1
00:00:00,000 --> 00:00:03,820
This episode is brought to you by Thorne and I have some incredible news for any of you

2
00:00:03,820 --> 00:00:07,960
that are in the military, first responder or medical professions.

3
00:00:07,960 --> 00:00:15,860
In an effort to give back, Thorne is now offering you an ongoing 35% off each and every one

4
00:00:15,860 --> 00:00:19,780
of your purchases of their incredible nutritional solutions.

5
00:00:19,780 --> 00:00:27,280
Now Thorne is the official supplement of CrossFit, the UFC, the Mayo Clinic, the Human Performance

6
00:00:27,280 --> 00:00:31,480
Project and multiple special operations organizations.

7
00:00:31,480 --> 00:00:36,420
I myself have used them for several years and that is why I brought them on as a sponsor.

8
00:00:36,420 --> 00:00:42,080
Some of my favorite products they have are their Multivitamin Elite, their Whey Protein,

9
00:00:42,080 --> 00:00:45,840
the Super EPA and then most recently, Cynaquil.

10
00:00:45,840 --> 00:00:50,120
As a firefighter, a stuntman and a martial artist, I've had my share of brain trauma

11
00:00:50,120 --> 00:00:55,520
and sleep deprivation and Cynaquil is their latest brain health supplement.

12
00:00:55,520 --> 00:01:02,640
Now to qualify for the 35% off, go to thorn.com, T-H-O-R-N-E dot com.

13
00:01:02,640 --> 00:01:05,460
Click on sign in and then create a new account.

14
00:01:05,460 --> 00:01:09,800
You will see the opportunity to register as a first responder or member of military.

15
00:01:09,800 --> 00:01:14,680
When you click on that, it will take you through verification with GovX.

16
00:01:14,680 --> 00:01:18,980
You'll simply choose a profession, provide one piece of documentation and then you are

17
00:01:18,980 --> 00:01:20,920
verified for life.

18
00:01:20,920 --> 00:01:26,680
From that point onwards, you will continue to receive 35% off through Thorn.

19
00:01:26,680 --> 00:01:33,120
For those of you who don't qualify, there is still the 10% off using the code BTS10,

20
00:01:33,120 --> 00:01:36,240
Behind the Shield 10 for a one time purchase.

21
00:01:36,240 --> 00:01:42,040
To learn more about Thorn, go to episode 323 of the Behind the Shield podcast with Joel

22
00:01:42,040 --> 00:01:45,680
Titoro and Wes Barnett.

23
00:01:45,680 --> 00:01:47,280
Welcome to the Behind the Shield podcast.

24
00:01:47,280 --> 00:01:51,280
As always, my name is James Gearing and this week it is my absolute honor to welcome back

25
00:01:51,280 --> 00:01:57,000
onto the show together two of my previous guests who are both some of the most respected

26
00:01:57,000 --> 00:02:00,900
psychologists when it comes to working with first responders.

27
00:02:00,900 --> 00:02:06,260
So both Dr. Brooke Bartler and Dr. Jenna Casas have been on the show before independently,

28
00:02:06,260 --> 00:02:12,480
but this time they came on together and we unpack all things first responder mental health.

29
00:02:12,480 --> 00:02:18,360
From the psychological testing of recruits, the efficacy of some of the choices used,

30
00:02:18,360 --> 00:02:23,320
access to mental health practitioners, the education requirements of each of the mental

31
00:02:23,320 --> 00:02:30,720
health practitioner labels, the EAP program, the financial barrier to entry, what counseling

32
00:02:30,720 --> 00:02:36,920
should look like, red flags when it comes to finding help and so much more.

33
00:02:36,920 --> 00:02:42,120
Now before we get to this amazing conversation, as I say every week, please just take a moment.

34
00:02:42,120 --> 00:02:47,260
Go to whichever app you listen to this on, subscribe to the show, leave feedback and

35
00:02:47,260 --> 00:02:49,280
leave a rating.

36
00:02:49,280 --> 00:02:54,440
Every single five star rating truly does elevate this podcast, therefore making it easier for

37
00:02:54,440 --> 00:02:56,040
others to find.

38
00:02:56,040 --> 00:03:01,340
And this is a free library of almost 1000 episodes now.

39
00:03:01,340 --> 00:03:07,280
So all I ask in return is that you help share these incredible men and women stories so

40
00:03:07,280 --> 00:03:12,720
I can get them to every single person on planet earth who needs to hear them.

41
00:03:12,720 --> 00:03:20,160
So that being said, I welcome back onto the show Dr. Brooke Bartler and Dr. Jenna Casas.

42
00:03:20,160 --> 00:03:40,000
Enjoy.

43
00:03:40,000 --> 00:03:44,760
Well Brooke and Jenna, I want to start by saying welcome back to the Behind the Shield

44
00:03:44,760 --> 00:03:45,760
podcast.

45
00:03:45,760 --> 00:03:51,080
A lot of you have been on once or a couple of times in Brooke's case, but never on together.

46
00:03:51,080 --> 00:03:55,360
So I want to welcome you first both to the Behind the Shield podcast.

47
00:03:55,360 --> 00:03:56,360
Thanks for having us.

48
00:03:56,360 --> 00:03:59,040
Yay, super excited.

49
00:03:59,040 --> 00:04:05,080
So each of your episodes, obviously we went from your early life, your journeys into the

50
00:04:05,080 --> 00:04:08,700
world of psychology, your work with first responders.

51
00:04:08,700 --> 00:04:14,600
So this time, you guys have come up with some pretty amazing kind of topics for us to hit.

52
00:04:14,600 --> 00:04:18,640
So I want to dive into those rather than kind of go back.

53
00:04:18,640 --> 00:04:22,680
Just so that people know who they're listening to though, I'll just go to each of you and

54
00:04:22,680 --> 00:04:27,720
just going to give an overview of your qualifications and who you work with today.

55
00:04:27,720 --> 00:04:29,960
So Jenna, let's start with you.

56
00:04:29,960 --> 00:04:30,960
Yeah.

57
00:04:30,960 --> 00:04:33,240
So I'm Dr. Jenna Casas.

58
00:04:33,240 --> 00:04:38,640
I'm a licensed clinical psychologist and I practice in police and public safety psychology.

59
00:04:38,640 --> 00:04:43,400
So that means that I primarily see people in fire, police, EMS, healthcare professionals,

60
00:04:43,400 --> 00:04:45,120
as well as their spouses.

61
00:04:45,120 --> 00:04:50,360
And I have a private practice where I see people across Northern Nevada and I'm licensed

62
00:04:50,360 --> 00:04:52,720
through an inter-jurisdictional compact as well.

63
00:04:52,720 --> 00:04:58,000
So I see people in states that are part of that compact called SIPACT.

64
00:04:58,000 --> 00:04:59,440
Beautiful.

65
00:04:59,440 --> 00:05:01,040
And Brooke.

66
00:05:01,040 --> 00:05:04,880
So I'm also a licensed clinical psychologist.

67
00:05:04,880 --> 00:05:09,160
I specialize in working with first responders and military.

68
00:05:09,160 --> 00:05:14,240
I also have a private practice where I provide therapy almost exclusively to first responders

69
00:05:14,240 --> 00:05:20,800
and military, but also do a lot of mental wellness programming for agencies and departments

70
00:05:20,800 --> 00:05:21,800
across the country.

71
00:05:21,800 --> 00:05:26,120
Things like building peer support programs, educational seminars and trainings and so

72
00:05:26,120 --> 00:05:27,920
on and so forth.

73
00:05:27,920 --> 00:05:28,960
Beautiful.

74
00:05:28,960 --> 00:05:34,760
I want to start with the first question, the psychologist's eyes when you first entered

75
00:05:34,760 --> 00:05:41,440
our profession and just some of the things that were glaring when you first kind of entered

76
00:05:41,440 --> 00:05:42,440
working with people in uniform.

77
00:05:42,440 --> 00:05:47,040
And then obviously we'll get to how to find a good counselor, what that looks like.

78
00:05:47,040 --> 00:05:52,120
So Brooke, you came through the educational route as far as psychology.

79
00:05:52,120 --> 00:05:56,840
What was some of the biggest aha moment or surprises when you started working with the

80
00:05:56,840 --> 00:05:58,600
first responder professions?

81
00:05:58,600 --> 00:05:59,880
Yeah.

82
00:05:59,880 --> 00:06:04,800
First thing that comes to mind is I went, wow, they're very similar to the military folks

83
00:06:04,800 --> 00:06:07,080
that I've been working with for many years.

84
00:06:07,080 --> 00:06:12,240
So I started off, as you know, if you listen to my past episodes, doing research at the

85
00:06:12,240 --> 00:06:18,440
National Center for PTSD at the VA and specifically being trained to work with military.

86
00:06:18,440 --> 00:06:22,160
And when I started to work with first responders, I realized that the overlap was very similar.

87
00:06:22,160 --> 00:06:29,520
And those similarities were not only in terms of what I saw similar patterns of what first

88
00:06:29,520 --> 00:06:34,840
responders struggled with, but also just kind of the culture, the camaraderie, how tight

89
00:06:34,840 --> 00:06:41,360
knit the first responder community is, how much pride there is in the first responder

90
00:06:41,360 --> 00:06:47,560
community and how important it is to establish trust and rapport and to really be able to

91
00:06:47,560 --> 00:06:55,200
connect on a different level with them than it is kind of with the civilian population.

92
00:06:55,200 --> 00:06:57,600
Staying with you for a second.

93
00:06:57,600 --> 00:07:00,040
What's the military population and the first responder?

94
00:07:00,040 --> 00:07:01,680
Obviously, there are a lot of parallels.

95
00:07:01,680 --> 00:07:05,880
What were the differences that you started seeing?

96
00:07:05,880 --> 00:07:10,520
I'd say one of the biggest differences would be in the nature of the job in terms of your

97
00:07:10,520 --> 00:07:15,040
first responders are on off, on off, on off, on off.

98
00:07:15,040 --> 00:07:17,520
So they're having to kind of manage seamlessly.

99
00:07:17,520 --> 00:07:24,600
Of course, it's not that easy, but they're having to manage switching from I'm on shift,

100
00:07:24,600 --> 00:07:29,680
I'm captain, I'm lieutenant, I'm on shift for one, two, three, four days.

101
00:07:29,680 --> 00:07:33,560
And then I'm off shift and I go back to being mom, dad, partner, sister, whoever it is,

102
00:07:33,560 --> 00:07:34,560
right?

103
00:07:34,560 --> 00:07:36,800
And having to manage these roles and expectations.

104
00:07:36,800 --> 00:07:42,200
My military, it was a lot more stop and go, meaning like they're gone for long periods

105
00:07:42,200 --> 00:07:43,200
of time, right?

106
00:07:43,200 --> 00:07:47,240
They're gone for six months to 12 months if they're going on deployment.

107
00:07:47,240 --> 00:07:52,080
And that is a it's similar, but also very different in terms of how you prepare for

108
00:07:52,080 --> 00:07:57,640
that and the things that they experience when they come back because it really kind of came

109
00:07:57,640 --> 00:08:03,040
down to, it really kind of comes down to expectations.

110
00:08:03,040 --> 00:08:09,400
I've had a lot of my first responders be like when I was in the military, when I was deployed,

111
00:08:09,400 --> 00:08:10,600
it was known that I was gone.

112
00:08:10,600 --> 00:08:12,880
I wasn't really expected.

113
00:08:12,880 --> 00:08:16,680
I didn't have these roles and expectations of being at home.

114
00:08:16,680 --> 00:08:21,720
For the first responder, it's very much like it's very hard to switch back and forth to

115
00:08:21,720 --> 00:08:26,520
having the expectations in my role in public safety and then having the expectations of

116
00:08:26,520 --> 00:08:27,520
being at home.

117
00:08:27,520 --> 00:08:32,000
There's not much space between those two.

118
00:08:32,000 --> 00:08:33,040
So Jenna, back to you.

119
00:08:33,040 --> 00:08:37,520
The first part of that question, when you went through his educational role through

120
00:08:37,520 --> 00:08:40,680
psychology, you start working with first responders.

121
00:08:40,680 --> 00:08:46,000
What was some of the aha moments or surprises that you kind of encountered as you entered

122
00:08:46,000 --> 00:08:48,440
those professions?

123
00:08:48,440 --> 00:08:53,200
I had a lot of really similar experiences to what Brooke was talking about where I was

124
00:08:53,200 --> 00:08:57,360
able to make comparisons between military populations and then our domestic first responders.

125
00:08:57,360 --> 00:09:01,720
Again, a lot of my training was looking at military first, so then making that switch

126
00:09:01,720 --> 00:09:02,720
over.

127
00:09:02,720 --> 00:09:05,120
I think it's just easy to draw those comparisons.

128
00:09:05,120 --> 00:09:09,840
But for me, one of the biggest pieces was just getting embedded in those cultures and

129
00:09:09,840 --> 00:09:15,960
realizing that it wasn't exactly what I expected it to be based on movies, TV shows, maybe

130
00:09:15,960 --> 00:09:18,340
conversations with friends or family.

131
00:09:18,340 --> 00:09:21,320
It was a bit different than I expected.

132
00:09:21,320 --> 00:09:25,480
The other part that's interesting, and I don't know how much this generalizes to other areas,

133
00:09:25,480 --> 00:09:30,640
but specifically with the people I've worked with in Nevada, it tends to be a multi-generational

134
00:09:30,640 --> 00:09:36,520
thing or an inter-family thing where you will work with an agency and you could have siblings,

135
00:09:36,520 --> 00:09:41,160
you could have parent and child, you could have spouses all within the same agency or

136
00:09:41,160 --> 00:09:43,040
even working within the same community.

137
00:09:43,040 --> 00:09:48,760
So when we talk about drawing that parallel between military and first responders here

138
00:09:48,760 --> 00:09:53,320
domestically, when they're on shift, they could be on the same shift as their spouse

139
00:09:53,320 --> 00:09:58,560
or the same shift as their brother or sister and experiencing the same incidents.

140
00:09:58,560 --> 00:10:03,800
So I think that was something very unique and unexpected for me is if you're managing

141
00:10:03,800 --> 00:10:10,540
one problem, one incident, one event with one person, the impact of that to impact that

142
00:10:10,540 --> 00:10:15,600
family or that community is even greater because of how embedded they are.

143
00:10:15,600 --> 00:10:20,960
One thing I've had people say to me recently is we used to have multi-generational element

144
00:10:20,960 --> 00:10:26,620
to the fire service, to law enforcement, but this young generation now coming up with them

145
00:10:26,620 --> 00:10:31,200
being a lot more in touch with emotions in general because we're having this conversation,

146
00:10:31,200 --> 00:10:36,600
but also the devolution of the work environment that's created mandatory over time and organizational

147
00:10:36,600 --> 00:10:41,480
stress and some of these things that are being witnessed by these young children is you're

148
00:10:41,480 --> 00:10:47,360
getting that less and less, that fewer children of first responders are wanting to go in our

149
00:10:47,360 --> 00:10:49,320
profession now.

150
00:10:49,320 --> 00:10:50,320
I hear that a lot.

151
00:10:50,320 --> 00:10:56,960
A lot of people that I work with will say, I have my kids and I'm coaching them in football

152
00:10:56,960 --> 00:11:01,800
or I'm going to their cheer practices and I'm encouraging them to stay in school and

153
00:11:01,800 --> 00:11:05,680
I want them to do anything but police, fire, EMS.

154
00:11:05,680 --> 00:11:06,680
And it's really sad.

155
00:11:06,680 --> 00:11:07,680
Absolutely.

156
00:11:07,680 --> 00:11:10,880
Brooke, anything to add before we move on?

157
00:11:10,880 --> 00:11:12,920
Yeah, no, I agree.

158
00:11:12,920 --> 00:11:16,840
I've come across that a lot as well.

159
00:11:16,840 --> 00:11:22,280
This idea of someone who's currently in the service, not really wanting their kids to

160
00:11:22,280 --> 00:11:29,240
do it just because of all the potential roadblocks and obstacles that can come with it.

161
00:11:29,240 --> 00:11:33,120
I also think there's a sense, I've also come across it almost on the opposite end where

162
00:11:33,120 --> 00:11:38,920
I've worked with a lot of first responders who almost felt pressured to become a first

163
00:11:38,920 --> 00:11:40,040
responder by their family.

164
00:11:40,040 --> 00:11:45,160
Almost like you hear about it or like, oh, my parents expected me to be a doctor, medical

165
00:11:45,160 --> 00:11:52,080
doctor, a dentist or whatever it was and that they really felt like they would be dishonoring

166
00:11:52,080 --> 00:11:59,200
their family in some way if they did not actually join up and become a first responder.

167
00:11:59,200 --> 00:12:08,280
So I've also come across that a lot, which comes with its own unique aspects.

168
00:12:08,280 --> 00:12:10,280
That reminds me of a few conversations I've had.

169
00:12:10,280 --> 00:12:15,640
One of them was with Angela Lee, who was an MMA champion under one championship.

170
00:12:15,640 --> 00:12:21,600
She had a suicide attempt and then she lost her younger sister to suicide very recently.

171
00:12:21,600 --> 00:12:25,980
And obviously she was just absolutely devastated and she's become a voice now for mental health,

172
00:12:25,980 --> 00:12:29,840
but they are both of Chinese heritage.

173
00:12:29,840 --> 00:12:33,040
And in some of these Asian households, that bar is very high.

174
00:12:33,040 --> 00:12:35,240
Now, more often than not, you think of it academically.

175
00:12:35,240 --> 00:12:40,640
In this particular household, it was in martial arts and kind of living vicariously through

176
00:12:40,640 --> 00:12:42,600
your children as a lot of people do.

177
00:12:42,600 --> 00:12:47,960
Either you're going to be a doctor or a lawyer or you're going to be in the NFL, the NHL.

178
00:12:47,960 --> 00:12:52,440
I don't think there's that conversation or that conversation isn't loud enough yet of

179
00:12:52,440 --> 00:12:56,280
the damage that can do mentally to a young boy or girl.

180
00:12:56,280 --> 00:12:57,280
Yeah, absolutely.

181
00:12:57,280 --> 00:12:58,280
Yeah.

182
00:12:58,280 --> 00:12:59,480
It's pretty prevalent too.

183
00:12:59,480 --> 00:13:03,840
I mean, like you're saying, it happens in a lot of different areas.

184
00:13:03,840 --> 00:13:07,880
I know in the sports world too, that happens a lot.

185
00:13:07,880 --> 00:13:12,480
But yeah, definitely is rather prevalent in the first responder world.

186
00:13:12,480 --> 00:13:13,480
Absolutely.

187
00:13:13,480 --> 00:13:20,720
Well, Jenna, let's go to the actual, I don't know if hierarchy is even the right word,

188
00:13:20,720 --> 00:13:24,040
the different specialties within the mental health professions.

189
00:13:24,040 --> 00:13:28,160
Because obviously you've got everything from a counselor through to psychologists, licensed

190
00:13:28,160 --> 00:13:31,080
psychologists, clinical psychologists, psychiatrists.

191
00:13:31,080 --> 00:13:36,720
So between the two of you, I'd love to kind of unpack that so people listening even understand

192
00:13:36,720 --> 00:13:41,200
what that title is and how much education that person has had.

193
00:13:41,200 --> 00:13:42,400
Yeah.

194
00:13:42,400 --> 00:13:46,200
So I often like to start out by describing to people something visual.

195
00:13:46,200 --> 00:13:48,800
I think it's easier to think about it this way.

196
00:13:48,800 --> 00:13:53,960
Imagine a Venn diagram and you have all these different circles around the outside and these

197
00:13:53,960 --> 00:13:56,700
are the different titles of the mental health field.

198
00:13:56,700 --> 00:14:01,840
You have psychologists, psychiatrists, licensed clinical social worker, marriage and family

199
00:14:01,840 --> 00:14:04,800
therapist, licensed professional counselor.

200
00:14:04,800 --> 00:14:09,760
And by state, there can be even more names and titles included in these bubbles.

201
00:14:09,760 --> 00:14:14,840
But what they all share, that middle part that overlaps in the Venn diagram is therapy.

202
00:14:14,840 --> 00:14:17,840
So I think that's helpful for people to be thinking about there's all these different

203
00:14:17,840 --> 00:14:21,680
titles and the one thing they share is therapy, but there's a lot of other parts that don't

204
00:14:21,680 --> 00:14:27,240
overlap and that create differences within these different fields.

205
00:14:27,240 --> 00:14:31,040
Psychologists being a doctoral level mental health professional that has knowledge and

206
00:14:31,040 --> 00:14:36,720
skills to do therapy, but also to be able to intervene in problems, assess problems,

207
00:14:36,720 --> 00:14:40,800
diagnose problems related to emotions, cognitions, behavior, and group processes.

208
00:14:40,800 --> 00:14:44,780
It's like a super broad definition of psychologists.

209
00:14:44,780 --> 00:14:49,600
We can go through psychiatrist, social worker, marriage and family therapist and talk about

210
00:14:49,600 --> 00:14:54,640
the differences, but it really has to do with the way that they view problems and then from

211
00:14:54,640 --> 00:14:59,600
that view how they approach and treat them.

212
00:14:59,600 --> 00:15:05,000
Psychiatrists being mainly someone with an MD that will look at a biological or a medical

213
00:15:05,000 --> 00:15:07,960
basis of behavior and typically does medication management.

214
00:15:07,960 --> 00:15:09,400
Again, they can do therapy.

215
00:15:09,400 --> 00:15:13,520
There's other modalities they can use, but the main one that people think about is the

216
00:15:13,520 --> 00:15:15,520
medication route.

217
00:15:15,520 --> 00:15:16,520
Social workers, same thing.

218
00:15:16,520 --> 00:15:21,160
They can do therapy, but they often will look at a client from a more holistic lens, that

219
00:15:21,160 --> 00:15:27,040
social lens, and think about doing case management, maybe advocacy or connecting them to different

220
00:15:27,040 --> 00:15:32,120
practical supports in the community to help reduce barriers, social barriers, socioeconomic

221
00:15:32,120 --> 00:15:33,560
barriers.

222
00:15:33,560 --> 00:15:37,720
And then marriage and family therapists, licensed professional counselors.

223
00:15:37,720 --> 00:15:40,740
The licensed professional counselor I'm not going to go into because that one does vary

224
00:15:40,740 --> 00:15:45,480
state by state and I don't know enough about it to speak intelligently about it, but what

225
00:15:45,480 --> 00:15:49,720
I will say about marriage and family therapists is they look at things from a relational lens,

226
00:15:49,720 --> 00:15:51,200
a systems lens.

227
00:15:51,200 --> 00:15:57,200
So they'll be able to look at a problem and think about family dynamics, the relationship,

228
00:15:57,200 --> 00:15:58,800
the couple piece of it.

229
00:15:58,800 --> 00:16:02,920
So again, therapy is that common thread throughout all of these, but the lens that's used to

230
00:16:02,920 --> 00:16:07,240
be able to craft a treatment plan is very different.

231
00:16:07,240 --> 00:16:08,240
Right.

232
00:16:08,240 --> 00:16:11,160
Yeah, that was well put.

233
00:16:11,160 --> 00:16:12,160
Wow.

234
00:16:12,160 --> 00:16:13,160
Thank you.

235
00:16:13,160 --> 00:16:14,160
Yeah.

236
00:16:14,160 --> 00:16:17,560
So yeah, Jenna worded that really well.

237
00:16:17,560 --> 00:16:22,640
And then outside of the therapy, I'll comment on just kind of the difference between psychologists

238
00:16:22,640 --> 00:16:28,560
and those other titles is, you know, what goes into being a psychologist.

239
00:16:28,560 --> 00:16:33,320
And I think I've talked about this a little bit on our past episodes, James, but, you

240
00:16:33,320 --> 00:16:38,280
know, typically it takes anywhere from five to eight years to actually become a licensed

241
00:16:38,280 --> 00:16:40,240
psychologist.

242
00:16:40,240 --> 00:16:43,040
That's not including undergraduate.

243
00:16:43,040 --> 00:16:47,960
And a lot of times for the PhD, which both Jenna and I have, you either have to go get

244
00:16:47,960 --> 00:16:52,680
a master's degree before you start that five to eight years, or you have to do, you know,

245
00:16:52,680 --> 00:16:58,480
anywhere from one to three years of a full time research position so that you can actually

246
00:16:58,480 --> 00:17:02,120
get accepted into a lab for a PhD and start that PhD.

247
00:17:02,120 --> 00:17:15,520
So for me from start to finish from, if I'm including undergrad, it took about 11 years.

248
00:17:15,520 --> 00:17:17,480
And I actually finished kind of fast in my PhD.

249
00:17:17,480 --> 00:17:22,240
I finished the PhD portion four years, I did a one year predoctoral internship, and then

250
00:17:22,240 --> 00:17:24,160
I did a one year fellowship.

251
00:17:24,160 --> 00:17:25,920
So I finished mine in six years.

252
00:17:25,920 --> 00:17:29,960
But like I said, it could take anywhere people, you know, sometimes up to eight, maybe even

253
00:17:29,960 --> 00:17:31,240
nine years to do that.

254
00:17:31,240 --> 00:17:36,880
So there's a lot of not only education, yes, you're in school that whole time, going to

255
00:17:36,880 --> 00:17:39,840
classes, doing didactics, things like that.

256
00:17:39,840 --> 00:17:46,080
But I think what really differentiates the psychologist is that we have very comprehensive

257
00:17:46,080 --> 00:17:52,440
training, not only clinically, which means like the therapy side of things, but PhDs

258
00:17:52,440 --> 00:17:55,760
psychologists have a very heavy research background.

259
00:17:55,760 --> 00:18:01,960
So not only are we learning in a specialized way how to treat specific areas of mental

260
00:18:01,960 --> 00:18:06,000
health, but we typically are also conducting research.

261
00:18:06,000 --> 00:18:10,720
And again, depending on what your specialty is, me and Jenna's both being in the first

262
00:18:10,720 --> 00:18:12,760
responder military trauma area.

263
00:18:12,760 --> 00:18:17,800
But that means we're writing grants, we're publishing scientific papers, we're collecting

264
00:18:17,800 --> 00:18:22,520
data, all these things while going to school.

265
00:18:22,520 --> 00:18:27,600
I also had to teach two to three classes at the university that I was getting my PhD at.

266
00:18:27,600 --> 00:18:29,800
So I was a professor.

267
00:18:29,800 --> 00:18:33,380
So you learn how to teach, you learn how to consult, you learn how to do all these things.

268
00:18:33,380 --> 00:18:39,640
So you come out and not only are you specialized in providing therapy, but you have a lot of,

269
00:18:39,640 --> 00:18:42,400
you know, the parts that also inform one another.

270
00:18:42,400 --> 00:18:45,280
My research makes me a better clinician.

271
00:18:45,280 --> 00:18:55,280
And my, you know, in the field clinical experiences inform the research side of things as well.

