Are you struggling with unresolved trauma and unsure where to turn for help? Join me as I sit down with Angela, a licensed trauma therapist, to uncover the complex world of trauma therapy and guide you through the process of finding the right therapist for your unique needs. Angela shares her expert insights on how to identify signs of trauma that may have gone unnoticed and how to know when it's time to seek professional assistance.
Trust your instincts and tune in to this powerful episode, where we provide you with the tools and insights needed to navigate the sometimes challenging journey of finding the right trauma therapist. Remember, you deserve to heal and live a fulfilling life, free from the burdens of past traumas. Don't miss this opportunity to take the first step towards a brighter future.
More about Angela Nauss, LMFT
Podcasts she has been on
More about James Marrugo, LPC:
https://morningcoffeecounseling.com/
If there are questions you want answered or topics you want me to cover, send me an email at
James.Marrugo@MorningCoffeeCounseling.com
Music by AlexGrohl from Pixabay
Are you struggling with unresolved trauma and unsure where to turn for help? Join me as I sit down with Angela, a licensed trauma therapist, to uncover the complex world of trauma therapy and guide you through the process of finding the right therapist for your unique needs. Angela shares her expert insights on how to identify signs of trauma that may have gone unnoticed and how to know when it's time to seek professional assistance.
Trust your instincts and tune in to this powerful episode, where we provide you with the tools and insights needed to navigate the sometimes challenging journey of finding the right trauma therapist. Remember, you deserve to heal and live a fulfilling life, free from the burdens of past traumas. Don't miss this opportunity to take the first step towards a brighter future.
More about Angela Nauss, LMFT
Podcasts she has been on
More about James Marrugo, LPC:
https://morningcoffeecounseling.com/
If there are questions you want answered or topics you want me to cover, send me an email at
James.Marrugo@MorningCoffeeCounseling.com
Music by AlexGrohl from Pixabay
Hello and welcome to a new episode of the Mental Health Without the Bullshit. For today I wanted to talk about how to find the right therapist for when you have trauma. But before we get into the meat of this conversation, i have a special person I want to introduce you to, angela. go ahead and let people hear your voice.
Speaker 2:Hi, i'm Angela Knoss. I specialize in trauma and I'm licensed in Colorado and California.
Speaker 1:Awesome. Thank you so much for that. So, angela, this is something you and I, prior to recording, we're actually talking about when we first meeting each other, is about your trauma background, your specialty in it, and then you were actually when it came up with a wonderful idea of spending a podcast episode on how to find the right therapist. And this is something I do with most of the guests I have when they talk about their own specialties, and this is something I've actually tried to help the general public with some of the blogs I've written and conversations I've had with clients, even the potential clients I'm not the right fit for or the right fit for me, like, how do you find the right person?
Speaker 1:And, all honestly, from my perspective, there's a lot of bullshit when it comes to finding the right therapist, and I think it's so sad because so many people out there want help or willing to do what it takes to get help, but they can't find the right person. So, first off, before we get into anything related to the topic, thank you for bringing this up, thank you for being here, and I am pumped to help people understand, like, how do you find the right therapist? Now, i think the first thing we should talk about in regard to trauma therapy is how does someone even know they have trauma? And obviously for you and I because we're trained in this, and more so you than me like it's easy for us to recognize someone else's trauma, but recognizing our own trauma, i've always felt, is harder. From your perspective, how can someone recognize signs of trauma within themselves?
Speaker 2:Right. So this is actually an extremely common presentation to therapy. People show up and they're like do I have trauma? I don't know, and that's okay, and you can kind of figure this out with your therapist. Lots of times people don't understand what they went through was traumatic, because they were young or naive. This is like it might look like you get older and realize, oh wow, that happened to me, didn't it? I guess that's abuse, isn't it? What do I do with this? And that's a wholesome experience to have. You should never feel like your therapist is trying to convince you that you have trauma. You should never feel like your therapist wants this more than you do. Therapist should be like a companion, not a salesman. Does that make sense?
Speaker 1:That is wonderful and absolutely accurate. I completely agree. As therapists, a lot of us are taught and trained and ingrained in us not to have a personal agenda with our client. It's one thing to point out someone's been through something. It's another thing to try to convince someone that they have something they don't fully believe in. You have to let them come to that term when they're ready and willing to.
Speaker 1:and trauma, specifically Because a lot of people have trauma and don't acknowledge it and don't realize what that means to them. in trying to force feed a client their own trauma, that is traumatizing. We have a responsibilities, therapist, to do the exact opposite of what trauma does. If someone isn't aware that they've had trauma, that they've been through something traumatic, what kind of signs or symptoms start to present? I know, for I've had my own trauma and I'm comfortable disclosing it.
Speaker 1:Years ago I worked with adolescents in a training facility and one kid had escaped, wanting to kill herself, ran onto train tracks with a train oncoming. Myself and other staff members is what we were called how to pull her off the tracks before the train came. For me that was horribly traumatic. I still to this day. this was over five years ago, almost 10 years ago now. I don't like the sound of trains. It makes me sweat is one thing I notice. I tense up my muscles.
Speaker 1:for a while I had this thing called flashbacks, in which I'd be kind of minding my own business and then, randomly, it was like I was there. I could hear the gravel beneath my feet, i could smell the cold night air. I could feel the vibrations from the train coming in, the horn and the rattling. Even talking about it right now, i can still kind of bring my senses back to that. It used to happen when I didn't want it to More, so if I was around train tracks I would just start having like all kinds of weird bodily reactions. is how I notice it first. What are other things people might notice about themselves where they might want to say, hey, i might want to talk to a professional about this and maybe this is a sign of trauma?
Speaker 2:An important question. There's a school of thought in the trauma treatment world which I always describe the trauma treatment community as like a dumpster fire, that I'm inside the dumpster, and there's definitely a school of thought that's like if you have any of these symptoms, you need to go to therapy immediately. And I want to shift in this conversation to focus from like a checklist to more of like, like a vibes. We'll call it vibes. It's a nice colloquial term And for me, the vibe is is this interfering in an important way in your life? Is it preventing you from doing something school work, interpersonal relationships that you used to be able to do before?
