Psyched to Practice
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Psyched to Practice
Master in Practice: Getting Unstuck from PTSD with Dr. Shannon Wiltsey Stirman and Dr. Stefanie LoSavio.
On this episode of the Psyched to Practice Podcast, Ray and Paul chat with award winning authors Dr. Shannon Wiltsey Stirman and Dr. Stefanie LoSavio about their new book, "Getting Unstuck from PTSD: Using Cognitive Processing Therapy to Guide Your Recovery." We dive into the world of CPT, a proven treatment method for PTSD, and discover how it can be applied from the comfort of our homes. Join us as we learn about challenging beliefs about trauma, overcoming stuck points, and finding lasting relief with this insightful guide. Don't miss out on this informative discussion in this Master in Practice episode: Getting Unstuck from PTSD with Dr. Shannon Wiltsey Stirman and Dr. Stefanie LoSavio.
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Master in Practice: Getting Unstuck from PTSD with Dr. Shannon Wiltsey Stirman and Dr. Stefanie LoSavio.
Hey everyone, welcome to the Psyched to Practice Podcast your one stop for practical and useful clinical information. Masterful insight from experts in the field and a guide to Daily Living. I'm Ray Christner and with me as always, Paul Wagner. And today is our first Masters in practice episode for 2024 and a new take for us because we talked to two authors of a self-help book, which we haven't done before. The title of the book is Getting Unstuck from PTSD. We had an opportunity to talk with Shannon Wiltsey Stirman and Stefanie LoSavio, and kind of going through the process for writing the book and really the functional use of the book. And it was an interesting take because the book itself already does that so well. So we got this like double duty of like, you know, we have the good stuff in the book and then we got the good stuff in the process of how the book was made. Yeah, it was just such a great conversation. Yeah, I agree. And it was really an enjoyable thing and I always like to hear people's take on content and how they talk about PTSD and the idea of recovery and you know, the words stuck and unstuck, how that how that kind of fits into that recovery mode was really interesting. And it was for for those of you who aren't familiar with our guests, Shannon Wiltsey Stirman, she's an associate professor of psychiatry and behavioral sciences at Stanford University. And SShannon Wiltsey Stirman is an assistant professor of psychiatry and behavioral sciences at University of Texas Health Science Center at San Antonio. And they wrote this book with Patricia Restock. And again, the book is titled Getting Unstuck from PTSD Using Cognitive Processing Therapy to Guide Your Recovery. So Paul, before we get into the interview with our guests, what was your takeaway today? You know, earlier on we were just talking about just again, like the really I think it was maybe even our conversation about what CBT is. And, you know, I wrote it down. It was the goal is not to take away negative emotions. It's for emotions to match the facts. And, you know, as so often I think that, you know, in therapy, there can be that perception of coming in. I was like, you know, I want to fix this. I want to challenge. I don't want to feel this, but really talk about trauma. That's not really the goal. The goal is to experience it more accurately. And when we're, you know, grounding our thoughts in the facts, like it allows us that opportunity to experience the emotions really in getting what we need out of them, but not then getting stuck on them. And so, you know, it was such a such a great there. So I just wanted to share that because it was it jumped out to me. Yeah, I think it's a great jump out point and I think, you know, there's there's other talk about the other emotions in that conversation, which was, I thought, wonderful. And, you know, for me it was really a simple comment that was made and something I just I don't know. I love when concepts are made real simple. And, you know, one of the guests said that, you know, it's this idea to help people tap into their inner wisdom. And that was a great quote. You know, it really is this idea of getting people to really. Rely on themselves to process through. We're along the journey with them, but it really is getting them to to process it on their own. So yeah, that is a great quote. And always for those of you listening, we'd love to hear your thoughts. And if there's any things that you have, join us on social media or shoot us an email we'd love to hear from you. And with that, we hope you enjoy this masters and Practice episode Eating Unstuck from PTSD. Jennifer. Stephanie, thanks so much for joining us on this Good Practice podcast. We appreciate you taking time tonight to chat with us. Thanks for having us. Thanks for having us. Absolutely. So, you know, we're kind of excited. You're despite the fact we've done this for a while. You're the first guests that have a book that is more patient centered or client centered. So it's like a self-help kind of model. So this is this is a little different for us because we've we've kind of approached this a little differently. So we're kind of excited. So you are bringing a different content to us tonight. So that's great. So, so when we start our podcast, we always like to ask guests just a few questions to kind of get an understanding of who they are. So maybe we'll start with you, Shannon, but we want to kind of just kind of hear a little bit about what got you into working in the mental health field to begin with. Yeah, you know, it's hard to say because I think for for as long as I can remember, it's it's the area I wanted to go into. In college, I had a brief foray into maybe I should do Russian literature. And then I quickly realized I should be reading it and not studying it, and that I've always just had an interest in in people, how they relate to each other, how they react to different situations. And the area of clinical psychology and working with people to try to help just alleviate suffering was really always pretty compelling to me. Great. And how about you, Stephanie? I'm glad you said that, Shannon, because I have a very similar answer that whenever people ask me about like choosing to be a psychologist, I feel like I never really chose. I feel like I was a psychologist since childhood and I just had to go through the process of earning the degrees to actually call myself a psychologist. But it was always who I was, was someone who was paying attention to people and keeping diaries of data. And it was just, you know, who I always was. And it was at the same time, it was hard to find like exactly where I fit in in my career. Even at the end of grad school and going into postdoc, I wasn't sure exactly what my career was going to look like, but it was always in psychology Well, you it's interesting. As we talk to psychologist, we always get this like, oh, I want it to be this and it changes. So it's interesting. Both of you kind of had that direct path, which is kind of awesome. So I think if anything, for me, the surprise was that I ended up going into a research direction as well as the clinical. I would have said, Oh, you know, I don't think I want to be a researcher. And then it became, well, maybe I do things to support research, but I don't think I would actually do research. And now it is, it's, it's a big piece of what I do, although it there's I love the well-rounded mix. I mean, I think this