What If Your Purpose Keeps Moving The Goalposts with Jake Orr

We sit down with Jake, an ER clinician and private practice counselor, to unpack crisis work, clinical pressure, and the moving target of purpose. We dig into the craft of change talk, why discomfort is often the doorway, and how authenticity protects both clients and clinicians.

• ER counseling triage explained and decision points for admission
• System limits, moral stress and taking hard calls home
• Grit, competition and the urge to over-engage in sessions
• Purpose as a moving target across seasons of life
• Mantras for change and using discomfort thoughtfully
• Rupture risk when confronting identity versus behavior
• Building clinical authenticity and ditching the therapist persona
• Supervision that sharpens judgment and voice
• Burnout signs, bandwidth management and honest pacing

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Transcript

Meet Jake: Therapist And Doc Student

SPEAKER_01 0:16

All right, man. Well, look, Jake, man, thanks for joining us. Man, this is this is great. We love having new guests on. We've been knowing each other for years, you know, through Jerry's classes and stuff. But the listeners, this is their first time meeting you. Why don't you tell them a little bit about yourself? And then what Juice and I came up with last night is some questions to ask you about practicing and yada yada yada. You know? So tell the people. Yeah. Let the people know.

SPEAKER_00 0:49

So uh hello people. Um my name is Jake. I'm a uh I'm a therapist in private practice here in Asheville, North Carolina. I'm a doctoral student at the University of Holy Cross where I met Jude and Julius um probably I guess it was a couple years ago when we were taking when I was taking theories or advanced theories, or maybe ethics, I can't remember. Um yeah, so uh I'm up in private practice up here in in uh Asheville and I work as an emergency clinician as well at the ER a couple days a week, um doing psych and take stuff. But yeah, I've been uh been really excited to make this happen. I'm finally here, finally here we are.

SPEAKER_01 1:26

Yeah, man.

SPEAKER_00 1:27

So where are you in the program right now? I have got man, why did you ask me that? I'm like, I'm just when do basically it's like basically it's like when do I want to graduate? How hard do I want to work? Oh you're at that stage.

SPEAKER_01 1:43

I don't think people realize that that that that's a stage in a doc because a graduate program is pretty laid out. It's like you you you get through it, you but a doc program is like at a certain point, it's like well it's laid out. Right. But then once you're kind of done with the layout of the courses, now it's like how much how many sleepless nights do you want to have in order to graduate.

SPEAKER_00 2:13

So yeah, so I've I've probably got I'm I'm shooting to graduate in December of 2026. So I've got probably right at a year left. And if I really you know, and that's really that's that's a pretty optimistic, I think, time frame. But yeah, you know, they don't that that's not a conversation that comes up when you're entering a you know a doctoral program, is like, hey, by the way, uh most, well not most, a good chunk of people in doctoral programs typically they they don't graduate because they don't finish their dissertations. Yep, yeah, and those classes that you take, you know, those are great. But once they're over, it's it's kind of just getting started, to be honest with you.

SPEAKER_01 2:54

Honestly, yeah. You're absolutely right. Yeah. All right. I mean, it seems like there's some some fodder to kind of like go off of, you know. I'm trying to before we die. Go ahead, Jim. Can we start with the emergency clinician? Like what what is

Life In The ER: Psychiatric Triage

SPEAKER_01 3:12

that? I don't think I've ever heard of that before.

SPEAKER_00 3:15

So the bait basically the reason the to the position exists is if hypothetically you present to the emergency department and you are in some sort of psychiatric emergency, crisis, uh, perhaps you're suicidal, maybe even your homicidal, uh, you're you know in an active psychotic state that needs to be stabilized. When you come into the ER, that that triage room or that physician or whoever does the nurse is going to decide based on what you bring in to you know triage you to the psychiatric unit where I work. And so you would you would meet somebody like myself in the ER, uh, and I would run a I would work with you and and do a full psychiatric assessment with you and to and to basically determine do you need do you meet criteria or do you need psychiatric stabilization, meaning do you need to be admitted to the inpatient wing of the hospital for stabilization? Or is this something where it's like, hey, let's make a safety plan and uh let's get you connected with some resources and then we'll get you out, we'll get you back home. That's the two options. But there's a lot of kind of there's a lot of nuance that happens in there, you know, things like if if you're maybe perhaps a danger to yourself or other people, that might be a situation where I need to, you know, involuntarily commit you to keep you safe and and perhaps other people safe. And that's a that's a whole other conversation we can we can have about that process.

SPEAKER_01 4:45

Yeah. How did you how did you even get started with that? Like how did you know, like let's say, let's say, you know, there's a master's student who's listening to this who's thinking that may be something I'm interested in. How do you even get into it?

SPEAKER_00 4:58

Uh you know, it really so I'll for some context, so I was a flight medic in the Air Force, and I've always enjoyed like the high speed, you know, very high-level crisis work. Um, and I I've I just it's always kind of found me, and I feel like I, you know, I I really enjoy that kind of work. It's always, it's always different, it's never the same. And so I really, when I got out of, or when I when I became a you know, a fully licensed clinician, I I was pretty dead set on incorporating that or at least maintaining that kind of energy in my clinical career. And so I was hard charging the the people that worked at the ER for, you know, geez, for a few years. And you know, because there's not a lot of turnover there, it's a pretty highly desirable, you know, position. Um, and they finally gave me a shot. And it's you know, it's it's a it's incredibly enjoyable. And what I'm what I'll tell people too is if you're into that, you know, I want a different day every day kind of thing, and you don't want to be sitting in a room doing the same stuff all the time. The the hospital setting and specifically the ER setting is is something to look into. And it's a you know, like you said, it's not very well known, you know, at least in our field, that that's a job we could actually go and go and do. Yeah.

