April 7, 2025 • 53 mins
Trauma is a crucial aspect of addiction treatment, often serving as the underlying cause for substance use. In this illuminating interview with trauma therapist Dr. Jessica Cooper, we explore the mechanics of trauma therapy and how it helps people heal from devastating experiences.
• Breaking down trauma therapy into three essential phases: establishing safety, processing memories, and reconnection/integration
• Understanding how childhood trauma creates patterns that can lead to re-traumatization in adulthood
• Exploring the "fawn" trauma response (people-pleasing) alongside the better-known fight/flight/freeze responses
• Examining the differences in approach between single-incident trauma vs. complex, repeated trauma
• Creating a trauma timeline with "stones" (traumatic events) and "flowers" (protective factors)
• Processing traumatic memories through multiple perspectives: factual, sensory, emotional, and belief-based
• Recognizing signs of healing while understanding recovery is non-linear
• Using creative expression as a powerful tool in trauma recovery
• Developing a collaborative approach to trauma treatment
To contact Dr. Grover: ammadeeasy@fastmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today's episode focuses ontrauma, which is a crucial
(00:44):
aspect of addiction treatment.
I recently sat down with DrJessica Cooper, a trauma
therapist in my area, to discusshow trauma therapy actually
works to help people heal.
Let's get started, Okay, Well,I am so excited to talk to you
today.
Why don't you start by tellingme who you are and what you do?
Speaker 2 (01:26):
for about 16 years now and my background I've
worked in different settingsincluding community mental
health, domestic violence,shelters, a lot of experience
with university mental health,working at counseling centers,
mostly in the UC system, andthen for the last three years I
have been based here in Montereyand have a private practice and
I specialize in working withsurvivors of trauma and, in
(01:50):
particular, survivors ofinterpersonal violence, so of
different forms of abuse andassault, intimate partner abuse.
I also have a lot of clientswho have experienced different
forms of trauma and traumarelated to marginalized
identities they hold so raciallybased trauma, trauma related to
(02:13):
immigration, you know, to beingLGBTQ, some experience working
with veterans as well andcurrently doing individual
therapy with teens and adults,but a lot of background with
group therapy for traumasurvivors too.
Speaker 1 (02:28):
So I like to think about things in a very simple
way.
The emergency departmentthere's so much you got to know.
You got to keep it simple.
So, at the 10,000 foot level,what I do as an addiction doctor
is I help people go fromregulating themselves with
substances to self-regulating.
How would you describe traumatherapy at that 10,000-foot
level?
Speaker 2 (02:50):
Yeah, well, I will refer to the great Judith Herman
and her book on trauma andrecovery that I really see the
stages of trauma therapy firstabout establishing safety and
trust in the therapeuticrelationship, then this process
(03:12):
of remembrance and mourningaround the trauma and what has
been taken away, and ultimatelymoving towards reconnection with
community and society and anintegration of the selves.
People often feel like theywere one self before that
(03:32):
experience and then another selfafterwards.
Speaker 1 (03:36):
So let's start with those three parts of what you do
Talk to me about the first part, which I believe you said was
safety.
Speaker 2 (03:40):
Yes, yeah, so starting with establishing
safety and you know a lot ofthat really is establishing
myself as a safe person for theclient.
So someone who's experiencedtrauma has had this profound
loss of control over their lives.
(04:00):
So, even just starting with howtherapy is going to work, they
are really in charge of thecontent and pacing of our
sessions and then I'm there as akind of a guide.
I also think that establishingsafety is looking at.
Often, clients are coming to mein crisis.
(04:22):
They are coping and usingsurvival skills the best they
know.
Speaker 1 (04:28):
Or substances.
Speaker 2 (04:29):
I was about to say, yeah, that often it is unhealthy
in ways of coping and a lot ofthat trauma survivors related to
alcohol and drug abuse,different forms of self-harm
relationships with reenactmentof trauma in them.
So before getting into more ofthe actual processing of trauma
(04:53):
memories and I do start with anoverview of what they've
experienced, but that firststage is much more skills-based
of how can I really help inproviding some grounding and
self-soothing and emotionalregulation skills and to address
(05:14):
ways that they may not feelsafe within their relationships.
Speaker 1 (05:20):
It's my belief that if they're still in their trauma
, as in they're still in adomestic violence relationship,
it's not appropriate really tostart trauma therapy.
Would you agree with that and,if not, tell me what I'm missing
?
Speaker 2 (05:33):
Well, I do think that's appropriate to start
therapy.
Speaker 1 (05:38):
I would agree.
Speaker 2 (05:38):
Yeah, with a pint while they're still experiencing
intimate partner abuse.
But it's true that the focuswouldn't be on like let's really
go through these memories indetail with one another.
Yeah, it's tricky working withsomeone who is still within an
abusive relationship, that maybethe most important thing I can
(06:02):
do as a therapist is to becompassionate and nonjudgmental.
But you know it's hard when I'mvery concerned about their
safety and, to be honest, andprobably are not going to be in
therapy for very long.
(06:29):
So it is this process aroundsafety planning and really
validating what's going on inthat relationship that they do
not deserve and attempting toempower them ultimately to make
choices around the safety or howto leave that relationship.
Speaker 1 (06:48):
Let's dig into this a little bit, because I think you
said it beautifully, that aperson might not be in a place
in their life where they aresafe, but they still would
benefit from therapy.
Do you counsel peopledifferently while they're in
their trauma, about how tomanage the trauma as it's
happening?
Speaker 2 (07:05):
that seems like it's a really weird position to be in
as a therapist yeah, I mean itmay be a a weird position but
you know I'm definitely part ofthe work and and often someone
who is experiencing intimatepartner abuse has a much longer
(07:28):
trauma history.
So maybe we would be workingaround how the child abuse and
neglect that they experiencedthen made them vulnerable to
intimate partner abuse and howthat intimate partner abuse can
even be like a kind ofreenactment of past trauma.
Speaker 1 (07:48):
Okay, so that makes sense.
So even if someone comes to youin a difficult relationship,
you still have stuff to work onearlier in their life that's
maybe primed them to be victimsof trauma in the future.
Speaker 2 (07:59):
Yeah, it's often the case.
Speaker 1 (08:01):
Yeah, it's the same thing with my patients is I have
some of them that can'tremember when the trauma started
, only that at some point thesexual assault stopped.
Yeah, yeah, very dark.
Talk to me about how being avictim as a child of trauma sets
a person up to be a victim asan adult.
Speaker 2 (08:20):
Yeah, that's a good question.
Yeah, that's a good question.
To be a victim of child abuseis really an experience of
betrayal that someone who issupposed to be a safe adult,
supposed to be a caregiver,instead is harming that child.
I talk a lot with my adultclients who experienced trauma
(08:43):
in childhood about survivalskills, of really trying to
honor the survival skills thatthey developed in childhood
while looking in adulthood atwhat may no longer be serving
them.
Of course, yeah.
So for example, it might be asurvival skill in childhood of
(09:06):
really how to please and appeasesomeone who is abusing them,
but then if we're talking aboutan adult romantic relationship
and those are still the samedynamics where it's all about
what the other person needs andthey're not allowed to have
needs and emotions Then thatsurvival skill they got through
(09:28):
childhood is no longer servingthem in the present.
Speaker 1 (09:31):
Are you talking about the so-called fawn of fight
flight freeze and fawn Exactly.
Let's unpack fawn, because Iheard about this recently from a
colleague of mine.
Speaker 2 (09:40):
Yeah, you don't hear as much about fawning.
Speaker 1 (09:42):
Yes, this is new to me.
Speaker 2 (09:43):
Right.
People are familiar with fightor flight.
Or freeze yeah, with freeze,but fawning, which can also be
known as the please and appeaseresponse, that someone who their
trauma response is throughfawning is probably going to be
(10:05):
really conflict avoidance.
They're so attuned to theperson who is harming them and
attempting to prevent furtherharm, but you know that really
it is then this relationshipthat often is like a reenactment
of trauma.
Is then this relationship thatoften is a reenactment of trauma
(10:25):
.
Speaker 1 (10:25):
One of my colleagues who I think should have a PhD at
this point she is just soextremely intelligent about
trauma, having lived it herselfwas describing to me that a lot
of what the brain does aroundtrauma is.
It has an unresolved trauma andit will seek out similar
situation because it needs thatclosure.
In other words, if a parentsexually assaults child, they'll
(10:47):
choose abuse in relationshipsas an adult because they need to
close that childhood trauma.
Is that on the right track?
Speaker 2 (10:54):
of childhood trauma, but reenactment of trauma is
very common, like that wish youknow of.
Well, maybe I can be different,or I can make this other person
(11:20):
be different this time to getthem to stop harming me.
And I think it's important totalk with clients about
reenactment of trauma when youhave a sense that that's
happening, because they probablyon some level, like really feel
ashamed and are confused andblaming themselves.
For example, like why am Istaying in this relationship
(11:43):
with someone who is hurting meso badly?
Speaker 1 (11:49):
Yes, I'm thinking about a lot of my patients that
have that reenactment ofchildhood abuse, multiple
abusive relationships.
I met a psychiatrist fromHarvard who spoke on my podcast
about trauma and he describedtrauma like a snowball as it
rolls down the hill, it picks upspeed and more snow and more
trauma.
And he described trauma like asnowball as it rolls down the
hill.
It picks up speed and more snowand more trauma and it just
grows.
What do you see in yourpractice around that?
