Conversation 30 - Beyond Physical Healing: The Impact of Medical Trauma - Ohio Counseling Conversations

Episode Transcript
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Marisa Cargill (00:00):
Welcome back to Ohio Counseling Conversations,
the official podcast of the OhioCounseling Association,
bringing you conversations fromaround the state.
On today's episode, we'rejoined by Dr Michelle Flom,
professor at Xavier University,anda, leading voice in medical
trauma-informed care, dr Flomshares how her groundbreaking
work, including the first evercertificate program and book on

(00:23):
medical trauma, is transforminghow counselors and healthcare
professionals respond to thepsychological impact of medical
treatment.
Rooted in both professionalexpertise and personal
experiences, her mission is toensure the patients feel safe,
seen and supported in everystage of their care.
And I'm your host, dr MarissaCargill.
Let's dig in.

(00:44):
Welcome back to Ohio CounselingConversations.
I am Dr Marissa Cargill and Iam so excited to get into
today's conversation.
We are joined by Dr MichelleFlom.
Michelle, we're so excited andeager to talk to you today, and
there might be some listenerswho don't know who you are,
don't know what you're about.
Can you tell us a little bitabout yourself and what led you

(01:06):
into the counseling profession?

Michelle Flaum (01:08):
Absolutely, and thank you so much for having me
today.
So yeah, absolutely so.
Um, I have been a proudcounselor in Ohio and actually,
um, uh, all my life at Ohio inand uh, and so I've been a
counselor for almost 25 yearsnow and educated here in Ohio,

(01:28):
got my bachelor's at the OhioState University, my master's
about 26 years ago at theUniversity of Dayton and then my
doctorate at the University ofCincinnati.
So I've been in privatepractice for almost 25 years and
I've been a professor foralmost 20 years.
So the first five years at theUniversity of Dayton and so then

(01:53):
the last 15 years I've been acounselor educator at Xavier
University.
So really what brought me to thecounseling profession was just
a strong desire to help people.
My initial calling was actuallyto be an attorney, and so I
started my educational journeydown in North Carolina.

(02:14):
So I said I've been in Ohio inmy whole life.
I spent a couple of years downin North Carolina at the
University of North Carolina andDuke University and spent
actually just a couple of weeksin law school.
Didn't take me long to realizethat was not my journey and left
there A few months later, foundmyself in a master's program in

(02:34):
counseling and then neverlooked back.
I knew that counseling was mycalling, and I've been a
clinical counselor ever since,and so I've just been passionate
about the field and an advocatefor our profession ever since.

That's amazing, yeah, and I love to hear you
know.
Yes, a couple years in NorthCarolina, but Ohioans and Ohio
counseling is such a rich fieldand it's in and of itself and we
love having like people who'vebeen here and kind of what's
going on in this state.
So, beyond counseling and acounselor education, I know that

(03:14):
you are also an author and thatyou have written the
groundbreaking book Managing thePsychological Impact of Medical
Trauma.
What inspired you to write this?

Yeah, thanks for the question.
So actually I can really,unlike some authors, maybe I can
pinpoint the exact day thatinspired me to write this book
and, bittersweet, it was the dayof my daughter's birth.
So back in 2004, april 9thbeautiful day in so many
respects, the day of mydaughter's birth, but actually

(03:50):
was my own medical trauma.
So I had a postpartumhemorrhage and a massive
hemorrhage right after her birthand experienced a significant
trauma her birth and experienceda significant trauma.
It fought for my own life formany hours after her birth and

(04:13):
almost lost my life as a resultof that and had a week-long
hospital stay in the ICU reallyfighting for my life.
So spent the first week or sowithout really having even met
my daughter, my newborn, and so,as you can imagine, just a
massive trauma in a cascade ofevents.
Following that experience andhaving experienced that as a

(04:36):
newly licensed clinician, whileI was experiencing this as a new
mother and as a patient, I wasalso experiencing this trauma
through the eyes of a mentalhealth professional and I was
seeing all of the missedopportunities.
I was seeing all of the waysthat I could have been helped

(05:00):
but wasn't.
While in the hospital and inthe days and months following my
experience, I started to seemyself really struggling and
subsequently I became more andmore affected by this trauma and

(05:28):
developed post-traumatic stressdisorder.
And so I spent the next severalmonths and even years really on
a journey to heal myself.
And while that was happening, Iwas really grappling with what
had occurred and recognizingthat it could have been very

(05:51):
different and I really didn'twant my wanted to do something

(06:13):
about it, and I had always beena writer, I'd always been a
creative writer and so I beganwriting.
I began writing about myexperience, I wrote a few
articles and, through the earlyyears of my daughter's life, I
decided to go back and get mydoctorate and I was writing at

(06:33):
that time.
And I wrote an article anddecided to take a risk and and
submit it to a nursing journal,because I thought, well, I'm
writing this article about allthe things that happened in my
experience that could have beendifferent and a lot of what I

(06:54):
was writing was really to thenursing audience.
And so I thought, well, let mesubmit this and see what happens
.
And it was accepted.
And so, long story short, someresearchers at Stanford
University read this article andcontacted me and asked me if I

(07:14):
would partner with them, and soI began working with them on
creating some protocols for whatwas called at the time is still
the California Maternal QualityCare Collaborative, which is an
organization that createsprotocols not only for
California but is a leader onthe national stage in setting

(07:41):
guidelines and standards formaternal care across the United
States.
And so I played a role insetting new protocols for mental
health and maternal care stagewith the National Obstetrics and

