Join us on a compelling journey as we unravel the complexities of Traumatic Brain Injury (TBI) with our esteemed guest, Daniel Gospodarek, a licensed clinical social worker and a TBI survivor himself. Offering an in-depth look into the world of TBI, Daniel enlightens us with his personal narrative and professional expertise. We dive into the two types of TBI, the multi-layered effects it has on an individual’s life, and how therapeutic techniques like EMDR aid in dismantling the traumatic pieces held in the nervous system.
In the final part of our discussion, we navigate the long, often nonlinear journey of TBI recovery. Daniel shares his insights on the importance of stability, access to clinical knowledge, and the value of celebrating small victories, like improvements in attention span and emotional processing. We address the concept of fatigue levels, a common feature in moderate to severe TBIs, and how EMDR therapy can serve as a beacon of hope. Whether you are a TBI survivor, a clinician, or simply interested in learning about TBI and its treatments, this episode promises to offer a fresh perspective and a wealth of knowledge. Tune in, and let's learn together.
To learn more about Daniel Gospodarek, LCSW
Facebook
Instagram
Clinical website
720.295.6703
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
Join us on a compelling journey as we unravel the complexities of Traumatic Brain Injury (TBI) with our esteemed guest, Daniel Gospodarek, a licensed clinical social worker and a TBI survivor himself. Offering an in-depth look into the world of TBI, Daniel enlightens us with his personal narrative and professional expertise. We dive into the two types of TBI, the multi-layered effects it has on an individual’s life, and how therapeutic techniques like EMDR aid in dismantling the traumatic pieces held in the nervous system.
In the final part of our discussion, we navigate the long, often nonlinear journey of TBI recovery. Daniel shares his insights on the importance of stability, access to clinical knowledge, and the value of celebrating small victories, like improvements in attention span and emotional processing. We address the concept of fatigue levels, a common feature in moderate to severe TBIs, and how EMDR therapy can serve as a beacon of hope. Whether you are a TBI survivor, a clinician, or simply interested in learning about TBI and its treatments, this episode promises to offer a fresh perspective and a wealth of knowledge. Tune in, and let's learn together.
To learn more about Daniel Gospodarek, LCSW
Facebook
Instagram
Clinical website
720.295.6703
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 another episode of Metal High.
Speaker 2:I'm Daniel Gospodarek. I'm a licensed clinical social worker in Colorado, denver, colorado. The main piece of the talk is the topic of TBI and I'll also share a little bit about my own TBI and recovery, injuries and recovery process that so many people go through at different levels.
Speaker 1:Awesome. Thank you for that. As a recap, what has been your experience as far as TBI personally?
Speaker 2:Yeah, so my TBI was sustained in an auto accident in July of 2009. It was a one car roll over and we rolled four times. The last thing I remember I was seeing like the circuit wire colors, so red, blue and yellow underneath the radio panel, if you will. And then I woke up three days later, didn't know what happened, but I thought I had never traveled outside the country and I thought I just went through like an extreme time change. So I thought I was in France when I came to in the hospital bed.
Speaker 2:So it was interesting how your brain kind of formulate stuff. But what happened to me in that accident so luckily had my seatbelt on was I needed to have brain surgery for a brain on my left temporal lobe and then fractured my skull. My left lung was collapsed and then, also because of the brain bleed, I had a stroke in my left prefrontal cortex. So those are the main injuries. You know I was knocked unconscious in the accident and luckily the driver was not, so he was able to find our cell phones, call for EMS and then they took me to a trauma hospital where I needed to have brain surgery.
Speaker 1:Man, even hearing it for a second time, it is just chilling that you're effectively just lucky to even be here.
Speaker 2:Yeah, they said. The doctor said it's about a 1 in 100,000% chance or 1 in 100,000 odds, not percent.
Speaker 1:Yeah, extremely low odds, and you made it through the accident, have a TBI and with through that, you decided to help others with TBI's. So, as a brief recap, what is a TBI?
Speaker 2:Usually two forms of TBI's, depending on the hospital, or even sometimes, I've seen, in terms of just the location. Right, in terms of like being on in Australia or Europe or Asia, or here, right, you have acquired and non acquired, or external and internal right. So external are those auto accidents, physical altercations, gunshots, sports. Right. Then you have the internal to that are usually related to disease, illness, lack of oxygen. So thinking like internal stroke if you stop breathing right from a heart attack or something, then also like meningitis or bacterial infections that can cross that blood brain barrier. So that can still cause injury in the brain, right, not any worse or worse or better than external. They're both harmful, right, but just two different routes.
Speaker 1:Wonderful. Thank you for that. Now, one of the things we didn't get into in a previous episode was EMDR and how it relates to TBI treatment and recovery. So before we get into the thick of that, what is EMDR?
Speaker 2:So EMDR, eye movement desensitization and reprocessing therapy Dr Shapiro started in the 80s. It was actually started as EMD. So eye movement desensitization is the initial protocol, right. And then the R was late or later added. But EMD is very laser focused in terms of one, one kind of incident or memory. It's very targeted in terms of your interventions. Emd little R is a little bit wider, so it allows for some cognitive associations related to that original memory to be brought into the reprocessing. And then EMDR. All capital is very wide and it's kind of just like it's just whatever associations come up in between your bilateral simulation sets is what you go with, right. And you know there's caveats to how do you fluidly, you know dip and intertwine it through and in and out of those. But that's probably not for this podcast, but your therapist can guide you.
Speaker 1:Wonderful. Thank you for that. Now, I'm not an EMDR specialist I don't have any training in it, but I've met plenty of therapists who do EMDR therapy or getting trained in it. One thing that I remember is EMDR has a focus on trauma. Would you say that working with clients who have a TBI is it also trauma work on a psychological and emotional level?
Speaker 2:100%.
Speaker 1:Fascinating. So how does EMDR help?