is one of the things about clinical psychology is you can you know, you can do clinical work. You can do training and supervision, you can teach, you can do research, and you're just prepared to do so many different things. And you can in theory, you can ramp it up and ramp it down at different points in your career. Although I think once you get into a track, it's a little harder to, you know, to to pivot sometimes. Yeah, that's and it's great. It's nice to have that kind of balance. And so what inspired the two of you and I know Patty Racing was part of your your book as well. What kind of inspired you guys to write Getting Unstuck from PTSD? How how did that come about? I think it had a lot to do with just how hard it is to access the access treatments, access right now, access any kind of treatment, but access PTSD treatments specifically and treatments that have been shown to work for PTSD. I think we we get a lot of inquiries from people who live hundreds of miles from the closest person who was trained in CBT. But they're they're interested. They they want to get treatment. They're interested in CBT. And, you know, as much work as we're doing to train people and to try to, you know, get to a point where it's more widely available, we just knew that we weren't going to be able to get it anywhere near as far as we'd like to. And there are some people who all they need as a you know, they need some help and support, but they can really run with it. And, you know, so we thought, you know, this could either be a tool to help support people as they're getting therapy. And for some people, it might be, you know, just what they need to jump start and get started if they can access treatment another way. Yeah, I agree. And we also at the time were doing other research trying to increase the availability of treatments, tinkering with ways to make it more accessible. So Shannon was working on research to deliver CBT via a texting platform. I was working on ways to refine clinician training to make treatment clearer and easier to deliver. And so it was really a natural outgrowth of that. We had already kind of built some of the tools that would help translate this protocol, this treatment protocol, into something that is explicit enough that a patient could pick it up and use as I think you know, you think, Shannon, you'd mentioned, you know, how hard it is to get services and you know, I think having these kind of options for for people, whether it's I think a jump start or for some people maybe just the right fit, maybe that's enough. I mean, you know, more and more I mean, I hear and, you know, we're here in Pennsylvania, you know, waitlists are 12 to 18 months to get in. So, yeah, I think creating these kind of resources just have such a value. And, you know, it was, I think what kind of got us curious about the topic was I don't see much of it around PTSD and reading a little bit as come out of a treatment protocol in what you wrote. I think such a unique fit. So really excited to. Talk about it. And I have to say, like, I use the word well-rounded earlier, and you were talking about the field, but the book, I think, really also does come across as very well rounded as going through it. As I found myself, there was those sections where it's kind of got to stop and check in and those, you know, what are the were anticipating thoughts that might be there where you know and here are some maybe responses as well as like just the general use of it. I think the introduction does a great job of talking about like the specific use of CBT for PTSD, but also acknowledging, you know, some of the other challenging life stressors. And you know, while there isn't necessarily that strong basis of research that says it's effective, you know, anecdotally seeing the connections there. And so, you know, after reading through the book, I think Well-rounded is a, you know, something I would put on there. I wrote the term comprehensive down earlier, but I think I would add well-rounded into that as well. You and I think we really wanted to create something that could functionally stand in for the therapist. So we had to really kind of put all three of our collective consciousnesses into the book and think about all the things that we might say to someone who was sitting in the room with us, and we had to try to make it fit across a lot of different trauma types. So sometimes we, you know, a lot of the book we address people in general because so much of the themes of PTSD are quite common across different traumas. But we also try to say, okay, you had childhood physical abuse. I wonder, you know, you're really stuck on thinking it happened because you were bad or you had interpersonal violence. I wonder if you're really stuck on, you know, thinking it must have been something I did and I should have left sooner. So really trying to put more in there so that anyone who picked it up could see themselves in the book. Yeah, I think that we we also used a lot of what we all do, a lot of training and clinical supervision and cognitive processing therapy. So it was a lot of when you do the training, it's kind of well, if you encounter this, here are some things that might be important to do and we have to translate that into. If this is happening for you, you kind of removed the therapist as the intermediary and just take it directly to the you know to the individual who's getting that, who's trying to do the treatment. So that was kind of an interesting thing in some ways. We all felt at the end like we kind of put in all the types of things that we want to tell people when we're training them in therapy. You know, because we thought, you know, we're not going to be working with therapists who get stuck somewhere. We're going to be working with clients, you know, individuals who are getting stuck as they try to do the treatment. And and they're not going to be able to call us or go on a listserv or something. So we've got to try to just put everything in. The other thing that was happening is, you know, we were we actually got together and wrote the book towards the end. Well, it was in the summer after COVID. So 2021, we all sat down and wrote it together. And over that year and even in the year, while we were editing it or editing after we did that first draft. More things kept happening in the world and we said, you know, we need some you know, we need to have some stuff points for people who are maybe refugees or who experience this kind of thing and medical professionals. And so we were really trying to make it as comprehensive as we could. I certainly think you captured that. And you were talking about, you know, PTSD. And I guess maybe if we're kind of jumping into into it a bit further, if you can both kind of talk about with the book, how do you both conceptualize PTSD and like really, what are we talking about here for maybe some of our clinicians that if they're picking up the book and looking at it? Yeah. So I would say the PTSD is what happens when people get stuck in the recovery process. Most of us in our lifetime will experience a traumatic event. Most of us will experience multiple traumatic events, and for many of those, we can recover without therapy. But when people have PTSD, something got in the way, something is keeping them stuck. The trauma continues to haunt them. So in thinking about why do some people recover and others don't, something that seems really important is that people have an opportunity to really process their