The Nonprofit Leader's Guide by Boundless

10 - Trauma-Responsive Care: Yes, You Are Worthy of this Moment

• Boundless • Season 2 • Episode 5

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Alicia Boreman, Boundless senior quality assurance manager and licensed professional clinical counselor, and Andrea Ryan, Boundless behavioral therapist and licensed professional clinical counselor, join Scott Light to discuss trauma-responsive care, fight, flight, and freeze mode, and why when neurons fire they rewire.


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Scott Light:

Welcome everyone to wellbeing a podcast brought to you by boundless and it's made possible by a grant from the city of Worthington. Boundless is a nonprofit that provides residential support, autism services, day programs, counseling, and a whole lot more to children and adults. Our mission is to build a world that realizes the boundless potential of all people. I'm your host, Scott light. We are going to center our conversation today around really one key word and that is trauma. So think about this, think about what we've all been through the last two years we've had COVID health challenges, massive changes in the workforce, kids in school at times, kids at a school at times the whole virtual learning thing we have all been through a lot. Our two guests today know this subject very well and you know what, they can help all of us. Alicia Boreman is a senior Quality Assurance Manager here at boundless and is certified in trauma care. She is also an LPC s Licensed Professional Clinical Counselor through the Ohio Board. Alicia, welcome to you.

Alicia Boreman:

Thank you.

Scott Light:

Andrea Ryan is a behavioral therapist at boundless as well. Also an LPC licensed professional clinic counselor. And she uses techniques that we're going to discuss right here right now with many of her clients. Andrea, welcome to you.

Andrea Ryan:

Thanks for having me.

Scott Light:

Good to have you here. Alicia, why don't you kick us off here? Let's start with this broad question. What is trauma.

Alicia Boreman:

Trauma is really a general term that we use to describe a lot of different experiences that people have throughout their life. What's important to remember about trauma is that it's always individualized that an experience that I may have, that you may have, the Andrea may have, it could be all the same experience. But we all internally respond differently to those experiences. So one event to me may be traumatic where as it may not be traumatic to someone else. So I think it's important to remember that we always think of very vague experiences or awful traumas that happened, but it really just depends on what the experience is. And the individual that experiences it.

Scott Light:

Alicia, let me hang with you here on on a follow up question. You know, I can remember whether it was family members, or even some of my educators, you know, when something happened in school traumatic experience, and they're like, Hey, kid, you know, suck it up. This is what high school is all about. That that is changing now, thankfully. But when we're talking about trauma, where strife, anxiety, whatever, whatever it is, how can we look at these things through a greater lens of of empathy.

Alicia Boreman:

I think we can definitely remember that it's first and foremost, important, important to validate the feelings of others, and be non judgmental. When I think of empathy, I think of Brene Brown, who's a great researcher. And there's this very short video, it's like three minutes on YouTube, and she talks about empathy. And in this video, she says that one of the things we do in the face of difficult conversations, which is what we make feel, when someone expresses a significant trauma or feeling like they're experiencing some sort of traumatic event or anxiety, as a result of a situation that we always try to make things better. But what she goes on to talk about in the video is that what makes things better is feeling with people and building connection. And so thinking about not feeling bad for a person, but feeling with them dropping down to their level, and being understanding that kind of cliche of walk a mile in someone shoes, just being there for a person is sometimes much better and much more responsive for that person than trying to make the situation better.

Scott Light:

Andrea to you what is a trigger? Let's talk about this a little bit when people say they are triggered by something, when something happens, talk about triggers a little bit here.

Andrea Ryan:

A trigger can happen in an experience in a multitude of different ways. So essentially, it'soccurs in our brains when we are perceiving a threat, and whether that's an actual threat or a perceived threat. So it can come through something that we see something that we hear, feel, smell, touch, so it when that happens, it feels as though something dangerous is about to happen to you and adrenal glands squirt out some adrenaline and cortisol is released in the brain and all those other stress hormones are released. And that causes us to go into what's called that fight flight or freeze mode. And that can be extremely uncomfortable and cause a lot of different sensations. It's kind of scary so people can get kind of trapped in these associations. So if they wore a shirt all the time and it smelled like cigarette smoke or something like that, anytime in the future or that person is around someone that has sees someone with a similar shirt on. And if it happens to smell like cigarette smoke, they're going to be triggered by that and go into a fight some sort of fight flight or freeze mode that essentially kind of shuts down the the frontal lobes the ability to think clearly and rationally.