Speaker 2:I will put an asterisk on the TBI. Right. Moderate concussion is considered a traumatic brain injury. Right, you won't always see the social changes or the terms of functioning, changes in terms of guilt, shame, identity shifts right, the mild or moderate concussion may not have those effects on somebody's life right. When you get into more moderate to severe TBI's right, then you may start seeing some of those shifts and that's where EMDR can come in and help heal essentially the pieces of.
Speaker 2:Maybe the person was the main breadwinner for their family, right, and now they can no longer work a 40-hour week, or maybe they can no longer do that job. So now not only is there a change in that person's functioning but there's also a shift in the family socioeconomic status right, and the guilt and shame that come with that. So there are pieces where EMDR can go in and, you know, heal some of that toxicity inside that nervous system, right, just in that case. But EMDR cannot heal the brain itself from the injury right, that injury is done. It could just heal those toxic pieces that are still held in that nervous system or continuing to occur as kind of that TBI fallout happens and ripples over the years that recovery takes place.
Speaker 1:Okay, so TBI work for you, regardless of the EMDR, it is a form of trauma work. It's you guess we could say that it's a TBI therapy from a mental health standpoint is a subcategory of trauma, because trauma is a big word, it's very vague and general and everyone has trauma but not everyone has the same type of trauma, whereas TBI, you could say, is a category, a subclass, a type of trauma. So you're essentially a trauma therapist who specializes in TBI. Would that be accurate?
Speaker 2:With a lot of EMDR work. That's one of my niches, right. But that TBI is a subcategory, but at the same time there are so many different intervals that come into player variables. For example, was that TBI sustained in combat right, and did you lose a partner, one of your men or one of your soldiers, right? Did the person in the auto accident die or did you end up killing or hurting somebody, Right? So there are those aspects of, yes, it's trauma work with the TBI, but it's also trauma work with however that was sustained.
Speaker 1:So how does trauma work with the TBI? How is it different in comparison to trauma work without a TBI?
Speaker 2:The first stance is A making sure the person with the TBI is stable enough cognitively to engage in EMDR protocol as well as depending on if they're wanting to do tapping or whether they're wanting to do eye movements, right, just getting it cleared through their doctor or neurologist, right, that we're not going to induce a seizure, so doing it with some kind of medical oversight, right. And it depends too right. Is somebody one or two weeks out from a traumatic brain injury, or are they six months, nine months out? All those pieces kind of come into play, but it's definitely important to have that medical piece, knowing what's going on, so that they can be monitoring if there are shifts, if there's increases in whatever it might be I don't know emotional dysregulation, seizure activity, right. So those pieces are crucial and I would say that's one of the biggest variables that we need to be cognizant of.
Speaker 1:So one of the major differences is with TBI work in EMDR and trauma it's multidisciplinary. In other trauma work, let's say trauma through grief and loss, you could just focus on that and over time the person will have healthy relationships with themselves, their emotions, be able to process their grief and their trauma. But with TBI, because there's also this medical component in there, you also have to rely on others outside from yourself to make sure that medically they're okay, that continuing the EMDR work or even talking about their trauma could be triggering in an unhealthy way for that person's, their psychology, their biology, the physiology from medical standpoint. So it's a bit more intricate and it sounds to me when it comes to trauma and TBI that the ecosystem there is more delicate than other forms of trauma. Would you agree?
Speaker 2:I think they are. That's a good question. I don't know if I don't. I don't want to throw out the word delicate because everyone's trauma is so unique and individualized. Right, I will say that there are more more parties in the treatment zones. Right, that we need to be cognizant enough and to have those working relationships with to make sure, holistically, we're supporting this person in terms of growth and recovery.
Speaker 2:Right, and you know I mentioned the seizure piece. But also one of the homework pieces of TBIs is also challenges with impulse control, right, or you know, emotion dysregulation, and then does that increase somebody's risk of suicide too? Right, like those pieces because of that impulse control, right, or something that is, you know, some the whole team needs to be aware of as we're supporting this person in this recovery journey. So there are many more parties involved, right, supporting the individual or even sometimes the couple or the family. Right, because that TBI is by one person. It's usually experienced by one person, but the ripple effects of the rage, the anger, irritability, fatigue, whatever it is impacts so many systems in their immediate network.
Speaker 1:Fascinating. I love that response. That was beautiful. Thank you for that. The one thing I'm curious about in terms of EMDR and TBI how much with any particular client is focused on the EMDR aspect in comparison to traditional talk therapy Just two people in a room talking about difficulties and challenges or fears and all that stuff. Is there like a standard there for you, or is it kind of just case by case?
Speaker 2:So it's gonna be case by case, but there's also a standard element that really healing takes place in the vicinity of a or inside of a relationship that feels safe, right, and usually that takes a number of sessions to establish that safety, that trust, that openness, that vulnerability. Because once you start opening up those EMDR topics even if it's guilt and shame related to a traumatic brain injury, those neural networks could be linked with the past trauma from childhood or something right, that they've never shared. And we need to be able to, we need to have that space, that trust in one another, kind of come what may, like we're gonna look at this, we're gonna hold it and we're gonna work through it whatever shows up, right. So I would say it's standard, but it's also unique.
Speaker 1:So both yeah, that's one thing that's really unique to mental health. There's a lot of ways to standardize and evaluate and assess, but every person's personality, very personal trauma is unique to them, so it always requires a nuanced approach, despite having assessments, to make sure that we're within bounds and ranges that makes sense for what our attemptings do, such as EMDR. It's not gonna hit the same with every client, but you need to make sure every client isn't gonna get worse because of it.
Speaker 2:Right. Right, and sometimes symptoms they do increase right during reprocessing and we get very curious in terms of ego states or parts work right or internal family systems, when people are more familiar with of what parts are showing up right. How are these parts functioning? What do we need to do to you know? Soothe them, comfort them, validate them, whatever it might be? So I think everyone is complex in terms of how they heal from trauma and there's those parts of us in terms of the TBI that are like grief and loss related to who I was and who I am now, what I can do, what I could do right. So like, almost like, the old self versus the new self.