experience, to feel their emotions about what happened and come to some kind of acceptable conclusion about why did this happen to me and what does this mean that it happened and part of what can keep people stuck in PTSD and prevent them from getting to do that processing is if there's avoidance going on, which totally makes sense because nobody really likes to sit and feel their most negative emotions or remember the worst things that have happened to them. And sometimes it doesn't even start as avoidance, it just starts is not really having an opportunity. Like if you were, you know, in a household with violence, you maybe just had to put your head down and survive for a while. Or if you were in a war zone, you might have had to do another mission the next day. So you don't really have that chance to make sense of this experience and make it a part of your history. And so it stays with you and continues haunting you over time. So, you know, we think about recovery as being needing to go back and figure out where we're stuck in that event. Usually that involves having to make sense of why it happened. People often get really stuck with Why did this happen to me? Was it something that I did wrong? Could I have prevented this in some way? So the way I conceptualize PTSD is that that tends to be pervasive because we want to believe that we have control, we have power, that we can prevent bad things from happening to us. And so saying I could have prevented it, although that might make us feel really guilty, it also allows us to keep feeling like we have control over what happens to us. And it can be really painful and uncomfortable to sit with that reality that we can't control and predict and prevent all bad events from happening to us, for our families. Yeah, I think the other thing that comes out of avoidance is that sometimes people, they make sense of it in one way and then that's it. That's the story. And because you don't nobody wants to go back and think about some of the worst things that have ever happened to us. There's not an opportunity to kind of look at the whole picture in the whole context. So some people sometimes people take on a lot of the responsibility when there are so many other factors that kind of come into play or they, you know, they focus on one specific aspect of the incident. So it happened because of this. It happened because I was too friendly. And so I gave them the wrong impression or, you know, or sometimes it's it's something like, well, you know, my mom should have protected me from the person who was abusing me, which, you know, might not be untrue, but maybe there were lots of other factors that were going on. And there's not a lot of processing of the fact that, well, there was actually an abuser there who's directly responsible. And so, you know, but by helping people kind of look at the whole picture, we're giving them an opportunity to really process what happened and come to a place where they can kind of accept the full reality of what happened and experience all the emotions that come from that. And then the emotions are we use the analogy of a soda bottle. A lot of times, all of these strong emotions, if they're just bottled up when you first open, you know, they're going to be pretty strong. But then they kind of once you have that, the experience is really feeling them. They settle down a little bit and the memories, everything is still there, but it's just not as it doesn't have the same. Hold on, you. And, you know, there's actually I didn't have all my notes from when I was reading through the book here. And there's a quote, I think it was pretty early on, but it was a when you change what you're saying to yourself, the more balanced and factual emotions will change and you'll be able to move forward in your recovery. And I think you both were expressing that beautifully as you were sharing that conceptualization, as well as talking about the importance and significance of processing. And, you know, we're talking about CBT or cognitive processing therapy and, you know, wanting to hear how that really functions. But also, I guess we talk a lot about CBT here on the podcast. And so if you both wouldn't mind for our listeners kind of what's the difference between CPT and CBT and we can then get into the way that it's utilized. But what are those pieces that really stand out as differences there? Yeah, I think CBT Piti is it is cognitive therapy predominantly cognitive. There are some behavioral pieces that especially somebody who does a lot of behavior therapy like will be behavioral. And so it really it is more cognitive, but there is a heavy emphasis on the emotional processing because it's so essential. And it's not I mean, I, you know, I was trained in CBT and trained with Tim back end so I Socratic dialog is like one of my favorite things to do and think about clinically like I just when you see the way that it kind of helps people tap into what they know themselves. It's it's really I think extraordinary. And I think that one of the things that CBT does that if you have a kind of a misunderstanding of CBT. It might be surprising, but it's actually very consistent across all the cognitive therapies is when you're using Socratic dialog, when you're looking really closely, it's not just like we're going to we're going to catch people in illogical errors and then they're going to see that like, oh, you know, they didn't they shouldn't have thought that way. And they're going to feel better. It's really much more much more about helping people tap into their inner wisdom. And it's much more of a collaborative process. And I think that the emphasis on Socratic dialog in CBT and really helping people look at what they themselves know about what happened, about the know, the way that the situation unfolded, about what they would expect from people in the same situation. All of these things that we do is really helping them come to a process of discovery. It's not us imposing something or leading them down some path, it's really them coming to these conclusions themselves. And I think that's what's so powerful. And then when that happens, it makes room for the emotion that needs to be processed to really instead of feeling guilt and shame and constantly kind of trying to tamp down all of these feelings that are so difficult, there's you know, it's much more of the natural emotions as we call them. You know, just the sadness, the grief, maybe remembering what that, you know, the fear that they felt and having those feelings of sorrow for that younger, you know, that younger version of themselves that was experiencing these things. And that, you know, it's a really profound experience that I think that kind of caricatures of just don't. Don't make room for it. Yeah, I agree. And I think that's a really important point that people might assume that the goal is to not feel negative emotions. And that's not the case because sometimes the negative emotions are what match the facts of the situation. I mean, it's a fact that the trauma happened to you. It's maybe a fact that you didn't have as much control as you wanted. It's a fact that this person chose to hurt you. Those are all really sad thoughts. And and we wouldn't want to take that away because that in a way might invalidate the trauma. So I think making room for those emotions that match the facts of the situation. But, you know, we do that, as Shannon said, by making room, by getting rid of the emotions that don't match the facts, you