Speaker 2 (12:12):
Yeah, I like that description.
Yeah, that does feel apt and Idon't know if this is quite
answering your question, but alot of what I also do with
clients is looking for where aretheir stuck points in healing,
like in trauma reenactment,which so frequently are
(12:33):
connected to that experience ofshame.
So there can be shame around,like initially experiencing a
trauma, but often even moreshame around how it then
continues to impact somebody inorder that they haven't gotten
over it yet.
Or like the ways that someoneis coping, for example, with
(12:57):
abuse of alcohol and drugs arethen resulting in more levels of
trauma and of shame.
Speaker 1 (13:07):
How do you, as a clinician with a focus on trauma
, differentiate between asingular big event, let's say a
car accident, versus repetitivetraumas over time?
What's different in yourapproach between those two?
Speaker 2 (13:18):
Great question and the diagnostic manual that we
both use, the DSM-5, only has aPTSD diagnosis.
It does not have a complex PTSDdiagnosis, although I really
think that it should.
So the complex PTSD diagnosisis for repeated and prolonged
(13:43):
trauma experiences and often ina relationship with someone who
that person is supposed to beable to trust.
So there are some keydifferences in how that can
present and where to focus intherapy.
Like, specifically with complexPTSD, there can be such
(14:07):
interpersonal issues aroundtrust and how to determine
whether another person istrustworthy, or also difficulty
with trusting the self, likebeing able to trust one's
intuition about other people.
I also think that, working withsomeone who has complex PTSD,
(14:30):
that it is really important overtime to move from that safety
stage of treatment into more ofthe processing and narrative
around traumatic experiences.
Speaker 1 (14:46):
That sounds like a great segue to talk about part
two of what you said, which isthe processing.
So this is the black box for me.
I understand safety and Iunderstand merging on the other
side, but what happens in themiddle?
Speaker 2 (15:00):
So in the middle and I do talk with clients about
really the need to acknowledgeand to mourn what has been taken
away by the experience oftrauma, for example, a sense of
safety, the ability to beintimate with others, how to
(15:22):
really trust I find it reallyuseful with the processing stage
of trauma therapy to have aclient create a timeline for me
and I like with narrativeexposure therapy, that it's
having clients do a lifelinewith what's called stones on one
(15:46):
side and flowers on the otherside, so that the stones are
those painful traumaticexperiences.
So, for example, if I'm workingwith someone who's 25 years old
, they do a timeline of theirlife where they're indicating
okay, here are the years that Iwas experiencing child abuse,
(16:08):
these are the years that I wascloseted, this is when bullying
was taking place, etc.
And then on the other side, theflowers are more of those
protective factors, the goodthings going on in that person's
life or sort of the protectivefactors.
Speaker 1 (16:26):
Would that be like a protected big brother or a
mentor or a sport or somethingExactly?
Speaker 2 (16:31):
Yeah, and so much of resilience is about how someone
finds the safe adults or safepeople in their life or
activities that they're good atto also have sense of self-worth
.
So then having this kind of mapthat we keep referring back to
(16:55):
throughout therapy we work withone of these particular
experiences of trauma and goingthrough the memories in stages.
So starting first with atraumatic memory kind of like
talking to a reporter with asmuch detail as possible who,
(17:19):
what, when, where, etc.
Then going back through thattraumatic memory together in
different ways.
So one way could be much moreof a focus on senses and body
sensations.
Then it could be going throughthis memory with more of an
emphasis on theirinterpretations of the event and
(17:43):
the beliefs that came out ofthe trauma and also really going
through with the emotions.
And often when I'm starting likethat processing with someone,
well, actually I find thateither when someone is
recounting a traumatic memory,they might be really emotionally
(18:04):
dysregulated and in tearsthroughout it and perhaps we're
having to pause and do groundingwith one another, or there can
be a level of numbing anddissociation, of course, that
it's as if they're telling astory that happened to somebody
else, and really avoidance ofexperiencing those painful
(18:24):
emotions but ultimately in thatstage of therapy we have to be
able to get to the morning.
We have to be able to get tothose painful emotions that now
this person is safe enough to beable to feel like what they
haven't been able to feel in thepast.
Speaker 1 (18:42):
So do you just let your client pick whichever is
the biggest rock and start withthat or the rock that they're
worried the most about?
Or how do you pick which rockto start with?
I'm sorry, you call them stonesor rocks.
Speaker 2 (18:53):
Stones, stones.
My apologies, can't be either.
Okay so, yeah so, same concept.
Speaker 1 (18:58):
Which stone do you pick?
Speaker 2 (18:59):
Yeah, Well, we make that decision together.
And, yeah, going back to, theyare in charge of content and
pacing of the sessions and I amthe guide walking alongside them
.
Typically it's either the worststone or going through it
(19:22):
chronologically with each other.
And another reason that I dolike to have this timeline is,
let's say, I'm working withsomeone because they recently
experienced a sexual assault,but then I recognize, oh, this
is someone who had to take careof alcoholic parents and they
(19:45):
got into this terrible caraccident at one point.
Just that.
So often if you're looking atjust one trauma, you're missing
a lot of context of earliertraumas that they had
experienced.
Speaker 1 (20:00):
So we talked briefly just before we started that I
have PTSD from my career in theemergency department and it's
interesting I've been justthinking about my own traumas
and a young woman who hungherself is the one that keeps
coming to mind.
I actually had flashbacks, ifwe've been sitting here, of
seeing her in the literaturemarks.
That makes perfect sense toreally allow the client to say
(20:22):
this is the one that's on mymind the most.
I want to talk about this.
I'm assuming you allow yourclients to self-regulate and
choose about what seems to bemost urgent or on their mind the
most, or do you ever have timeswhere you say that's too
intense?
We're not ready to do that yet.
Speaker 2 (20:38):
Yes and yes.
Speaker 1 (20:39):
Of course.
Yeah, I figured.
Speaker 2 (20:41):
Yeah.
Yeah and there are differentschools of thought on this that
another trauma therapist mightsay no, you really have to go
through establishing safetystage before getting to
discussion of a worst trauma,like over what we're talking
about.
If someone comes in and theywant to start with talking about
(21:08):
a worst traumatic memory, I'mprobably going to go with that,
while saving at least 10 minutesin that session for some
grounding and then figuring outwhat the plan should be to take
care of themselves that night.
But there have been times thatI've stopped someone.
For example, if I know thatsomeone is suicidal, then it's
(21:33):
really not appropriate for us tostart by going into the worst
trauma that can be reallydangerous.
I then, of course, would stopthat person and just explain my
rationale about how we need tostart in establishing safety
before getting to the worst ofit together.
Speaker 1 (21:56):
So it sounds like and I'm a fitness person, that's
what keeps me sane.
I'm almost thinking of what youdo as like a workout.
You do a warmup, you have anintense workout, you do a
cool-down and then you have arecovery.
Does that sound like a fair wayto think about it?
Speaker 2 (22:13):
your sessions- yes, yeah, and I do really think that
it's important to not justleave someone in a worst
traumatic memory of like, oh,we're out of time, we're going
to talk.
Speaker 1 (22:28):
I was going to ask you about that, please, please,
log in.
Speaker 2 (22:32):
Yeah, we'll pick this back up next week.
That's why I can be reallyadamant around saving the last
10 minutes of the session.
Are you open to my leading youthrough a grounding exercise
right now and I give differentoptions with grounding exercises
and what is the plan for thisevening Just acknowledging that
(22:56):
we've opened a lot up togetherand so there can then be a flare
up of PTSD symptoms.
Here's why I also like to havestarted with more of that
skills-based approach, becausethen we're able to reference
what has been helpful for themwith self-soothing and grounding
(23:18):
and having that be a part ofthe plan of what they're going
to do that night.
Speaker 1 (23:23):
And in terms of what this processing actually looks
like practically?
Right, and in terms of whatthis processing actually looks
like practically, I'm assumingit varies person to person, but
would you say it's roughly anaverage of 20 sessions, 50
sessions, 200 sessions.
Let's imagine one person has asingular trauma, a bad car
accident, they were almostkilled.
For that sort of singular event, big T trauma would you
(23:43):
estimate roughly how manysessions a person needs to
process?
Speaker 2 (23:47):
Someone with a singular trauma.
It is possible that when we'rein the processing part of
therapy, maybe we would do thatwithin five to 10 sessions I'm
reluctant to put a specificnumber on it and I definitely
have people who I've beenworking with for years around
(24:09):
processing the trauma timelines,because there's so much for us
to go through together.
Speaker 1 (24:16):
Well, it's like you asking me, how long does it take
someone to get sober?
It's like, well, it depends.
Correct Contrast for me, though.
Let's say somebody again hasthis singular traumatic car
accident event and someone else,a second person, has 10 years
of sexual assault as a child.
I'm assuming the second clientis much more complicated.
More sessions takes more timeOverall.
(24:37):
Obviously people are going tobe different, but I'm assuming
more trauma means more time toprocess.
Is that about right?
Speaker 2 (24:43):
Yeah, that's probably true.
And also, what was the age thattrauma began?
If I'm working with someone whoexperienced 10 years of sexual
abuse, they probably don'tremember their life before
trauma.
If I'm working with someone whodoesn't have a significant
trauma history up until aterrible car accident, then
(25:09):
they've had an opportunity toreally develop their sense of
who they are and what theircoping skills are.