SPEAKER_01 6:17

I think most students would feel like it's not something we should we we can do. You know, you think about like psychologists doing that stuff. You know. Or even uh psychiatrists. Yeah, when I worked at when I worked at Tulane Universities, like uh we had an on-campus hospital. Um that was ki that was a a like a piece of my job would be I was on the third floor, kind of like in the corner where like the psych uh I guess psychiatric section would be, which was like, you know, two psychiatrists, me a social worker, and uh maybe a um psychiatric nurse practitioner. Um that was kind of like our little wing. I mean, people would just kind of get funneled up stairs to us, and whoever was available did like the assessments.

SPEAKER_03 7:06

Yeah.

SPEAKER_01 7:07

Uh and sometimes it would be like it that was during COVID. So sometimes it would be uh hospital staff that were going through stuff, you know, that would kind of get funneled up to our wing, you know. Uh which is like an interesting little niche.

SPEAKER_00 7:23

Yeah. It's cool. Yeah, it's it sounds like that's the same exact kind of thing

Paths Into Emergency Mental Health

SPEAKER_00 7:28

we're doing here.

SPEAKER_01 7:29

That's tough work, man. Like, how do you how do you navigate the pressure? You know, or do you even feel pressure doing it?

SPEAKER_00 7:36

Um you definitely do. You definitely do. And the in the times where you feel the most pressure, and this is what I've shared with people that are coming in to work there, is that you you will inevitably encounter a situation where you your moral compass will be jeopardized. For sure. You know, yeah, and and what that looks like typically is this is is somebody is you know, probably you didn't uh perhaps it's a homeless person or it's a person that needs to be that you you would love to really just scoop up and help and and and and they have housing and they have everything that they need, and every met is you know right at their feet, their every need is right at their feet, but it doesn't work that way. And so for the purpose of what we do at the ER, it's typically like once you're stable, we're gonna move you out of there. We're gonna we're gonna discharge you. And it's hard when you have to discharge someone back to a shelter, or uh maybe there's a child in there that is having a behavioral episode where they're they're really at risk of hurting themselves, but they don't have that insight to understand that that that that you have taken their rights away and that the parents are sending them to the hospital, you know, really against their will. And you're like, right now this hurts, but this is you know, in this very moment, this is the safest and most uh indicated option that we have. And so, yeah, that's the pressure. And you take that home with you. Um, you really do. But you have to just kind of understand like once the decision's been made, you have to move forward. You can't, you can't really, you know, you can't ruminate on it that you did the right or the wrong thing. You just have to keep moving forward.

SPEAKER_01 9:27

Man, the the amount of well what so you you're a flight medic, right? And I'm assuming that based because me and you were talking about how, and I'm I'm in no way equating the two, but just like being a collegiate athlete m redefine what stress looks like for us. Yeah, you know, and what like pressure feels like for us. You know. Um so I'm assuming that being a flight medic kind of re-orient what like reorients what pressure or anxiety feels like in a situation where you're kind of sitting in an air-conditioned room, yeah, you know, uh where things are pretty stable and you're having a conversation with someone who is, you know, like I would say fairly coherent enough to have a conversation, but you know, you're like actually sitting in a room on a comfortable chair. I'm assuming flight medications, you weren't in a comfortable room.

SPEAKER_00 10:28

Yeah. You know, that's a good point. Yeah, and I didn't I you know, and I know you guys played soccer too, and so yeah, I mean, you know, and and I talked to my wife about this frequently, you know, she she was a D1 soccer player, and just like we connect on that, you know, level of grit that it takes to be in those situations that you know, let's be honest, and this is not to cast shame you know on anybody, but like not a lot of people are going to do that.

SPEAKER_02 10:54

Yeah.

SPEAKER_00 10:56

And especially subje uh to subject themselves to it on their own volition. Like, um so there there is a there's a certain component of, yeah, you know, when I was a when I was a flight medic, it was an incredibly fast-paced, uncomfortable, highly rewarding, and sometimes devastating environment. Um and that bone is still in me, and it's I have to kind of as a clinician go out and look for things that kind of scratch that itch. But here's the other thing, though, and tell me what y'all think about this. Nowadays, it's like I have the capacity to do that, but I also understand that my central nervous system deserves a break. Yeah, man. And that's hard to like be like, I'm gonna I'm gonna step back from this right now because I know I need to take a break from this.

SPEAKER_01 11:49

Sometimes I find myself in it with a couple and and and I'm in it with them. We're arguing, all three of us, you know. Let's go. And and and then I and it reminds me of like playing, you know, training, like hurt and suffering, and and and then and then I realize I what am I doing? What what why why why am I why am I getting so involved in that?

SPEAKER_00 12:28

They pulled you up into that thing.

