort of competence.
Speaker 3 (10:30):
How do you get there?
Speaker 1 (10:31):
Well, the obvious is trainings and that sort of thing.
And maybe you are a member of the US Association
of Body Psychotherapy. You know, you pay your dues or whatever.
That's an obvious way. But I don't believe that that's
the only road to competency. You can also gain competency
just by studying it, by having a consult group or
(10:54):
a person that you know that knows more about this,
or just a practice of consulting about it. Maybe you've
inched towards those kinds of experiences and process them yourself
and consulted maybe supervision. So there's a lot of roads
to competency in my view. The other thing, the other
(11:15):
principal guideline is autonomy. That the client needs to feel
like they could say yes or no obviously throughout the process.
The other principle is that the touch is done in
a helpful way. It's with the intent of helping, and
there's enough justification from the therapist to believe that the
touch would help and not harm. Often that has to
(11:39):
be pre thought about and documented. Obviously, that would help
and is a good practice to get into. Also, another
principle is consultation and possible supervision. Oversight is always helpful.
Right now, maybe as a therapist, you have a general
policy that you have a set group of behaviors that
(12:01):
you will use as interventions with clients as a corrective experience.
Speaker 3 (12:06):
You've thought about it already.
Speaker 1 (12:07):
This is the best, This is the hope is that
there's been some pre thoughts in planning and it's not
just something you're doing out of the boot, particularly holding
a client for a while, and through that thought process,
you've looked into the guidelines, you've consulted, you've read some articles,
you've heard, some experiences, you have maybe even in your
disclosure statements something around this, because it it's too much
(12:31):
to ask a therapist without having done some pre thought
to be able to check all the boxes before, during,
and after an event like this in therapy. This isn't
to say like it's this huge event and it's just
like this big deal, but it does require that not well,
partially to cover your own ass, but mainly so that
the client is helped the most right And the last
(12:59):
principle is document So you ask about overdependency, and you know,
as long as he isn't isolating you and harming you,
for you to become more dependent on your therapist isn't
necessarily harmful. It actually could be helpful. The idea is
that through dependency, which you already are to some extent on,
(13:21):
the therapist is healing, and that through those corrective experiences
with someone that's safe and that doesn't exploit you, you
will be able to generalize that experience to your trust
of people outside of therapy, and you'll be able to
have dependency outside of therapy, that's the idea, and then
you will no longer feel dependent on your therapist. So
(13:43):
this idea of overdependency is a bit of a misnomer,
especially among relational therapists like you and me, Bob. The
other thing. The one of the risks though, is that
it could be replaying old traumas and you show signs,
as Bob point it out, that you are freezing. Now
there's another explanation because the way you describe it, I
(14:05):
want to read it specifically. You say that, let's see
very soothing. However, I'm afraid during those moments.
Speaker 3 (14:14):
I don't you know.
Speaker 1 (14:16):
However, I'm afraid to move during those moments because I
don't want to do anything wrong and I often feel
very dazed afterward. So it most people would hear it,
would read that and say that you are dissociative. But
it's not entirely the case, or it's not a slam
(14:39):
dunk indication. It could be for sure, especially the dazed part,
and most people would assume that you saying you don't
want to move is this freeze reaction and is either
you're being traumatized in the moment or it's provoking old trauma.
But that's not necessarily true, particularly given the way that
you're describing I want to say that it could be that,
(15:00):
and this is something you obviously should be talking with
your therapist about. But this feeling, the way you describe it,
I'm afraid to move during those moments because I don't
want to do anything wrong. That is a way of
describing it. That leads to the very clear possibility that
what you're experiencing is actually just a normal part of
(15:25):
the interplay of a corrective experience with someone that is safe.
So he's safe, and he's and he's providing you this
corrective experience, and he's hugging you sort of. I don't
know you said holding. You didn't say hug, So it
sounds like maybe he's sitting by your side and maybe
has loosely it's like a loose hug it kind of
(15:47):
the way you describe it, And in those moments, you're
just like, I like this, this feels very helpful. But
I have a lot of shame, and I have a
lot of experience from my past, from my childhood where
I would fuck things up and people would become flung
away from me, and I would later conclude I must
(16:08):
have done it wrong, and so you know, you're afraid
and you are afraid to move. So it could just
be that, but it also could be or it could
be both. You know, it's just a lot of everything.
The central the one thing that I want to say
as one takeaway is that all your questions should be
(16:30):
answered by your therapist. In fact, your therapist should have
addressed these questions before this ever happened, which is a
little concerning.
Speaker 3 (16:39):
I have to say.
Speaker 1 (16:40):
It doesn't necessarily mean that he's unsafe and that he's
his predatory, but it could mean that he isn't aware
of the guidelines, which raises risks. Doesn't guarantee harm, but
it raises risks. Body therapists, people who generate, you know,
as a routine, use touch and therapy, have a whole
(17:02):
routine of ramping up to this kind of behavior, this
kind of intervention. They will say, here are the risks,
here is what you do if this happens, Here is
how it might feel, And there will be explicit conversations afterwards.
It won't just be something that is spontaneously done and
(17:22):
then never talked about. That's not the way you're supposed
to do this. It doesn't mean you have to spend
hours and hours talking about it.
Speaker 3 (17:28):
But you know it.
Speaker 1 (17:29):
Doesn't take long to ask a question. Thirty seconds, you know,
So I would if I were you, I would say
I very much appreciate what seems to me to be
a very healing thing that when needed you do hug
me and I But I'm worried about over dependency. I'm
(17:49):
wondering about the risks. I am also having this experience
of being dazed afterwards that I would like you to
assess to make sure that I'm not being harmed. You
know those things you absolutely have the right to ask,
and and it's a little concerning that he's putting you
in the position where you would have to ask honestly.
(18:10):
So that's what I'll say about that. Take a break
and we get back more emails.
Speaker 3 (18:14):
What do you say about yes.
Speaker 1 (18:20):
Or back from the break, let's do an opp so, Bob,
in the last episode, you gave me a name like Carl,
I did give me a name.
Speaker 3 (18:28):
I like that.
Speaker 1 (18:29):
Zoe Zoe so z Oe z.
Speaker 3 (18:33):
O o e y.
Speaker 2 (18:34):
I think z o O E y.
Speaker 3 (18:37):
I don't know. I suppose Zoe No, it's I mean.
Speaker 2 (18:42):
You can't have too many z's. I imagine if you
just pop up the zas.
Speaker 1 (18:46):
Okay. So I like this because it's always so fascinating
to type in. You know, Zoe is common, but not
super common.
Speaker 2 (18:54):
Not super common.
Speaker 1 (18:55):
But when we look at all the Zoey's of patrons,
we got a lot of them. We got a number.
So we have I believe as Zoe in ann and Dale, Virginia,
who's been a patron for the past nine months, eight months.
We have Zoe from God knows where who's been a
(19:17):
patron for a couple of years. Zoe B is the
first letter of the last name from Westlake Village, California,
been a patron for a couple of years. We have
Zoe P from Washington, d C. Which rhymes been a
patron for a few years. We have Zoe E, who
(19:40):
has been a patron for a few years and is
one of our top contributors, by the way, which is
very nice of you. Zoe E from God knows where.
We have Zoe another Zoe B from Raleigh, North Carolina.
I hear that Raleigh. I have a friend from Raleigh
in lovely town. I think it's a college town. Been
a patron for four years. We have Zoe S, who
(20:03):
I believe I've interacted with over email from Melbourne, Australia
or specifically Colberg. Been a patron for four years. We
have Zoe S from Brooklyn, New York.
Speaker 3 (20:17):
Who has been a.
Speaker 1 (20:18):
Patron for seven years. Wow, actually coming up on the
seven year anniversary. Thank you Zoe S. Looks like maybe
Zoe has been a patron on and off. Not sure,
so thank you to all the Zoey's. Let's read another
email right now. Highest tier patron Gabby from Texas. He says, Hi,
(20:42):
Kirk and Bob. I was listening to y'all's episode on
Serenity Mental Health Centers.