(08:06):
Gynecology Association and somenational nursing associations
to create mental healthstandards for maternal care.
And so my work with maternalmental health kind of expanded
from there.
And all the while I'm I'mbeginning to think about medical

(08:27):
trauma, and when I firststarted doing this work the term
medical trauma really didn'texist, you know.
And when I started to talk withphysicians and and and really
other providers about medicaltrauma, they would kind of look
at me, you know, curiously andjust kind of push back a little

(08:47):
bit and say, well, medicaltrauma, that's really not a
thing.
I mean there's.
You know there's no differencebetween medical trauma and other
kinds of trauma, and I thoughtyou know what there is.
Medical trauma is very unique,it's a different kind of
experience, and I'm glad I keptpushing back because it really
kind of spurred me on in my workand really it's been a labor of

(09:12):
love.
And it's also been a lot ofadvocacy about our profession

(09:32):
because all the while I've beenI've really been advocating for
counselors Because you know, asthe quote unquote, kind of new
kids on the block in the mentalhealth sphere we sometimes can
be overlooked, you know, andsocial workers and psychologists
are often the first kind ofnamed in the mental health

(09:54):
sphere, within healthcare.
And so I've, you know, I'vebeen really kind of banging the
drum for counselors withinhealthcare as part of my
advocacy about medical trauma.
So maybe long answer to yourquestion, but that's kind of
what sparked my work and kind ofwhere that came from.

I'm sorry that you had to experience that, but
I, I think you know the messagethat that you created and the
advocacy that you're doing is someaningful, and so you know
thank you.
That inspiration is.
I got like teary eyed at thebeginning of you sharing, like
your, your own personal story.
Um, just because, like eventhough maybe not the same and

(10:40):
maybe not to the same degreelike I had like an outpatient
surgery, but I'd never hadsurgery before and I remember
after my mom left the room,being alone kind of waiting for
them, and I was like so scaredand vulnerable right.
And that that feeling is maybenot unique to just one

(11:02):
individual right, like it's avulnerable position and, um,
being in those spaces is, youknow, often very unfamiliar for
people, which makes it evenscarier.
Um, yes, yes.
So yeah, I really appreciateyou sharing your, your own
experience.
I think a lot of people canprobably relate to just some of
that vulnerability that theyfelt.

Yeah, yeah, thank you for sharing that too,
because I, you know, I talkabout medical traumas being kind
of a disenfranchised kind oftrauma, especially for adults,
because we were socialized to,you know, really submit to
whatever needs to happen for uswithin the medical setting, you
know, and we, because we, weunderstand that this is to treat

(11:47):
us, to heal us.
There's this expectation thatthat you know that we are almost
that, that you know that, thatwe aren't allowed to be scared,
or that you know that, that wewere quiet about it.
You know we don't, um, we don'tnecessarily talk about it and

(12:09):
it is scary, it is vulnerable.

And as a counselor, I was like thinking
like, why aren't like no one'seven saying like let's breathe
for a minute?
Or you know like and I knowthese things but it's just like
I felt very alone in it and andso.
I like was relating on adifferent level, but relating
that like, yeah, probably thisis happening more frequently
than maybe other professions areaware of.

Yes.

Yeah, you conceptualize in the book the
psychological aspects of medicaltrauma.
Can you elaborate on thatconcept for our listeners?

Sure, sure, absolutely.
So really, I mean we can thinkabout medical trauma as
traumatic stress, a traumaticstress response to pain, to
injury, to serious or chronicillness, to medical procedures,
to being in the medical settingreally anything to do with our

(13:07):
bodies or being in the medicalsetting.
So the threat, the traumaticthreat, could be our own bodies,
it could be the hospital or themedical setting, it could be
staff or providers.
That could be kind of a triggerfor us, especially if we've had
past traumas.

(13:28):
You know medical traumas.
It could be the proceduresthemselves, it could be pain,
really any combination of thosethings.
Yeah, and and and.
So any of those kinds oftraumas.
They can lead to clinicaldisorders.
I mean they can lead to what wecall medical PTSD.
They can lead to anxiety.

(13:49):
They can lead to depression,grief.
They can lead to substance use.
You know substance use disorder.
They can lead to, you know,subclinical kinds of issues or
other kinds of crises.
You know lots of differentkinds of difficulty in people's
lives.
So so you know, these kinds oftraumas can have wide ranging

(14:15):
effects for people and ascounselors, we, you know we we
might treat the clinical issuesthemselves.
We might be helping people workthrough sometimes the
invalidation that they mightexperience with, maybe,
healthcare staff, maybe theyexperience some dehumanizing

(14:37):
treatment, maybe they strugglewith the vulnerability that
they've experienced, maybethey've experienced some what's
been termed medical gaslighting,and maybe they're struggling
with medical avoidance, which isanother really important
consideration with medicaltrauma.
And that makes sense, right,when we're working with trauma,

(14:59):
experiential avoidance is aconcern, and so when we're
talking about medical trauma, itmakes sense if someone has
experienced a significant traumawithin the medical setting,
well, you know, it makes sensethat someone would want to avoid
that experience.
Well, if they're avoidinghealthcare, that has wide

(15:20):
ranging implications for them,and so our part of our role as a
counselor, then is to help themre-engage with healthcare.
Um so, so, hopefully that giveskind of a sense of really the
the broad focus of medicaltrauma, um, andanging kind of

(15:49):
interventions and the way thatwe can conceptualize our work
and many different factors thatcan contribute to medical trauma
, where we might be focusing onthe client.
You know the client factors.
I mean people come with manyrisk factors that can contribute

(16:10):
to their experiencing medicaltrauma, maybe previous traumatic
experiences or mental healthconcerns that make them more
vulnerable to experiencingmedical trauma.
You know, maybe it's, you knowthey've, you know, had a very

(16:34):
traumatic medical experience,such as maybe you know they've
gone into cardiac arrest or youknow they've had kind of a
life-threatening medicalincident.
There's so many factors thatcontribute to, you know, to
medical trauma.
It's quite complex, you knowwhen you really start to think
about it.