Speaker 1:Mm. As someone who practices Gestalt, which is a heavy focus on self-awareness and acceptance, I love that there's this notion of old self and new self and there's trauma in that, underlying trauma, because we as humans, when things change without our consent, particularly our functionality, our capabilities, there's a chance for grief, loss, trauma in that. And a lot of the work that I do with my clients not that they have TBI's is finding ways to accept their new self, to be at peace with who they are now and who they could be in the future. Does that come up a lot with the TBI? Explain that. What do you see? How do you help?
Speaker 2:So you mentioned I mentioned old self, new self, right, or old self changed self, however they wanna refer to it the grief and loss that's in there, the changes in identity in terms of social networks, because maybe now, after that TBI, you are not able to I mean, I guess you could nobody's gonna say no, but the doctor will probably recommend, like don't go snowboarding or skiing, right, but all your friends do that, right. So then there's grief and loss in a different domain or a different area of a person's life, right. Changes in social networks.
Speaker 2:Acceptance is a at least I found in my clinical experience.
Speaker 2:It's something that people not only struggle with, but it's almost like it's almost too simple and it's too complicated at the same time.
Speaker 2:So a lot of what I work on is just how do we notice that there is a difference and hold that discomfort, hold that awareness right? What is that feeling like in terms of your nervous system right now? Is that putting you? Is that you know most likely it won't, but is that putting you back into ventral where you feel safe and connected, or is it moving you to sympathetic fight or flight? Or is it moving you to dorsal right, freeze and collapse? Or is it mixed states, right.
Speaker 2:So just getting very familiar about how do we track that nervous system and then also finding those ways to move us back to ventral and through EMDR, right, we're able to kind of reprocess some of those components of our lives that we are almost white-knuckling to hold onto. And not saying that we can't we could still. You know, if our friends are going to the mountains to go skiing, we could still hang out at the resort, right and see them in the evenings, right. And it's finding those avenues to still live out our values and the things that we love and care about, but just finding how do we maybe tweak some of those activities a little bit.
Speaker 1:Mm. So from your perspective, it's about slowing down, paying attention to yourself and acknowledging you know, your reflexes, your reactions, and processing what that means and what to do about it outside, off the couch, outside the therapy room. I love that approach because for me that's the approach I like, for the Gestalt perspective is to just sit with yourself and see what comes up and talk about it. And just because it's uncomfortable doesn't mean it's bad. It's just a sense of discomfort and that's all it is at the moment, and it might not need to be anything more than that. But people often find meaning through their own discomfort when they allow themselves to sit in it. How does EMDR help that?
Speaker 2:Sure, I'm just gonna put a plug in there, like that discomfort, right, there's a lot of avoidance, a lot of escape, a lot of control that we as human beings exhibit because we want some level of certainty, we want some level of influence in our immediate environment. Going back to usually trauma occurs when we lose that influence, right, when we lose that predictability piece. And we also live in a society too that really emphasizes like go, go, go, go, go, go, not go go, maybe just rest for 30 minutes and see where you're at. Right. And I myself have experienced friends, clients, right, where it's like I always feel like I have so much to do and it's like where does that come from?
Speaker 2:Who teaches us this? Right, and it's like if we can just pump the brakes on some level and just notice, and everybody's gonna have their own kind of area. For me, mine is nature, being outdoors, right, that slows my nervous system, slows my cognition down, and what else. What works for you? Right, sometimes it's water or baths or being by a river, whatever, right, you gotta come up with your own stuff, but finding those ways to pump your brakes, naturally.
Speaker 1:I love that. That's something I tell my clients too. A lot of mental health work. It's finding the brake pedal and learning to apply pressure. Our American culture in particular. It encourages all gas and no brakes. And then we wonder why we have so many car accidents, both mentally and also physically, is people are always on the go, we don't slow down, we don't really check in with ourselves, and then everything goes to shit one day and we don't know how we got there. It's because we just never found that brake pedal. We don't use it. In particular, trauma work too. A lot of our clients will want to gas through it and just be like well, this is my trauma, now what? And it's like well, what are the details? What happened? Let's sit like how do you react? Are you gonna get angry, anxious, are you gonna cry? A combination of the rub, and then we just need to sit in it, let you marinate in it so we can process everything, which is extremely uncomfortable.
Speaker 2:And we have to almost be, as clinicians, the vessel to slow things down right, to co-regulate somebody's nervous system inside that session, right Through neuroception. And I think you know, like you said, american culture right. But if you travel outside of America, part of my undergrad was in Mexico. In the first week I was like we take a nap during the day, like I got stuff to do, right. And then I was like, well, how do I fill that time? I can rest and I can spend time with, you know, my host, family or loved ones. Like the world will keep spinning, we will be okay. So sometimes traveling is a great way to jolt that system right, that perspective that we are very much ingrained in throughout our lives.
Speaker 1:I've noticed that myself. I've done a lot of traveling. My father worked for United Airlines, so I was very fortunate. I've been to a lot of countries, and that's something I've always taken away too from experiencing different cultures is there's a lot of different ways to achieve the same thing. It doesn't always, it's not always the American way. It's one that I use. I have.
Speaker 1:I try to employ a more holistic approach to almost everything I do, based off of my fortunate and personal experiences in different parts of the world and understanding that everyone's gonna get their bills paid, they're all gonna get jobs. We're all figured out some way. But there's lots of different ways to accomplish those things, to have those achievements and that's something I really appreciate about mental health is everyone who's a client is trying to effectively get the same thing just happiness, less pain, right? Those are the general sense of what clients say. The specifics are dependent upon that person and their personal struggles, but the end results the same A happier, healthier person. But there I don't believe there's one right way to get there. There's a million different ways to get there. It's just a matter of picking the approaches that work for both the therapist and that person.