Alicia Boreman:

We said earlier, it's very individualized trauma is I think, sometimes we forget, even though we might be on the upswing of COVID, that trauma can also be experienced through loss and grief, that can be definitely a traumatic event for someone. If we think back to COVID, or even now, people in helping professions lost patients or people here boundless loss individuals that we'd serve for many, many years. You know, a lot of our individuals lost their natural supports friends, family members, lost friends and loved ones, many organizations, lost supervisors, lost colleagues, lost loved ones, and we don't always think about grief and loss when it comes to trauma. But grief and loss can be experienced, just like we did through COVID, both through physical absence of someone, which is what a lot of us went through with COVID. And in quarantine, you know, not being able to see our friends and family individuals not being able to see their natural support, or the emotional absence from others. So if someone does pass, the loss of emotional connections, the loss of that support, and many of these losses were experienced unexpectedly, quickly, without the opportunity for people to say what they would think might be a goodbye, or to tell someone that they loved them. Because they hadn't seen them for many months, or, you know, days. And so those experiences of grief and loss can impact the body and the emotions the brain like Andrea mentioned, just like a traumatic event could.

Scott Light:

We don't know yet the our long term impacts here from the last two years, we may know some short term, but do we have a measure yet?

Andrea Ryan:

Not as far as the past two years ago? I'm not sure. But if a person has experienced traumatic events in their childhood, particularly until the age of two, their brain development is highly affected. And in they Yeah, they have they hold that imprint on their brains for the rest of their lives.

Scott Light:

Yeah, I heard somebody say, and this is not scientific, but I like the line, you guys can tell if it's true, but I just heard somebody say, you know, when neurons fire over and over they wire when they fire they wire is that, okay? So it's about as scientific as I can get here with you, too. So.

Andrea Ryan:

So if someone has that deficit, there's a lack of if they're being neglected or abused in any way, that essential part of their brains are the the they're only being the neurons that are being fired are the survival neurons.

Alicia Boreman:

And I think just to add on to what Andrea said, which is great, when we also think about teenagers, adults who may intrude introduce substance use as a result of their traumatic event in order to cope. Now we have an entirely different issue that we're working with, which is probably a topic for another day. But when we're talking about how the brain functions and how substances can impact how the brain is functioning, and how the neurons are firing, we kind of go into an a whole different area of treatment and how that traumatic event is experienced, because now we're using something to try to avoid triggers, and avoid the symptoms that come along with trauma that is also rewiring our brain.

Scott Light:

Alicia, you mentioned treatment. Let's let's go there a little bit here. Let's talk about that you both work in what's called trauma responsive care. What does that mean?

Alicia Boreman:

I actually was part of leading this at Boundless. And the training really walks you through a lot of what Andrea talked about, which is how the brain responds to trauma. And they talked about what they developed as a skill set skill set called the calmer skills. And so these skills stand for check in except, be lovingly and kind, mindful, express and respond. So from from my standpoint of point of view, from Quality Assurance, I look at this not just from Andrea's lens of treating individuals that we serve, but also from how we treat our colleagues and employees here at Boundless. So the training goes on to talk about identifying how to use these skills and when to use them to manage stress in your day to day work with staff or colleagues as well.

Scott Light:

Will you go over those again, those were, I mean, we can maybe unpack a couple of those being kind and what were a couple, a couple of the others.

Alicia Boreman:

Sure. So check in that's checking in with the individual to find out you know, where they are, what's going on with them. Be accepting, like we talked about empathy, lovingly and kind, you know, that kind of brings me back a little bit, really, to our Boundless fundamental. Some of them treat each other like family, treat others with dignity, some of those things that align with our fundamentals here. Unless be mindful, express your concerns, express how you're feeling express whatever it is the individual may need, and then respond appropriately.