Speaker 2:So I think the really good first step is, if this is an opportunity for you, check in with your support system. There are people who love and care about you And if you're not doing well, they would like to be able to support you, and I think that should be the first step. Tell them what you're going through. If this is, you know, if you have a support system, check in. You know I'm if you were my friend and you were going through that, i want you to tell me about it And I think a lot of times accessing your support system, you you may not even need to go to therapy. You may get the help you need An important step, i think. If it is interfering in your life in a way that just using coping skills and talking with your support system is not sufficient like maybe you're feeling like work or school or something is too much, then maybe you should talk to a therapist. How does that sound?
Speaker 1:That sounds awesome. I love that approach of sort of like a concrete checklist, just like take a self evaluation How are you feeling? How are you doing? How interruptive is this thought or bodily reaction for you on a regular basis? And that's something we as therapists look for.
Speaker 1:When someone tells me they're depressed, you know that can mean a lot of things. I don't know really what that means, but how bothersome is it to that individual for their lifestyle day to day? If they tell me I haven't been able to get out of bed for four days up until now, oh, you're really struggling and we can't let you live like this. That's not sustainable And unfortunately the rest of society doesn't give a shit. You know your boss expects you to get up and get to work anyway. Or if they say you know, on every weekend when I have a long time, i cry for like four hours straight. But I'd like to stop because I'd rather not cry for four hours. You're functioning But understandably this is kind of uncomfortable and you know being full of sadness for four hours consecutively every weekend kind of puts a damper on the weekend.
Speaker 1:It's also that sounds exhausting to sit there and cry for four hours. Let's see what we can do for you. So kind of checking in with yourself, and I love the access to your support system. So many of my clients come in with their own trauma And I'm literally the only soul on the planet that knows And I respect that. Trauma is very personal. It's very private. No one has any business to know anything about it if you don't want them to. But that's hard to live with by yourself. You're kind of isolated and dealing with your own trauma And unless you really understand what's going on, that's heavy. I wouldn't wish that on anyone because that's that's a lot. So I love your approach of check in with yourself, check in with people who know you as well as you know yourself. What's their take on it.
Speaker 1:One thing I did when I had my trauma my wife would notice like I was having more and more nightmares than normal. I normally sleep very peacefully. I always have my entire life And I don't remember my nightmares. But she would tell me like you were kind of kicking and making noise And like are you okay? And I'm like I don't fucking think so Honestly, like I rarely have nightmares And if it's getting to the point where I'm apparently just like not normal, even when I'm unconscious.
Speaker 1:I might want to actually investigate this, and that was what sparked me into exploring myself. That's when I started noticing I would get sweaty and tense around trains or noises of trains. I was like shit, this is trauma. Like this is the stuff people talk about. I'm actually experiencing a little piece of this. Wow, that's, that's heavy, and I was fortunate that I had a good support structure.
Speaker 1:Not everyone does and it's unfortunate, but I that approach of check in with yourself. How bothersome is this to you? I think those are great questions to ask And that's something I always promote my practices Talk to yourself, ask yourself a question, get to know yourself. How are you doing? How often does anyone else ask you that And how often do you take the time to do it for yourself is what I always tell my clients. So thank you for that.
Speaker 1:To get into the meat the conversation of how do we pick the right therapist when we have trauma, one thing you had mentioned earlier was a sales pitch, and that I've heard it. You've heard it. I've, admittedly, had developed one because I thought that's what I was supposed to do, and it is what it is. Folks, It is a sales pitch coming from your therapist? Do you, as a potential client, do you ever really want to hear your therapist give you a sales pitch? I've stopped using mine because I'd rather be organic and natural with my clients. So, from your perspective, angela, what are your thoughts on a rehearsed sales pitch coming from your therapist to a potential client?
Speaker 2:It's not even rehearsed. So I think the approach of first check in with your natural support system friends, family, loved ones one of the sales pitches I hear is definitely you need a therapist for sure. Don't even talk about this with your husband, just come to me. But I'll give you some more examples. So therapists are business people And there are some sales pitches I don't like because I don't think they're true And I'm going to give you some examples. The first one is I'm the only person who can help you. Ok, that doesn't sound true. That sounds probably fake. Or I'm the only person who can know you and understand you Definitely fake. This therapy is the only therapy that can help you Pretty unbelievable, i would say.
Speaker 2:In general, feeling convinced in a consultation or like you've just listened to a therapist's sales pitch, that's a red flag. I would say other red flags include when looking for a therapist, if you like them really intensely the first time you've met them, that could be a red flag, i think. A healthier relationship. You need someone you get to know them. When looking for a therapist, i always tell people pick someone who you'll listen to, like. If they say I think we should explore this more, you'll be inclined to listen to them or take their advice. Because if you're not going to take their advice, what are you paying them for? You're hiring me. I work for you In terms of cringe therapy, sales pitches. I never had one. If I had a sales pitch, i guess my sales pitch is see me or don't.
Speaker 2:But if I was going to make one a while back. I joked that it was going to be the Oil Man sales pitch. From There Will Be Blood. Have you seen that film?
Speaker 1:Oh, I don't think so.
Speaker 2:Classic film. There's a psychopath in the movie who gives the speech about like I'm an oil man. I've always been an oil man. Many people will tell you they're oil men, but I'm a real oil man. I'm like I've heard therapists give that sales pitch And it feels like you're being sold. So feeling like you're being sold biggest red flag.
Speaker 1:Yes, i completely agree. I always try to help people understand. Interview your therapist When you're looking for someone to help you. They need to understand what you're bringing to the table so that way they can make sure they're within their scope of skill sets. You also need to make sure they're right for you, as not only their skill sets but who they are as a person. This is a relationship. You're not hiring a plumber who's just going to come in, fix some stuff up and you'll never see them again. It's a one-time thing. This is a relationship of healing, and relationship of healing You're going to heal. That's the goal. That's why people get into therapies to heal. But you first need to develop a relationship for that, and I've heard plenty of therapists design what's called an elevator pitch. It's a 30-second pitch to close the deal.
Speaker 1:I, admittedly, used to work in car sales, so I'm familiar with the process. I've done it. I used some of those skills early on in my career. I didn't like it when I first learned about it in sales. Oh man, i barely even remember it.
Speaker 1:It is. I kept changing it and that's why I quit using it. I think I started off with you know you'll like me because of my clinical experience. I have done things most other therapists can't hope to accomplish.
Speaker 2:Love this. Yes, that's how I started off, and then I'll kind of tweak it according to who it was.