Speaker 3 (20:50):
Do you remember when we're talking about.
Speaker 1 (20:51):
That, Yeah, that marketing ad that they had about denigrating
therapy and stuff. I was appalled to hear about the
graphic they posted and agreed with you and Bob's take.
With your and Bob takes. I've been going to therapy
for years and it has helped me more than anything else.
So Gabby is saying, you know, therapy is a good thing.
(21:17):
I wanted to bring up my experience with visiting them,
so highest to your patron. Gabby from Texas has been
to Serenity Mental Health Center.
Speaker 2 (21:28):
Was she undercover?
Speaker 1 (21:29):
Huh?
Speaker 2 (21:29):
Was she undercover?
Speaker 3 (21:30):
No, this is in the past.
Speaker 1 (21:33):
I did not have any issues with my care and
only left because of insurance changes. But something they pushed
a lot was transcranial magnetic stimulation or TMS. I went
for ADHD to get tested and at my first appointment,
they pushed TMS transcranio magnetic stimulation as something that could
basically cure my ADHDU with brain waves or something. I
(21:55):
had never heard of this. It was kind of strange
to me that they pushed it so much. TMS a
thing you've heard of? Thanks so much.
Speaker 3 (22:02):
I love y'all. End of email, Bob, what do you think?
Speaker 2 (22:05):
Yeah, I've heard of TMS, but not as a treatment
for ADHD, though I don't know about that as a
treatment for depression. It seems to me that any good
treatment provider is gonna make a person aware of what
they know to be, you know, out there and available
as a resource for healing or whatever, but isn't going
to push shit. Yeah, Like, why would anybody push anything?
(22:27):
Like somebody doesn't want it, they don't want it. Fuck it.
You know, if you don't think that what you're doing
is the right thing to do, then you should say so.
But I've never heard of TMS for ADHDV. I'm not
saying that I haven't that it doesn't. I don't know
anything about it, one way or the other. No, NOMS
is just an MRI. It's a fucking MRI. That's all
it is, except they stick to your brain and they
(22:49):
run it for longer I think.
Speaker 1 (22:50):
Yeah, yeah, so it's not supposed to be used for adhds.
It's not been demonstrated to help with ADHD at all.
Speaker 2 (23:00):
Well, then that's just stupid.
Speaker 1 (23:01):
So yeah, now we don't know the pressure that I'm
sure was being put on her. You know, maybe it
was within reason, but it doesn't sound like the patient
was being served correctly. But now I'm guessing that this
(23:21):
organization is for the most part on the up and up.
You know, the individual psychiatrists who work there, I'm sure
are you know, on the average up and ups. So
I'm not denigrating that, but we do have one experience.
So let's talk about TMS because we get questions about
it sometimes. So, yeah, as you're saying, Bob it. It
is typically for treatment resistant depression, and basically in transcranial
(23:48):
magnetic stimulation. It is the way it sounds. It's transcranial,
meaning that you use magnetic stimulation that's targeted and strong
enough so that it goes across the skull. There's a
bug in my face right now. It keeps flying around
my and it will stimulate the electrical impulses of a
(24:10):
kind of large part of the brain. I mean, we
have a really hard time pinpointing these sorts of things,
and everyone's brain is different and dah dah, da da da.
So it's pretty ham fisted, but so are medications because
when you use medication that affects serotonin, like serotonin is
used in various ways throughout the body. So it's not
(24:34):
any different from that. And it is a viable treatment
for treatment resistant depression. Also to a lesser extent, for
treatment resistant OCD. It is used for that as well.
But basically you lay down and like you said, it's
like an MRI, and it is focused on a particular
(24:56):
part of the brain, and there's different protocols blah blah blah,
and it's pretty low side effect, right one could argue
far less than even SSRIs or other antidepressions. But there
can be some temporary problems, temporary side effects like pain
on the scalp. You can be light headed, or you
(25:18):
can have a mild headache or something. Sometimes people have
seizures because you know, you're involving the brain, but that's
pretty rare, and some people would actually take a couple
seizures now and then to get relief from treatment resistant
depression because it's no joke treatments. You know, people who
resort to TMS fur the depression have typically been through
(25:44):
you know, ten years or longer of very different meds
and very little relief. The studies show that there's about
on average, about a thirty five percent response rate to
TMS for treatment resistant depression. That about a third of
the patients will experience about a fifty percent or greater
(26:06):
reduction symptoms, which is which is a pretty big deal.
Speaker 2 (26:08):
That's great.
Speaker 1 (26:09):
And this is all compared to placebo and sham treatments
because those will also show a response rate. You know,
like you have people, you do, you do the whole thing.
You have them sit in the device, but you don't
actually turn on the machine, but you act like you
turn on the machine, and there is a fair amount
of people that will experience improvement just because of that,
(26:33):
either because there's just a random uptick or downtick in
their symptoms, or they are paying attention to themselves, they're relaxing,
they're getting care. It feels nice and it can cause people,
you know, depression to reduce because of that. And another finding,
(26:54):
because it's been researched a lot over the past few decades,
is that there's about a fourth of people will no
longer qualify for the diagnosis eventually, which.
Speaker 3 (27:03):
Is a big deal.
Speaker 1 (27:07):
So that means that it's an absolute viable option. Sometimes
it's not covered by insurance, this is bullshit, but it's
an absolute viable option for people with treatment resistant depression.
It's kind of it's a pain in the ass, right
because it's not a pill. You've got to go into
the thing, sit in the thing, and do it frequently.
(27:28):
But for the payoff, you know, it's a big deal.
Having said that, most people who go through this treatment
don't experience much, if any improvement, So it's a roll
of the dice, but worth rolling of the dice. If
you have life crushing depression over time. There's a similar
usage for OCD, although it's even less but still significant.
(27:52):
You know, again, OCD can be life ruining, and if
the typical meds aren't working and the typical psychotherapy is
only helping so much, you might as well.
Speaker 3 (28:01):
Give it a try.
Speaker 1 (28:02):
There is a research currently looking into other disorders like psychosis,
bipolar depression, chronic pain, migraine, stroke, rehabilitation, Parkinson's and PTSD.
But for someone, as you're saying, Gabby, to push it severely,
especially for ADHD, is extremely problematic given what I understand. Now,
(28:26):
maybe I'm wrong. You know, I'm not a psychiatrist. I
don't do this kind of work. But let's move on
to another email after a break.
Speaker 3 (28:32):
What do you say?
Speaker 1 (28:32):
Yep, all right, we're back from the break. I like
this game of opp Give me another name, Bob, Belinda Bah?
Speaker 3 (28:43):
Is that a B E or E?
Speaker 2 (28:44):
I think bee?
Speaker 3 (28:45):
Linda?
Speaker 1 (28:46):
Belinda?
Speaker 3 (28:47):
It's a good name.
Speaker 1 (28:48):
Are there any Belinda's It's nope, not not a single
balladic Okay? Margaret Margaret. How many Margarets looks like there are?
There are five Margarets. That's a good name, Bob. We
have Margaret O from Washington, d C. Been a patron
(29:12):
for about five months ish. We have another Margaret Oh
from god knows where who's been a patron for a
couple of years. We have a Margaret s from Boulder, Colorado.
Speaker 3 (29:22):
Who's been a patron for four years.
Speaker 1 (29:25):
We have an an Margaret from Seattle, Washington. Looks like
she might live in West Seattle ish or actually actually
I won't mention because it's kind of a specific neighborhood
but not far from where we live. And then she's
(29:46):
been a patron for four years, thank you, and Margaret local.
And then there's a Margaret that goes by Greta from Shoreline,
Washington who's been a patron since twenty twenty one. So
isn't that interesting? It's very five margarets Greta.
Speaker 2 (30:06):
I like that name.
Speaker 1 (30:07):
Yeah, all right, Next email from patron Minnie. She says, Hi,
doctor Kirk and Bob and Stephanie. Hey girl. I think
that patron Minnie has a friend named Stephanie that listens
to the podcast.
Speaker 3 (30:21):
Oh so, I was like.
Speaker 2 (30:23):
Is there someone on staff?