know, the the guilt and the shame and the anger at oneself when you didn't have all the control or that wasn't your intention for that outcome to occur. So yeah, I think, you know, C cognitive processing therapy is just a really specific form of CBT. It's very trauma focused. You get right to the trauma right away. You keep it pretty focused on the trauma throughout treatment because that's the conceptualization that that's where the patient is stuck. And a lot of the here and now everyday problems stem back to interpretations about the trauma that, as Shannon said, you know, when you're not letting yourself think about it, you don't see all of that. So a few Socratic questions can go such a long way in helping them remember these details that change the whole meaning of the event. Yeah, I think maybe another slight difference is that, you know, when I do CBT some it for something like anxiety or or depression, you can you can work in the here and now and you know, you can go for kind of low hanging fruit, you know. So something that we hear. So people with PTSD say a lot is like, you know, I can't trust anyone. And, you know, that seems like an easy thing to kind of do some cognitive restructuring around and help people get a little more flexible. I don't know, maybe there are some people I can trust more than others. And when you're dealing with trauma, trying to do that first is just not going to have the same impact as doing it after people have dealt with the kind of initial, you know, that trauma related why the trauma happened and what it means for them. Then you can kind of go in and start doing those things. But if you try to do it too soon, we find that you just don't get anywhere. So some of the things that might seem like an easy win early on in therapy and CBT, we wouldn't go to those things first when we're doing cognitive processing therapy. Yeah, and I actually I think that that's not inconsistent with CBT. They don't label the cognitive distortions or stuck points, you know, the same way we do in CBT. But you know, you don't in CBT in session one, go after someone's core beliefs, you start with their automatic thoughts and you've got to first of all, like build some credibility, build some mastery in how do I do this process? But in the case of PTSD, the conceptualization is usually that those bigger beliefs actually are related to some of the beliefs about the trauma. So to Shannon's example, if someone's thinking like, I can't trust anyone, you really curious, you know, do you think the trauma happened because you trusted someone? Now we're getting to the heart of the PTSD and that's going to have these downstream effects on those broader beliefs about trust. And. In the. Having read through the book, there's this next question. Kind of feels almost odd to put out there. But, you know, for those individuals that are maybe like, you know, a book that's geared more towards self-help, how much help can this really give me when I'm talking about these? Really for some, maybe like it feels like a foundational moment or a moment that I can't challenges for myself. How is this book going to do this for me? I really I think it does a great job of talking exactly about those points of CBT and laying them out in a way that is functional. And so I guess, as you were both, you know, part of the writing process here. How do you visualize the book doing that? Like, what are the pieces of CBT that it really generates and how does it translate it from, you know, as clinicians sitting down across from someone really and just someone picking it up and utilizing it as that self-help tool, really working to ask some of those Socratic questions for themselves and challenging some of those belief systems. Yeah. I think, you know, we tried to get rid of, you know, some, you know, some simple things. We tried to get rid of jargon and try to just explain things as clearly as we could, you know, without any assumption that people would have had a background in what trauma was or anything like that. So we really tried to start from basics and explain things as conversationally as possible. We try to provide a lot of encouragement because, I mean, one of the things that is a challenge when you're doing something like this without a therapist is that there is something really important and powerful about having somebody there with you as you work on and process and think about these really difficult things. And we wanted to help people feel encouraged and feel like this is something that they can take on and do themselves and there are going to be tools to support them, but that it is going to feel hard. And it doesn't mean that there's something wrong if they're if they're struggling in different places. So I think we try to provide, you know, encouragement. We try to be as simple as we could. There are some concepts that are a little trickier to explain. So we provided videos as well because some people just are much more. It's going to be easier to just watch a five minute video and read a bunch of dense text. We tried to break things down and break out of exercises a little differently than we might do in therapy where there's a person walking them through it So we would break out the worksheets in certain places and spend time kind of showing people how to do one part and then another and troubleshoot. So I think those are some of the things that we tried to do to make it a little more digestible. There are also some things that in the therapy the therapist would do that we actually break into exercises in the book. So for example, Stephanie developed something to walk people through hindsight bias. We would normally do that through Socratic dialog. Now we have sets of questions that we ask people to reflect on that because that's something a therapist would typically be doing. And in the back of the book, we actually have questions that you might want to ask yourself if you experienced this type of thing versus this kind of thing, because those are the types of things that a therapist might be doing with them in session. Stephanie What did I miss? I'm sure it was something that was pretty thorough. You know, we try to include a lot of vignettes of real examples of cases that we've seen. The sad thing about PTSD is it's really isolating and people usually feel like they're the only ones who are struggling when in reality it's just not commonplace for people to talk about it. Luckily, that is getting better over time and people are more open about trauma. But just to show that other people have had thoughts just like you have after a trauma like that. And one of the things is as I kind of look through it and you've kind of hit on this, is that I think one thing that this book stood out to me different from other self-help books is I think the way the questions are framed, it does really create that Socratic dialog. Like when you kind of go through I mean, they're doing it on their own. But I it was something I noticed going throughout the show, looking at how the questions are written. It really does lend for really good reflection. And I have to give you all credit with anticipating questions. Like, as I was going through, I was thinking like, okay, what would a patient ask or what? What would I see? And then all of a sudden it kind of popped up in the book. So kudos to your writing process for that because it really, as I kind of went through it, you know, reading it as a therapist, it felt like a therapy session to me, like it