And multifaceted in that, like you mentioned
before, it can be a combinationof all of these things too, and
that it extends past even likethe healthcare system or like
the setting too, because if your, your healthcare providers, are
invalidating you, it's reallyeasy for other people to kind of

(17:12):
pile on, Like if the doctordoesn't think it's a problem,
then your partner or your youknow, your family members maybe
like it's not that big of a deal.

Right.

Right yeah absolutely yes.
Yes, while I think everythingyou've shared highlights the
importance of raising awarenessabout this explicitly like why
do you think it's important forus to make sure we're raising
awareness about medical traumaand its impact?

Yeah, I, you know, I think in part because,
again, as counselors we wereally value soulism and and
kind of treating our clients,you know, mind, body, spirit and
and, and you know, and treatingthe whole person and and
valuing that when we're workingwith our clients and we're

(18:06):
learning about their histories,you know these are important
opportunities for us to, youknow, really help our clients to
when you know they are kind ofexploring their stories.
You know, number one, I thinkoftentimes we can miss aspects

(18:30):
of their stories that couldpotentially contribute to their
current difficulties andstruggle, difficulties and
struggle.
You know, I've worked with somany clients who might be
struggling currently and notrealize that some of their
struggle ties back to maybeprevious, you know, medical

(18:57):
struggles or previous, maybechronic illness.
Or you know, oftentimes thereare so many dots that we can
help them connect that if wedon't kind of bring forth um,
this, um, I guess this umadditional kind of way to

(19:18):
conceptualize our clients, umwe're we're really missing out
on an opportunity.
I think also, you know, when welearn more about medical trauma
, this gives us another I guessyou know toolkit and opportunity
to learn how to collaboratewith other professionals, with

(19:40):
healthcare professionals.
It gives us another kind oflanguage, I guess, to be able to
collaborate with healthcareprofessionals.
It gives us another kind oflanguage, I guess, to be able to
collaborate with healthcareprofessionals.
We are such of value this youknow and their history, and you

(20:02):
know maybe the implications oftheir health history and chronic

(20:35):
illness and those kinds ofexperiences.

Yeah.
Yeah, it might seem just like alittle blip on an assessment
question.
Yes, Question or something, butthat generally there's a much
larger story.
Even if, like someone's been,you know, relatively healthy,
they may still have likeexperiences that have that tell
the story about theirrelationship with health care.

Absolutely, and you know, I'm glad that you said
that, because oftentimes, youknow, on our, on our intake
forms, we have a section that ismedical history and when I talk
to clinicians sometimes they'llsay things like well, I just
kind of glance at that, or theremay be there's a part where it
might say past surgeries and Ijust quickly read over that

(21:21):
because I kind of think, well,that's not my, that's not my
purview.
That's not my, you know right,that's, that's medical and you
know.
But when we stop and say like,even if we ask a simple
follow-up question, how was thatfor you?
I mean, what was that like foryou?
I can't tell you how many timesclients have said, well, you
know, actually, when I, when Iwent into, you know, to have my,

(21:46):
you know, my, my daughter, I, I, I did, you know experience,
you know X, y and Z, and it wasreally terrifying and no one's
ever asked me about it before.
I was just kind of toldeverything was fine, I was fine,
my child was fine, so get onwith it.

(22:06):
You know, and there's so muchthat happens that's invalidating
for us.
You know there's thatdisenfranchisement that I was
talking about earlier follow-upquestions.
It can really kind of, you know, bring forth so much more

(22:27):
important conversation andexploration with our clients.

Yeah, and you mentioned, like the integration
of counselors into like other,you know, professional treatment
teams.
How do you feel like this canreally enhance patient
experience, improve the carethat is given?
I think this can really enhancepatient experience, improve the
care that is given.

I think it can enhance the patient experience
tremendously.
You know, right now, I mean,there are so many opportunities
that really aren't being seizedright now, especially within the
hospital setting.
Especially within the hospitalsetting, I think about this

(23:11):
ideal world in which patientswho are in the hospital setting
from the time they enter thehospital to the time they're
discharged, and I imagine, wow,if there were counselors at each
step of the way, from um thetime they enter, you know, from
the the aspect of prevention,you know if we are, if we are,
screening you know patients andum, even helping them with

(23:35):
giving them some tools for um,for stress management or
checking in with them.
How are you feeling about thisupcoming, you know, surgery?
Or if patients you know arecoming into the hospital for,
you know, for emergencies, youknow sitting with them, helping
them kind of work throughwhatever kind of you know mental

(24:00):
health kind of reactionsthey're having to this
experience as they are kind ofmoving through their episode of
care.
You know, I often kind ofthought about, when I was in ICU
after having my daughter, if atany moment while I was in ICU,

(24:22):
a mental health professional hadwalked into that room and taken
a few moments to look at me.
They would have known somethingwas very wrong If I had been
assessed at any moment andsomeone would have intervened.
That could have made such adifference in my outcome.
That could have meant a verydifferent trajectory.