Speaker 2:Our society has norms and it's okay to step outside those norms. Right, like, having one family unit inside of a house can work for some people and instead, of having two or three different family units inside of a house can be just as effective or more effective. Right, no way is right or wrong. It's just how we go about meeting our needs in life, and as long as we're not harming ourselves or other people in the process. And you asked a question that was a little bit of a tangent, but you asked the question. But how does EMDR then get into? What part was it? What was that question?
Speaker 1:Helping people with TBIs sit in their own discomfort.
Speaker 2:So I think through EMDR is supported by the adaptive information processing system that we have and it's essentially the innate system. Right, if you cut your hand with a knife, you don't have to consciously think about your hand minus if you need stitches. But if not right, it'll heal on its own right. You don't have to consciously be like I want that skin to go back together, right? So the adaptive information processing system is inside that nervous system, or nervous system or body knows how to heal, but it gets stuck right Through maybe dysfunctional thoughts, guilt and shame, right Toxicity in terms of I should have done that, I should have been better.
Speaker 2:Maybe it's how I was raised, I didn't do that well because I didn't put in the effort, right, and maybe there's some truth in it. But maybe you're also beating yourself disproportionately up from that experience. And EMDR goes back in and heals that by through bilateral stimulation, tapping eye movements, even noises in the ears and stuff like that reignites that healing in a healing system and just processes out those dysfunctional pieces to say you know what, like you're right, maybe you could have tried better and next time you will right. And that's a lot, gentler, that's a lot. That's a much calmer perspective to have inside that nervous system. And then I needed to do better and I didn't.
Speaker 1:I'm reminded that earlier you had mentioned part of TBI comes along guilt and shame and a change in identity. With with your TBI did you experience guilt and shame and throughout your recovery Are you willing to disclose any information as far as some of your personal experiences Go for it?
Speaker 2:Oh, you know, I kind of used that skiing example right before earlier in the interview. Mine wasn't so much skiing, but it was so. July 2009, it was the summer going into my senior year of high school. So all my friends, thinking in fall and winter and spring, were going or hanging out at people's houses on Friday or Saturday nights, right, and then I'd hear about it Monday when I'm back at school.
Speaker 2:But I was in my fatigue level after my. My accident was probably 12 to 14 hours a night asleep, and then plus taking a nap there in the middle of the day, right. So I'm missing out on all those social connections, all those memories, all those experiences, because I need to sleep, right. So then that internal battle of inward anger, right, internal battle of why is this taking so long? Guilt, shame bubble up, right, irritability I Mean, you name it, I mean the hallmarks of Some of the hallmark pieces of TBI is being like you know, I'm fine, I can do it, but then I pass out because I'm so exhausted after 30 minutes of whatever walking, right.
Speaker 2:So you know, those, those are Pieces that then impact not only our identity through recovery, but then is well after, right, because then it's like maybe your friendship circle has changed, minded Right, and then that acceptance piece or sitting with that, you know dysfunctional or not dysfunctional, but discomfort comes in and then it's also like well, how do I use this too right, a lot there's a lot of talk out there about post-traumatic growth Not saying I'd PTSD, but it definitely had traumatic growth from that, that experience.
Speaker 2:And how do we use that to a create a foundation that is almost like a I Don't want to say like a better version of ourselves, because I don't want to imply that who we were before was was bad innately, but Almost like? How do we use that foundation to Maybe pursue our values at a different level that we didn't before? Right, or pursue those things that we love and are passionate and care about? Right, whether it's climate change, whether it's mental health therapy right, whatever it is. But how do we use that as that kind of that internal flame that can't be put out, even when we do get tired, even even though we may need to take a break, right?
Speaker 1:Hmm, what came up for me as you were describing your own personal experiences? Grief, that was sad. I'll just be blunt, that was, that was sad and thank you for sharing that such a powerful moment there. But I was just thinking at that stage in your life You're missing out on things. Things are different, yours limitations, you didn't have before, that. You kind of didn't give consent to that. You had to just deal with on a day to day. I mean, because you're dealing with it daily, you had to constantly think about it at some point because, like, what else were you gonna do?
Speaker 2:Half your head is shaved because they needed to remove part of your skull right, and you have staples on the side of your head. You look down, you have cuts and stuff all over your hands that are healing with stitches in and like, yeah, I mean grief, right, loss, sadness, I mean there was. There was nights where I would just sob and bed Because I didn't have any other outlet, like I couldn't. You know, the brain is, the brain is particularly sensitive to pressure, right, and working out puts a lot of pressure on your brain. And before that, before this, tbi X and I worked out a crap ton but I couldn't work out after because I need to tell my brain heal right, so I didn't have that outlet.
Speaker 2:Mmm and it's just like, well, you know, at some point it has to come out Right and it did come out in other ways irritability, rage. Usually that's that immediate network right, your support network, your family, because they're around you 24-7, right. They love you, they care about you, they want, they want to see you heal and at the same time they're also the closest people to that, to that fire in line.
Speaker 1:That's extremely challenging and it because you've you live through this. You you're still dealing with your tbi Because, as you mentioned earlier, like when there's a tbi, that that's that's done with People. Don't that part of your brain, whatever happened, it doesn't come back. You just find workarounds and those are permanent adjustments. That needs to be made and ongoing because our bodies age and things change and Hopefully you know you don't hit your head that hard ever again. But also it's possible shit happens and then restart all over.
Speaker 1:Look fortunately so for you when, when you're sitting across from a client and they're talking to you about their tbi and you're noticing Holy shit, I see myself. This person is at the early stages. They're going to get angry here soon. They're starting to acknowledge they can't do anything or things are different. At the very least, their social health is in severe decline because they're kind of basically at home rest With whatever happened to them. How do you deal with that? You're basically just revisiting your personal trauma Every time a client tells you their story and you're realizing if I was talking, I would be saying the exact same thing. It's like hearing your own voice through another person.