Speaker 1:So I would go in to talk about like depression or anxiety or work stress, and in exploring why the hell I was doing that, i realized I was being inauthentic. Now I don't have one. Now, when I meet new clients, i'll ask them what brings you to counseling pretty generic and stable question. They'll tell me about you know what's going on. I'll give them some feedback and insight from my perspective and then I'll tell them go ahead and put me in the hot seat. This I'm me learning about you is just as important as you learning about me. Start asking me questions about anything, and if you still aren't interested after getting to know me, beginning to know you, then we can both know for sure I am or am not the right fit for you, and so that's what I do now. If I have a sales pitch, it's just that, like, just just put me in the hot seat.
Speaker 1:But before I had this, this very oily nature about getting a new client in and I've realized this. This isn't how this works, and I, okay, actually got some clients to sign in who I was not the right fit for or they weren't the right fit for me, and that was because I had a sales pitch and I was trying to be a business owner, which I've learned not to. So I agree, one of the red flags is like do you feel like you're being pitched to? you know, one thing I don't do is immediately talk about my clinical experience. I let them ask because I feel like a lot of us will. Part of our pitch is like all the things we've done in our career and all these credentials, and it's not everyone understands. I won't even give the shit, honestly. And if they want to know my clinical experience, it's very public. I don't hide it. They can know whatever they want about it. It's all pretty much on my website anyway. But I don't open up with that. I open up with just ask me questions, what do you even care about? Some of my clients really do care about my clinical experience, others don't.
Speaker 1:But part of that red flag is yeah, if you're super bought in and super sold really early, i'm like is that person being authentic? Because I know I'm not perfect. I've had clients tell me there's things about me they don't like you know. During the consultation I'm like well, this is great. The fact that you can tell me that is wonderful. That means you're somewhat skeptical. You're wanting to get to know me, you want to build a relationship and you're trying to be honest with things about me. You already aren't completely in for that's good, though, because this is a relationship. So this whole sales pitch thing that a lot of us do Yeah, i wish a lot of us would get away from that and just be more authentic. That's the thing I also want to talk about with you. Know, red flags Trust your gut.
Speaker 1:Does it feel like you're the person you're meeting who's going to poke at your vulnerabilities? Do they feel authentic to you, or does it feel like guarded and distant and they seem kind of cold? You know, i try to have as much open and honest approach as I can, and so part of that is just me being who I am. Naturally, i curse in this podcast and I curse in front of my clients, and I wear shorts and t-shirts on this podcast and I do the same thing in front of my clients. Whoever I am to you in this podcast, if you ever have meet me in person, it's identical. I don't change who I am, i change. You know what I talk about, but how I present myself doesn't differ And that's what I've told people too is when you're meeting a new therapist like you, do they feel real to you or does everything come back to some kind of clinical term? that doesn't seem like normal, like they're rehearsing out of a textbook. What are your thoughts on a therapist being their authentic selves when their first meeting a client?
Speaker 2:Oh, dude, i'm with you. It's so cringe. Have you ever done a therapy voice? Do you have one?
Speaker 1:I used to. Before I even left school, I had a therapy voice and I was kind of instructed to have one, and I don't think it stuck because I don't even remember what it sounded like.
Speaker 2:I share it. Say something to me, please.
Speaker 1:I'm trying to think of how I used to sound when I did it.
Speaker 2:Say thank you for sharing that with me, or how do you feel about that?
Speaker 1:Oh yeah, those were questions I was taught to ask. How would I phrase those? Thank you for sharing that with me.
Speaker 2:I just put the hair on the back of my neck.
Speaker 1:Yes, a therapy voice. I totally forgot about that. That's literally a thing a lot of us are taught to have is a therapy voice.
Speaker 2:I'm not about it, and I think it's not only inauthentic, but it's not convincing. Humans are naturally awful liars. Which is why it hurts so much when you're lied to is because you fall for it. But for the most part, people can tell when they're being lied to, and so even if I wanted to be nice, sweet girl I'm not going to convince you of that It's not going to last very long. If you wanted to be soft, gentle, suit wearing boy who doesn't swear, i'd give it 15 minutes Talks.
Speaker 1:Yes, yes, i like that. I like that Using a therapy voice. I'm not sure why a lot of us are trained like that. That's something I noticed about some of the pioneers of our field. They were just not how they presented during a video recorded therapy session compared to like them being interviewed. I noticed they would speak differently and I always preferred them when they were just being interviewed and talking normally.
Speaker 1:And that's something I tell a lot of people when they're looking for a therapist is find one who's just remind If you think you could meet this person at like a brewery and just talk about your mental health, that's a person you might want to really consider, because they make you feel normal. They make it seem like you can talk about anything, versus if you think you can only talk about this stuff in the room with them because you're in the room with them. That's something to consider too is what are you willing to talk about And what does that mean to your mental health? You want a therapist who makes you feel like talking about your mental health is a normal conversation, because I believe it should be. I don't think enough of us talk about our mental health in our day to day, which is part of the reason why, as a culture, we're suffering right now a lot, especially recently. What else comes to mind if red flags are like meeting a new therapist?
Speaker 2:Oh God, can I get into trauma focus versus not trauma focus first?
Speaker 1:Of course.
Speaker 2:Because I feel like that's relevant to this.
Speaker 1:Yeah, absolutely Go right into it.
Speaker 2:Okay, so there's. I'm going to divide trauma therapy into two kinds of categories for the purposes of this, which is trauma focused and not trauma focused, and the definition of trauma focused therapy that I like the best is any therapy that involves real or imagined exposure to reminders of the traumatic. Again, right, non trauma focused does not have that. So, according to their various organizations that study what PTSD treatment is the best And most of them say some kind of extinction learning with CBT. And these models have the strongest research base, and they generally involve exposure to three things. Well, three, let's say three important things Exposure to traumatic images or memories through some kind of narrative or imaginal exposure.
Speaker 2:So, like, like, i'm going to use your training example, we're going to talk about the train incident, we're going to think about it. The second thing is exposure to avoided or triggering cues in in vivo, which means in real life or through visualization. So some of your homework might be listening to train noises And she said that's a trigger. Or eventually building up to visiting a train station, you know whatever. And the third one is cognitive restructuring fancy jargon. That means changing the way you think about things. Cbt therapists are going to hit me up on Twitter and yell at me for defining it like that Come with me.