It would also be a differentapproach with a car accident
that probably part of what wewould be doing would include
exposure therapy.
(25:29):
Someone who's been through acar accident natural for them to
be frightened to drive againand avoiding driving.
So, with that person, I wouldwork with them on establishing a
hierarchy of their fears.
Work with them on establishinga hierarchy of their fears,
(25:57):
starting with actions that theycan take to challenge avoidance,
that are less scary, and thenworking up to what's more scary.
So maybe we would start withthem driving around a parking
lot that's empty with a trustedperson in the car, and then work
their way up to a Los Angelesfreeway at rush hour.
Speaker 1 (26:10):
Well, the good news is the Los Angeles freeway is a
rush hour.
You don't go more than fivemiles an hour.
Speaker 2 (26:15):
I spent a lot of time in Los Angeles freeways.
I lived in LA for a decade.
Yeah, I had a lot of experiencewith Los Angeles freeways too.
Speaker 1 (26:23):
So I'm going to make a big jump here, because this is
a question that comes up allthe time for me and it sounds
like the process ofunderstanding this is similar to
what you just described arounddriving after a car accident.
But I have so many victims ofsexual assault and as human
beings we're wired to have closerelationships and intimacy, and
(26:44):
the process of dating andintimacy after sexual assault
just seems insurmountable to meand I'm curious how you work
with clients around that,because I would love my patients
who've been sexually assaultedto heal and move on and find
meaningful relationships and, ifit's right for them, start
families.
But I don't even, can't evenimagine what that's like.
Speaker 2 (27:05):
Yeah Well, this is a good moment for me to include
that.
I am such a proponent of grouptherapy for survivors of sexual
assault and abuse, especiallylike when they are in more of
that, building connections, youknow, phase of therapy, and when
(27:28):
I would lead support groups forsurvivors.
Whenever it would be the groupsession that we would talk about
dating and sex and intimacy.
You could sort of feel thissense of oh well, this is the
hardest part of recovery formany of them, but also like
what's bringing them to thegroup, what they want to change
(27:49):
the most.
And you know that these clientswe would talk about how, for so
many survivors of sexualassault, there's sex, there's
intimacy.
But the challenge is reallyaround experiencing sex with
intimacy, Of course, and sexualassault can often cause
(28:12):
different extremes in behavior.
So one survivor might reallyavoid sex and intimacy even if
they want that.
Another one might be in sexualrelationships where there can be
a reenactment of trauma or it'srisky or not safe for them in
(28:34):
some way.
So a lot of what I do withclients is acknowledging the
difficulties, talking abouttriggers and handling triggers
and when that does come upduring sex and also what their
rights are.
For example, like to not havesex when they don't actually
(28:57):
want to have sex, or like, ifthey're having sex and are
triggered or, for whateverreason, don't want to continue
to have talked in advance with apartner about how the partner
might be able to tell if it'snot something that they can put
into words that that ishappening, and then the
(29:19):
understanding of stopping andmaybe, if they're open to it,
some other type of physicalintimacy.
Also, often it's best to startwith sex with one's self
Masturbation.
Speaker 1 (29:35):
Trying to understand what the body feels.
Speaker 2 (29:36):
Yeah, really trying to get like reacquainted with
the body, to have experiences ofbeing in the body while aroused
, rather than to be dissociatedand having a sense of what they
like and don't like, how toexperience pleasure.
And then, when it comes to sexwith a partner, my clients can
(30:00):
often be reluctant to tell thepartner that they are a survivor
of sexual assault or abuse, andit's a very difficult
conversation to have withanother person.
I mean, talk about like reallyjust the trust and bravery it
takes to have that conversation.
However, I think it's a reallyimportant conversation to have.
Speaker 1 (30:23):
Absolutely.
Yeah, I have a number of femalepatients that talked about
becoming very promiscuous afterbeing assaulted because they
wanted to be in control.
Talk to me about the variousresponses that you see in your
clients after a trauma.
Whether it's avoidance, whetherit's again sexual assault is
unique.
The promiscuousness.
But let's say, somebody has acar accident, do they not drive?
(30:46):
Do they only let someone elsedrive?
Do they speed recklessly?
What are some of the commonresponses of the brain trying to
regain control after a trauma?
Speaker 2 (30:54):
Yeah, most commonly it is avoidance.
Speaker 1 (30:57):
Oh, that makes sense.
Speaker 2 (30:58):
You know, like the core components of PTSD are
Avoidance yeah, some sort ofintrusive, re-experiencing
avoidance alterations to moodand cognition and nervous system
hyper arousal I still don'twalk through the er.
Speaker 1 (31:13):
Yes, yeah, I'll avoid it.
I'll go all the way around thehospital to avoid the er.
I love my colleagues in theyear, but I totally avoid it
avoidance is that naturalresponse.
Speaker 2 (31:24):
But when it's avoidance of something that is
not actually dangerous, not athreat, even though the body
still experiences it as a threat, then avoidance can just be so
limiting and is sort ofreinforcing oh that this threat
(31:46):
really is something to be feared.
Speaker 1 (31:50):
So we've talked about establishing safety as part one
.
The processing itself is parttwo and I'm sure we could do two
to three hours on theprocessing, the third part.
You talked about merging andreintegrating.
What's that like?
Speaker 2 (32:09):
merging and reintegrating.
What's that like?
Yes, so you know that thirdpart around reconnection and
integration is a stage that ismore present and future-oriented
, so it can be much more focusedon healthy relationships with
other people, which ofteninvolves a lot of boundary
(32:33):
setting and knowing aboutinterpersonal rights and, after
trauma, how to recognize waysthat you are actually the same
person and often where I go withthat, like it is around, like
(32:56):
core values that remainunchanged, for example, like a
core compassionate to otherpeople.
It can also be this recognitionof this trauma happened.
It was outside of this person'scontrol and the ways that they
(33:17):
had to grow and change to copewith what happened, like that
they like those things aboutthemselves, wouldn't want to
give that up.
So it can also be recognizing,for example, like becoming a
much more honest person inrelationships.
(33:40):
But, yeah, it really tends tobe this stage where we're not
focused on looking into the pastanymore.
We're more focused on thepresent and the life that
survivor wants to build.
Speaker 1 (33:57):
So let me see if I can make this make sense in my
simple former ER doc brain.
In stage one, people are in abad place destructive behavior,
bad environment.
They're often so focused onothers like their aggressor.
Stage two after we achievesafety, we learn to
self-regulate.
It seems like step three isalmost learning how to actually
(34:20):
think about others and yourselftogether in a healthy way.
Speaker 2 (34:24):
Does that sounday yeah, definitely, I think that's
a good way of describing it.
And yeah, the stage three thingTo some extent it was also
maintenance of change, Of course, At that point that overall my
client is more stable, happierin their life, but probably
(34:51):
still experiencing flare-up ofPTSD symptoms, especially during
periods of heightened stress orloss or transition.
So the part of therapy is alsoaround recognizing that's a
normal part of recovery andpracticing how to take care of
(35:15):
themselves when PTSD flare-upsoccur and to recognize that
actually they really have made alot of progress.
Speaker 1 (35:24):
When my daughter had asthma as a child.
She's grown out of it, but inorder to go to school she had to
have an asthma action plansigned by her pediatrician.
You had the green light, onepuff of the inhaler.
The yellow light was threepuffs of the inhaler, wait a few
minutes, do this.
The red light was take oralmedicine and then do this and
(35:44):
the crisis was called 911.
Do you create that granularlevel of a relapse prevention or
a you-just-got-triggeredprevention plan?
How do you set people up toself-regulate in the future With
how to self-regulate?
Speaker 2 (35:57):
in the future With how to self-regulate in the
future.
I do think a lot of that ispsychoeducation around
understanding what happensduring a trigger response and
then having the skills to beable to deal with that.
So, to be more specific, I likethe analogy that for a trauma
(36:23):
survivor, a threat isexperienced as if there is an
ambulance siren going off nextto them.
For someone who hasn'texperienced a lot of trauma, it
can be more like oh, someone'scell phone alarm is going off in
the other room, but it reallyis this different experience.
(36:45):
So for a trauma survivor who'striggered, then some of what
they're going to do is theself-talk around telling
themselves how they actually aresafe in that moment.
But a lot of it is going to begrounding and self-soothing
(37:05):
skills.
So, for example, can be like akind of physical grounding, of
focusing on, like I'm sitting inthis chair right now, all of
the contact points between mybody and the chair, my feet and
the ground beneath me, ways toengage the senses, to be back
(37:30):
into that present moment.
Speaker 1 (37:34):
One thing you hinted at when we were just getting
started was people actuallymourning the loss of a former
self.
Do people change their names?
Do they change their hair color?
How do people emerge on theother side?
What do people tend to do inyour experience?
Speaker 2 (37:50):
One way they do that is to get tattoos.
Really, yeah, I don't thinkI've worked with anyone who
changed their name through atrauma journey, unless they're
trans, which is a whole.
Very unique yeah of course, yeah, which is different, but a lot
of my clients at some point doget a tattoo, a tattoo.
(38:26):
For example, I have a clientthat for her and for family
members that when a hummingbirdappears, you know that it's this
reminder that, no matter howbad things get, you know that
there's still beauty in theworld.
So then having this hummingbirdtattoo is something that they
can look at on their body andyou'll have that memory.
I've had other clients tattoomessages to themselves, like to
(38:48):
remember to breathe.