(24:59):
Intervene early, you know, andable to be a bridge for patients
, helping to connect them withmental health resources at
discharge, because right now,when patients are discharged at
the hospital, they often aren'ttold.
Things like what you've justbeen through is potentially

(25:23):
traumatic, and here are someresources for mental health.
What they're given areinstructions for caring for
their wounds and here are yourprescriptions.
So people are leaving thehospital and, if anything, if
they are recognizing thatthey're struggling with their

(25:44):
mental health, they're eithersecond-guessing that or it's not
in their awareness, or, if theyare struggling, maybe they're
told look, get over it, yousurvived.

Yeah, you should be grateful.

You should be grateful, you know.
And so that is reallyinvalidating for people.
And so we have so many peoplefalling through the cracks and
they're just getting on withtheir lives and maybe, and so
then they might land in ouroffices months later, years

(26:20):
later, when they're finallyputting the pieces together, or
maybe even not.
They're just coming to see usand they're thinking I don't
know what's going on with me,but I'm struggling, I'm stuck.
And then if we have this lensof medical trauma as one of the
many lenses that we use andwe're asking those follow-up

(26:42):
questions and we see in theirmedical history two years ago
you had the surgery and we'reasking follow-up questions,
maybe the dots do connect backand they say you know what?
This might be one of thefactors for me.
I had this surgery and I'vebeen struggling ever since.

Right, right, you know, and the lack of
conversations around it, youknow, indirectly, are
stigmatizing right, like ifwe're not gonna talk about it,
it means we're not supposed to.

Exactly or something.

And so, by getting this collaborative
approach and working into theseteams where we can be supportive
and, like you said, interveneearlier, it normalizes like hey,
there might be some mentalhealth impact of what you've
experienced.

Yes, and that that I think what you said it's
validating.
And I think what you said is soimportant because I can't tell
you how many clients have saidto me you mean, I'm allowed to
call this trauma, yeah.
And and I'll tell you thatsomething that there's been
sometimes troubling to me, evenin conversations that I've had

(27:58):
with a few colleagues aboutmedical trauma and and I think
that there's been some confusionabout this and I've had to kind
of clarify, and sometimesthere's been some confounding
between medical trauma and PTSD.
And so in some of theseconversations sometimes the

(28:26):
conversation has gone well, I'vehad these clients but they
haven't met the criteria forPTSD, so they can't call it
trauma.
And I've come back and said no,no, no, no, no.
We're talking about twodifferent things Trauma, trauma.
There's a subjectivity to trauma.
There's a subjectivity totrauma If something was

(28:51):
traumatic, if someone hasexperienced traumatic stress as
a result of an experience,that's trauma Period, full stop.
That is my philosophy and noone can talk me out of that.
And so when I hear sometimesour mental health colleagues,

(29:13):
you know, be kind of a littlemore rigid about that and say,
no, you need to meet thecriteria, that post-traumatic
stress disorder, that is oneeffect of trauma, but that's one
effect of trauma.
That's a clinical diagnosis,but that's very different.
Medical trauma can lead to manyeffects, one of which is a very,

(29:38):
you know, severe I mean, thisis a clinical disorder, medical
PTSD.
That's one effect of medicaltrauma, one of many effects of
medical trauma.
So it's, you know, and, as Isaid previously, it's amazing
how many clients have said to meand I am just, by virtue of

(30:00):
what you said just a moment ago,I'm guessing that you've had
this experience too where it'sso validating for clients when
you know, when they hear us usethis language, like you know, I
can, I can say that this wastraumatic for me, yes, this was
trauma, and hearing theircounselor say that, and yes, you

(30:21):
can, you can, of course, youcan say that that's what this
was for you.

Yeah, and that we're validating by, like,
reflecting back what they'resharing, like this is your
experience, like I'm project foryou, your mission.
You developed a certificate,the first ever certificate in

(31:00):
medical trauma-informed care atXavier.
Can you tell us more about that?

Sure, sure, yeah , so yeah, this is actually this
is the first certificateworldwide, so it's been really
exciting.
So we've had internationalstudents yes, yes, yes, and Ohio
, yes, so yeah, it's been reallyexciting.
So this was back in 2022.
So this is a it's a nine credithour certificate and been kind

(31:28):
of a labor of love and been kindof a labor of love, and so this
is a postgraduate certificatethat is open to not only mental
health professionals.
So it's been exciting to seeit's an interprofessional

(32:00):
certificate Counseling studentsor licensed professional
counselors, social workers,psychologists, nurses,
physicians, health careadministrators so that's been
really exciting to see, you know, such an interprofessional
representation of students kindof moving through this
certificate.
And so really it is a kind oftraining in trauma informed care

(32:40):
, kind of fundamental kind ofconcepts.
And then the most exciting partof the certificate for me is in
the last course there's acapstone experience, what I call
a project of impact, and soevery student creates this
project that really justconnects back to whatever

(33:04):
they're passionate about, be itresearch or clinical work or
education, training,consultation, and it really just
moves the work forward in somesignificant way.
They've done presentations,international presentations, and

(33:31):
write articles and do trainingsat their organizations, do
social media campaigns, and soit's been just amazing to see
the work and to see people sopassionate about medical trauma
in so many other disciplines andto move this work forward, has

(33:56):
been it just it's justincredible to see.

Yeah, just because I know like the question
occurred in my mind and so ifit's occurring for someone
listening.
The practical part of thisprogram is it virtual?
What's the length of the ninecredits?
Tell us more about that too,just in case people are
interested in like a certificate.