Speaker 2:I don't care. Anyway, the focus is on enhancing meaning and shifting problematic appraisals. So like you take these problematic thoughts, you just you change it, You find something believable to replace it with right. Does that make sense?
Speaker 2:So, some examples of trauma focus therapies are cognitive processing therapy. That's used by the military, a lot prolonged exposure. You might have heard that being used for phobias. It's also used for trauma. Emdr, which is, i, initially developed for trauma and now used for like everything narrative exposure therapy Pretty much exactly what it sounds like.
Speaker 2:Some non trauma trauma focused therapies are like DBT, act, eft, solution focused, great stuff. It's just a different category. Does that make sense? Mm, hmm, okay, so I would say in in, you know, in the interest of not making your listeners completely fall asleep, the thing you want would be, in general, individual, manualized, trauma focused psychotherapies, something that involves in vivo exposure, imaginal exposure and cognitive restructuring. Does that make sense? Now, if you want to dig into this and you can, the places I recommend you look are division 12 of the APA has a list of empirically supported treatments for PTSD. So that's literally just a list. You can go to the division 12.org and they're like these are the ones the American Psychological Association recommends You can look at.
Speaker 2:The VA DOD did like a deep dive and they put together like this paper of we looked at all the therapies for PTSD and these are the ones that work best. They love CPT and PE. You can look at the American Psychiatric Association. They say the same thing. I don't think they name specific ones. I think they like the CPT ones. There's a warning about EMDR. There's a lot of not agreeing within the trauma therapy world, for example, of the three sites that I told you to look at. They contradict each other. So, for example, the psychiatric association does not recommend EMDR. The APN, the VA, love it. Like you can do that, that's fine. Whatever CPT is great. I do PE, mostly in my practice now. I used to be EMDR certified but I let it lapse because it just didn't work as well for me. I'd say what you do is not as important as the relationship with your therapist. What do you want to add, james?
Speaker 1:I love that final bit. A lot of people will ask me things like that What types of empirically validated therapy is good for me? And my response is what's it matter if you don't trust the person you're talking to? Who gives a shit? They could be the best at whatever Gestalt, cbt, dbt, trauma Who cares if they're ranked number one somehow on the planet for what they do? And that means something to you. For what you're healing with or wanting to heal from What if you can't stand the sound of their voice, does it matter? now That person's clinical skill and everything about them just went completely out the window because you can't stand the sound of their voice. Who gives a shit? You need to be able to actually talk and have real honest conversations about what you're dealing with. That requires you to be able to find that person relatable. You need to have trust with that person And you need to have a sense of safety that this person is going to help you and be there for you when you talk about these challenging things, whatever it is that you're dealing with. So that's great. If you research your therapist And you're looking at all these credentials and looking up their degree, that's fine. I encourage you to make sure this person actually is who they are. Sure, 100%. But if you can't sit in the room for an hour at a time and talk about your personal shit, who cares if they spend a thousand hours studying anything that relates to you, because it doesn't matter now. So I agree When people look at the research as far as what type of treatment or technique works best for X problem, not everyone's in agreement of any one particular thing.
Speaker 1:Aside from don't be a shitty therapist, that's something everyone agrees on. There's plenty of research. What happens when a therapist just sucks at their job? But aside from that, it's all over the place. Right now, emdr is the big hot topic of being almost secure, all for a lot of things. And you're right, originally it was designed for trauma. Now people are using it for a lot more than that. That's fine, like if people are actually getting benefit from it.
Speaker 1:Go do EMDR. Go get some EMDR in you. If it's making you a healthier, happier person, have at it. But rather or not it's going to work for you as an individual. There's so many variables to that And a lot of it has to do with your relationship with the therapist. And so when we're having a sales pitch from a therapist and they're talking about their research and their clinical experience on this particular technique for their particular problem. I'm just like do you like that? Do you like when a therapist talks to you, like that? If you do, you found the person, pay them. Set up a schedule and pay them. If you like that approach, have at it. If you're sitting here thinking please shut up, can you help me? I don't know what you're talking about Then tell them this isn't for you and you move on to the next person.
Speaker 2:Can we talk about hype therapies please, james?
Speaker 1:100%. I know we're both itching for hype therapies. Let's first define it From your perspective. what is a hype therapy?
Speaker 2:I don't think I have a definition. I can tell you, vibes, what makes me feel like it's a hype therapy.
Speaker 1:What's your definition?
Speaker 2:Do you have one?
Speaker 1:For me it depends. I think CBT has a bit of hype. Cognitive behavioral therapy The reason why I say this and I call it a hype therapy because almost everyone everywhere, at least in a general sense, publicly, will say that CBT works for everything. Yes and no, cbt requires skill. For those of you who don't fully understand cognitive behavioral therapy, it's a type of treatment perspective therapists will learn. It takes skill, like any other type of therapy we use as therapists to help heal people, to help them heal. It requires skill. So, yes, cbt is very impactful.
Speaker 1:Not everyone's good at using it And not everyone is good at getting CBT. I've had plenty of clients with their own personal stuff. Try several CBT therapists and it not work. No fault of the therapist entirely, it's just CBT is not for them. But everyone talks about it. Most of the therapists I know and we go to psychology today and the ones you look for, almost all of them say that they practice CBT in their profile. So for me it's like just becoming hype, because I have so many clients come in kind of questioning why I don't use CBT And my response is I'm not good at it. Honestly, i have no problem with it, i suck and it doesn't fit for everybody.
Speaker 2:So I just added that to my list. I made a list of language that I feel like is a red flag of like. this is hype And I'm going to read it to you.
Speaker 2:Okay, these are the criteria. Anything that advertises itself is a one session cure, like no, you're off the team. Anything with the word miracle in it This miraculous, watch this miraculous, he works with this, this person and they get better one session. Whatever Stories about therapy where there is zero effort required by the client and they recover. Ie, i just sat there and they gave me the drug and I didn't have to do anything. No, this is sus. Anything injectable or ingestable that's a cure. I, you know, i did the mushroom, i did the ketamine, i did the. Whatever you pick a drug, i'm not, i'm not hating on those, i just picked those as an example because I hear people say that about it. The words sudden realization I had a sudden realization And then suddenly I was better, oh my God. And then the one I just added was it works for everything.