was, which was, I think, hard to do for a self-help book. And I don't think I don't think most of them are written like that. So yeah, that really stood out that we went through it. That's that's nice to hear because there's there's the sense that you write the book, it takes a while for it to get published, that it goes out into the ether. And you just gave it to people to try to get some feedback before we you know, we actually sent it off to the publisher because we really wanted to make sure we were getting the mark in that people can understand and use it. But aside from that, you know, you don't really know if some of the things that you're hoping are conveyed or that you're hoping. So, you know, you just don't know how it lands. So it's it's it's nice to get a little bit it's nice to get that feedback. Yeah. And, and I appreciated the videos too. I thought that was another piece that I thought was unique too, where you have the call outs about watching the videos that was was great. And I didn't get to see all of them, but I did get to pop on. And look, we use those videos for lots of things and it's really actually we, we developed them for another project. We were where we were trying to provide support to therapists who were learning and trying to use CBT or on just how to do a worksheet and and also around some of the concepts because again, it seems like, well, if you see it, you know, or if you share it, it sometimes just lands differently than if you read it. And then during COVID, when some therapists were actually doing treatment on its own, until we're going to got telehealth all together, it's impossible. In any of our telehealth, I can think pretty hard to walk somebody through the worksheet. You know, now we have it, you can screen share and things but so those that the videos were used for that and so it was it was good to be able to kind of repurposed them here. And, you know, and it is a little daunting sometimes the goal really isn't to fill out the worksheet perfectly. It's to help spark your thinking. But it is daunting sometimes for people to fill those out. So we wanted to have a tool where people are walked through how to do it and see examples so that they can go back to them and use them if they need them. Because again, they don't have a therapist to do that for them. Reminding me to of when we were having some of our friends and family members review the book before we sent the final copy in. One of my family members thought it was funny that at the end of each section we had a troubleshooting section and she just thought that was funny. Like, as if like, like troubleshooting or fixing your. You know, like so many things that you can get stuck in in the process. And again, just really trying to stand in for a therapist and help them in any potential place. They might feel stuck in the book so that they can keep going and get the benefit. Yeah, I actually like the use of that word because I when I saw that it was I that's how I talk in therapy, you know, it's you know, I would have probably written it different, but I would say, hey, let's troubleshoot. So I kind of I like that part of it. I was like, Yeah, but people get that. But it's, it's very, very, very user friendly term. That's right. And the repetition throughout it. And I'm blanking on the specific name that was at the top of the worksheet, which is kind of the rating scale on the severity of the PTSD symptoms. And I don't I can't recall those after after every chapter or it was after every section, but I, you know, multiple times kind of coming into that and like the value and, you know, just lets you progress. And then also where are the areas where we're getting stuck and about troubleshooting that being such a phenomenal place because not only do we have like I am feeling stuck, but we can then go back and review some of those skills and being able to say, okay, what are the specific areas? And yeah, so I think again, it does a great job of connecting and combining those different pieces. And it's a it's a great addition. And I'm, you know, I'm hopeful that, you know, for reviewing future self-help books, we're making the same comments if it feels like we're in therapy when we're reading through it. And that kind of talking about therapy, maybe. Jumping over into, I guess a lot of our audience maybe has some background with mental health, whether they're in, you know, clinicians or if they're students. And I'm wondering what are the ways that you could see your book being utilized, like if a client is coming in and sharing with their clinician, hey, I'm reading this. What are the ways clinicians can help to support? Or also, what are the ways that the book helps to support clinicians in doing CPT? And does it provide like a more in-depth opportunity for them to review what's being talked about? Like what what are your thoughts there? Yeah, I think it's it's certainly could be a companion to CPD, where people use the books to do the worksheets. And it's it's a review of the concepts that they would be getting in treatment. So there there is research to show that people actually remember a pretty small proportion of what's covered in therapy. I mean, there's so much, you know, and so I think it can certainly support in that that, you know, the client can review the concepts. It's a you know, it's a it's a tool that can be used during CBT. I think it can also be used during a time, you know, for for therapists to want to brush up on concepts or something they learn in a workshop isn't completely clear or potentially is a companion to the manual. Just because we talk about it a little bit differently and sometimes something lands differently one way, you know, if you read it from the manual and they go and try to do it a little bit, or you think about, Well, how would I say this to my client in the book? I think give some, some good examples. I think there might be situations where somebody comes in and says, I have this book and the therapist hasn't been trained in CBT. I would I would recommend trying to read along and work along through with your client. We have workshops available and consultation, but that might not always be available and that's why. But you know, providing support as people do it, encouraging them when it gets harder, you know, just helping monitor progress and supporting and cheerleading and discussing the concepts I think is, you know, could be valuable in this in those cases. And along with that, I. I find myself wondering are. Are there certain individuals that you think would struggle with using the book? And I'm trying to think of some of my maybe more resistant clients that really just try to. It holds so tightly onto those beliefs. And I'm wondering if there has been any feedback on, you know, individuals that have maybe been resistant towards treatment previously and if the book is a different experience for them or vice versa, if it's if it's a good companion or if, you know, if that would be a population that would maybe struggle, I guess, has there been any insight or conversation surrounding individuals who would struggle or even benefit more so from the book? Yeah, I think when people are really avoidant, we talk about this early in the book. You know, I think people have to make the decision that they're going to try to notice when they avoid and push through it, because obviously somebody is really one, they're probably not going to even pick out a book that much or they're going to not read it for