272
00:18:55,280 --> 00:19:00,420
When I speak to so many members of the military that have been on here, it's like a broken

273
00:19:00,420 --> 00:19:02,120
record the response.

274
00:19:02,120 --> 00:19:04,880
Well, they prescribe me meds.

275
00:19:04,880 --> 00:19:09,600
And it kind of makes me think my wife's just about to graduate in May from a doctor of

276
00:19:09,600 --> 00:19:10,600
optometry.

277
00:19:10,600 --> 00:19:14,520
Now, the optometrist is the person that you actually go to get your eyes tested.

278
00:19:14,520 --> 00:19:19,440
You know, what's better one, two, and all the glaucoma testing and all those things.

279
00:19:19,440 --> 00:19:24,160
And if they find something that's, you know, bad that you're going to need surgery or expertise,

280
00:19:24,160 --> 00:19:28,560
a specialist, then the ophthalmologist is who you go and see.

281
00:19:28,560 --> 00:19:33,640
But ophthalmologists are not usually doing eye tests and prescribing lenses and glasses.

282
00:19:33,640 --> 00:19:40,120
Why is it in the world of the VA that it always seems to be the psychiatrist that our military

283
00:19:40,120 --> 00:19:44,640
members are seeing rather than some of these specialties that maybe wouldn't be going to

284
00:19:44,640 --> 00:19:47,240
med straight away?

285
00:19:47,240 --> 00:19:49,240
I have three theories.

286
00:19:49,240 --> 00:19:55,160
One, I think it's human nature that we want a quick fix.

287
00:19:55,160 --> 00:19:58,480
And people view medication as a quick fix.

288
00:19:58,480 --> 00:20:04,680
And in some cases, and unfortunately, the more destructive cases it is, right, you're

289
00:20:04,680 --> 00:20:10,080
getting prescribed benzodiazepines because you have post-traumatic stress or high anxiety.

290
00:20:10,080 --> 00:20:11,560
That's a pretty short-term quick fix.

291
00:20:11,560 --> 00:20:15,160
You just pop a benzo and you feel better, right?

292
00:20:15,160 --> 00:20:18,840
So I think quick fix.

293
00:20:18,840 --> 00:20:26,640
I also think that, I don't know what you think about this, Jenna, but in my experience, you

294
00:20:26,640 --> 00:20:34,720
know, I think that the MD behind the psychiatrist's name, people, you know, that's a doctor, so

295
00:20:34,720 --> 00:20:37,520
I'm going to go see them.

296
00:20:37,520 --> 00:20:42,200
Not really knowing that, again, as Jenna was saying, some psychiatrists have some training

297
00:20:42,200 --> 00:20:47,760
in therapy, but like really theirs is on the medical side and medication management.

298
00:20:47,760 --> 00:20:52,560
So I think that sometimes we can get a little bit looked over in that sense, and people

299
00:20:52,560 --> 00:20:56,760
are more likely to go to that because a lot of people don't even know what a psychologist

300
00:20:56,760 --> 00:20:57,760
is, right?

301
00:20:57,760 --> 00:20:59,760
Like, what does that even really mean?

302
00:20:59,760 --> 00:21:04,640
So that would be, I said three theories, but I'd say those are my top two theories, the

303
00:21:04,640 --> 00:21:07,080
first being quick fixes.

304
00:21:07,080 --> 00:21:13,680
I agree, and I also think that when you look at a system like the VA, because it's multidisciplinary,

305
00:21:13,680 --> 00:21:17,240
they tend to have their own processes and procedures for how a client enters on the

306
00:21:17,240 --> 00:21:21,080
doors, where they want them to go, and what it looks like when they exit.

307
00:21:21,080 --> 00:21:25,440
And so it might just be, and I haven't worked in the VA, so I can't speak specifically

308
00:21:25,440 --> 00:21:29,780
to this process, it might just be that they start there and there isn't a clinical rhyme

309
00:21:29,780 --> 00:21:33,560
or reason why that's the first thing they do.

310
00:21:33,560 --> 00:21:37,840
What I can say, at least from my training, is that there often is that co-management

311
00:21:37,840 --> 00:21:41,760
piece where medication plus psychotherapy can be effective.

312
00:21:41,760 --> 00:21:46,760
So if you combine what we know on that end with maybe a process and procedure for a large

313
00:21:46,760 --> 00:21:52,780
organization like the VA, my guess is they can see a lot more people, psychiatrists can,

314
00:21:52,780 --> 00:21:56,160
and they just start getting people in the system through the works, and medication is

315
00:21:56,160 --> 00:21:57,580
the first way to go.

316
00:21:57,580 --> 00:22:01,680
And then while you're on a wait list for a psychologist, which could be days, weeks,

317
00:22:01,680 --> 00:22:06,960
months, I don't know, it depends, then you can get that ball rolling.

318
00:22:06,960 --> 00:22:07,960
That's my best guess.

319
00:22:07,960 --> 00:22:10,040
I'd agree with that too.

320
00:22:10,040 --> 00:22:16,920
I worked in several VAs in my pre-doctoral and post-doctoral training, and it's a very

321
00:22:16,920 --> 00:22:22,280
large organization, which has its pros and definitely has its cons.

322
00:22:22,280 --> 00:22:27,880
In the clinics that I worked in, that I trained in, sometimes we had wait lists up to three

323
00:22:27,880 --> 00:22:28,880
to six months.

324
00:22:28,880 --> 00:22:32,720
I mean, just absolutely absurd.

325
00:22:32,720 --> 00:22:37,320
So yeah, they'd get sent somewhere where they can just, hey, here's someone you can have.

326
00:22:37,320 --> 00:22:44,160
And as Jenna was saying, most psychiatrists, you just meet with 15, 10, 15, 20, maybe 30

327
00:22:44,160 --> 00:22:45,160
minutes, right?

328
00:22:45,160 --> 00:22:49,880
You just talk to them about what you're experiencing, and they might provide you medication.

329
00:22:49,880 --> 00:22:56,440
So I do agree that sometimes it definitely was my case at the VA where when someone would

330
00:22:56,440 --> 00:23:04,960
finally get to me, they'd be so angry, understandably, they deserved to be angry because they had

331
00:23:04,960 --> 00:23:10,120
been sent around for four months to this person, to that clinic, to this, to that, and then

332
00:23:10,120 --> 00:23:14,840
they landed in the PTSD clinic to see me.

333
00:23:14,840 --> 00:23:19,040
So it definitely, I think there is sometimes no rhyme or reason to it, but I agree with

334
00:23:19,040 --> 00:23:22,560
Jenna where it's like, okay, if we can just get that person in to see that person, we

335
00:23:22,560 --> 00:23:24,240
can get that ball rolling.

336
00:23:24,240 --> 00:23:25,560
Yeah, it's interesting.

337
00:23:25,560 --> 00:23:29,920
I mean, obviously the whole point is to reverse engineer and figure out what we're doing wrong,

338
00:23:29,920 --> 00:23:33,680
how we can be proactive and reduce the number of people so we're not straining the system.

339
00:23:33,680 --> 00:23:35,600
And I talk about this a lot.

340
00:23:35,600 --> 00:23:41,640
The NHS in England, I love, the one in Britain, but Britain's again fatter and sicker.

341
00:23:41,640 --> 00:23:46,160
So that's starting to collapse because they haven't done the proactive side to make British

342
00:23:46,160 --> 00:23:47,160
people healthy.

343
00:23:47,160 --> 00:23:50,120
They've followed the American model and here we are.

344
00:23:50,120 --> 00:23:53,760
When it comes to the snobbery as well, I've seen this because even my wife's profession

345
00:23:53,760 --> 00:23:59,880
was attacked and they have to word their doctorate a certain way because some people are like,

346
00:23:59,880 --> 00:24:02,440
oh, you're not a real doctor, air quotes.

347
00:24:02,440 --> 00:24:06,880
The irony is how many real doctors prescribe meds to very overweight people and never talk

348
00:24:06,880 --> 00:24:08,920
about sleep, nutrition or exercise.

349
00:24:08,920 --> 00:24:09,920
You know what I mean?

350
00:24:09,920 --> 00:24:16,140
So I think that even evaluating the weight of an MD and empowering some of the other

351
00:24:16,140 --> 00:24:18,920
professions that support them, and I was one of them.

352
00:24:18,920 --> 00:24:23,920
I was working under a medical director's license, a doctor's license, and we were out in the

353
00:24:23,920 --> 00:24:29,080
field cutting holes in people's throats and sticking tubes down their necks because you

354
00:24:29,080 --> 00:24:33,120
have to trust the people beneath you and allow us to use our skill sets.

355
00:24:33,120 --> 00:24:35,400
And it feels like that's the same in the psychology world.

356
00:24:35,400 --> 00:24:39,560
We need to kind of cut those apron strings, allow the psychiatrist to be there for the

357
00:24:39,560 --> 00:24:46,080
specialties when you're talking about a medication being needed in that case, but empower the

358
00:24:46,080 --> 00:24:52,040
other professions and trust them to work with these people because more often than not,

359
00:24:52,040 --> 00:24:54,680
it's the other modalities that actually seem to work.

360
00:24:54,680 --> 00:24:56,600
Yeah, I agree.

361
00:24:56,600 --> 00:25:03,680
I do think there's a massive disconnect between psychiatrists and psychologists.

362
00:25:03,680 --> 00:25:09,320
There's one psychiatrist I worked in all my years of training when I was working in an

363
00:25:09,320 --> 00:25:12,200
inpatient unit with combat veterans in Houston.

364
00:25:12,200 --> 00:25:18,240
I will never forget her, she was such a fantastic psychiatrist and her motto was skills before

365
00:25:18,240 --> 00:25:19,860
pills.

366
00:25:19,860 --> 00:25:26,200
She was, of course, providing medication appropriately when needed, but was very much wanting to

367
00:25:26,200 --> 00:25:33,080
be on a team with the psychologist, which is how it should be.

368
00:25:33,080 --> 00:25:36,920
But I feel like that's pretty rare.

369
00:25:36,920 --> 00:25:42,200
I didn't have an experience like that again in any of my training in any of the hospitals

370
00:25:42,200 --> 00:25:43,200
I worked in.

371
00:25:43,200 --> 00:25:49,800
It's obviously harder to comment on in the private sector, in the private practice world,

372
00:25:49,800 --> 00:25:55,960
but I do think there is like more often than not, they're not working together in tandem

373
00:25:55,960 --> 00:26:01,120
thinking about like we're doing this as a multidisciplinary approach to helping this

374
00:26:01,120 --> 00:26:02,120
person.

375
00:26:02,120 --> 00:26:06,280
Jen, anything to add before we move on?

376
00:26:06,280 --> 00:26:11,960
I was just having flashbacks to a clinic that I worked at on my postdoc year and this clinic

377
00:26:11,960 --> 00:26:12,960
was absolutely phenomenal.

378
00:26:12,960 --> 00:26:16,060
It was a rural clinic and it was multidisciplinary.

379
00:26:16,060 --> 00:26:23,120
We had one psychiatrist and this is not a dig at them because there were good reasons

380
00:26:23,120 --> 00:26:26,800
why they weren't able to attend these meetings, but they were the only individual out of the

381
00:26:26,800 --> 00:26:32,200
entire clinic that didn't attend our weekly staff meetings.

382
00:26:32,200 --> 00:26:36,600
I thought that was a huge issue because we would talk about cases, we would staff, we

383
00:26:36,600 --> 00:26:41,160
would figure out if people were making progress and they were absent in that.

384
00:26:41,160 --> 00:26:44,960
One thing that I did, knowing that they weren't able to make that meeting again for their

385
00:26:44,960 --> 00:26:49,800
own good reasons, was make sure that if they were the psychiatrist on any of the cases

386
00:26:49,800 --> 00:26:55,340
that I had, that I made sure that I was in regular contact with them.

387
00:26:55,340 --> 00:27:01,320
Because I think what Brooke had said is true, it's pretty rare for at least psychology and

388
00:27:01,320 --> 00:27:07,440
psychiatry to be on the same game plan with clients where they're in regular communication

389
00:27:07,440 --> 00:27:12,160
and we are so much stronger when we're together on the same team and we can say, hey, you

390
00:27:12,160 --> 00:27:14,960
just up their medication and here's what I'm seeing.

391
00:27:14,960 --> 00:27:15,960
Is this normal?

392
00:27:15,960 --> 00:27:18,640
Is it just a phase?

393
00:27:18,640 --> 00:27:21,480
Is there any way that we can reduce the side effects while increasing the things that they

394
00:27:21,480 --> 00:27:23,040
want to be happening?

395
00:27:23,040 --> 00:27:26,320
If we're not talking about that and you're just relying on the client's self-report,

396
00:27:26,320 --> 00:27:29,880
sometimes they'll miss things because they're not an expert in the way that the medication

397
00:27:29,880 --> 00:27:31,960
could impact their whole physiology.

398
00:27:31,960 --> 00:27:36,680
They're just an expert in their experience and there could be misses there.

399
00:27:36,680 --> 00:27:37,680
Absolutely.

400
00:27:37,680 --> 00:27:46,800
Well, I want to go next to testing for a fire slash PCMS agency or corrections.

401
00:27:46,800 --> 00:27:52,960
My personal experience for fire departments, that's three polygraphs that I lied through

402
00:27:52,960 --> 00:28:00,560
and four MMPIs, correct me if I'm wrong, Minnesota Multiphasic Personality Interview.

403
00:28:00,560 --> 00:28:02,560
Have I got that right?

404
00:28:02,560 --> 00:28:03,880
Okay, brilliant.

405
00:28:03,880 --> 00:28:09,000
In my opinion, and then you sat down with a psychologist and hilariously enough, the

406
00:28:09,000 --> 00:28:12,880
people that I sat down with usually were more crazy than any of the people that I ran on

407
00:28:12,880 --> 00:28:15,400
in uniform.

408
00:28:15,400 --> 00:28:20,780
When I look back now and people talking about the funds to, for example, hire a full-time

409
00:28:20,780 --> 00:28:26,680
physical health practitioner in a department, I look at the seemingly wasted money on these

410
00:28:26,680 --> 00:28:30,880
box checking elements of hiring a young recruit.

411
00:28:30,880 --> 00:28:33,120
You've got a physical test, you've got a written test.

412
00:28:33,120 --> 00:28:37,640
Obviously, you've got an intense background check on us to make sure that we're not the

413
00:28:37,640 --> 00:28:40,200
kind of people that shouldn't be in uniform.

414
00:28:40,200 --> 00:28:46,360
Then you have a year probation as well to filter out anyone that shouldn't be there.

415
00:28:46,360 --> 00:28:50,160
I would love to unpack, firstly, and I know we've talked about this and both of you individually,

416
00:28:50,160 --> 00:28:56,760
but I think it's worth revisiting the ability to select a fire or police recruit with the

417
00:28:56,760 --> 00:28:59,120
MMPI on its own.

418
00:28:59,120 --> 00:29:05,640
Then what should, if anything, a psychological testing look like for a fire department?

419
00:29:05,640 --> 00:29:10,560
At the moment, if we're doing these two that seem not to be effective because the polygraph

420
00:29:10,560 --> 00:29:16,760
is a smoke and mirrors magic show that you confess to, then to me, the money is better

421
00:29:16,760 --> 00:29:22,240
served investing and giving these young new firefighters counseling right from the front

422
00:29:22,240 --> 00:29:23,240
door.

423
00:29:23,240 --> 00:29:27,280
I'll revisit that question because I just monologue for a second.

424
00:29:27,280 --> 00:29:32,680
Talk to me firstly about the ability of the MMPI on its own to successfully filter out

425
00:29:32,680 --> 00:29:37,080
fire and police recruits.

426
00:29:37,080 --> 00:29:40,880
Short answer, it can't.

427
00:29:40,880 --> 00:29:45,080
Short answer on the psychological aspect, you shouldn't.

428
00:29:45,080 --> 00:29:51,160
Then in terms of a full pre-employment assessment evaluation, there's a lot of things that should

429
00:29:51,160 --> 00:29:56,920
be incorporated in that if you're going to do it by best practices in the field.

430
00:29:56,920 --> 00:30:01,800
Again, if you are practicing in police and public safety psychology and this is one of

431
00:30:01,800 --> 00:30:06,300
your areas, the International Association of Chiefs of Police has guidelines for how

432
00:30:06,300 --> 00:30:07,720
to conduct these things.

433
00:30:07,720 --> 00:30:10,840
You should be getting regular supervision and consultation around it.

434
00:30:10,840 --> 00:30:15,040
You should understand what instruments are well validated to answer the questions at

435
00:30:15,040 --> 00:30:20,240
hand, how to work with agencies, convey results, understand what the referral question is.

436
00:30:20,240 --> 00:30:22,560
There's a lot that goes into that process.

437
00:30:22,560 --> 00:30:26,800
But the MMPI to RF on its own, no.

438
00:30:26,800 --> 00:30:29,440
Never use one data point that's not acceptable.

439
00:30:29,440 --> 00:30:31,880
If you know what you're doing, you wouldn't do that.

440
00:30:31,880 --> 00:30:33,800
It's not going to give you anything.

441
00:30:33,800 --> 00:30:37,600
On its own, it's just a personality inventory that's going to tell you a little bit about

442
00:30:37,600 --> 00:30:39,980
a person's personological characteristics.

443
00:30:39,980 --> 00:30:44,800
It's going to tell you, are they maybe a little bit more labile in their mood?

444
00:30:44,800 --> 00:30:47,240
Are they a bit impulsive in their behavior?

445
00:30:47,240 --> 00:30:51,160
It's not going to give you, is this person suitable for the job at hand?

446
00:30:51,160 --> 00:30:54,400
100%, everything that Jenna just said.

447
00:30:54,400 --> 00:30:55,400
100%.

448
00:30:55,400 --> 00:30:56,400
I agree.

449
00:30:56,400 --> 00:31:01,160
I mean, it's like that with a lot of things in this field, but like she said, it's one

450
00:31:01,160 --> 00:31:08,320
data point and it can be a helpful data point in conjunction with a lot of other means.

451
00:31:08,320 --> 00:31:14,200
But on its own, yeah, it's not going to tell you whether or not someone's fit to join public

452
00:31:14,200 --> 00:31:15,200
safety.

453
00:31:15,200 --> 00:31:21,160
So, this is my point is when people say, oh, we don't have the funding for a mental health

454
00:31:21,160 --> 00:31:25,920
practitioner, well, if you get rid of the polygraph and the MMPI, ideally, like you

455
00:31:25,920 --> 00:31:27,120
said, put something else in place.

456
00:31:27,120 --> 00:31:32,920
But if you're not, then now this new person could come in and let's say have five sessions

457
00:31:32,920 --> 00:31:39,120
in their probationary year or in the first six months and have a mental health conversation

458
00:31:39,120 --> 00:31:43,580
from the door, have zero barrier to entry because you're not looking at EAPs and copays

459
00:31:43,580 --> 00:31:47,960
and all these things, and give them a chance to offload some of the stuff they brought

460
00:31:47,960 --> 00:31:52,800
into the job because every single one of us, more of us than the average civilian, have

461
00:31:52,800 --> 00:31:55,640
things that send us into uniform.

462
00:31:55,640 --> 00:32:02,080
Yeah, I've definitely followed a lot of, I know you're a huge advocate for that, James,

463
00:32:02,080 --> 00:32:03,920
and I agree with you.

464
00:32:03,920 --> 00:32:14,080
I think that it's a delicate situation because understandably, you want to make sure you

465
00:32:14,080 --> 00:32:19,680
do some form of testing when someone's trying to enter the service to make sure that there

466
00:32:19,680 --> 00:32:28,760
aren't any glaring reasons or issues or problems why someone wouldn't be fit to serve.

467
00:32:28,760 --> 00:32:35,320
At the same time, as I'm sure we all know, is a lot of these fitness for duty evaluations

468
00:32:35,320 --> 00:32:42,280
and assessments aren't necessarily looking at or promoting or sending the right message

469
00:32:42,280 --> 00:32:46,480
of what kind of characteristics we are looking for.

470
00:32:46,480 --> 00:32:52,240
Or even, I look at it from the standpoint too, of what it is we want to build in that

471
00:32:52,240 --> 00:32:53,320
person.

472
00:32:53,320 --> 00:32:57,100
What makes someone good in public safety?

473
00:32:57,100 --> 00:33:03,440
We're talking about certain characteristics, social characteristics and psychological characteristics

474
00:33:03,440 --> 00:33:10,720
and styles of thinking and not the expectation that you're coming into this field tip top

475
00:33:10,720 --> 00:33:11,720
perfect.

476
00:33:11,720 --> 00:33:15,960
You have to be so perfect and all that stuff that's happened to you before, you just need

477
00:33:15,960 --> 00:33:19,320
to be a robot and a machine and operate through this.

478
00:33:19,320 --> 00:33:24,960
Because what I also think it does is in the long term, it also sends this message that

479
00:33:24,960 --> 00:33:31,640
perpetuates the culture and public safety of, I can't have any flaws or weaknesses lest

480
00:33:31,640 --> 00:33:40,880
I lose my job, lose my promotion or be ostracized or looked upon negatively in some way.

481
00:33:40,880 --> 00:33:48,600
I think that sometimes that precedence gets set at the very beginning when someone is

482
00:33:48,600 --> 00:33:50,720
just joining the job.

483
00:33:50,720 --> 00:33:51,720
Jenna.

484
00:33:51,720 --> 00:33:59,600
Yeah, I often think about the message that some of this testing sends too.

485
00:33:59,600 --> 00:34:04,840
I think when you're doing the pre-employment evaluation, it can look like it's an impediment

486
00:34:04,840 --> 00:34:06,920
to somebody's goal.

487
00:34:06,920 --> 00:34:11,080
This is my dream, I want to do this thing and you're the person standing in the way.

488
00:34:11,080 --> 00:34:15,760
That's not a really great spot for a psychologist to be in if that's the perspective that they

489
00:34:15,760 --> 00:34:16,760
have.

490
00:34:16,760 --> 00:34:20,520
Then if they're on the job and they're getting in trouble, they're not meeting those essential

491
00:34:20,520 --> 00:34:25,560
job functions, a supervisor writes it up, puts it into a fitness for duty evaluation,

492
00:34:25,560 --> 00:34:28,040
requests that and then an evaluation is conducted.

493
00:34:28,040 --> 00:34:31,880
Again, it's like I was doing the thing that I wanted to do and you don't think I'm doing

494
00:34:31,880 --> 00:34:32,880
a good enough job.

495
00:34:32,880 --> 00:34:35,680
Again, you're the person standing in the way.

496
00:34:35,680 --> 00:34:40,120
I think in some ways that perspective is true.

497
00:34:40,120 --> 00:34:44,080
There has to be an objective person on the outside saying that this is acceptable, this

498
00:34:44,080 --> 00:34:46,080
is a cutoff or not.

499
00:34:46,080 --> 00:34:52,040
On the other hand though, I think it gets a bad rap and that we do have to have standards.

500
00:34:52,040 --> 00:34:58,960
These professions, they place themselves as well as the community in difficult positions

501
00:34:58,960 --> 00:35:03,520
and you have to be able to make sure that somebody can handle that.

502
00:35:03,520 --> 00:35:07,000
I look at pre-employment as a baseline standard.

503
00:35:07,000 --> 00:35:09,200
Can you meet these requirements today?

504
00:35:09,200 --> 00:35:12,960
Knowing that on the job, these experiences are going to change you and you might have

505
00:35:12,960 --> 00:35:13,960
some bumps in the road.

506
00:35:13,960 --> 00:35:18,320
Then I look at fitness for duty as an opportunity, not a punishment.

507
00:35:18,320 --> 00:35:23,560
It's an opportunity for people to be able to think critically about what's causing them

508
00:35:23,560 --> 00:35:29,200
problems, come up with a rehabilitation plan and come back better than they were before.

509
00:35:29,200 --> 00:35:31,320
It's also a recognition on everybody's part.

510
00:35:31,320 --> 00:35:33,760
Hey, this is not working for us.

511
00:35:33,760 --> 00:35:36,600
Now, is it always used that way?

512
00:35:36,600 --> 00:35:37,760
No.

513
00:35:37,760 --> 00:35:41,560
In theory, this is how it's supposed to look.

514
00:35:41,560 --> 00:35:48,240
In practice, it depends on who you're hiring, what the goals are, lots of other things.

515
00:35:48,240 --> 00:35:52,160
I love the fact that you just said better than when you were before because this is

516
00:35:52,160 --> 00:35:57,880
I think the message that is so needed in the mental health conversation and this applies

517
00:35:57,880 --> 00:36:03,080
to a brand new recruit that again, you've done some evaluation, realized all right,

518
00:36:03,080 --> 00:36:06,440
there's something that needs to be worked through all the way through to obviously our

519
00:36:06,440 --> 00:36:11,120
10, 20 plus year people that really start to struggle if it hasn't reared its head early

520
00:36:11,120 --> 00:36:13,160
in our career.

521
00:36:13,160 --> 00:36:18,680
The resilience that appears to be forged from hundreds and hundreds of conversations I've

522
00:36:18,680 --> 00:36:24,600
had on here that when you find that toolbox that works for you, that mental health toolbox

523
00:36:24,600 --> 00:36:30,080
and you do the work and you come out the other end, we talk about resilience and we put firefighters

524
00:36:30,080 --> 00:36:33,440
through mazes and play loud noise and bang on the walls.

525
00:36:33,440 --> 00:36:34,720
I don't think that's it.

526
00:36:34,720 --> 00:36:38,480
Of course, that's overcoming fear and that's a skill in itself.

527
00:36:38,480 --> 00:36:44,440
To me, resilience of the struggles that we had that were buried down, pulling them out

528
00:36:44,440 --> 00:36:49,560
into the light, working through them and that becomes that badge of honor then, that scar

529
00:36:49,560 --> 00:36:54,120
that you're proud of, the gold ink in the Japanese metaphor or the gold glue, excuse

530
00:36:54,120 --> 00:36:55,120
me.

531
00:36:55,120 --> 00:36:59,480
So talk to me about that concept because we don't really hear it discussed very often

532
00:36:59,480 --> 00:37:04,840
but through your eyes, I'm not wanting to load the question, but the ability for someone

533
00:37:04,840 --> 00:37:10,840
to be even better than they were prior to struggling, the hope that is forged from post

534
00:37:10,840 --> 00:37:13,880
traumatic growth.

535
00:37:13,880 --> 00:37:15,800
Yeah.

