July 30, 2025 • 44 mins
In this episode we interview Dr. Sarah Anderson, professor at Midwestern University and mental health occupational therapist, who unveils the powerful intersection of neurodiversity and recovery in this intriguing conversation.
With neurodivergent individuals making up a significant portion of those struggling with addiction, Dr. Anderson's expertise couldn't be more timely. She explains how ADHD, autism, and other neurocognitive differences affect executive functioning – impacting impulse control, emotional regulation, and the very skills needed for successful recovery. "Substance use often helps with coping," she notes, especially when we understand how a person's brain uniquely processes information and responds to their environment.
Dr. Anderson champions a treatment approach that integrates sensory processing assessments into addiction and mental health treatment. Through her work at Scottsdale Providence Recovery Center and her private practice, she demonstrates how simple environmental modifications and personalized tools dramatically improve outcomes. From creating sensory-friendly spaces to developing individualized systems for time management, her methods honor neurodiversity and help clients embark on a journey of discovery for personal values. Her approach offers a framework for sustainable change that extends far beyond the treatment setting for long-term success.
Whether you're a mental health professional seeking innovative approaches, someone in recovery looking for more effective strategies, or simply interested in understanding neurodiversity better, this conversation offers invaluable insights. Discover how the subtle yet powerful adjustments in how we approach mental health can transform lives when we honor each person's unique neurological makeup.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hello folks, thanks for joining us on Head Inside
Mental Health, featuringconversations about mental
health and substance usetreatment with experts,
advocates and professionals fromacross the country sharing
their thoughts and insights onthe world of behavioral health
care.
Broadcasting on WPVM 1037, thevoice of Asheville Independent
Commercial Free Radio, I'm ToddWeatherly, your host consultant
(00:23):
and behavioral health expert,and with me today is somebody I
got the pleasure to meet veryrecently, dr Sarah Anderson.
Dr Sarah is a licensed andpracticing occupational
therapist with over a decade ofexperience.
She owns and operates a grouppractice in Scottsdale, arizona,
and serves as adjunct facultymember and the occupational
therapy department at MidwesternUniversity.
(00:43):
Prior to transitioning intoprivate practice full-time, dr
Sarah spent several years as acore faculty member and
professor at Midwestern, whereshe is deeply involved in
teaching mentorship.
She earned herpost-professional doctorate in
occupational therapy from ATStill University in 2019, her
master's degree in occupationaltherapy from Midwestern
(01:04):
University in 2014, andbachelor's in kinesiology from
the University of Minnesota in2012.
As an occupational therapist, drSarah specializes in mental
health, with a focus on trauma,anxiety, adhd, autism and
addiction recovery, supportingindividuals from adolescence
through adulthood.
Her therapeutic approach isgrounded in neurofirming and
trauma-informed care, drawingfrom advanced training in
(01:26):
polyvagal theory, attachmenttheory and the biopsychosocial
model.
She is especially passionateabout developing programs that
promote emotional intelligence,stress management and
self-regulation in ways thathonor each individual's
neurodiversity and livedexperience.
And I met her because she doesa lot of work for a program out
there Scottsdale Providence, andtheir residential treatment,
(01:47):
php and IOP program and I wassuper, you know, I was like wow,
we got to get on the show sothat you and I can nerd out
together.
Yeah, you're talking about howyou're using, you know, the
approach that you have and anoccupational therapy approach.
And then you and I also startedtalking about cognitive
remediation with regard todealing with individuals now in
(02:10):
recovery from substance use.
How did you tell me about thejourney from kinesiology to here
, supporting the individualsthat you support there at
Scottsdale Providence and inyour private practice?
Where did that?
tell me about that journey.
Speaker 2 (02:24):
Yeah.
So when I was getting mybachelor's at the University of
Minnesota, I thought I wanted tobe a physical therapist and I
hated chem and physics and allof those really hardcore science
classes.
And in the midst of, you know,questioning my life choices, I
had this intro to kinesiologycourse and they had an OT come
in and in my mind I thought thatthat's what PT was.
(02:46):
Ot has more of a strongermental health component to it,
and some OTs are hand therapistsand some OTs work in neuro
rehabilitation.
Obviously, my specialty ismental health, so it's a little
bit different.
And so in that moment I knewthat I wanted to go into
occupational therapy.
And then, my sophomore year ofcollege, I had an uncle who fell
(03:08):
from a deer stand hunting andhe sustained a C2, c2, his
cervical vertebrae.
He had a spinal cord injury ata C2 level and so, along with
the in the spinal cord injury,he also sustained a TBI, and so
my dad's family is very close.
And so, you know, in the midstof all of that, I got to
(03:30):
experience, you know, like, whowere the professionals working
with him?
And I got to connect with theOT and I just saw there was so
much value in that.
So when I got into Midwesternand he needed both.
Speaker 1 (03:40):
He needed PT and OT oh, he needed everything Right
Like he needed.
He needed across the board.
Speaker 2 (03:51):
Yes, and he did not live very long after the injury
because it was so significant.
I think Chris passed maybe fourgosh, no, not even.
It was probably like a year anda half to two years after.
And so even the midst of seeinglike the grief and all of that,
and he also was highlyintoxicated at the time of the
fall.
And so you know, alcoholismruns in my family.
I am no stranger to mentalhealth and addiction and so I've
(04:13):
always had like a love andpassion for that.
My grandparents, my dad'sparents, are, you know, like
they made an active choice whenthey were young to kind of
remove themselves from some likegenerational trauma.
And so you know, like I alwaysthink like they made that choice
for all of us futuregenerations to have a different
life.
And so I'm like, I know, right,like looking through the
(04:36):
disease model of addiction orthe biopsychosocial or the
learning model, there's so manycomponents to addiction.
So when I got to Midwestern Ifell in love with the mental
health classes.
My professor at the time was DrKatina Brown.
She is a world-renownedoccupational therapist.
She's written all the mentalhealth textbooks, she's written
the research textbooks and she'salso the editor of Willard and
(04:58):
Spackman, which is like the mainbook of OT, and so I was so
fortunate to have her as aprofessor.
She later became a colleagueonce I started teaching at
Midwestern.
Her as a mentor, she reallyfacilitated, like, my confidence
in becoming a mental health OTand a professor and I think it
was her love and passion thatfurther drove me to have such a
(05:18):
love and passion for mentalhealth OT.
When I got out of school I didnot start in mental health.
Only about 2% of us at the timeworked at mental health in
mental health.
Now only about four and a halfpercent work in mental health.
We are like a very it's like atiny little niche, and so I
started in home healthpediatrics.
But again, I love like thefamily dynamic stuff, like you
(05:39):
know how family systems work andthe mental health components of
working with kids who had, youknow, cerebral palsy and autism
and Down syndrome, and you knowwhat the parents were
experiencing.
Then I transitioned and workedfor a day school for the deaf in
Phoenix, arizona, and alsoworking at a school where you
know I think it was like 5% ofthe kids' families learned sign
(06:02):
language.
Part of it was accessibility tolearn right Resources, time.
All of that, though you knowbeing at the school and seeing
kids you know go homeessentially to homes where there
was more language deprivationbut also seeing all of those
other factors that contribute toit.
It wasn't just that the parentsdidn't want to right there's.
It's so complex and I fell inlove with that piece and looking
(06:25):
into some of you know thetrauma that some of the kids
experienced and how thataffected their ability to engage
in school.
And then after that, in thattime, I decided to go back and
get my doctorate.
I had so many questions thatdidn't have answers?
And I wanted to be a part ofthat process of how can we do
more when we haven't figuredthat out yet, like what that
(06:47):
looks like.
And so at that time I got anoffer from Midwestern to come on
part time and be a facultymember and so I left my full
time job for a part time job andthen probably a month later I
got hired on at Child Health,which is a childhood advocacy
center.
So the kids that come therehave pretty substantial trauma
and so I did that for a whileand that time of my life was
(07:10):
just really incredible, beingcompletely immersed in mental
health.
It was hard as a mom Now Icould never go back and work in
that environment.
It was just, it was a lot, butI learned a lot.
And then I became um, then, kindof like when the pandemic hit,
I transitioned into full-timeand then, you know, it was
(07:30):
fairly like a year ago, Itransitioned to part-time and
then I grew my practice and itreally boomed.
And then in November of lastyear I stepped down as like a
official, like full facultymember, but I still adjunct and
help out and I do a lot of guestlecturing at different
universities in the Valley.
Cause again mental health.
Ot is so rare.
It's so rare, not, there's nota lot of it.
Speaker 1 (07:51):
That's why I was like we got to talk about this, yeah
.
Speaker 2 (07:55):
And so, yeah, and you know, kind of at the same time
I got connected with someone atSPRC and they're like would you
want to do OT work, or why don'tyou come and meet the owners?
And so I sat down with Alex andDan and I'm like I want to be
in here, like I love being aclinician, I love aspects of
research.
It's really fun and it's reallygreat.
(08:16):
And then there's other aspectsthat are not my favorite, like
the nitty gritty details.
Speaker 1 (08:20):
You know the brutal hours of nitty gritty details.
Speaker 2 (08:24):
My brain doesn't work that way.
So the clinical piece I love somuch and so so, yeah, so now I
have the practice and then wehave a contract with SPRC and so
you know we get a.
Speaker 1 (08:35):
We can have a variety of things that we do that
really um, the and the reasonwhy the, the people that I
invite to the show are, you know, they're passionate about
something.
A lot of times they're offeringsomething unique or they're
offering something that'sinstrumental in care.