Speaker 3 (30:24):
No?
Speaker 2 (30:24):
No?
Speaker 1 (30:25):
Okay, uh so, Hi doctor Kirk and Bob and Stephanie.
Speaker 3 (30:29):
Hey girl.
Speaker 1 (30:30):
When I was a teenager, I was incontinent for more
than three years, just chiming in, Bob, what is being
in continent.
Speaker 2 (30:38):
Means when you pee your pants?
Speaker 1 (30:39):
Yeah, it was a very shameful and depressing issue to
live with when I was a teen. My mom really
did her best to help me and get me the
care and supplies I needed to live cleanly and unrestricted,
but it drove me into a deep depression to feel
uncomfortable at school, at sleepovers, and even around the house
(30:59):
at one point. Now that I have overcome this issue
with medications, lifestyle changes, and physical therapy, I find myself
questioning the reason behind why it happened in the first place.
Because my doctors found no discernible cause. I questioned whether
it was my depression in PTSD causing it to get worse,
or was the depression a symptom of the shame of
(31:20):
being incompetent incontinent sorry chicken and the egg sort of
thing I did suffer. I did suffer a childhood sexual abuse,
but it was long term. It was not long term
and severe. Okay, so she's saying, you know, being incontinent
(31:42):
could be related to the childhood sexual abuse, but it
wasn't long term or severe, and I was in deep
denial at that point in my development. So my main
question is, have you ever worked with anyone with an
issue like mine where trauma caused incontinents or other embarrassing
psychosomatic symptoms in teens? Or is it usually an unrelated
(32:03):
problem that causes an increase in mental illness symptoms ps.
My current therapist who treated me as a teen does
not know about this because how severe the shame has
been for me. So I have processed all this on
my own. I really appreciate how you are willing to
address issues that many won't touch with a ten foot pole,
and there are very few people who talk about this.
(32:25):
I love y'all's podcasts, and I hope you're having a
great summer, patron Mini, so Bob, have you ever worked
with anyone with an issue like this where trauma has
caused incontinence or another embarrassing psychosomatic or what we call
somatic reaction?
Speaker 2 (32:41):
No, not that I'm aware of.
Speaker 3 (32:42):
No, Okay, what do you think about it?
Speaker 2 (32:45):
I don't know enough about the body. I was thinking,
just did all this sex therapy training, and I'm just
thinking about we can pelvic floor muscles maybe being a
part of the trouble, but I don't really know. And
I'll say this when you're gonna touch us with a
ten foot pole, because you're not talking about it with
the therapist. So come on, let's get on that.
Speaker 1 (33:06):
Yeah, there's so many benefits. You don't have to obviously,
there's a lot of other things you could be working.
Speaker 3 (33:12):
On, but you do have to.
Speaker 1 (33:14):
But well, I'm kidding. But the secondary benefit, indirect benefit
is just talking about something that you unfairly are shaming
yourself for because of eternalized voices and overcoming that and
standing tall. Just that you know, regardless of what the
(33:34):
topic is specifically, that's a very healing therapeutic activity. But
I will answer the question and say, yeah, it's a
common enough symptom of abuse, and specifically sexual abuse, but
also just general abuse that for people that work with
kids and teens that it is kind of a red flag.
(33:56):
If we hear about an incontinent kid and we don't
know about any abuse, it is one of the questions
you will hear in consultation of just like I wonder
if there's some unknown abuse that the child has been through.
It's not an assumption and should never be an assumption,
but there's that and given your scenario, yeah, it's a
question that we have as well as clinicians that really
(34:19):
can't be answered. There can be ways of assessing for this,
like if through treatment or through getting away from the
abusive person, the incontinence goes away without any other changes,
and you're like, well, seems likely it was related to that,
but it doesn't sound like we have that luxury of
(34:41):
having that variable isolated in that way. And so, yeah,
it's possible, it's possible.
Speaker 3 (34:46):
It's both.
Speaker 1 (34:47):
It's possible it was partially a physical issue that would
have happened anyway, and partially a psychological issue.
Speaker 3 (34:54):
And that the.
Speaker 1 (34:58):
Mental issues that our result of your life PTSD as
as you're saying, and depression was also making it worse,
and then through a feedback loop, was making your depression
worse and back and forth. You know, it's all there,
but it's it's a it's a pretty common thing.
Speaker 2 (35:20):
And uh.
Speaker 1 (35:22):
In fact, I would say anecdotally, if I was working
with a teen who wasn't content and had experienced trauma
in their past, I would say the vast majority of
time it would be conceptualized as as a symptom of
the trauma.
Speaker 3 (35:42):
And and lesser.
Speaker 1 (35:44):
Because of a functional problem with one's pelvic floor, because
of other there are other causes to this sort of thing,
And it makes some sense, right because on the general level,
when we're suffering from trauma, we're not often given a
way to talk about it, and our body will try
to express itself in some way, either to tell the self, hey,
(36:07):
something's wrong, or to alert others. Also, it kind of
makes sense that if it's sexual abuse, that it would
manifest in a somatic symptom of the genitals, of the bladder,
of one's you know, quote unquote private parts in this way.
So there's that also Metaphorically, it can be considered as
(36:32):
one is going through abuse. Often there is a sort
of letting go of one's body, of releasing control over
one's selfhood. Right, you just have to you know, surrender
and say I'm not of my body or my body
is not.
Speaker 3 (36:54):
Under my control.
Speaker 1 (36:55):
And the physicality even sometimes of giving up under the
intimidation and coercion and control and harm that your body
just relaxes and it's just you know, not that you're relaxed,
but your body, your body below the.
Speaker 3 (37:13):
Neck says okay, I am now just going to. You know.
Speaker 1 (37:17):
The way that I can think about it is if
I'm having a medical procedure and I I don't like
what's happening, you know, like I don't even like IVS,
and if I went with my instinct, I would like
resist it right at the real least, I would be tense,
and that doesn't usually go well. So I have to
kind of force my body, even though my mind is
(37:39):
freaking out. I have to force my body to sort
of become like Jello on a certain level. It's like
just let it, let it, let it happen. And that's
not anything like sexual abuse, but it's a kin in
that way. And you could see how that could manifest
in a variety of reflexive relaxations, including relaxing of one
(38:00):
bladder control. So there's a lot of different thoughts as
to why this would happen.
Speaker 2 (38:06):
That could be vagel collapse, yeah, yeah, so yeah.
Speaker 1 (38:11):
It also is considered to be a way for the
body to protect itself of like ridding itself. Also possibly
a way for the body to repel, to say, well,
if I'm all soiled down there, maybe they won't attack
me anymore.
Speaker 3 (38:28):
You know.
Speaker 1 (38:29):
It's why some abuse victims will try to gain weight
as a way to unconsciously or even consciously be unappealing
to abusers. So there's you know, a lot of different
ways that we think about this. But but yeah, so
you say, have ever worked with anyone with this issue?
I would say yeah, and other as you say, embarrassing
(38:52):
somatic symptoms for children and teens, Like, what other kinds
of things can I think of?
Speaker 3 (39:04):
Well?
Speaker 1 (39:04):
I kind of mentioned them, but also hygiene issues I suppose,
but that's not really the.
Speaker 3 (39:12):
Same thing in caprices right in.
Speaker 1 (39:14):
Capriesis also sleep issues or being incontinent in bed sleeping. Yeah,
I'm trying to think of other kinds of things like this.
It is kind of interesting that that is one of
the only ways that your body can express itself in
(39:35):
a very clear way, you know, like.
Speaker 2 (39:38):
Just void avoid itself.
Speaker 1 (39:39):
Yeah, because we do it throughout the day, So why
not do it in a way that's unplanned as a
way to alert the self and others that something's wrong here?
Speaker 3 (39:51):
You know? Now?
Speaker 1 (39:54):
Uh, I want to be clear though that you know,
you mentioned this childhood sexual abuse, but you're saying it
wasn't long term or s now that can be enough.