SPEAKER_01 12:30

You know, and uh we No no no no no it's me. I'm the problem. They didn't do anything. I

Pressure, Morality, And Taking It Home

SPEAKER_01 12:36

I I see a chance to go, oh, this is where we can get into it. And I don't need to do that. I I we I could have a civil session. Listen, you know me and my whole family did a one mile marathon thing for cancer, you know. Uh this is Miles Parette. It was a glow run. It was supposed to be a fun night with the kids. Everybody had their little glow sticks, and like, you know, I put glow little things in my daughter's hair. It was cute, right? And so we're about to start, and I'm thinking it's just gonna be a nice little mile, you know, we're done. Man, as soon as the guy said go, this like something snapped. And I was like, Oh, I gotta beat all of these humans. I was like, what's my age group's best time? Who like what how fast can okay? I got I have four kids and I'm pushing a buggy. How fast can I run this mile pushing a buggy? And will my wife keep up, or will I have to make a decision to leave her behind her daughter? Like, and I'm like, why am I doing what is wrong with me? I didn't even stretch. You just you know like you go because you're so accustomed to it, and because there's a little part of you that has the bone inside of you. Like I sometimes in session, I go looking for it. Just in like you with the race. I mean with the couple, and and I hear myself saying, You just gonna let them talk to you like that? And I don't know, I don't know why. And then we're in it and we're sweating and we're arguing, and I'm like, Yeah, this is you know, and then you're not even talking to the couple, you're talking to your ex-girlfriend. You know, like that's who I'm talking to now, you know, and and so yeah, if you don't if you don't if you have that inside of you, you don't find an appropriate place to put it, either in emergency counseling or in high-risk situations, at least one of those. I being a doc student, I you know, you go looking for it.

SPEAKER_00 14:58

Yeah. You do. And some kind of and you know that's I was when you were just when y'all were talking about like basically it's competition. That's it. Yeah, it's it's an internal competition. And there is, at least for me, um, something I'm becoming aware of as I as I kind of get closer to closer to this goal line is that I'm competing against myself.

SPEAKER_01 15:23

Yeah.

SPEAKER_00 15:24

And and there are days where I don't want to do that. Um, but that's where the grit comes out, and you're like, I told I made the commitment to myself that I'm going to do this, and I have to do it. Like it's there's just not even another option. Um and that ain't easy, man.

SPEAKER_01 15:45

No, not at all. Especially when it's so easy to not. You know, like it's so easy to not. But there's something about there's something about, and maybe it's just me. There's something about working while everybody else is sleeping. You know, like it feels like everybody in the world is sleeping, and uh and or like, you know, so staying up late and working while everybody's sleeping, or like waking up early and knowing that like everybody everybody's sleeping, like if I can just get like an edge on myself, you know. I there's nobody else I'm competing against. But it's like who's who who am I, you know, like what am I doing this for? You know, it's a good question. Why am I why am I doing this? That's the that's the question. That is the question. Why am I doing this? Why am I doing this? Yeah. You know, we've written seven books, you know? And and and there's something about it, like we just finished one. And I'm not gonna lie. I'm I know what you're gonna say. Yeah, I'm missing I miss the I miss the like, can can I do this? That deadline, the line of like the deadline. Can I balance a family and can I can I sacrifice parts of myself to get this job done? Right. You know, can I can I live with the with the tiredness and the weariness dysfunction? Oh my god. What's wrong? What what what is what's wrong with this? I don't know. I don't know what's wrong with this.

SPEAKER_00 17:23

It's it's something. I mean, you know, it's like fighting, it's like Rocky in the eighth round. He's got two big swollen black eyes, and he's like, It's like but like bro, just sit down. Sit down. Somebody throw a towel in. You know? But it's I think it's to it to a certain point, you know, someone asked me the other day, they're like, What do you actually asked me this this exact uh this exact sentence? They're like, are you scared about what what you're gonna what's gonna happen when you graduate? And I was like, Yeah, I'm I mean I'm not scared, but I'm I'm already thinking like, okay, what's next? Because you know, I guess stillness is not a part of my vocabulary, which I'm trying to incorporate, but it's you know, I I do find, at least for myself, that I have to have things to look forward to, like, you know, metrics or I guess aspirations or you know, that kind of thing, what have you.

SPEAKER_01 18:22

Yeah. I love that. Yeah, I that I think that kind of perspective took me to an R1,

Grit, Competition, And Rest

SPEAKER_01 18:30

a research one institution after I graduated. You know, and Oh, yeah. I remember you were hyped about that. You were like, I'm getting a stand-up dance skin. I'm gonna be able to do that. Well, here's the thing. Here's the thing. It wasn't really at me. It wasn't really even about like achievement, you know, like I wasn't even gonna help people. I just want them. I did say that that one. No. No, I I was at ODU and it was great, you know, number one cunt number one program, all of the stuff, man. And I remember when I was there, that I think that was like a wake-up call for me because I love the people. I love the fact I'm still connected to the university, you know. But there was something about the achievement of it all that felt disconnected from the purpose, you know, and and then it was that that gave me the wake-up call to go, oh man, I need to reorient myself. Because I it's not it's not just the hustle or the striving just for striving's sake. It's the when it's connected to you know purpose, like when we were writing the this last book, uh Mind Your Business, it was always connected to that one student who just they don't know enough to take a chance on themselves. And and that's the purpose of it. You know, and so oh my gosh, like I can like winning a championship, you know, like there's I've done Unspeakable things to my body to win a championship for a program or to try to make the Olympic team or to you know whatever the thing is. You you ever tell a story about what you've done to yourself to do that in a like in like in class to your students and you see your students' faces and they're like Yeah. Oh that's a bit much. Do we have to do that too? Is that something like that reflects you think? So your wife she played D1, right? So there was probably times where she has ran herself into tears. You know, where she's training and and suffering and a little thug tear comes out. She doesn't even notice it, but her eyeballs are crying. You know, we've all been there, I think. And and but it's connected to the purpose, you know. And I think so often, this is my opinion, students start this with the purpose of helping, and they're hooked on like I'm going to help people. And that isn't as concrete as I think we would hope that it is. You know, like it like in your situation where you're making these calls and it's like, gosh, I hope this is helping. You know what I mean? But there's no real way you discharge them, they go back on the street or they go back into a dysfunctional system, and it's like I mean, do you do you it is gonna sound like a super philosophical question, but do you have do you feel like you have a purpose, Jake? Like is there like a like a through line of everything you're doing? Is there like an end goal of like now I'm gonna feel happy?