Another client who had a cabintattooed, that was this symbol
of how she's reclaimed ownershipof her body as a safe place.
So yeah, actually I got reallycommon for my clients and I
(39:11):
don't think it's ever somethingI've suggested, but many of them
do get tattoos in later stagesof their recovery of them do get
tattoos in later stages oftheir recovery.
Speaker 1 (39:24):
Two interesting reflections back on that.
One of them is I mentioned afriend and colleague who is very
knowledgeable about trauma andshe's a victim of trauma herself
, and she talked about tattooingwas a way to take her body back
to my body.
It's interesting, though I hadmajor depression in college,
along with self-harm and aneating disorder, and I was going
to get my dad's initialstattooed on my chest because my
dad was in the process of dyingof cancer, and that was a major
(39:44):
part of what I was dealing with,and my psychiatrist said
absolutely not.
You will get one, then you willwant two, then you will want
three, then you will want four.
He really recommended againstit.
Speaker 2 (39:55):
So did you get any tattoos?
Speaker 1 (39:57):
No, I do not.
Speaker 2 (39:58):
Still no tattoos.
Speaker 1 (40:05):
No tattoos.
I do have a couple of scars,and cutting and self-harming
behavior is very interesting andwe could spend another hour
talking about that, butironically my scar is in that
spot where I was going to get mytattoo.
Speaker 2 (40:13):
Yeah, I think I would have given you different advice
if I had been your therapist atthat time.
It is true that when clientsbring up tattoos that I suggest
not making that choiceimpulsively, of taking some time
to really consider.
Do they want that tattoo?
Maybe even like inking it onfor a while.
(40:35):
But yeah, I wouldn't tellsomeone.
If you get one tattoo, you'rejust going to want more and more
Interesting.
Maybe you'll still get a tattoo, I don't know.
Speaker 1 (40:44):
We'll see and then forgiveness.
So again, a car accident is theword in that term.
Is accident Presumably there's.
Well, there may be someone atfault, but presumably it was a
horrible thing that happened anda person recovers.
But when someone harms another,when a person is the victim of
physical, sexual, verbal,assault, abuse, whatever, how do
(41:07):
you talk about forgiveness withthe victim?
Speaker 2 (41:09):
Yeah.
So what I tell the victim isthat the only forgiveness that
needs to be a part of theirhealing and recovery is the
forgiveness of themselves, whichcan be forgiving, blaming
themselves for the trauma havinghappened.
(41:30):
Often it's more forgivenessblaming themselves around the
impact and how long that impacthas lasted.
I don't think that forgivingwhoever caused the harm has to
be a part of therapy, but ifthat is important to my clients,
(41:53):
then I will work with themaround that and, for example, I
have a lot of conversations withclients who experienced abuse
by a parent about how to holdboth the harm that that parent
caused and the empathy that theyfeel for that parent.
(42:19):
An intergenerationaltransmission of trauma is so
common.
So often my clients will beexpressing well, my dad had been
abandoned by a parent and wasbeaten by another parent, or had
all this immigration trauma andgetting to the US, etc.
(42:41):
So, yeah, we just talk a lotabout it's possible to hold both
, like the recognition of theharm that was caused, along with
empathy and perhaps forgivenessfor that person.
How do you take care of youhearing all these stories?
Speaker 1 (43:05):
I really have to take care of myself.
Speaker 2 (43:07):
You have to do yes, yeah.
So I often remember I think itwas my first week of grad school
and my ethics professor sayingwell, you can't ever ask a
client to do something that youwouldn't be willing to do
yourself, and that honestlyfreaked me out.
You know, I'm just I'm going toask my clients to do so many
(43:31):
difficult things, but I can'task my clients to be taking good
care of themselves if I'm notdoing that myself.
So I think it's reallyimportant as a trauma therapist
to not go it alone.
Although I am now an individualin private practice, I have a
(43:52):
lot of great former colleaguesand friends who are also trauma
therapists, so I'm able to getsupport from them.
My husband's an amazing cook.
He makes delicious meals.
I have a really cute dog andcat.
I appreciate getting to thepoint of my day that is more
(44:18):
restorative.
I'm also such a reader and filmlover, so having ways to really
immerse myself in somethingelse.
I am a compassionate meditationpractitioner and facilitator
too, which I really like toincorporate into therapy.
My clients are open to thatwhich I really like to
(44:40):
incorporate into therapy and myclients are open to that.
So, especially when I go backto where I lived before here in
Santa Barbara and part ofMindful Heart Programming where
I'd done my training.
That just for an afternoon andbeing back in that space or at
times like taking a longer in ameditation retreat is really
restorative.
And lastly, travel.
I love travel.
I also experience that isreally restorative.
And lastly, travel I lovetravel.
I also experience that as veryrestorative.
(45:01):
What percentage?
Speaker 1 (45:02):
of therapists, would you say, have therapists
themselves.
Speaker 2 (45:08):
At some point should be all of us, I think the
majority.
I really appreciated that itwas a requirement of my graduate
program to do a year's worth ofweekly therapy.
I did much more than thatmyself, and I think both again,
because I shouldn't ask if Iwant to do something I'm not
(45:30):
willing to do myself.
Speaker 1 (45:51):
It can be wonderful to have it be okay.
This is really now my turn tounload and to receive caretaking
from someone else who also justreally relates to what it is
that I do.
So I've obviously asked youloads of my questions.
You're the expert here.
What have I missed?
Speaker 2 (46:04):
What are important parts of managing trauma in what
you do that we haven't talkedabout yet.
Well, one of the questions thatyou had sent in advance of how
can someone tell when they arehealing I really like that
question, so I just wanted tobring that into the conversation
too.
It's important to talk aboutthe process of healing and to
(46:24):
redefine together what healinglooks like.
It doesn't mean that PTSDsymptoms are fully in remission
permanently, and hopefully itmeans that they are going to
really lessen intensity and infrequency.
But just really knowing howhealing is nonlinear, how often
(46:52):
with therapy, and choosing totalk about all the scary stuff
that someone might feel.
Talk about all the scary stuffthat someone might feel worse
before they get better.
Yeah, I'm also always lookingfor the ways that I'm able to
point out like well, when wefirst started meeting with one
another, I really think that youwould have reacted to this
stressor in this way, and I'mhearing that you were able to
(47:15):
handle it in this very differentway.
So, yeah, really bringing inthe strengths as well, but, I
think, a lot of discussionaround what healing does and
does not look like.
I also think it's such a giftwhen my clients have artistic
talent.
I wish that I did.
(47:36):
Talent, I wish that I did.
But if they are able to haveart or music or dance or writing
be a part of their healing too.
Speaker 1 (47:48):
A lot of my patients are very artistically minded.
I keep encouraging them to putsomething on this blank wall
here no takers yet, but the iconfor my podcast is a painting by
a friend of mine who died fromoverdose.
I'm so sorry, no, no, well,thank you.
I spoke at his funeral and hehad shared his art with me while
he was still alive.
And I spoke at his funeral andI brought this painting that he
(48:10):
had made before he ever knew meand shared it with me.
And yeah, so people across theglobe see his art and it helps
his family have closure.
So I love this idea ofencouraging my patients to be as
creative as possible.
I think of processing traumafor my patients can be talk
therapy, it can be journaling.
It not like therapy, medicines,medical.
(48:32):
I like kind of a person intheir own environment being
creative.
It really seems to empower them, to show that they have value
and uniqueness as a human being.
Speaker 2 (48:49):
I hope so.
I love that.
That's a way that you rememberyour friend.
My best friend died severalyears ago due to alcoholism,
which is such a heartbreak.
And yeah, in my office I dohave a photo that she had taken
of a mural with an eye in it andit does give me the sense of
(49:12):
her watching over me.
I have to say I will bedefinitely referring patients to
(49:34):
you and you are welcome torefer patients to me in return.
How common is it in the therapycommunity was especially focused
on working with interpersonalviolence survivors, which I
loved that opportunity forconsultation and collaboration.
Yeah, I think that a lot oftherapists do focus on trauma
and even if a therapist is nottrauma-focused, they can still
(49:57):
be trauma-informed, for example,actually asking about a
client's trauma history atintake or holding that in mind
and looking for the ways tobring that back into therapy
when it feels relevant.
And I would love to be able torefer to one another.
I don't think I've said yetthat I also think that ideally,
(50:21):
trauma therapy is a team.
You know that perhaps I'm doingindividual therapy with someone
.
They're also in group therapy.
They have a greattrauma-sensitive psychiatrist.
Maybe they're doing alcohol anddrug counseling too.
So both just in terms of notburning out as professionals,
(50:44):
it's important to have that teamand also for the client to have
that kind of multidisciplinarysupport.
Speaker 1 (50:52):
I will be a better doctor next week after talking
to you.
You're so kind.
Any last thoughts that you wantto leave?
Speaker 2 (50:57):
us with.
I just I appreciate the workthat you're doing with this
podcast and I really appreciatefor any physicians and
psychiatrists to be sotrauma-sensitive that it's also
part of trauma to often minimizethe impact while really
(51:24):
suffering or not make theconnections like between the
trauma and that present daysuffering.
So for you to have this podcastand to be having these
conversations here with clientsis so valuable.
Speaker 1 (51:44):
It's funny we started with talking about safety and
I'm going to finish us up bysaying that's what we really try
to create in this space issafety.
Speaker 2 (51:48):
Yes, we have to be that trusted person Well said.