So I'll say that but it's also possible that I
could see a lot of people focusing on that and
saying like, well, that's the clear cause, you know, it
sounds like your depression in PTSD has a number of causes,
(40:16):
and all of those causes could be related, and it
could be in addition to the child that'd sexual abuse
experienced or instead of it. So there's just no way
to know, is the thing. And then you also ask
is it usually an unrelated problem that causes an increase
in mental health mental illness symptoms?
Speaker 3 (40:37):
Is it usually an unrelated problem?
Speaker 1 (40:40):
I see, Yeah, it's not usually, like I said, but
that is absolutely possible for an unrelated psychological you know,
like you just had a functional issue of incapricis and
had nothing to do with your psychology. Could that cause
depression and PTSD like symptoms? Absolutely? Absoluteolutely. I would find
(41:02):
that most incontinent teens have some emotional fallout, including depression.
I mean, PTSD is kind of specific, but you know,
you could see that happening, you pee your pants in
the middle of class, and even if no one found
out like that, would that would leave a mark on
(41:23):
one's psychology so to speak. So but yeah, as Bob says,
what a wonderful thing you could talk with your therapist about.
And therapists generally speaking, are extremely comfortable talking about this
because there's there's nothing more. I don't know, there's nothing
more understandable than something like this. Therapists understand this sort
(41:49):
of Yeah makes sense to me, you know. And there's
nothing to be ashamed of, absolutely nothing. You know, in
our society we have some really fucked up ideas what
to be ashamed of, and uh, there's nothing to be
a shame in. And I'll delineate you know that there
are situations where we should feel shame, like if you
(42:10):
purposely killed someone or a puppy, or you did something
on purpose, you knew the consequences and did it anyway.
I feel like feeling being ashamed of that is, you know,
maybe why we have shame.
Speaker 2 (42:22):
I don't know if you want to keep this in,
but I shout it at Costco once.
Speaker 1 (42:27):
Tell us about it.
Speaker 2 (42:29):
Oh, I thought I had to fart walking down the island.
Costco turned out little bonus and yeah, there it is.
Speaker 3 (42:35):
Yeah.
Speaker 2 (42:36):
I go to my dock and I'm like, I shout
it at Costco and he's like, what's a shark so
I told him. He's like, oh, that's called rectal incontinence, bob.
Speaker 3 (42:46):
Or incaprisis.
Speaker 1 (42:49):
How much product was produced? Ah?
Speaker 2 (42:52):
Product, but a great word. I would have called it waste.
Oh not much, just.
Speaker 1 (42:57):
A little splash, and you immediately knew.
Speaker 2 (43:01):
Oh well yeah, because I could kind of feel it.
And then I went into the bathroom and discovered yep.
Speaker 1 (43:05):
Oh And then what did you do?
Speaker 2 (43:08):
I told Kyleen, and we laughed and we continued to shop.
Speaker 1 (43:12):
Did you clean it up with toilet paper and stuff?
Speaker 2 (43:15):
I cleaned up when I could, and then I went
home and took care of the rest.
Speaker 1 (43:17):
Yeah, but you didn't immediately go home?
Speaker 2 (43:19):
Nah?
Speaker 3 (43:20):
Yeah? Yeah? Yeah fuck it?
Speaker 1 (43:21):
Yeah yeah yeah, Well, thanks for leading the way on that.
Speaker 3 (43:26):
Hey, right on, man, nothing wrong.
Speaker 2 (43:29):
Next time I shired, I'll let you know.
Speaker 3 (43:30):
Yeah.
Speaker 1 (43:32):
So ten foot poll eliminated. Yeah right, And everyone out
there please take care of yourself because you deserve it.
So, Bob, we have some emails here. This first one
is about touch in therapy. Shall we go over it?
Let's do it. This is the Psychology and Seattle podcast.
I'm your host, doctor Kirk Khana. I'm a therapist at
a professor.
Speaker 2 (00:12):
Who are you, Bob, I'm surprised we're doing this. My
name's Bob. I'm your good friend from graduate school from
one hundred years ago and a therapist here in practice
in Seattle.
Speaker 1 (00:21):
It's right anonymous listener. She says, Hello, Kirk and Bob.
I have a question regarding physical touch in therapy. I'm
twenty five years old and I was diagnosed with borderline
personne I sorer by the way, I've been seeing my
current therapist for over a year now, and over time
we've we've been able to build a trusting and safe relationship. Okay,
(00:42):
I've been seeing my current therapist for over a year now,
and we have a good relationship.
Speaker 3 (00:46):
We have.
Speaker 1 (00:47):
We have a very close therapeutic bond, and it's new
to me. I still often struggle with intense feelings of
shame and sometimes fear, but I'm now able to talk
more and open up. I have strong warm feelings towards
my therapist and eventually gathered the courage to tell him
about these feelings. We've talked about transference and also discovered
(01:09):
that for me, feelings of love are closely linked with
shame and guilt. When I feel that way, I sometimes
long for comfort and want to hug him. For the
past few sessions, we've occasionally sat next to each other
and he has held me for a while and gently
stroked my arm or shoulder. The past few sessions, we've
(01:29):
occasionally sat next to each other and he has held
me for a while and gently.
Speaker 3 (01:33):
Stroked my arm or shoulder. Okay, I'm trying to envision
that a while. What is that? It says five minutes,
ten minutes, so I don't know, I don't know.
Speaker 1 (01:43):
This feels very soothing and comforting, and it has helped
reduce my self hating thoughts. However, I'm afraid to move
during those moments because I don't want to do anything wrong,
and I often feel very dazed afterwards. I also worry
that my fear feeling of love might intensify and that
I could become too dependent on him. I don't want
(02:04):
to want too much, and I don't want to be
too much. My question is when is physical touch and
therapy okay and when is it not? What are the
potential benefits and especially the potential risks. Thank you so
much for the amazing work that all of you do.
End of email, Bob, what do you think?
Speaker 2 (02:23):
Yeah, this is a great email, a bit prevocative to me.
So one of the things that you're talking about that
I really appreciated is that you guys are deliberate in
the way that it sounds like you're deliberate in how
you use affection in your session. And I don't know
(02:45):
this is true, but it sounds like your therapist is
really mindful of their impact on you, and you guys
have what I think is a good basis to keep
talking about this. So what I hope you'll do is
you'll say, you know that you freeze when you feel
your therapist arm around you. I'm presuming that you want
(03:06):
to have their arm around you, and that you guys
are clear that this is part of what's in part
of what's therapeutic, like a corrective experience of affection and care,
and you're having what I would call probably a pretty
typical response if you've got a trauma and abuse history
(03:26):
of freezing, So talk about it. Definitely talk about it,
and you guys might actually play with moving, like let's
just move, we can just move, we can come back
to this, we can also just move again right to
kind of help you, you know, shift your nervous system
maybe a little bit, or teach your brain that it's
actually safe to move. Just because someone's arm around it
(03:46):
doesn't mean he got to be frozen in still. And
I'm guessing, though I don't know if this is true,
that your therapist is managing their feelings that are arising.
So the chances of you being too much aren't maybe
not that great though the fear of being too much
is probably pretty pretty typical for those of us who
have this kind of stuff. And so let's see. And
(04:11):
then there was one more thing.
Speaker 1 (04:14):
Well, would you ever do this kind of work as
a therapist.
Speaker 2 (04:17):
I get scared, I think because my own stuff. I
get a little bit scared. But I've done some small
amount of that.
Speaker 3 (04:25):
Yeah, like what I think.
Speaker 2 (04:27):
I held hands with the client once who was going
through some really hard ship. We talked about that that's
what we were, that that was what was going to do,
and I sat next to them and they were immersed
in some pretty heavy duty trauma exposure.
Speaker 3 (04:43):
Was it a woman, yes? Were you afraid of being
sued or something?
Speaker 2 (04:49):
No, not being sued?
Speaker 3 (04:50):
I was.
Speaker 2 (04:51):
I think I was afraid of like would my colleagues
think I was, you know, fucking up? And I was
afraid that I might be seeing by my client as
having some kind of you know, motive beyond care for
her well being. Yeah, which I mean that client was
very important to me. I cared a great deal about.