536
00:37:15,800 --> 00:37:23,880
I think that this aspect goes under looked a lot, overlooked a lot with respect to, I

537
00:37:23,880 --> 00:37:30,160
mean, my approach from the work that I do is very much that proactive approach where

538
00:37:30,160 --> 00:37:36,400
we're setting someone up to be able to not only keep themselves healthy if they're feeling

539
00:37:36,400 --> 00:37:40,320
pretty good mentally and physically, but so that they're also equipped with the tools

540
00:37:40,320 --> 00:37:48,800
to learn, bounce back and intervene, whether it's through themselves, using tools and skills

541
00:37:48,800 --> 00:37:52,760
themselves to intervene when they're noticing things aren't going great for them or that

542
00:37:52,760 --> 00:37:58,840
they have support resources that they can utilize and reach out to at that time to prevent

543
00:37:58,840 --> 00:38:02,440
the snowball from continuing to roll and getting to that, what I call the third line, which

544
00:38:02,440 --> 00:38:04,680
is the crisis part.

545
00:38:04,680 --> 00:38:09,520
So post-traumatic growth, there's a plethora of scientific research on something, on a

546
00:38:09,520 --> 00:38:14,600
topic like post-traumatic growth, which really kind of goes in line with resilience.

547
00:38:14,600 --> 00:38:19,960
I feel like resilience has become like a super hot topic, resilience, resilience, I'm a resilience

548
00:38:19,960 --> 00:38:25,040
this, I'm a resilience coach, I'm a resilience that, but what actually is resilience?

549
00:38:25,040 --> 00:38:29,560
And I feel like sometimes when people hear the word resilience, they think that I'm going

550
00:38:29,560 --> 00:38:35,920
to get the information, tools, whatever it is to protect me from ever having any problems

551
00:38:35,920 --> 00:38:38,480
so that nothing ever affects me.

552
00:38:38,480 --> 00:38:40,680
And that's actually not what resilience is.

553
00:38:40,680 --> 00:38:48,000
I like to utilize the analogy of if I was working with a professional athlete at the

554
00:38:48,000 --> 00:38:52,040
very beginning of their career and I said, let me tell you what you need to do and you

555
00:38:52,040 --> 00:38:57,160
will never have an injury, you will never be sore, you will never have anything like

556
00:38:57,160 --> 00:39:00,000
that because you're going to be so resilient.

557
00:39:00,000 --> 00:39:05,360
You'd look at me like I was a snake oil salesman, which I would be, right?

558
00:39:05,360 --> 00:39:08,840
And it's the same when we're talking about mental health and resiliency.

559
00:39:08,840 --> 00:39:13,560
And so something like post-traumatic growth is being able to have the information, tools

560
00:39:13,560 --> 00:39:19,160
and resources to experience what it is that you've experienced, hardship, trauma, and

561
00:39:19,160 --> 00:39:25,640
be able to use that and take that to build upon who you already were and enhance skills

562
00:39:25,640 --> 00:39:31,720
you already had and learn new skills to continue to forge through and live your life in a way

563
00:39:31,720 --> 00:39:34,240
that is best for you.

564
00:39:34,240 --> 00:39:38,200
So it's not, I'm protecting myself from ever being touched.

565
00:39:38,200 --> 00:39:42,400
I'll never get touched by any of this stuff on the job ever because I'm so resilient.

566
00:39:42,400 --> 00:39:47,800
It's actually having the tools and the resources to be able to, despite the aspects that you

567
00:39:47,800 --> 00:39:53,000
might be experiencing on the job and off the job, that you are able to then learn and grow

568
00:39:53,000 --> 00:39:55,560
and adapt from that.

569
00:39:55,560 --> 00:39:57,200
Jenna.

570
00:39:57,200 --> 00:40:01,400
Yeah, everything you just said, totally agree with.

571
00:40:01,400 --> 00:40:05,920
And I think the one part that I'd add is, when you think about what trauma does for

572
00:40:05,920 --> 00:40:09,840
a person, typically it affects their belief system, their beliefs about themselves, the

573
00:40:09,840 --> 00:40:11,160
world or other people.

574
00:40:11,160 --> 00:40:15,880
And we tend to think about it in the post-traumatic stress way where it changes those beliefs

575
00:40:15,880 --> 00:40:17,360
to be maladaptive.

576
00:40:17,360 --> 00:40:18,920
It makes people afraid.

577
00:40:18,920 --> 00:40:21,000
It's that fear system that's triggered.

578
00:40:21,000 --> 00:40:25,720
When you're looking at something like post-traumatic growth, you're really flipping it on its head

579
00:40:25,720 --> 00:40:31,080
asking what purpose and meaning does this provide for your life now that you've gotten

580
00:40:31,080 --> 00:40:32,860
through this thing?

581
00:40:32,860 --> 00:40:34,360
And then focusing there.

582
00:40:34,360 --> 00:40:39,560
So it's really about perspective, in my opinion, and being able to put effort in something

583
00:40:39,560 --> 00:40:41,260
that I believe is changeable.

584
00:40:41,260 --> 00:40:44,760
So the event happened, that trauma is in the past.

585
00:40:44,760 --> 00:40:49,420
And if you can focus on who you are today because of it, what you want to do today because

586
00:40:49,420 --> 00:40:53,780
of it, or in addition to it, that allows you to put your effort in something that you have

587
00:40:53,780 --> 00:40:55,480
control over.

588
00:40:55,480 --> 00:40:59,260
And that tends to be pretty powerful and motivating for people.

589
00:40:59,260 --> 00:41:03,360
What I've seen so often is that when people have come out the other end, they become a

590
00:41:03,360 --> 00:41:04,800
beacon of light for others.

591
00:41:04,800 --> 00:41:08,000
And people come out the shadows and say, you know, I've been going through it too.

592
00:41:08,000 --> 00:41:10,760
And the irony is that they were looking at each other and both of them thought they were

593
00:41:10,760 --> 00:41:15,120
fine because this bloody mask that we wear so well in our profession.

594
00:41:15,120 --> 00:41:19,960
But I was just thinking when you were both talking, a good analogy is when we learn extrication,

595
00:41:19,960 --> 00:41:22,680
they say never get your body between the tool and the vehicle.

596
00:41:22,680 --> 00:41:28,040
Because as you try and spread a car, it tends to turn and you literally will get crushed.

597
00:41:28,040 --> 00:41:33,920
So you know, the resilience piece is the experienced firefighters teaching an academy.

598
00:41:33,920 --> 00:41:37,400
They know they've been taught and most of us have been pinched at least once and we

599
00:41:37,400 --> 00:41:38,600
remember then.

600
00:41:38,600 --> 00:41:40,560
So that trauma isn't forgotten.

601
00:41:40,560 --> 00:41:44,460
You're not scared of the hydraulic tools anymore.

602
00:41:44,460 --> 00:41:47,040
You've just learned in a way to use it in a different way.

603
00:41:47,040 --> 00:41:50,200
And your vulnerability of like, let me tell you when I was an idiot and I almost got crushed

604
00:41:50,200 --> 00:41:53,320
by one of these now becomes a lesson for someone else.

605
00:41:53,320 --> 00:41:58,400
So I think that it's owning that but using it in a positive way, whether it's beckoning

606
00:41:58,400 --> 00:42:03,440
people from their own struggles to be vulnerable enough to talk to them about yours or like

607
00:42:03,440 --> 00:42:06,640
I said, parallel with an extrication tool in your hand.

608
00:42:06,640 --> 00:42:11,680
Yeah, not to go too far down a rabbit hole, but when we're talking about post-traumatic

609
00:42:11,680 --> 00:42:18,600
stress in particular, what leads to the development of severe post-traumatic stress injury or

610
00:42:18,600 --> 00:42:23,200
a diagnosis of post-traumatic stress disorder would be what we call avoidance.

611
00:42:23,200 --> 00:42:26,040
And typically that comes with I'm not talking to anyone.

612
00:42:26,040 --> 00:42:27,040
I'm going into autopilot.

613
00:42:27,040 --> 00:42:31,440
You know, it can lead to severe isolation, but typically it's just keeping my mouth shut,

614
00:42:31,440 --> 00:42:32,440
putting the mask on.

615
00:42:32,440 --> 00:42:33,440
I'm good.

616
00:42:33,440 --> 00:42:34,440
I'm good.

617
00:42:34,440 --> 00:42:36,040
I'm good until the levy breaks.

618
00:42:36,040 --> 00:42:44,320
So like you're saying, James, when I give trainings and presentations on trauma and

619
00:42:44,320 --> 00:42:49,820
stress and I'm talking about the tips in my tips section, the first thing I talk about

620
00:42:49,820 --> 00:42:51,840
is talking to other people.

621
00:42:51,840 --> 00:42:56,240
You know, these aren't like groundbreaking things that I'm going to tell you.

622
00:42:56,240 --> 00:42:59,760
Like this is exactly how you manage it or how you prevent it.

623
00:42:59,760 --> 00:43:07,280
But talking is scientifically proven to not only help resolve post-traumatic stress if

624
00:43:07,280 --> 00:43:13,040
you're in utilizing an evidence-based treatment, but it's actually a very, very massive protective

625
00:43:13,040 --> 00:43:14,600
factor.

626
00:43:14,600 --> 00:43:19,120
And so I have found, like you're saying, James, I've worked with several first responders

627
00:43:19,120 --> 00:43:26,480
over the years who are in a leadership position, a higher ranking position who start in treatment

628
00:43:26,480 --> 00:43:30,480
and then they become empowered to kind of share their story with their crews and other

629
00:43:30,480 --> 00:43:31,480
people.

630
00:43:31,480 --> 00:43:37,600
And it's just, it never ceases to amaze me the domino effect that starts to happen.

631
00:43:37,600 --> 00:43:40,520
And then they're telling me that, you know, other people in their crew are now kind of

632
00:43:40,520 --> 00:43:44,240
speaking up about certain things or willing to talk about how something bothered them

633
00:43:44,240 --> 00:43:45,800
or whatever it was.

634
00:43:45,800 --> 00:43:47,480
So talking is massive.

635
00:43:47,480 --> 00:43:54,180
It's really a massive tool at our disposal, of course, talking to people that we trust,

636
00:43:54,180 --> 00:43:58,160
but it's scientifically proven to be helpful.

637
00:43:58,160 --> 00:44:01,400
Anything to add, Gemma?

638
00:44:01,400 --> 00:44:06,240
Yeah, I think what's really funny about what Hugh just said is that most people think it

639
00:44:06,240 --> 00:44:10,000
needs to be more complicated than that, or more sexy than that.

640
00:44:10,000 --> 00:44:16,360
And I think people don't value that it could be something as simple as talking with somebody

641
00:44:16,360 --> 00:44:19,880
who's qualified to be able to navigate you through something like that.

642
00:44:19,880 --> 00:44:23,320
So then we have this host of other things, and I'm sure we'll get to it in other parts

643
00:44:23,320 --> 00:44:27,600
of this podcast that people are drawn to, to try to solve the problem because in their

644
00:44:27,600 --> 00:44:30,280
eyes it needs to be more complicated.

645
00:44:30,280 --> 00:44:33,720
What built up to create this problem was complicated and long standing.

646
00:44:33,720 --> 00:44:36,280
So the solution has to be complicated.

647
00:44:36,280 --> 00:44:37,600
It has to take a lot of time.

648
00:44:37,600 --> 00:44:39,560
It needs to be difficult.

649
00:44:39,560 --> 00:44:41,880
And that's just not necessarily the case.

650
00:44:41,880 --> 00:44:47,640
Well, I want to explore the elements that contribute to our challenges.

651
00:44:47,640 --> 00:44:52,160
And then obviously we'll get to how to find the right solutions as well as highlighting

652
00:44:52,160 --> 00:44:53,840
the wrong solutions.

653
00:44:53,840 --> 00:44:56,560
But without loading the question, I've discussed it many, many times.

654
00:44:56,560 --> 00:44:58,400
I'm just going to give you guys the mic.

655
00:44:58,400 --> 00:45:07,440
What are the multitude of contributing factors that together lead to someone struggling mentally

656
00:45:07,440 --> 00:45:08,440
in our profession?

657
00:45:08,440 --> 00:45:11,440
You want me to go?

658
00:45:11,440 --> 00:45:12,800
I'll go.

659
00:45:12,800 --> 00:45:13,800
Yeah.

660
00:45:13,800 --> 00:45:18,560
Multitude of factors that lead to someone struggling in your profession.

661
00:45:18,560 --> 00:45:24,400
All right, so let's talk about, I like the Venn diagram aspect.

662
00:45:24,400 --> 00:45:30,600
Sometimes I'll put this on a screen when I'm giving presentations on this.

663
00:45:30,600 --> 00:45:33,280
One thing, one point I want to get across.

664
00:45:33,280 --> 00:45:35,900
It's never one thing.

665
00:45:35,900 --> 00:45:40,400
Even if there was one specific thing that you can point to that that's when my problem

666
00:45:40,400 --> 00:45:43,280
started, it's never one thing.

667
00:45:43,280 --> 00:45:44,280
Okay.

668
00:45:44,280 --> 00:45:50,720
It is a combination, like you said, James, the multitude of factors that leads to someone

669
00:45:50,720 --> 00:45:52,960
struggling.

670
00:45:52,960 --> 00:45:57,160
So we obviously can talk about experiences and events.

671
00:45:57,160 --> 00:46:03,800
And what I also want to really, really highlight is it's not always the job.

672
00:46:03,800 --> 00:46:05,080
Not always.

673
00:46:05,080 --> 00:46:11,520
Meaning I can tell you anecdotally, at least 50% of the first responders who come to work

674
00:46:11,520 --> 00:46:20,120
with me have childhood trauma, ranging from sexual abuse, physical abuse, neglect, and

675
00:46:20,120 --> 00:46:25,960
everything that falls underneath those.

676
00:46:25,960 --> 00:46:28,060
Trauma is cumulative.

677
00:46:28,060 --> 00:46:32,840
So when we grow up in environments like that, and then we join a profession where we're

678
00:46:32,840 --> 00:46:36,840
exposed to a lot of trauma and just high stress, all these things accumulate.

679
00:46:36,840 --> 00:46:42,880
So of course the events, those things can add up and accumulate and lead to someone

680
00:46:42,880 --> 00:46:44,000
struggling.

681
00:46:44,000 --> 00:46:50,080
But what really in the first responder profession, other factors that I see contributing to someone

682
00:46:50,080 --> 00:46:53,420
struggling is what we were actually just talking about.

683
00:46:53,420 --> 00:47:00,320
One being very much of put the mask on, keeping my mouth shut in terms of, you know, I'm good,

684
00:47:00,320 --> 00:47:01,320
I'm fine.

685
00:47:01,320 --> 00:47:06,040
I use the example of driving your car when the check light is on.

686
00:47:06,040 --> 00:47:07,040
Okay?

687
00:47:07,040 --> 00:47:08,320
We all have a check engine light on our car.

688
00:47:08,320 --> 00:47:13,600
When the check engine light goes off, doesn't mean there's something terribly wrong.

689
00:47:13,600 --> 00:47:15,800
Just means, hey, you check in on this.

690
00:47:15,800 --> 00:47:18,840
Could be something as minuscule as change your oil.

691
00:47:18,840 --> 00:47:19,840
Right?

692
00:47:19,840 --> 00:47:25,280
But you can still drive your car for a long time with the check engine light on.

693
00:47:25,280 --> 00:47:26,280
Long time.

694
00:47:26,280 --> 00:47:27,280
You know how I know?

695
00:47:27,280 --> 00:47:28,280
Because I've done it.

696
00:47:28,280 --> 00:47:30,680
And six months later, my transmission blew out.

697
00:47:30,680 --> 00:47:36,600
And I was left with a very costly repair and, you know, that set in motion a lot of other

698
00:47:36,600 --> 00:47:38,280
things with my car.

699
00:47:38,280 --> 00:47:42,640
That being said, when we're driving our car with our check engine light on for months,

700
00:47:42,640 --> 00:47:50,240
years on end, at some point, that transmission is likely going to blow out and cause a lot

701
00:47:50,240 --> 00:47:54,520
more issues, you know, and have a lot more of a significant impact on our life.

702
00:47:54,520 --> 00:47:59,360
So I'd say the multitude of factors that go into someone struggling, particularly in the

703
00:47:59,360 --> 00:48:06,960
first responder world, are just autopilot, you know, not talking to other people, at

704
00:48:06,960 --> 00:48:10,640
least not about things that we're experiencing or going through.

705
00:48:10,640 --> 00:48:11,640
Using vices.

706
00:48:11,640 --> 00:48:16,200
You know, instead of talking to people, I'm just going to have a couple more drinks or

707
00:48:16,200 --> 00:48:18,640
I'm going to watch more pornography.

708
00:48:18,640 --> 00:48:20,560
Next thing you know, I'm watching more porn.

709
00:48:20,560 --> 00:48:27,480
I'm going to keep myself so busy or I'm going to keep getting those adrenaline hits outside

710
00:48:27,480 --> 00:48:28,520
of the job.

711
00:48:28,520 --> 00:48:31,560
So I notice that I need to just keep going and going and going.

712
00:48:31,560 --> 00:48:34,720
And when I have to be stagnant, something's not right, right?

713
00:48:34,720 --> 00:48:36,080
I don't feel great.

714
00:48:36,080 --> 00:48:43,000
So that is a long winded answer of like, broadly speaking of what I think leads to someone

715
00:48:43,000 --> 00:48:48,240
in the first responder world developing like more significant issues is that check engine

716
00:48:48,240 --> 00:48:54,960
light is on and we are still going forward without actually looking at doing any maintenance,

717
00:48:54,960 --> 00:49:00,480
looking at why the check engine light is on and we just keep driving the car for hundreds,

718
00:49:00,480 --> 00:49:02,480
thousands of miles.

719
00:49:02,480 --> 00:49:04,840
Yeah.

720
00:49:04,840 --> 00:49:06,600
And I think it's pretty easy.

721
00:49:06,600 --> 00:49:08,180
Everything you said, I agree with.

722
00:49:08,180 --> 00:49:12,280
And I'm just adding that it's pretty easy for people, especially in these roles and

723
00:49:12,280 --> 00:49:16,640
with how understaffed agencies are right now for them to just say, I'll take care of myself

724
00:49:16,640 --> 00:49:17,640
later.

725
00:49:17,640 --> 00:49:20,360
So I'll just put myself on the back burner because the job's got to get done today and

726
00:49:20,360 --> 00:49:21,360
I'll take care of myself tomorrow.

727
00:49:21,360 --> 00:49:26,000
I'll take care of myself next week, next month, next shift, bid, whatever it is.

728
00:49:26,000 --> 00:49:27,360
And that day never comes.

729
00:49:27,360 --> 00:49:33,080
So a lot of the people that come to me, it's a mixture of disconnection from self, disconnection

730
00:49:33,080 --> 00:49:38,680
from others, and then disconnection from their, like their, their community.

731
00:49:38,680 --> 00:49:44,240
So others more broadly, where they're not investing in passions or hobbies or any self

732
00:49:44,240 --> 00:49:46,200
care activities at all.

733
00:49:46,200 --> 00:49:48,880
They're not connected to their spirituality, if that's important to them.

734
00:49:48,880 --> 00:49:52,480
They're not connected to their family, if they have, if they have one.

735
00:49:52,480 --> 00:49:54,540
They're not seeing their friends anymore.

736
00:49:54,540 --> 00:49:58,080
They're doing the job, but they're not getting any source of satisfaction from it at all.

737
00:49:58,080 --> 00:49:59,920
They don't understand why they're still doing it.

738
00:49:59,920 --> 00:50:02,560
It's just money in the bank type of deal.

739
00:50:02,560 --> 00:50:08,580
And then where they are putting their effort tends to be in things that are quick, convenient,

740
00:50:08,580 --> 00:50:10,440
and easily pleasurable.

741
00:50:10,440 --> 00:50:17,180
So like Dr. Brooke was saying, they're using pornography, they're engaging in maybe affairs

742
00:50:17,180 --> 00:50:19,720
with other people at work or otherwise.

743
00:50:19,720 --> 00:50:23,080
They're reckless driving.

744
00:50:23,080 --> 00:50:27,080
They're getting drunk on the weekends with family or friends, but they're taking it a

745
00:50:27,080 --> 00:50:28,480
little too far.

746
00:50:28,480 --> 00:50:30,360
It's this kind of stuff that they're doing.

747
00:50:30,360 --> 00:50:31,860
So, but it's a slow roll.

748
00:50:31,860 --> 00:50:35,480
So it's not just, you know, one day I was okay in the job and I was really getting a

749
00:50:35,480 --> 00:50:36,880
lot of satisfaction from it.

750
00:50:36,880 --> 00:50:40,360
And then next Sunday, it's totally flipped the script on me.

751
00:50:40,360 --> 00:50:41,360
It's gradual.

752
00:50:41,360 --> 00:50:42,700
It's that grind.

753
00:50:42,700 --> 00:50:48,000
So when I see people in my practice, I often ask them, draw out for me what the last week

754
00:50:48,000 --> 00:50:53,840
looked like for you from 7 a.m. to 7 p.m. or whatever your hours of being awake are,

755
00:50:53,840 --> 00:50:56,240
draw out for me how you spent your time.

756
00:50:56,240 --> 00:51:01,520
And in this week, tell me how on average, if this is regular for you or if this is something

757
00:51:01,520 --> 00:51:04,020
totally off base, it was just a weird week.

758
00:51:04,020 --> 00:51:08,860
And what I end up seeing is that they're almost doing nothing for themselves that would lead

759
00:51:08,860 --> 00:51:10,940
to being an adaptive behavior.

760
00:51:10,940 --> 00:51:14,360
Their nutrition's out of whack, their exercise is non-existent, they're not spending any

761
00:51:14,360 --> 00:51:16,000
time with friends or family.

762
00:51:16,000 --> 00:51:19,240
They're just working themselves into a puddle.

763
00:51:19,240 --> 00:51:23,720
And so I would just ask would anybody have good mental health if they were doing that,

764
00:51:23,720 --> 00:51:27,800
regardless of first responder occupation or not?

765
00:51:27,800 --> 00:51:28,800
No.

766
00:51:28,800 --> 00:51:34,000
One area that's just hands down getting worse and worse and worse is our recruitment crisis.

767
00:51:34,000 --> 00:51:39,560
You know, I've been very vocal about the ridiculous nature of our even basic work week, but then

768
00:51:39,560 --> 00:51:43,520
you add the mandatory overtime into that or the voluntary overtime, which I would argue

769
00:51:43,520 --> 00:51:45,880
is another unhealthy coping mechanism.

770
00:51:45,880 --> 00:51:48,880
I think work is the unspoken one.

771
00:51:48,880 --> 00:51:51,680
You have responders working insane hours.

772
00:51:51,680 --> 00:51:59,440
My goal is to make it a 42-hour work week nationally, 24, 72 standard shift cycle.

773
00:51:59,440 --> 00:52:03,800
And that would then attract young people back into our profession and therefore resolve

774
00:52:03,800 --> 00:52:05,560
most of the staffing problems as well.

775
00:52:05,560 --> 00:52:10,000
That way people will be back in their homes, in their beds with their families.

776
00:52:10,000 --> 00:52:16,160
Talk to me about the impact of sleep deprivation when it comes to the mental health side.

777
00:52:16,160 --> 00:52:17,800
How much time do you have?

778
00:52:17,800 --> 00:52:20,720
All the time in the world, Brooke.

779
00:52:20,720 --> 00:52:24,840
Well spoiler alert, sleep is very important.

780
00:52:24,840 --> 00:52:30,640
And it just, I think, including myself, I was guilty of this in the past, you know,

781
00:52:30,640 --> 00:52:34,240
yeah, yeah, yeah, yeah, yeah, sleep is important, sleep is important, sleep is important.

782
00:52:34,240 --> 00:52:39,040
But when we actually like learn about what sleep does, quite literally what it does both

783
00:52:39,040 --> 00:52:43,000
for our physical and our mental health, and physical and mental health are, you know,

784
00:52:43,000 --> 00:52:45,480
tied together, right?

785
00:52:45,480 --> 00:52:47,600
It's really, really, really fascinating.

786
00:52:47,600 --> 00:52:55,120
On the mental side of things, when we're sleeping, our memories are being consolidated and stored

787
00:52:55,120 --> 00:52:56,660
properly.

788
00:52:56,660 --> 00:53:01,360
Our emotions are actually processing while we're sleeping.

789
00:53:01,360 --> 00:53:07,320
All very important things, right, on the physical side of things, we repair, our body is repairing

790
00:53:07,320 --> 00:53:13,600
our muscle tissues, it's regenerating cells, it's doing all these things to make sure we're

791
00:53:13,600 --> 00:53:14,600
healthy.

792
00:53:14,600 --> 00:53:23,700
Here's kind of the way I explain it now, is that our sleep prepares us to be as optimized

793
00:53:23,700 --> 00:53:26,080
as possible when we're awake.

794
00:53:26,080 --> 00:53:31,560
Meaning it's not, I need to be as productive and optimal when I'm awake and then I have

795
00:53:31,560 --> 00:53:33,040
to sleep.

796
00:53:33,040 --> 00:53:38,580
Your sleep actually sets the precedence for how productive and optimal your health, mental

797
00:53:38,580 --> 00:53:40,840
and physical health are going to be when you're awake.

798
00:53:40,840 --> 00:53:43,440
That is quite literally what it is for.

799
00:53:43,440 --> 00:53:50,060
So when we're not sleeping, when we have chronic sleep deprivation or chronic sleep issues,

800
00:53:50,060 --> 00:53:53,200
it takes a massive toll on our mental and physical health.

801
00:53:53,200 --> 00:53:57,440
They typically tend to plummet.

802
00:53:57,440 --> 00:54:01,840
In very important aspects, if we're talking about the requirements of a job in public

803
00:54:01,840 --> 00:54:10,080
safety, things like decision making, snap decision making, logical reasoning, memory,

804
00:54:10,080 --> 00:54:16,560
all these things that our research has shown that things like reaction time, snap decision

805
00:54:16,560 --> 00:54:21,520
making, all of those things plummeted for first responders when they were chronically

806
00:54:21,520 --> 00:54:22,880
sleep deprived.

807
00:54:22,880 --> 00:54:28,540
These things affect the first responder, not only on the individual level, but what I really

808
00:54:28,540 --> 00:54:34,800
try and get across the leadership is it has a macro impact on the organization.

809
00:54:34,800 --> 00:54:38,000
It can lead to more sick time.

810
00:54:38,000 --> 00:54:42,160
It can lead to more line of duty injuries or God forbid line of duty deaths.

811
00:54:42,160 --> 00:54:44,840
It can lead to more turnover because people are just tired of it.

812
00:54:44,840 --> 00:54:45,840
It's not manageable, right?

813
00:54:45,840 --> 00:54:50,520
And then you have to spend more money to recruit and train.

814
00:54:50,520 --> 00:54:55,120
But sleep is extremely important and I do a lot of sleep trainings.

815
00:54:55,120 --> 00:55:01,360
I have my on demand sleep course now because I feel like if we're talking about, if an

816
00:55:01,360 --> 00:55:05,000
organization wants to bring me in, they're like, we don't even know where to start.