Speaker 1:Yeah To me. Whenever I hear therapists say that the thing that they do for their clients that works for everyone, i'm like no, it doesn't. I've had several clients personally try several different types of therapeutic techniques or modalities or approaches to growth and healing and it do nothing for them because that's just their personality, it's their stuff, for all unique individuals, and so nothing is going to be a cure all for everyone, because that's that's just not realistic. And you know a lot of us will use dialogue like miraculous and you know, little to no effort on your part, you just have to show up and like no.
Speaker 2:Which, by the way, even ketamine and psilocybin, require effort. Those treatment interventions involve a medication, a medication component, sure, but you're still doing EMDR or prolonged exposure or whatever. That's right. You still have to do therapy. You're just doing therapy on drugs. There is no.
Speaker 2:I took mushrooms and had a sudden realization and never had a flashback, a nightmare, an intrusive thought or unwelcome memory ever again. My guilt was gone and I could trust again, my acne cleared up and my crops were watered, like no, that doesn't happen. So you know, this kind of thing doesn't usually happen and you need to train yourself to be skeptical of those stories. This is why follow up studies are so important in research, because that's how we weed out the placebo effect right Like. you can find a grip of studies on acute stress disorder, which is onset of symptoms. I think it's three days to one month. So if you talk to someone who's just been through something traumatic, they will feel so much better because they've never talked about it before. right, that feeling typically gradually wears off and, you know, long term symptoms set in. So I do see a lot of clients. I think this is common for all therapists. You see people who've done the miracle cure and then they come back and they're like six months later It's not working anymore.
Speaker 1:Yep, I always tell my clients when it comes to therapy it is. It's a lifestyle. Your mental health is a lifestyle like physical fitness. Showing up once a week to talk to me is not going to get you mentally fit. You need to have like a daily lifestyle approach to it. Everything needs to be evaluated and examined and a lot of things are going to have to change and then you're going to have to make permanent changes to maintain whatever goals you're trying to accomplish. So if mental health is a lifestyle of just dedication and commitment and a willingness to do the work and to show up, then there is no magic bullet here for anything. There's no magic pill anyone can prescribe to fix all of it. That's going on with you.
Speaker 1:Yeah, and anyone trying to sell you? that is questionable.
Speaker 2:I do think it's important to speak to this that trauma treatment is very popular right now. I don't know why. There is a phase about 10 years ago where everyone had bipolar. Like I heard one comedian say, bipolar is the new gladiator sandal and right now PTSD is more hype than whatever. The freshest sneaker is Like give it 10 years, it'll be something else and just works like this. But this means there's a lot of money being spent to train therapists and trauma treatment modalities right now And, as a result, there's a lot of pressure to recruit trauma patients to therapy.
Speaker 2:So maybe you've got your client. You've got a lot going on. You've got multiple diagnoses. People with PTSD typically have multiple diagnoses at a higher rate than non PTSD clients who present to therapy. There could be pressure to put. There could be pressure on you to treat trauma first or put the focus on trauma. Like you show up and you just want to talk about your relationship and your therapist is like no, we need to do EMDR on your trauma. Why, i don't think you do Now. You don't need to know about therapies, you don't need to read the studies or be an expert. I recommend listening to your needs. Focus on whatever you think are the most disruptive symptoms in your life. If you feel sold or convinced or pushed to work on your trauma or talked into trauma, as you need to work on this first, that's your biggest red flag. Maybe this relationship with this therapist isn't for you.
Speaker 1:Yes, my approach to counseling is we'll talk about whatever they need to talk about, they being the client, however, they need to talk about it, you know, for however many sessions they need. It's about me helping this person understand they have needs and wants that are probably getting ignored for one reason or another, and to help them learn how to address those in ways that are healthy and self serving and minimizing. You know the stress and damage comes from trying to get your needs met. If you feel like your therapist in particular is pushing some kind of agenda that you don't give a shit about, that's a red flag. I would encourage you to tell your therapist how you feel.
Speaker 1:I always tell my clients there's anything I do that if I disappoint you piss you off or you don't agree with it, i want you to feel like you can just say it. I don't care what it is, just put it out there. Let us talk about it together and go from there, because if you feel like I'm trying to push something, then I need to be told that this isn't okay. It's completely fine to have that open dialogue with your therapist. And another red flag I often tell my clients about do you feel comfortable telling your therapist that they fucked up. If you cannot tell your therapist they made a mistake, then that is an issue with your guys' relationship. I've had plenty of my clients tell me when I made mistakes, when I had fucked up, when they felt disappointed in me.
Speaker 1:I'm fine, my male ego is not nearly as fragile by getting feedback from my clients and how I can better help them is gonna hurt me. I help me. Help you is always my approach. If I'm not it or you need something different from me, tell me. I can't read your mind. It sometimes seems like I can, but I cannot And if there's something you need that I honestly cannot provide, then I need to know that and we need to find you someone who can, And that's part of what I need to do for you. I'm supposed to, I'm trained to, I want to. So if you can't have that honest conversation with your therapist, listen to that red flag. I can't.
Speaker 1:so many of my clients have ends right after a session with their previous therapist, will schedule a consultation with me And literally the therapy is about their previous therapist, And I'm like dude, have you considered telling that person that they're fucking up? And they're like. I would never say that. Why not, though? Like, do you ever tell someone they fuck up? Is this something that you need to work on or is it just between you and the therapist? And a lot of the times is like I can't tell a professional they're fucking up. Well, I mean, that's dangerous. Professionals need to be told when we make mistakes. That's part of the relationship And for us who are comfortable with it, we'll handle it just fine. If you don't trust your therapist to get some feedback from you, that's questionable. That relationship to me is questionable, And what are you really getting out of that?
Speaker 2:Can we talk about how to tell if therapy isn't working?
Speaker 1:100%.
Speaker 2:So obviously my answer is gonna be listen to yourself. I think that's your answer too, but there's for trauma therapy there's no set amount of time like 90 days or 12 sessions or whatever It's. Do you feel like you're making progress And then, what is progress?
Speaker 2:So some examples of progress are like opening up about things connecting to your emotions, decreasing the presenting symptoms like sleep or self-destructive behavior, whatever. I think behavior is a noteworthy early sign because the cognitive stuff can sometimes take longer. But if you feel like you're not comfortable talking to your therapist, if you don't think you'll become more comfortable if no change has been made and you're pessimistic, therapists talk about motivation to change And I think it's a really undervalued therapeutic factor. Essentially, if you decide this is hopeless, i can't change your mind. If you feel safe enough to push yourself, then we can make progress. So if you don't feel safe, maybe consider a different therapist. Another red flag is feeling like I have to do this, or your therapist saying you have to. I hear therapists say the only way out is through, or if you don't do this, you'll never truly process your trauma. No, that's a red flag. They're pushing you. You don't have to feel pushed.