And you're right, the, the useof ot and mental health is
pretty rare.
(08:56):
I don't see it a lot and when,when I you know, came to visit
you at scottsdale providence andsat there on campus and you
came in and gave your piece, I'mlike, oh, because you see it a
lot in the developmental delaypopulation, the kids with very
significant disorders who arestruggling with kinesiology
(09:17):
kinds of challenges and PT kindsof challenges, but in their
long-term care, ot has to be apart of it.
You know they've got to be ableto function in the world and do
things and hopefully have a jobone day and all these kinds of
stuff.
And the fact this is where thesilo thing happens in mental
health care and in all carereally is that we get these
(09:39):
people and they become reallygood at doing what they do.
It's been largely aimed at acertain population, so they stay
there, you know.
They kind of don't leave theiryard.
And the cool thing about youI'm going to compliment you
right now is that you have thisbrilliant insight to be like,
wow, this really fits in mentalhealth and addictions care and I
want to do this, so you know.
(10:01):
My other question for you ishow does that, does that look on
campus at Scottsdale Provinceor in your private practice with
what I might say are notnecessarily traditional OT kinds
of clients?
Yeah, you know you have peoplewho are smart and maybe they've
had degrees but they've sufferedfrom an addictions issue.
(10:21):
And now they're in front of youand you're like, hey, let's get
some alignment going on here,Like, tell me about that, work
on a day to day basis.
I want to hear a little moreabout it.
Speaker 2 (10:34):
So I'm always looking at what is the function of
behavior, like what is what'sgoing on, yeah, and so most of
the clients I see at ScottsdaleProvidence are neurodivergent,
and so for anyone that isunfamiliar with that term, it's
an umbrella term, it's not adiagnosis itself but, and
depending on the umbrella andmodel you're looking at, there's
(10:54):
a whole host of things that canfall under it.
But almost always there'sagreement upon autism, adhd,
audi, hd, which is autism andADHD, combined epilepsy, other
learning disabilities, likethings like dyslexia, dysgraphia
, dyscalculia.
Sometimes we pull trauma underthere as well, but it's this
(11:15):
idea of, you know, havingneurocognitive differences, so
the way that the brain processesinformation and how the body
responds to it, like what doesit do when the brain, like brain
, sends a message, and then whathappens after, and so that
really is what separates, kindof things that fall under that
neuro divergent umbrella.
And so at Scottsdale ProvidenceI primarily work with people
(11:40):
who have those other thingsgoing on, and so, from an OT
lens, we are inherently a veryholistic profession.
We are naturally what we callpretty neuroaffirming, where we
are honoring individual strength.
We're really looking at likefunction of behavior, versus
labeling a behavior good or bad,and then we like extinguish the
behaviors Like where is itcoming from.
(12:00):
Extinguish the behaviors likewhere is it coming from.
And so when I am working withclients who are experiencing
addiction and are, you know, inthe early midst of early like
addiction recovery and they haveadhd, right um I'm looking at.
Of course they do I'm looking atthe adhd components that also
relate to the addiction,challenges with impulse control,
difficulty with self-monitoringof behavior, maybe even just
(12:24):
like challenges withdysregulation.
So, although it's not in theDSM, a core component of ADHD is
significant emotionaldysregulation.
There's another new term that'skind of been connected with
ADHD, again not in the DSM, butmany psychiatrists have like
acknowledged this is a thinggoing on, a phenomenon rejection
(12:45):
sensitivity, dysphoria, so ahigh sensitivity to rejection.
But we think about what ittakes to adult.
There's a lot of executivefunction related for success.
Speaker 1 (12:56):
You're saying you know what, what it does take to
adult.
Speaker 2 (12:59):
Yeah, I mean.
Speaker 1 (13:00):
I'm interested.
What's your answer to that?
Speaker 2 (13:02):
Yeah, it takes a lot right.
Like adulting is really hard.
And if you have executivedysfunction, if it's hard for
you to plan, to organize, tostart a task, to complete that
task, to monitor your ownbehavior, to regulate when
you're overstimulated, like it,you're going to have challenges
(13:22):
with like adulting.
And so many of the individualsI see at Scottsdale Providence
have experienced thesechallenges and so coping.
You know, substance use oftenhelps with coping right,
especially when we look at thesubstance of choice and how it
impacts the brain and thenervous system right, the
central nervous system as wellas the autonomic nervous system.
(13:43):
And so I'm always looking atfunction of behavior, like
what's going on.
Individuals with executivefunction issues also don't know
what to do when they're bored,and sometimes boredom is a
common thing that comes up whenI'm like what are your triggers
for relapse?
Boredom?
And so we look at how do wedevelop leisure relapse boredom,
and so we look at how do wedevelop leisure, healthy leisure
occupations, how do we engagein play more as, like an adult,
(14:07):
we adults we forget to play andhave fun.
But when you struggle toorganize and initiate and like
whether it's initiate a task,initiate conversation, organize
your life, those things aregoing to be hard.
So I'm always looking throughmultiple models when I'm working
with any client to figure outlike where's the function of the
behavior and how can I supportboth skill development as well
(14:31):
as like systems development intheir life, so that life feels
easier and they feel successful,they increase confidence, have
more of a deeper connection totheir own identity and then can
experience mental well-being.
Speaker 1 (14:45):
Well, and you know, it sounds to me that part of
this process, which is wherethis crossover is really
beautiful in my mind theawareness of my own emotive
process when I becomeoverwhelmed, when I become bored
(15:06):
, what I do in response to thesestimuli, et cetera.
But then you've got the othertools.
It's like how to be organized,how to use a calendar, how to
let you know all that stuff.
What are the kind of tools thatyou're using?
If I didn't know any better,I'd say you probably crafted
some of your own that fit intothe ot process but, are linked
(15:27):
to emotional awareness as wellas executive functioning pieces,
and they come together.
What?
What are the tools that you'reusing to work with these?
What are you giving them asthey, as they progress and
develop?
Speaker 2 (15:38):
the first thing we always look at before
implementing like a tool ismotivation.
How are they inherentlymotivated?
So neurotypical people,typically it's like they can be
and neurotypical is a term usedfor someone who's not
neurodivergent, right and sothey're inherently more easily
motivated and so they canwithhold gratification, whereas
(16:00):
neurodivergent people struggle alittle bit more with motivation
or seek out immediatelygratifying activities.
Right, they need that dopamineright away.
And so first we look at youknow, are you motivated by
challenge, passion, interest,novelty or urgency?
And then, once we can identifywhat are the primary motivators
(16:21):
for a person, then we can figureout how do we incorporate tools
that can then match thosemotivators.
And sometimes the tools aren'talways matching motivators, but
we try to incorporate ways to bemotivated to use the tools.
So, planners, we do use somedigital stuff.
I love this app called HabitShare.
It's completely free.
Speaker 1 (16:41):
It allows for Habit Share it's completely free.
Speaker 2 (16:42):
It allows for HabitShare, it allows for
accountability.
So I have some clients thatwill send me their habits and
they check in and what's reallynice.
Of course, I make them sign aconsent form because HabitShare
is not HIPAA compliant.
But I can directly message themand just say hey, like I
noticed that you didn't do, youdidn't brush your teeth for two
days in a row.
Let's track that the next timethat we meet, like.
(17:03):
And then they're like oh gosh,she is watching.
And then sometimes for some ofthem that accountability is
really helpful until it becomesa habit.
I really love incorporatingsensory-based tools.
So before we implement anexecutive function tool, we look
at a person's sensoryprocessing.
So we use an evidence-basedassessment called the adolescent
(17:26):
adult sensory profile, and ithelps us understand.
Does this person have sensoryprocessing differences?
Are they more sensitive?
Are they a sensation seeker?
Do they avoid when things aretoo much, or do they have
something called lowregistration, which essentially
means they need a lot of thestimuli to register that it's
(17:47):
there, and typically with peoplewith ADHD we see a lot of that,
and also for people whoexperienced trauma and are
dissociating, we also see thatas well, and so that helps us
understand if we need certaintypes of cues.
So let's say, someone showsthat they have low registration
patterns for visual stimuli.
(18:08):
It doesn't matter.
Speaker 1 (18:10):
Now define for our audience what that means.
Speaker 2 (18:12):
Yep.
So the low registration meansright.
So for sensory processing, withthis model that we use, with
this assessment, we look atthreshold.
Does a person have a highthreshold where they need a lot
of the stimuli, whether it'svisual or movement or touch, to
know that it's there?
Or do they have a low thresholdwhere a little bit goes a long
(18:37):
way?
So someone who would wear noisecanceling headphones would
likely have a low threshold forauditory stimuli.
Speaker 1 (18:44):
Your high threshold of folks are the ones that are
out there doing verystimulant-based drugs.
They can be.
They're like I need somethingto crank me up because I'm going
for the stimuli right.
Speaker 2 (18:55):
So my colleague that I had mentioned before, dr Brown
, she actually did a study onthis two years ago, thinking
that drug of choice would matchthe sensory processing pattern,
and it actually didn't.
Speaker 1 (19:06):
All in all.
Speaker 2 (19:09):
all in all, it's just being and, yes, is there very
are?
Is there some truth?
Potentially there, Absolutely,but it wasn't statistically
significant enough to say, yes,someone who is a high threshold
is going to seek out a stimulant, versus someone who has a high
threshold is going to seek out astimulant versus someone who
has a low threshold is going toseek out more of like a
depressant, like alcohol.
However, I will say I do trackthat with the clients I work
(19:32):
with and I do see some patterns.
It just wasn't significantenough in the research.