817
00:55:05,000 --> 00:55:07,600
What should we just, what's the first thing we should focus on?

818
00:55:07,600 --> 00:55:10,960
I always say sleep because I'm like, this is something we can all relate to because

819
00:55:10,960 --> 00:55:13,800
it's all something we have to do, right?

820
00:55:13,800 --> 00:55:19,360
And it's something that is at the foundation of physical and mental health.

821
00:55:19,360 --> 00:55:23,480
Yeah, sleep is absolutely fundamental.

822
00:55:23,480 --> 00:55:24,860
We have to be focusing on it.

823
00:55:24,860 --> 00:55:28,600
And I think the work that I do with a lot of organizations, it starts at sleep too.

824
00:55:28,600 --> 00:55:32,280
I'm thinking about the annual wellness visits that I do for staff.

825
00:55:32,280 --> 00:55:37,520
I hand everybody an educational packet and I was smiling as Dr. Brooke was talking because

826
00:55:37,520 --> 00:55:40,780
the first page of my packet is sleep education.

827
00:55:40,780 --> 00:55:44,560
And it gives them information about how many hours when you're awake, what it's related

828
00:55:44,560 --> 00:55:47,320
to as blood alcohol content.

829
00:55:47,320 --> 00:55:52,960
To be able to give them a comparison of if you are awake for 24 hours at a time, there's

830
00:55:52,960 --> 00:55:56,240
significant detrimental effects to that.

831
00:55:56,240 --> 00:56:01,080
And not only for you as the person that's experiencing it, but in your job, if it is

832
00:56:01,080 --> 00:56:05,800
to be interacting with the community in some capacity and maybe you have the opportunity

833
00:56:05,800 --> 00:56:10,720
to use lethal force if necessary, that's a huge decision to be making.

834
00:56:10,720 --> 00:56:14,160
You don't want to be making that decision sleep deprived.

835
00:56:14,160 --> 00:56:21,200
I think the really difficult part for me is we are working with the individual level factor.

836
00:56:21,200 --> 00:56:24,840
How sleep deprived is this person or how much sleep are they getting?

837
00:56:24,840 --> 00:56:28,840
But the actual intervention point is within something outside of that person.

838
00:56:28,840 --> 00:56:30,660
It's within the organization.

839
00:56:30,660 --> 00:56:35,400
So a lot of the work that you're doing, James, talking about wanting to shift the focus at

840
00:56:35,400 --> 00:56:40,160
the organizational level is huge because if we don't have the ability to impact change

841
00:56:40,160 --> 00:56:44,320
there, talking to a person about what they can do individually is only going to get us

842
00:56:44,320 --> 00:56:49,480
so far because we're always going to be constrained by what those organizational demands are.

843
00:56:49,480 --> 00:56:54,000
And I've run into that where I'll be talking to supervisors about, hey, a lot of your people

844
00:56:54,000 --> 00:56:57,520
are requesting time off and it seems like they're not able to get that.

845
00:56:57,520 --> 00:57:02,300
And they'll say things like, I know, literally my hands are tied, there's nothing I can do.

846
00:57:02,300 --> 00:57:07,440
And that creates its own issues on the supervisory level where they feel like they are harming

847
00:57:07,440 --> 00:57:12,640
their own people because they're between a rock and a hard place with the organizational

848
00:57:12,640 --> 00:57:15,280
demand and what they know is best for their employees.

849
00:57:15,280 --> 00:57:18,400
So it's really a huge problem.

850
00:57:18,400 --> 00:57:19,400
Absolutely.

851
00:57:19,400 --> 00:57:20,400
Two things.

852
00:57:20,400 --> 00:57:25,160
Firstly, the blood alcohol element, the sleep medicine world has talked about that.

853
00:57:25,160 --> 00:57:29,560
But I think what's interesting is if you think about how most research studies are done,

854
00:57:29,560 --> 00:57:31,360
a lot of times it's college kids.

855
00:57:31,360 --> 00:57:35,800
You get 50 bucks and you come do the study and then you can go buy beer the next day.

856
00:57:35,800 --> 00:57:40,160
So you've got people that I would argue are usually in their beds every night, maybe not

857
00:57:40,160 --> 00:57:42,300
Friday, Saturday night, but most of the time they are.

858
00:57:42,300 --> 00:57:47,360
So these studies are probably on well-slept people that didn't sleep for 24 hours.

859
00:57:47,360 --> 00:57:52,760
So what is actually the cognitive parallel of blood alcohol for a firefighter that's

860
00:57:52,760 --> 00:57:56,520
worked for 20 years every third day plus mandatory overtime?

861
00:57:56,520 --> 00:57:58,480
Probably way past point one.

862
00:57:58,480 --> 00:58:00,540
It's probably much higher than that.

863
00:58:00,540 --> 00:58:01,920
So I think that's a big issue.

864
00:58:01,920 --> 00:58:07,760
The other thing as well with this conversation, and I'm always fair, even with the obesity

865
00:58:07,760 --> 00:58:13,680
element in uniform, when you look at the environment we work in, it sets these responders up for

866
00:58:13,680 --> 00:58:14,760
failure.

867
00:58:14,760 --> 00:58:19,080
You are far more likely to be overweight, have your testosterone in the toilet, all

868
00:58:19,080 --> 00:58:22,460
these things working the way we work.

869
00:58:22,460 --> 00:58:24,980
So ownership is absolutely part of it.

870
00:58:24,980 --> 00:58:25,980
What do you eat?

871
00:58:25,980 --> 00:58:26,980
Are you moving?

872
00:58:26,980 --> 00:58:27,980
Are you trying to sleep?

873
00:58:27,980 --> 00:58:28,980
But the environment is the other part.

874
00:58:28,980 --> 00:58:30,440
And it's the same with this.

875
00:58:30,440 --> 00:58:36,720
And to put it on us, if we forge a work week that is healthy, then we as a responder have

876
00:58:36,720 --> 00:58:38,560
to own our sleep hygiene when we're home.

877
00:58:38,560 --> 00:58:43,000
We have to not take overnight shifts to the ER or an ambulance company.

878
00:58:43,000 --> 00:58:45,960
But we can absolutely, and this is what drives me crazy, oh, they'll work anyway.

879
00:58:45,960 --> 00:58:50,000
Well, yeah, but they'll hang drywall, do landscaping, personal train.

880
00:58:50,000 --> 00:58:53,400
They'll be tired and they'll sleep next to their husband or wife and wake up next to

881
00:58:53,400 --> 00:58:54,640
their kids in the morning.

882
00:58:54,640 --> 00:58:56,480
So I think that this is the thing.

883
00:58:56,480 --> 00:58:57,640
It's not one or the other.

884
00:58:57,640 --> 00:58:59,000
Again, it's both.

885
00:58:59,000 --> 00:59:02,920
But if the organization is turning their back and just saying they need to sleep better

886
00:59:02,920 --> 00:59:07,640
when they're at home, you're missing, I would argue, two thirds of the conversation.

887
00:59:07,640 --> 00:59:10,120
Yeah, I agree.

888
00:59:10,120 --> 00:59:14,440
And like what Dr. Jenner was saying, I've run into this a lot too, where I'm working

889
00:59:14,440 --> 00:59:22,000
with an agency that at the organizational level is not necessarily being run in a way

890
00:59:22,000 --> 00:59:25,800
that's optimal for sleep.

891
00:59:25,800 --> 00:59:30,560
But another reason why I like to come in and do these sleep trainings is because it's one

892
00:59:30,560 --> 00:59:35,560
of the few aspects that I feel like I can empower first responders with and be like,

893
00:59:35,560 --> 00:59:41,280
okay, I understand that you're really pissed off at leadership and the way things have

894
00:59:41,280 --> 00:59:45,680
been running and you're running 10 calls a night and having to do so much manatee over

895
00:59:45,680 --> 00:59:48,000
time and that's impacting your sleep.

896
00:59:48,000 --> 00:59:55,760
But let me at least give you scientific ways, show you based on scientific evidence how

897
00:59:55,760 --> 01:00:03,240
you can prioritize and manage and behaviorally habitually operate outside of the job so that

898
01:00:03,240 --> 01:00:09,000
you can optimize your sleep off the job, which then ends up actually diminishing the effects

899
01:00:09,000 --> 01:00:11,160
that the sleep deprivation can have on the job.

900
01:00:11,160 --> 01:00:15,640
And it's called sleep banking and it's been studied by sleep neuroscientists.

901
01:00:15,640 --> 01:00:20,920
But basically the idea of can we make up for lost sleep?

902
01:00:20,920 --> 01:00:25,120
No, we can't say I haven't slept for two weeks, but I got a night or two good sleep, which

903
01:00:25,120 --> 01:00:28,120
means that didn't matter anymore.

904
01:00:28,120 --> 01:00:34,360
But what we can do is we can optimize our sleep leading into times like when we know

905
01:00:34,360 --> 01:00:41,600
we're going on shift for a few days so that the effects of that sleep deprivation on shift

906
01:00:41,600 --> 01:00:45,300
are slightly diminished, that the negative effects of that sleep deprivation are slightly

907
01:00:45,300 --> 01:00:46,720
diminished.

908
01:00:46,720 --> 01:00:51,560
And that's where we come in where the important message is then it's up to you, right?

909
01:00:51,560 --> 01:00:56,120
Meaning like how much do you actually prioritize this because if you're not actually prioritizing

910
01:00:56,120 --> 01:01:01,400
your sleep when you have when it's in your control and you have the opportunity to, you

911
01:01:01,400 --> 01:01:04,000
know, then you're getting it on both ends.

912
01:01:04,000 --> 01:01:05,000
Right.

913
01:01:05,000 --> 01:01:09,400
And I also wanted to comment on it made me think James, because when you ask this, like

914
01:01:09,400 --> 01:01:18,040
the multitude of factors that go into someone in service having issues, sleep is a big one.

915
01:01:18,040 --> 01:01:19,220
Right.

916
01:01:19,220 --> 01:01:24,480
Sleep is massive and I talk about this a lot too, is that there is a plethora of scientific

917
01:01:24,480 --> 01:01:30,360
research studies that show that sleep deprivation is associated with higher risk of developing

918
01:01:30,360 --> 01:01:36,160
every major psychiatric problem, post-traumatic stress disorder, major depression, anxiety

919
01:01:36,160 --> 01:01:37,160
disorders.

920
01:01:37,160 --> 01:01:38,160
Right.

921
01:01:38,160 --> 01:01:40,760
And it's a risk factor for suicide.

922
01:01:40,760 --> 01:01:45,240
And the way I explain this is doesn't mean that because I'm not sleeping, that means

923
01:01:45,240 --> 01:01:48,880
I'm just all of a sudden going to be taken over and attempt suicide.

924
01:01:48,880 --> 01:01:54,140
That's not what that means, but it's one factor of many, because let's talk about review.

925
01:01:54,140 --> 01:01:57,360
What we just talked about with what sleep does is it's optimal for our physical and

926
01:01:57,360 --> 01:01:58,360
mental health.

927
01:01:58,360 --> 01:02:01,400
So when we're chronically sleep deprived, we're not thinking straight.

928
01:02:01,400 --> 01:02:02,400
We're exhausted.

929
01:02:02,400 --> 01:02:03,400
We're grumpy.

930
01:02:03,400 --> 01:02:04,400
We're irritable.

931
01:02:04,400 --> 01:02:07,320
We're snapping at our family members or our family relationships start to go down.

932
01:02:07,320 --> 01:02:11,160
We don't have the energy to socialize or engage in hobbies or things we enjoy doing off the

933
01:02:11,160 --> 01:02:12,160
job.

934
01:02:12,160 --> 01:02:13,200
So that goes downhill.

935
01:02:13,200 --> 01:02:17,020
Then we're on the job and we're just a zombie and we're going through all these things build

936
01:02:17,020 --> 01:02:24,080
up and make way for problems like post-traumatic stress and anxiety and depression and alcoholism,

937
01:02:24,080 --> 01:02:28,280
which then increase the risk for suicide at some point.

938
01:02:28,280 --> 01:02:31,840
If someone gets to the point where they're not getting the help they need and it just

939
01:02:31,840 --> 01:02:33,020
continues to snowball.

940
01:02:33,020 --> 01:02:34,800
So sleep is so important.

941
01:02:34,800 --> 01:02:36,720
It's a huge prevention factor.

942
01:02:36,720 --> 01:02:40,640
Jen, anything to add before we move on?

943
01:02:40,640 --> 01:02:44,200
I think she covered it well said.

944
01:02:44,200 --> 01:02:49,640
The other crazy thing that I've realized now is it's a money saver as well.

945
01:02:49,640 --> 01:02:55,360
And sadly, I'm glad that this is the thing that's actually moving the conversation because

946
01:02:55,360 --> 01:02:59,900
to me, the parallel I use is we used to send children up chimneys and work in factories

947
01:02:59,900 --> 01:03:01,000
in Victorian times.

948
01:03:01,000 --> 01:03:04,360
And then one day someone said, this isn't right and we stopped doing it.

949
01:03:04,360 --> 01:03:07,360
Well this is where we're at in the mental health and physical health conversation in

950
01:03:07,360 --> 01:03:08,960
the first responders.

951
01:03:08,960 --> 01:03:10,920
But the good news is it saves money too.

952
01:03:10,920 --> 01:03:14,880
It's an absolute false economy when you drive your responders into the ground.

953
01:03:14,880 --> 01:03:18,100
And that's why we have a recruitment crisis and so many vacancies.

954
01:03:18,100 --> 01:03:22,200
But if you look at the money that departments spend on new recruits that will walk out the

955
01:03:22,200 --> 01:03:27,240
back door in a year or two and the overtime costs alone, there is more than enough money

956
01:03:27,240 --> 01:03:30,660
to staff up a fourth shift, a D shift.

957
01:03:30,660 --> 01:03:35,160
And then that excites young people to come to your department, filling all the holes

958
01:03:35,160 --> 01:03:37,500
and now you're operating optimally.

959
01:03:37,500 --> 01:03:42,600
So this is a beautiful thing is the solution not only saves first responders lives, which

960
01:03:42,600 --> 01:03:47,960
is what I care about, it also saves cities and counties money, which then will put that

961
01:03:47,960 --> 01:03:52,780
fourth person back on the engine, help put a gym in the stations, help hire a mental

962
01:03:52,780 --> 01:03:58,200
health counselor and we start filling in all these other areas that we can address.

963
01:03:58,200 --> 01:04:04,920
I quote you in some of my talks, James, from your first book where you talk about that.

964
01:04:04,920 --> 01:04:12,160
And I quote you in when I'm really trying to get across the idea that, you know, ideally

965
01:04:12,160 --> 01:04:16,720
leadership would want their workforce to be just healthier and happier in general.

966
01:04:16,720 --> 01:04:20,800
But hey, if that's not really at the top of mind, then what about money?

967
01:04:20,800 --> 01:04:21,800
How about saving money?

968
01:04:21,800 --> 01:04:22,800
Right.

969
01:04:22,800 --> 01:04:26,400
So I really tried to hit it from both sides.

970
01:04:26,400 --> 01:04:27,400
Absolutely.

971
01:04:27,400 --> 01:04:28,400
Well, thank you.

972
01:04:28,400 --> 01:04:29,640
The second one's coming out next week.

973
01:04:29,640 --> 01:04:34,080
So it's a story this time is fiction, but it's basically historical fiction.

974
01:04:34,080 --> 01:04:35,440
It's all pretty much true.

975
01:04:35,440 --> 01:04:39,640
But hopefully that, you know, my goal is to make that into a TV show because I want this

976
01:04:39,640 --> 01:04:43,800
to be through the screens and people to really understand what our men and women do and the

977
01:04:43,800 --> 01:04:49,280
costs of that and the multi-generational trauma story that's woven in as well.

978
01:04:49,280 --> 01:04:54,260
So I'm hoping that most people that watch it and or read it will see themselves in one

979
01:04:54,260 --> 01:04:55,400
of the characters in the story.

980
01:04:55,400 --> 01:04:59,440
And we can put some compassion and empathy back in this mental and physical health conversation.

981
01:04:59,440 --> 01:05:00,440
All right.

982
01:05:00,440 --> 01:05:02,100
Well, they're moving on.

983
01:05:02,100 --> 01:05:08,680
So the next topic I want to hit EAP is, you know, an acronym that doesn't mean that much

984
01:05:08,680 --> 01:05:09,680
to most people.

985
01:05:09,680 --> 01:05:13,920
But when you have a podcast like this and you've spoken to so many first responders

986
01:05:13,920 --> 01:05:19,480
who were struggling, the EAP Russian roulette or EAP nightmare is something that I get a

987
01:05:19,480 --> 01:05:20,480
lot.

988
01:05:20,480 --> 01:05:26,320
Now, the framework obviously can be incredibly proactive and full of culturally competent

989
01:05:26,320 --> 01:05:33,200
clinicians or it can be an absolute shit show of randomly selected low bid people that probably

990
01:05:33,200 --> 01:05:38,240
are going to do more harm than good if a responder even manages to get an appointment with them.

991
01:05:38,240 --> 01:05:44,720
So I'd love to just unpack, you know, what the the framework of the EAP is supposed to

992
01:05:44,720 --> 01:05:45,800
be like.

993
01:05:45,800 --> 01:05:49,680
And let's kind of paint the picture of what it should contain, the kind of providers that

994
01:05:49,680 --> 01:05:53,680
people should be able to find in a good EAP program.

995
01:05:53,680 --> 01:05:58,240
So EAP stands for Employee Assistance Program.

996
01:05:58,240 --> 01:06:05,600
And broadly, it's supposed to be a resource that employees can access through their work

997
01:06:05,600 --> 01:06:11,160
where it's paid for, it's confidential, and they can get in for an appointment relatively

998
01:06:11,160 --> 01:06:13,500
quickly.

999
01:06:13,500 --> 01:06:17,880
In practice, whether or not that happens is different and based on a lot of different

1000
01:06:17,880 --> 01:06:18,880
factors.

1001
01:06:18,880 --> 01:06:23,580
EAPs are staffed by providers that are available in that area.

1002
01:06:23,580 --> 01:06:28,680
So resources, the availability of mental health professionals to be able to join an EAP, the

1003
01:06:28,680 --> 01:06:33,840
willingness of them to do that, and then whichever company is contracted with that organization

1004
01:06:33,840 --> 01:06:37,880
that that can impact who you could get on the other end of the line when you're making

1005
01:06:37,880 --> 01:06:41,000
the phone call.

1006
01:06:41,000 --> 01:06:48,040
I think one thing I can say confidently is I don't believe that anybody gets into the

1007
01:06:48,040 --> 01:06:54,240
mental health field and wants to have bad intentions, wants to do harm, wants to do

1008
01:06:54,240 --> 01:06:56,480
a bad job doing therapy with people.

1009
01:06:56,480 --> 01:07:01,160
I think whether or not somebody is effective at their job is a culmination of their education,

1010
01:07:01,160 --> 01:07:07,760
training experiences, willingness to be humble, gain supervision and consultation, and have

1011
01:07:07,760 --> 01:07:09,880
an appropriate work-life balance.

1012
01:07:09,880 --> 01:07:14,000
I cannot speak for all the EAPs out there and say whether or not the providers that

1013
01:07:14,000 --> 01:07:18,380
are part of that have all of that together or not.

1014
01:07:18,380 --> 01:07:23,040
But in the organizations that I've worked with, when I've had phone calls with EAPs

1015
01:07:23,040 --> 01:07:26,560
and been able to talk about their process for making referrals, whether or not people

1016
01:07:26,560 --> 01:07:31,840
have choice in picking their providers, the ones in my area are fairly good in terms of

1017
01:07:31,840 --> 01:07:37,120
having immediate availability for someone, making sure that the payment process is not

1018
01:07:37,120 --> 01:07:41,560
a hassle, they're not worried about that, and if they weren't satisfied, being able

1019
01:07:41,560 --> 01:07:43,960
to be transferred to another provider.

1020
01:07:43,960 --> 01:07:52,600
I think there is a, maybe not a misconception, but I think that there's talk about EAPs being

1021
01:07:52,600 --> 01:07:56,600
like quote unquote garbage and therefore people don't want to go to them, and I don't think

1022
01:07:56,600 --> 01:07:57,800
that that's the case.

1023
01:07:57,800 --> 01:08:02,880
I think that there are people who have had bad experiences, and that is probably true,

1024
01:08:02,880 --> 01:08:05,400
and that's soured their taste.

1025
01:08:05,400 --> 01:08:07,180
And that's valid.

1026
01:08:07,180 --> 01:08:10,920
They're entitled to their opinion, their experience likely was what it was, but I don't think

1027
01:08:10,920 --> 01:08:15,200
that's a call to just throw the baby out with the bathwater.

1028
01:08:15,200 --> 01:08:16,960
Yeah.

1029
01:08:16,960 --> 01:08:23,640
My experiences with public safety and for responders and EAPs hasn't been as positive.

1030
01:08:23,640 --> 01:08:34,000
And I really think that I agree with Dr. Jen on the intention behind it, but I think that

1031
01:08:34,000 --> 01:08:40,560
having an EAP workforce, your clinicians that are available, making sure if we're talking

1032
01:08:40,560 --> 01:08:44,640
about working with public safety, putting in the measurements, and even if that means

1033
01:08:44,640 --> 01:08:49,240
a little bit of extra money or a little bit extra time at the front end to ensure that

1034
01:08:49,240 --> 01:08:56,260
you have providers that are well equipped to actually work with first responders.

1035
01:08:56,260 --> 01:09:02,640
They don't need to be the best, most highly specialized people ever or anything like that,

1036
01:09:02,640 --> 01:09:09,160
but just kind of has the foundational, knows the foundational aspects of the culture and

1037
01:09:09,160 --> 01:09:12,080
the ins and outs of that.

1038
01:09:12,080 --> 01:09:16,640
And so that also that the EAP providers are aware of whether or not this is actually a

1039
01:09:16,640 --> 01:09:19,240
population they want to work with.

1040
01:09:19,240 --> 01:09:24,800
I have come across EAP providers who are like, I learned that this is not healthy for me.

1041
01:09:24,800 --> 01:09:27,480
It's too difficult for me.

1042
01:09:27,480 --> 01:09:29,200
It's not a good fit.

1043
01:09:29,200 --> 01:09:33,760
So I think that comes at the macro level, like the organizational level and whatever

1044
01:09:33,760 --> 01:09:41,840
EAP company is to ensure that they're providing therapists to a public safety agency that are

1045
01:09:41,840 --> 01:09:48,400
actually culturally competent, but also on the agency's end to make sure that the EAP

1046
01:09:48,400 --> 01:09:53,600
that they're contracting with meet those just basic prerequisites.

1047
01:09:53,600 --> 01:09:59,100
And like Jenna was saying, on top of just the cultural competency, making sure it's very

1048
01:09:59,100 --> 01:10:09,160
clear how many sessions you get, what problems you can seek therapy for through the EAP.

1049
01:10:09,160 --> 01:10:13,800
Is there a process for if there's someone that I'm seeing or I have a session, it's

1050
01:10:13,800 --> 01:10:16,520
not a good fit for me and I want to find someone else.

1051
01:10:16,520 --> 01:10:17,520
What about confidentiality?

1052
01:10:17,520 --> 01:10:20,880
If I'm going to EAP, what am I going to do then?

1053
01:10:20,880 --> 01:10:26,560
If I tell them something, are they going to run with it and tell my command staff?

1054
01:10:26,560 --> 01:10:33,080
And so I think the responsibility is on both ends of the spectrum.

1055
01:10:33,080 --> 01:10:37,120
And I've definitely worked with public safety agencies that don't really look into it that

1056
01:10:37,120 --> 01:10:38,120
much.

1057
01:10:38,120 --> 01:10:42,080
They're just like, it's an EAP and look at that number is pretty low.

1058
01:10:42,080 --> 01:10:44,500
So let's go with that one.

1059
01:10:44,500 --> 01:10:45,500
And they do that.

1060
01:10:45,500 --> 01:10:50,200
And that's obviously super harmful as well.

1061
01:10:50,200 --> 01:10:54,600
I've also worked with organizations where I've asked them if they have any statistics,

1062
01:10:54,600 --> 01:10:58,120
that they look at what their EAP usage is.

1063
01:10:58,120 --> 01:11:01,480
So they even have a baseline of whether or not what they're paying for to provide that

1064
01:11:01,480 --> 01:11:05,240
service, if they're getting any return on the investment, where people are even feeling

1065
01:11:05,240 --> 01:11:08,600
comfortable to be able to go in and utilize it.

1066
01:11:08,600 --> 01:11:13,160
And a lot of organizations don't have any, they're not tracking any of that.

1067
01:11:13,160 --> 01:11:18,080
Now, depending on who they're contracting with, sometimes that data is available, like

1068
01:11:18,080 --> 01:11:22,720
a certain percentage of phone calls per month, per year, whatever it is.

1069
01:11:22,720 --> 01:11:25,160
In some organizations, they won't provide that.

1070
01:11:25,160 --> 01:11:29,320
So it really depends on who they're contracting with and what they have access to.

1071
01:11:29,320 --> 01:11:32,640
But I think that's a really important number to be tracking.

1072
01:11:32,640 --> 01:11:36,960
Is the service that we've decided we're going to spend money on even being utilized?

1073
01:11:36,960 --> 01:11:41,040
Because what I've watched happen in my area is a lot of organizations decide to embed

1074
01:11:41,040 --> 01:11:47,100
their own mental health provider for their people to use, which is a great resource,

1075
01:11:47,100 --> 01:11:50,180
but it is in a way double dipping a bit.

1076
01:11:50,180 --> 01:11:53,760
If you have this EAP program and nobody's using it, but you're spending money on it,

1077
01:11:53,760 --> 01:11:57,800
and now you're trying to argue we need somebody that's embedded because we get to see them

1078
01:11:57,800 --> 01:12:02,640
every day, we know who they are, we trust them, we know they're culturally competent,

1079
01:12:02,640 --> 01:12:07,820
then everything that Dr. Brooks said about ensuring on the EAP and that that's happening,

1080
01:12:07,820 --> 01:12:10,760
you're just doubling back and doing on the agency side.

1081
01:12:10,760 --> 01:12:15,740
So just some things for agencies to think about there.

1082
01:12:15,740 --> 01:12:20,240
Some of the horror stories that have been repeated over and over again were anything

1083
01:12:20,240 --> 01:12:25,540
from the phone number not even working, not be able to get an appointment for as you touched

1084
01:12:25,540 --> 01:12:31,320
on in the VA, you know, three, six months and you go to someone who's in crisis, the

1085
01:12:31,320 --> 01:12:35,880
the clinician breaking down in tears, the clinician telling them I can't help you get

1086
01:12:35,880 --> 01:12:38,600
out, you know, and I say this a lot.

1087
01:12:38,600 --> 01:12:39,920
These are the ones I heard.