Speaker 3 (05:12):
Her, But you are in a purf for her?
Speaker 1 (05:13):
No? Fuck?
Speaker 2 (05:14):
No?
Speaker 3 (05:14):
Yeah, did you address that at all directly?
Speaker 1 (05:18):
Yeah?
Speaker 2 (05:18):
I think one of the things that I said to
is that I didn't know if I wanted to do
this because it was making me uncomfortable. Not because there's
anything wrong with what she wanted, but I think it
might just be my own limit for whatever reason, Like
I don't feel comfortable with touched like that, and then
I probably wouldn't do that.
Speaker 3 (05:33):
Again. Who initiated it? We talked about it, but who
initiated it? I don't recall.
Speaker 1 (05:38):
Okay, it could have been you. It could have been
like do you want me to hold your hand?
Speaker 3 (05:43):
Is that?
Speaker 2 (05:43):
Yeah? It could have been It could have been that.
Speaker 3 (05:45):
Yeah.
Speaker 1 (05:46):
Yeah, So in response to your email, anonymous listener, I
believe you are. What I'll say is that, yeah, as
Bob was saying, it sounds like you have a really
good therapeutic situation happening here and there isn't any overt
sign of anything bad happening. Touch can accelerate therapy and
(06:09):
healing in a way that talk can never do. Well.
What I'll say is that what we hope for for
people with relational traumas, like people with borderline personality, that
they have significant time spent with their therapists experiencing corrective experiences,
(06:30):
and that can be sometimes accelerated by physical touch, physical warmth.
But there are risks, right, and that's what you're asking about. Also,
if you presented this case on the internet, then everyone
would assume that your therapist is a creep and has
(06:51):
already sexually assaulted you, if not grooming you for more predation.
But it doesn't mean that. It could mean that, but
it's that's not my assumption because that's not common.
Speaker 3 (07:03):
You know.
Speaker 1 (07:04):
The more likely scenario is that he is on the
up and up, and he has a style where he
does that sometimes, and it has been found to be
helpful and he knows that he's not going to cross
the line. That isn't to say that this isn't some
sort of grooming situation, but that's not my assumption.
Speaker 3 (07:27):
You know.
Speaker 1 (07:27):
It's sort of like if someone said, I had this
friend that likes to hug whenever we meet up, and
I'm not familiar, I'm not very comfortable with hugs, so
I don't really know. I wouldn't assume that the friend
is a rapist, you know. It's kind of in that category.
Could the friend be a rapist? Yeah, but it's not.
But here's the thing is, when it comes to touch
(07:49):
and therapy, especially at this level where he's holding you
for a while, as you put it, there are ethical
codes that are a help in this situation, and guideline
and our general professional ethics don't address this directly for
a variety of reasons that I won't go into. But
we do have an organization called the United States Association
(08:11):
of Body Psychotherapy and they do provide a code of ethics,
and it has been vetted for a long time and
it is researched. But I will look to this sometimes.
But the general guideline is also just present in the
other professional organization ethical codes, but they just don't really
(08:32):
orient it towards the body and the physical and the.
Speaker 3 (08:35):
Touch in therapy.
Speaker 1 (08:36):
But just to go over those principles, one is consent
is making sure that the client is consenting and that
there's ongoing explicit discussion of.
Speaker 3 (08:47):
It, like the way you were talking about with that
one incident.
Speaker 1 (08:51):
There has to be a fair amount of odd because
you know, if you have a friend that is grieving
the loss of something and you just held their hand
or hugged them, you wouldn't have a three minute conversation
about the hug before hugging them. But in therapy you
have to have that conversation and there's a lot of
corrective experiences that can happen just from that conversation. It's
(09:12):
not an impediment, it's a part of the therapy. It
can be therapeutic. Also, the therapist needs to be competent. Well,
what constitutes competency in using touch and therapy. Well, on
one of the spectrum, you have a therapist who has
never looked into it and maybe never even done it,
and suddenly decides to use touch significantly. Now I would
(09:33):
say holding hands is not really in that category, as
you were saying in your story, because I would say
that holding hands is pretty low grade. But if you're
going to be hugging your client, then I would say
that you need to make sure that you can demonstrate competence.
Then there's various different ways to demonstrate competence. I would
(09:55):
say that if you sat next to a client on
the couch and maybe your sides were touching and you
were holding hands, or or you were side by side
and you had your arm around the client or something,
I would say, maybe that wouldn't require a ton of competency,
but probably we're getting in that direction. But if you're
(10:22):
embracing a client for a while, like the way this
therapist is, then I think ninety nine percent of therapists
would say that you have to demonstrate some sort of competence.
Speaker 3 (10:30):
How do you get there?
Speaker 1 (10:31):
Well, the obvious is trainings and that sort of thing.
And maybe you are a member of the US Association
of Body Psychotherapy. You know, you pay your dues or whatever.
That's an obvious way. But I don't believe that that's
the only road to competency. You can also gain competency
just by studying it, by having a consult group or
(10:54):
a person that you know that knows more about this,
or just a practice of consulting about it. Maybe you've
inched towards those kinds of experiences and process them yourself
and consulted maybe supervision. So there's a lot of roads
to competency in my view. The other thing, the other
(11:15):
principal guideline is autonomy. That the client needs to feel
like they could say yes or no obviously throughout the process.
The other principle is that the touch is done in
a helpful way. It's with the intent of helping, and
there's enough justification from the therapist to believe that the
touch would help and not harm. Often that has to
(11:39):
be pre thought about and documented. Obviously, that would help
and is a good practice to get into. Also, another
principle is consultation and possible supervision. Oversight is always helpful.
Right now, maybe as a therapist, you have a general
policy that you have a set group of behaviors that
(12:01):
you will use as interventions with clients as a corrective experience.
Speaker 3 (12:06):
You've thought about it already.
Speaker 1 (12:07):
This is the best, This is the hope is that
there's been some pre thoughts in planning and it's not
just something you're doing out of the boot, particularly holding
a client for a while, and through that thought process,
you've looked into the guidelines, you've consulted, you've read some articles,
you've heard, some experiences, you have maybe even in your
disclosure statements something around this, because it it's too much
(12:31):
to ask a therapist without having done some pre thought
to be able to check all the boxes before, during,
and after an event like this in therapy. This isn't
to say like it's this huge event and it's just
like this big deal, but it does require that not well,
partially to cover your own ass, but mainly so that
the client is helped the most right And the last
(12:59):
principle is document So you ask about overdependency, and you know,
as long as he isn't isolating you and harming you,
for you to become more dependent on your therapist isn't
necessarily harmful. It actually could be helpful. The idea is
that through dependency, which you already are to some extent on,
(13:21):
the therapist is healing, and that through those corrective experiences
with someone that's safe and that doesn't exploit you, you
will be able to generalize that experience to your trust
of people outside of therapy, and you'll be able to
have dependency outside of therapy, that's the idea, and then
you will no longer feel dependent on your therapist. So
(13:43):
this idea of overdependency is a bit of a misnomer,
especially among relational therapists like you and me, Bob. The
other thing. The one of the risks though, is that
it could be replaying old traumas and you show signs,
as Bob point it out, that you are freezing. Now
there's another explanation because the way you describe it, I
(14:05):
want to read it specifically. You say that, let's see
very soothing. However, I'm afraid during those moments.
Speaker 3 (14:14):
I don't you know.
Speaker 1 (14:16):
However, I'm afraid to move during those moments because I
don't want to do anything wrong and I often feel
very dazed afterward. So it most people would hear it,
would read that and say that you are dissociative. But
it's not entirely the case, or it's not a slam
(14:39):
dunk indication. It could be for sure, especially the dazed part,
and most people would assume that you saying you don't
want to move is this freeze reaction and is either
you're being traumatized in the moment or it's provoking old trauma.
But that's not necessarily true, particularly given the way that
you're describing I want to say that it could be that,
(15:00):
and this is something you obviously should be talking with
your therapist about. But this feeling, the way you describe it,
I'm afraid to move during those moments because I don't
want to do anything wrong. That is a way of
describing it. That leads to the very clear possibility that
what you're experiencing is actually just a normal part of
(15:25):
the interplay of a corrective experience with someone that is safe.