Scott Light:

Andrea, how do you know if someone needs that type of care?

Andrea Ryan:

Sometimes you can't tell, you know, right away. But if someone comes into therapy, sometimes they know right off the bat, hey, I want to work on my trauma. And it's like, okay, great, let's get into it. And other times, it's, it's discovered along the way. So it's just discovered, it might start in and always, you know, in therapy, it's always based off of what the individual wants to work on what their goal is. So we always need to respect that. So if I see oh, there has been some trauma in the past, the individual might not be ready to identify that with the word trauma, trauma is very, that's a scary word. So for me to see something that's there, walk through that with the individual and be very, you know, gentle, and in the process with that. So someone might, you know, I know that like, they might benefit from some trauma therapy in the future. But we I need to, you know, kind of assess, are they ready for this, there's a number of different therapies that obviously can can address trauma. And what I tend to focus on is more of a body awareness. So listening to the site, paying attention to what your body is telling you, and listening to that, and then responding accordingly. So I really try and work with individuals on how does your body feel right now, just as we're talking about this, for example, in the session itself, maybe it's putting your hand over your chest over your heart, and just stopping with what we're talking about and listening to what is my body feel like in this moment. And there has been such a huge disconnect with that piece with individuals who've gone through trauma. And so I really try and with the body awareness piece, it can create some more of a connection of flow with the mind body connection. And without that, it is very, very difficult to understand what your triggers are to listen and respond with more kindness, so that it can kind of helped the individual understand more about themselves, in order to create more like healthy relationships, for example.

Scott Light:

Do you get into breathing to parasympathetic, sympathetic breathing, things like that?

Andrea Ryan:

For sure, that's a huge piece. So there's a number of different you know, breathing deep breathing techniques that I use with individuals and it's the absolute number one like avenue to to ignite that parasympathetic nervous system. So to calm calm yourself down with the the deep breathing, and it can really create that like internal sense of security that has been lost along the way. So there's, everything has been so like, fragmented, from trauma, trauma causes like fragmentation of the brain. And that, obviously, like interrupts with life with life's pleasures, and what's safe, what's scary, what's, you know, like we were talking about earlier, just perceiving things as a threat when there's really no threat going on. So, working on these things, the deep breathing, the body awareness, mindfulness skills are very, very important with that also. And without that peace, you kind of depend on like, external, external things to regulate you. So like Alicia was talking about turning to things like drugs, alcohol, constant reassurance from others, because you people who are, you know, traumatized, they, they lack that ability to give the assurance to themselves.

Scott Light:

I love it when I have experts here at the table, because again, I can throw out things that I hear and then you guys can tell me if it's true or not. So, on the subject of breathing, let me follow up with one other thing I heard. Well, alright, I'm gonna be honest, it was Dr. Phil. I was watching Dr. Phil. But here's what he said. If you do five minutes of concentrated breathing, breathing exercises, whatever it may be, he said that can carry you for hours into your day.

Andrea Ryan:

I think it's absolutely true. I think when especially for if we're practicing something like deep breathing or mindfulness skill, just paying attention to how your body feels, but not trying to necessarily change anything that definitely carries on throughout the rest of the day throughout the rest of the week, even to help us identify like we can identify quicker and it just more more organically when we need something when our body needs something we It allows us to be more in tune with that mind body connection and so we can listen to ourselves.

Alicia Boreman:

It reminds me of my Apple Watch and I can remember not too long ago after I got one that was newer. I would get this buzz on my wrist and it would tell me to take a minute to breathe. And I thought, This is annoying. I don't I don't feel like breathing right now. And so it did this over the course of maybe a couple of weeks. And so then I looked on my phone and I thought, why does it keep doing this. And then I noticed that it was associated with my heart rate. And so when my heart rate was increasing, my watch was notifying me to take 30 seconds or a minute to deep breathe, and it has this little circle that you're supposed to watch and breathe in while you do that. And so I thought, well, this isn't annoying, actually, this is science telling me that it's time for me to calm down, like Andrea was saying, like you said, you know, to take a minute to bring my body back to be aware of how I'm actually feeling so that I can realign and like Andrea mentioned, go back to that, that normal functioning in my brain to get away from the impairment in that frontal lobe of whatever I'm experiencing in that moment.