Speaker 2:It's a big question. So there's, I'm going to give multiple answers, right. A, I think, being that person to slow it down for the as a therapist right in the room, we're not going to tackle everything at one time for this person. We're going to work slow, we're going to be intentional, we're going to chip away right, is this? Is there one domain of life? Right? Maybe it's employment, maybe it's relationships, right? Is it sleep? Right?
Speaker 2:So very, in terms of EMDR, we fractionate it right, except we're not fractionating memory or we're just breaking things down in terms of a person. Where do we want to start? Look, I mean there's counter transference, transference, right. A, awareness is big B. It's also there's. There's that level of empathy and validation that come through and just be like I can, can feel that Right, and if they, if they ask like self disclosure is there right, and sometimes that helps clients.
Speaker 2:Right and very judicious, of course. Right and very judicious about how I use it, when I use it. Be in granted, it's also on my website, so like they could just read it to, right, but you know you don't want to throw it out right there, like you want to? A, maybe it's invited you can ask. Right, and I also went through my own therapy, like going to therapy is normal, right, and I still think there's a pretty big stigma around, like you know mental illness, substance use, you know all those different things and Like that therapy helped me too, right. So it helped me. How to? It helped teach me how do I regulate my nervous system right, how do I keep it regulated for that person Across from me that maybe is not regulated or dysregulated or maybe just need some support, right? I?
Speaker 1:Love your approach to this, not only because you You've been through it yourself, but I think it's Unique nuance. I've spoken to a lot of people who Do EMDR and and trauma work and I've never met someone who focuses on TBI While simultaneously doing EMDR, and I think it's a wonderful balance. Did you do your own EMDR? Is that how you came up with this idea?
Speaker 2:I did not. I don't I mean obviously in 2009 was out, but I don't think it hit like mainstream yet, mm-hmm. I just did regular talk therapy but it definitely Definitely taught me some skills to regulate emotions, right, mm-hmm. And then I think, the farther out too that you get from recovery, hopefully your body heals from the TBI. More so, more so, every month, every year, right, and it's kind of interesting, like at first, that TBI recovery there's, there's a lot of healing that's going on, right. You're seeing your wounds heal.
Speaker 2:Well, if you have those, sometimes they're internal, but the gains are fast. The cognitive gains, like you see them, I couldn't I couldn't maintain attention a Month ago for more than five minutes. Now I can maintain from five to seven, right. Then, as you get a year, two years, three years out, five years, ten years, right, those gains are slower, so you don't see them, but I think that they're still there and you're still healing, right. So I think a the therapy piece is huge. But also being out, like coming out of that TBI and being what now it's 14 years, right, so like having that stability Is crucial. Also, the clinical knowledge I gained in grad school through EMDR trainings, right, somatic, experiencing like all these. All these things kind of help the clients, but they also help me too as a clinician, like wow, I could use that right.
Speaker 1:Yes, yeah, something I definitely Totally understand some of the stuff I've been through and then learning Therapy and clinical skills and all this stuff that's out there. I think back then how much would have made a difference to make this recovery easier if I had that. You know, during my darker moments and I'm sure it was the same for you and learning about EMDR, the benefits with people struggling with TBI is you didn't have that opportunity because EMDR wasn't that popular at the time. But you've noticed through your own recovery that adding EMDR for individuals who are ready for it and willing will probably make things smoother for them, because TBI recovery, from my perspective, sounds absolutely horrible. It seems like an absolute, really shitty spot to be in physically, mentally and emotionally. And EMDR I Would agree, from what I know and how you've described, to that it's. It helps people just Heal, which is the operative word here.
Speaker 2:And it's and it can be very gentle healing, and I think that is that's a big part like going back to. We want to heal so quickly, right, and the EMDR is broken up into eight phases right, phase four is actually where the reprocessing starts, or the desensitization of the memory start. Phases one and two Especially two are heavily focused on prep work. How do you, how do you handle, how do you reregulate your nervous system when it does become dysregulated? Right, how do you handle distress as well as staying in that present moment in terms of the therapy session, but also when maybe your kid is like throwing a tantrum at Walmart and you're about to lose your shit? Right, how do you stay present with that and notice Okay, I still need to be an adult and Pay for my items, as well as check out and get my kittens in the car or onto the bus? Right, those are all pieces. The skills are very generalizable and that's one of the things I love about EMDR.
Speaker 1:I'm curious. A lot of us as Clinicians do a bit of coaching and it sounds like with TBI, depending on severity and parts of the brain you know, functionality, I'm sure you, for your personal recovery, had a lot of medical professionals Coach you and how to do things, because your, your brain's different now and depending if it's a physical, external TBI you know, like such as yours as a car accident, maybe even physically like I Might have to do things differently. Anyway, you know spying, damage, nervous system, broken bones and ligaments, things like that on top of the brain stuff. Do you do any type of coaching when you're helping someone with the TBI?
Speaker 2:I'll say yes, I mean, it's still in the realm of therapy, so it's not like am I a certified coach? But there are these pieces around, like you know. Maybe trying like these activities can't help kind of stimulate XYZ, right? Or I think the other piece too is Once you're connected inside that TBI community, especially if you've gone through a TBI and Recovery process, right, like you know. Okay, this person could also benefit from speech therapy, right?
Speaker 2:this person could maybe benefit from OT, occupational therapy or physical therapy, right, or maybe you know what. There's a pretty moderate or mild TBI, but maybe there's some stuff that needs to be tested with a neuropsychologist, right, and then we can get data right and then we can say, okay, six months from now, this is where you were Now, where are you right, or a year from now, whatever it is right, and I think that data is really important A, because it shows where we can continue to improve, but, b, it also shows what's going right, and I think, sometimes, when your world is crumbling in terms of trauma, in terms of TBI, maybe they're both happening right.
Speaker 2:Seeing what's going right is also just as beneficial as the areas that we need to grow more in.
Speaker 1:Got it. So the minimal coaching you do is focus on the person's mental health, probably suggestions, recommendations for them to be able to regulate themselves, probably breathing techniques, stuff like that that most of us do.