So he's safe, and he's and he's providing you this
corrective experience, and he's hugging you sort of. I don't
know you said holding. You didn't say hug, So it
sounds like maybe he's sitting by your side and maybe
has loosely it's like a loose hug it kind of
(15:47):
the way you describe it, And in those moments, you're
just like, I like this, this feels very helpful. But
I have a lot of shame, and I have a
lot of experience from my past, from my childhood where
I would fuck things up and people would become flung
away from me, and I would later conclude I must
(16:08):
have done it wrong, and so you know, you're afraid
and you are afraid to move. So it could just
be that, but it also could be or it could
be both. You know, it's just a lot of everything.
The central the one thing that I want to say
as one takeaway is that all your questions should be
(16:30):
answered by your therapist. In fact, your therapist should have
addressed these questions before this ever happened, which is a
little concerning.
Speaker 3 (16:39):
I have to say.
Speaker 1 (16:40):
It doesn't necessarily mean that he's unsafe and that he's
his predatory, but it could mean that he isn't aware
of the guidelines, which raises risks. Doesn't guarantee harm, but
it raises risks. Body therapists, people who generate, you know,
as a routine, use touch and therapy, have a whole
(17:02):
routine of ramping up to this kind of behavior, this
kind of intervention. They will say, here are the risks,
here is what you do if this happens, Here is
how it might feel, And there will be explicit conversations afterwards.
It won't just be something that is spontaneously done and
(17:22):
then never talked about. That's not the way you're supposed
to do this. It doesn't mean you have to spend
hours and hours talking about it.
Speaker 3 (17:28):
But you know it.
Speaker 1 (17:29):
Doesn't take long to ask a question. Thirty seconds, you know,
So I would if I were you, I would say
I very much appreciate what seems to me to be
a very healing thing that when needed you do hug
me and I But I'm worried about over dependency. I'm
(17:49):
wondering about the risks. I am also having this experience
of being dazed afterwards that I would like you to
assess to make sure that I'm not being harmed. You
know those things you absolutely have the right to ask,
and and it's a little concerning that he's putting you
in the position where you would have to ask honestly.
(18:10):
So that's what I'll say about that. Take a break
and we get back more emails.
Speaker 3 (18:14):
What do you say about yes.
Speaker 1 (18:20):
Or back from the break, let's do an opp so, Bob,
in the last episode, you gave me a name like Carl,
I did give me a name.
Speaker 3 (18:28):
I like that.
Speaker 1 (18:29):
Zoe Zoe so z Oe z.
Speaker 3 (18:33):
O o e y.
Speaker 2 (18:34):
I think z o O E y.
Speaker 3 (18:37):
I don't know. I suppose Zoe No, it's I mean.
Speaker 2 (18:42):
You can't have too many z's. I imagine if you
just pop up the zas.
Speaker 1 (18:46):
Okay. So I like this because it's always so fascinating
to type in. You know, Zoe is common, but not
super common.
Speaker 2 (18:54):
Not super common.
Speaker 1 (18:55):
But when we look at all the Zoey's of patrons,
we got a lot of them. We got a number.
So we have I believe as Zoe in ann and Dale, Virginia,
who's been a patron for the past nine months, eight months.
We have Zoe from God knows where who's been a
(19:17):
patron for a couple of years. Zoe B is the
first letter of the last name from Westlake Village, California,
been a patron for a couple of years. We have
Zoe P from Washington, d C. Which rhymes been a
patron for a few years. We have Zoe E, who
(19:40):
has been a patron for a few years and is
one of our top contributors, by the way, which is
very nice of you. Zoe E from God knows where.
We have Zoe another Zoe B from Raleigh, North Carolina.
I hear that Raleigh. I have a friend from Raleigh
in lovely town. I think it's a college town. Been
a patron for four years. We have Zoe S, who
(20:03):
I believe I've interacted with over email from Melbourne, Australia
or specifically Colberg. Been a patron for four years. We
have Zoe S from Brooklyn, New York.
Speaker 3 (20:17):
Who has been a.
Speaker 1 (20:18):
Patron for seven years. Wow, actually coming up on the
seven year anniversary. Thank you Zoe S. Looks like maybe
Zoe has been a patron on and off. Not sure,
so thank you to all the Zoey's. Let's read another
email right now. Highest tier patron Gabby from Texas. He says, Hi,
(20:42):
Kirk and Bob. I was listening to y'all's episode on
Serenity Mental Health Centers.
Speaker 3 (20:50):
Do you remember when we're talking about.
Speaker 1 (20:51):
That, Yeah, that marketing ad that they had about denigrating
therapy and stuff. I was appalled to hear about the
graphic they posted and agreed with you and Bob's take.
With your and Bob takes. I've been going to therapy
for years and it has helped me more than anything else.
So Gabby is saying, you know, therapy is a good thing.
(21:17):
I wanted to bring up my experience with visiting them,
so highest to your patron. Gabby from Texas has been
to Serenity Mental Health Center.
Speaker 2 (21:28):
Was she undercover?
Speaker 1 (21:29):
Huh?
Speaker 2 (21:29):
Was she undercover?
Speaker 3 (21:30):
No, this is in the past.
Speaker 1 (21:33):
I did not have any issues with my care and
only left because of insurance changes. But something they pushed
a lot was transcranial magnetic stimulation or TMS. I went
for ADHD to get tested and at my first appointment,
they pushed TMS transcranio magnetic stimulation as something that could
basically cure my ADHDU with brain waves or something. I
(21:55):
had never heard of this. It was kind of strange
to me that they pushed it so much. TMS a
thing you've heard of? Thanks so much.
Speaker 3 (22:02):
I love y'all. End of email, Bob, what do you think?
Speaker 2 (22:05):
Yeah, I've heard of TMS, but not as a treatment
for ADHD, though I don't know about that as a
treatment for depression. It seems to me that any good
treatment provider is gonna make a person aware of what
they know to be, you know, out there and available
as a resource for healing or whatever, but isn't going
to push shit. Yeah, Like, why would anybody push anything?
(22:27):
Like somebody doesn't want it, they don't want it. Fuck it.
You know, if you don't think that what you're doing
is the right thing to do, then you should say so.
But I've never heard of TMS for ADHDV. I'm not
saying that I haven't that it doesn't. I don't know
anything about it, one way or the other. No, NOMS
is just an MRI. It's a fucking MRI. That's all
it is, except they stick to your brain and they
(22:49):
run it for longer I think.
Speaker 1 (22:50):
Yeah, yeah, so it's not supposed to be used for adhds.
It's not been demonstrated to help with ADHD at all.
Speaker 2 (23:00):
Well, then that's just stupid.
Speaker 1 (23:01):
So yeah, now we don't know the pressure that I'm
sure was being put on her. You know, maybe it
was within reason, but it doesn't sound like the patient
was being served correctly. But now I'm guessing that this
(23:21):
organization is for the most part on the up and up.
You know, the individual psychiatrists who work there, I'm sure
are you know, on the average up and ups. So
I'm not denigrating that, but we do have one experience.
So let's talk about TMS because we get questions about
it sometimes. So, yeah, as you're saying, Bob it. It
is typically for treatment resistant depression, and basically in transcranial
(23:48):
magnetic stimulation. It is the way it sounds. It's transcranial,
meaning that you use magnetic stimulation that's targeted and strong
enough so that it goes across the skull. There's a
bug in my face right now. It keeps flying around
my and it will stimulate the electrical impulses of a
(24:10):
kind of large part of the brain. I mean, we
have a really hard time pinpointing these sorts of things,
and everyone's brain is different and dah dah, da da da.
So it's pretty ham fisted, but so are medications because
when you use medication that affects serotonin, like serotonin is
used in various ways throughout the body. So it's not
(24:34):
any different from that. And it is a viable treatment
for treatment resistant depression. Also to a lesser extent, for
treatment resistant OCD. It is used for that as well.