1088
01:12:39,920 --> 01:12:43,480
How many will I never hear because that was the final nail in the coffin, you know, so

1089
01:12:43,480 --> 01:12:46,340
I think this is a really important conversation.

1090
01:12:46,340 --> 01:12:49,840
You can't make, you know, make it 100% the right fit, especially when you're doing it

1091
01:12:49,840 --> 01:12:54,640
blindly, but you can at least make sure, for example, I think Brooke and I, we spoke about

1092
01:12:54,640 --> 01:13:01,160
this before, how many of these clinicians list first responders amongst roller skating,

1093
01:13:01,160 --> 01:13:06,920
badger, you know, taming all the other expertise that they supposedly have, you know, I mean,

1094
01:13:06,920 --> 01:13:11,640
if you are a first responder and or military specialist, then that should be somewhat your

1095
01:13:11,640 --> 01:13:12,640
field.

1096
01:13:12,640 --> 01:13:15,160
It's an extremely broad group to work with.

1097
01:13:15,160 --> 01:13:21,200
So with that being said, let's talk about a culturally competent clinician.

1098
01:13:21,200 --> 01:13:24,560
What kind of, you know, person are we looking for?

1099
01:13:24,560 --> 01:13:28,680
Because as you said, it's a very diverse group, you know, working with everything from children

1100
01:13:28,680 --> 01:13:31,360
to marriages to all kinds of areas.

1101
01:13:31,360 --> 01:13:35,280
And that might be an expertise that you need for one part of your mental health journey.

1102
01:13:35,280 --> 01:13:40,640
But for an EAP, for a first responder, kind of first contact, what kind of professional

1103
01:13:40,640 --> 01:13:45,640
were we looking for and how do we the responder make sure that's at least in the parameters

1104
01:13:45,640 --> 01:13:52,160
when we're researching the people that we're trying to find?

1105
01:13:52,160 --> 01:13:57,640
So there's a lot that goes into being culturally competent, a lot of different factors.

1106
01:13:57,640 --> 01:14:02,640
Unfortunately, like you were saying, James, and we've talked about it before is there's

1107
01:14:02,640 --> 01:14:08,520
a lot of people, Jenna and I have talked about this a lot too, is that there's a lot of clinicians

1108
01:14:08,520 --> 01:14:11,760
that will operate outside of their scope.

1109
01:14:11,760 --> 01:14:16,560
And that will, you know, think that because they worked with one retired police officer

1110
01:14:16,560 --> 01:14:21,660
five years ago, that when they're being asked, can you, you know, be, you know, work embedded

1111
01:14:21,660 --> 01:14:25,980
in this, you know, AP and work with these people, they're like, oh, yeah, I have experience

1112
01:14:25,980 --> 01:14:26,980
doing that.

1113
01:14:26,980 --> 01:14:27,980
Right.

1114
01:14:27,980 --> 01:14:29,560
That's not culturally competent.

1115
01:14:29,560 --> 01:14:33,820
Having one, two or three cases spread out over years, that doesn't mean you're culturally

1116
01:14:33,820 --> 01:14:36,680
competent to work with that population.

1117
01:14:36,680 --> 01:14:44,760
Cultural competency comes from years of a multitude of things, direct experience, right?

1118
01:14:44,760 --> 01:14:46,560
Working with individuals.

1119
01:14:46,560 --> 01:14:52,120
It could be spending your own time off the job, let's say going on ride alongs, you know,

1120
01:14:52,120 --> 01:14:56,720
going to fundraisers, meeting up, spending time around the culture.

1121
01:14:56,720 --> 01:15:00,400
I mean, for me, I was fortunate enough to, you know, spend my, you know, my years of

1122
01:15:00,400 --> 01:15:02,480
doctoral training embedded in a department.

1123
01:15:02,480 --> 01:15:07,720
So I was doing much more than just therapy and crisis response with them.

1124
01:15:07,720 --> 01:15:08,720
Right.

1125
01:15:08,720 --> 01:15:09,720
I was showing up to the promotions.

1126
01:15:09,720 --> 01:15:11,280
I was showing up to the funerals.

1127
01:15:11,280 --> 01:15:13,960
I was showing up to their galas and their events.

1128
01:15:13,960 --> 01:15:14,960
Right.

1129
01:15:14,960 --> 01:15:19,840
Is just getting to know the culture, both on the therapy side and outside of the therapy

1130
01:15:19,840 --> 01:15:21,720
side.

1131
01:15:21,720 --> 01:15:29,360
Attending trainings by actual culturally competent specialists, you know, like Jenna or I, on

1132
01:15:29,360 --> 01:15:31,080
working with first responders.

1133
01:15:31,080 --> 01:15:32,080
Right.

1134
01:15:32,080 --> 01:15:36,240
Even supervision at the beginning when you're, when you're starting to work with first responders

1135
01:15:36,240 --> 01:15:40,920
from someone who's culturally competent so you can continue to refine your skills.

1136
01:15:40,920 --> 01:15:44,960
Reading books on working with first responders, reading books written by first responders.

1137
01:15:44,960 --> 01:15:45,960
Right.

1138
01:15:45,960 --> 01:15:51,720
All of these things go into becoming culturally competent, not just like one thing that I

1139
01:15:51,720 --> 01:15:56,360
did one time or that one book I read or I went on that one site and I took a 30 minute

1140
01:15:56,360 --> 01:16:01,200
online self paced little course and it gave me a little certificate that said I can work

1141
01:16:01,200 --> 01:16:04,360
with first responders now so I'm culturally competent.

1142
01:16:04,360 --> 01:16:08,320
There's a lot of factors that go into being culturally competent.

1143
01:16:08,320 --> 01:16:14,120
I'll also add here that broadly when you're thinking about cultural competence, you're

1144
01:16:14,120 --> 01:16:18,440
thinking about somebody's ability to understand a culture and then interact effectively with

1145
01:16:18,440 --> 01:16:19,440
them.

1146
01:16:19,440 --> 01:16:28,040
So having the awareness that it's even a culture with its own values, norms, traditions, schedules,

1147
01:16:28,040 --> 01:16:36,640
languages, uniforms, you know, colors, whatever it is, you have to be able to just have awareness

1148
01:16:36,640 --> 01:16:39,960
that that's a culture that you're even looking into at all.

1149
01:16:39,960 --> 01:16:45,840
Then you have to have the knowledge and the skills necessarily to look at what's going

1150
01:16:45,840 --> 01:16:48,720
on for that person and put it in context.

1151
01:16:48,720 --> 01:16:51,760
So a lot of times I'll work with people in first responder professions and I'll realize

1152
01:16:51,760 --> 01:16:56,640
that that first responder piece isn't even a huge piece for them for their life.

1153
01:16:56,640 --> 01:16:58,480
They don't identify strongly with that part.

1154
01:16:58,480 --> 01:17:02,120
It's a part of their life but it's not something that they themselves have identified being

1155
01:17:02,120 --> 01:17:04,040
a huge part in that culture.

1156
01:17:04,040 --> 01:17:09,720
So if I as the provider go in and I treat them as if, you know, they are this first

1157
01:17:09,720 --> 01:17:13,600
responder, that's their most salient identity, I'm going to do wrong by them.

1158
01:17:13,600 --> 01:17:17,080
So you have to be able to look at the person in front of you and figure out what are their

1159
01:17:17,080 --> 01:17:18,240
cultural elements.

1160
01:17:18,240 --> 01:17:23,200
How strong do they identify with them and then what can I do, you know, taking my clinical

1161
01:17:23,200 --> 01:17:27,960
training, taking my experiences and looking at them as the expert on them to be relevant

1162
01:17:27,960 --> 01:17:29,320
for them.

1163
01:17:29,320 --> 01:17:34,240
When you're talking about cultural competence around people in police or public safety professions,

1164
01:17:34,240 --> 01:17:39,160
you need to be able to understand how specific occupational factors are going to influence

1165
01:17:39,160 --> 01:17:40,160
their behavior.

1166
01:17:40,160 --> 01:17:42,880
That includes their stress response or mental health issues.

1167
01:17:42,880 --> 01:17:47,360
And we had a bit of a conversation about this earlier so I won't go into depth about that.

1168
01:17:47,360 --> 01:17:51,240
But this might include, you know, if you're looking for a provider and asking are they

1169
01:17:51,240 --> 01:17:57,000
going to get it, do they understand what shift you work and do they understand how the demand

1170
01:17:57,000 --> 01:17:59,840
of that shift is going to play into your family life?

1171
01:17:59,840 --> 01:18:04,320
Can they talk about how if they've read through your policies and procedures, some of those

1172
01:18:04,320 --> 01:18:08,940
policies might inadvertently punish people who are seeking treatment and therefore have

1173
01:18:08,940 --> 01:18:12,520
a cultural piece where there's stigma towards treatment seeking.

1174
01:18:12,520 --> 01:18:16,080
This is the difference between somebody who gets it and somebody who just thinks it's

1175
01:18:16,080 --> 01:18:19,920
fun to work with a first responder because it could be exciting or they could kind of

1176
01:18:19,920 --> 01:18:21,600
be a trauma tourist, right?

1177
01:18:21,600 --> 01:18:22,600
There's a big difference there.

1178
01:18:22,600 --> 01:18:23,600
Trauma tourist.

1179
01:18:23,600 --> 01:18:24,600
I like that.

1180
01:18:24,600 --> 01:18:33,880
I want to just add on because Jenna, she commented on this and I'm glad she did.

1181
01:18:33,880 --> 01:18:41,300
Another aspect of that is being able to knowing the culture and being confident that being

1182
01:18:41,300 --> 01:18:47,760
able to adapt that with your actual clinical training, meaning like how you actually, let's

1183
01:18:47,760 --> 01:18:52,240
say, implement an evidence-based treatment for post-traumatic stress, right?

1184
01:18:52,240 --> 01:18:54,120
So I'm going to give you an example.

1185
01:18:54,120 --> 01:19:00,640
So when you are using the gold standard to diagnostically assess for, let's say, PTSD,

1186
01:19:00,640 --> 01:19:05,240
it's called the CAHPS-5, the clinician-administered PTSD scale, okay?

1187
01:19:05,240 --> 01:19:11,200
You start off that diagnostic interview by saying pick one trauma, your worst trauma,

1188
01:19:11,200 --> 01:19:14,240
what is your one trauma that your symptoms are tied to?

1189
01:19:14,240 --> 01:19:20,360
That's like what the actual language is in it.

1190
01:19:20,360 --> 01:19:22,760
Now imagine saying that to a first responder.

1191
01:19:22,760 --> 01:19:28,800
Now once in a while, I have had first responders who come in and there's like one very particular

1192
01:19:28,800 --> 01:19:34,160
incident whether it be on the job or off the job, right, that is like very much tied to

1193
01:19:34,160 --> 01:19:36,280
when their symptoms started.

1194
01:19:36,280 --> 01:19:41,440
But nine out of 10 times, they're like, what do you mean pick one, right?

1195
01:19:41,440 --> 01:19:42,800
What are you talking about?

1196
01:19:42,800 --> 01:19:43,800
Pick one.

1197
01:19:43,800 --> 01:19:45,880
It's the same for evidence-based treatments.

1198
01:19:45,880 --> 01:19:50,080
We're talking about cognitive processing therapy for PTSD or prolonged exposure for PTSD.

1199
01:19:50,080 --> 01:19:53,080
It'll be like pick one, right?

1200
01:19:53,080 --> 01:19:54,920
Choose your worst one.

1201
01:19:54,920 --> 01:20:01,080
So understanding the culture and what goes into the job, the things you have to see,

1202
01:20:01,080 --> 01:20:05,600
the things you have to do, just again, the mindset towards it.

1203
01:20:05,600 --> 01:20:10,760
You know how to kind of adapt your language a little bit to even if you say, I'll still

1204
01:20:10,760 --> 01:20:15,400
say let's talk about, I know you've experienced a lot of different things and it could be

1205
01:20:15,400 --> 01:20:17,360
really hard to just pick one.

1206
01:20:17,360 --> 01:20:18,840
Is there one that pops in mind?

1207
01:20:18,840 --> 01:20:24,720
And if not, let's talk about, talk to me about a few that like really stick out to you, things

1208
01:20:24,720 --> 01:20:28,720
that really stick out to you that like the thoughts and the memories you have.

1209
01:20:28,720 --> 01:20:31,240
And then I'm going to ask you questions about those, right?

1210
01:20:31,240 --> 01:20:33,360
So you learn how to kind of adapt that.

1211
01:20:33,360 --> 01:20:36,760
So you're not just going, well, just tell me one and then I ask this and then I do that

1212
01:20:36,760 --> 01:20:37,860
and then I do that.

1213
01:20:37,860 --> 01:20:42,440
So that's also the aspect of cultural competency is being able to integrate those two things

1214
01:20:42,440 --> 01:20:48,680
together so that you can provide that effective individualized care.

1215
01:20:48,680 --> 01:20:52,880
I've never been asked this, but I know so many responders are, you know, what's the

1216
01:20:52,880 --> 01:20:54,500
worst thing you've ever seen.

1217
01:20:54,500 --> 01:21:00,040
And it's so funny because I actually wrote down, these are just the horrendous deaths,

1218
01:21:00,040 --> 01:21:04,300
not the hundreds and hundreds of deaths, you know, the passing asleep, the kind of pseudo

1219
01:21:04,300 --> 01:21:05,580
natural deaths.

1220
01:21:05,580 --> 01:21:10,560
And preparing for the first book, it was two sides of A4 paper, you know, thin lined A4

1221
01:21:10,560 --> 01:21:12,460
and I'm like, Jesus Christ.

1222
01:21:12,460 --> 01:21:15,040
So when people say that, it's like, we got to be more specific.

1223
01:21:15,040 --> 01:21:16,040
Do you want a baby?

1224
01:21:16,040 --> 01:21:17,040
Do you want a gangbanger?

1225
01:21:17,040 --> 01:21:18,040
Do you want, you know, a suicide?

1226
01:21:18,040 --> 01:21:21,720
I mean, you have to narrow it down a little bit, you know, and then obviously then they'd

1227
01:21:21,720 --> 01:21:22,720
be shocked.

1228
01:21:22,720 --> 01:21:25,080
But I mean, it is, it's a death by a thousand cuts.

1229
01:21:25,080 --> 01:21:29,640
If you were at the World Trade Center, like Wil Hemenno, who I'm about to rerelease his

1230
01:21:29,640 --> 01:21:36,560
episode this week and the WTC collapsed on you and one of your friends died next to you

1231
01:21:36,560 --> 01:21:39,920
and you almost died from crush injuries and you got out.

1232
01:21:39,920 --> 01:21:43,120
I'm thinking maybe that's one of the most traumatic things for Wil.

1233
01:21:43,120 --> 01:21:49,320
But for the, you know, the other 99.9% of first responders, it's so many of these, a

1234
01:21:49,320 --> 01:21:52,060
lot of times it's not even the thing.

1235
01:21:52,060 --> 01:21:55,620
It's the whales of the family from the death.

1236
01:21:55,620 --> 01:21:56,620
You know what I mean?

1237
01:21:56,620 --> 01:21:58,840
So it is, I mean, it's, you know, there isn't a thing.

1238
01:21:58,840 --> 01:22:00,560
This is what I've always observed too.

1239
01:22:00,560 --> 01:22:05,640
It's like when you take that multifaceted approach and then you add in early life and

1240
01:22:05,640 --> 01:22:09,320
the fact that, you know, you've just gone to your third death and then you get written

1241
01:22:09,320 --> 01:22:13,200
up for not wearing a traffic vest, backing up a fucking ambulance at a hospital.

1242
01:22:13,200 --> 01:22:19,040
You know, these are the small Lego bricks that make up someone's overall stresses.

1243
01:22:19,040 --> 01:22:20,040
Yeah.

1244
01:22:20,040 --> 01:22:25,000
And another, you know, common theme I've heard from my first responders in terms of, you

1245
01:22:25,000 --> 01:22:29,880
know, bad experiences they've had before with therapists who weren't culturally competent.

1246
01:22:29,880 --> 01:22:36,360
And I've directly, you know, seen therapists do this, but is kind of like assuming that

1247
01:22:36,360 --> 01:22:40,040
because they've seen this thing that I think is super traumatic, right?

1248
01:22:40,040 --> 01:22:41,960
That like that, that's no, let's talk about that.

1249
01:22:41,960 --> 01:22:44,280
No, we really need to break that apart and talk about that.

1250
01:22:44,280 --> 01:22:47,120
And they're like, I'm literally not fazed by that.

1251
01:22:47,120 --> 01:22:49,520
Like let's talk about more like about these things, right?

1252
01:22:49,520 --> 01:22:54,800
So kind of like assuming that, you know, because they've seen this or they tell you that that

1253
01:22:54,800 --> 01:22:58,920
must just like really be affecting them, right?

1254
01:22:58,920 --> 01:23:03,160
Because that's just for a civilian would probably be the worst day of their life, but it was

1255
01:23:03,160 --> 01:23:10,440
just one call on one shift of thousands of shifts for this first responder, right?

1256
01:23:10,440 --> 01:23:14,040
So that's another thing I come across a lot.

1257
01:23:14,040 --> 01:23:16,040
Absolutely.

1258
01:23:16,040 --> 01:23:21,440
I think a huge part of being in therapy and with a culturally competent provider is that

1259
01:23:21,440 --> 01:23:24,800
you will, it will feel like a good fit.

1260
01:23:24,800 --> 01:23:29,700
And the reason for that, and I know you can't really quantify feel, but I think the reason

1261
01:23:29,700 --> 01:23:36,120
why that's the case is you'll be able to experience non-judgment and that curious approach where

1262
01:23:36,120 --> 01:23:39,120
you're really the seen as the expert on you.

1263
01:23:39,120 --> 01:23:42,680
Like as a provider, my job is not to be entertained.

1264
01:23:42,680 --> 01:23:46,520
My job is to not get whatever answers to questions that I want answered.

1265
01:23:46,520 --> 01:23:51,140
It's to try to pave that way where the person in front of me can feel comfortable and safe

1266
01:23:51,140 --> 01:23:54,160
to be able to get what they need from the process.

1267
01:23:54,160 --> 01:23:58,120
When somebody is not culturally competent, they're not sensitive, meaning sort of what

1268
01:23:58,120 --> 01:24:01,280
you were talking about earlier, people asking the question, what's the worst thing you've

1269
01:24:01,280 --> 01:24:02,820
ever seen?

1270
01:24:02,820 --> 01:24:07,280
If you understand the culture, you would recognize that that's an insensitive question to ask

1271
01:24:07,280 --> 01:24:09,560
and you wouldn't make maneuvers like that.

1272
01:24:09,560 --> 01:24:13,460
So part of understanding a culture really well is being able to have that sense of what

1273
01:24:13,460 --> 01:24:19,720
are these different characteristics that make up this profession, these professions, who

1274
01:24:19,720 --> 01:24:22,360
are the types of people that work in those places?

1275
01:24:22,360 --> 01:24:26,960
How do I get the experience to be able to understand what it would feel like to be there

1276
01:24:26,960 --> 01:24:30,840
with them, to have gone through the same things, to see things through their eyes so that I

1277
01:24:30,840 --> 01:24:33,600
don't make missteps like that?

1278
01:24:33,600 --> 01:24:38,200
Not saying that the provider you work with is never going to make an expectation or an

1279
01:24:38,200 --> 01:24:42,920
assumption and that they can ask that with you, hey, did I get this right?

1280
01:24:42,920 --> 01:24:47,520
But if they get it wrong, another hallmark of a culturally competent therapist is humility,

1281
01:24:47,520 --> 01:24:49,280
saying, okay, I understand.

1282
01:24:49,280 --> 01:24:50,960
Thank you for teaching me.

1283
01:24:50,960 --> 01:24:53,560
Moving forward, now I understand it from your perspective.

1284
01:24:53,560 --> 01:24:57,760
It's not a place to be defensive or argumentative or I'm the expert.

1285
01:24:57,760 --> 01:24:58,760
Absolutely.

1286
01:24:58,760 --> 01:25:03,660
Well, on that theme, I want to go to paint the picture of what counseling should even

1287
01:25:03,660 --> 01:25:04,660
look like.

1288
01:25:04,660 --> 01:25:07,880
I think that was a great point that you brought up to talk about today.

1289
01:25:07,880 --> 01:25:09,840
But prior to that, red flags.

1290
01:25:09,840 --> 01:25:11,680
Let's get that out of the way.

1291
01:25:11,680 --> 01:25:18,460
What are some of the red flags that a responder looking for some sort of clinician should

1292
01:25:18,460 --> 01:25:23,800
be aware of that maybe will get them to avoid that experience in the first place or at least

1293
01:25:23,800 --> 01:25:29,040
acknowledge that that is not a healthy practice when they're sitting with a counselor?

1294
01:25:29,040 --> 01:25:31,400
You want to go back and forth on this one, Dr. Brooke?

1295
01:25:31,400 --> 01:25:32,400
Okay.

1296
01:25:32,400 --> 01:25:37,120
Dr. Drew and I talk about this a lot offline.

1297
01:25:37,120 --> 01:25:41,960
So, LinkedIn is a great place, but it's also a terrible place when you wake up and you

1298
01:25:41,960 --> 01:25:43,600
see some of the things on LinkedIn.

1299
01:25:43,600 --> 01:25:46,400
So yeah, you want to start?

1300
01:25:46,400 --> 01:25:47,400
Sure.

1301
01:25:47,400 --> 01:25:52,560
So, the first red flag for me that I'm looking for is whether or not a person is even qualified

1302
01:25:52,560 --> 01:25:56,560
to help you with the issue that you're experiencing, even though they're advertising that they

1303
01:25:56,560 --> 01:25:57,560
can.

1304
01:25:57,560 --> 01:26:02,320
Everybody, especially with social media, the internet, you can buy a website, you can talk

1305
01:26:02,320 --> 01:26:06,320
about what you want to do, you can advertise that you can help people, but whether or not

1306
01:26:06,320 --> 01:26:11,440
you have the backing through specific education, training, and experience, that's going to

1307
01:26:11,440 --> 01:26:15,620
give you credibility to know that that provider can help you with that.

1308
01:26:15,620 --> 01:26:19,120
It seems like a little bit of work, and it is, but investigate what the standard is for

1309
01:26:19,120 --> 01:26:20,120
the field.

1310
01:26:20,120 --> 01:26:21,400
So, in mental health, what are the standards?

1311
01:26:21,400 --> 01:26:25,880
We talked a lot about in the beginning with our Venn diagram, different labels and titles

1312
01:26:25,880 --> 01:26:28,760
that people hold in the mental health field.

1313
01:26:28,760 --> 01:26:30,280
That's the standard.

1314
01:26:30,280 --> 01:26:34,080
If you're going outside of that and you see people calling themselves like counselors

1315
01:26:34,080 --> 01:26:41,320
or clinicians, specialists, technicians, analysts, coaches, mentors, any other word like this,

1316
01:26:41,320 --> 01:26:46,480
do your due diligence to look into that person's education, training, certifications, whatever

1317
01:26:46,480 --> 01:26:49,320
their qualifications are to make sure that they can help you.

1318
01:26:49,320 --> 01:26:54,200
Just because somebody says they can doesn't mean that they can.

1319
01:26:54,200 --> 01:26:57,200
Yes.

1320
01:26:57,200 --> 01:27:05,160
Along those lines, I think I've seen a lot with the individuals who promote or advertise

1321
01:27:05,160 --> 01:27:12,760
to help people with mental health related issues and problems like trauma and alcohol

1322
01:27:12,760 --> 01:27:18,680
and whatever else it is that don't actually have the education, the licensure, the training

1323
01:27:18,680 --> 01:27:24,360
to do that, is that they'll cite their lived experience.

1324
01:27:24,360 --> 01:27:34,400
Now, lived experience can be a very beneficial aspect of helping someone who's struggling

1325
01:27:34,400 --> 01:27:40,000
with some kind of mental health issue, 100% or having someone who's a licensed clinician

1326
01:27:40,000 --> 01:27:42,640
who was also a first responder.

1327
01:27:42,640 --> 01:27:45,080
Massive advantage.

1328
01:27:45,080 --> 01:27:47,000
That's very helpful.

1329
01:27:47,000 --> 01:27:53,000
Lived experience on its own is not enough to help someone who's suffering from post-traumatic

1330
01:27:53,000 --> 01:27:54,000
stress.

1331
01:27:54,000 --> 01:27:57,160
Just because that person has suffered from post-traumatic stress doesn't mean that they

1332
01:27:57,160 --> 01:28:02,280
are then able to actually use evidence-based, scientifically supported means to actually

1333
01:28:02,280 --> 01:28:05,560
resolve that other person's traumatic stress.

1334
01:28:05,560 --> 01:28:10,420
Unfortunately, I see this a lot in the first responder world, someone being like, I have

1335
01:28:10,420 --> 01:28:13,320
lived experience with this.

1336
01:28:13,320 --> 01:28:18,400
So therefore, I'm trauma-informed is a nice word.

1337
01:28:18,400 --> 01:28:25,160
I'm trauma-informed so then I can help you when you're struggling.

1338
01:28:25,160 --> 01:28:32,160
It's not only inaccurate, but for me personally, it makes me really mad.

1339
01:28:32,160 --> 01:28:37,000
I think that most of these people are coming from a really good place of wanting to help.

1340
01:28:37,000 --> 01:28:41,880
If you want to be a peer supporter, meaning I want to support this person, and then I

1341
01:28:41,880 --> 01:28:47,320
can help steer you or motivate you to get in the direction of seeing a licensed therapist

1342
01:28:47,320 --> 01:28:50,160
who's specialized in treating this, awesome.

1343
01:28:50,160 --> 01:28:56,080
I've seen a lot of people who advertise, I save lives.

1344
01:28:56,080 --> 01:29:02,480
Come to me because I can help you with your trauma because I am trauma-informed when they

1345
01:29:02,480 --> 01:29:09,000
don't actually have any of the education or really the training or the licensure to do

1346
01:29:09,000 --> 01:29:10,000
that.

1347
01:29:10,000 --> 01:29:11,000
It's dangerous.

1348
01:29:11,000 --> 01:29:12,240
That's the bottom line.

1349
01:29:12,240 --> 01:29:23,520
It's very, very, very dangerous because when you are not actually equipped to truly address

1350
01:29:23,520 --> 01:29:29,080
mental health issues, it can put that other person in the position where their mental

1351
01:29:29,080 --> 01:29:34,240
health issue is not only worsen, but it can lead to potentially catastrophic outcomes.

1352
01:29:34,240 --> 01:29:39,160
So the thing I get most upset about when I see that is I just see it and I'm like, this

1353
01:29:39,160 --> 01:29:40,360
is dangerous.

1354
01:29:40,360 --> 01:29:47,720
It's so, so dangerous and I think that it might be more appealing to some first responders

1355
01:29:47,720 --> 01:29:51,760
because therapy is icky and that means they're weak and this and that.