Yeah, so it is.
It's over the course of well,it's over the course of two
semesters.
It begins every May.
It is fully online because wehave international students and
it's asynchronous because wehave international students and
it's asynchronous it needs to bebecause of the international
students.
So, yeah, so fully online, ninecredit hours, and so students

(34:39):
take the first two courses overthe summer.
So from May to August they taketwo courses back to back and
they take their final courseover the fall semester and they
end in December, over the fallsemester and they end in
December.
So it's a May to Decemberprogram.
And then that leads to thecertificate from Xavier

(35:01):
University and medical traumainformed care, and so, yeah, so
we've.
This is going to be our fourth,yes, our fourth cohort, which
is really exciting.
That's incredible.
Yeah.

I love that.
It's a labor of love and thatit's like actually expanding
beyond counseling, like you said, like there are other people
taking it, because it'simportant that they kind of have
a seat at the table so that wecan understand their perspective
, but that they understand, likefrom you know, how we can
advocate for clients ascounselors too.

Yes, yes, it really is.
And and something excitingthat's come out of of this
certificate is I have now threegraduates of the certificate,
all social workers who decidedto go on.
They were master's level socialworkers who decided to go on.
They were master's level socialworkers who decided to go on to
doctoral programs.
And all three are studying andfocusing on medical trauma and

(35:59):
doing dissertations in medicaltrauma in social work.
So that's been amazing.
And two of them I'm on theirdissertation committee.
Yeah, so it's been reallyrewarding.
And again, thatinterprofessional collaboration
is so important yeah, definitely.

Now you know, switching to sort of the
patients and the clients thatare experiencing the medical
trauma.
What are some of the commonchallenges that you see them
facing?

That's a great question.
So you know, I would say we see, you know a lot of complex
medical and mental health issues.
For one, I mean that you knowcertainly is a challenge.
One of the things I mentionedpreviously is medical avoidance.
I would say that's a reallycommon challenge that I see with

(36:51):
medical trauma and somethingthat certainly I have kind of on
my radar when I first beganworking with anyone who's
experienced trauma.
We have to be really carefulwith that because oftentimes

(37:15):
people who first begin intherapy, they're often not ready
to reenter the medical settingand that takes time.
But at the same time we're veryaware that you know, to be
disconnected from all healthcarehas, you know, some really

(37:36):
significant implications, youknow, in terms of overall health
and well-being, and so that'scertainly a challenge, you know.
I would say you know.
Another challenge that you knowthat I see with us is, or you
know with our clients iscertainly a need for advocacy.

(37:58):
Often, working with medicaltrauma and working with clients,
we do quite a bit of advocacyas counselors, advocacy in terms
of speaking on behalf of ourclients, or I would say more
empowerment, speaking with ourclients, helping our clients

(38:22):
build the skills to be able toadvocate for ourselves in terms
of creating new protocols withinthe healthcare space.
So, just to give a really quickclinical example, I have a
client who has significantmedical trauma and she recently
turned 50 and had to scheduleher first colonoscopy.

(38:45):
And so the protocols at thisdigestive center were that her
husband could only kind of goback with her to kind of one
part of the facility but couldnot go back to another part of
the facility.
And so I, you know, and myclient, was very nervous about

(39:10):
the whole kind of procedure andshe wanted to meet the doctor
ahead of time and there weresome other things that she, you
know, she wanted to kind of putin place.
She also really struggles withIVs.
She struggles, you know, withdifferent aspects of the kind of
the procedure, of um, of thekind of the procedure so, um, so

(39:33):
I helped her with writing, youknow, a letter and um with kind
of changing the protocols, andso she, I mean she's just such
an amazing, um, amazing kind ofperson, um anyway, and she's
just come so far in in our worktogether, and she, she's done so
much to advocate for herself,but she, in the process of this

(39:54):
work, she ended up advocatingfor herself changing so much of
the protocol for how they dothings at this particular clinic
that they ended up changing theprotocols for everyone.
That they ended up changing theprotocols for everyone because
of her advocacy.

(40:15):
They kind of realized that theway they were doing things that
really wasn't great foreverybody and so by kind of her
challenging them to look at howthey were kind of going about
just their procedures, that youknow how they were kind of going

(40:54):
about you know just theirprocedures.
You know that I mean that reallybenefited all at healthcare
organizations to help kind ofbetter meet the needs of people
with medical trauma.
But then also helping kind ofclients with brainstorming to
how to help with pain management, how to help with the
vulnerability, know, with thevulnerability in being in the
healthcare setting.

(41:14):
I've written several meditationscripts and recorded some
meditations for clients that youknow that they use to, you know
, to kind of help them kind ofmove through the healthcare
experience.
And so you know, there we wehave a lot of challenges in

(41:37):
working with medical trauma, butbut I would say that you know
the challenges that the clientsface really are kind of engaging
in the healthcare system,because this is something that
as, as people we're, we'realways facing, as people we're,
we're always facing, I meanwe're always going to be going
to the doctor.
We're always going to be youknow kind of facing illness and

(41:59):
injury and and needing you knowthis, you know wellness checks
and and preventative care.

Yeah, yeah, and, and I think it's so powerful
that, like in letter writing andhaving the conversations within
session, we are empoweringclients to be, able to
self-advocate as well, but likeit sometimes does start with us
modeling.
What does that look like?

(42:29):
How do we say and stand up forwhat is maybe necessary if it's
a protocol change or things likethat, that we can also sort of
help lead the way in a lot ofthose capacities?