Scott Light:

Well in two with your jobs, you need this kind of self care.

Andrea Ryan:

Yes, daily.

Scott Light:

Talk and talk about what works for both of you.

Andrea Ryan:

Just before this podcast, I was doing a little bit of like just gentle yoga and in some deep breathing, and I like to listen to other podcasts to help with your meditations. And that really helps align my my self for the day, it helps clarify things in my brain, things seem much more simple. And I feel more just relaxed and then can control.

Scott Light:

Alicia, what about for you besides your Apple Watch?

Alicia Boreman:

Yeah, besides my Apple watch? Yeah, I try to make sure that I make time to read, I try to make sure that I make time. Like I've mentioned with COVID, you don't always have the opportunity to meet with people as frequently in person. And I've been able to utilize some apps on my phone, where I have standing appointments with my friends to play games over FaceTime, or, you know, different things like that, that I used to look forward to a lot that has been impacted by some of the illnesses that have gone on. I also am in a bowling league. Not that not that, that means I'm any good. But just doing things that, you know, bring you back to that sense of what Andrew said, pleasure, you know, having fun, letting go of stress, being mindful of enjoying life and enjoying the moments, because some of the premise of mindfulness is being in the present moment. And so taking your mind and body away from Oh, I have this tomorrow, oh, I have to do this later their dishes, I have this project I'm running behind on and just being present in that very moment and enjoying or being aware of what's going on.

Scott Light:

Yeah, it's super individualized. And you know, when people when you talk about mindfulness or whatever, and I'm sure you guys hear this a lot. People say, Well, you know, I just can't sit and not do anything. And that's it. There's no goal to it. I mean, I can, I can sit and listen to Metallica and relax. That's me. I mean, you know, so

Andrea Ryan:

Absolutely is and what I hear time and time again, is that I suck at this, I'm not doing it, right? And I'm like, no, no, no, there's no expectation here. But that's what they're so used to throughout their whole lives. So there's these these hard expectations that they have on themselves. And deep, you know, core beliefs like I'm not good enough and whatnot. So that all plays into Yeah, practicing mindfulness for the first time can feel very odd, very different. And practicing, especially like loving kindness and saying kind words to yourself, it, it can feel very odd at first.

Alicia Boreman:

And part of that too, just to add on to what you said, Andrea is that mindfulness, the some of the core fundamentals of it is being non-judgmental to yourself. And so those thoughts of I'm not doing this, right, I, you know, I should be doing something else, or I'm bad at this. It Just feeling like you deserve it, too. Yeah, I'm worthy of just goes back to practicing mindfulness is so important because it's not something that comes naturally to really any of us. And so being able to know that practicing it and I don't want to say failing, but like not feeling good about how you did just shows that the mindfulness is starting to work because you're acknowledging those things and you need to address those thoughts and like you Andrea said, you know, giving yourself loving words and kindness and reminding yourself that I'm trying this I'm doing good I'm working through today, you know, I'm in this moment this moment right now.

Scott Light:

Even just a shift in words. Substituting maybe could instead of should, should should get to me, You know what I mean? It's like, you know what, no, I'm not gonna put that pressure right on myself. Absolutely.

Andrea Ryan:

Yeah, we work a lot in therapy on replacing the shoulds you don't "should" yourself you say so. Replace it with I want or I wish it's much more gentle because that should places a lot of pressure

Scott Light:

Let's talk about trauma in this sense with with someone who is on the spectrum or with with IDD.

Andrea Ryan:

Yeah, it can, it can just such a wide range there. So it's really dependent on on what an individual is capable of. So some individuals that I see who have a developmental or intellectual disability really do struggle with the ability to be able to just identify what their body's telling them. So to feel like, Oh, my heart's beating right now really fast, or I'm starting to get really hot can be really challenging. So what we can do is really work with individuals around them, their caretakers, or staff to help identify, like, what what are those initial signs that the person is starting to get uncomfortable or escalated and sometimes it's the opposite. It's not like their behaviors are ramping up, so to speak, but it's that they're isolating or not talking, and it can so it's there's such a wide range to look for. But the key is to understand what their triggers are, if possible, and, and, and identify what behaviors are signaling this person needs some coping skills, and then the staff or caretakers can intervene.