Speaker 1:Yes, they're healing in growth and progress. It's different for every person. It presents itself differently. It's about that person's individual journey, their process, on how that looks. We, as a therapist, our role is to help, not to make someone do anything, out to force anything or push anything. We encourage our clients, we might challenge them for their own benefit, but it's their agenda that we, as therapists, have to attune ourselves to, not our own.
Speaker 1:If you're showing up to therapy and you normally talk about your depression because that's what you're dealing with, then one day you're more angry than depressed and you'd rather talk about your anger. Talk about your anger. but if your therapist is like, no, let's focus on your depression, what the fuck? You're not depressed? that day You're angry and it's to a point where you're uncomfortable with it. That needs to be addressed, because that's what you're struggling with in that moment. Your therapist's agenda should be whatever the hell your agenda is. And if your agenda changes every once a month or every couple of months or every session, you just have something new come up. then that's your therapist's agenda, is what's happening in that moment for you, even if it seems to be a fluid back and forth thing.
Speaker 1:I was taught that is therapy. It's not linear, right? If you were to graph this on a piece of paper, it looked like some drunk idiot was just squiggling lines, because that's people's emotions, that's their lives. It's not linear, it's all over the place, that's it. but we're supposed to meet our clients where they're at, and so if your therapist won't meet you or you're at, that's a red flag for that relationship. That's not someone who you feel totally comfortable with, because that's the feedback you get. Let's not talk about what you wanna talk about. Let's talk about what the therapist wants to talk about. What the fuck are you in therapy for, if not to talk about what you wanna talk about?
Speaker 2:Right and it's like I've done like a grip of these therapy trainings now. So I know the protocol. It's like well, session four, we're supposed to talk about your trauma history or whatever. It's session four, we have to do this. Session four. I'm like eat me.
Speaker 1:Yep, i was taught that same thing that under a certain number of sessions, this is what you do, and then, after so many sessions, you do this, and I believe that for, i think, the first year and after a while, i was like I'm going against the grain here.
Speaker 2:You made it one year.
Speaker 1:Yeah, I was like this doesn't make sense, because some clients come in ready to go session one. They don't need four sessions to get there and others need more time to get there. So who am I to tell them where they should or should not be? Am I not just contributing to why they're here the first ways, being told how to live their lives by people who aren't living their lives? Why not just let them be whoever they need to be in front of me and me facilitate that, so they can actually talk about things with me and get something out, instead of just trying to learn through therapy how they should be? You should be, however you need to be.
Speaker 2:That's my approach, And there's such a push to like this one size. No, the problem isn't that it's one size fits all. The problem is there's such a push to diagnose every single person with PTSD So you can use all these expensive trainings you've paid for. In reality, inaccurately diagnosed with PTSD results in unintended harms And if somebody gets labeled with a mental health disorder and they have side effects from going through this treatment they don't need. I think that's so bad, so awful and not talked about enough 100%.
Speaker 1:I love that you brought that up, because in my private practice I don't currently take insurance, so I don't diagnose unless the client needs me to give them a diagnosis. And should those moments occur cause they do, i talk to my client about that diagnosis that I am considering labeling them with, cause it's essentially what's happening. I give them an opportunity to understand it and to accept it. If they have strong pushback about it cause they doesn't really identify or they don't make sense, i allow them time to process that, ask me questions, do research, anything. Because I'm labeling them with a mental health diagnosis that for them could be permanently there on a record in their mind, in their life, how they daily function. I'm not gonna just slap one of these out like it's a tic-tac-up. We're gonna have an open dialogue about the diagnosis that I'm coming up with And we'll talk about it. For as long as you need to talk about it, it's fine, it's completely okay.
Speaker 1:A lot of therapists will not take that approach. They will not talk to their client about a diagnosis, so they'll just give them one and not even say anything, just submit it to insurance. And to me it's like do you want your therapist to have that kind of behavior Cause I always tell my clients I don't diagnose, i don't need to, i don't take health insurance, but there are benefits to getting diagnosis cause I offer super bills and other things. So if you need that documentation, that means I need to give you diagnosis. Let's talk about what that looks like, my process, how I handle it, how you're gonna respond, what that looks like for you, what this diagnosis means. Let's actually sit down and talk about this so that way you have agency and what's happening here. I'm not gonna force feed you diagnosis if I don't absolutely have to. So far I've yet to do so.
Speaker 1:To me, it's questionable at times when therapists will give a pretty heavy diagnosis like PTSD and just say nothing about it, and then later on it comes up in their life somehow that they had a PTSD diagnosis. So it's like that's a pretty serious thing to say. Do we need to have that diagnosis? Talk to the client about it, have an open discussion about it. For me, i've always thought as a red flag therapists are unwilling to openly discuss a client's mental health diagnosis or diagnoses if there's more than one going on. What are your thoughts?
Speaker 2:Oh yeah, i mean, i'm with you. I do work with insurance, so I have to give diagnoses. But I'll cheat And I think therapy outcomes are better if you tell someone what their diagnosis is and if you get their input and treatment. So I'll meet a lot of people and I'll be like you meet criteria for PTSD And they're like great, i don't wanna talk about trauma, it's not what I'm interested in working on. I'm not gonna steamroll you Or same thing. I'll meet a lot of people and they'll have a trauma history, but they don't need criteria for PTSD. It happens more often than you think And they're like every single practitioner I'm working with has diagnosed me with PTSD And I'm like I can see that happening. I'm still not gonna diagnose you with something you don't have.
Speaker 1:Yeah, 100% right. It's. That's another part of the therapeutic relationship is just willingness for a therapist to talk about those things, and some therapists will steamroll the diagnosis. I'm like that's. You're getting into damaging territory there, because you're kind of forcing your own agenda by giving this person diagnosis that they don't fully agree with or they don't fully understand, or maybe that's not what they're here for.