Speaker 2:Breathing techniques, sleep routines, right Finding ways to de-stimulate the environment.
Speaker 2:It's hard to sleep when there's a TV on in your room. I know we live in America and a lot of people sleep with them on, right. But that's also a lot of sensory detail, right, and that's something I picked up from my own TV. I recovery. It's like when I was in the ICU, my family wasn't allowed to touch me for the first three days because of that sensory input, right, and my body was so much that my body needed to focus on healing. So, like finding ways to decrease sensations, right, or stimuli or input, whatever it is noises people are dealing, right. Whatever I mean it can be various things, right.
Speaker 1:I didn't even think about that. Wow, that's really hard. I mean, you had no touch from loved ones for a few days there, which is a lot. Yeah, that's a lot for the average person because when we're around our loved ones we're encouraged through brain chemistry to touch and hug and love and kiss and, you know, have those moments. But you're right, it makes complete sense With the TBI and particularly for yours. As far as you were concerned, woke up in a different country. There's a lot going on there and sensory overload. It's not worth that risk, even though it hurts to just lay there and not be touched in such a vulnerable moment by people you care about.
Speaker 2:Well, that's also like the ripple effect, too, of TBI is right. I've never I mean, my mom, my parents and I and my family have talked about what that was like being in the ICU room, right, but they've never gone to therapy for that. But talk about trauma from that standpoint, right, like wanting to express affection, but you can't, and I was in a coma so it's not like I was hearing them.
Speaker 1:Holy crap.
Speaker 2:And then you get into the trauma too that, like you think, just the medical professionals see on a daily basis. Right, like those nurses in ICU or the surgeons or the speech therapists on the inpatient rehab floors.
Speaker 1:Would you say that EMDR helps individuals recovering at the TBI? With that, I guess, the sensory sensitivity?
Speaker 2:I don't know that for sure and my sensitivity to stimuli went down naturally through the recovery process. Right, it didn't go down because of therapy. So the further I got out from, the further I was out from that injury date, the better the sensory and still got.
Speaker 1:Have you seen that in a client in which they're let's say they're a year out from the incident, they're functioning optimally, right, as high as it goes, given their situation, but they report to you that they get overwhelmed, Like when they're out, and about every once in a while it's like it's too much right that sensory input have has. Do you see that? Because I'm thinking if someone hasn't fully emotionally healed, there's a possibility that they go overwhelmed and something like any kind of mental health therapy at that point I think would be advantageous. But EMDR, from your perspective, could it help someone if they're feeling sensitive, but maybe it's more of a. There's so much pent up emotion and trauma that working through that gives them that resilience back.
Speaker 2:I think that would decrease if you targeted the actual trauma. I do think that you could target it with like EMD, for example, that laser focused piece of EMDR. If there are aspects around like I'm getting overwhelmed and you to leave, like my cousin's wedding right, and maybe you feel shitty about that, right, like EMD could take care of those pieces. But I would be curious to see if those pieces decreased if you targeted the overall memory, the incident right. I'm also not aware of any like research on this, so I'm kind of speaking just from my curiosity. Clinician, I don't know any of any RCTs out there, meta, meta analyses that saying, yeah, like you know, three months out, people from TBI's are still extremely sensitive to stimuli but by targeting, by targeting their initial memory of the TBI, will decrease that level of over stimulation. I don't know that just from what I've seen working with EMDR, both with people who have TBI's as well as people who do not.
Speaker 1:I mean, you're part of the people who are in the front line of this stuff, right, like I mean, obviously they need to get to a certain point before they can come physically see you, but if that person starts, you know, mental treatment with you as early as they possibly can, right, you are part of the group of people who are in the front line Maybe this is another research project for you and a group of people who understand this stuff, because that might be something that could be relevant to treatment at large, particularly, you know, maybe certain types of TBI or maybe parts of the brain struggle this more than than others and everyone's recovery is different. So there's a lot of nuance here. But I was just curious if you would come across this whatsoever, because it never occurred to me that people recovering from a TBI have sensory overload. But it makes sense because I mean, until you've gone through enough of your cover, your brain's pretty screwed up at the moment because of it, like it's just a, it's just mush our brains motion general anyway, and I'll in your, in your case, where it was more blunt force trauma, if you're your skull, you know, whipping around way too fast too many times, your brain's just kind of floating and fluid and slapping the inside of your skull horrible.
Speaker 1:Or in the case of others with you know, infections, bacteria, stuff like that. It's a different type of TBI but still your brain's trying to heal, recover and you're effectively learning new things that you technically are, you know how to do but depending on what happened to your brain, you have to like relearn to do it. I've heard some people have, you know, had major accidents and they know how to walk but their brain can't get it to happen anymore and they have to do a lot of physical recovery to relearn how to do something like writing or speaking and food or like really any of this stuff a lot of us take for granted because we don't go through that. And so I was just curious if it's possible, if EMDR can help with that sensory input or if you would even notice something like that within some of the clients you've worked with.
Speaker 2:Not, not that I've seen heavily. I've definitely seen like the charges from emotions come down right or anxiety, but I don't, I'm not testing right, like if you know, like the noises that that when you're doing the dishes like you make like is that still bothering them Right, when they're sleeping, or something. Because that was for me that was a big one. My dad was a farmer. He would wake up at four, 30, four o'clock and do the dishes at five and I'm just like why are you doing the dishes? Like my, my ears were just like honing, even though I was sleeping on the other side of the house, like you're disrupting my sleep, and but he had done that his whole life and you know yeah.
Speaker 2:So, yeah, there's, there's a, there's a lot of components to TBI recovery in general, right, and then also treating that underlying trauma, the grief and loss, identity shifts and then also the continued stressors that can sometimes come down the road in terms of financial stuff like that.
Speaker 1:Yeah, one. One thing you had mentioned earlier we haven't had a chance to dig into fully was you'd mentioned this term fatigue level. What is that?