Yes.

Yeah, I'm thinking of like so many
different examples.
Like I have a client whorecently, you know, told a new
doctor hey, I don't like whenpeople say this and actually,
you know, I think the physicianunderstood but also said
something like later in theappointment where they were like
you know what, I'm going tofind someone else.

(43:04):
I just didn't like that theysaid that yes, and that they
have, like you know, choice andI was, like you know, happy that
she felt empowered to do that,because in the past maybe she
would have just been like thisis what physicians do.
They just say it's weight yes.

Yes, yes, and that's such a great example that
I mean that that's such aperfect example, I think you
know.
And what I think is really coolabout our work and you know,
with medical trauma, is seeingthose kind of changes over time
that clients, you know, whenthey become more empowered and

(43:43):
they learn that they do havechoices and they can, you know,
they can decide.
You know what?
I don't necessarily like theway that the communication is
going with this particularprovider, and I consider it a

(44:05):
win when I'm working with aclient and they come back to me
and say you know what I feltreally invalidated, I didn't
like the way that thisparticular, you know, physician
talked to me and so I've decidedI'm going to look for a
different provider and and soyou know, that kind of really
speaks to that sense ofempowerment which I think is is

(44:28):
fantastic sense of empowerment,which I think is fantastic.

What advice would you give to counseling
professionals at any stop in thejourney, because this is maybe
a concept that they haven'tfamiliarized themselves with.
What would you share with themto help them better identify or
support clients who are, or haveexperienced medical trauma?

who are or have experienced medical trauma.
I would say I mean, first, youknow, educate yourself more
about medical trauma.
I mean conceptually.
I think you know there are alot of articles out there at
this point, which is fantastic.
There are several trainings outthere now, which is really
great too, you know, certainly.
You know you don't have to dolike a full certificate, you

(45:15):
know, unless it's somethingyou're passionate about.
But I mean there's certainlysome really good trainings, you
know, out there.
At this point, I mean even youknow Pessy has some great
trainings, my co author of thissecond book that I'm working on
now, sasha McBain.
She does some fantastictrainings through PESI, live

(45:38):
trainings, which I think aregreat.
So I would say, definitelyfamiliarize yourself, get some
training there in terms oftraining there, in terms of, you
know, conceptually, and I wouldsay too, even you know, in a
very kind of you know simple wayto get started and I mentioned

(45:59):
this earlier paying attention toyour client's medical history.
You know, paying attention tothe in a really simple way.
You know, paying attention tothe in a much as this is part of

(46:32):
my client's history and thiscould really be a source for,
you know, distress.
This could be, you know, one ofthe, the kind of the first
dominoes you know to fall in inmy client's life and could be
really significant, definitely.

I am curious if there are any assessments or
protocols like you would suggest, like in tandem with kind of
getting more familiar.

Absolutely so.
One I would say is that I thinkis really helpful is called the
Brief Experiential AvoidanceQuestionnaire.
That can be helpful when you'resuspecting maybe that there's
some medical avoidance going onand so you can have some

(47:24):
conversation with your clientsaround kind of medical care.
So that would be one that youcould use with your clients.
Certainly some some you knowPTSD assessments, you know and
you know whatever assessmentsthat you're using to look at
some of the potential clinicalkind of you know implications of

(47:47):
medical trauma.
You know the PCL-5 or you knowthe CAPS-5.
Some others that you know andI've shared and will share some
of the assessment tools that Icreated with Stanford and then
rolled out internationally, likethe Experience of Medical
Trauma Scale, which I firstdeveloped for the hospital

(48:08):
setting, which really looks atall of the different factors in
the hospital setting that couldcontribute to distress in
clients.
One of the ways that I use thistool within our practice as
counselors is when I ask thesereally simple follow-up

(48:29):
questions about clients' medicalhistory.
So let's say clients did have asurgery or they had a hospital
stay and you ask that reallysimple follow-up question how
was that for you, or wasanything distressing about that
experience and if your clientssay like, yeah, I mean it was
really difficult or it was ascary experience, then you could

(48:54):
use that experience of medicaltrauma scale, even sitting down
with your client and looking ata lot of the factors
environmental factors,communication factors,
relational factors with theirproviders, and as you're looking
at those kind of differentfactors, some of those might

(49:16):
really connect or resonate withyour clients.
They may look at that scale andsay you know what, now that I'm
thinking about it, it wasreally distressful for me that I
was pretty much kind of tied tomy bed for three days.

(49:36):
I couldn't leave my bed and Ifelt really trapped and that
really triggered somethingwithin me, I mean.
So, so you know there arecertain aspects of the hospital
environment or you know thingslike that that you know having a
, a, a screening tool like thatin front of you can can help to

(50:03):
really kind of elicit some ofthat conversation.
Yeah, and so I, you know,certainly can can provide that
resource and yeah, so becausethere's several assessment tools
that are, you know that that Iat a lot of secondary crises
that clients can experience as aresult of medical trauma,

(50:37):
really looking at kind of thewellness dimensions and kind of
where clients may struggle aftermedical trauma.
So maybe struggling in theirrelationships, struggling
occupationally struggling, youknow, psychologically,
physically, maybe even in withrespect to even leisure their

(51:01):
ability to engage in activitiesthat they once really loved they
can't do anymore.
Yeah, the whole person you know.