Speaker 1 (19:36):
Well, you're also talking about a person's
chemistry, like their drug ofchoice is their drug of choice.
You know what I mean and that'sand that's what they're using.
So it may not line up.
That's an interesting finding.
That's really cool.
Speaker 2 (19:48):
It is yeah and so right.
So someone who is showing lowregistration patterns with
visual stimuli right, they'renot actively seeking out,
they're just hanging out andthey're just missing stuff.
So these are like the peoplethat are being labeled like lazy
, or they're just choosing notto engage, they don't want to
engage or like like a child inthe classroom and they're
(20:10):
missing cues.
They're missing things on theboard.
They might need things boldedand highlighted and maybe they
need an auditory cue with thevisual cue.
And so, as an OT, if someone isshowing that type of pattern
visually, I'm not going to justsay put it in your calendar and
then make sure you look at it.
We're going to have alarms,we're going to have a calendar
(20:30):
on their wall.
We're going to have thecalendar in the phone with the
alarm paired with it.
We are pairing a lot of sensorycues that you need to pay
attention to this.
But when you're doing executivefunction work and you don't
understand the sensoryprocessing component, we can
miss a lot of things, and sothose paired together can really
help support success forindividuals.
Speaker 1 (20:53):
So the thing that occurs to me is let's circle
back to trauma for a second.
When you're engaged in thiskind of evaluative and
observative process with aperson and one of their key
triggers is traumatic events andyou know, some of the things
that you see in people whosuffer from significant trauma
(21:15):
is there, are, you know, people,places or things that can be a
trigger.
Sometimes they're aware of themand sometimes they're not and
even processing with them aboutpotential triggers and these
places and being able toidentify okay, let's track this,
let's figure out where you'regoing, let's make sure that
we're aware of what's in ourenvironment.
(21:36):
Do you see trauma response,response, re-engage, sometimes
when you're working with them inot session, does that happen?
Speaker 2 (21:46):
oh, it can happen, and usually, like when I do my
evaluation, and I try to grab asmuch information as I can,
whether from a previoustherapist, or intake paperwork
about the trauma and thentracking that as it matches then
like different sensory stimuli,or we try to work around it,
(22:08):
and so that is something thatI'm really conscientious of, and
that's also why it's reallyimportant to pair with a primary
therapist or a trauma therapistwho's working with a client to
understand, like, what thosetriggers are and how to avoid
them until they are at a pointwhere they're not getting out of
their window of tolerance,because if someone is getting
triggered by a past trauma, thework that I do is probably not
(22:32):
going to stick because they'reso activated yeah.
Yeah, they're either insympathetic right when where the
fight or flight, or they arepast that and they are
dissociating and they're notconnected with the present
moment.
Speaker 1 (22:48):
Right.
Well, and I guess that's whenyou know you've got an entire
clinical team that's surroundingyou.
You know, as you work withthese individuals, it's like,
hey, they may not be ready forOT.
It sounds like they really needto ground out and do some more
trauma work so that they canfeel like they're able to
regulate as they go out into theworld and they do some of this
OT executive functioning workwith me, and so you know, that's
(23:13):
this is so.
This is where I mean all thisstuff is cool to me, but I think
that some of the you peel backto the veil on how programming
works, and that's something thatI like to.
Some of the you peel back theveil on how programming works,
and that's something that I liketo do in the show.
How does that like, how do youinterface with the clinical team
?
You got a psychiatrist, you gotclinicians, you got coaches
that are on the ground every daywith folks.
(23:34):
Like, how does that mechanismwork?
As you're working with a personindividually, I know that
you're also passing informationoff to the other care providers.
What does that look like inyour day?
Speaker 2 (23:45):
I am constantly in communication, right, so I think
about, like, let's even justsay residential.
If someone is in residentialcare, usually, right, the
capacity of what we expect forlike active cognitive engagement
is a little bit less than whensomeone moves to PHP or IOP.
And so I might get called in todo a sensory eval and then give
(24:09):
some sensory tools forgrounding while they're working
on maybe some of the processingand stuff like that before they
come to more intensiveprogramming.
And so I'm communicating withthe residential staff in terms
of, like, let's do a sensoryassessment.
What are the sensory tools?
Whether they're focused toolslike fidgets or weighted
products, or using smell in alike a very intentional way to
(24:29):
help facilitate grounding andregulation.
At the same time, whenever ourpsychiatric practitioner at SPRC
is doing an evaluation, if sheis noticing potential
neurodivergence or she sees aclient who has ADHD, she
immediately will, like, put inthe chat.
Hey, I want you to have eyes onthis person, let me know your
(24:50):
thoughts.
Often also, what she ispotentially catching is autism.
That is the biggest thingyou're noticing specifically
more with, like, the millennialand Gen X population is missed
like level one autism.
So very low support needs, highmasking individuals and
probably in the time that I'veworked at SPRC, I mean and like
(25:14):
probably.
I mean like I'm thinking like10 to 15 people we have caught
like missed autism as it'srelated to significant mental
health struggles and oraddiction, and that is a very
important thing not to miss, andso I'm constantly communicating
.
It is, and you know, like the AQisn't going to catch it which
is the autism quotient.
That is one that was kind ofdeveloped, and it does focus
(25:37):
more on more male traits.
However, the CATQ, which isCamouflage Autistic Test
Questionnaire, something likethat that is a really good one
very low support needs, highmaskers, and so that's like one
piece of the puzzle.
And then the primary therapist.
We are interfacing on a veryregular basis of like, what are
(25:59):
they doing?
What am I seeing?
I am typically advocating forclients to like be able to not
engage as much.
Right, when we think abouttreatment facilities, you know
most of them have a lot ofstructure, and they have to,
otherwise it could be completechaos.
But neurodivergent individualsneed a lot of flexibility and
(26:20):
autonomy for regulation.
Structure is important, butthere's got to be flexibility in
it, and so when someone is onmy caseload, everyone at SPRC is
interested in hearing like howdo we integrate more autonomy
and flexibility for their care,but also making sure it's
structured enough thatexpectations are known, and so
(26:40):
that is probably a huge part ofmy job, um, whether it's being
able to stay back from events orhaving alternative events to go
to, like we even think about,they are very stimulating.
Um, and I've had a lot ofpeople even ask like hi, are
there any?
Like neuro affirming AAmeetings and I don't know of any
yet Doesn't mean they're notout there and it doesn't mean
(27:01):
that they won't be developed.
But these individuals have highsensitivity to sound and smell
and movement and when they arein fight or flight, that can
also be really triggering andthey get out of the window of
tolerance and then the meetingis no longer beneficial.
So we're always trying tocollaborate like what is the
best path for each individual sothat they can have a
(27:24):
sustainable recovery.
I even collaborate with, likeour CEO, alex, all of the time.
We just got a new PHP house forthe women and I'm designing one
of the rooms to be like asensory space slash lounge area
and also.
So it's like how do you makethis space beautiful and adult
(27:44):
focused but also have all of thenecessary sensory components
that people can go in and learnhow to self-regulate when they
are overwhelmed?
So we'll have things like noisecanceling headphones that also
are like similar to Bose there'sreally a really great brand
that's not quite as expensive,but they can access music or
podcasts but also have the noisecanceling feature, having
(28:06):
chairs that swivel.
Speaker 1 (28:08):
Yeah, right.
Speaker 2 (28:10):
I.
We also talked about likehaving a swing from the ceiling
because that linear vestibularinput right, which is not
spinning, it's just going backand forth, can be really
regulated for some weighted lappads and pillows and blankets
and different textures in theroom, helping people understand,
like, how much of a differencethat can make.
So it's like creating thisspace allows them to practice
(28:31):
these skills outside of the OTsession.
Speaker 1 (28:35):
Well and know what tools they need when they leave
you know it's like I need my ownchair and I need my own
weighted blanket or I need thesethings, you know.
And the other thing that thatyou know, as you talk about
working with these individualsand working with them in the
context of a treatment program,and they've got all these tools
(28:57):
that are available to them.
We'll shift over to theoutpatient side of things.
What does it look like when youdon't have a team but you're
addressing an individual who'syou know, maybe they're trying
to go back to school or they gotback to work, whatever it is?
How does the outpatientpractice differ?
A little bit Like what?
Speaker 2 (29:16):
does that look like.
So my team isn't there with me,but if they have a team.
I am coordinating with them allthe time.
For the most part.
There are some clients wherethey actually don't want as much
coordination and sometimes evenin the ROI they'll say I need
some tools, and then I'm good,yeah.
And so my office space is verysensory friendly, like
(29:38):
everything about it.
We have lamps everywhere so wedon't have to turn the big light
on, but for people that want it, we can do it.
If they're, if they have visualsensitivity, we've got tons of
sensory based tools that mirrorlike what a home looks like, so
that they can.
We're modeling essentially howthey could design and set up
their own space.
We are working on groundingexercises.
(30:01):
We do.
We do help with likemindfulness and breathing, but
we're always other sensorycomponents.
We have planners up the wazoo,every type of planner you could
imagine in our cabinets to tryto see if it could help support
a client.
We use old school timers fortime management If people have
time blindness, because once youget into your phone most people
(30:22):
forget why they were there inthe first place, and so we're
very focused on what are thegoals for that person.
And so let's say they want togo back to work or they're
trying to go back to work.
The first thing I do ask iswould you like formal
accommodations or a letter ofaccommodations written?
And so the big thing to knowwith this one is they have to be
(30:44):
feasible and doable for theemployer.