1356
01:29:51,760 --> 01:29:56,600
I don't want to go to a shrink because there might be some culturally incompetent shrinks,

1357
01:29:56,600 --> 01:29:59,560
but this person used to be a first responder and they're saying they can help me, so I'm

1358
01:29:59,560 --> 01:30:01,960
going to go to them.

1359
01:30:01,960 --> 01:30:10,040
So that is, I think, one of the top red flags to look out for and to have understanding

1360
01:30:10,040 --> 01:30:16,080
of everything that Dr. Gena was saying is do the due diligence and do some research

1361
01:30:16,080 --> 01:30:22,040
on what is the standard of this and how does this look.

1362
01:30:22,040 --> 01:30:23,960
I never understood the term life coach.

1363
01:30:23,960 --> 01:30:27,840
I'm hopefully only 50% through mine and I don't feel like I'm an expert in anything.

1364
01:30:27,840 --> 01:30:33,960
So how other people can tell you how to live your life, I find an intriguing philosophy.

1365
01:30:33,960 --> 01:30:39,440
I have seen every name word in the gamut now in front of the word coach.

1366
01:30:39,440 --> 01:30:40,520
I'm a life coach.

1367
01:30:40,520 --> 01:30:42,420
I'm a resiliency coach.

1368
01:30:42,420 --> 01:30:44,360
I'm a trauma coach.

1369
01:30:44,360 --> 01:30:47,920
I'm a relationship coach.

1370
01:30:47,920 --> 01:30:50,040
I started keeping a list.

1371
01:30:50,040 --> 01:30:54,200
I don't have it in front of me, but I've seen some very wild ones where I'm like you literally

1372
01:30:54,200 --> 01:30:58,160
just use an adjective and put the name coach after it.

1373
01:30:58,160 --> 01:31:04,280
So yeah, there can be a time and place for coaching if we're talking about someone who

1374
01:31:04,280 --> 01:31:09,680
has been a public safety provider and they're coaching.

1375
01:31:09,680 --> 01:31:11,240
I think of it as consulting.

1376
01:31:11,240 --> 01:31:14,040
I think coaching is the wrong word for it.

1377
01:31:14,040 --> 01:31:19,120
If you're saying that you offer consulting on how best to prepare for the entry exam

1378
01:31:19,120 --> 01:31:23,400
into the police academy, great, consult on that.

1379
01:31:23,400 --> 01:31:25,520
You have the experience to do that, right?

1380
01:31:25,520 --> 01:31:33,880
But when we're talking about like I'm going to coach you through your mental health problems,

1381
01:31:33,880 --> 01:31:35,960
is that healthy?

1382
01:31:35,960 --> 01:31:36,960
Absolutely.

1383
01:31:36,960 --> 01:31:41,920
Yeah, I think it's a huge problem and I'll just say one more piece on it before I move

1384
01:31:41,920 --> 01:31:44,280
on to a second red flag that I have.

1385
01:31:44,280 --> 01:31:49,640
But I agree what you said, Dr. Brooke about first responders potentially thinking it's

1386
01:31:49,640 --> 01:31:56,360
more appealing to go to this safer perceived middle ground of a peer where they're like,

1387
01:31:56,360 --> 01:31:58,920
I'm not quite invested in the idea of therapy yet.

1388
01:31:58,920 --> 01:32:01,320
I don't know what I think about that field.

1389
01:32:01,320 --> 01:32:03,280
Maybe I don't know how to reach out or who to reach out to.

1390
01:32:03,280 --> 01:32:07,800
It seems complicated, but there's this guy or gal at my agency that I know has been through

1391
01:32:07,800 --> 01:32:12,080
something similar with me or a guy or gal at an agency, you know, one state over.

1392
01:32:12,080 --> 01:32:14,240
They say that they've been through the same thing.

1393
01:32:14,240 --> 01:32:18,960
I'm going to talk to them, feel it out, see if that's helpful and then I'll make a decision.

1394
01:32:18,960 --> 01:32:23,080
I think it can be helpful as long as you understand what you're getting into and you recognize

1395
01:32:23,080 --> 01:32:25,440
the limitations of that.

1396
01:32:25,440 --> 01:32:31,160
If you think that talking to a peer supporter is the same as going to therapy, that would

1397
01:32:31,160 --> 01:32:34,960
be an incorrect conclusion and you're going to set yourself up for failure.

1398
01:32:34,960 --> 01:32:38,760
You're also going to set up the peer supporter to practice out of scope, which again is a

1399
01:32:38,760 --> 01:32:40,560
huge problem.

1400
01:32:40,560 --> 01:32:44,880
If you can see it for what it is, peer support, this person just talking to me about what

1401
01:32:44,880 --> 01:32:49,240
I've been through and helping me navigate to get to more appropriate resources, I think

1402
01:32:49,240 --> 01:32:54,200
it's totally fine.

1403
01:32:54,200 --> 01:32:59,240
In terms of a second red flag, I think it's a red flag when you look at people's advertising,

1404
01:32:59,240 --> 01:33:02,840
whether it's psychology today, good therapy, whatever the directory is that they're using

1405
01:33:02,840 --> 01:33:05,800
and they specialize in everything.

1406
01:33:05,800 --> 01:33:10,800
So if they just have a laundry list of 120 different things that they specialize in,

1407
01:33:10,800 --> 01:33:11,800
that's a problem.

1408
01:33:11,800 --> 01:33:15,920
And the reason for that is if you think about the earlier part of the conversation where

1409
01:33:15,920 --> 01:33:19,520
Dr. Brooke was talking about how much time it takes for psychologists to get through

1410
01:33:19,520 --> 01:33:23,960
school and how through that process, it's like a funnel where you start really broad

1411
01:33:23,960 --> 01:33:27,160
and then you narrow yourself all the way into a specialty.

1412
01:33:27,160 --> 01:33:31,160
Unless you're funneling, you're also taking stuff and you're throwing it out of being

1413
01:33:31,160 --> 01:33:32,800
out of your area of expertise.

1414
01:33:32,800 --> 01:33:36,720
So by the end of the time that you're getting through your education and training and your

1415
01:33:36,720 --> 01:33:41,440
license, you should have fewer things on the list that you can treat competently than you

1416
01:33:41,440 --> 01:33:42,640
started with.

1417
01:33:42,640 --> 01:33:45,040
You might be interested in everything in psychology.

1418
01:33:45,040 --> 01:33:53,160
I know I am for sure, but I'm not competent to treat every diagnostic issue in the book

1419
01:33:53,160 --> 01:33:58,600
as well as not being able to competently and culturally competently provide care to every

1420
01:33:58,600 --> 01:34:01,320
population that exists under the sun.

1421
01:34:01,320 --> 01:34:06,720
So it's a red flag if they have a huge laundry list, but it's also something where if you

1422
01:34:06,720 --> 01:34:09,920
really jive with that person's profile and you're interested to determine whether or

1423
01:34:09,920 --> 01:34:14,320
not they would be a good fit for you and you're willing to look past that, call them and make

1424
01:34:14,320 --> 01:34:16,440
sure that they fit with your characteristics.

1425
01:34:16,440 --> 01:34:20,600
Do they actually have the education, training, and experience to work with whatever it is

1426
01:34:20,600 --> 01:34:23,400
that you're managing and who you think you are?

1427
01:34:23,400 --> 01:34:26,960
If they can answer those questions well, then it doesn't really matter if they can treat

1428
01:34:26,960 --> 01:34:31,640
the 119 other things because you're coming to them for the one thing that you've determined

1429
01:34:31,640 --> 01:34:34,640
they can treat you with.

1430
01:34:34,640 --> 01:34:35,640
Love it.

1431
01:34:35,640 --> 01:34:36,640
What did you say earlier, James?

1432
01:34:36,640 --> 01:34:38,760
You said like they list like honey badger hunting or something.

1433
01:34:38,760 --> 01:34:41,200
Yeah, badger taming and roller skating.

1434
01:34:41,200 --> 01:34:42,200
Badger taming, yeah.

1435
01:34:42,200 --> 01:34:48,160
Yeah, the listing, a lot of different things typically is a red flag that that person probably

1436
01:34:48,160 --> 01:34:52,400
actually isn't like well equipped or specialized to treat whatever it is or address whatever

1437
01:34:52,400 --> 01:34:53,560
it is that you're coming in for.

1438
01:34:53,560 --> 01:34:58,200
It's possible that they can, but like Dr. Geno was saying, giving them a call and asking

1439
01:34:58,200 --> 01:35:02,640
them and I love, I'm so glad you explained that Dr. Geno too because it's very true.

1440
01:35:02,640 --> 01:35:09,720
Like we start off here and then over the years, at least for the psychologists, we become

1441
01:35:09,720 --> 01:35:14,280
very specialized and that doesn't mean we only treat one very thing, one specific thing,

1442
01:35:14,280 --> 01:35:18,520
but like specializing in trauma and anxiety, those are the umbrellas and there's common

1443
01:35:18,520 --> 01:35:21,160
things that fall underneath those umbrellas.

1444
01:35:21,160 --> 01:35:26,360
But like she was saying, through my years of training, I have done therapy and clinical

1445
01:35:26,360 --> 01:35:31,040
work with a lot of different presenting problems.

1446
01:35:31,040 --> 01:35:36,980
I mean, my second year of my PhD, I treated someone for bulimia.

1447
01:35:36,980 --> 01:35:39,480
I treated someone for binge eating disorder.

1448
01:35:39,480 --> 01:35:42,560
I treated someone for body dysmorphia and you're in training, right?

1449
01:35:42,560 --> 01:35:43,560
So this is okay.

1450
01:35:43,560 --> 01:35:47,760
You're a student, they're well aware, they sign consent forms for this, like you're getting

1451
01:35:47,760 --> 01:35:51,640
supervision and you're learning.

1452
01:35:51,640 --> 01:35:58,060
But as I go on and I specialize, yeah, I just had someone reach out to me the other day

1453
01:35:58,060 --> 01:36:01,800
or clinician being like, hey, I have someone with pretty severe post-traumatic stress and

1454
01:36:01,800 --> 01:36:05,200
they also have pretty bad disordered eating.

1455
01:36:05,200 --> 01:36:09,920
And I referred them out and I'm like, I can target that, but I'm not, yeah, I've seen

1456
01:36:09,920 --> 01:36:17,680
cases in the past where I've addressed that, but I'm not competent enough to do that.

1457
01:36:17,680 --> 01:36:22,440
So knowing your scope of practice is pretty important and then it's a red flag when someone

1458
01:36:22,440 --> 01:36:27,840
is not necessarily very clear on what their scope of practice is.

1459
01:36:27,840 --> 01:36:28,840
Beautiful.

1460
01:36:28,840 --> 01:36:34,200
Well, before we move on to what counseling should look like, are there any more red flags?

1461
01:36:34,200 --> 01:36:42,440
I think one of the most important ones that has become very prevalent, I think, to me

1462
01:36:42,440 --> 01:36:49,120
in recent years, especially with social media, is when clinicians or providers, I should

1463
01:36:49,120 --> 01:36:54,640
say, excessively self-disclose and there's not a clinical reason for it.

1464
01:36:54,640 --> 01:36:56,680
And it's looking like me and Dr. Berger on the same page.

1465
01:36:56,680 --> 01:36:58,680
That's the one I was going to go for next.

1466
01:36:58,680 --> 01:37:00,640
Two thumbs up.

1467
01:37:00,640 --> 01:37:06,040
So self-disclosure is a tool and self-disclosure is exactly what it sounds like.

1468
01:37:06,040 --> 01:37:10,240
It's the provider centering themselves in the therapy space, making it about them for

1469
01:37:10,240 --> 01:37:11,240
a moment.

1470
01:37:11,240 --> 01:37:14,240
And there's lots of good reasons to do it.

1471
01:37:14,240 --> 01:37:19,400
If you need to be more relatable to the client, if you need to be more transparent to the

1472
01:37:19,400 --> 01:37:23,720
client, depending on the population that you work with, my first responders being one,

1473
01:37:23,720 --> 01:37:27,120
they're typically not super cool with walking in the room and knowing nothing about me.

1474
01:37:27,120 --> 01:37:28,440
They don't want that blank slate.

1475
01:37:28,440 --> 01:37:31,480
They want to know basic things.

1476
01:37:31,480 --> 01:37:35,960
But when I go into the therapy room, I make sure that I have a set amount of information

1477
01:37:35,960 --> 01:37:39,840
that I'm comfortable sharing and that there's a clinical reason for doing so.

1478
01:37:39,840 --> 01:37:45,680
If you're looking for a provider and they have social media or they have profiles or

1479
01:37:45,680 --> 01:37:50,720
websites or whatever presence where you have the opportunity to learn more about them and

1480
01:37:50,720 --> 01:37:56,000
the self-disclosure is excessive, I would ask myself whether or not that person is appropriate

1481
01:37:56,000 --> 01:38:01,320
to treat me because the more that you disclose, the more potential there is for you to feel

1482
01:38:01,320 --> 01:38:06,620
judged and misunderstood as a client, the more the opportunities there are for breaches

1483
01:38:06,620 --> 01:38:14,160
of privacy or confidentiality for clients, and the more that you learn about them, the

1484
01:38:14,160 --> 01:38:17,000
more that can shift the power dynamic in the therapy.

1485
01:38:17,000 --> 01:38:22,040
And there's a lot I could say about that, but the short of it is in therapy, it should

1486
01:38:22,040 --> 01:38:24,920
be a collaboration and the therapy should be about you.

1487
01:38:24,920 --> 01:38:29,400
I had a clinical trainer that said one time, you should not be the most interesting thing

1488
01:38:29,400 --> 01:38:32,880
in the room to us as trainees.

1489
01:38:32,880 --> 01:38:35,040
And I thought that that was a really beautiful way of saying it.

1490
01:38:35,040 --> 01:38:36,640
It's not that I can't show up in the room.

1491
01:38:36,640 --> 01:38:37,640
I obviously have my stuff.

1492
01:38:37,640 --> 01:38:38,640
I have my experiences.

1493
01:38:38,640 --> 01:38:42,120
I have my preferences.

1494
01:38:42,120 --> 01:38:45,760
All of that is true, but it's not about me in that moment.

1495
01:38:45,760 --> 01:38:49,560
And so just take a look at that and figure out would I feel comfortable with this person

1496
01:38:49,560 --> 01:38:55,280
providing care for me based on how they show up in their own life.

1497
01:38:55,280 --> 01:38:56,280
Beautiful.

1498
01:38:56,280 --> 01:38:57,280
Yep.

1499
01:38:57,280 --> 01:39:00,400
I second all that.

1500
01:39:00,400 --> 01:39:07,400
And Jenna and I have talked about this before, but particularly when you're getting a doctorate,

1501
01:39:07,400 --> 01:39:11,320
you spend seven years just being scared shitless.

1502
01:39:11,320 --> 01:39:18,280
They train you to be so afraid of crossing ethical boundaries and doing all that.

1503
01:39:18,280 --> 01:39:23,840
So you come out as a licensed psychologist and you're just so terrified of everything.

1504
01:39:23,840 --> 01:39:30,360
But once you work out the kinks there, part of that is they're like, you just keep that

1505
01:39:30,360 --> 01:39:34,400
boundary between you and the client and no self-disclosure at all.

1506
01:39:34,400 --> 01:39:38,360
And I don't think that that's appropriate either.

1507
01:39:38,360 --> 01:39:42,600
As Jenna is saying, it's important and I think especially important in working with first

1508
01:39:42,600 --> 01:39:48,800
responders, I'm a human too and I want them to know who I am at the foundational level

1509
01:39:48,800 --> 01:39:52,200
and my characteristics and my personality.

1510
01:39:52,200 --> 01:39:54,560
And I'll self-disclose things, particularly when I'm in training.

1511
01:39:54,560 --> 01:39:58,280
So if I'm doing a sleep training, I talk about how I struggle with sleep my whole life.

1512
01:39:58,280 --> 01:40:00,440
I've done CBTI.

1513
01:40:00,440 --> 01:40:06,720
Share that I see my own psychologist and I go to therapy, but there is a limit to what

1514
01:40:06,720 --> 01:40:09,280
I share about my personal life.

1515
01:40:09,280 --> 01:40:16,640
And so on top of what Dr. Jenna said is another thing that I, why I would be very cautious

1516
01:40:16,640 --> 01:40:27,000
about working, having a therapist who really overshares is I really question their ethical,

1517
01:40:27,000 --> 01:40:31,240
their understanding of ethics in general, because it's actually very important when

1518
01:40:31,240 --> 01:40:36,320
we're talking about therapy and effective therapy and things like maintaining, like

1519
01:40:36,320 --> 01:40:38,360
Jenna was saying, privacy and whatnot.

1520
01:40:38,360 --> 01:40:43,880
So if there's someone who is just letting you know everything about their life on social

1521
01:40:43,880 --> 01:40:50,320
media and honestly, some things that I've seen therapists share things where I'm like,

1522
01:40:50,320 --> 01:40:54,920
I would never even share that on my personal social media platform.

1523
01:40:54,920 --> 01:40:59,680
Like, oh my God, but knowing that about your therapist, what do I want my client to know

1524
01:40:59,680 --> 01:41:03,120
about me when they come into the room?

1525
01:41:03,120 --> 01:41:05,400
That's really kind of like what it boils down to.

1526
01:41:05,400 --> 01:41:13,760
It's like, what am I comfortable with my client knowing about me when they come into the room?

1527
01:41:13,760 --> 01:41:19,840
So I would really see it as a red flag for kind of like their understanding of ethical

1528
01:41:19,840 --> 01:41:21,840
boundaries and guidelines.

1529
01:41:21,840 --> 01:41:22,840
Brilliant.

1530
01:41:22,840 --> 01:41:23,840
Yeah.

1531
01:41:23,840 --> 01:41:28,240
It's, I mean, every time I even see with the sploomin' TikTok and all that stuff, if I'm

1532
01:41:28,240 --> 01:41:32,720
going to anyone and they're out there dancing, I'm going somewhere else.

1533
01:41:32,720 --> 01:41:33,720
I'm sorry.

1534
01:41:33,720 --> 01:41:34,720
Like you're a dentist.

1535
01:41:34,720 --> 01:41:35,720
You're a fucking ballerina.

1536
01:41:35,720 --> 01:41:37,760
Just focus on teeth.

1537
01:41:37,760 --> 01:41:39,000
All right.

1538
01:41:39,000 --> 01:41:42,400
Well, moving on, I digress.

1539
01:41:42,400 --> 01:41:46,960
So let's talk about what people can actually expect in counseling, because that's one of

1540
01:41:46,960 --> 01:41:48,920
the things you had on here and it was such an interesting point.

1541
01:41:48,920 --> 01:41:53,060
And we talk all about the philosophy of mental health and counseling, but not actually what

1542
01:41:53,060 --> 01:41:56,600
to expect for the first, you know, the person who's never done it before.

1543
01:41:56,600 --> 01:41:57,640
What will that look like?

1544
01:41:57,640 --> 01:41:59,720
So I'll kind of again, give you the microphone.

1545
01:41:59,720 --> 01:42:01,760
Go ahead, Jen.

1546
01:42:01,760 --> 01:42:02,760
Okay.

1547
01:42:02,760 --> 01:42:06,720
So starting out, let's say that you've done all of the groundwork.

1548
01:42:06,720 --> 01:42:09,000
You've vetted your person.

1549
01:42:09,000 --> 01:42:11,360
You've decided that they're culturally competent.

1550
01:42:11,360 --> 01:42:14,120
You've landed that they're the person that you're going to go see.

1551
01:42:14,120 --> 01:42:17,560
You're going to start off with a phone call or emailing them through their website to

1552
01:42:17,560 --> 01:42:21,480
be able to put that inquiry in and ask whether or not you can consult with them and determine

1553
01:42:21,480 --> 01:42:23,540
if they're accepting new clients.

1554
01:42:23,540 --> 01:42:25,320
So let's say you've gone through that process.

1555
01:42:25,320 --> 01:42:26,940
They're like, yep, I'm accepting new clients.

1556
01:42:26,940 --> 01:42:27,940
You're getting ready.

1557
01:42:27,940 --> 01:42:28,940
Here's your appointment date.

1558
01:42:28,940 --> 01:42:30,860
It's tomorrow at 9 a.m.

1559
01:42:30,860 --> 01:42:35,140
You should be ready to just bring yourself to that appointment.

1560
01:42:35,140 --> 01:42:36,760
You don't have to have anything prepared.

1561
01:42:36,760 --> 01:42:41,320
You don't have to do anything other than make sure that you had a good breakfast and an

1562
01:42:41,320 --> 01:42:42,320
okay night's sleep.

1563
01:42:42,320 --> 01:42:46,600
And when you show up at that office, either waiting in their waiting room for them to

1564
01:42:46,600 --> 01:42:50,920
call you back or immediately walking in and being greeted at the door by them.

1565
01:42:50,920 --> 01:42:54,880
For me, I've I've put a lot of thought and consideration into my practice and how that

1566
01:42:54,880 --> 01:42:59,000
feels for people where I did everything from choosing the building to make sure that there

1567
01:42:59,000 --> 01:43:04,960
was parking directly out front, having a waiting room that was mixed with other specialties

1568
01:43:04,960 --> 01:43:08,880
like physical therapy attorneys, that there's some privacy in the waiting room.

1569
01:43:08,880 --> 01:43:11,760
People don't know necessarily who you're going back to see.

1570
01:43:11,760 --> 01:43:14,200
And that creates a bit more comfort for people.

1571
01:43:14,200 --> 01:43:18,040
And then I show up in that waiting room and I am there at their appointment time.

1572
01:43:18,040 --> 01:43:20,280
So they're not waiting for more than half a second.

1573
01:43:20,280 --> 01:43:24,440
I know for a lot of my first responders, every opportunity they have between the phone call

1574
01:43:24,440 --> 01:43:27,940
and the appointment, they're thinking about using that out.

1575
01:43:27,940 --> 01:43:31,460
So if they can't find parking, if they have to wait in the waiting room, if they have

1576
01:43:31,460 --> 01:43:34,920
any seconds to second guess themselves, we'll often talk about it in the meeting.

1577
01:43:34,920 --> 01:43:35,920
They do.

1578
01:43:35,920 --> 01:43:38,320
So I've made that process very seamless.

1579
01:43:38,320 --> 01:43:42,400
So you can expect to do something similar when you see your provider waiting at the

1580
01:43:42,400 --> 01:43:45,480
waiting room, getting called back to their office.

1581
01:43:45,480 --> 01:43:49,160
Once you start that process, you're it varies a little bit.

1582
01:43:49,160 --> 01:43:51,680
But generally, the first meeting is a meet and greet.

1583
01:43:51,680 --> 01:43:52,960
They want to get to know you.

1584
01:43:52,960 --> 01:43:54,400
You get to know them.

1585
01:43:54,400 --> 01:44:00,320
It's a conversation about what therapy is, what confidentiality is, as well as getting

1586
01:44:00,320 --> 01:44:03,240
to know the reason for your visit that day.

1587
01:44:03,240 --> 01:44:04,720
Why today are you coming in?

1588
01:44:04,720 --> 01:44:06,560
How can I help?

1589
01:44:06,560 --> 01:44:10,680
From there, the therapy, the provider is going to use that information to develop a treatment

1590
01:44:10,680 --> 01:44:14,620
plan that you're a part of in that collaboration of that process creating.

1591
01:44:14,620 --> 01:44:17,160
And then you get to sign on for the treatment or not.

1592
01:44:17,160 --> 01:44:23,160
Depending on what your provider's theoretical orientation is, the way that they think about

1593
01:44:23,160 --> 01:44:26,480
symptoms, there can be some some variance here.

1594
01:44:26,480 --> 01:44:29,880
Some might have you fill out questionnaires about signs and symptoms.

1595
01:44:29,880 --> 01:44:34,200
Other ones might ask you to invite people close to you into the therapy session, whether

1596
01:44:34,200 --> 01:44:40,580
that's a family member, you know, or other people close to you in your life.

1597
01:44:40,580 --> 01:44:42,720
And then they determine how often they want to see you.

1598
01:44:42,720 --> 01:44:46,840
Is it is it a serious problem that requires quick intervention and and it needs to be

1599
01:44:46,840 --> 01:44:48,120
a bit more of a dose of therapy?

1600
01:44:48,120 --> 01:44:49,120
You might see them weekly.

1601
01:44:49,120 --> 01:44:53,040
If it's anything less than that, maybe they'll collaborate with you and do it every

1602
01:44:53,040 --> 01:44:55,000
other week, every month, something like that.

1603
01:44:55,000 --> 01:44:58,320
But in general, you can expect show up to the appointment.

1604
01:44:58,320 --> 01:45:01,560
Just bring yourself fill out a little bit of paperwork or discuss it.

1605
01:45:01,560 --> 01:45:04,760
If you filled it out beforehand, have a conversation about you.

1606
01:45:04,760 --> 01:45:05,760
You're the expert on you.

1607
01:45:05,760 --> 01:45:09,960
Those questions should be pretty easy and then potentially discuss where you're going

1608
01:45:09,960 --> 01:45:10,960
in the therapy.

1609
01:45:10,960 --> 01:45:13,840
I love it.

1610
01:45:13,840 --> 01:45:19,040
It's funny the the character in my new book, some of my personal experiences, and it's

1611
01:45:19,040 --> 01:45:21,040
exactly the opposite of what you said.

1612
01:45:21,040 --> 01:45:26,320
You know, that first impression can be so detrimental for someone who's finally got

1613
01:45:26,320 --> 01:45:29,480
the courage to try and get some help.

1614
01:45:29,480 --> 01:45:32,520
And you know, let's say using an example, they can't park or they sit in the waiting

1615
01:45:32,520 --> 01:45:37,640
room for 20 minutes while the person and the counselor is doing whatever the hell they're

1616
01:45:37,640 --> 01:45:40,840
doing and you go in and the room is chaos, you know, and they have to move.

1617
01:45:40,840 --> 01:45:44,320
This is actually happened to me move piles of paper off the couch so you can even sit

1618
01:45:44,320 --> 01:45:45,320
down.

1619
01:45:45,320 --> 01:45:47,580
So again, we're talking about red flags.

1620
01:45:47,580 --> 01:45:50,920
You know, if you've got the opposite of that might be a good time to just turn around and

1621
01:45:50,920 --> 01:45:52,720
go find another one.

1622
01:45:52,720 --> 01:45:53,720
Yeah.

1623
01:45:53,720 --> 01:45:55,320
So I'll talk a little bit more.

1624
01:45:55,320 --> 01:45:58,440
So I do right now I do fully telehealth.

1625
01:45:58,440 --> 01:46:04,240
And so I think all those factors that Dr. Jenna mentioned and the in person are so important,

1626
01:46:04,240 --> 01:46:06,320
you know, very similar process.