SPEAKER_00 21:44

That's a good question, man. And you know, it's funny, I've this just mainly this past year, I've really been reflecting a lot on like what is purpose? What does it mean to have purpose? You know, who are the people in my life that have you know clearly have a purpose? Like, you know, talking to Jerry Corey and you know, seeing this man, he's you know in his late 80s, and he's you know, he's he's the godfather of this field, basically, and that's a purpose. You know, that's a purpose. Um, you know, thinking about um like one of my role models, Irving Polster, as a Gastalt therapist, he's like he's the GOAT, you know, and and but you know, my the answer to that question is I'll get back to you on purpose. Because I feel like it changes, I feel like it changes year to year.

SPEAKER_01 22:36

Literally, yeah, absolutely.

SPEAKER_00 22:37

Um so right now, if I had to answer the question, you know, my purpose right now is to be as truth to my true to myself and and honest to myself in the process of completing this document that is a dissertation. That is my purpose. My purpose is to be a good husband. Um my purpose is to, you know, maybe have kids here soon and get ready for that. Like, what do I need to do to take care of my body to prepare for that chapter of my life? Um, you know, like but I don't know. It's a moving target. That's our I already got I got them on board right now, man.

SPEAKER_01 23:13

Yeah, I I don't know if you're asking for advice, but from somebody who didn't take steroids or cocaine and he has four kids, it could help.

SPEAKER_00 23:21

One or the other. He couldn't help. Why is dad mad all the time? You know? Why is dad crying? Yeah, he kind of goes from like one thing over here to like immediately this thing over here. He's always sweating. I don't even hit and that's how Julius ended up in my ER.

SPEAKER_01 23:44

Yeah, that's how that's how we knew he wanted to be an emergency therapist. Not you, dad, not you. I'm walking there be like, big dog, what you doing here, dude? I don't know how I got here. No, no, no, you can't leave. Nope. You can't oh oh oh, okay. Sit down. We're gonna have to get the paperwork.

SPEAKER_00 24:11

Get a blow dart. Sit down. The blow dart would be clutch for sure.

SPEAKER_01 24:18

You ain't even gotta talk to them. Shit, I would abuse that shit so much. It would be, oh man, it I I wouldn't even be able to I they would have to it would they would have to start taking it out of my salary. Yeah. Because I would use it on colleagues. It'd be worth it. The toxins, the toxins that we use in the dark cost a lot. No, no, no. I'd start growing on frogs. Just the survival of them. Man, I mean what'd you say?

SPEAKER_00 24:48

That's it. Dude, though. That would be helpful probably in the classroom, though, because someone starts getting on a rant and you're like, I got an hour to teach.

SPEAKER_01 24:58

Have you taught lifespan before? Man, sometimes a lifespan. Oh man, sometimes a lifespan, it it's people take it as an invitation. People get triggered. Yeah, people get triggered. Yeah, you can't. Trevor Burrus, Jr.: We had a class just on like birth, and because that's part of it. And then birth stories. You know, jump out. And you it's it's like a wildfire, man. You just gotta let it burn its way out. You know? No. Yeah. But but the the the purpose that you were talking about is is so true. Like it I think when you're when you're especially as a doc student, you know, you get kind of the blinders, you know, and you're like, this document is the the most important thing. And I'm so glad that we we I mean, uh, you know, we wrote our our dissertations before we had kids. Um I feel like the people who do dissertations while raising a family, uh, there's there's just like another gear. Yeah, different animal. Yeah. Just another gear that they hit, you know. Um we but this guy named Paul Maddox, who was uh in our doc program. Shot a full edge family. This is a grown man with a wife and kids, you know, in our in our doc program. You know, and it's just one of those things where like, how are you functioning? He had little kids at the time, too. It's like, how are you even what gear do you hit to process this stuff, you know? But that that's the that's the goal. And I rem I remember in our doc program, when you when you finished your dissertation and you def you successfully defended it, you had to ring this cowbell. Um and I remember I remember ringing the cowbell and my hands slipping off of the rope that held the bell. And in that moment, I was like, okay, this is done. Like this part of of my life is done. And immediately it was like, okay, so like what's next? Yeah. There was no and I there was no like, let's let's wallow and celebrate and be appreciated. You know, appreciated. Yeah. You know, uh literally, I rang the bell and I was like, what's next? And the thing that was next was the edits. I had to turn in some edits because, you know, in order for it to be completely done. And I went home that night and started working on those edits.

unknown 27:19

Yeah.

SPEAKER_01 27:19

Like that night. There was no lag time, you know. Um would you do it differently? Would you do it differently if you No. No. You wouldn't? No. I think that's just who I am. I think I think that's just who I am. Like I literally, it's like there is I don't know I don't know if this is good or healthy or bad, whatever, but there is no time to wallow in success or achievement. You know? You keep saying wallow. Like

Purpose, Achievement, And What’s Next

SPEAKER_01 27:52

oh, I hear it like appreciating.

unknown 27:54

Trevor Burrus, Jr.