So things like you know, breaksor noise canceling, headphones
or like a dedicated space if youhave to have a one-to-one
meeting, if someone struggleswith attention regulation, right
.
So the focus is really hard.
Most of the time those areeasily met.
I have had clients that havesaid you know, I work a 40-hour
(31:07):
work week but I only want towork 25 hours and like that's
just not doable, right, they'repaying you for a job.
So I always keep that in mindwhen I am writing my letters of
accommodation, that I've done somany of them.
I know what will get rejected,um, and I know what likely won't
, um.
Oftentimes I'll go into umaccommodation focused meetings
with HR and the client to beable to help further explain or
(31:31):
to clarify what theaccommodation means.
I always tell my clients,though, like as an advocate with
them, I don't speak for themand so we practice like what are
the cues when you want me tojump in?
Or they'll just say you know,I'm going to have you know, dr
Sarah, explain this part.
They'll just say you know, I'mgoing to have you know, dr Zara,
explain this part, because it'sreally important that in that
process I'm also helping tofoster and develop skills around
(31:52):
empowerment and self-advocacy.
Same thing goes for schools.
So, having worked as aprofessor, I know the back end
of that.
I know what universities doneed to honor and I know what is
feasible to honor.
And I know what is feasible andso I do a lot of letters of
accommodation for whether it'sundergrad or graduate programs
(32:13):
to help support that.
And then the other part isskill development around time
management, skill developmentaround organization and planning
.
And so I have to know a lotabout like what is the job
they're wanting to do or what isthe program that they are in
and what do they have to do onan everyday basis.
Study skills is the big onethat comes up.
(32:35):
No one ever gets motivated tostudy, and so it's like, how can
we make that as engaging andpleasurable as possible?
And so every client I work withit looks different, but we use
a lot of the same types oftechniques and strategies.
We just adapt them.
Speaker 1 (32:53):
Wow, uh, you know the um.
The one of the things that I'mtrying to bridge when we go out
and we do the podcast, we'rewe're passing information to the
, the greater public is thatthere are all kinds, you know
these, as you say, theneurodiverse umbrella.
A lot of us could fall in there.
(33:16):
Some of us fall in there alittle easier than others, but
everybody's got this littlequirk or there's something else,
and one of the things is that alot of the stuff, that this
kind of ingenious stuff thatwe're, that we're life and these
things are habit tracking andwhere are you?
You know where are you feelinglike depression onsets?
(33:53):
You know what part of the day,do you?
feel best in and just havingthose kinds of awareness, like
sharing some of this stuff tothe world is part of the goal of
what we're doing here.
If you were to share one, maybetwo things with just the
average Joe slash Jill in theworld, slash they in the world
(34:15):
what would you say is greatcommon practice for the person
who didn't necessarily needtreatment, who didn't
necessarily need therapeuticapproaches, but could really
benefit from some of this stuff,like what's the, what are a
couple of things that you wouldgive to the world?
Speaker 2 (34:29):
Number one know what your values are, because if your
goals don't match your values,you will never have the
motivation to meet them.
And so, like an example is, Ihad a client come to me and say
I want to work on organizing mycar and keeping it really clean,
and I said, okay, tell me thevalue behind that.
And they're like my mom and dadalways instill that into me.
(34:51):
And I said, no, what is thevalue for you?
And they're like I don't reallyhave one, it doesn't really
matter to me.
And like, well, this is whythis isn't working.
You've been trying this forthree months.
It's not working because you'renot motivated, it's not a value
.
And so I think important forevery single person Like what
are your values and how does italign to a goal?
Because then there will be adirect connection and more of an
(35:11):
internal motivation to tofulfill and meet that goal.
Like that's number one.
And for some people it givesthem pause and they think about
like what are my values?
And I don't just mean likehonesty and respect, I mean like
your values as a person.
So for me, I have ADHD.
I found out when I was an adultand I love stimulation, I love
(35:35):
learning.
My job is not a job.
It is like every part of mybeing.
I'm also a mom to a child whohas ADHD.
She is level one autism, superhigh maskers, so if someone met
her on the street they wouldhave no idea, right?
But it's very clear to us asparents and so there is this
greater drive for me to do thistype of work.
(35:57):
It's my special interest and sothat is a value for me.
Like neuroaffirming care andneuroaffirming support and
building a community is a hugevalue for me.
So when I am working withclients, I really want them to
think about like, what are yourvalues?
I had one client the other daylist alone time is a huge value
for me.
Like that is really important,and so sometimes our values
(36:21):
aren't what we actually expectedour values to be.
So that would be my first one.
The other one is slowing downand being willing to have less.
And right, when you have tomaintain a lot, it's a lot
harder, and when we're in ourday-to-day life, it's really
easy to accumulate a lot, andusually having less to take care
(36:46):
of makes it so much easier tocare for the things that you
have to be able to find thingsin your space.
So many of the people I workwith, and even if you're out
there and you struggle withorganization and planning,
having a decluttered space isgoing to make a huge difference,
and so that goes into theenvironment aspect.
(37:06):
Your environment plays a hugerole in how you feel and how you
perceive the world.
Um, and then the last one wouldbe I like understand your own
sensory processing.
So many people don't realizehow much sensory processing
plays a role in mental health.
Um, there are a lot of toolsout there that can support
(37:28):
sensory processing, whether it'snoise-canceling headphones or
loop earbuds or just havingsunglasses with you every time
you step outside, if you'rereally visually sensitive, or
keeping the drapes drawn duringthe day.
Understanding your own sensoryprocessing is a really easy way
to feel empowered in terms ofbeing able to control for things
(37:50):
that might make you feelanxious, and so that's a really
easy one.
Usually, when people I'll doworkshops in sensory processing,
people will be like I learnedso much, but now I can like just
take this information and adaptit to my own life.
You know that's not a I need tosee your type of thing Usually
it's just I need to learn aboutthis and learn about mine, and
(38:10):
then I can move forward andimplement this stuff in my
everyday life.
Speaker 1 (38:13):
Well, and it goes to this, you know, what you're
talking about is just thisincreased awareness of self.
Um.
One thing I would probably addto this having, you know, being
a person with ADHD who's had tocome up with these strategies
and doing all these things, andthen I also noticed that it's,
you know, every decade goes byand changes a little bit.
You know your values change,which you, your sensory stuff
(38:37):
changes.
In your fifties, your memorystarts to go, especially after
two kids.
You know what I mean, right,and so you know the, the.
The interesting thing about alot of this conversation and you
and I are probably just goingto have to come back and do some
more but the, the thing aboutmasking, um, and you and I have
(38:58):
a.
We have an understanding ofthat from a clinical standpoint
and what it looks like in a, ina clinical environment.
But I think the world does it.
You know everybody's masking onsome level, like your guy with
the car.
It's like why are you doingthis?
This was, and I you know, partof the process.
Developmental process, for meas an adult, has been like you
know, there are things that yourparents gave you, and some of
(39:20):
those things were values andthen you get to a certain point
and you're like wait a minute,those actually aren't my values.
I, I have different values thanthat and you do this, you do
this.
You know this individuation,you know and.
I think, individuation issomething that you're doing all
along and, um, people who, ifyou feel like you're wearing a
mask to the world, to your job,to your kids, to your spouse, to
(39:45):
these people like you'retalking about a process, and I
think the most salient thing andsomething that's really
valuable is a lot of the changesthat you're looking for,
because we think of change as,like grand life change, this big
thing.
The changes you're looking forare often really subtle.
I need a chair that swings backand forth.
I need a little more privatetime.
(40:07):
I just need these tiny littlethings to implement in my life
that are going to make thismassive difference in everything
and my satisfaction witheverything you know.
On the other side, do you seepeople kind of coming away with
this like great gratitude to youbecause you pointed out
something?
What does that look like?
Speaker 2 (40:26):
Yeah, yes, often, and that takes time, like I just
met with a client yesterdaywhere they've hit that point.
They are an adult, verysuccessful, struggled with
addiction, found out that theyhad autism, had no idea.
Their whole life their parentshave been reading books and
learning and, like now they'vegot all these systems in place.
But it's a very up and downprocess.
(40:47):
Sometimes there will besessions where they're very
angry not with me, but they'reupset that they didn't know
about this earlier.
Or the you know the question oflike who am I outside of these
instilled values?
Like what are my values?
And that's a hard thing.
But what a gift at any point inyour life to start reconnecting
with who you are naturally.
And I think the more that wecan do this, and especially for
(41:11):
those of you who are listenersand have children.
You know, the number one thingis to support who they are
naturally and to naturally helpthem develop coping skills and
regulation skills that naturallymeet their own, like body and
brain needs versus you know,here's a sticker for sitting
still in a chair, right, Ifthey're a mover and groover,
(41:33):
let's help them learn how tomove and groove in an
appropriate way in the verycontext right, and so so many
millennials and Gen Xers didn'thave that, and so once they
start to learn like these are mynatural needs and now I know
how to meet them they seethemselves very different, and
especially when we can connectthat to substance use, that can
(41:54):
also help support sustainablerecovery.
Speaker 1 (41:58):
Absolutely.
Well, I mean, you threw GenXers in.
I'll agree that we have somedeficits we had to work through.
Speaker 2 (42:06):
But now we know more, we have some deficits.
Speaker 1 (42:07):
we had to work through, but now we know more.
Sarah, it has been.
You know I've just had so muchfun, you know, being here with
you and the show today.
Thanks for taking the time.
I appreciate it very much.
This has been Head InsideMental Health.
Todd Weatherly, your host, DrSarah Anderson has been our
guest and we really appreciatethe work that you're doing out
there.