Speaker 2:Yeah, so one of the hallmarks, especially with like moderate to severe TBIs, is this, just this innate level of fatigue, and whether that's your physical body healing, the brain, maybe that's your physical body healing if you needed surgery, right, I don't know what it is, but it's there and, and it's very prominent Again, I was sleeping 12, 14 hours a day, and I would go to school for my senior year of high school from like eight to 1030, and I would come home and take a two or three hour nap and then still go to bed by eight, 30, ish, usually, until, like mine.
Speaker 2:Then my anxiety got started getting in the way and I would have to go to bed at eight and not fall asleep until 10. So that so, between between that I was sleeping quite a bit and most of the time that fatigue will naturally dissipate over months or years after. I think it was about a year-ish year and a half. For me, it kind of naturally did. Sometimes it doesn't, though, and I don't. I don't know if the medical profession or nor the mental health profession know why it does for some and does not for some other people.
Speaker 1:So one thing I track with with my private practice and my clients when we have heavier topics, sometimes they don't have the energy to sit for a full 50 minutes and it's not always necessary. I'm a believer that you know, therapy lasts as long as it needs to. It happens as often as it needs to as well, and we discuss and process whatever needs to happen. Some of my clients who have more trauma don't always sit in a 50 minute session with me if we're discussing traumatic memories, traumatic events, because it's mentally taxing and I'm not the last thing they do in their day usually. So I know that they have lives and sometimes it makes more sense to cut out early, conserve some energies. They can, you know, go home, take care of their kids or whatever it is they have to do.
Speaker 1:Do you see the same thing? People are recovering with TBI in your practice. Do you sometimes cut sessions early or have to adjust what's happening because you're noticing that they don't have much left in the tank? Or they verbally tell you, like I don't think I want to sit here anymore, Not because I'm not getting benefits, but because, like, I'm getting to a limit where it's like I got nothing left to give to therapy. Do you see that?
Speaker 2:I see that with in generally all clients on some level, depending on what topic, right. And then I think there are also patterns, not just with TBI. I've definitely seen people with TBI's and it's like you know, we're doing an evening session after a Wednesday or something like I'm spent like my attention, like I'm here but I'm not here, right, and that can, that's okay, like we show up how we show up, right. But I think there is that mental piece around what topics are being discussed and the stress level and the discomfort level and the energy it takes to hold that. I also think there are patterns too in terms of are you seeing, do you see people on Fridays, like after they've had a week of work, right? Or are you seeing them fresh on a Monday on the heels of a weekend, right? What it?
Speaker 2:What has been there like you know, just their past week or two? Have home stressors been around, right? Have people been visiting? Have the kids been sleeping Well, right? All these different components kind of come in. So I Don't know if it's always necessarily related to specifically TB eyes, but Is being in recovery with the TBI? Typically people, people see me and Start working, especially in EMDR, you know, a few months out from the TBI event, right. So sometimes their fatigue is also starting to resolve on some level. But again, that's just assessment, figuring out when works best for them for a session.
Speaker 1:In terms of TBI recovery. One thing I talk about in in relation to mental health is it's. It's a non linear process, it it? I tell my clients, if you took a five-year-old and have them, just, you know, give them coloring tools and a piece of paper, it's just, it's just like a bunch of squiggly lines and random shapes and they're getting something done, but the path they're taking there is all over the place and that's normal and that's how I describe mental health Improvements. My clients is you're gonna have your up days, your down days and it's not gonna be linear like you want it to be. Would you say it's he be a TBI, is in recovery without the mental health component. But just just having the TBI is it linear or is it just kind of like mental health? That's everywhere?
Speaker 2:I mean I think when you, if you step back and you look at like data from Maybe on like a year or a three to five year scale, they'll be like a linear trajectory.
Speaker 2:But when you go day by day or week by week, it's gonna be like six flags going through a mountain, like I can't be all over the place. Yeah, I like that and that's okay, right, like that's. But but you you want and it's hard to, because you're living it every moment of every day, right every second To step back and see, last week I could only concentrate for five minutes and now I'm at seven Right, and sometimes that gain also too, if you're coming from a, coming from a place where you're like, yeah, I used to do like I used to do AP classes in high school, like seven minutes is not gonna give me an AP class Right for 40 minutes. Or if you're on a block schedule for an hour and 25, right, we've got a long ways to go. But so even some of those gains feel kind of just like pathetic right and like kind of as you know, as a clinician, to being that vessel, being that, being that hope space, that.
Speaker 2:Let me just hold that hope right while we continue to work, while you continue to heal in terms of EMDR as well as just TBI recovery, in terms of sleep and health and wellness.
Speaker 1:Did you have those moments, too, in which, during your recovery, you had improvement and people tell you improve, but you're also thinking I Haven't come that far, though, in comparison to who I was before. How did you deal with that I?
Speaker 2:mean it was a lot of, like I mentioned before to a lot of that kind of sobbing Right. I mean not even just crying like going from again somebody that would work out, you know, two to four times a week to you know being in the.
Speaker 2:ICU and needing to walk with a wheelchair and three nurses around you with a gate belt, or Needing a nurse to hold you while you take a shower because you can't stand up for that long, like you know. You see, go from this high level of functioning downs and, you know, almost like an infant on some level, right. So the grief, loss, shame, I mean guilt, it's all in there and I think also some of the like I use humor a lot. I think humor is a great tool. So I will say too that Some of the pain meds I was on helped me deal with that.
Speaker 2:Initially too, right, I mean, there was on some pretty heavy stuff.
Speaker 2:So like I couldn't really feel Right, and it's just like when you're in a hospital and it's just like when you numb stuff out mentally, right, you numb out the good too. And it took a while, it took a few weeks, for, you know, I knew cognitively, like this, I don't need to have People, I didn't need to have people walking with me before, and at the same time they're telling me what to do and I'm not in a place to, like, physically right, do anything about it. So you just kind of have to go with the program on some level and they really like push you because that you the more effort, the more, the more you put into that recovery and the momentum, and it's just like mental health right, the more intention, the more time. Right, the more quiet silence Maybe it is like you can get that momentum going and that's what they want you to do in terms of tbi recovery too. So it's like I don't feel like doing another physical therapy Activity today and they're like no, you have to.