Looking at the whole person.
Yeah, to anymore.
Yeah, yeah, the whole person,you know.
Looking at the whole person.
Yeah, um, you know, when wewere doing our show prep, we
also learned that live the painis an organization, an
international organization, um,that you're a part of, and it's
professionals who are working tocreate um and develop solutions
for pain management.
Can you tell us more about yourrole within the group and how

(51:32):
counseling professionals mightbenefit from their work?
Sure sure.

So, uh, yeah, so I originally connected with, uh
, the founder of theorganization, aura Kalfa, uh,
many years ago.
So she, she read my book and solive the pain really came out
of a lot of conversations thatwe had early on, a lot of
brainstorming.
So Ora is in Jerusalem now, inTel Aviv.

(51:59):
So exciting about Live the Painis she took a lot of my book,
which is mostly conceptual, andshe created an organization out

(52:20):
of a lot of these concepts.
I mean, she made it happen inIsrael and so this is an
organization that focuses onchronic pain and living with
chronic pain.
So she's created therapy groups.
So therapists across Israelhave therapy groups with clients

(52:43):
.
But they also do education,research, and they raise so much
funding for research, trainother therapists, and so,
between research and developmentand education and training and

(53:05):
psychoeducation for clients andfamilies, it's a pretty
phenomenal organization.
So I'm, I'm on their board ofdirectors, I'm a consultant for
them now and um, and so they dohave a couple of um clinicians
in New York and so really it,the organization in Israel, is

(53:27):
really a model and they want tokind of bring that to the states
.
But it's, you know, it's a,it's a process and, of course,
um, I was supposed to travelthere, um, right before, of
course, the you know the.
The.
The war broke out and and beganin Israel, so that's on hold
right now, um, but you know,hopefully at some point we'll be

(53:51):
able to continue that work.

Yeah, it sounds like it's an amazing work and,
like the surgery that Imentioned earlier, I was having
chronic pain issues, so like Ihave lived that experience and
can certainly recognize you know, even as an individual, how
beneficial those kinds of umsupports are.
Yes, yes, so valuable,incredibly Um, because while my

(54:19):
physical health was not great atenduring chronic pain, my
mental health was not greateither, as, as part of that,
where it is like holy cow, likewhat is happening and, as you
mentioned, like with kind ofthese other areas of life that
get affected, right that justthe ripple effects of the

(54:41):
physical pain were incredible.
Um yeah, so I, I resonate witheverything and then the work
that they do, know howmeaningful it can be.
So you know, whether with theorganization or really just in
this focus area of medicaltrauma, what are some

(55:01):
developments or directions yousee like for the future of this
work?

this work.
Yeah, I see, in terms ofdevelopments, I certainly see
More in expanded roles forcounselors.
I would, I would I guess Ishould say I would I would love
to see more expanded roles forcounselors in, in, in more kind

(55:36):
of diverse types of healthcaresettings.
Types of healthcare settings.
Certainly, I see us kind ofmoving into kind of specialty
care, things like oncologycenters, cancer support, which I
love to see.

(55:56):
You know, heart hospitals andyou know cardiovascular centers,
which I love to see, you knowwe are certainly present in.
You know hospice and palliativecare.
I, you know I see us movinginto the women's health space

(56:20):
and you know, primary care space.
I, you know, I would, I wouldlove to see counselors moving
into the hospital space andexpanding our roles there.
I think there's so muchopportunity there, certainly,
and so I think that's a reallyimportant development for us.
I think too, you know, in Ohioespecially and I hear this, I've

(56:46):
heard this so much and Icontinue to hear it this idea of
of, from a health careperspective, ohio being kind of
quote unquote a social workstate, meaning, you know, within
the hospital setting and mentalhealth, social workers and
psychologists, kind of they arein the hospital, you know and we

(57:09):
are, we're behind in terms ofand obviously you know we've
talked about this with the fightwith you know Medicare and
reimbursement and all of that.
There's so many opportunitiesfor us and so we, I think we
need to continue to advocate forcounselors.
We are so uniquely qualifiedand educated and suited for this

(57:34):
work and and so that the theopportunities are, opportunities
are endless.
We have, you know, okay, so I'mbiased towards counselors.
I'll just, if that isn'tobvious, already it's a
counseling podcast.
You're allowed to be, I'mallowed to be.
This is a safe space, right tobe biased, but we are just so

(57:57):
uniquely suited to this work,you know, I mean for this
holistic work and, and I would,I would, you know, I would just
love to see more counselors inthis space working in the
hospitals, you know, working ininterprofessional teams, not
only for patients, but also tosupport staff.

(58:18):
Not only for patients, but alsoto support staff.
I mean vicarious trauma,secondary trauma, compassion,
fatigue.
This is huge, and this affectsthe quality of care for patients
as well, because our staff, ourphysicians and nurses, are
struggling and they could useour help too, and so this is a

(58:39):
systems issue.
I could go on and on about this, and, and we are so uniquely
suited for this work, and um,and so I, you know, I see, I see
so many opportunities here.

Yeah, yeah, and I appreciate you saying that too
, because I have, you know, afair share of healthcare
providers different um, you knowa fair share of healthcare
providers different um rolesthat they've worked with, and
you know it often comes up.
You know the stress of work,but, like if we unpack, that
it's not always just the stressof work, it's the trauma of the

(59:14):
things that they they witnessand experience on a day in, day
out basis Absolutely, absolutely.
Day in, day out basis,absolutely, absolutely.
You have another book comingout you mentioned coming out
next year.