We'll look forward to seeingyou all next time.
Thanks, Sarah.
Speaker 2 (43:22):
Thank you.
I'm a little little, littlelittle little little little
little little little littlelittle little little little
little little little littlelittle little little little
little little little littlelittle little little little
little little little littlelittle little little little
little little little littlelittle little little little
(43:45):
little little little littlelittle little little little
little little little littlelittle little little.
Thank you, bye.
I feel so lonely and lost inhere.
I need to find my way home.
I feel so lonely and lost inhere.
I need to find my way home.
(44:06):
I feel so lonely and lost inhere, bye.
Hello folks, thanks for joining us on Head Inside
Mental Health, featuringconversations about mental
health and substance usetreatment with experts,
advocates and professionals fromacross the country sharing
their thoughts and insights onthe world of behavioral health
care.
Broadcasting on WPVM 1037, thevoice of Asheville Independent
Commercial Free Radio, I'm ToddWeatherly, your host consultant
(00:23):
and behavioral health expert,and with me today is somebody I
got the pleasure to meet veryrecently, dr Sarah Anderson.
Dr Sarah is a licensed andpracticing occupational
therapist with over a decade ofexperience.
She owns and operates a grouppractice in Scottsdale, arizona,
and serves as adjunct facultymember and the occupational
therapy department at MidwesternUniversity.
(00:43):
Prior to transitioning intoprivate practice full-time, dr
Sarah spent several years as acore faculty member and
professor at Midwestern, whereshe is deeply involved in
teaching mentorship.
She earned herpost-professional doctorate in
occupational therapy from ATStill University in 2019, her
master's degree in occupationaltherapy from Midwestern
(01:04):
University in 2014, andbachelor's in kinesiology from
the University of Minnesota in2012.
As an occupational therapist, drSarah specializes in mental
health, with a focus on trauma,anxiety, adhd, autism and
addiction recovery, supportingindividuals from adolescence
through adulthood.
Her therapeutic approach isgrounded in neurofirming and
trauma-informed care, drawingfrom advanced training in
(01:26):
polyvagal theory, attachmenttheory and the biopsychosocial
model.
She is especially passionateabout developing programs that
promote emotional intelligence,stress management and
self-regulation in ways thathonor each individual's
neurodiversity and livedexperience.
And I met her because she doesa lot of work for a program out
there Scottsdale Providence, andtheir residential treatment,
(01:47):
php and IOP program and I wassuper, you know, I was like wow,
we got to get on the show sothat you and I can nerd out
together.
Yeah, you're talking about howyou're using, you know, the
approach that you have and anoccupational therapy approach.
And then you and I also startedtalking about cognitive
remediation with regard todealing with individuals now in
(02:10):
recovery from substance use.
How did you tell me about thejourney from kinesiology to here
, supporting the individualsthat you support there at
Scottsdale Providence and inyour private practice?
Where did that?
tell me about that journey.
Speaker 2 (02:24):
Yeah.
So when I was getting mybachelor's at the University of
Minnesota, I thought I wanted tobe a physical therapist and I
hated chem and physics and allof those really hardcore science
classes.
And in the midst of, you know,questioning my life choices, I
had this intro to kinesiologycourse and they had an OT come
in and in my mind I thought thatthat's what PT was.
(02:46):
Ot has more of a strongermental health component to it,
and some OTs are hand therapistsand some OTs work in neuro
rehabilitation.
Obviously, my specialty ismental health, so it's a little
bit different.
And so in that moment I knewthat I wanted to go into
occupational therapy.
And then, my sophomore year ofcollege, I had an uncle who fell
(03:08):
from a deer stand hunting andhe sustained a C2, c2, his
cervical vertebrae.
He had a spinal cord injury ata C2 level and so, along with
the in the spinal cord injury,he also sustained a TBI, and so
my dad's family is very close.
And so, you know, in the midstof all of that, I got to
(03:30):
experience, you know, like, whowere the professionals working
with him?
And I got to connect with theOT and I just saw there was so
much value in that.
So when I got into Midwesternand he needed both.
Speaker 1 (03:40):
He needed PT and OT oh, he needed everything Right
Like he needed.
He needed across the board.
Speaker 2 (03:51):
Yes, and he did not live very long after the injury
because it was so significant.
I think Chris passed maybe fourgosh, no, not even.
It was probably like a year anda half to two years after.
And so even the midst of seeinglike the grief and all of that,
and he also was highlyintoxicated at the time of the
fall.
And so you know, alcoholismruns in my family.
I am no stranger to mentalhealth and addiction and so I've
(04:13):
always had like a love andpassion for that.
My grandparents, my dad'sparents, are, you know, like
they made an active choice whenthey were young to kind of
remove themselves from some likegenerational trauma.
And so you know, like I alwaysthink like they made that choice
for all of us futuregenerations to have a different
life.
And so I'm like, I know, right,like looking through the
(04:36):
disease model of addiction orthe biopsychosocial or the
learning model, there's so manycomponents to addiction.
So when I got to Midwestern Ifell in love with the mental
health classes.
My professor at the time was DrKatina Brown.
She is a world-renownedoccupational therapist.
She's written all the mentalhealth textbooks, she's written
the research textbooks and she'salso the editor of Willard and
(04:58):
Spackman, which is like the mainbook of OT, and so I was so
fortunate to have her as aprofessor.
She later became a colleagueonce I started teaching at
Midwestern.
Her as a mentor, she reallyfacilitated, like, my confidence
in becoming a mental health OTand a professor and I think it
was her love and passion thatfurther drove me to have such a
(05:18):
love and passion for mentalhealth OT.
When I got out of school I didnot start in mental health.
Only about 2% of us at the timeworked at mental health in
mental health.
Now only about four and a halfpercent work in mental health.
We are like a very it's like atiny little niche, and so I
started in home healthpediatrics.
But again, I love like thefamily dynamic stuff, like you
(05:39):
know how family systems work andthe mental health components of
working with kids who had, youknow, cerebral palsy and autism
and Down syndrome, and you knowwhat the parents were
experiencing.
Then I transitioned and workedfor a day school for the deaf in
Phoenix, arizona, and alsoworking at a school where you
know I think it was like 5% ofthe kids' families learned sign
(06:02):
language.
Part of it was accessibility tolearn right Resources, time.
All of that, though you knowbeing at the school and seeing
kids you know go homeessentially to homes where there
was more language deprivationbut also seeing all of those
other factors that contribute toit.
It wasn't just that the parentsdidn't want to right there's.
It's so complex and I fell inlove with that piece and looking
(06:25):
into some of you know thetrauma that some of the kids
experienced and how thataffected their ability to engage
in school.
And then after that, in thattime, I decided to go back and
get my doctorate.
I had so many questions thatdidn't have answers?
And I wanted to be a part ofthat process of how can we do
more when we haven't figuredthat out yet, like what that
(06:47):
looks like.
And so at that time I got anoffer from Midwestern to come on
part time and be a facultymember and so I left my full
time job for a part time job andthen probably a month later I
got hired on at Child Health,which is a childhood advocacy
center.
So the kids that come therehave pretty substantial trauma
and so I did that for a whileand that time of my life was
(07:10):
just really incredible, beingcompletely immersed in mental
health.
It was hard as a mom Now Icould never go back and work in
that environment.
It was just, it was a lot, butI learned a lot.
And then I became um, then, kindof like when the pandemic hit,
I transitioned into full-timeand then, you know, it was
(07:30):
fairly like a year ago, Itransitioned to part-time and
then I grew my practice and itreally boomed.
And then in November of lastyear I stepped down as like a
official, like full facultymember, but I still adjunct and
help out and I do a lot of guestlecturing at different
universities in the Valley.
Cause again mental health.
Ot is so rare.
It's so rare, not, there's nota lot of it.
Speaker 1 (07:51):
That's why I was like we got to talk about this, yeah
.
Speaker 2 (07:55):
And so, yeah, and you know, kind of at the same time
I got connected with someone atSPRC and they're like would you
want to do OT work, or why don'tyou come and meet the owners?
And so I sat down with Alex andDan and I'm like I want to be
in here, like I love being aclinician, I love aspects of
research.
It's really fun and it's reallygreat.
(08:16):
And then there's other aspectsthat are not my favorite, like
the nitty gritty details.
Speaker 1 (08:20):
You know the brutal hours of nitty gritty details.
Speaker 2 (08:24):
My brain doesn't work that way.
So the clinical piece I love somuch and so so, yeah, so now I
have the practice and then wehave a contract with SPRC and so
you know we get a.
Speaker 1 (08:35):
We can have a variety of things that we do that
really um, the and the reasonwhy the, the people that I
invite to the show are, you know, they're passionate about
something.
A lot of times they're offeringsomething unique or they're
offering something that'sinstrumental in care.
And you're right, the, the useof ot and mental health is
pretty rare.
(08:56):
I don't see it a lot and when,when I you know, came to visit
you at scottsdale providence andsat there on campus and you
came in and gave your piece, I'mlike, oh, because you see it a
lot in the developmental delaypopulation, the kids with very
significant disorders who arestruggling with kinesiology
(09:17):
kinds of challenges and PT kindsof challenges, but in their
long-term care, ot has to be apart of it.
You know they've got to be ableto function in the world and do
things and hopefully have a jobone day and all these kinds of
stuff.
And the fact this is where thesilo thing happens in mental
health care and in all carereally is that we get these
(09:39):
people and they become reallygood at doing what they do.
It's been largely aimed at acertain population, so they stay
there, you know.
They kind of don't leave theiryard.