very long. So I think for folks who are really still pretty avoidant, you know, they would need some support. Right. Yeah, nothing works 100% for everyone. So and this is really, you know, a lower intensity intervention compared to coming in and seeing a therapist every week. So especially when you reduce the intensity of intervention, it it's not going to work for 100% of people. But the hope is that it will work for a lot of people and and it will maybe reach people that can't access therapy or for whatever reason, choose not to at this time. So I think it's all about finding the right the right evidence based approach for the right person at the right moment. Yeah, I think that there might be some people who, you know, if they can get to therapy, they're already you know, they might be the types of folks who could really run with it, but they just can't. Maybe they're in school or they've got caregiving responsibilities and work and lots of other things. And if they had something like this, they could make some good progress. You know, and then there are other people that really might need a little more support and that tries to encourage people to, you know, if if you're trying it and it doesn't feel like you're getting where you need to, you know, it might be time to to see if there's an additional level of support that you can get. And I think another thing that's really I think another thing that's interesting, too, is with a self-help book, you can really go at your own pace. And so there's probably going to be some people who go through the whole book and write in every space, and they do it all in a week. And then there's probably going to be some people who they pick it up and they start and they put it away and then they come back to it. And, you know, they keep like leaving it and coming back to it and eventually they get through it. And I know that there was someone that tested the book out for us who when she was first going through it, she couldn't bring herself to write in the book like she don't want to write it down. And so we actually like took that feedback and put that into the book about the importance of writing it down. But that was someone who then, like, they kept coming back to it. It was like a little bit struggling to fully engage but kept turning back to it. And, and that's okay to, you know, you don't have to do it in one hour increments for 12 weeks. It could it could look different for different people. And really that approachability, I think is such a benefit to this. And actually, you know, in Internet. But before we were actually started, I was telling Stephanie that I made a referral for the book to one of my clients, whether their child is struggling. And just some of the pieces are really just kind of a fortuitous timing. I was like, and we are talking about that resistance that is his child is having to seeking treatment. And really just when the conversation comes up, it's just shutting it down and really just holding on tightly to those belief systems. And we were talking about how, you know, for my client, like, was the push to try to say, but this is going to help, you know, going and seeking treatment is going to help. And it just if the belief is it's not going to, then it's not going to. And so we talked about how finding a different way that if it's just there, you know, if it's on, if it's in the study or on the coffee table or even just, you know, sitting in the club child's room and it just, you know, it's an opportunity to pick it up and just start leafing through it. That might then be that buying and that engagement. And I think, you know, the value of that compared to, you know, we were talking earlier, the waitlist with therapy, it can really just be an opportunity to jump in, jump out or meeting someone where they're at. That doesn't take the shame of almost acknowledgment of trauma before seeking it, especially if there's individuals who are, you know, like my client feel like I think my child would benefit or I think someone I care about would benefit. Being able to share it I think is it is a great resource. Yeah, I hope it can be. And I do think there's something about reading where, you know, people might live through and something might click in a way that or resonate just enough to kind of pique their curiosity and then maybe they decide to give it a shot. You know, I think when we're when we're doing therapy, sometimes it's you know, it takes some time before things really click or people really decide that they're ready. And yeah, I think the book being there whenever they are, can be, you know, it might be that some people kind of have this, you know, pre contemplation about it for a while. Or maybe if they look at the book and they decide not to buy it or they, you know, they have it. So I, you know, I'd be really interested in what people's processes are like with, you know, whether they, you know, if they jump right in or if it takes some time to really warm up to the idea of trying to work through some of this because it is daunting and then it's a lot for somebody to do on their own. But, you know, hopefully for the people that feel ready or people who feel like they, you know, they want or need to try something, you know, it's an option I think this was maybe even said earlier. I think the other thing is I read through it, you know, when I read books like this, I started thinking about patients that I have or patients that I've had and and I've had several in therapy that they're coming in not because of the trauma. They're coming in for something else that's kind of immediate. Maybe it's a relationship issue. And while we might uncover a little bit of that in therapy, it's still difficult for them. And I really saw this as as I was reading it, I thought of a few people where, you know, now I feel like there's a resource that I could say, okay, listen, we're not ready for us to do this yet, but let's let's use this as kind of a springboard or a starting point and letting them kind of maybe work through this on their own, which might open it up more for discussion in therapy. So, you know, as I went through it, I was like, oh, gosh, I wish I had this two years ago because you had a few people that it was like, this would have been great because they were they were great about reading things. I could give them information. But having something that has an action to it, I think really could could even help therapists really let the discussion of trauma open up a little bit for those that, you know, they kind of think that's the past and they don't see how it's affecting these other things in their life. So, yeah, I think for me, that's that's something I'm going to kind of hold on to is that it's something it would be a great way for some some individuals that I work with, especially some of the men that I work with that are at the trauma, is really hard for them to talk about with someone. So I think could be a good springboard for discussion. Yeah, absolutely. If it could spark discussion, I think that could be great. You know, another thing that we see a lot is in some health care settings, people can't be seen every month either because of their own schedules or their therapist scandals. And if, you know, if this could be something that people could be doing in between, so they're not losing momentum and they're making some progress rather than, okay, you know, it's been three or four weeks since we saw each other. So now we're just catching up and now