1627
01:46:06,320 --> 01:46:13,360
So I'll go back to say someone hears about me or, you know, finds me online and they

1628
01:46:13,360 --> 01:46:16,760
email me, hey, I'm looking for therapy.

1629
01:46:16,760 --> 01:46:22,840
I'll email them back typically within 24 hours or less and tell them that I like to set up

1630
01:46:22,840 --> 01:46:27,720
a free 15 minute phone call with them.

1631
01:46:27,720 --> 01:46:33,440
And I emphasize that this phone call is not only so that I can hear what they're looking

1632
01:46:33,440 --> 01:46:38,240
for and make sure that I'm competent and it's within my scope of practice to address, but

1633
01:46:38,240 --> 01:46:42,600
almost more importantly, it's an opportunity for them to talk to me to get a feel for me.

1634
01:46:42,600 --> 01:46:46,840
And of course, you don't know, get a full feel for me in 15 minutes, but you can get enough

1635
01:46:46,840 --> 01:46:48,180
of a feel.

1636
01:46:48,180 --> 01:46:51,120
And so you can ask questions and I can answer them.

1637
01:46:51,120 --> 01:46:55,960
And this is the opportunity for everyone out there who's listening.

1638
01:46:55,960 --> 01:46:59,160
You got to shop around for a provider that's a good fit for you.

1639
01:46:59,160 --> 01:47:01,240
And it can be really frustrating.

1640
01:47:01,240 --> 01:47:06,200
And I'll disclose, like I said, I get my own therapy and throughout my years of doctoral

1641
01:47:06,200 --> 01:47:09,120
training and everything, I've lived all over the country, which means every single time

1642
01:47:09,120 --> 01:47:14,360
I moved to a new state, I'd have to find a new provider and it'd be really, really frustrating.

1643
01:47:14,360 --> 01:47:19,200
But you need to shop around for your provider and make sure that not only are they competent

1644
01:47:19,200 --> 01:47:25,400
and trained in the scope of what it is you want addressed, but that you feel good with

1645
01:47:25,400 --> 01:47:26,400
them.

1646
01:47:26,400 --> 01:47:33,280
You could have the most highly trained star psychologist in the world.

1647
01:47:33,280 --> 01:47:39,080
And if you don't really like jive with them just on a personality level, not a good fit,

1648
01:47:39,080 --> 01:47:45,360
it's very, very important to just feel like you can connect with that person in some way.

1649
01:47:45,360 --> 01:47:52,440
So that 15 minute phone consult is just a brief way for you to talk to me and see if

1650
01:47:52,440 --> 01:47:53,800
I might be a good fit.

1651
01:47:53,800 --> 01:47:56,940
And then we do a lot of what Dr. Jenna was saying.

1652
01:47:56,940 --> 01:48:01,920
If you schedule an appointment, I use a system called simple practice.

1653
01:48:01,920 --> 01:48:05,360
And basically that's where you schedule your appointments.

1654
01:48:05,360 --> 01:48:09,320
Where I send you the intake paperwork, which is mostly electronic signing, electronically

1655
01:48:09,320 --> 01:48:12,080
signing things like consent forms and whatnot.

1656
01:48:12,080 --> 01:48:16,640
And then you schedule our appointment and we see each other through a secure video platform.

1657
01:48:16,640 --> 01:48:18,320
So we're looking at each other.

1658
01:48:18,320 --> 01:48:23,920
Once in a while, someone might need to request a phone session if the circumstances are such,

1659
01:48:23,920 --> 01:48:28,440
but otherwise, we're visually seeing each other and we're working through that secure

1660
01:48:28,440 --> 01:48:29,440
platform.

1661
01:48:29,440 --> 01:48:34,760
First session, like Dr. Jenna said, is really about getting to know you a little bit better,

1662
01:48:34,760 --> 01:48:38,080
meaning the bigger scope of what's bringing you in and background and the factors that

1663
01:48:38,080 --> 01:48:39,560
might be contributing to this thing.

1664
01:48:39,560 --> 01:48:46,920
And then collaboratively developing treatment goals that we use as goalposts to assess how

1665
01:48:46,920 --> 01:48:49,200
you're progressing.

1666
01:48:49,200 --> 01:48:53,480
And then a treatment plan and what that might look like moving forward.

1667
01:48:53,480 --> 01:48:58,260
So it should always feel very collaborative.

1668
01:48:58,260 --> 01:49:04,480
It should always feel like you can connect in some way to this provider and that they're

1669
01:49:04,480 --> 01:49:09,000
genuinely trying to connect with you as opposed to you're just another person on the couch

1670
01:49:09,000 --> 01:49:13,800
and they're taking notes and they forget what your kid's name was and if you've told them

1671
01:49:13,800 --> 01:49:17,400
10 times and you're just another person there.

1672
01:49:17,400 --> 01:49:24,560
It should feel personal in that sense that they are truly there for you and they are

1673
01:49:24,560 --> 01:49:28,600
wanting to develop a treatment plan specifically for you.

1674
01:49:28,600 --> 01:49:33,080
Let's talk about confidentiality because you touched on that, especially in the first responder

1675
01:49:33,080 --> 01:49:39,280
professions if you're in an AAP provider or the one that works for the agency.

1676
01:49:39,280 --> 01:49:42,320
What are some of the myths around confidentiality?

1677
01:49:42,320 --> 01:49:44,600
What are some of the justified fears?

1678
01:49:44,600 --> 01:49:49,480
And then what is the ideal model to make sure that our responders feel comfortable about

1679
01:49:49,480 --> 01:49:53,000
being open without fearing losing their jobs?

1680
01:49:53,000 --> 01:49:59,040
Okay, so I'm going to address maybe like one question, one of those questions.

1681
01:49:59,040 --> 01:50:04,560
Well, first, let's talk about what confidentiality is when we're talking about therapy.

1682
01:50:04,560 --> 01:50:12,160
That means that I'm not only ethically obligated to keep what we talk about in sessions private

1683
01:50:12,160 --> 01:50:16,900
and I'm not allowed to talk about that outside of the session, but I'm legally obligated

1684
01:50:16,900 --> 01:50:17,900
to that too.

1685
01:50:17,900 --> 01:50:25,040
I could be legally reprimanded in some way if I break that confidentiality.

1686
01:50:25,040 --> 01:50:26,800
So that means I can't share your name.

1687
01:50:26,800 --> 01:50:28,880
I can't share the information we talk.

1688
01:50:28,880 --> 01:50:32,840
Any type of protected health information or what we talk about, things like that.

1689
01:50:32,840 --> 01:50:38,760
Now I can potentially consult, let's say, with Dr. Jenna on a case that I'm working

1690
01:50:38,760 --> 01:50:43,040
on that I need some consultation because it's important to do that if you're kind of stuck

1691
01:50:43,040 --> 01:50:45,800
on something and you need to kind of reach out to someone.

1692
01:50:45,800 --> 01:50:47,640
But again, I'm not giving your name away.

1693
01:50:47,640 --> 01:50:50,640
I'm not giving specific identifying information away.

1694
01:50:50,640 --> 01:50:56,440
I'm more so saying, Jenna, I have this case where someone came in and they're struggling

1695
01:50:56,440 --> 01:51:00,720
with significant guilt, but they've recently started using some narcotics.

1696
01:51:00,720 --> 01:51:06,780
And what's your experience of the best way to address this in a way that we're addressing

1697
01:51:06,780 --> 01:51:08,460
both aspects, right?

1698
01:51:08,460 --> 01:51:13,640
So it's very broad-based and I'm not giving any specific information away.

1699
01:51:13,640 --> 01:51:22,460
So confidentiality is something that's extremely imperative that clinicians and providers follow

1700
01:51:22,460 --> 01:51:23,560
in the therapy room.

1701
01:51:23,560 --> 01:51:27,200
But there are four exceptions we call limitations to confidentiality.

1702
01:51:27,200 --> 01:51:33,040
We are mandated reporters and you're probably aware of what that is, James, right?

1703
01:51:33,040 --> 01:51:34,040
Educate me, please.

1704
01:51:34,040 --> 01:51:38,800
I think I understand the concept, but let's not ask my opinion of it.

1705
01:51:38,800 --> 01:51:45,200
So there are a few circumstances in which I'm legally obligated to actually break that

1706
01:51:45,200 --> 01:51:48,160
confidentiality that I just talked about.

1707
01:51:48,160 --> 01:51:55,280
One would be if I suspected that my client was in imminent danger of harming themselves,

1708
01:51:55,280 --> 01:51:57,200
imminent danger of suicide.

1709
01:51:57,200 --> 01:52:01,360
And when I'm talking to my first responders, I make it very clear when I say imminent for

1710
01:52:01,360 --> 01:52:05,200
me as a clinician is much more specific.

1711
01:52:05,200 --> 01:52:10,640
I work with first responders with varying levels of suicidality to people who have chronic

1712
01:52:10,640 --> 01:52:14,800
thoughts of wanting to kill themselves and maybe even like they've started to drive by

1713
01:52:14,800 --> 01:52:21,280
bridges and they've engaged in some behavior, even that in and of itself wouldn't necessarily

1714
01:52:21,280 --> 01:52:25,400
lead for me to break that confidentiality and call 911.

1715
01:52:25,400 --> 01:52:32,280
For me, examples of imminent would be if someone says I've made up my mind, I made up my mind,

1716
01:52:32,280 --> 01:52:34,800
I'm going to do it.

1717
01:52:34,800 --> 01:52:38,000
Something like that, for example, I would break confidentiality for that.

1718
01:52:38,000 --> 01:52:40,080
I would consider that imminent.

1719
01:52:40,080 --> 01:52:47,480
Or if there is a multitude of pieces of information present that indicate, that lead me to believe

1720
01:52:47,480 --> 01:52:54,600
with the information I have that it's quite possible that this person might attempt suicide

1721
01:52:54,600 --> 01:52:59,000
when they leave the session, soon after they leave the session.

1722
01:52:59,000 --> 01:53:03,440
So I like to make that very clear because I've had first responders say that they're

1723
01:53:03,440 --> 01:53:07,440
worried that if they tell me that they've attempted suicide recently or that they've

1724
01:53:07,440 --> 01:53:12,960
been thinking about it, that then I'm going to go tell someone about it.

1725
01:53:12,960 --> 01:53:19,400
In most cases, that is not the case, but there are certain circumstances where that would

1726
01:53:19,400 --> 01:53:20,400
be the case.

1727
01:53:20,400 --> 01:53:24,440
Do you have anything to add to that one, Dr. Jena?

1728
01:53:24,440 --> 01:53:28,480
I love that you went into detail more specifically about it because I think when we're talking

1729
01:53:28,480 --> 01:53:32,860
about first responders, one of the biggest challenges for clinicians is a lot of them

1730
01:53:32,860 --> 01:53:34,920
have access to lethal means.

1731
01:53:34,920 --> 01:53:37,280
So that can feel kind of spooky, right?

1732
01:53:37,280 --> 01:53:41,560
There's a group of people who are highly trauma exposed that have a lot of those risk factors

1733
01:53:41,560 --> 01:53:42,840
for suicide.

1734
01:53:42,840 --> 01:53:46,520
They have access to lethal means, which we know it can be a problem.

1735
01:53:46,520 --> 01:53:47,600
How do we keep them safe?

1736
01:53:47,600 --> 01:53:53,080
But remember the goal in therapy, if you're suicidal and you're coming to a therapist

1737
01:53:53,080 --> 01:53:56,000
and you're asking them to help you is that you want to live.

1738
01:53:56,000 --> 01:54:01,480
So I look at my role as have we done everything that we can to get you there, right?

1739
01:54:01,480 --> 01:54:07,480
Including but not limited to can you voluntarily choose other methods to keep yourself safe

1740
01:54:07,480 --> 01:54:08,680
at this time?

1741
01:54:08,680 --> 01:54:14,400
So the last option for me, and again, it has to be the imminent threat is let me call somebody

1742
01:54:14,400 --> 01:54:17,480
else and do this thing with you.

1743
01:54:17,480 --> 01:54:20,480
Let's involuntarily take you somewhere maybe where you don't want to go.

1744
01:54:20,480 --> 01:54:22,920
I'm willing to exhaust all options with somebody.

1745
01:54:22,920 --> 01:54:28,200
And in fact, we as providers are the perfect people to talk about suicidal thoughts with

1746
01:54:28,200 --> 01:54:32,000
because we're well equipped to be able to their suicide trained, well equipped to be

1747
01:54:32,000 --> 01:54:38,600
able to manage those problems.

1748
01:54:38,600 --> 01:54:39,720
So that's one circumstance.

1749
01:54:39,720 --> 01:54:41,800
So that's one of the limits of confidentiality.

1750
01:54:41,800 --> 01:54:46,560
And I should also comment that this very much varies confidentiality, whether you're in

1751
01:54:46,560 --> 01:54:52,580
a private practice like me and Dr. Jenna are, whether you work for an EAP, whether you're

1752
01:54:52,580 --> 01:54:56,480
an embedded psychologist in an agency.

1753
01:54:56,480 --> 01:54:59,320
This can all look very different.

1754
01:54:59,320 --> 01:55:03,640
So I'm commenting from the perspective of someone who's in a private practice, which

1755
01:55:03,640 --> 01:55:12,480
means that your agency, your captain, they have nothing to do with you and I's work together.

1756
01:55:12,480 --> 01:55:13,480
Nothing.

1757
01:55:13,480 --> 01:55:14,960
I've had so many first responders call me.

1758
01:55:14,960 --> 01:55:16,320
They'll sometimes not give me their name.

1759
01:55:16,320 --> 01:55:18,200
They'll be like, I'm not giving you my name yet.

1760
01:55:18,200 --> 01:55:19,560
And we'll do the 15 minute consult.

1761
01:55:19,560 --> 01:55:20,560
I'm like, that's fine.

1762
01:55:20,560 --> 01:55:23,000
You know, because they want to feel me out and talk to me.

1763
01:55:23,000 --> 01:55:27,320
But unfortunately they think that, let's say, especially if I work with an agency, like

1764
01:55:27,320 --> 01:55:34,000
I come in and I do trainings there, that they'll think that if something's wrong with them,

1765
01:55:34,000 --> 01:55:39,040
then I'm going to go tell their leadership or even in the instance of imminent suicide

1766
01:55:39,040 --> 01:55:43,480
that I'm calling their agency or their leadership about that.

1767
01:55:43,480 --> 01:55:49,600
As Dr. Jenna said, if all options are exhausted and someone I believe is an imminent risk

1768
01:55:49,600 --> 01:55:53,480
of taking their own life, I'm not calling their agency, right?

1769
01:55:53,480 --> 01:55:58,160
I'm calling an emergency service so that we can get them the help that they need at that

1770
01:55:58,160 --> 01:55:59,160
time.

1771
01:55:59,160 --> 01:56:03,800
So I think that that's very important when we're talking about practitioners like me

1772
01:56:03,800 --> 01:56:08,600
and Dr. Jenna in private practice is you're only working with us.

1773
01:56:08,600 --> 01:56:16,400
None of those other factors have any, any, any handle on the care we do together to the

1774
01:56:16,400 --> 01:56:17,400
point.

1775
01:56:17,400 --> 01:56:20,640
You know how strict confidentiality is in private practice.

1776
01:56:20,640 --> 01:56:27,720
If your supervisor calls me, say you tell your supervisor, you openly tell them, I've

1777
01:56:27,720 --> 01:56:30,680
been seeing Dr. Brooks, she's been great, blah, blah, blah, blah.

1778
01:56:30,680 --> 01:56:35,720
And your supervisor calls me and says, John Smith said that he's been seeing you and I

1779
01:56:35,720 --> 01:56:36,720
want to see you.

1780
01:56:36,720 --> 01:56:40,800
You know, so, you know, do you think that John's care has been helpful for him?

1781
01:56:40,800 --> 01:56:43,320
And can you provide me the same care as John?

1782
01:56:43,320 --> 01:56:45,240
I don't know, John.

1783
01:56:45,240 --> 01:56:50,320
I don't even say, listen, I can't give you that information, specific information about

1784
01:56:50,320 --> 01:56:54,880
John, but he's been great to work with and let's talk about how that looks with you.

1785
01:56:54,880 --> 01:56:57,040
I don't even know John.

1786
01:56:57,040 --> 01:56:58,040
He doesn't exist.

1787
01:56:58,040 --> 01:56:59,040
I'm sorry.

1788
01:56:59,040 --> 01:57:03,600
I can't comment on whoever it is that you're talking about under my care, but, you know,

1789
01:57:03,600 --> 01:57:07,160
I'm not sure I can, you know, identify anyone that you're talking about.

1790
01:57:07,160 --> 01:57:12,840
So that's how strict confidentiality is in private practice is that it's just you and

1791
01:57:12,840 --> 01:57:13,840
me.

1792
01:57:13,840 --> 01:57:17,040
No one else has access to those things.

1793
01:57:17,040 --> 01:57:20,160
So I wanted to make that very clear to you because I feel like that's probably like one

1794
01:57:20,160 --> 01:57:25,960
of the most common concerns that I have with first responders who reach out and for a consult

1795
01:57:25,960 --> 01:57:28,640
is they're like, you know, I see you all the time.

1796
01:57:28,640 --> 01:57:31,200
I see four times a year giving trainings here.

1797
01:57:31,200 --> 01:57:32,840
Are you going to talk to my leadership?

1798
01:57:32,840 --> 01:57:34,760
What if I tell you something really bad?

1799
01:57:34,760 --> 01:57:36,080
Then are you going to tell them?

1800
01:57:36,080 --> 01:57:37,080
Right.

1801
01:57:37,080 --> 01:57:38,080
So no contact.

1802
01:57:38,080 --> 01:57:39,080
There is no conversation.

1803
01:57:39,080 --> 01:57:41,040
They have no access to the records.

1804
01:57:41,040 --> 01:57:42,440
So that's super important.

1805
01:57:42,440 --> 01:57:44,400
I want to highlight that.

1806
01:57:44,400 --> 01:57:49,680
Yeah, I think it's really helpful to let people know that there is a difference between privacy

1807
01:57:49,680 --> 01:57:50,680
and confidentiality.

1808
01:57:50,680 --> 01:57:53,880
So what Dr. Brooke is talking about is privacy.

1809
01:57:53,880 --> 01:57:57,680
You have the right to control the disclosure of your own personal information.

1810
01:57:57,680 --> 01:58:00,960
If you want to go and tell the whole world that you're seeing Dr. Brooke and she's doing

1811
01:58:00,960 --> 01:58:02,800
an amazing job, that is up to you.

1812
01:58:02,800 --> 01:58:06,440
You get to say that you choose who, what, when, where, and why you're disclosing that

1813
01:58:06,440 --> 01:58:08,520
information.

1814
01:58:08,520 --> 01:58:14,080
Privacy is the provider's vehicle by which they uphold that on their end of the deal.

1815
01:58:14,080 --> 01:58:18,280
So if even if you've told everybody in the world, you've written books about it, you've

1816
01:58:18,280 --> 01:58:21,280
advertised about it, Dr. Brooke's therapy is the best.

1817
01:58:21,280 --> 01:58:25,800
If you, if anybody was to call or inquire about that, again, I can't confirm or deny

1818
01:58:25,800 --> 01:58:28,000
that this person is a client.

1819
01:58:28,000 --> 01:58:29,000
What are you looking for?

1820
01:58:29,000 --> 01:58:30,240
How can I help you?

1821
01:58:30,240 --> 01:58:31,240
Right.

1822
01:58:31,240 --> 01:58:37,680
I think a lot of my people, the sticky situation to sort of segue into this piece of the conversation

1823
01:58:37,680 --> 01:58:42,960
is when agencies call and consult saying that they have, they want to support an employee.

1824
01:58:42,960 --> 01:58:46,680
They don't want to go the fitness for duty route, but they want to support an employee

1825
01:58:46,680 --> 01:58:48,960
by paying for some therapy.

1826
01:58:48,960 --> 01:58:55,080
And this is very provider specific and I encourage anybody doing this to get consultation around

1827
01:58:55,080 --> 01:58:58,720
it and contact their liability insurance and make sure they're going about it the right

1828
01:58:58,720 --> 01:58:59,720
way.

1829
01:58:59,720 --> 01:59:04,160
But what I've done with some agencies has said, if the client calls me on their own

1830
01:59:04,160 --> 01:59:09,160
volition and decides that they want to enter into therapy, what I will do with them is

1831
01:59:09,160 --> 01:59:14,440
explain the limits to confidentiality and I will have them sign a release of information

1832
01:59:14,440 --> 01:59:18,480
for the billing information so that you can cover the end of the billing.

1833
01:59:18,480 --> 01:59:22,920
It does not give you access to anything other than how much money you owe me.

1834
01:59:22,920 --> 01:59:24,600
You don't get to have access to their records.

1835
01:59:24,600 --> 01:59:28,320
I don't get to make any formal opinions about their performance or whether or not they're

1836
01:59:28,320 --> 01:59:34,020
fit to come to work, stay at work, do anything different, go to any other duty status.

1837
01:59:34,020 --> 01:59:38,560
If you want to support the employee in that way, I'm willing to do that as long as both

1838
01:59:38,560 --> 01:59:42,480
of you are aware that I can't even if you were to call me outside of that, confirm if

1839
01:59:42,480 --> 01:59:43,960
they're attending.

1840
01:59:43,960 --> 01:59:47,400
Again, different providers have different comfort levels, but I think that's helpful

1841
01:59:47,400 --> 01:59:51,880
for people to know because when we're talking about this confidentiality piece, it applies

1842
01:59:51,880 --> 01:59:53,860
to voluntary therapy.

1843
01:59:53,860 --> 01:59:59,080
If somebody is being mandated to some other type of service, like a fitness for duty evaluation

1844
01:59:59,080 --> 02:00:03,000
or a pre-employment evaluation, audience members that have gone through something like this

1845
02:00:03,000 --> 02:00:07,160
might remember you sign releases that say that you don't get access to some of the results

1846
02:00:07,160 --> 02:00:08,160
in your agency does.

1847
02:00:08,160 --> 02:00:11,120
That is a limitation to confidentiality.

1848
02:00:11,120 --> 02:00:16,640
All of this information about how services are being provided should be outlined in informed

1849
02:00:16,640 --> 02:00:18,260
consent with your provider.

1850
02:00:18,260 --> 02:00:22,440
If you have any questions about that, it should be directly outlined and discussed in that

1851
02:00:22,440 --> 02:00:26,220
first meeting and that should answer any questions people have.

1852
02:00:26,220 --> 02:00:30,760
What about the other side of that before we go to the other elements?

1853
02:00:30,760 --> 02:00:32,740
Where has this fear come from?

1854
02:00:32,740 --> 02:00:39,400
Have there been history of agencies providing what their employees thought was simple mental

1855
02:00:39,400 --> 02:00:46,280
health resources, but then that confidentiality wasn't honored in that particular case?

1856
02:00:46,280 --> 02:00:49,320
Sure, there have been.

1857
02:00:49,320 --> 02:00:50,320
I've heard of cases.

1858
02:00:50,320 --> 02:00:54,080
There's two sides of this.

1859
02:00:54,080 --> 02:00:56,080
I've heard of horror stories.

1860
02:00:56,080 --> 02:01:01,960
What I think are horror stories of clinicians not knowing ethical guidelines and boundaries,

1861
02:01:01,960 --> 02:01:04,880
oversharing things.

1862
02:01:04,880 --> 02:01:12,140
I've heard of it on that side and I've heard all too often organizations that are able

1863
02:01:12,140 --> 02:01:19,120
to get access to previous therapy records or to find out that one of their personnel

1864
02:01:19,120 --> 02:01:21,400
has gone to therapy in some way.

1865
02:01:21,400 --> 02:01:24,320
Not if you're going to a private paper rider though, we'll talk about that.

1866
02:01:24,320 --> 02:01:29,000
But this is typically if someone went through insurance-based means of some sort and they're

1867
02:01:29,000 --> 02:01:33,000
able to find out that they went to therapy and then they're like, oh, now we need to

1868
02:01:33,000 --> 02:01:38,960
evaluate you on all these factors because we found out that you went to therapy for

1869
02:01:38,960 --> 02:01:39,960
depression.

1870
02:01:39,960 --> 02:01:40,960
Yikes.

1871
02:01:40,960 --> 02:01:41,960
Five years ago.

1872
02:01:41,960 --> 02:01:43,920
So we got to make sure you're not crazy.

1873
02:01:43,920 --> 02:01:50,520
So let's go ahead and put you through the wringer and make sure because you did the

1874
02:01:50,520 --> 02:01:52,840
right thing and got help five years ago.

1875
02:01:52,840 --> 02:01:54,240
So I've had people call me.

1876
02:01:54,240 --> 02:01:59,160
I've had people in aviation specifically, it's bringing to mind most recently, call

1877
02:01:59,160 --> 02:02:00,160
me.

1878
02:02:00,160 --> 02:02:02,360
It was like 10 years ago they went to therapy.

1879
02:02:02,360 --> 02:02:03,360
They were struggling with depression.

1880
02:02:03,360 --> 02:02:04,360
They went to therapy.

1881
02:02:04,360 --> 02:02:10,360
They've been doing pretty well, but their agency found out and they were making them

1882
02:02:10,360 --> 02:02:15,640
do this whole reevaluation to make sure that they're mentally stable.

1883
02:02:15,640 --> 02:02:19,120
Otherwise they were going to not let them fly anymore.

1884
02:02:19,120 --> 02:02:22,480
So that's a real sight.

1885
02:02:22,480 --> 02:02:27,200
I always tell my first responders, your fears around these things are, they're there for

1886
02:02:27,200 --> 02:02:28,200
a reason.

1887
02:02:28,200 --> 02:02:33,480
Like I'm not going to sit here and tell you, you got nothing to worry about because there's

1888
02:02:33,480 --> 02:02:36,960
a lot of that that's going on.

1889
02:02:36,960 --> 02:02:39,840
Maybe the pilot could do an MMPI and a polygraph and then it'd be sweet.

1890
02:02:39,840 --> 02:02:40,840
It'd be golden after that.

1891
02:02:40,840 --> 02:02:41,840
Yeah, and they're good.

1892
02:02:41,840 --> 02:02:42,840
Yeah, exactly.

1893
02:02:42,840 --> 02:02:49,720
Well, you mentioned four elements when it came to when you have to disclose.

1894
02:02:49,720 --> 02:02:50,720
What were the other three?

1895
02:02:50,720 --> 02:02:59,240
Yeah, another one would be if I suspect any harm or abuse to anyone under the age of 18,

1896
02:02:59,240 --> 02:03:07,200
anyone from a protected population, someone with disabilities of any kind or anyone over

1897
02:03:07,200 --> 02:03:08,200
the age of 65.

1898
02:03:08,200 --> 02:03:10,520
That's what they constitute as elderly.

