Podcasts about DSM

Post Traumatic Stress Disorder first appeared in the DSM-3 in 1980, and was clinically defined as exposure to an actual or threat of death, serious injury, or sexual violence. Today, clinicians and pop health proponents have expanded the definition broadly, without supporting research, and the result is a catch-all term used to describe any past stress. Labeling mental health challenges is crucial for research, funding, and appropriate treatment, so on this week's show, you'll meet a doctor and researcher who will help us understand trauma based on science. Learn Toxic stress theory and misunderstandings Why complex PTSD is not based on research How to advocate for your children or yourself if you have PTSD MDMA and psilocybin treatment options - the future?  Links Michael's website  ABOUT OUR GUESTDr. Scheeringa is a practicing clinician and the principal investigator on five large, federally-funded research projects on PTSD in children and adolescents. He's the author of, They'll Never Be the Same: A Parent's Guide to PTSD in Youth and a new book, The Trouble with Trauma. Nutritional Tip of the Week Pig Fat or Beef Fat Like the Show? Leave us a Review on iTunes

Oh gosh oh gee it's the FIRST EVER VIDEO PODCAST (if you're listening on Spotify). In this episode, Cate and Erik sit down to discuss the 4th DSM criteria for ADHD but instead, Cate has a vulnerable ADHD moment. They discuss the frustration of losing a train of thought, of the inherent judgement often associated with completing tasks, and spend a weird amount of time talking about squirrel-based irony. If you liked this video version of the podcast, don't forget to email us at ask@infinitequestpodcast.com and let us know what you think! Find us on TikTok and Instagram at: @catieosaurus @heygude We also stream daily on Twitch: https://www.twitch.tv/catieosaurus https://ww.twitch.tv/heygude Cool new listener email: ask@infinitequestpodcast.com Media/Business Email: infinitequestpodcast@gmail.com Find all of our links and cool stuff at: www.infinitequestpodcast.com Get your own podcast by visiting anchor.fm --- Send in a voice message: https://anchor.fm/infinitequest/message Support this podcast: https://anchor.fm/infinitequest/support

Laurens en Stefan gaan verder. Of eigenlijk, voegen iets toe. Waar de Denia Tapes II al een afgesloten boek leek komen de mannen toch nog terug voor een encore. En ze zijn uiteraard niet alleen. Niemand minder dan Cees Bol, de uitvinder van de Cees Bol classic, schuift aan. Het gaat over zijn stormachtige entree in het peloton, zijn lange afwezigheid vanwege een hersenschudding en over DSM. De ploeg waar zo veel over te doen is maar waar hij zich als een vis in het water voelt. En hoe kwam hij eigenlijk op die skitterende route van de Cees Bol Classic? Je hoort het allemaal in de Live slow Ride Fast podcast...