you're going to go and I'll see you in another month and catch up again. You know, there is there's the potential for some some some work to happen between meetings where, you know, then you could be having discussions about it or, you know, helping them with their stuff somewhere. And that might be a good use for something like this, especially given that today a lot of people just cannot be seen in therapy as often as they want, even if they are in therapy. And there's so much valuable content, but especially that engagement piece of it. And I think the very beginning of the book again does a great job of talking about that, you know, addressing how, you know, the value of starting with the most challenging trauma. And, you know, I know, you know, in working with clients, sometimes it's just like, well, you know, like that. I can't even think about that part of things. And yet that's the most valuable part of starting with. And I think again, the book does a great job of explaining and talking about why and what the intention is in the use of it and really breaking it down. And there's some great visual aids in there as well. I mean, actually, one of their client I was referencing earlier today, you know, I didn't have the book on hand. I wasn't able to pull it up on my on my desktop. So but there is a visual of the drawing of where that we're getting stuck in that process, you know, of the emotions and just not letting ourselves getting over that hump and kind of that's where we just come back time and time again. And that was the piece. I was like, you know, if you can, this is the image. I want you to just kind of go and and share because that image of being stuck just felt like so significant. And, you know, when we were discussing it, he was like, Yeah, that, that is nice. That is my child. So, you know, again, I feel like we've been talking about it throughout, but just it's such a great resource for a variety of a variety of reasons. Yeah. And I think that's just so important, this idea that, you know, framing PTSD as being stuck, but that recovery is possible. A lot of people might assume that, you know, that they can get better, that this is something that's a lifelong illness that they'll never be able to move forward from and have a normal life. And it doesn't erase some of the trauma happened. The trauma is always going to be a part of their history, but it can really change their relationship with that trauma. It can be a memory, it can be a part of their history and just one piece of the story of their life, not the whole story. So. Well, with our guests, we always like to kind of wrap up with a few questions to just kind of, again, kind of some takeaways. So I guess maybe. Stephanie, we'll start with you this time you. We're called the Psych to Practice podcast. And so we always are interested in what makes people psyched to do what they do. So I'm interested in what keeps you motivated. I mean, maybe this is, you know, too obvious of an answer, but it's, you know, when you see patients that have been stuck for a really long time and they get better, you know, and they come to life before you. And I don't you know, whether it's seeing the patients yourself or hearing about them in consultation or cases that you're supervising, you know, knowing that this person who has suffered for maybe decades, you know, finally can move on and live their life, or if it's a younger person, an adolescent, that their trauma and PTSD can be something in their history and they still have their whole life ahead of them where they're now less likely to have PTSD ever again, even if they experience trauma again. And I've just seen so many patients who have been in therapy for a long time. So not all therapy is equally effective. So it's really very important to my career to be promoting evidence based treatments, helping, making sure that as many clinicians as possible are able to deliver treatments that work so that patients can recover because it's just such a rewarding thing to be along with a patient on that journey of trauma recovery. Shannon, same question. Yeah. I mean, I think, you know, so the thing that keeps me awake at night really is just that there are so many people that it's it's really hard to get access to effective treatment or any treatment, you know. And so, you know, that's definitely one thing that keeps me going. And I think clinically and this is something that I talk with people about when I'm supervising or, you know, when we're training is, you know, you get the question, when you work with trauma, how do you manage it? How do you how do you just manage? And you do hear about a lot of really terrible things that happen to people. And but on the other hand, when you see people getting better, it sort of gives you the energy and the confidence to sort of keep going. You know, it's you know, it's it's sort of the decorating part and why you know, why we can why I can I can work with trauma because I you know, I have confidence that people can recover and that the treatments can help. So I think I think those are the things for me. So other than your own book, if you could pick one piece of media for for people and it could be book, podcasts, videos, movies that you think are important for people to watch, specifically clinicians or those going into the field. What's what's a recommendation you would have? I would say if you're interested in learning more about CBT, there was an episode of the podcast This American Life on MPR called Ten Sessions, and the reporter goes through CBT in a two week period, and it really gives such like an amazing insight into what it's really like for patients to do this therapy. So it's it's such a good lesson. I highly recommend them. Great. I think. Well, since you asked me to just pick one. The National Center for PTSD has a really nice podcast called PTSD Bites. Yes, that is a very, very brief, you know, ten, 15 minutes. And it covers a lot of things. It covers different types of treatment. It covers a lot of technology that's available to support people with PTSD. It has information and content about them supporting family and, you know, just very, you know, really, really nice series. So that's definitely worth a listen. And our our last question for if you could provide our listeners or new clinicians with kind of three gems or takeaways that you've learned in your career, what would they be? I think so. One thing, you know, we we do a lot of, you know, the evidence based treatments that have been tested and their you know, their treatment manuals, the things that are written. And I think, you know, when these manuals were written, there is a there's an assumption that people are already therapists. They know how to do this. They they know how to build a rapport and really be there with their client. And so a lot of those kind of intangible things didn't I mean, I think most manuals talk about the importance, but they sort of assume, you know, how to do it. And so I think it's just important to remember that, you know, you can have you can have both. You can have you can be working through a trauma focused treatment. It's essential that when you do this work, that you are focused on the relational aspects of the therapy as well as the, you know, the the technical elements of the treatment, so to speak. You know, they're both important. We we all know this. But I think it it's worth saying, because I think a lot of times people think when you're doing a treatment manual