SPEAKER_01 27:55

Because you could do that too, wallow in appreciating. Trevor Burrus, Jr. Yeah. Whatever, whatever it is, but uh there's no time to like sit there and be like, man, I really worked hard on that and I deserve you know uh like oh man. What do you think, Jake? Like i how do you feel about that? Like when you get done, you successfully defend, what's your is it gonna be more like two years, or do you feel like you'll sit and take a beat, you know?

SPEAKER_00 28:24

So there's two sides of the coin. The the urge will be to go down the path that Julius is talking about, which is like all right, that's done. That was cool. And then That was fun. But like I know, kind of like what I was saying earlier, is I know I need to build in time to kind of revel in it. But um, and this isn't self-aggrandizing. I you know, I don't really like I kind of have the same thing, Julius, where it's like I just don't have time to like really stop and smell the roses and be like, oh, that was a cool thing I did. I'm really proud. Like, you know, I don't have a birthday month. You know, some people like have a birthday month, I got a day.

SPEAKER_01 29:06

Give it a day. Give a day.

SPEAKER_00 29:08

Yeah, I guess I get a day because and I can that's a special thing. Um, and I know it will be special when I cross the goal line, but like, you know, I will be thinking, you know, and I it may maybe the the answer, another answer to this question is why I got into this in the in the first place, which was to to further my career and to put to position myself in a way that I can step into teaching and preserve my emotional and my energetic bandwidth so that I can continue the work and also keep and also uh influence students and and and new clinicians down the road, you know? So long long story short, it's just you don't I don't got no time.

SPEAKER_01 29:49

It's har it's hard. So like okay, so I so I defended, rung the bell, and then my parents were there, my mom and my sister were there, and I I remember telling them, y'all go back to the apartment, I'm gonna take a walk. You know? And it I didn't I didn't it wasn't like a moment where I felt like I it wasn't transcendent. Like it just I just I just didn't think about anything. I wasn't like smelling roses or skipping down the quad, like nothing. I walked to my office and it was across campus from where I defended. And so I walked to my office, and there was this guy who cleans up the office, you know, and he was like a janitor. And he would sometimes wake me up, you know, in the middle of the night while he was cleaning so I can uh analyze my data, you know. And I, you know, I walked in and told I gave him, I dapped him up, and I was like, I defended, I did it. I'm Dr. Austin now. And then he, you know, congratulations, and then I walked back to my car and drove back to the apartment. But it was in that walk, I felt like I let go of so much I I don't know, like it wasn't even tension, because I don't I wasn't tense while I was doing it. I was just getting it done, you know. But I needed that, I don't know, like that that moment to just kind of sh like shed what I was holding on to because and I still believe this. My dissertation is the worst piece of research I've ever done in my life. It's the worst writing I've ever done. I've only gotten better at both writing and research. It was the most stressed one. It was under the gun, you know. Yeah the whole time. You kind of feel the sense of like if I don't do this, I'm letting my whole family down. Yeah. And I told her that we prayed for this life, and that life directly hinges on me. Hinges on me. Doing this. And but I think that's what that walk was about. Was like, okay. I just and as a matter of fact, I remember saying to myself on the walk, okay, all right, all right. Just I know other students were looking at me like it send him to the ER, you know. But I was just like, oh, all right, okay, all right. And then I got back to the hotel, I got back to my apartment, and then uh, and then I got a mac and cheese at a restaurant and then signed it. Signed the receipt, Dr. Jude Austin, you know. It's the first time. And it was I I think I do some I think it might be in a book that is on my bookshelf. But I took the receipt, signed it, Dr. Jude Austin, and that was like the first time it hit me. I was like, oh, this is me forever. You know, like this is Wow, I I wish I would have had the foresight to do something about that. Yeah, and I I did not think about it again, you know. And I and then and then it was like, all right, I start I start a job in August, you know. Uh and then Yeah, because that's right. Because you were yeah, you were already committed, you had already committed to the university. Yeah, I defended in February. Yeah, I defended in February, got the job in in February. And so I mean, because the job depended on me successfully defending. Yeah. And so they were invested in if I if I succeeded. You know. It's a lot of pressure. Um anyway, let's move on a little bit if we can, because I know we got about twenty minutes left or so. Um but I want to ask about the primal practice, man. How we gotta we gotta well we're really we got a couple questions. You you mentioned a couple questions, right? Yeah, one because Jake, you're really our first like clinician's clinician. Like you're really somebody who is like in the field doing the clinical work that this people who listen to this guy asked do.

unknown 34:12

Yeah.

SPEAKER_01 34:12

Yeah, and we we've been talking about doing a series where we just we just have a hang with clinicians, you know? Um and one of the questions we wanted to ask was, uh geez, you you you phrased it a lot better than I phrased it. But I think what we what we said was what's the thing in session that you find yourself saying over and over to clients? Right? Like if you had a nickel for every time you said this thing. Yeah, it's like a thing that's like on repeat.

SPEAKER_00 34:46

Well the first thing that comes up if is if nothing changes, nothing changes. And you you it's it's and you know what these these little things are so obvious. They're so obvious. It's not rocket science, y'all. It's not we just we're just keeping people in check, really. But um, yeah, no, it's it's it's that. It's you know, right, it's Ronnie Coleman's um everybody wants to be big, but nobody wants to lift these heavy ass weights.

The Line Between Help And Hustle

SPEAKER_00 35:20

Gosh.