And the cool thing about youI'm going to compliment you
right now is that you have thisbrilliant insight to be like,
wow, this really fits in mentalhealth and addictions care and I
want to do this, so you know.
(10:01):
My other question for you ishow does that, does that look on
campus at Scottsdale Provinceor in your private practice with
what I might say are notnecessarily traditional OT kinds
of clients?
Yeah, you know you have peoplewho are smart and maybe they've
had degrees but they've sufferedfrom an addictions issue.
(10:21):
And now they're in front of youand you're like, hey, let's get
some alignment going on here,Like, tell me about that, work
on a day to day basis.
I want to hear a little moreabout it.
Speaker 2 (10:34):
So I'm always looking at what is the function of
behavior, like what is what'sgoing on, yeah, and so most of
the clients I see at ScottsdaleProvidence are neurodivergent,
and so for anyone that isunfamiliar with that term, it's
an umbrella term, it's not adiagnosis itself but, and
depending on the umbrella andmodel you're looking at, there's
(10:54):
a whole host of things that canfall under it.
But almost always there'sagreement upon autism, adhd,
audi, hd, which is autism andADHD, combined epilepsy, other
learning disabilities, likethings like dyslexia, dysgraphia
, dyscalculia.
Sometimes we pull trauma underthere as well, but it's this
(11:15):
idea of, you know, havingneurocognitive differences, so
the way that the brain processesinformation and how the body
responds to it, like what doesit do when the brain, like brain
, sends a message, and then whathappens after, and so that
really is what separates, kindof things that fall under that
neuro divergent umbrella.
And so at Scottsdale ProvidenceI primarily work with people
(11:40):
who have those other thingsgoing on, and so, from an OT
lens, we are inherently a veryholistic profession.
We are naturally what we callpretty neuroaffirming, where we
are honoring individual strength.
We're really looking at likefunction of behavior, versus
labeling a behavior good or bad,and then we like extinguish the
behaviors Like where is itcoming from.
(12:00):
Extinguish the behaviors likewhere is it coming from.
And so when I am working withclients who are experiencing
addiction and are, you know, inthe early midst of early like
addiction recovery and they haveadhd, right um I'm looking at.
Of course they do I'm looking atthe adhd components that also
relate to the addiction,challenges with impulse control,
difficulty with self-monitoringof behavior, maybe even just
(12:24):
like challenges withdysregulation.
So, although it's not in theDSM, a core component of ADHD is
significant emotionaldysregulation.
There's another new term that'skind of been connected with
ADHD, again not in the DSM, butmany psychiatrists have like
acknowledged this is a thinggoing on, a phenomenon rejection
(12:45):
sensitivity, dysphoria, so ahigh sensitivity to rejection.
But we think about what ittakes to adult.
There's a lot of executivefunction related for success.
Speaker 1 (12:56):
You're saying you know what, what it does take to
adult.
Speaker 2 (12:59):
Yeah, I mean.
Speaker 1 (13:00):
I'm interested.
What's your answer to that?
Speaker 2 (13:02):
Yeah, it takes a lot right.
Like adulting is really hard.
And if you have executivedysfunction, if it's hard for
you to plan, to organize, tostart a task, to complete that
task, to monitor your ownbehavior, to regulate when
you're overstimulated, like it,you're going to have challenges
(13:22):
with like adulting.
And so many of the individualsI see at Scottsdale Providence
have experienced thesechallenges and so coping.
You know, substance use oftenhelps with coping right,
especially when we look at thesubstance of choice and how it
impacts the brain and thenervous system right, the
central nervous system as wellas the autonomic nervous system.
(13:43):
And so I'm always looking atfunction of behavior, like
what's going on.
Individuals with executivefunction issues also don't know
what to do when they're bored,and sometimes boredom is a
common thing that comes up whenI'm like what are your triggers
for relapse?
Boredom?
And so we look at how do wedevelop leisure relapse boredom,
and so we look at how do wedevelop leisure, healthy leisure
occupations, how do we engagein play more as, like an adult,
(14:07):
we adults we forget to play andhave fun.
But when you struggle toorganize and initiate and like
whether it's initiate a task,initiate conversation, organize
your life, those things aregoing to be hard.
So I'm always looking throughmultiple models when I'm working
with any client to figure outlike where's the function of the
behavior and how can I supportboth skill development as well
(14:31):
as like systems development intheir life, so that life feels
easier and they feel successful,they increase confidence, have
more of a deeper connection totheir own identity and then can
experience mental well-being.
Speaker 1 (14:45):
Well, and you know, it sounds to me that part of
this process, which is wherethis crossover is really
beautiful in my mind theawareness of my own emotive
process when I becomeoverwhelmed, when I become bored
(15:06):
, what I do in response to thesestimuli, et cetera.
But then you've got the othertools.
It's like how to be organized,how to use a calendar, how to
let you know all that stuff.
What are the kind of tools thatyou're using?
If I didn't know any better,I'd say you probably crafted
some of your own that fit intothe ot process but, are linked
(15:27):
to emotional awareness as wellas executive functioning pieces,
and they come together.
What?
What are the tools that you'reusing to work with these?
What are you giving them asthey, as they progress and
develop?
Speaker 2 (15:38):
the first thing we always look at before
implementing like a tool ismotivation.
How are they inherentlymotivated?
So neurotypical people,typically it's like they can be
and neurotypical is a term usedfor someone who's not
neurodivergent, right and sothey're inherently more easily
motivated and so they canwithhold gratification, whereas
(16:00):
neurodivergent people struggle alittle bit more with motivation
or seek out immediatelygratifying activities.
Right, they need that dopamineright away.
And so first we look at youknow, are you motivated by
challenge, passion, interest,novelty or urgency?
And then, once we can identifywhat are the primary motivators
(16:21):
for a person, then we can figureout how do we incorporate tools
that can then match thosemotivators.
And sometimes the tools aren'talways matching motivators, but
we try to incorporate ways to bemotivated to use the tools.
So, planners, we do use somedigital stuff.
I love this app called HabitShare.
It's completely free.
Speaker 1 (16:41):
It allows for Habit Share it's completely free.
Speaker 2 (16:42):
It allows for HabitShare, it allows for
accountability.
So I have some clients thatwill send me their habits and
they check in and what's reallynice.
Of course, I make them sign aconsent form because HabitShare
is not HIPAA compliant.
But I can directly message themand just say hey, like I
noticed that you didn't do, youdidn't brush your teeth for two
days in a row.
Let's track that the next timethat we meet, like.
(17:03):
And then they're like oh gosh,she is watching.
And then sometimes for some ofthem that accountability is
really helpful until it becomesa habit.
I really love incorporatingsensory-based tools.
So before we implement anexecutive function tool, we look
at a person's sensoryprocessing.
So we use an evidence-basedassessment called the adolescent
(17:26):
adult sensory profile, and ithelps us understand.
Does this person have sensoryprocessing differences?
Are they more sensitive?
Are they a sensation seeker?
Do they avoid when things aretoo much, or do they have
something called lowregistration, which essentially
means they need a lot of thestimuli to register that it's
(17:47):
there, and typically with peoplewith ADHD we see a lot of that,
and also for people whoexperienced trauma and are
dissociating, we also see thatas well, and so that helps us
understand if we need certaintypes of cues.
So let's say, someone showsthat they have low registration
patterns for visual stimuli.
(18:08):
It doesn't matter.
Speaker 1 (18:10):
Now define for our audience what that means.
Speaker 2 (18:12):
Yep.
So the low registration meansright.
So for sensory processing, withthis model that we use, with
this assessment, we look atthreshold.
Does a person have a highthreshold where they need a lot
of the stimuli, whether it'svisual or movement or touch, to
know that it's there?
Or do they have a low thresholdwhere a little bit goes a long
(18:37):
way?
So someone who would wear noisecanceling headphones would
likely have a low threshold forauditory stimuli.
Speaker 1 (18:44):
Your high threshold of folks are the ones that are
out there doing verystimulant-based drugs.
They can be.
They're like I need somethingto crank me up because I'm going
for the stimuli right.
Speaker 2 (18:55):
So my colleague that I had mentioned before, dr Brown
, she actually did a study onthis two years ago, thinking
that drug of choice would matchthe sensory processing pattern,
and it actually didn't.
Speaker 1 (19:06):
All in all.
Speaker 2 (19:09):
all in all, it's just being and, yes, is there very
are?
Is there some truth?
Potentially there, Absolutely,but it wasn't statistically
significant enough to say, yes,someone who is a high threshold
is going to seek out a stimulant, versus someone who has a high
threshold is going to seek out astimulant versus someone who
has a low threshold is going toseek out more of like a
depressant, like alcohol.
However, I will say I do trackthat with the clients I work
(19:32):
with and I do see some patterns.
It just wasn't significantenough in the research.
Speaker 1 (19:36):
Well, you're also talking about a person's
chemistry, like their drug ofchoice is their drug of choice.
You know what I mean and that'sand that's what they're using.
So it may not line up.
That's an interesting finding.
That's really cool.
Speaker 2 (19:48):
It is yeah and so right.
So someone who is showing lowregistration patterns with
visual stimuli right, they'renot actively seeking out,
they're just hanging out andthey're just missing stuff.
So these are like the peoplethat are being labeled like lazy
, or they're just choosing notto engage, they don't want to
engage or like like a child inthe classroom and they're
(20:10):
missing cues.
They're missing things on theboard.
They might need things boldedand highlighted and maybe they
need an auditory cue with thevisual cue.