1899
02:03:10,520 --> 02:03:14,840
So that would be like if someone comes to my session and they're bawling their eyes

1900
02:03:14,840 --> 02:03:18,600
out and they're like, I feel so guilty.

1901
02:03:18,600 --> 02:03:23,360
My anger got the best of me and I hit my kid and they have a bruise.

1902
02:03:23,360 --> 02:03:30,800
Unfortunately, I have to report that, make a call CPS and file a report in that.

1903
02:03:30,800 --> 02:03:35,840
I'm legally obligated to do that and for psychologists, at least in the state of California, and

1904
02:03:35,840 --> 02:03:40,560
I'm sure it is in most places, not only can we lose our license if we don't do that, but

1905
02:03:40,560 --> 02:03:47,080
we could actually receive a pretty hefty fine and face jail time.

1906
02:03:47,080 --> 02:03:53,440
So in those cases, very few and far between, particularly in my private practice world,

1907
02:03:53,440 --> 02:03:59,060
but in those cases, it's not like, oh my God, I can't believe you told me that and then

1908
02:03:59,060 --> 02:04:02,200
I got to end the session, I'm going to go do this.

1909
02:04:02,200 --> 02:04:07,640
I very much reiterate, so I told you about the limits of confidentiality and I can see

1910
02:04:07,640 --> 02:04:13,600
that you're very upset about this and I want to work with you through this.

1911
02:04:13,600 --> 02:04:18,240
However, this is something that I'm legally obligated to call CPS on, is are you willing

1912
02:04:18,240 --> 02:04:19,880
to be there on the phone with me?

1913
02:04:19,880 --> 02:04:23,640
I'd really like you to be there on the phone with me to do that.

1914
02:04:23,640 --> 02:04:26,400
So I see if they're willing to do that.

1915
02:04:26,400 --> 02:04:27,600
We call CPS.

1916
02:04:27,600 --> 02:04:31,600
I only give the minimal amount of information necessary.

1917
02:04:31,600 --> 02:04:36,600
So that's another really important part, which means I don't say, well, John Smith here,

1918
02:04:36,600 --> 02:04:40,760
he's a firefighter, he came in, he's been cheating on his wife for a bunch of years

1919
02:04:40,760 --> 02:04:44,600
and he's just had so much anger and blah, blah, and last night he did this.

1920
02:04:44,600 --> 02:04:50,320
I just say, my client here, do you want to tell them what happened?

1921
02:04:50,320 --> 02:04:54,440
Sometimes I ask them if they want to, but they're able to disclose that or just the

1922
02:04:54,440 --> 02:04:59,120
details surrounding the hitting of the child, they struck their child, they report that

1923
02:04:59,120 --> 02:05:00,120
there's a bruise.

1924
02:05:00,120 --> 02:05:02,880
CPS gets to do whatever they want with that.

1925
02:05:02,880 --> 02:05:08,480
I have no decision of what goes with that, but that's another example of a limit to confidentiality

1926
02:05:08,480 --> 02:05:10,920
that we're legally required to report.

1927
02:05:10,920 --> 02:05:15,560
Do you have anything to add to that, Jenna, that I missed anything?

1928
02:05:15,560 --> 02:05:16,680
No, I do.

1929
02:05:16,680 --> 02:05:18,360
I go about the process the same way.

1930
02:05:18,360 --> 02:05:23,320
And I think for some people, they can be upset about the consequences of that action, right?

1931
02:05:23,320 --> 02:05:26,600
But if they can be a part of the solution, it tends to be a bit better.

1932
02:05:26,600 --> 02:05:31,920
So I also will sit down with people, have them call CPS, walk through that process,

1933
02:05:31,920 --> 02:05:36,420
and then there is a lot of transparency there, which I think is helpful.

1934
02:05:36,420 --> 02:05:39,440
A lot of people will think, oh, you're going to call and tell my whole life story.

1935
02:05:39,440 --> 02:05:43,640
But when they can be there present for the information that's being given, they realize

1936
02:05:43,640 --> 02:05:47,600
that, like you said, only the minimum amount of information is given.

1937
02:05:47,600 --> 02:05:48,920
They were in control of that.

1938
02:05:48,920 --> 02:05:50,680
Maybe they even were the ones to share it.

1939
02:05:50,680 --> 02:05:52,960
And so it makes them part of that process.

1940
02:05:52,960 --> 02:05:56,840
And that tends to be better.

1941
02:05:56,840 --> 02:06:01,440
You mentioned children, special needs population, the elderly.

1942
02:06:01,440 --> 02:06:03,000
Is that the fourth one?

1943
02:06:03,000 --> 02:06:07,400
If there's imminent harm to someone else, if someone says, I'm going to go and shoot

1944
02:06:07,400 --> 02:06:10,600
Brian Smith, my brother, as soon as I leave here.

1945
02:06:10,600 --> 02:06:11,600
Yeah.

1946
02:06:11,600 --> 02:06:15,360
So there's an I'm is it just in California, the Terrace off?

1947
02:06:15,360 --> 02:06:16,840
Or do you have Terrace off too?

1948
02:06:16,840 --> 02:06:18,400
You have Terrace off.

1949
02:06:18,400 --> 02:06:19,400
Yeah.

1950
02:06:19,400 --> 02:06:20,400
So the Terrace off also.

1951
02:06:20,400 --> 02:06:21,400
Yeah.

1952
02:06:21,400 --> 02:06:23,680
There's imminent danger to someone else with an identifiable target.

1953
02:06:23,680 --> 02:06:25,800
It has to be an identifiable target.

1954
02:06:25,800 --> 02:06:31,640
And what that means by that is if you just said, I want to go kill someone.

1955
02:06:31,640 --> 02:06:34,000
I actually can't break that confidentiality.

1956
02:06:34,000 --> 02:06:37,360
I'd probably ask a lot more questions and say, what do you mean?

1957
02:06:37,360 --> 02:06:38,360
Who?

1958
02:06:38,360 --> 02:06:39,360
What are you talking about?

1959
02:06:39,360 --> 02:06:40,360
Is there anyone you have in mind?

1960
02:06:40,360 --> 02:06:41,360
Right.

1961
02:06:41,360 --> 02:06:46,640
But if someone says my neighbor, John Smith, he's seen his last day and I'm going to make

1962
02:06:46,640 --> 02:06:47,640
sure of that.

1963
02:06:47,640 --> 02:06:51,640
I'd have to legally report that or that post office over on the corner of GenC and Point

1964
02:06:51,640 --> 02:06:52,640
Loma.

1965
02:06:52,640 --> 02:06:55,040
I'm going to blow it up tomorrow.

1966
02:06:55,040 --> 02:06:57,800
Or like I, you know, I want to make sure I have some fun with that tomorrow.

1967
02:06:57,800 --> 02:07:01,960
I got, I went and got a bunch of fireworks in Tijuana and I want to make sure I have

1968
02:07:01,960 --> 02:07:02,960
some fun with that.

1969
02:07:02,960 --> 02:07:08,160
I'd have to report that because that's an identifiable, an identifiable target.

1970
02:07:08,160 --> 02:07:14,880
Believe it or not, confidentiality is so strict in the private practice world and such that

1971
02:07:14,880 --> 02:07:20,840
if someone told me they've killed five people, they've killed five people.

1972
02:07:20,840 --> 02:07:23,680
I'm not legally allowed to tell anyone about that.

1973
02:07:23,680 --> 02:07:24,880
I can't call 911.

1974
02:07:24,880 --> 02:07:26,360
I can't make a report.

1975
02:07:26,360 --> 02:07:29,240
I'm not condoning you coming to me after killing people.

1976
02:07:29,240 --> 02:07:35,400
But my point is, is that it needs to be danger, imminent future danger to someone.

1977
02:07:35,400 --> 02:07:39,920
If someone's done really bad things in the past or let's even get into the weeds a little

1978
02:07:39,920 --> 02:07:42,860
bit more.

1979
02:07:42,860 --> 02:07:48,680
If someone discloses that they've done some other not so great things in the past, whether

1980
02:07:48,680 --> 02:07:52,320
it be with children or things like that, like they've hit children in the past or anything

1981
02:07:52,320 --> 02:07:57,480
like that, our job is to assess what's their access to children now, if they have children

1982
02:07:57,480 --> 02:07:58,480
in the house now.

1983
02:07:58,480 --> 02:08:04,640
It gets a little bit more complicated there, but really that imminent future dangers to

1984
02:08:04,640 --> 02:08:12,200
oneself or to others with an identifiable target are the ones that we are clearly required

1985
02:08:12,200 --> 02:08:15,760
to report.

1986
02:08:15,760 --> 02:08:18,080
Anything to add, Jenna, before we go to one last area?

1987
02:08:18,080 --> 02:08:19,080
Nope.

1988
02:08:19,080 --> 02:08:20,560
I think she covered it.

1989
02:08:20,560 --> 02:08:21,560
All right.

1990
02:08:21,560 --> 02:08:25,760
Well, the very last one, then we'll make sure everyone knows where to find you guys.

1991
02:08:25,760 --> 02:08:27,840
What about the financial element?

1992
02:08:27,840 --> 02:08:33,320
I think this has actually become quite a big barrier to entry to departments where they

1993
02:08:33,320 --> 02:08:34,840
just don't have a lot of support.

1994
02:08:34,840 --> 02:08:40,000
An EAP, for example, it might only cover five sessions and then you're on your own.

1995
02:08:40,000 --> 02:08:46,720
Talk to me about the different methods of payment or being in a network, the user's

1996
02:08:46,720 --> 02:08:54,800
insurance or doesn't, and then what have you seen as far as the best dynamics or philosophies

1997
02:08:54,800 --> 02:08:57,240
to enable first responders?

1998
02:08:57,240 --> 02:09:00,960
Arguably a lot of them in crisis are probably not doing well financially and it seems like

1999
02:09:00,960 --> 02:09:03,920
everything falls apart when it does.

2000
02:09:03,920 --> 02:09:08,760
Kind of trying to reduce those barriers to entry to get our first responders to good

2001
02:09:08,760 --> 02:09:12,480
culturally competent clinicians.

2002
02:09:12,480 --> 02:09:18,320
Generally speaking, there's sort of two ways into the field of psychology payment wise,

2003
02:09:18,320 --> 02:09:19,720
private payer insurance.

2004
02:09:19,720 --> 02:09:24,160
I think there's a third middle ground where we're seeing kind of an increase of that of

2005
02:09:24,160 --> 02:09:30,600
nonprofits that are something that providers can contract with and then have that party

2006
02:09:30,600 --> 02:09:36,000
pay, but essentially it ends up being some private payer or insurance.

2007
02:09:36,000 --> 02:09:39,120
Most of the time, and I'm private pay, so just speaking from my own experience and reasoning

2008
02:09:39,120 --> 02:09:43,600
for me choosing it, but also I know reasons for other people going to that route.

2009
02:09:43,600 --> 02:09:48,000
I'm aware that my first responders are not the richest people in the world and that there

2010
02:09:48,000 --> 02:09:49,140
is a barrier to care.

2011
02:09:49,140 --> 02:09:54,120
They already have insurance and that paying for something out of cost, out of pocket can

2012
02:09:54,120 --> 02:09:59,560
be difficult, but my rationale for choosing private pay over insurance are kind of three

2013
02:09:59,560 --> 02:10:00,560
main ones.

2014
02:10:00,560 --> 02:10:04,000
Number one, I like to be in control of my patient's care.

2015
02:10:04,000 --> 02:10:07,960
I want to be able to make the decisions about whether or not they meet criteria for a diagnosis

2016
02:10:07,960 --> 02:10:10,760
and what I think essential care is for them.

2017
02:10:10,760 --> 02:10:15,080
When you work with an insurance company, not only are you working with them deciding what

2018
02:10:15,080 --> 02:10:19,000
they are going to reimburse you for the session, what that should cost as opposed to what you

2019
02:10:19,000 --> 02:10:20,720
think the session costs.

2020
02:10:20,720 --> 02:10:25,600
Not only is there administrative burden associated with filling out all of the paperwork continuously

2021
02:10:25,600 --> 02:10:30,960
to continue to get authorization for the services, but you have to be able to determine by their

2022
02:10:30,960 --> 02:10:33,240
standards that the care is essential.

2023
02:10:33,240 --> 02:10:35,480
I'm the provider.

2024
02:10:35,480 --> 02:10:39,520
My job is to determine what care this person needs and then articulate to that person that

2025
02:10:39,520 --> 02:10:43,280
this is what the game plan is and here's how we're going to move forward.

2026
02:10:43,280 --> 02:10:47,880
When you talk about cultural competency like we did earlier, some of that means adapting

2027
02:10:47,880 --> 02:10:52,080
things to fit the context and the person in front of you.

2028
02:10:52,080 --> 02:10:57,720
It's not always the case that that care will be covered by an insurance company.

2029
02:10:57,720 --> 02:11:01,400
Those are kind of my reasons for private pay.

2030
02:11:01,400 --> 02:11:03,480
What about you, Dr. Brooke?

2031
02:11:03,480 --> 02:11:08,800
All those, and on top of that, they typically require you to diagnose someone.

2032
02:11:08,800 --> 02:11:13,480
They require, like she was saying, you need to prove why this person actually needs this

2033
02:11:13,480 --> 02:11:17,240
care and the best way to do that is to diagnose them.

2034
02:11:17,240 --> 02:11:23,760
Now, there's schools of thought that are like, let's just get rid of diagnoses completely.

2035
02:11:23,760 --> 02:11:25,320
I'm not from that school of thought.

2036
02:11:25,320 --> 02:11:28,160
I think that they are very important.

2037
02:11:28,160 --> 02:11:31,600
We're talking about assessment and learning what someone's needs are and being able to

2038
02:11:31,600 --> 02:11:33,560
provide them the treatment that they need.

2039
02:11:33,560 --> 02:11:38,240
However, there are a lot of people that actually don't have a diagnosis.

2040
02:11:38,240 --> 02:11:40,480
They don't meet criteria for a diagnosis.

2041
02:11:40,480 --> 02:11:46,240
There's no reason to assign them a diagnosis, but a lot of insurance companies require that

2042
02:11:46,240 --> 02:11:50,680
you give them a diagnosis regardless so that you can prove why it is that they need that

2043
02:11:50,680 --> 02:11:51,680
care.

2044
02:11:51,680 --> 02:11:56,440
I'd add that on too, like she was saying, is that insurance companies are the ones who

2045
02:11:56,440 --> 02:12:03,080
determine what they think you need and what your treatment looks like.

2046
02:12:03,080 --> 02:12:08,400
In addition to that, a reason why I'm also private pay is that confidentiality aspect.

2047
02:12:08,400 --> 02:12:13,280
When you go through insurance, they have access to everything, everything.

2048
02:12:13,280 --> 02:12:16,920
They can do what's called clawbacks, which is when they're like, we don't actually think

2049
02:12:16,920 --> 02:12:21,240
we need to pay you, Dr. Jennifer, that appointment that you just have with that person because

2050
02:12:21,240 --> 02:12:23,440
we don't actually think they need this care.

2051
02:12:23,440 --> 02:12:29,480
Give us all their records so you can prove to us why they actually need that care.

2052
02:12:29,480 --> 02:12:34,680
They have full access to all that stuff.

2053
02:12:34,680 --> 02:12:38,280
That's an important thing to consider when going through insurance is there's a possibility

2054
02:12:38,280 --> 02:12:43,640
that your records are not as protected as they would be in private pay where Dr. Jenna

2055
02:12:43,640 --> 02:12:47,680
and I are the ones who are in control of everything.

2056
02:12:47,680 --> 02:12:49,280
You're working directly with us.

2057
02:12:49,280 --> 02:12:53,920
No one else has access to any of your information or records unless you quite literally sign

2058
02:12:53,920 --> 02:12:58,840
a release of information willingly and voluntarily because you want me to provide these records

2059
02:12:58,840 --> 02:13:00,800
to someone else.

2060
02:13:00,800 --> 02:13:07,600
That's another major factor for also why I do not take insurance in private pay.

2061
02:13:07,600 --> 02:13:10,200
I had Greg from the Overwatch Collective on.

2062
02:13:10,200 --> 02:13:16,840
That's one organization though that helps fund counseling for first responders.

2063
02:13:16,840 --> 02:13:21,320
Seeing all the things that you said and realizing that obviously the private model is a great

2064
02:13:21,320 --> 02:13:27,120
model for a number of reasons, have you seen any departments that have something in place

2065
02:13:27,120 --> 02:13:32,760
where they will fund for that first responder to go and find a counselor of their own?

2066
02:13:32,760 --> 02:13:38,480
Yeah, I contract with, I guess it's not technically a contract, but I work with two organizations

2067
02:13:38,480 --> 02:13:43,920
right now who have a policy and a procedure in place that if an employee wants to utilize

2068
02:13:43,920 --> 02:13:49,160
anybody else's services, all they have to do is have that provider send them a de-identified

2069
02:13:49,160 --> 02:13:50,880
bill at the end of the month.

2070
02:13:50,880 --> 02:13:52,240
They aggregate it to the month.

2071
02:13:52,240 --> 02:13:57,480
It just says number of appointments and a dollar amount and the agency will pay for

2072
02:13:57,480 --> 02:13:58,480
that.

2073
02:13:58,480 --> 02:14:00,960
It doesn't go back to anybody in particular.

2074
02:14:00,960 --> 02:14:04,580
That's the most progressive of the agencies that I've seen so far in terms of the agency

2075
02:14:04,580 --> 02:14:05,640
owning it.

2076
02:14:05,640 --> 02:14:11,120
Again, they can pick whatever provider they want, which again gives them a bit more autonomy

2077
02:14:11,120 --> 02:14:14,480
to pick that culturally competent person.

2078
02:14:14,480 --> 02:14:17,800
I work with an agency that does that as well.

2079
02:14:17,800 --> 02:14:20,080
It's really fantastic that they do that.

2080
02:14:20,080 --> 02:14:26,400
Now they do set a limit on, which is still within my normal fee, but the chief had told

2081
02:14:26,400 --> 02:14:31,680
me at one point they found out that one of their people was seeing someone who was charging

2082
02:14:31,680 --> 02:14:38,280
like $700 for one session, like something insane, obviously just completely abusing

2083
02:14:38,280 --> 02:14:40,000
and taking advantage of that person.

2084
02:14:40,000 --> 02:14:46,520
But anyways, yeah, they pay your full fee given that it's within a reasonable, the average

2085
02:14:46,520 --> 02:14:50,160
for a psychologist.

2086
02:14:50,160 --> 02:14:55,640
You just send in a de-identified bill and you assign a number to that firefighter, like

2087
02:14:55,640 --> 02:15:00,400
a five digit number, and then you send them a bill and they send the money to you.

2088
02:15:00,400 --> 02:15:03,720
That's definitely one of the more progressive routes.

2089
02:15:03,720 --> 02:15:13,640
There's other aspects, like I've contracted with departments where we decide on a number

2090
02:15:13,640 --> 02:15:14,640
in advance.

2091
02:15:14,640 --> 02:15:19,600
Basically, they pay for six sessions a month.

2092
02:15:19,600 --> 02:15:22,920
Say this is a smaller department or something, they cover six sessions a month.

2093
02:15:22,920 --> 02:15:27,520
They pay upfront for it and whether or not someone utilizes those, they've still paid

2094
02:15:27,520 --> 02:15:28,520
upfront for it.

2095
02:15:28,520 --> 02:15:33,040
But first responders, they get set up with me just like it's in private practice.

2096
02:15:33,040 --> 02:15:38,720
I'm not working for the agency and then they can utilize those sessions if need be.

2097
02:15:38,720 --> 02:15:42,560
I've even worked with agencies that are like, if you go over, then let us know and we'll

2098
02:15:42,560 --> 02:15:43,560
cover those as well.

2099
02:15:43,560 --> 02:15:46,080
But again, it's completely de-identified.

2100
02:15:46,080 --> 02:15:51,600
They just like to see the data of how many people are actually utilizing the services,

2101
02:15:51,600 --> 02:15:58,600
but without any de-identified, without any specific information that can give away the

2102
02:15:58,600 --> 02:16:00,280
person that's going to therapy.

2103
02:16:00,280 --> 02:16:03,200
That's also a route to go.

2104
02:16:03,200 --> 02:16:04,200
Beautiful.

2105
02:16:04,200 --> 02:16:10,160
With that model, does that somewhat eliminate the need for an EAP if you've just got practitioners

2106
02:16:10,160 --> 02:16:12,660
that you're doing that with?

2107
02:16:12,660 --> 02:16:14,660
I believe so.

2108
02:16:14,660 --> 02:16:15,660
I believe so.

2109
02:16:15,660 --> 02:16:17,600
Again, this is me.

2110
02:16:17,600 --> 02:16:22,760
An advantage of doing that for the agencies, I typically give a significant discount because

2111
02:16:22,760 --> 02:16:27,080
it's upfront and they're paying me for that, whether or not people use them, meaning I'm

2112
02:16:27,080 --> 02:16:31,280
not charging my full fee for those six sessions.

2113
02:16:31,280 --> 02:16:35,200
I give a pretty significant discount on those.

2114
02:16:35,200 --> 02:16:37,680
That's one way to go about it.

2115
02:16:37,680 --> 02:16:42,040
But yeah, I think that that could be a really good way to go if an agency doesn't have access

2116
02:16:42,040 --> 02:16:47,920
to an EAP that they think is effective, is to maybe do that with multiple, depending

2117
02:16:47,920 --> 02:16:50,200
on the size of the agency.

2118
02:16:50,200 --> 02:16:55,920
I operate on my own in my private practice and I do a lot of consulting too, so it's

2119
02:16:55,920 --> 02:16:58,360
not like I'm spending all my time doing therapy.

2120
02:16:58,360 --> 02:17:04,340
I've actually gotten brought into agencies to actually train other providers to be culturally

2121
02:17:04,340 --> 02:17:08,120
competent so that then they can use those providers as well.

2122
02:17:08,120 --> 02:17:10,880
There's a lot of different ways to go about it.

2123
02:17:10,880 --> 02:17:15,560
It might involve a little bit more work on the upfront for them and maybe a little bit

2124
02:17:15,560 --> 02:17:21,760
more money on the upfront, but I think that the benefits of it in the long term are super,

2125
02:17:21,760 --> 02:17:24,640
super valuable and important.

2126
02:17:24,640 --> 02:17:26,680
Brilliant.

2127
02:17:26,680 --> 02:17:27,680
All right.

2128
02:17:27,680 --> 02:17:31,800
Well, we have been talking for over two hours now, so I want to be mindful of your time.

2129
02:17:31,800 --> 02:17:37,000
So Jenna, for people listening, where can they find you online and any kind of courses

2130
02:17:37,000 --> 02:17:40,280
or services that you want to talk about?

2131
02:17:40,280 --> 02:17:41,600
Yeah.

2132
02:17:41,600 --> 02:17:50,600
So you can find out about me and all the services that I offer at my website, www.theregnvlikenevada.com.

2133
02:17:50,600 --> 02:17:53,040
You can also follow me on my professional social media.

2134
02:17:53,040 --> 02:17:55,600
I post a lot of psychoeducational topics.

2135
02:17:55,600 --> 02:17:59,980
A lot of the stuff that we talk about today, there's little informational posts about that.

2136
02:17:59,980 --> 02:18:03,480
Every once in a while, I'll post something interesting that I'm doing.

2137
02:18:03,480 --> 02:18:06,740
You can find me at doc.jena.

2138
02:18:06,740 --> 02:18:12,320
And just as a broad overview, I provide consultation, therapy, assessment, the works.

2139
02:18:12,320 --> 02:18:14,480
So learn more on my website.

2140
02:18:14,480 --> 02:18:16,080
Do you have any dances on TikTok?

2141
02:18:16,080 --> 02:18:18,280
Because I'm not interested if you do.

2142
02:18:18,280 --> 02:18:19,280
Zero TikTok dances.

2143
02:18:19,280 --> 02:18:25,760
It would be embarrassing if I did because I am a terrible dancer.

2144
02:18:25,760 --> 02:18:30,560
I don't even have TikTok on my phone or anything like that.

2145
02:18:30,560 --> 02:18:39,200
So you can find me at my website, www.centertas.com.

2146
02:18:39,200 --> 02:18:41,360
I'm also on Instagram.

2147
02:18:41,360 --> 02:18:44,040
It's Dr. Brooke PhD.

2148
02:18:44,040 --> 02:18:45,760
I post a lot of...

2149
02:18:45,760 --> 02:18:47,200
I'm not going to over post.

2150
02:18:47,200 --> 02:18:48,200
Don't worry.

2151
02:18:48,200 --> 02:18:49,600
I'm not going to learn too much about me.

2152
02:18:49,600 --> 02:18:50,920
But I do a lot of...

2153
02:18:50,920 --> 02:18:56,240
Share a lot of the things I've been doing lately, whether it be podcasts or if I'm offering

2154
02:18:56,240 --> 02:19:02,640
new courses or webinars, things like that, and just some psychoeducation as well.

2155
02:19:02,640 --> 02:19:07,480
And as I mentioned earlier that like Dr. Jenna, I do a lot of different things, including

2156
02:19:07,480 --> 02:19:12,920
therapy, but also a lot of wellness programming for agencies across the country.

2157
02:19:12,920 --> 02:19:17,280
I do a lot of educational trainings, get brought in to give presentations to agencies on mental

2158
02:19:17,280 --> 02:19:20,160
wellness topics and peer support programming.

2159
02:19:20,160 --> 02:19:22,800
So yeah, feel free to reach out.

2160
02:19:22,800 --> 02:19:23,800
Beautiful.

2161
02:19:23,800 --> 02:19:24,800
Sorry about my distraction.

2162
02:19:24,800 --> 02:19:26,960
My son just came home as a thunderstorm in Florida.

2163
02:19:26,960 --> 02:19:31,440
He came home drenched and then my dog just pushed away into my office.

2164
02:19:31,440 --> 02:19:35,080
Well, I want to thank you so, so much.

2165
02:19:35,080 --> 02:19:39,240
I mean, obviously we've had great conversations just individually on some of the previous

2166
02:19:39,240 --> 02:19:43,160
episodes and I'll put those on the intro to this so people know where they are.

2167
02:19:43,160 --> 02:19:46,200
But this dynamic of the two of you together has been phenomenal.

2168
02:19:46,200 --> 02:19:50,440
And I think I hope it's really brought a lot of kind of understanding to areas that I know

2169
02:19:50,440 --> 02:19:52,840
I've touched on, but we've, we've glossed over.

2170
02:19:52,840 --> 02:19:57,120
So I want to thank you both so, so much for being so generous with your time and coming

2171
02:19:57,120 --> 02:20:00,000
on the Behind the Shield podcast today.

2172
02:20:00,000 --> 02:20:02,000
Thanks for having me on again, James.

2173
02:20:02,000 --> 02:20:16,640
Yeah, me too.