SPEAKER_01 35:23

Oh my god, I command you to grow. Yeah. No, you're absolutely right, man. You're absolutely right. Let's break down the first one, right? So if nothing changes, then nothing changes. What when do you say that? What comes up in session that makes you go, something's gotta give.

SPEAKER_00 35:45

It's typically around behavior that is self is apparently self-sabotaging or self-harmful. Yeah. And there's a there's a lack, there's apparently a lack of insight in the client. It's a blind spot that they feel is there, but they don't know is there. It's like it's not in their awareness. And so, like, a prime example would be like, you know, I'm in a relationship and I don't want to be, even though I know I I want to leave, um, and I want to maybe even move across the state, uh, I I don't want to hurt their feelings. So I'm not going to do that thing. And so what we have here is this incongruence of desire versus circumstance. And I'm like, so what happens here if nothing changes?

SPEAKER_03 36:37

Yeah.

SPEAKER_00 36:38

Is that a life worth living?

SPEAKER_01 36:40

God.

SPEAKER_00 36:41

Well, that's like a central question.

SPEAKER_01 36:44

Um, because that's really what that's really what is it about, you know, like uh I mean, what's the point of this? Well, what do you what do you see as the like when you talk about change with clients or just like in in people's lives? What's the thing that creates change for? Like what needs to exist in a client's life to where they're go, all right, I'll change.

SPEAKER_00 37:12

Discomfort. Enough discomfort to surpass the threshold of of tolerance.

SPEAKER_01 37:22

Yeah. That looks different for everybody, right?

SPEAKER_00 37:25

It does. It does.

SPEAKER_01 37:26

And and go ahead, Jude. Well, I was just gonna say, because this is me. And and this gets it to my to my limitations as a human being. Do you create the discomfort for them sometimes in session? What do you mean? Like there's times where okay. So I hear students say things like, um I'll say that when I have enough relationship currency. You know, or I I gotta build trust first, and then I'll say in that there's something inside of my brain that goes, oh no. Once once they ask for this pain. Yeah, no, once you make the call, I'm assuming you've done enough looking around the the website to build a relationship enough for me to be able to have a honest conversation.

SPEAKER_03 38:23

Yeah.

SPEAKER_01 38:24

You know? And so sometimes it's me creating the discomfort in session. You know, like if I'm working with a couple, you know, and it's and it it maybe they're talking about cheating or something, infidelity, it's a triangulation to some extent, and they don't want to talk about it, it's because they're avoiding discomfort. And I'm like, no. What happened? You know, like I I I think I think we all should know. Like, what did it feel like? What was going like, do you know what I mean? To to be able to create the discomfort for something to change. You know, now they may hit me, but that's change, you know.

SPEAKER_00 39:09

Like, you know. Man, I'll I'll turn the heat up to 85 in the office. I'll take the I take the we I take the cushions off the sofa. Take the take the Kleenex off out of the room.

SPEAKER_01 39:23

They were all trained by the same person. This is wild.

SPEAKER_00 39:25

They they walk in there and like, where's the sofa at? Right, we're sitting on the floor today. We're standing up.

SPEAKER_01 39:31

Yeah. Yeah, no, no, no, no. We're standing up. Yeah, and I scoured the guys' Facebook and I brought pictures from 2008. Uh that you guys didn't have to finish before.

SPEAKER_00 39:42

So what's this?

SPEAKER_01 39:47

Um we can finish this before she comes or afterwards. No matter what. She comes.

SPEAKER_00 39:55

But you can't. Yes, I can, and I did.

SPEAKER_02 39:57

Yes, I can. Yeah.

SPEAKER_00 39:58

Um So but for real, the the answer is yes. Um I do apply the discomfort um because I feel like and this is a personality, this is a style thing, um, but you called me, you're paying me a lot to to to help you. Um I'm not gonna I'm not gonna be, you know, I I think you know, harm you and telling you to tell you. But you know, listen, um what I might be sharing with you right now is going to sound harsh. Um because I'm gonna I'm I'm I am I feel like I'm the person you you deserve to have that truth.

unknown 40:44

Gosh.

SPEAKER_01 40:45

Yes. Yeah. You deserve that. We tell we tell our students that all the time. All the time. You know. I mean, the sacrifice to make it to session, the sacrifice to pay for it, the sacrifice to what's gonna happen afterwards, like after you have the conversation, i it it means a lot to me, and I want to respect that. You know, and I want to respect it by offering you genuineness. Not just unconditional promise of regard, but but genuineness, authenticity, and immediacy.

SPEAKER_02 41:18

You know?

SPEAKER_01 41:19

It's like I'm not going to wait until we have like by what metric am I deciding what a strong relationship is. Third session love fest. Well now we feel connected. You know? Yeah. Yeah. It's happening. Connection is happening now. You know, and we'll see by me making this reflection if our relationship can handle that tension. And if it can't, then we then we talk about the relationship, maybe not handling the tension and what needs to be in place. You know, but I can't wait until session three or four to be like, are we there yet? Like, are we in a place where I can finally be honest about some of the stuff I've been holding back from you for the past three weeks? You know? Um it does, yeah.

SPEAKER_00 42:06

It feels like I anytime there's something that's bubbling up for me. I mean, obviously, I'm not gonna just you know, you know, blurt it out. Like I need to I need to run it through a filter real quick and make sure I'm reading it correctly. I think it comes in on the relationship. Right. Yeah, maybe this is more useful to bring up next time. Um but you know, something that uh I was told, you know, a few years ago um by a mentor of mine. It it's like if you are able to come into the room as a clinician and be completely yourself and honest, and then then the right clients will find you and the right clients will stick around. The ones that don't vibe with you will just leave. And guess what? You've just saved yourself some heartache and some bandwidth for the people that want what you have to offer.