And so, as an OT, if someone isshowing that type of pattern
visually, I'm not going to justsay put it in your calendar and
then make sure you look at it.
We're going to have alarms,we're going to have a calendar
(20:30):
on their wall.
We're going to have thecalendar in the phone with the
alarm paired with it.
We are pairing a lot of sensorycues that you need to pay
attention to this.
But when you're doing executivefunction work and you don't
understand the sensoryprocessing component, we can
miss a lot of things, and sothose paired together can really
help support success forindividuals.
Speaker 1 (20:53):
So the thing that occurs to me is let's circle
back to trauma for a second.
When you're engaged in thiskind of evaluative and
observative process with aperson and one of their key
triggers is traumatic events andyou know, some of the things
that you see in people whosuffer from significant trauma
(21:15):
is there, are, you know, people,places or things that can be a
trigger.
Sometimes they're aware of themand sometimes they're not and
even processing with them aboutpotential triggers and these
places and being able toidentify okay, let's track this,
let's figure out where you'regoing, let's make sure that
we're aware of what's in ourenvironment.
(21:36):
Do you see trauma response,response, re-engage, sometimes
when you're working with them inot session, does that happen?
Speaker 2 (21:46):
oh, it can happen, and usually, like when I do my
evaluation, and I try to grab asmuch information as I can,
whether from a previoustherapist, or intake paperwork
about the trauma and thentracking that as it matches then
like different sensory stimuli,or we try to work around it,
(22:08):
and so that is something thatI'm really conscientious of, and
that's also why it's reallyimportant to pair with a primary
therapist or a trauma therapistwho's working with a client to
understand, like, what thosetriggers are and how to avoid
them until they are at a pointwhere they're not getting out of
their window of tolerance,because if someone is getting
triggered by a past trauma, thework that I do is probably not
(22:32):
going to stick because they'reso activated yeah.
Yeah, they're either insympathetic right when where the
fight or flight, or they arepast that and they are
dissociating and they're notconnected with the present
moment.
Speaker 1 (22:48):
Right.
Well, and I guess that's whenyou know you've got an entire
clinical team that's surroundingyou.
You know, as you work withthese individuals, it's like,
hey, they may not be ready forOT.
It sounds like they really needto ground out and do some more
trauma work so that they canfeel like they're able to
regulate as they go out into theworld and they do some of this
OT executive functioning workwith me, and so you know, that's
(23:13):
this is so.
This is where I mean all thisstuff is cool to me, but I think
that some of the you peel backto the veil on how programming
works, and that's something thatI like to.
Some of the you peel back theveil on how programming works,
and that's something that I liketo do in the show.
How does that like, how do youinterface with the clinical team
?
You got a psychiatrist, you gotclinicians, you got coaches
that are on the ground every daywith folks.
(23:34):
Like, how does that mechanismwork?
As you're working with a personindividually, I know that
you're also passing informationoff to the other care providers.
What does that look like inyour day?
Speaker 2 (23:45):
I am constantly in communication, right, so I think
about, like, let's even justsay residential.
If someone is in residentialcare, usually, right, the
capacity of what we expect forlike active cognitive engagement
is a little bit less than whensomeone moves to PHP or IOP.
And so I might get called in todo a sensory eval and then give
(24:09):
some sensory tools forgrounding while they're working
on maybe some of the processingand stuff like that before they
come to more intensiveprogramming.
And so I'm communicating withthe residential staff in terms
of, like, let's do a sensoryassessment.
What are the sensory tools?
Whether they're focused toolslike fidgets or weighted
products, or using smell in alike a very intentional way to
(24:29):
help facilitate grounding andregulation.
At the same time, whenever ourpsychiatric practitioner at SPRC
is doing an evaluation, if sheis noticing potential
neurodivergence or she sees aclient who has ADHD, she
immediately will, like, put inthe chat.
Hey, I want you to have eyes onthis person, let me know your
(24:50):
thoughts.
Often also, what she ispotentially catching is autism.
That is the biggest thingyou're noticing specifically
more with, like, the millennialand Gen X population is missed
like level one autism.
So very low support needs, highmasking individuals and
probably in the time that I'veworked at SPRC, I mean and like
(25:14):
probably.
I mean like I'm thinking like10 to 15 people we have caught
like missed autism as it'srelated to significant mental
health struggles and oraddiction, and that is a very
important thing not to miss, andso I'm constantly communicating
.
It is, and you know, like the AQisn't going to catch it which
is the autism quotient.
That is one that was kind ofdeveloped, and it does focus
(25:37):
more on more male traits.
However, the CATQ, which isCamouflage Autistic Test
Questionnaire, something likethat that is a really good one
very low support needs, highmaskers, and so that's like one
piece of the puzzle.
And then the primary therapist.
We are interfacing on a veryregular basis of like, what are
(25:59):
they doing?
What am I seeing?
I am typically advocating forclients to like be able to not
engage as much.
Right, when we think abouttreatment facilities, you know
most of them have a lot ofstructure, and they have to,
otherwise it could be completechaos.
But neurodivergent individualsneed a lot of flexibility and
(26:20):
autonomy for regulation.
Structure is important, butthere's got to be flexibility in
it, and so when someone is onmy caseload, everyone at SPRC is
interested in hearing like howdo we integrate more autonomy
and flexibility for their care,but also making sure it's
structured enough thatexpectations are known, and so
(26:40):
that is probably a huge part ofmy job, um, whether it's being
able to stay back from events orhaving alternative events to go
to, like we even think about,they are very stimulating.
Um, and I've had a lot ofpeople even ask like hi, are
there any?
Like neuro affirming AAmeetings and I don't know of any
yet Doesn't mean they're notout there and it doesn't mean
(27:01):
that they won't be developed.
But these individuals have highsensitivity to sound and smell
and movement and when they arein fight or flight, that can
also be really triggering andthey get out of the window of
tolerance and then the meetingis no longer beneficial.
So we're always trying tocollaborate like what is the
best path for each individual sothat they can have a
(27:24):
sustainable recovery.
I even collaborate with, likeour CEO, alex, all of the time.
We just got a new PHP house forthe women and I'm designing one
of the rooms to be like asensory space slash lounge area
and also.
So it's like how do you makethis space beautiful and adult
(27:44):
focused but also have all of thenecessary sensory components
that people can go in and learnhow to self-regulate when they
are overwhelmed?
So we'll have things like noisecanceling headphones that also
are like similar to Bose there'sreally a really great brand
that's not quite as expensive,but they can access music or
podcasts but also have the noisecanceling feature, having
(28:06):
chairs that swivel.
Speaker 1 (28:08):
Yeah, right.
Speaker 2 (28:10):
I.
We also talked about likehaving a swing from the ceiling
because that linear vestibularinput right, which is not
spinning, it's just going backand forth, can be really
regulated for some weighted lappads and pillows and blankets
and different textures in theroom, helping people understand,
like, how much of a differencethat can make.
So it's like creating thisspace allows them to practice
(28:31):
these skills outside of the OTsession.
Speaker 1 (28:35):
Well and know what tools they need when they leave
you know it's like I need my ownchair and I need my own
weighted blanket or I need thesethings, you know.
And the other thing that thatyou know, as you talk about
working with these individualsand working with them in the
context of a treatment program,and they've got all these tools
(28:57):
that are available to them.
We'll shift over to theoutpatient side of things.
What does it look like when youdon't have a team but you're
addressing an individual who'syou know, maybe they're trying
to go back to school or they gotback to work, whatever it is?
How does the outpatientpractice differ?
A little bit Like what?
Speaker 2 (29:16):
does that look like.
So my team isn't there with me,but if they have a team.
I am coordinating with them allthe time.
For the most part.
There are some clients wherethey actually don't want as much
coordination and sometimes evenin the ROI they'll say I need
some tools, and then I'm good,yeah.
And so my office space is verysensory friendly, like
(29:38):
everything about it.
We have lamps everywhere so wedon't have to turn the big light
on, but for people that want it, we can do it.
If they're, if they have visualsensitivity, we've got tons of
sensory based tools that mirrorlike what a home looks like, so
that they can.
We're modeling essentially howthey could design and set up
their own space.
We are working on groundingexercises.
(30:01):
We do.
We do help with likemindfulness and breathing, but
we're always other sensorycomponents.
We have planners up the wazoo,every type of planner you could
imagine in our cabinets to tryto see if it could help support
a client.
We use old school timers fortime management If people have
time blindness, because once youget into your phone most people
(30:22):
forget why they were there inthe first place, and so we're
very focused on what are thegoals for that person.
And so let's say they want togo back to work or they're
trying to go back to work.
The first thing I do ask iswould you like formal
accommodations or a letter ofaccommodations written?
And so the big thing to knowwith this one is they have to be
(30:44):
feasible and doable for theemployer.
So things like you know, breaksor noise canceling, headphones
or like a dedicated space if youhave to have a one-to-one
meeting, if someone struggleswith attention regulation, right
.
So the focus is really hard.
Most of the time those areeasily met.
I have had clients that havesaid you know, I work a 40-hour
(31:07):
work week but I only want towork 25 hours and like that's
just not doable, right, they'repaying you for a job.
So I always keep that in mindwhen I am writing my letters of
accommodation, that I've done somany of them.
I know what will get rejected,um, and I know what likely won't
, um.
Oftentimes I'll go into umaccommodation focused meetings
with HR and the client to beable to help further explain or
(31:31):
to clarify what theaccommodation means.
I always tell my clients,though, like as an advocate with
them, I don't speak for themand so we practice like what are
the cues when you want me tojump in?
Or they'll just say you know,I'm going to have you know, dr
Sarah, explain this part.