Speaker 1 (51:50):
Well, I have to say thank you so much, I have
learned so much, and may Iinvite you again for future
topics?
Speaker 2 (51:55):
I would be happy to return in the future Sounds good
.
May I invite you again forfuture topics?
I would be happy to return inthe future Sounds good.
Speaker 1 (52:06):
Before we wrap up, a huge thank you to the Montage
Health Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
(52:29):
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
saves lives.
Speaker 2 (52:47):
I'll see you next time.
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today's episode focuses ontrauma, which is a crucial
(00:44):
aspect of addiction treatment.
I recently sat down with DrJessica Cooper, a trauma
therapist in my area, to discusshow trauma therapy actually
works to help people heal.
Let's get started, Okay, Well,I am so excited to talk to you
today.
Why don't you start by tellingme who you are and what you do?
Speaker 2 (01:26):
for about 16 years now and my background I've
worked in different settingsincluding community mental
health, domestic violence,shelters, a lot of experience
with university mental health,working at counseling centers,
mostly in the UC system, andthen for the last three years I
have been based here in Montereyand have a private practice and
I specialize in working withsurvivors of trauma and, in
(01:50):
particular, survivors ofinterpersonal violence, so of
different forms of abuse andassault, intimate partner abuse.
I also have a lot of clientswho have experienced different
forms of trauma and traumarelated to marginalized
identities they hold so raciallybased trauma, trauma related to
(02:13):
immigration, you know, to beingLGBTQ, some experience working
with veterans as well andcurrently doing individual
therapy with teens and adults,but a lot of background with
group therapy for traumasurvivors too.
Speaker 1 (02:28):
So I like to think about things in a very simple
way.
The emergency departmentthere's so much you got to know.
You got to keep it simple.
So, at the 10,000 foot level,what I do as an addiction doctor
is I help people go fromregulating themselves with
substances to self-regulating.
How would you describe traumatherapy at that 10,000-foot
level?
Speaker 2 (02:50):
Yeah, well, I will refer to the great Judith Herman
and her book on trauma andrecovery that I really see the
stages of trauma therapy firstabout establishing safety and
trust in the therapeuticrelationship, then this process
(03:12):
of remembrance and mourningaround the trauma and what has
been taken away, and ultimatelymoving towards reconnection with
community and society and anintegration of the selves.
People often feel like theywere one self before that
(03:32):
experience and then another selfafterwards.
Speaker 1 (03:36):
So let's start with those three parts of what you do
Talk to me about the first part, which I believe you said was
safety.
Speaker 2 (03:40):
Yes, yeah, so starting with establishing
safety and you know a lot ofthat really is establishing
myself as a safe person for theclient.
So someone who's experiencedtrauma has had this profound
loss of control over their lives.
(04:00):
So, even just starting with howtherapy is going to work, they
are really in charge of thecontent and pacing of our
sessions and then I'm there as akind of a guide.
I also think that establishingsafety is looking at.
Often, clients are coming to mein crisis.
(04:22):
They are coping and usingsurvival skills the best they
know.
Speaker 1 (04:28):
Or substances.
Speaker 2 (04:29):
I was about to say, yeah, that often it is unhealthy
in ways of coping and a lot ofthat trauma survivors related to
alcohol and drug abuse,different forms of self-harm
relationships with reenactmentof trauma in them.
So before getting into more ofthe actual processing of trauma
(04:53):
memories and I do start with anoverview of what they've
experienced, but that firststage is much more skills-based
of how can I really help inproviding some grounding and
self-soothing and emotionalregulation skills and to address
(05:14):
ways that they may not feelsafe within their relationships.
Speaker 1 (05:20):
It's my belief that if they're still in their trauma
, as in they're still in adomestic violence relationship,
it's not appropriate really tostart trauma therapy.
Would you agree with that and,if not, tell me what I'm missing
?
Speaker 2 (05:33):
Well, I do think that's appropriate to start
therapy.
Speaker 1 (05:38):
I would agree.
Speaker 2 (05:38):
Yeah, with a pint while they're still experiencing
intimate partner abuse.
But it's true that the focuswouldn't be on like let's really
go through these memories indetail with one another.
Yeah, it's tricky working withsomeone who is still within an
abusive relationship, that maybethe most important thing I can
(06:02):
do as a therapist is to becompassionate and nonjudgmental.
But you know it's hard when I'mvery concerned about their
safety and, to be honest, andprobably are not going to be in
therapy for very long.
(06:29):
So it is this process aroundsafety planning and really
validating what's going on inthat relationship that they do
not deserve and attempting toempower them ultimately to make
choices around the safety or howto leave that relationship.
Speaker 1 (06:48):
Let's dig into this a little bit, because I think you
said it beautifully, that aperson might not be in a place
in their life where they aresafe, but they still would
benefit from therapy.
Do you counsel peopledifferently while they're in
their trauma, about how tomanage the trauma as it's
happening?
Speaker 2 (07:05):
that seems like it's a really weird position to be in
as a therapist yeah, I mean itmay be a a weird position but
you know I'm definitely part ofthe work and and often someone
who is experiencing intimatepartner abuse has a much longer
(07:28):
trauma history.
So maybe we would be workingaround how the child abuse and
neglect that they experiencedthen made them vulnerable to
intimate partner abuse and howthat intimate partner abuse can
even be like a kind ofreenactment of past trauma.
Speaker 1 (07:48):
Okay, so that makes sense.
So even if someone comes to youin a difficult relationship,
you still have stuff to work onearlier in their life that's
maybe primed them to be victimsof trauma in the future.
Speaker 2 (07:59):
Yeah, it's often the case.
Speaker 1 (08:01):
Yeah, it's the same thing with my patients is I have
some of them that can'tremember when the trauma started
, only that at some point thesexual assault stopped.
Yeah, yeah, very dark.
Talk to me about how being avictim as a child of trauma sets
a person up to be a victim asan adult.
Speaker 2 (08:20):
Yeah, that's a good question.
Yeah, that's a good question.
To be a victim of child abuseis really an experience of
betrayal that someone who issupposed to be a safe adult,
supposed to be a caregiver,instead is harming that child.
I talk a lot with my adultclients who experienced trauma
(08:43):
in childhood about survivalskills, of really trying to
honor the survival skills thatthey developed in childhood
while looking in adulthood atwhat may no longer be serving
them.
Of course, yeah.
So for example, it might be asurvival skill in childhood of
(09:06):
really how to please and appeasesomeone who is abusing them,
but then if we're talking aboutan adult romantic relationship
and those are still the samedynamics where it's all about
what the other person needs andthey're not allowed to have
needs and emotions Then thatsurvival skill they got through
(09:28):
childhood is no longer servingthem in the present.
Speaker 1 (09:31):
Are you talking about the so-called fawn of fight
flight freeze and fawn Exactly.
Let's unpack fawn, because Iheard about this recently from a
colleague of mine.
Speaker 2 (09:40):
Yeah, you don't hear as much about fawning.
Speaker 1 (09:42):
Yes, this is new to me.
Speaker 2 (09:43):
Right.
People are familiar with fightor flight.
Or freeze yeah, with freeze,but fawning, which can also be
known as the please and appeaseresponse, that someone who their
trauma response is throughfawning is probably going to be
(10:05):
really conflict avoidance.
They're so attuned to theperson who is harming them and
attempting to prevent furtherharm, but you know that really
it is then this relationshipthat often is like a reenactment
of trauma.
Is then this relationship thatoften is a reenactment of trauma
(10:25):
.
Speaker 1 (10:25):
One of my colleagues who I think should have a PhD at
this point she is just soextremely intelligent about
trauma, having lived it herselfwas describing to me that a lot
of what the brain does aroundtrauma is.
It has an unresolved trauma andit will seek out similar
situation because it needs thatclosure.
In other words, if a parentsexually assaults child, they'll
(10:47):
choose abuse in relationshipsas an adult because they need to
close that childhood trauma.
Is that on the right track?
Speaker 2 (10:54):
of childhood trauma, but reenactment of trauma is
very common, like that wish youknow of.
Well, maybe I can be different,or I can make this other person
(11:20):
be different this time to getthem to stop harming me.
And I think it's important totalk with clients about
reenactment of trauma when youhave a sense that that's
happening, because they probablyon some level, like really feel
ashamed and are confused andblaming themselves.
For example, like why am Istaying in this relationship
(11:43):
with someone who is hurting meso badly?
Speaker 1 (11:49):
Yes, I'm thinking about a lot of my patients that
have that reenactment ofchildhood abuse, multiple
abusive relationships.
I met a psychiatrist fromHarvard who spoke on my podcast
about trauma and he describedtrauma like a snowball as it
rolls down the hill, it picks upspeed and more snow and more
trauma.
And he described trauma like asnowball as it rolls down the
hill.
It picks up speed and more snowand more trauma and it just
grows.
What do you see in yourpractice around that?
Speaker 2 (12:12):
Yeah, I like that description.
Yeah, that does feel apt and Idon't know if this is quite
answering your question, but alot of what I also do with
clients is looking for where aretheir stuck points in healing,
like in trauma reenactment,which so frequently are
(12:33):
connected to that experience ofshame.
So there can be shame around,like initially experiencing a
trauma, but often even moreshame around how it then
continues to impact somebody inorder that they haven't gotten
over it yet.
Or like the ways that someoneis coping, for example, with
(12:57):
abuse of alcohol and drugs arethen resulting in more levels of
trauma and of shame.