Scott Light:

Alicia, what do you see, in terms of progress from this type of treatment? I bet you see some pretty amazing things.

Alicia Boreman:

Yeah, we, you know, you definitely see a reduction of symptoms. So symptoms can be a variety of things. They can be intrusive thoughts, they can be flashbacks, they can be dreams, they can be anxiety, depression, all of those things. Andrea mentioned coping skills, hopefully we see an improvement of adaptive coping skills. Some people struggle with appetite, sleep, hopefully we see an improvement in those areas. A lot of things that occur when we are experiencing traumas, we, we encourage people to access their natural supports, or supports that maybe they didn't know were available. So for instance, counseling, case management, it could be support groups, natural supports, or like, if they have a religious background, or spirituality, if they have friends, family members, those kinds of things. And then hopefully, we receive, we see an improvement, or, or restoration to where they were before, and they're functioning. So better outcomes in school, returning to work, better performance at work, better engagement in social activities are restoring to where they were, and then emotionally, being able to better identify their emotions are Andrea talked about triggers, identifying what those triggers are, and B, being able to cope with them or prepare for them in advance.

Andrea Ryan:

Working with someone to identify what emotion are you feeling? Or what are you feeling right now, just that first awareness of what identify what this feeling is, and come up with a word for what what is going on in your body through a feeling word, and then regulating that. So helping with whether that's coping skills, or an activity that can help calm them down instead of escalate. is just huge for anyone whether, you know, whoever comes, refer all of us actually.

Scott Light:

Let me flip the question this way, what happens to a person who doesn't get this this type of treatment, what can happen?

Andrea Ryan:

I think, more or less, they could just get stuck in the cycle that they're in, which is of constantly being triggered, constantly going into fight flight or freeze, and there's no break in cycle then. And there's a kind of like a constant state of collapse, that can happen. And when that happens, there can be all sorts of different repercussions. So one thing that can happen with complex trauma is an individual might not be able to put into again kind of put into words, what they're feeling. They truly don't know how they're feeling. They can be numb, for example. And when that lasts for a long period of time, it can be experienced through physical sensation. So a person might not be able to say how they are feeling. There's no feeling there. But they say I'm in a lot of pain, physical pain, my back is killing me. And but there is no like, they go to the doctor and there's no answer. There's no like, well, this is causing this or anything. So a lot of muscle pain or bowel irregulations, in particular, and it was just a lot of such a wide range of things physically that can happen in the body if they don't get help.

Alicia Boreman:

I think to the way that I try to explain this to kiddos, or for people who are more visual is when you're not able to regulate your emotions. appropriately, right? If you think of you have a bottle of pop, and you haven't opened it yet. And all day, when you're triggered, you shake it up, you shake it up, you shake it up all day. And then there might be a point that day or the next day or a month from then when you open it, and it just explodes. You know, you have that sense of all of a sudden, I thought I was functioning, okay, or I was just in that survival mode, like Andrea said, and now I've had an explosion, maybe it's at school, maybe it's at work, maybe it's with my friends, family members, maybe now my relationships are impacted. I'm unemployed because of this explosion. And when we are able to regulate, that happens. And on the reverse side, like Andrea mentioned, I explained this like a bottle of water. So you shake it up, you shake it up, you shake it up, and then when you open it, nothing happens, you become numb to all the things that are around you. So maybe your relationships are still disintegrating. But that's because you're unable to give emotionally what you were before or socially what you were before. So it feels like every day is like Groundhog Day. It's just the same day over and over again.

Scott Light:

Our podcast series is titled Well-Being and we discuss all facets of it right here with all of our guests. And we certainly did that today. Let's end it this way. I like to ask the both of you what what your life what your work has been like the last couple of years? And then that will you layer on to that? What have you learned about your own well-being? How have you taken better care of yourself? And maybe your loved ones your family? During COVID?