They'll just say you know, I'mgoing to have you know, dr Zara,
explain this part, because it'sreally important that in that
process I'm also helping tofoster and develop skills around
(31:52):
empowerment and self-advocacy.
Same thing goes for schools.
So, having worked as aprofessor, I know the back end
of that.
I know what universities doneed to honor and I know what is
feasible to honor.
And I know what is feasible andso I do a lot of letters of
accommodation for whether it'sundergrad or graduate programs
(32:13):
to help support that.
And then the other part isskill development around time
management, skill developmentaround organization and planning
.
And so I have to know a lotabout like what is the job
they're wanting to do or what isthe program that they are in
and what do they have to do onan everyday basis.
Study skills is the big onethat comes up.
(32:35):
No one ever gets motivated tostudy, and so it's like, how can
we make that as engaging andpleasurable as possible?
And so every client I work withit looks different, but we use
a lot of the same types oftechniques and strategies.
We just adapt them.
Speaker 1 (32:53):
Wow, uh, you know the um.
The one of the things that I'mtrying to bridge when we go out
and we do the podcast, we'rewe're passing information to the
, the greater public is thatthere are all kinds, you know
these, as you say, theneurodiverse umbrella.
A lot of us could fall in there.
(33:16):
Some of us fall in there alittle easier than others, but
everybody's got this littlequirk or there's something else,
and one of the things is that alot of the stuff, that this
kind of ingenious stuff thatwe're, that we're life and these
things are habit tracking andwhere are you?
You know where are you feelinglike depression onsets?
(33:53):
You know what part of the day,do you?
feel best in and just havingthose kinds of awareness, like
sharing some of this stuff tothe world is part of the goal of
what we're doing here.
If you were to share one, maybetwo things with just the
average Joe slash Jill in theworld, slash they in the world
(34:15):
what would you say is greatcommon practice for the person
who didn't necessarily needtreatment, who didn't
necessarily need therapeuticapproaches, but could really
benefit from some of this stuff,like what's the, what are a
couple of things that you wouldgive to the world?
Speaker 2 (34:29):
Number one know what your values are, because if your
goals don't match your values,you will never have the
motivation to meet them.
And so, like an example is, Ihad a client come to me and say
I want to work on organizing mycar and keeping it really clean,
and I said, okay, tell me thevalue behind that.
And they're like my mom and dadalways instill that into me.
(34:51):
And I said, no, what is thevalue for you?
And they're like I don't reallyhave one, it doesn't really
matter to me.
And like, well, this is whythis isn't working.
You've been trying this forthree months.
It's not working because you'renot motivated, it's not a value
.
And so I think important forevery single person Like what
are your values and how does italign to a goal?
Because then there will be adirect connection and more of an
(35:11):
internal motivation to tofulfill and meet that goal.
Like that's number one.
And for some people it givesthem pause and they think about
like what are my values?
And I don't just mean likehonesty and respect, I mean like
your values as a person.
So for me, I have ADHD.
I found out when I was an adultand I love stimulation, I love
(35:35):
learning.
My job is not a job.
It is like every part of mybeing.
I'm also a mom to a child whohas ADHD.
She is level one autism, superhigh maskers, so if someone met
her on the street they wouldhave no idea, right?
But it's very clear to us asparents and so there is this
greater drive for me to do thistype of work.
(35:57):
It's my special interest and sothat is a value for me.
Like neuroaffirming care andneuroaffirming support and
building a community is a hugevalue for me.
So when I am working withclients, I really want them to
think about like, what are yourvalues?
I had one client the other daylist alone time is a huge value
for me.
Like that is really important,and so sometimes our values
(36:21):
aren't what we actually expectedour values to be.
So that would be my first one.
The other one is slowing downand being willing to have less.
And right, when you have tomaintain a lot, it's a lot
harder, and when we're in ourday-to-day life, it's really
easy to accumulate a lot, andusually having less to take care
(36:46):
of makes it so much easier tocare for the things that you
have to be able to find thingsin your space.
So many of the people I workwith, and even if you're out
there and you struggle withorganization and planning,
having a decluttered space isgoing to make a huge difference,
and so that goes into theenvironment aspect.
(37:06):
Your environment plays a hugerole in how you feel and how you
perceive the world.
Um, and then the last one wouldbe I like understand your own
sensory processing.
So many people don't realizehow much sensory processing
plays a role in mental health.
Um, there are a lot of toolsout there that can support
(37:28):
sensory processing, whether it'snoise-canceling headphones or
loop earbuds or just havingsunglasses with you every time
you step outside, if you'rereally visually sensitive, or
keeping the drapes drawn duringthe day.
Understanding your own sensoryprocessing is a really easy way
to feel empowered in terms ofbeing able to control for things
(37:50):
that might make you feelanxious, and so that's a really
easy one.
Usually, when people I'll doworkshops in sensory processing,
people will be like I learnedso much, but now I can like just
take this information and adaptit to my own life.
You know that's not a I need tosee your type of thing Usually
it's just I need to learn aboutthis and learn about mine, and
(38:10):
then I can move forward andimplement this stuff in my
everyday life.
Speaker 1 (38:13):
Well, and it goes to this, you know, what you're
talking about is just thisincreased awareness of self.
Um.
One thing I would probably addto this having, you know, being
a person with ADHD who's had tocome up with these strategies
and doing all these things, andthen I also noticed that it's,
you know, every decade goes byand changes a little bit.
You know your values change,which you, your sensory stuff
(38:37):
changes.
In your fifties, your memorystarts to go, especially after
two kids.
You know what I mean, right,and so you know the, the.
The interesting thing about alot of this conversation and you
and I are probably just goingto have to come back and do some
more but the, the thing aboutmasking, um, and you and I have
(38:58):
a.
We have an understanding ofthat from a clinical standpoint
and what it looks like in a, ina clinical environment.
But I think the world does it.
You know everybody's masking onsome level, like your guy with
the car.
It's like why are you doingthis?
This was, and I you know, partof the process.
Developmental process, for meas an adult, has been like you
know, there are things that yourparents gave you, and some of
(39:20):
those things were values andthen you get to a certain point
and you're like wait a minute,those actually aren't my values.
I, I have different values thanthat and you do this, you do
this.
You know this individuation,you know and.
I think, individuation issomething that you're doing all
along and, um, people who, ifyou feel like you're wearing a
mask to the world, to your job,to your kids, to your spouse, to
(39:45):
these people like you'retalking about a process, and I
think the most salient thing andsomething that's really
valuable is a lot of the changesthat you're looking for,
because we think of change as,like grand life change, this big
thing.
The changes you're looking forare often really subtle.
I need a chair that swings backand forth.
I need a little more privatetime.
(40:07):
I just need these tiny littlethings to implement in my life
that are going to make thismassive difference in everything
and my satisfaction witheverything you know.
On the other side, do you seepeople kind of coming away with
this like great gratitude to youbecause you pointed out
something?
What does that look like?
Speaker 2 (40:26):
Yeah, yes, often, and that takes time, like I just
met with a client yesterdaywhere they've hit that point.
They are an adult, verysuccessful, struggled with
addiction, found out that theyhad autism, had no idea.
Their whole life their parentshave been reading books and
learning and, like now they'vegot all these systems in place.
But it's a very up and downprocess.
(40:47):
Sometimes there will besessions where they're very
angry not with me, but they'reupset that they didn't know
about this earlier.
Or the you know the question oflike who am I outside of these
instilled values?
Like what are my values?
And that's a hard thing.
But what a gift at any point inyour life to start reconnecting
with who you are naturally.
And I think the more that wecan do this, and especially for
(41:11):
those of you who are listenersand have children.
You know, the number one thingis to support who they are
naturally and to naturally helpthem develop coping skills and
regulation skills that naturallymeet their own, like body and
brain needs versus you know,here's a sticker for sitting
still in a chair, right, Ifthey're a mover and groover,
(41:33):
let's help them learn how tomove and groove in an
appropriate way in the verycontext right, and so so many
millennials and Gen Xers didn'thave that, and so once they
start to learn like these are mynatural needs and now I know
how to meet them they seethemselves very different, and
especially when we can connectthat to substance use, that can
(41:54):
also help support sustainablerecovery.
Speaker 1 (41:58):
Absolutely.
Well, I mean, you threw GenXers in.
I'll agree that we have somedeficits we had to work through.
Speaker 2 (42:06):
But now we know more, we have some deficits.
Speaker 1 (42:07):
we had to work through, but now we know more.
Sarah, it has been.
You know I've just had so muchfun, you know, being here with
you and the show today.
Thanks for taking the time.
I appreciate it very much.
This has been Head InsideMental Health.
Todd Weatherly, your host, DrSarah Anderson has been our
guest and we really appreciatethe work that you're doing out
there.
We'll look forward to seeingyou all next time.
Thanks, Sarah.
Speaker 2 (43:22):
Thank you.
I'm a little little, littlelittle little little little
little little little littlelittle little little little
little little little littlelittle little little little
little little little littlelittle little little little
little little little littlelittle little little little
little little little littlelittle little little little
(43:45):
little little little littlelittle little little little
little little little littlelittle little little.
Thank you, bye.
I feel so lonely and lost inhere.
I need to find my way home.
I feel so lonely and lost inhere.
I need to find my way home.
(44:06):
I feel so lonely and lost inhere, bye.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Special Summer Offer: Exclusively on Apple Podcasts, try our Dateline Premium subscription completely free for one month! With Dateline Premium, you get every episode ad-free plus exclusive bonus content.