Speaker 1 (13:07):
How do you, as a clinician with a focus on trauma
, differentiate between asingular big event, let's say a
car accident, versus repetitivetraumas over time?
What's different in yourapproach between those two?
Speaker 2 (13:18):
Great question and the diagnostic manual that we
both use, the DSM-5, only has aPTSD diagnosis.
It does not have a complex PTSDdiagnosis, although I really
think that it should.
So the complex PTSD diagnosisis for repeated and prolonged
(13:43):
trauma experiences and often ina relationship with someone who
that person is supposed to beable to trust.
So there are some keydifferences in how that can
present and where to focus intherapy.
Like, specifically with complexPTSD, there can be such
(14:07):
interpersonal issues aroundtrust and how to determine
whether another person istrustworthy, or also difficulty
with trusting the self, likebeing able to trust one's
intuition about other people.
I also think that, working withsomeone who has complex PTSD,
(14:30):
that it is really important overtime to move from that safety
stage of treatment into more ofthe processing and narrative
around traumatic experiences.
Speaker 1 (14:46):
That sounds like a great segue to talk about part
two of what you said, which isthe processing.
So this is the black box for me.
I understand safety and Iunderstand merging on the other
side, but what happens in themiddle?
Speaker 2 (15:00):
So in the middle and I do talk with clients about
really the need to acknowledgeand to mourn what has been taken
away by the experience oftrauma, for example, a sense of
safety, the ability to beintimate with others, how to
(15:22):
really trust I find it reallyuseful with the processing stage
of trauma therapy to have aclient create a timeline for me
and I like with narrativeexposure therapy, that it's
having clients do a lifelinewith what's called stones on one
(15:46):
side and flowers on the otherside, so that the stones are
those painful traumaticexperiences.
So, for example, if I'm workingwith someone who's 25 years old
, they do a timeline of theirlife where they're indicating
okay, here are the years that Iwas experiencing child abuse,
(16:08):
these are the years that I wascloseted, this is when bullying
was taking place, etc.
And then on the other side, theflowers are more of those
protective factors, the goodthings going on in that person's
life or sort of the protectivefactors.
Speaker 1 (16:26):
Would that be like a protected big brother or a
mentor or a sport or somethingExactly?
Speaker 2 (16:31):
Yeah, and so much of resilience is about how someone
finds the safe adults or safepeople in their life or
activities that they're good atto also have sense of self-worth
.
So then having this kind of mapthat we keep referring back to
(16:55):
throughout therapy we work withone of these particular
experiences of trauma and goingthrough the memories in stages.
So starting first with atraumatic memory kind of like
talking to a reporter with asmuch detail as possible who,
(17:19):
what, when, where, etc.
Then going back through thattraumatic memory together in
different ways.
So one way could be much moreof a focus on senses and body
sensations.
Then it could be going throughthis memory with more of an
emphasis on theirinterpretations of the event and
(17:43):
the beliefs that came out ofthe trauma and also really going
through with the emotions.
And often when I'm starting likethat processing with someone,
well, actually I find thateither when someone is
recounting a traumatic memory,they might be really emotionally
(18:04):
dysregulated and in tearsthroughout it and perhaps we're
having to pause and do groundingwith one another, or there can
be a level of numbing anddissociation, of course, that
it's as if they're telling astory that happened to somebody
else, and really avoidance ofexperiencing those painful
(18:24):
emotions but ultimately in thatstage of therapy we have to be
able to get to the morning.
We have to be able to get tothose painful emotions that now
this person is safe enough to beable to feel like what they
haven't been able to feel in thepast.
Speaker 1 (18:42):
So do you just let your client pick whichever is
the biggest rock and start withthat or the rock that they're
worried the most about?
Or how do you pick which rockto start with?
I'm sorry, you call them stonesor rocks.
Speaker 2 (18:53):
Stones, stones.
My apologies, can't be either.
Okay so, yeah so, same concept.
Speaker 1 (18:58):
Which stone do you pick?
Speaker 2 (18:59):
Yeah, Well, we make that decision together.
And, yeah, going back to, theyare in charge of content and
pacing of the sessions and I amthe guide walking alongside them
.
Typically it's either the worststone or going through it
(19:22):
chronologically with each other.
And another reason that I dolike to have this timeline is,
let's say, I'm working withsomeone because they recently
experienced a sexual assault,but then I recognize, oh, this
is someone who had to take careof alcoholic parents and they
(19:45):
got into this terrible caraccident at one point.
Just that.
So often if you're looking atjust one trauma, you're missing
a lot of context of earliertraumas that they had
experienced.
Speaker 1 (20:00):
So we talked briefly just before we started that I
have PTSD from my career in theemergency department and it's
interesting I've been justthinking about my own traumas
and a young woman who hungherself is the one that keeps
coming to mind.
I actually had flashbacks, ifwe've been sitting here, of
seeing her in the literaturemarks.
That makes perfect sense toreally allow the client to say
(20:22):
this is the one that's on mymind the most.
I want to talk about this.
I'm assuming you allow yourclients to self-regulate and
choose about what seems to bemost urgent or on their mind the
most, or do you ever have timeswhere you say that's too
intense?
We're not ready to do that yet.
Speaker 2 (20:38):
Yes and yes.
Speaker 1 (20:39):
Of course.
Yeah, I figured.
Speaker 2 (20:41):
Yeah.
Yeah and there are differentschools of thought on this that
another trauma therapist mightsay no, you really have to go
through establishing safetystage before getting to
discussion of a worst trauma,like over what we're talking
about.
If someone comes in and theywant to start with talking about
(21:08):
a worst traumatic memory, I'mprobably going to go with that,
while saving at least 10 minutesin that session for some
grounding and then figuring outwhat the plan should be to take
care of themselves that night.
But there have been times thatI've stopped someone.
For example, if I know thatsomeone is suicidal, then it's
(21:33):
really not appropriate for us tostart by going into the worst
trauma that can be reallydangerous.
I then, of course, would stopthat person and just explain my
rationale about how we need tostart in establishing safety
before getting to the worst ofit together.
Speaker 1 (21:56):
So it sounds like and I'm a fitness person, that's
what keeps me sane.
I'm almost thinking of what youdo as like a workout.
You do a warmup, you have anintense workout, you do a
cool-down and then you have arecovery.
Does that sound like a fair wayto think about it?
Speaker 2 (22:13):
your sessions- yes, yeah, and I do really think that
it's important to not justleave someone in a worst
traumatic memory of like, oh,we're out of time, we're going
to talk.
Speaker 1 (22:28):
I was going to ask you about that, please, please,
log in.
Speaker 2 (22:32):
Yeah, we'll pick this back up next week.
That's why I can be reallyadamant around saving the last
10 minutes of the session.
Are you open to my leading youthrough a grounding exercise
right now and I give differentoptions with grounding exercises
and what is the plan for thisevening Just acknowledging that
(22:56):
we've opened a lot up togetherand so there can then be a flare
up of PTSD symptoms.
Here's why I also like to havestarted with more of that
skills-based approach, becausethen we're able to reference
what has been helpful for themwith self-soothing and grounding
(23:18):
and having that be a part ofthe plan of what they're going
to do that night.
Speaker 1 (23:23):
And in terms of what this processing actually looks
like practically?
Right, and in terms of whatthis processing actually looks
like practically, I'm assumingit varies person to person, but
would you say it's roughly anaverage of 20 sessions, 50
sessions, 200 sessions.
Let's imagine one person has asingular trauma, a bad car
accident, they were almostkilled.
For that sort of singular event, big T trauma would you
(23:43):
estimate roughly how manysessions a person needs to
process?
Speaker 2 (23:47):
Someone with a singular trauma.
It is possible that when we'rein the processing part of
therapy, maybe we would do thatwithin five to 10 sessions I'm
reluctant to put a specificnumber on it and I definitely
have people who I've beenworking with for years around
(24:09):
processing the trauma timelines,because there's so much for us
to go through together.
Speaker 1 (24:16):
Well, it's like you asking me, how long does it take
someone to get sober?
It's like, well, it depends.
Correct Contrast for me, though.
Let's say somebody again hasthis singular traumatic car
accident event and someone else,a second person, has 10 years
of sexual assault as a child.
I'm assuming the second clientis much more complicated.
More sessions takes more timeOverall.
(24:37):
Obviously people are going tobe different, but I'm assuming
more trauma means more time toprocess.
Is that about right?
Speaker 2 (24:43):
Yeah, that's probably true.
And also, what was the age thattrauma began?
If I'm working with someone whoexperienced 10 years of sexual
abuse, they probably don'tremember their life before
trauma.
If I'm working with someone whodoesn't have a significant
trauma history up until aterrible car accident, then
(25:09):
they've had an opportunity toreally develop their sense of
who they are and what theircoping skills are.
It would also be a differentapproach with a car accident
that probably part of what wewould be doing would include
exposure therapy.
(25:29):
Someone who's been through acar accident natural for them to
be frightened to drive againand avoiding driving.
So, with that person, I wouldwork with them on establishing a
hierarchy of their fears.
Work with them on establishinga hierarchy of their fears,
(25:57):
starting with actions that theycan take to challenge avoidance,
that are less scary, and thenworking up to what's more scary.
So maybe we would start withthem driving around a parking
lot that's empty with a trustedperson in the car, and then work
their way up to a Los Angelesfreeway at rush hour.