But basically you lay down and like you said, it's
like an MRI, and it is focused on a particular
(24:56):
part of the brain, and there's different protocols blah blah blah,
and it's pretty low side effect, right one could argue
far less than even SSRIs or other antidepressions. But there
can be some temporary problems, temporary side effects like pain
on the scalp. You can be light headed, or you
(25:18):
can have a mild headache or something. Sometimes people have
seizures because you know, you're involving the brain, but that's
pretty rare, and some people would actually take a couple
seizures now and then to get relief from treatment resistant
depression because it's no joke treatments. You know, people who
resort to TMS fur the depression have typically been through
(25:44):
you know, ten years or longer of very different meds
and very little relief. The studies show that there's about
on average, about a thirty five percent response rate to
TMS for treatment resistant depression. That about a third of
the patients will experience about a fifty percent or greater
(26:06):
reduction symptoms, which is which is a pretty big deal.
Speaker 2 (26:08):
That's great.
Speaker 1 (26:09):
And this is all compared to placebo and sham treatments
because those will also show a response rate. You know,
like you have people, you do, you do the whole thing.
You have them sit in the device, but you don't
actually turn on the machine, but you act like you
turn on the machine, and there is a fair amount
of people that will experience improvement just because of that,
(26:33):
either because there's just a random uptick or downtick in
their symptoms, or they are paying attention to themselves, they're relaxing,
they're getting care. It feels nice and it can cause people,
you know, depression to reduce because of that. And another finding,
(26:54):
because it's been researched a lot over the past few decades,
is that there's about a fourth of people will no
longer qualify for the diagnosis eventually, which.
Speaker 3 (27:03):
Is a big deal.
Speaker 1 (27:07):
So that means that it's an absolute viable option. Sometimes
it's not covered by insurance, this is bullshit, but it's
an absolute viable option for people with treatment resistant depression.
It's kind of it's a pain in the ass, right
because it's not a pill. You've got to go into
the thing, sit in the thing, and do it frequently.
(27:28):
But for the payoff, you know, it's a big deal.
Having said that, most people who go through this treatment
don't experience much, if any improvement, So it's a roll
of the dice, but worth rolling of the dice. If
you have life crushing depression over time. There's a similar
usage for OCD, although it's even less but still significant.
(27:52):
You know, again, OCD can be life ruining, and if
the typical meds aren't working and the typical psychotherapy is
only helping so much, you might as well.
Speaker 3 (28:01):
Give it a try.
Speaker 1 (28:02):
There is a research currently looking into other disorders like psychosis,
bipolar depression, chronic pain, migraine, stroke, rehabilitation, Parkinson's and PTSD.
But for someone, as you're saying, Gabby, to push it severely,
especially for ADHD, is extremely problematic given what I understand. Now,
(28:26):
maybe I'm wrong. You know, I'm not a psychiatrist. I
don't do this kind of work. But let's move on
to another email after a break.
Speaker 3 (28:32):
What do you say?
Speaker 1 (28:32):
Yep, all right, we're back from the break. I like
this game of opp Give me another name, Bob, Belinda Bah?
Speaker 3 (28:43):
Is that a B E or E?
Speaker 2 (28:44):
I think bee?
Speaker 3 (28:45):
Linda?
Speaker 1 (28:46):
Belinda?
Speaker 3 (28:47):
It's a good name.
Speaker 1 (28:48):
Are there any Belinda's It's nope, not not a single
balladic Okay? Margaret Margaret. How many Margarets looks like there are?
There are five Margarets. That's a good name, Bob. We
have Margaret O from Washington, d C. Been a patron
(29:12):
for about five months ish. We have another Margaret Oh
from god knows where who's been a patron for a
couple of years. We have a Margaret s from Boulder, Colorado.
Speaker 3 (29:22):
Who's been a patron for four years.
Speaker 1 (29:25):
We have an an Margaret from Seattle, Washington. Looks like
she might live in West Seattle ish or actually actually
I won't mention because it's kind of a specific neighborhood
but not far from where we live. And then she's
(29:46):
been a patron for four years, thank you, and Margaret local.
And then there's a Margaret that goes by Greta from Shoreline,
Washington who's been a patron since twenty twenty one. So
isn't that interesting? It's very five margarets Greta.
Speaker 2 (30:06):
I like that name.
Speaker 1 (30:07):
Yeah, all right, Next email from patron Minnie. She says, Hi,
doctor Kirk and Bob and Stephanie. Hey girl. I think
that patron Minnie has a friend named Stephanie that listens
to the podcast.
Speaker 3 (30:21):
Oh so, I was like.
Speaker 2 (30:23):
Is there someone on staff?
Speaker 3 (30:24):
No?
Speaker 2 (30:24):
No?
Speaker 1 (30:25):
Okay, uh so, Hi doctor Kirk and Bob and Stephanie.
Speaker 3 (30:29):
Hey girl.
Speaker 1 (30:30):
When I was a teenager, I was incontinent for more
than three years, just chiming in, Bob, what is being
in continent.
Speaker 2 (30:38):
Means when you pee your pants?
Speaker 1 (30:39):
Yeah, it was a very shameful and depressing issue to
live with when I was a teen. My mom really
did her best to help me and get me the
care and supplies I needed to live cleanly and unrestricted,
but it drove me into a deep depression to feel
uncomfortable at school, at sleepovers, and even around the house
(30:59):
at one point. Now that I have overcome this issue
with medications, lifestyle changes, and physical therapy, I find myself
questioning the reason behind why it happened in the first place.
Because my doctors found no discernible cause. I questioned whether
it was my depression in PTSD causing it to get worse,
or was the depression a symptom of the shame of
(31:20):
being incompetent incontinent sorry chicken and the egg sort of
thing I did suffer. I did suffer a childhood sexual abuse,
but it was long term. It was not long term
and severe. Okay, so she's saying, you know, being incontinent
(31:42):
could be related to the childhood sexual abuse, but it
wasn't long term or severe, and I was in deep
denial at that point in my development. So my main
question is, have you ever worked with anyone with an
issue like mine where trauma caused incontinents or other embarrassing
psychosomatic symptoms in teens? Or is it usually an unrelated
(32:03):
problem that causes an increase in mental illness symptoms ps.
My current therapist who treated me as a teen does
not know about this because how severe the shame has
been for me. So I have processed all this on
my own. I really appreciate how you are willing to
address issues that many won't touch with a ten foot pole,
and there are very few people who talk about this.
(32:25):
I love y'all's podcasts, and I hope you're having a
great summer, patron Mini, so Bob, have you ever worked
with anyone with an issue like this where trauma has
caused incontinence or another embarrassing psychosomatic or what we call
somatic reaction?
Speaker 2 (32:41):
No, not that I'm aware of.
Speaker 3 (32:42):
No, Okay, what do you think about it?
Speaker 2 (32:45):
I don't know enough about the body. I was thinking,
just did all this sex therapy training, and I'm just
thinking about we can pelvic floor muscles maybe being a
part of the trouble, but I don't really know. And
I'll say this when you're gonna touch us with a
ten foot pole, because you're not talking about it with
the therapist. So come on, let's get on that.
Speaker 1 (33:06):
Yeah, there's so many benefits. You don't have to obviously,
there's a lot of other things you could be working.
Speaker 3 (33:12):
On, but you do have to.
Speaker 1 (33:14):
But well, I'm kidding. But the secondary benefit, indirect benefit
is just talking about something that you unfairly are shaming
yourself for because of eternalized voices and overcoming that and
standing tall. Just that you know, regardless of what the
(33:34):
topic is specifically, that's a very healing therapeutic activity. But
I will answer the question and say, yeah, it's a
common enough symptom of abuse, and specifically sexual abuse, but
also just general abuse that for people that work with
kids and teens that it is kind of a red flag.
(33:56):
If we hear about an incontinent kid and we don't
know about any abuse, it is one of the questions
you will hear in consultation of just like I wonder
if there's some unknown abuse that the child has been through.