What can we expect from this resource?
Yeah, so I'm really excitedabout this.
This is a book that's writtenspecifically for clinicians and
clients.
So, while the first book wasreally just to establish medical
trauma in the space, and it'smore, you know, the first book
is more academic and systemskind of focused.
This book is specifically atreatment book, and so this is

(59:53):
for clinicians and patients.
So this is treating medicaltrauma and it's um, it's, it's a
resource and a workbook.
So many activities, um, sothere will also be digital
downloads.
So the um, the I'm a lot of mytraining is in mindfulness-based

(01:00:14):
interventions.
So those, um, those scriptsthat I talked about and those
mindfulness meditations.
So I'm going to be recordingthose and those will be part of
the resource.
And so I'm working with my, mycoauthor, Sasha McBain, who is a
health psychologist.
So nice interprofessionalcollaboration there, and so,

(01:00:38):
yeah, so we'll be.
We'll be wrapping up themanuscript towards the end of
this year and it'll be availablein the spring of 2026.

Marisa Cargill (01:00:47):
Wonderful.
We might have to have you backso that we can talk more about
that, but I, you know, I findthat that is such a helpful.
Kind of like you know, sequelfollow up.
Kind of like you know, sequelfollow up.

Michelle Flaum (01:01:00):
Sure.

Because I know a lot of people, both counselors
and clients, can really likewrap their head around concepts
Right, and that awareness andinsight is so incredibly
meaningful, but that then thepractical strategies sometimes
are like well, now what Right?
And this book sounds like it'sanswering that question.

Exactly, exactly .

Yeah, so this is a question we ask on every
every episode.
The name of our podcast is OhioCounseling Conversations, and
we just like to hear from ourguests what important
conversations do you thinkcounseling professionals should
be having with each other and ortheir clients here in our state
and or their clients here inour state?

Yeah, yeah, you know, I would say in this really
kind of piggybacks off of whatI was kind of just saying.
I mean, how can we create moreopportunities for counselors in
healthcare, in the healthcarespace?
You know?

(01:02:15):
I mean, as I said, we are asocial work state when it comes
to hospitals.
How can we?
Because we're, we are, I think,if we don't, we're missing a
big opportunity for ourprofession to serve clients in
this setting.

Yeah, yeah, and I think it's important.
I, I, one of our previousguests and pretty well known, I
think, now throughout thecountry, throughout the world.
But Dr Vicki Kress, who is ourupcoming president elect for ACA
, you know, talked about usingthe word counseling and
counselors and making sure thatwe're creating language so that

(01:02:58):
we can continue advocating ineven like that smallest way like
language is so important andand recognizing the role that
counselors play.
And so, even when I'm speakingto clients, I try to avoid
therapy as a word which is tough.
Yes, but I think it ismeaningful to establish like
counselors roles, right?

(01:03:19):
Yes, yes.
May seem small but like thatripple effect too, of making
sure like our profession isknown and distinguished from
maybe other professions, is soincredibly important.
And I believe your point iswell taken because I have the
counseling bias as well but weare holistic and that that means

(01:03:42):
so much in that space where youknow, I know that maybe this
was also part of your counselored training when you were in
your master's program.
But like the medical model waslike ew, avoid, avoid, but also
recognizing that like we areshifting back that in
collaborative treatment we canbecome part of the medical model

(01:04:06):
.
Yes, that we can shift themedical model by like using our
voices.

Yes, yes, absolutely.
And that's why you know, with,like with the certificate that I
designed, I mean it's reallyyou know, helping to educate us.
I mean you're exactly right,like, oh, medical model.
But then it's like, okay, sohow can we learn the language to
be able to collaborate in thatspace and to work

(01:04:33):
interprofessionally?
Speak the language, but bringour unique identity, our stamp
on it, like we are uniquelycounselors, we are holistic, we
are, we are bringing our um, ouridentity, and our lens, our
lens, which is so valuable, um,but we need to be able to

(01:04:56):
operate within the space.
So we need to know the language, we need to know how to speak
it and we need to know how tooperate within the space.
So we need to know the language, we need to know how to speak
it and we need to know how tooperate within this space.
So, you know, we learn thisteam-based model to do that, so
that we can operate within thisspace, but using our unique

(01:05:19):
talents and our skill set, whichis so valuable and it's needed.
We just need to get in there.

Yes, this is incredible, so informative.
I've been a counselor for alittle over a decade and I feel
like I'm like, oh, I'm going totake this way, I'm going to take
this way.
And even though a lot of itmakes sense, it's like, oh, am I
doing that?
Or am I doing that to the bestof my ability?
Can I assess more with myclients to say, you know like,

(01:05:50):
hey, I know you have children.
What was your, you know like,childbirth experience, like, or
things of that nature that maybedon't get talked about, and
leaning more into some of thosethings to just make sure we
understand the whole person evenfurther.

So I know I'll be taking away.

I am certain that our listeners will be
taking so much away from thisconversation, michelle.
Thank you so much.
Is there anything else you wantto plug or add before we wrap
for today?

You know I can't think of anything.
I just I'm so thankful for theopportunity just to connect with
counselors.
It's been wonderful.

Yes, and we will be linking a bunch of these
resources in the show notes foryou listener, michelle.
This is incredible.
Again, I can't emphasize howgreat and informative,
educational this conversationhas been, and I'm excited for
people to listen because this isvaluable information for them

(01:06:45):
to take back too.

Yeah, well, thank you.
Thank you so much.

Yeah, no problem and thank you, listener.
We will see you next time onOhio Counting Conversations.

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Conversation 30 - Beyond Physical Healing: The Impact of Medical Trauma

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}Conversation 30 - Beyond Physical Healing: The Impact of Medical Trauma