Speaker 1:I have had clients, plenty of clients, who have a diagnosis they'll tell me And then they'll follow up with. That's not what I'm seeing you for, though I have a therapist for that, but I need someone who specializes in what you do, so I'd rather we focus on that. I'm like great, that's fine. If you're not here for the other thing, i'm not gonna force it either. I know it's there. So, thank you. You know, hopefully, your other therapist and I can talk and make sure everyone's on the same page. But if you were here for one thing, you have another person for another. Fine. If something changes, please let me know. But I'm not going to force feed the other problem down your throat, even if it shows up, because you've just now set the boundary. I'm not here for that. I'm here for something else. It's I.
Speaker 1:I choose and I feel like I have to for my own, my own mental health and just being a, being a therapist and being a professional, to respect that boundary of client sets And some of my clients. I've offered a diagnosis and they're like no, no, thanks, even with the advantages, fuck that. I'm like okay, great, that's fine, i don't have to, and if you don't want one, i'm not going to give one to you. The only times I do so is when I have to. So if it's not something you care for and I don't have to do it, i'll leave you alone.
Speaker 1:If it ever changes, come talk to me, but if not, we're going to table that. For now, my approach is to work with my clients, and I feel like a lot of us Don't often work with our clients. We work on our clients. I'm like I'm not working on anything That's. This isn't a home project. This is a person who has a voice And I'm going to make sure that they get every opportunity for it to be heard in front of me, because they can't guarantee that anywhere else.
Speaker 2:You and I. I feel like we're we're two auxiliaries. I do get a lot of people who are like my primary therapist referred me out because you like specialized in trauma, you've like written all the papers and stuff and I'm like here for that. And then you're the person I refer people to because I don't do sex therapy. I just don't, i just don't know enough about. I refer out for that. So it's like we're finally meeting other therapist.
Speaker 1:Yes.
Speaker 2:I want to hear about it. What do you do for sex therapy and trauma? This is a common one. I, like you, know common presentations people will have like sexual side effects or like Impaired functioning sexually because of their trauma, stuff like that I mean. I don't know what do you do.
Speaker 1:It depends on their presentation and what's what's struggling. So I've seen clients with Out of control sexual behavior is the clinical term. What that basically means Is they're they're engaging very risky behavior. Um, i've had clients just have like Meet up random people in like a park light at night and they can't see each other's faces, but they're just having, you know, unprotected sex with complete randos or put themselves in very vulnerable positions Where they might not have full agency of themselves, either through drug use or because you know they're in a very Isolated environment with another person. They don't know who knows what's going to happen. You know, if you're not fully consenting to everything, so to.
Speaker 1:Usually men are the only ones who talk to me about this. You know they Not everything's functioning. They have a desire in a craving to, but physically it's just not there, and so how I Approach it kind of depends on what's happening, and almost all of it relates to some type of trauma regarding sex in some way. So for me it's What do you notice thing about yourself as an individual? Are you engaging in risky behavior and you know that you are? or you engaging in really risky behavior And you you don't really think it's a risk? Those are two different things, because that kind of tells me If you are gauging in risky behavior And you are aware of it, that means you're aware of you probably have some trauma. You just haven't gone to a point of processing it or maybe you just don't want to talk about it yet, but you are aware that what you're doing is unsafe. On the flip side, if they're like oh, you know what's wrong with that, a million things could happen to you, with you putting yourself under vulnerable positions, such as A park in the middle of nowhere at like midnight with someone who you can't see and you don't know. You've no idea what's gonna happen. You know Then that's part of the goal and I know it is because that's why you're doing it. That tells me something else about that person's State of mind when it comes to those things. And then When you have the people who are like I want to, i crave it, it just like doesn't happen. You're having some kind of mental block somewhere along your past That hasn't been fully processed. We need to find out what messages you got from your environment, what happened to you, how you processed it then in comparison to what we need to do for you now.
Speaker 1:So sex therapy and trauma are often linked, because If someone doesn't have trauma within the realm of sex, they almost always go about their day, their lives, very normally. It doesn't seem, you know, too Crazy or exciting or too dull. It's, it's very average, essentially. Not to say that people who are involved in kink or anything like that means they have trauma. It just means that to them It's just like they're personal, what, what makes them happy, it makes them fulfilled, and someone has trauma In this.
Speaker 1:In the realm, of instance, me and sex, or just physical safety, It presents itself in so many different ways. It's both fascinating and and sad. So for me, my, my go-to is What do you notice thing about yourself and what makes you say it's a problem? because the other thing I notice a lot clients are in have a sexual preferences That are outside the, the american norm and that alone can be traumatizing because of how people respond. Or individuals who are into polyamory if that's their thing, that it can also be traumatic. So for me, it's Well, who says that this is an issue? so many time I've had clients who are like well, you know, like why can't I just be happy with one person? I'm like what's who says who, though Why do you have to be monogamous? Why says says who? Who dictated that? we're actually not like that. Naturally, if you look at human history, we lived in tribes and huts. All of us had multiple partners. It was normal, so weirdly enough.
Speaker 2:I have absolutely. I've done zero research on this. I only have empirical evidence, but I think it's the kink people that are healthier. It's the vanilla ones, i think, that are unhealthy.
Speaker 1:They can be right. Often of several people I've worked with, will describe themselves as being vanilla In the american sense, and that's not what makes them happy or fulfilled. And from the gestalt perspective, there is this term called underdog and top dog. The top dog is oppressing your underdog, the top dog is is your shoulds and should nots, it's your judgments and criticisms from yourself or your environment, and the underdog Is your needs and wants. And the underdog always comes out. But if you don't let the underdog out, it'll come out in unhealthy ways, usually something that's not completely self-serving. So when people are to be clear, i'm not saying vanilla people are unhealthy.
Speaker 2:I correct. Yes, that was a bad example. No, not at all It's. it's unhealthy when that's not truly who you are.
Speaker 1:So quite often right, i'll have a client In their interrelationship and they're pretty convinced, or they know, that their partner isn't into, you know, bdsm, but their vanilla sex life is Unsatisfying for them. So their underdog needs some bdsn, but the top dog says, well, no, you don't do that. So what happens is eventually that need gets so strong that they're not going to be able to get into the top dog, so strong they just start engaging in risky behavior that could blow up their lives. To get that need bit, and that That can also cause a lot of trauma in and of itself is you know people, perceptions on You know their sex life or what the american standard norm is. So there's a lot of conversations that need to happen. Um, a lot, a lot more knowledge and awareness, and the thing is is like all of us are here because two people had sex. So it's like it's such a normal thing for humans to do. Yet, particularly in american culture, we just don't talk about those things And for a lot of the clients I work with, just talking about their sex life in and of itself is just healing, regardless of what else is going on, just knowing they can talk to it about their sex life with someone.