SPEAKER_01 42:56

Yeah.

SPEAKER_00 42:57

It's a great way to put it.

SPEAKER_01 42:59

That's a great way to put it, man. And from a business perspective, like if I'm working with somebody that it doesn't click and I I know it, and I'm being inauthentic, and it's not working, and this person has a terrible experience and then shares that with other people, like it does more harm than good rather than to say in the first session, here's who I am. Is this somebody you want to be in a relationship with? If not, dude, let me point you to the direction of somebody who I think you'd have a better relationship with and it it saves the So on that point though, Jake, like is there was there a time where this is where we get into like what was your worst mistake in session, but like was there a time where you you thought that like you know you were connected or you thought that the client was vibing with you and you may have like said something that like really created a riff or a strong disconnection. Tell us about that. Air your dirty laundry out for the people listening

Clinician Mantras: If Nothing Changes

SPEAKER_01 44:05

to this. And if you're wondering, he his name's Jake, and he'll link that address in the chat.

SPEAKER_00 44:15

Mash that subscribe button. Um so dude, how much time you got? Man, I've made so many mistakes. Um it's that's why they call it practicing. You know, I mean we're we're literally practicing all the time. Um but for but for real, the the most notable ex example of this was um in my graduate program at the community counseling clinic, and after listening to y'all's podcast a lot, like it sounds like our experience as far as it being a community clinic is pretty similar. Um I'm already advocating. You get what you get. It's five dollars a session. Yeah, it'd be it's five dollars. That's enough to pay for the paper and the pens that we use.

SPEAKER_01 45:03

You're getting you're paying five dollars, but I'm laying my heart out. I'm giving you a $25 session at least as a student.

SPEAKER_00 45:11

Oh yeah. So um my guy, we had been in session for probably two months at this point. Good, you know, he was a younger guy, but uh, you know, I felt like the rapport was there and we were vibing, and um he kept telling me he wanted to build wealth. I want to build wealth, I want to build wealth. This is like back when uh crypto was like kind of coming into the scene and he was like, I'm gonna build wealth, man. And I was like, but tell me how though. Like how? And I got I got pretty I I pressed him, I was like, hey man, you you keep saying this thing, I'm just curious about what you mean. And it was confrontational, and my my man stands up in the room and he like stands over me in my seat, and I'm like looking up at him, I was like, I was like, you're about to make a big mistake, man.

SPEAKER_01 46:00

Seriously, and I've been waiting for this. I've been waiting for this. You don't you don't know how much I need you to hit me right now.

SPEAKER_00 46:10

It and we cooled off. Like I was like, hey, let's just end it right here, you know. And I went and told my supervisor and all that, but I was like, it was really tense, and uh, and I definitely came on too strong because I had I had overestimated the rapport for some really the safety of the situation. I mean, this guy could have really it could have been bad. Um but yeah, I mean, you know, like I said, I could I could go on and on, but that was definitely like my first and most notable experience is like I I have done something wrong.

SPEAKER_01 46:42

Yeah, and and that's and that's the chance. I feel like I feel like that's the chance you take whenever you're trying to do therapy in the way that uh creates change, you know, and and and and gets the client to kind of confront what's going on for them and the and the consistency of the pattern is you take a chance. And like you, I mean I share my stuff before, I'm not going to again, but I think the mistakes I've made has been when I overestimate the connection and underestimate uh the significance of the rootedness for a client. Like their stuckness is is is fused with their identity, you know, and so for me to for me to overestimate the relationship and confront the stuckness, I'm actually confronting their identity, but I don't know enough about the situation to be able to go, oh, this is an identity thing, not uh a poor choices kind of thing. You know? Right. And every single time it's ended in like an explosion of some sort, you know. Um but it's it's hard to read that. And you gotta go for it when you see it. You gotta go for it, man. Yeah. Well, and that's need that. Oh, go ahead, Jake.

SPEAKER_00 48:10

Well, I was just gonna say if it if there's anybody listening to this, which I would assume there is. Yeah. It's to go for it is it is it's to be with yeah, it's just our moms. Like our babies. Um so I just want people to I want to I want people to know that it's okay to fail. And that it's okay to like to to like be willing to look like an idiot in front of a client, um, just to go for it, man. Because like the the you're we're all we're all just aiming to, I think, be the best version of ourselves in this field, and you won't be able to do that if you're not willing to take the chances.

SPEAKER_01 48:53

That's what I was gonna ask. Like, you know, there's prime primarily students listening to this, you know? And so there's a lot of them at different phases of their career, you know, some of them just starting out, you know, and they like

Choosing Discomfort To Create Change

SPEAKER_01 49:05

hadn't even seen their first client, all the way up to students who are, you know, maybe pre-licensed clinicians who's like just about to cut the apron string of a supervisor, you know, and like taking chances and like, you know, kind of putting yourself out there with clients and not feeling or not feeling like saturated in vulnerability to where you you don't take those chances can kind of create little stoppages for you that can halt you in a process, you know. What did you what did you do to feel comfortable enough to like take chances in session? Was it anything that you had to work on within yourself?