Alicia Boreman:

That's such a great question.

Andrea Ryan:

Loaded question.

Alicia Boreman:

Yeah, I think it first starts with that mindfulness that Andrea brought up and, and understanding what's happening in your body, because you don't always know that you are stressed out or overwhelmed and how it's impacting you. And so a lot of times, I just need to stop, I force myself to stop. A lot of us work remote now, which you know, has its benefits. But I noticed since I work remote, I don't take a lunch break, or I don't take breaks, I have meetings back to back. And so I rarely get up from my desk, and I'm not walking around, I'm not going outside, I'm not interacting with people other than through the computer. And so I've been more mindful to schedule out breaks in my calendar, or to stop and say, You don't have to work through lunch, you know, it's okay to take a lunch break, it's okay to take a break. And, and with that, also reminding myself that each day brings something new, you know, and each day can be a reset, or restart and a reset or restart can be can happen at any point throughout the day. So if you're feeling frustrated, you know, sometimes I'll just kind of like whoosah, okay, I need to take a few minutes. I may walk around the house, I may, you know, color a little bit, do some things that can just for a few minutes, take my mind off of whatever might be feeling overwhelmed, and then start back over. I do a lot of team meetings where we have goofy fun things. I'm not sure they always like it. But just to bring back that sense, at least in the workplace of of what we're missing. When we were in an office, you could always stop by and chat with someone, how's your day? How are your kids? I you know, how was your wedding, all these things. But when you're virtual, it seems to be like, well, we have from nine to 10, we have this agenda, we need to get this done. And this done. And we forget that personal experience that we used to have, and we're now missing. And so I tried to bring that back to myself and to the team. And then you know work life balance and helping professions is is always a struggle. We talk about different things like burnout, vicarious trauma, compassion, fatigue, in other words for all of those things, but knowing when you're being impacted by things and taking the time to address that. Boundless is great in that we have great employee assistance program resources. So knowing that you can access those if you need to talk to someone, I think you get like 10 free sessions or something, which is great. And I've had to use those before, you know, I'm not ashamed to say that because understanding even as a counselor or a leader here, when you're overwhelmed and you want to talk with someone is very important. I think it shows vulnerability and it shows the leadership that you want to stress upon your team that you know it's okay to access these resources. That's why they're here. So, you know, just being aware and doing things that I enjoy, I pick up my niece from school sometimes because I like to see her running out. And that gives me joy so.

Scott Light:

Well and like you said it is a sign of strength to access those services. It absolutely is. And there's I love the fact that finally mental health is you know, it's not there yet, but we're starting Do you see some parity get there between mental health and physical health? SO and SO? We are we're getting there. Andrea, last couple of years that layered question through your way would you learn just about yourself and yeah, last couple of years.

Andrea Ryan:

A lot. So the word the word multitask comes to my mind. So I have three kids six, ages six, three and two. And one was born right before the pandemic and it really opened my eyes to hey, I have got to stop and focus on what I'm doing here because my brain especially in the morning, like there's so much chaos going on before I transition to work modes to therapy mode. It it's really hard to just stop so in some way you get to relate to some some maybe some things that have some clients are going through because it's like okay, now I need to practice these things that I am suggesting to clients so I try and stop and think of does this have to be done now and focus I take some deep breaths as I'm making breakfast for example but I'm thinking I might body's actually like being pulled in five different directions to try and do like a lot of things at once there's a high demand and going on. So it's the pandemic has really been challenging to to just teach myself to to do one thing at a time and relax because the pressure has been put on.

Scott Light:

You both have talked about this just you know in the in the heat of getting breakfast ready for three kids. You know even 30 seconds of breathing that can huge difference huge difference. Huge difference can make a big big impact in the day. Thank you both for being here. This has been a great conversation thank you you both have open invites to come back anytime and we say this to you our listeners thank you you as well. You can be part of the episodes to come to we want to hear from you. Email us your questions comments at podcast at I am boundless dot O R G. This is the Well-Being podcast brought to you by boundless. Until next time Take good care everyone.