Speaker 1 (26:10):
Well, the good news is the Los Angeles freeway is a
rush hour.
You don't go more than fivemiles an hour.
Speaker 2 (26:15):
I spent a lot of time in Los Angeles freeways.
I lived in LA for a decade.
Yeah, I had a lot of experiencewith Los Angeles freeways too.
Speaker 1 (26:23):
So I'm going to make a big jump here, because this is
a question that comes up allthe time for me and it sounds
like the process ofunderstanding this is similar to
what you just described arounddriving after a car accident.
But I have so many victims ofsexual assault and as human
beings we're wired to have closerelationships and intimacy, and
(26:44):
the process of dating andintimacy after sexual assault
just seems insurmountable to meand I'm curious how you work
with clients around that,because I would love my patients
who've been sexually assaultedto heal and move on and find
meaningful relationships and, ifit's right for them, start
families.
But I don't even, can't evenimagine what that's like.
Speaker 2 (27:05):
Yeah Well, this is a good moment for me to include
that.
I am such a proponent of grouptherapy for survivors of sexual
assault and abuse, especiallylike when they are in more of
that, building connections, youknow, phase of therapy, and when
(27:28):
I would lead support groups forsurvivors.
Whenever it would be the groupsession that we would talk about
dating and sex and intimacy.
You could sort of feel thissense of oh well, this is the
hardest part of recovery formany of them, but also like
what's bringing them to thegroup, what they want to change
(27:49):
the most.
And you know that these clientswe would talk about how, for so
many survivors of sexualassault, there's sex, there's
intimacy.
But the challenge is reallyaround experiencing sex with
intimacy, Of course, and sexualassault can often cause
(28:12):
different extremes in behavior.
So one survivor might reallyavoid sex and intimacy even if
they want that.
Another one might be in sexualrelationships where there can be
a reenactment of trauma or it'srisky or not safe for them in
(28:34):
some way.
So a lot of what I do withclients is acknowledging the
difficulties, talking abouttriggers and handling triggers
and when that does come upduring sex and also what their
rights are.
For example, like to not havesex when they don't actually
(28:57):
want to have sex, or like, ifthey're having sex and are
triggered or, for whateverreason, don't want to continue
to have talked in advance with apartner about how the partner
might be able to tell if it'snot something that they can put
into words that that ishappening, and then the
(29:19):
understanding of stopping andmaybe, if they're open to it,
some other type of physicalintimacy.
Also, often it's best to startwith sex with one's self
Masturbation.
Speaker 1 (29:35):
Trying to understand what the body feels.
Speaker 2 (29:36):
Yeah, really trying to get like reacquainted with
the body, to have experiences ofbeing in the body while aroused
, rather than to be dissociatedand having a sense of what they
like and don't like, how toexperience pleasure.
And then, when it comes to sexwith a partner, my clients can
(30:00):
often be reluctant to tell thepartner that they are a survivor
of sexual assault or abuse, andit's a very difficult
conversation to have withanother person.
I mean, talk about like reallyjust the trust and bravery it
takes to have that conversation.
However, I think it's a reallyimportant conversation to have.
Speaker 1 (30:23):
Absolutely.
Yeah, I have a number of femalepatients that talked about
becoming very promiscuous afterbeing assaulted because they
wanted to be in control.
Talk to me about the variousresponses that you see in your
clients after a trauma.
Whether it's avoidance, whetherit's again sexual assault is
unique.
The promiscuousness.
But let's say, somebody has acar accident, do they not drive?
(30:46):
Do they only let someone elsedrive?
Do they speed recklessly?
What are some of the commonresponses of the brain trying to
regain control after a trauma?
Speaker 2 (30:54):
Yeah, most commonly it is avoidance.
Speaker 1 (30:57):
Oh, that makes sense.
Speaker 2 (30:58):
You know, like the core components of PTSD are
Avoidance yeah, some sort ofintrusive, re-experiencing
avoidance alterations to moodand cognition and nervous system
hyper arousal I still don'twalk through the er.
Speaker 1 (31:13):
Yes, yeah, I'll avoid it.
I'll go all the way around thehospital to avoid the er.
I love my colleagues in theyear, but I totally avoid it
avoidance is that naturalresponse.
Speaker 2 (31:24):
But when it's avoidance of something that is
not actually dangerous, not athreat, even though the body
still experiences it as a threat, then avoidance can just be so
limiting and is sort ofreinforcing oh that this threat
(31:46):
really is something to be feared.
Speaker 1 (31:50):
So we've talked about establishing safety as part one
.
The processing itself is parttwo and I'm sure we could do two
to three hours on theprocessing, the third part.
You talked about merging andreintegrating.
What's that like?
Speaker 2 (32:09):
merging and reintegrating.
What's that like?
Yes, so you know that thirdpart around reconnection and
integration is a stage that ismore present and future-oriented
, so it can be much more focusedon healthy relationships with
other people, which ofteninvolves a lot of boundary
(32:33):
setting and knowing aboutinterpersonal rights and, after
trauma, how to recognize waysthat you are actually the same
person and often where I go withthat, like it is around, like
(32:56):
core values that remainunchanged, for example, like a
core compassionate to otherpeople.
It can also be this recognitionof this trauma happened.
It was outside of this person'scontrol and the ways that they
(33:17):
had to grow and change to copewith what happened, like that
they like those things aboutthemselves, wouldn't want to
give that up.
So it can also be recognizing,for example, like becoming a
much more honest person inrelationships.
(33:40):
But, yeah, it really tends tobe this stage where we're not
focused on looking into the pastanymore.
We're more focused on thepresent and the life that
survivor wants to build.
Speaker 1 (33:57):
So let me see if I can make this make sense in my
simple former ER doc brain.
In stage one, people are in abad place destructive behavior,
bad environment.
They're often so focused onothers like their aggressor.
Stage two after we achievesafety, we learn to
self-regulate.
It seems like step three isalmost learning how to actually
(34:20):
think about others and yourselftogether in a healthy way.
Speaker 2 (34:24):
Does that sounday yeah, definitely, I think that's
a good way of describing it.
And yeah, the stage three thingTo some extent it was also
maintenance of change, Of course, At that point that overall my
client is more stable, happierin their life, but probably
(34:51):
still experiencing flare-up ofPTSD symptoms, especially during
periods of heightened stress orloss or transition.
So the part of therapy is alsoaround recognizing that's a
normal part of recovery andpracticing how to take care of
(35:15):
themselves when PTSD flare-upsoccur and to recognize that
actually they really have made alot of progress.
Speaker 1 (35:24):
When my daughter had asthma as a child.
She's grown out of it, but inorder to go to school she had to
have an asthma action plansigned by her pediatrician.
You had the green light, onepuff of the inhaler.
The yellow light was threepuffs of the inhaler, wait a few
minutes, do this.
The red light was take oralmedicine and then do this and
(35:44):
the crisis was called 911.
Do you create that granularlevel of a relapse prevention or
a you-just-got-triggeredprevention plan?
How do you set people up toself-regulate in the future With
how to self-regulate?
Speaker 2 (35:57):
in the future With how to self-regulate in the
future.
I do think a lot of that ispsychoeducation around
understanding what happensduring a trigger response and
then having the skills to beable to deal with that.
So, to be more specific, I likethe analogy that for a trauma
(36:23):
survivor, a threat isexperienced as if there is an
ambulance siren going off nextto them.
For someone who hasn'texperienced a lot of trauma, it
can be more like oh, someone'scell phone alarm is going off in
the other room, but it reallyis this different experience.
(36:45):
So for a trauma survivor who'striggered, then some of what
they're going to do is theself-talk around telling
themselves how they actually aresafe in that moment.
But a lot of it is going to begrounding and self-soothing
(37:05):
skills.
So, for example, can be like akind of physical grounding, of
focusing on, like I'm sitting inthis chair right now, all of
the contact points between mybody and the chair, my feet and
the ground beneath me, ways toengage the senses, to be back
(37:30):
into that present moment.
Speaker 1 (37:34):
One thing you hinted at when we were just getting
started was people actuallymourning the loss of a former
self.
Do people change their names?
Do they change their hair color?
How do people emerge on theother side?
What do people tend to do inyour experience?
Speaker 2 (37:50):
One way they do that is to get tattoos.
Really, yeah, I don't thinkI've worked with anyone who
changed their name through atrauma journey, unless they're
trans, which is a whole.
Very unique yeah of course, yeah, which is different, but a lot
of my clients at some point doget a tattoo, a tattoo.
(38:26):
For example, I have a clientthat for her and for family
members that when a hummingbirdappears, you know that it's this
reminder that, no matter howbad things get, you know that
there's still beauty in theworld.
So then having this hummingbirdtattoo is something that they
can look at on their body andyou'll have that memory.
I've had other clients tattoomessages to themselves, like to
(38:48):
remember to breathe.
Another client who had a cabintattooed, that was this symbol
of how she's reclaimed ownershipof her body as a safe place.
So yeah, actually I got reallycommon for my clients and I
(39:11):
don't think it's ever somethingI've suggested, but many of them
do get tattoos in later stagesof their recovery of them do get
tattoos in later stages oftheir recovery.
Speaker 1 (39:24):
Two interesting reflections back on that.
One of them is I mentioned afriend and colleague who is very
knowledgeable about trauma andshe's a victim of trauma herself
, and she talked about tattooingwas a way to take her body back
to my body.