that you're really constrained. And I think there's a lot of room, you know, especially when you're doing Socratic dialog, to really match what you're hearing from your client and be, you know, attending to and validating, you know, what they're telling you about their experience. And so I think that's that's one for me. Another is that there's kind of a balance because on the one hand, there are many, many things that can help people with PTSD. You know, there is there are several treatments that we have really good evidence for. And so it's important not to get locked into this treatment. And if it doesn't work, you know, it's hopeless. At the same time, it's really important to get, you know, to give it a shot, you know, with one treatment before you bounce to another. Something that I think I've seen and people that I've supervised earlier in their career is the tendency to pull back a little too early instead of maybe adjust how they're doing, what they're doing, or having a conversation with the client about what's not working. There can be a tendency, and I do this, I think, early on to where I'd bounce even within, say, a cognitive behavioral framework. Well, this is working. So now I'm going to try this. And sometimes you've got to kind of find that right, that balance between giving something a real shot, but also responding and knowing when you need to maybe switch approaches a little bit or try something a little different. And then I think finally, there's just there's so much value to continuing to consult. We have to be we have to recognize that we don't always have all the answers and that sometimes we need just another perspective. And so consultation, I think, is just so essential and so valuable, no matter how long you've been doing it. Are you and Stephanie? How about you? I'm thinking a little bit about PTSD treatment specifically. And the first thing that I would say is ask your patients about trauma because they might be waiting for you to bring it up. A lot of the patients that I've seen who've seen their peers for years before, they didn't ever talk about their trauma with their peers, with their therapist. And it wasn't because they weren't willing to maybe the therapist was afraid to bring it up, maybe the patient was afraid to bring it up, but ask them really directly about their trauma history and ask it in a way with kind of inclusive language so that they will recognize their experiences and the questions. Not just like, have you ever been raped, but have you ever had any unwanted sexual experiences? So ask them about trauma. The second thing I would say is not to be afraid to confront patients about their avoidance. We really conceptualize that avoidance is what keeps patients stuck in PTSD. It can be really uncomfortable to do so, but that's really important. And we have to remember that we didn't go tackle these people in the street and drag them into our office. They came to us for help. They came to us for our professional expertize. So it's your job to share what you know about PTSD and share your conceptualization. If you think that avoidance might be going on and it doesn't have to be antagonistic. But, you know, we talked about avoidance. Do you think that any avoidance might have been slipping in this week? Do you think that might have been part of what was going on? And lastly, I would say really central to CBT, really central to the Socratic approach that Shannon was talking about. With CBT in general, you don't have to make assumptions. You can ask questions, really respecting the collaboration that, well, we're experts in helping patients recover from PTSD. The patients are the experts in their experience. They know their thoughts, they know their emotions. They know what happened. So you don't have to pretend to be an expert. You don't have to pretend to have all the answers. Be curious. The patients have the answers within them. Yeah. And I think if I can just highlight something there, Stephanie, I think, you know, something that we haven't talked about is it's actually really important not to make assumptions and especially because, you know, there are times when someone experiences something where we might think we know what happened and we're completely wrong. And then, you know, another example is when you're dealing with things like race based, traumatic stress, you know, people who are there, they know they know what the experience was. And I think it's really important to make room for them to really talk about what happened and what the experience is like without making assumptions and acknowledging that there are some really, really difficult and harsh and unfortunate realities and the experiences that people have and giving them space to really acknowledge and talk about that. You know, it's a place where you're going to be really thoughtful about your Socratic dialog and make sure you're not making any assumptions or or. Making sure that people don't feel that you don't believe them. Because I think it's a place where a lot of times people come in feeling primed, you know, race and gender based trauma, for example, that that they're not going to be believed. Yeah. They, they're just great points. And I, I honestly we appreciate so much you taking time to talk a little bit about your book and, and cognitive processing therapy. And, you know, we really, again, thank you both for taking some time out of your schedule to chat with us. And we hope other people get a chance to take a look at the book. We really appreciated having that opportunity. To thank you both for joining us for today's episode and really getting a chance to talk about your book, Getting Unstuck from PTSD. You know, Shannon and Stephanie, if there there's a place where you'd like our listeners to kind of go and follow or where they can go and find the book. Where would they where would they look? The book is available at Amazon.com through the publisher Guilford or through any other major booksellers. And we have some information about the book at a few different places. We have websites. I have a LinkedIn and an Instagram account that's S.W. Sterman. And I think both of our both of our websites are just our wholesome dot com standard Stephanie Lasagna dot com. And we do post information there things about promotions or workshops or things that we're giving or information about research or training. So those are great places to check. And I post this on my LinkedIn as well. Certainly hope our audience takes an opportunity to check out both the resources as well as checking the book out. If you're interested in hearing more and staying up to date with what's going on for site to practice, you can visit our website at WW. So you do practice dot com as well as following us on our social media by searching search practice. We'll be back in two weeks. But until then, be well. Stay psyched. The information contained in this podcast and on the site. The practice website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, educational or medical advice, diagnosis or treatment. Please note that no professional patient relationship is formed here, and similarly, no supervisory or consultative relationship is formed between the host guest and listeners of this podcast. If you need the qualified advice of a mental health professional or practitioner, please contact services in your area. Similarly, if you need supervision on clinical matters, please locate a supervisor with experience to fit your professional needs.