Speaker 1:It's like okay.
Speaker 2:What are you gonna do if I don't right, but we're gonna shut your tb off? I was like, okay, right, so so, and it's different for everyone and you know, definitely different in terms of like demographics, in terms of age right, an approach to a 17 year old with the tbi is much different. When you're 16, you fall.
Speaker 1:I love that. No, that was uh. Thank you for sharing all of that. I'm sure it's not like the easiest conversation to to talk about or think to her members Some of the worst moments in your life, but I think that lends a lot to your strength as a professional, as a person, for what you do today. Because when people I can sit here and try to empathize with you To the best of my ability, but I don't fully understand what that's like and I hope I never have to fully understand it. But I also have to respect and admiration for your, your constant push.
Speaker 1:And it makes a lot of sense that you focus on one of your specialties is it's tbis, because you, no matter what these people are gonna say, like, you Experience a piece of it, if not all of it, yourself, and so you really have a lot of empathy for what they go through the guilt, the shame, the fatigue, the identity, all the trauma, all the, the thoughts, the loss. Helping someone of the tbi it's a lot all at once. Because, as you describe it like there, you also need to have expertise in people in grief, and that's a specialty in and of itself. But with tbi it's there is a lot of grief there and, and depending on the severity there, there might be a shit ton of grief there If some things are just never going to come back or have a workaround, which is, you know, we're talking about brain damage, who knows? And you know, shifting identities and the emotion, emotional regulation. It's. It's a lot to handle, um, and it's it's also very fascinating work. I find this very interesting and intriguing.
Speaker 1:But there's a tremendous amount of depth in tbi work that I don't think there's ever enough time on the planet to actually get into all of it, because the more I dig into this with you and learn about it, the deeper it goes and the more I learn and understand. But it's also kind of scary, honestly. It's when someone's dealing with that you know, as as person who's recovering with the tbi, that depth at some level. When you really sit and think about it, you know it's kind of the same effect of Looking to the ocean but not being able to see the bottom and not knowing what's down there, and that's where the fear comes from. And I think tbi recovery why it's Part of the reason why it's so hard, not just the physical components and all that brings.
Speaker 1:And as you've we talked about in previous episodes. It's like finances and work and social health. There's also you don't really know what you're gonna look like when you're done recovering, like you don't really know until you're there. You don't know what your new normal is until you find it. But the depth of potential for damage from having a tbi it it's as deep as our ocean, like you really have no idea what you're really looking at until you just go swimming down there. The man is that scary. I would not wish that on on anyone and I don't I think anyone should try to do any of that alone because it's it's a lot to manage for an individual. Um, so yeah, I think that's. The biggest thing I got from this is the depth of tbi. Not only is Potential for for damage, but also the recovery has a lot of depth and the emotional component, which is one I understand the most. It is just, it's seemingly boundless, for better, for worse.
Speaker 2:It is, and that's also why you have a tbi treatment team, because there are so many nuances like I'm only touching on what I know from speech therapy, physical therapy, massage therapy, right, all ot, but that's why there's professions, right? I don't need to know all that, I just need to know who. I just need to know who do I need to contact.
Speaker 1:Wonderful. Yeah, no, we both have things to do. It's a weekend. I know you have family. I'm sure they're itching to see you. Thank you so much for returning to further discuss tbi's, to help potential listeners, but to also teach me a lot about what you do, why this matters and what it really takes to get through it. Thank you so much for your vulnerability as well. I know I'm very blunt and I ask very deep and personal questions, but I I loved what you were willing to share and it's it's so impactful and powerful and it's uh. You have a lot of my admiration and respect and gratitude for for what you do.
Speaker 1:There isn't a whole lot of people like you who specialize on the mental health aspects of tbi and it's. It is a form of trauma work, but it's. It's not the same as a lot of other trauma work. There is similarities, traumas, trauma regardless, but it is its own category and it.
Speaker 1:I don't know how anyone who doesn't have a tbi could work on a Emotional level with people who do have a tbi, because even talking to you and the times we've spoken off this podcast, I still can't fully grasp what you've actually been through, and I know it's been a while.
Speaker 1:So you know a lot of this stuff you've emotionally healed from. But even if, even if this was like recent, I don't think I'd ever fully Get it, because some of these I don't think you can honestly understand it unless you experience it like I don't know what it's like to be in a hospital and wake up and just think I'm in a different country or, you know, recovering from like being completely unconscious for hours on end days or having a host of people Help me do Everything and anything, because my brain or body or both Can't seem to put it together for me to do it independently. I don't know what it's like to lose that level of independence. I could imagine how fucking horrible that is, but I don't fully get it. And the strength and courage you have to intentionally spend a career on this to not only Think about your own personal recovery and everything you've been through, but to Emotionally touch someone on that level who gets it, man, that's profound Congrats.
Speaker 2:Thank you so much for having me, you know, for your listeners, for listening to.
Speaker 1:Absolutely before you go. If someone wants to find you, if they think you can help or you're the person for them, how can they find you?
Speaker 2:so they can give me a call 720-295-6703. I'll always submit a form on the website wwwrevitalizedmentalhealthcom, and I usually get back with people within 24 or 48 hours, depending on the weekend.
Speaker 1:Listeners. Look for that information in the description of this episode. Thank you again so much for being here. It's been absolute blast. If you ever want to come back Regarding anything more tbi, anything else, e-mdr, or just because you have something you really want to talk about, you're more than welcome. It's always a pleasure to have you here.
Speaker 2:Same, james, appreciate you creating this space for everyone, not just me, to share.
Speaker 1:Thank you. Thank you for all of you out there. This is it. I'll catch you next time you.