SPEAKER_00 49:47

Yes. I had to A have quality, high quality supervision. Um find finding the right supervisor was the best decision I ever made in my clinical career. Um and so but but really what it what it inevitably was was you know, obviously making the the mistake in the first place tells you that you're it afterward you're gonna be okay, you're still safe, like you move forward. Um but when there's a voice that pops up inside of your head while a client's telling you something and you're noticing something, that to me is is your truth in your in your clinical perspective, and it is your duty, it's it's been my duty to share that. And if it's wrong, and I'll tell people like, hey man, if what I'm about to say is wrong or you disagree with it, please tell me, and then let's talk about that.

SPEAKER_01 50:43

Yeah, yeah, yeah, yeah, yeah, yeah, yeah. Do you do you do that for students? Like, do you try to do you try to get them connected to that inner voice? Because for a lot of students, man, a lot of students they have this therapist, this image of a therapist that they've created inside of their body. And they want to listen to that, but then there's this other voice that's that they're trying to shut down. Yeah. You know? Do you try to do that? They've defined they've defined as like less therapeutic. Less therapeutic are are harsh or n or gonna get them kicked out of the program. You know, like do you yeah in what way and how do you do that for supervise?

SPEAKER_00 51:37

It's it's it's a lot for for me in the past when I've been when I've when I've had the the the ability to really supervise like high quality students that are hungry, it's like I'm I'm self-disclosing a lot about my experience in what they're looking at coming into as students. And so um I I by proxy and by I think modeling in the way that I am with students, and I'm the I'm the same way I am with students as the and it's I'm the same way I am I am with clients, and it's the same way I am in the world. I'm hoping to model to them that like this is what uh uh the the hopeful congruence looks like, and that's what I'm trying to expect, I'm expecting of you. And so if there's a tape that we're listening to together where it's like, I don't hear you in here, I hear the therapist you feel like you should be. Yes, like let's roleplay what it would look like if you were actually in the room. And they and they respond, it can people typically respond well to it, but it's it can be it's hard because you're you people are like, who well, what do you mean I can do I can be myself? And it's like that's the point.

SPEAKER_01 52:49

Yeah, it's actually what people prefer. Uh people prefer that's what we're expecting of our clients. Exactly. That's the literal expectation for our clients, you know, as opposed to like the oh, let me put on my therapist hat. Now I'm therapist, and then when I go out, I take off my therapist hat, and now I'm like a person. Yeah, it's like, oh, how do you person? Yeah. Yeah, I try to I sometimes will well when I start supervision, I'll say something like, Who's the person that you can be most honest with in your life? Like, you know, like if if like if the chat got leaked, you would get arrested. Yeah, if they would be a good thing. Who that person you know? Okay. And so then most of the sessions I see, I'm like, how would you say that but if you were talking to that person? You know, and then and tr to to get them to say it. And then how do we make that therapeutic? How do we bring that into the rum and make it so where you don't get fired? You know? But you got to say that because you can't be in therapy with the mm-hmm and the that sounds interesting and the tell me more about it. But but thinking, but thinking's the most ratchet like gun to rat type stuff. Yeah, you can't, you're not gonna, you're gonna burn out. You know, you're you're gonna burn out, you know.

SPEAKER_00 54:18

You will, man. And that's a that's a really good point and and something I've noticed about myself. As a person who has hit the sun and you know, bounced off in this career. It's uh it's really important to know like to really be uh attuned to yourself and like to notice like I have to really pay attention to how I'm feeling because if I notice that I'm doing the oh wow, I'm probably smoked and I'm not cooking. I wouldn't pay myself my hourly rate.

SPEAKER_01 54:50

No, no, no, no.

unknown 54:52

No.

SPEAKER_01 54:52

When you start thinking about giving refunds, that's when it's like I need to take a break. You know what? I'm not gonna charge you for this session. Uh I know I'm not sure. Matter of fact, I'm gonna close up shop. Yeah, just take the sign when you leave. Take it, put it in the dumpster. And they're like, no, this is good. And you're like, no, no, it's not.

SPEAKER_00 55:13

You know. I'm just gonna go sell cars.

When Confrontation Backfires

SPEAKER_01 55:21

It works comes to words. You can just sell cars. Yeah, man. You know, that'd probably be pretty good. Same skills. We're just trying to sell stuff. Same skills. All right, man. Alright, I gotta jump out, I gotta meet with another student, but man, this is this was not this is not gonna be the last time that we have a conversation with you. Because I feel like there's so much more, especially when it comes to like uh, you know, the the way that you see the therapeutic relationship and how that's tied to your clinical identity. Like, I love to hear more about how you merge the two together to where you show up as yourself in kind of all these arenas, you know. Um that'd be cool, man. Good gang. Yeah, good gang. Thanks for listening. Let's make sure you guys uh continued. And um, anything coming up to you? We got AC8 coming up. Are you gonna be at AC8 coming up? I'm gonna try that. I'm gonna pile them. Got a little document to write. Plus, it costs $15,000 just to buy over there.

SPEAKER_00 56:24

For two days, too. It's a lot too. Two days.

SPEAKER_01 56:27

Like for a couple hours. I don't know how much money we make these e, but I feel like at some point they gotta copy our registration. Yeah, I mean. Yeah, not a few minutes. Not a that's frowned upon, geez. Remember, remember the last time. Yeah, daddy's gonna move these hips. Speaking of hips, this episode has been brought to you by H E B Nutrition O'Shake.

SPEAKER_00 56:56

Uh this is not an FDA approved product.

SPEAKER_02 57:04

Uh, I appreciate that.