Speaker 1:It be non-judgmental to talk about um, hundreds of times they masturbate in a day. And if i had clients tell me like is, is that make me a freak? i'm like. Who the fuck told you that i'm like well, like ever, ever, you know. You just Like more than once a week. Is is, you know, i'm like the fuck. I mean that depends on your libido and whether or not you're fucking happy Like if you're masturbating multiple times a day, that doesn't mean there's something wrong with you. It's. It's an indicator that sexually you're unsatisfied and the need is building up. Do you have satisfying sex? and a lot of times you're like well, no, like well, then That's like you know, never eating something that tastes good, wondering why you keep fucking eating. You're gonna keep fucking eating because your brain's trying to find something that tastes good. You need a little bit of that goodness, you know, just, even, just just keep yourself sane.
Speaker 1:And in this particular area of your life And normalizing that conversation, i love it when they were able to fully talk about like, their sex lives and What they are into, what they're not into, what they're exploring. A lot of it is They don't know what they like or want, but society keeps telling them you're supposed to just be normal, whatever the fuck that means. And so they're like well, i must not be a normal person, because i'm what makes me. What is normal makes me unhappy. I'm like that's. That's a traumatizing message the like what You're normal. The problem is, no one talks about the fact that Millions of people are into the same thing. You're into Tons.
Speaker 1:Yeah, I mean, i could go.
Speaker 2:I love this I.
Speaker 1:I fully enjoyed it and so many people Find benefit in it because it's We're very sexualized culture But we're not supposed to talk about any of it, which I Have always disagreed with that and like we should talk about it more and create more healthy expectations in this area. I love.
Speaker 2:I could do like a whole other hour on this, i'm not gonna lie. To do the sequel on trauma and sex therapy? I think that'd be so good.
Speaker 1:We absolutely could because it walks hand in hand and there's there's so much about sex therapy and being sex positive. I've A lot of therapists are really Against talking about it or very uncomfortable, which is understandable. If this is not you, then don't do it. But I wish more of us were, just because I know a lot of people need it. I've I've even told therapists like I'm fine with sex workers, like I'm totally comfortable with that. I don't see those people as a problem.
Speaker 2:In this house we love and support sex workers. Hell, yeah, yeah I.
Speaker 1:I've, and you know, a lot of therapists have given me weird looks. It's like they're people too, though, like the fact that they do whatever they do for money, like that's, that's their life, that's their prerogative. But they, they also have their own shit, and I don't see your problem with helping those individuals. I'm totally comfortable with it. It's just what they, what they do for A job like anyone else, what do I care?
Speaker 2:Yeah, it's got no impact on me. You can hate amazon, but you don't hate amazon workers.
Speaker 1:Exactly right, the people who work there. They're doing what everyone else is doing trying to figure this whole thing out We call life and trying to get there as best they can with as much happiness as they can. Right. it just looks different for every person. So, yeah, for me, sex therapy and trauma It goes hand in hand.
Speaker 1:There's, when you get involved in in sex therapy sex positive, anything relating to sex or kink or any of that stuff, or You know variations of different types of relationships, can You know polyamory and all those things You're gonna find trauma related to relationships and and sex and physical safety, because that's it just comes with it. And there's And there's a lot of unspoken about stuff going on in that area. Unfortunately That's not very public or people feel it's taboo to talk about and I say The hell with that It's. You know a lot of people go through some horrific shit and hiding it, pretending it didn't happen. Who does that serve? It serves nobody, you know.
Speaker 1:So I got into sex positivity and sex therapy because A couple of my clients a couple of years ago Were trying to talk about their sex life with me and but they were being really hesitant And I finally said just say it like, whatever it is you got going on your sex life I can't figure out what you're trying to tell me because you're speaking in code and Just say it just what is going on so I can try to help you or find someone who can. And you know one of them Had been through some trauma. The other one is trying to explore things and And they didn't want to talk to anyone else because they were comfortable with me. And that's What I took away from a lot of the therapy and red flags is you need to be comfortable with your therapist. It's not just about their clinical skill, but you need to be able to talk to them about it.
Speaker 1:So I did the. What I thought was best is go learn about sex therapy and sex positivity And be more well informed, because these people Don't want to talk to anyone else. If you're not talking to me, they might be talking to nobody and I. That's not fair to them. So that's how I got into it and I I like it. Almost every client I have talks about their sex life and there's Always a lot of pain and hurt and confusion and fear, then just unnecessary amounts of suffering. So yeah, obviously I have a passion for this area of mental health.
Speaker 2:I love it. We again. It's lacking And it's just fascinating to me, dude, what are we doing? the sequel. I'll interview you.
Speaker 1:Anytime. Anytime we can do the sequel. Um, i know we both have things to do. There's a couple of topics we couldn't get into this time around, which was exposure therapy, somatic therapy and gatekeeping by therapists. I definitely want to have you back on um And talk about more of how to pick the right therapist and different types of trauma and what it looks like to recover, but with that is There are any final statements you want to make for the listeners, anything you want them to know about finding right therapists for trauma.
Speaker 2:No, i think we, i think we crushed it.
Speaker 1:If someone's listening and they want to find you, if they think that you're the right person for them, how can they get in contact with you? Is it a website and email? What is it?
Speaker 2:Sure. So I have a website. It's gnostherapycom. It's my last name, gnos. Uh, you could also find me on all the major directories and I'm on twitter. If you want to come yell at me, which people often do, my handle is well, you just search angela nos lmft when I come up awesome Listeners.
Speaker 1:I'll put all that information into the description of this podcast episode. So if you think angela is the right person for you, or if you think she could help you find someone For whatever it is you're dealing with, look into the description. You'll you'll find all of her information to get in contact. Angela, this has been great. Having you on here was an absolute blast. The the stuff we talked about was Phenomenal for me. I know it's going to benefit whoever finds this podcast episode. Um, thank you, just thank you so much for showing up being your true, authentic self And helping people find the right therapist by looking for all the red flags. I appreciate you so much and all the work that you do.
Speaker 2:This was good for me too, james. You.