It's not an assumption and should never be an assumption,
but there's that and given your scenario, yeah, it's a
question that we have as well as clinicians that really
(34:19):
can't be answered. There can be ways of assessing for this,
like if through treatment or through getting away from the
abusive person, the incontinence goes away without any other changes,
and you're like, well, seems likely it was related to that,
but it doesn't sound like we have that luxury of
(34:41):
having that variable isolated in that way. And so, yeah,
it's possible, it's possible.
Speaker 3 (34:46):
It's both.
Speaker 1 (34:47):
It's possible it was partially a physical issue that would
have happened anyway, and partially a psychological issue.
Speaker 3 (34:54):
And that the.
Speaker 1 (34:58):
Mental issues that our result of your life PTSD as
as you're saying, and depression was also making it worse,
and then through a feedback loop, was making your depression
worse and back and forth. You know, it's all there,
but it's it's a it's a pretty common thing.
Speaker 2 (35:20):
And uh.
Speaker 1 (35:22):
In fact, I would say anecdotally, if I was working
with a teen who wasn't content and had experienced trauma
in their past, I would say the vast majority of
time it would be conceptualized as as a symptom of
the trauma.
Speaker 3 (35:42):
And and lesser.
Speaker 1 (35:44):
Because of a functional problem with one's pelvic floor, because
of other there are other causes to this sort of thing,
And it makes some sense, right because on the general level,
when we're suffering from trauma, we're not often given a
way to talk about it, and our body will try
to express itself in some way, either to tell the self, hey,
(36:07):
something's wrong, or to alert others. Also, it kind of
makes sense that if it's sexual abuse, that it would
manifest in a somatic symptom of the genitals, of the bladder,
of one's you know, quote unquote private parts in this way.
So there's that also Metaphorically, it can be considered as
(36:32):
one is going through abuse. Often there is a sort
of letting go of one's body, of releasing control over
one's selfhood. Right, you just have to you know, surrender
and say I'm not of my body or my body
is not.
Speaker 3 (36:54):
Under my control.
Speaker 1 (36:55):
And the physicality even sometimes of giving up under the
intimidation and coercion and control and harm that your body
just relaxes and it's just you know, not that you're relaxed,
but your body, your body below the.
Speaker 3 (37:13):
Neck says okay, I am now just going to. You know.
Speaker 1 (37:17):
The way that I can think about it is if
I'm having a medical procedure and I I don't like
what's happening, you know, like I don't even like IVS,
and if I went with my instinct, I would like
resist it right at the real least, I would be tense,
and that doesn't usually go well. So I have to
kind of force my body, even though my mind is
(37:39):
freaking out. I have to force my body to sort
of become like Jello on a certain level. It's like
just let it, let it, let it happen. And that's
not anything like sexual abuse, but it's a kin in
that way. And you could see how that could manifest
in a variety of reflexive relaxations, including relaxing of one
(38:00):
bladder control. So there's a lot of different thoughts as
to why this would happen.
Speaker 2 (38:06):
That could be vagel collapse, yeah, yeah, so yeah.
Speaker 1 (38:11):
It also is considered to be a way for the
body to protect itself of like ridding itself. Also possibly
a way for the body to repel, to say, well,
if I'm all soiled down there, maybe they won't attack
me anymore.
Speaker 3 (38:28):
You know.
Speaker 1 (38:29):
It's why some abuse victims will try to gain weight
as a way to unconsciously or even consciously be unappealing
to abusers. So there's you know, a lot of different
ways that we think about this. But but yeah, so
you say, have ever worked with anyone with this issue?
I would say yeah, and other as you say, embarrassing
(38:52):
somatic symptoms for children and teens, Like, what other kinds
of things can I think of?
Speaker 3 (39:04):
Well?
Speaker 1 (39:04):
I kind of mentioned them, but also hygiene issues I suppose,
but that's not really the.
Speaker 3 (39:12):
Same thing in caprices right in.
Speaker 1 (39:14):
Capriesis also sleep issues or being incontinent in bed sleeping. Yeah,
I'm trying to think of other kinds of things like this.
It is kind of interesting that that is one of
the only ways that your body can express itself in
(39:35):
a very clear way, you know, like.
Speaker 2 (39:38):
Just void avoid itself.
Speaker 1 (39:39):
Yeah, because we do it throughout the day, So why
not do it in a way that's unplanned as a
way to alert the self and others that something's wrong here?
Speaker 3 (39:51):
You know? Now?
Speaker 1 (39:54):
Uh, I want to be clear though that you know,
you mentioned this childhood sexual abuse, but you're saying it
wasn't long term or s now that can be enough.
So I'll say that but it's also possible that I
could see a lot of people focusing on that and
saying like, well, that's the clear cause, you know, it
sounds like your depression in PTSD has a number of causes,
(40:16):
and all of those causes could be related, and it
could be in addition to the child that'd sexual abuse
experienced or instead of it. So there's just no way
to know, is the thing. And then you also ask
is it usually an unrelated problem that causes an increase
in mental health mental illness symptoms?
Speaker 3 (40:37):
Is it usually an unrelated problem?
Speaker 1 (40:40):
I see, Yeah, it's not usually, like I said, but
that is absolutely possible for an unrelated psychological you know,
like you just had a functional issue of incapricis and
had nothing to do with your psychology. Could that cause
depression and PTSD like symptoms? Absolutely? Absoluteolutely. I would find
(41:02):
that most incontinent teens have some emotional fallout, including depression.
I mean, PTSD is kind of specific, but you know,
you could see that happening, you pee your pants in
the middle of class, and even if no one found
out like that, would that would leave a mark on
(41:23):
one's psychology so to speak. So but yeah, as Bob says,
what a wonderful thing you could talk with your therapist about.
And therapists generally speaking, are extremely comfortable talking about this
because there's there's nothing more. I don't know, there's nothing
more understandable than something like this. Therapists understand this sort
(41:49):
of Yeah makes sense to me, you know. And there's
nothing to be ashamed of, absolutely nothing. You know, in
our society we have some really fucked up ideas what
to be ashamed of, and uh, there's nothing to be
a shame in. And I'll delineate you know that there
are situations where we should feel shame, like if you
(42:10):
purposely killed someone or a puppy, or you did something
on purpose, you knew the consequences and did it anyway.
I feel like feeling being ashamed of that is, you know,
maybe why we have shame.
Speaker 2 (42:22):
I don't know if you want to keep this in,
but I shout it at Costco once.
Speaker 1 (42:27):
Tell us about it.
Speaker 2 (42:29):
Oh, I thought I had to fart walking down the island.
Costco turned out little bonus and yeah, there it is.
Speaker 3 (42:35):
Yeah.
Speaker 2 (42:36):
I go to my dock and I'm like, I shout
it at Costco and he's like, what's a shark so
I told him. He's like, oh, that's called rectal incontinence, bob.
Speaker 3 (42:46):
Or incaprisis.
Speaker 1 (42:49):
How much product was produced? Ah?
Speaker 2 (42:52):
Product, but a great word. I would have called it waste.
Oh not much, just.
Speaker 1 (42:57):
A little splash, and you immediately knew.
Speaker 2 (43:01):
Oh well yeah, because I could kind of feel it.
And then I went into the bathroom and discovered yep.
Speaker 1 (43:05):
Oh And then what did you do?
Speaker 2 (43:08):
I told Kyleen, and we laughed and we continued to shop.
Speaker 1 (43:12):
Did you clean it up with toilet paper and stuff?
Speaker 2 (43:15):
I cleaned up when I could, and then I went
home and took care of the rest.
Speaker 1 (43:17):
Yeah, but you didn't immediately go home?
Speaker 2 (43:19):
Nah?
Speaker 3 (43:20):
Yeah? Yeah? Yeah fuck it?
Speaker 1 (43:21):
Yeah yeah yeah, Well, thanks for leading the way on that.
Speaker 3 (43:26):
Hey, right on, man, nothing wrong.
Speaker 2 (43:29):
Next time I shired, I'll let you know.
Speaker 3 (43:30):
Yeah.
Speaker 1 (43:32):
So ten foot poll eliminated. Yeah right, And everyone out
there please take care of yourself because you deserve it.
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