It's interesting, though I hadmajor depression in college,
along with self-harm and aneating disorder, and I was going
to get my dad's initialstattooed on my chest because my
dad was in the process of dyingof cancer, and that was a major
(39:44):
part of what I was dealing with,and my psychiatrist said
absolutely not.
You will get one, then you willwant two, then you will want
three, then you will want four.
He really recommended againstit.
Speaker 2 (39:55):
So did you get any tattoos?
Speaker 1 (39:57):
No, I do not.
Speaker 2 (39:58):
Still no tattoos.
Speaker 1 (40:05):
No tattoos.
I do have a couple of scars,and cutting and self-harming
behavior is very interesting andwe could spend another hour
talking about that, butironically my scar is in that
spot where I was going to get mytattoo.
Speaker 2 (40:13):
Yeah, I think I would have given you different advice
if I had been your therapist atthat time.
It is true that when clientsbring up tattoos that I suggest
not making that choiceimpulsively, of taking some time
to really consider.
Do they want that tattoo?
Maybe even like inking it onfor a while.
(40:35):
But yeah, I wouldn't tellsomeone.
If you get one tattoo, you'rejust going to want more and more
Interesting.
Maybe you'll still get a tattoo, I don't know.
Speaker 1 (40:44):
We'll see and then forgiveness.
So again, a car accident is theword in that term.
Is accident Presumably there's.
Well, there may be someone atfault, but presumably it was a
horrible thing that happened anda person recovers.
But when someone harms another,when a person is the victim of
physical, sexual, verbal,assault, abuse, whatever, how do
(41:07):
you talk about forgiveness withthe victim?
Speaker 2 (41:09):
Yeah.
So what I tell the victim isthat the only forgiveness that
needs to be a part of theirhealing and recovery is the
forgiveness of themselves, whichcan be forgiving, blaming
themselves for the trauma havinghappened.
(41:30):
Often it's more forgivenessblaming themselves around the
impact and how long that impacthas lasted.
I don't think that forgivingwhoever caused the harm has to
be a part of therapy, but ifthat is important to my clients,
(41:53):
then I will work with themaround that and, for example, I
have a lot of conversations withclients who experienced abuse
by a parent about how to holdboth the harm that that parent
caused and the empathy that theyfeel for that parent.
(42:19):
An intergenerationaltransmission of trauma is so
common.
So often my clients will beexpressing well, my dad had been
abandoned by a parent and wasbeaten by another parent, or had
all this immigration trauma andgetting to the US, etc.
(42:41):
So, yeah, we just talk a lotabout it's possible to hold both
, like the recognition of theharm that was caused, along with
empathy and perhaps forgivenessfor that person.
How do you take care of youhearing all these stories?
Speaker 1 (43:05):
I really have to take care of myself.
Speaker 2 (43:07):
You have to do yes, yeah.
So I often remember I think itwas my first week of grad school
and my ethics professor sayingwell, you can't ever ask a
client to do something that youwouldn't be willing to do
yourself, and that honestlyfreaked me out.
You know, I'm just I'm going toask my clients to do so many
(43:31):
difficult things, but I can'task my clients to be taking good
care of themselves if I'm notdoing that myself.
So I think it's reallyimportant as a trauma therapist
to not go it alone.
Although I am now an individualin private practice, I have a
(43:52):
lot of great former colleaguesand friends who are also trauma
therapists, so I'm able to getsupport from them.
My husband's an amazing cook.
He makes delicious meals.
I have a really cute dog andcat.
I appreciate getting to thepoint of my day that is more
(44:18):
restorative.
I'm also such a reader and filmlover, so having ways to really
immerse myself in somethingelse.
I am a compassionate meditationpractitioner and facilitator
too, which I really like toincorporate into therapy.
My clients are open to thatwhich I really like to
(44:40):
incorporate into therapy and myclients are open to that.
So, especially when I go backto where I lived before here in
Santa Barbara and part ofMindful Heart Programming where
I'd done my training.
That just for an afternoon andbeing back in that space or at
times like taking a longer in ameditation retreat is really
restorative.
And lastly, travel.
I love travel.
I also experience that isreally restorative.
And lastly, travel I lovetravel.
I also experience that as veryrestorative.
(45:01):
What percentage?
Speaker 1 (45:02):
of therapists, would you say, have therapists
themselves.
Speaker 2 (45:08):
At some point should be all of us, I think the
majority.
I really appreciated that itwas a requirement of my graduate
program to do a year's worth ofweekly therapy.
I did much more than thatmyself, and I think both again,
because I shouldn't ask if Iwant to do something I'm not
(45:30):
willing to do myself.
Speaker 1 (45:51):
It can be wonderful to have it be okay.
This is really now my turn tounload and to receive caretaking
from someone else who also justreally relates to what it is
that I do.
So I've obviously asked youloads of my questions.
You're the expert here.
What have I missed?
Speaker 2 (46:04):
What are important parts of managing trauma in what
you do that we haven't talkedabout yet.
Well, one of the questions thatyou had sent in advance of how
can someone tell when they arehealing I really like that
question, so I just wanted tobring that into the conversation
too.
It's important to talk aboutthe process of healing and to
(46:24):
redefine together what healinglooks like.
It doesn't mean that PTSDsymptoms are fully in remission
permanently, and hopefully itmeans that they are going to
really lessen intensity and infrequency.
But just really knowing howhealing is nonlinear, how often
(46:52):
with therapy, and choosing totalk about all the scary stuff
that someone might feel.
Talk about all the scary stuffthat someone might feel worse
before they get better.
Yeah, I'm also always lookingfor the ways that I'm able to
point out like well, when wefirst started meeting with one
another, I really think that youwould have reacted to this
stressor in this way, and I'mhearing that you were able to
(47:15):
handle it in this very differentway.
So, yeah, really bringing inthe strengths as well, but, I
think, a lot of discussionaround what healing does and
does not look like.
I also think it's such a giftwhen my clients have artistic
talent.
I wish that I did.
(47:36):
Talent, I wish that I did.
But if they are able to haveart or music or dance or writing
be a part of their healing too.
Speaker 1 (47:48):
A lot of my patients are very artistically minded.
I keep encouraging them to putsomething on this blank wall
here no takers yet, but the iconfor my podcast is a painting by
a friend of mine who died fromoverdose.
I'm so sorry, no, no, well,thank you.
I spoke at his funeral and hehad shared his art with me while
he was still alive.
And I spoke at his funeral andI brought this painting that he
(48:10):
had made before he ever knew meand shared it with me.
And yeah, so people across theglobe see his art and it helps
his family have closure.
So I love this idea ofencouraging my patients to be as
creative as possible.
I think of processing traumafor my patients can be talk
therapy, it can be journaling.
It not like therapy, medicines,medical.
(48:32):
I like kind of a person intheir own environment being
creative.
It really seems to empower them, to show that they have value
and uniqueness as a human being.
Speaker 2 (48:49):
I hope so.
I love that.
That's a way that you rememberyour friend.
My best friend died severalyears ago due to alcoholism,
which is such a heartbreak.
And yeah, in my office I dohave a photo that she had taken
of a mural with an eye in it andit does give me the sense of
(49:12):
her watching over me.
I have to say I will bedefinitely referring patients to
(49:34):
you and you are welcome torefer patients to me in return.
How common is it in the therapycommunity was especially focused
on working with interpersonalviolence survivors, which I
loved that opportunity forconsultation and collaboration.
Yeah, I think that a lot oftherapists do focus on trauma
and even if a therapist is nottrauma-focused, they can still
(49:57):
be trauma-informed, for example,actually asking about a
client's trauma history atintake or holding that in mind
and looking for the ways tobring that back into therapy
when it feels relevant.
And I would love to be able torefer to one another.
I don't think I've said yetthat I also think that ideally,
(50:21):
trauma therapy is a team.
You know that perhaps I'm doingindividual therapy with someone
.
They're also in group therapy.
They have a greattrauma-sensitive psychiatrist.
Maybe they're doing alcohol anddrug counseling too.
So both just in terms of notburning out as professionals,
(50:44):
it's important to have that teamand also for the client to have
that kind of multidisciplinarysupport.
Speaker 1 (50:52):
I will be a better doctor next week after talking
to you.
You're so kind.
Any last thoughts that you wantto leave?
Speaker 2 (50:57):
us with.
I just I appreciate the workthat you're doing with this
podcast and I really appreciatefor any physicians and
psychiatrists to be sotrauma-sensitive that it's also
part of trauma to often minimizethe impact while really
(51:24):
suffering or not make theconnections like between the
trauma and that present daysuffering.
So for you to have this podcastand to be having these
conversations here with clientsis so valuable.
Speaker 1 (51:44):
It's funny we started with talking about safety and
I'm going to finish us up bysaying that's what we really try
to create in this space issafety.
Speaker 2 (51:48):
Yes, we have to be that trusted person Well said.
Speaker 1 (51:50):
Well, I have to say thank you so much, I have
learned so much, and may Iinvite you again for future
topics?
Speaker 2 (51:55):
I would be happy to return in the future Sounds good
.
May I invite you again forfuture topics?
I would be happy to return inthe future Sounds good.
Speaker 1 (52:06):
Before we wrap up, a huge thank you to the Montage
Health Foundation for backing mymission to create fun, engaging
education on addiction, and ashout out to the nonprofit
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
(52:29):
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together we can make it happen.
Thanks for listening andremember treating addiction
saves lives.
Speaker 2 (52:47):
I'll see you next time.
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