Today, I am blessed to have here with me Michael Collins. He has been completely sugar-free for over 30 years. The 8th Annual Quit Sugar Summit! January 24 - 30, 2022. Register for FREE:  https://quitsugarsummit.com?afmc=bv He is past Chairman of the Board of a Food Addiction Institute and current board member, a 501(c) non-profit, that helps raise awareness about processed food and sugar worldwide and is the founder of Sugarfreeman.com, which has been helping thousands successfully quit sugar for over nine years. Michael and his wife raised two children sugar-free from the womb to six years of age. For over 30 years, Michael has worked closely with others to help them regain lives ravaged by various substance use disorders. In this episode, Michael talks about all the reasons why he decided to go entirely sugar-free for over thirty years. He explains why many people are reluctant to call sugar a real addiction. Then, Michael reveals what exactly is going on in the brain when we eat sugar and what happens when we stop eating sugar. Tune in as Michael gives tips for starting a keto lifestyle in the new year, and we chat all about the upcoming Quit Sugar Summit. It's free, and you can sign up here: https://quitsugarsummit.com?afmc=bv 90 Day Detox Program: http://www.ketokampdetox.com Order Keto Flex: http://www.ketoflexbook.com -------------------------------------------------------- / / E P I S O D E   S P ON S O R S  PureForm Omega Plant Based Oils (Best Alternative to Fish Oil): http://www.purelifescience.com Use ben4 for $4.00 off. Paleo Valley beef sticks, apple cider vinegar complex, organ meat complex & more. Use the coupon code KETOKAMP15 over at https://paleovalley.com/ to receive 15% off your entire order. Upgraded Formulas Hair Mineral Deficiency Analysis & Supplements: http://www.upgradedformulas.com Use KETOKAMP15 at checkout for 15% off your order.  Text me the words "Podcast" +1 (786) 364-5002 to be added to my contacts list.  [01:00] The Reason Why Michael Went Completely Sugar-Free Michael got sober almost thirty-seven years ago. When he got sober, he started to use sugar instead of drugs and alcohol. Flour and sugar were just the staples of his diet. One day, Michael read a book called Sugar Blues by William Dufty. You can check it out here: https://www.amazon.com/Sugar-Blues-William-Dufty/dp/0446343129/benazadi-20 Eventually, he started putting out his own information about sugar addiction on the internet. [12:00] Why People Don't Recognize Sugar As An Addiction People are going blind and losing limbs because of sugar addiction. Some people biochemically cannot ingest sugar. 95% of all people that lose any amount of weight gain it all back and then some in the first year. The word addiction is still stigmatized. So many people are not willing to consider sugar addiction a real thing. [24:00] What Exactly Is Happening In The Brain When We Eat Sugar All of the brain reward chemicals are affected by sugar. In fact, they are manually manipulated by sugar. When you stop eating sugar, your dopamine receptors will be thinned out. If you have a sweet tooth craving, you are looking for a dopamine hit. You can give sugar to a one-year-old, and there are no ethical worries. If you have high-stress events in your day-to-day, maybe you eat sugar as a response. Then it's time to remove the stressful situation so you can ditch the sugar. [37:15] Caffeine Use Disorder Is Accepted By The Medical Community Caffeine use disorder is actually in the DSM. The medical establishment has seen what happens when people overuse caffeine. So, we still have to fight for people who have sugar use disorder. Science is catching up around sugar addiction, and hopefully, people can get the help they need from the medical community. [41:20] Tips For Making The Transition To Keto In 2022 Keto is going to be hard for about seven to ten days. Most likely, you are not going to feel well. If you have a sugar addiction, you are going to be lethargic, and you are going to be depressed. This is normal because your dopamine is finally getting a rest. However, in the long run, you will have a better mood, you'll sleep better, and you'll be able to focus more. [50:15] All About The Quit Sugar Summit 2022 The 8th Annual Quit Sugar Summit is coming up in 2022. It goes through January 24 – 30, 2022. You'll hear from some amazing speakers like Dr. David Perlmutter, Dr. Richard Johnson, Dr. Nicole Avena, Bitten Jonsson, Cristy “Code Red” Nickel, Ben Azadi, and much more! The diet industry is a $70 billion industry, and no one believes it. At the summit, people are selling nothing. Instead, they are just bringing information to people that need it. The 8th Annual Quit Sugar Summit! January 24 - 30, 2022. Register for FREE: https://quitsugarsummit.com?afmc=bv AND MUCH MORE! Resources from this episode: Check out Sugar Detox: https://sugardetox.com/ Follow Mike Collins Facebook: https://www.facebook.com/QuitSugarNow/ Pinterest: https://www.pinterest.co.uk/sugaraddictionsupport/ Instagram: https://www.instagram.com/sugar_free_man/ Twitter: https://twitter.com/sugar_free_man YouTube: https://www.youtube.com/channel/UCD80CgQ0bDPXO_Jo5ES0YqA/featured LinkedIn: https://www.linkedin.com/company/sugarfreeman/about/ Get The Last Resort: Sugar Detox Guide: https://www.sugaraddiction.com/ The 8th Annual Quit Sugar Summit! January 24 - 30, 2022. Register for FREE:  https://quitsugarsummit.com?afmc=bv The Sugar Detox and Sugar Addiction Daily Support Group: https://www.facebook.com/groups/sugardetox.sugaraddiction.supportgoup/about/ Join theKeto Kamp Academy: https://ketokampacademy.com/7-day-trial-a WatchKeto Kamp on YouTube: https://www.youtube.com/channel/UCUh_MOM621MvpW_HLtfkLyQ 90 Day Detox Program: http://www.ketokampdetox.com Order Keto Flex: http://www.ketoflexbook.com -------------------------------------------------------- / / E P I S O D E   S P ON S O R S  PureForm Omega Plant Based Oils (Best Alternative to Fish Oil): http://www.purelifescience.com Use ben4 for $4.00 off. Paleo Valley beef sticks, apple cider vinegar complex, organ meat complex & more. Use the coupon code KETOKAMP15 over at https://paleovalley.com/ to receive 15% off your entire order. Upgraded Formulas Hair Mineral Deficiency Analysis & Supplements: http://www.upgradedformulas.com Use KETOKAMP15 at checkout for 15% off your order.  Text me the words "Podcast" +1 (786) 364-5002 to be added to my contacts list.  *Some Links Are Affiliates* // F O L L O W ▸ instagram | @thebenazadi | http://bit.ly/2B1NXKW ▸ facebook | /thebenazadi | http://bit.ly/2BVvvW6 ▸ twitter | @thebenazadi http://bit.ly/2USE0so ▸clubhouse | @thebenazadi Disclaimer: This podcast is for information purposes only. Statements and views expressed on this podcast are not medical advice. This podcast including Ben Azadi disclaim responsibility from any possible adverse effects from the use of information contained herein. Opinions of guests are their own, and this podcast does not accept responsibility of statements made by guests. This podcast does not make any representations or warranties about guests qualifications or credibility. Individuals on this podcast may have a direct or non-direct interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.  

Und wieder mal ist es geschafft, eine neue Folge geht online. Wir hatten viel Spaß, wir hoffen ihr auch und jetzt, Download! Show-Notes Metalhenge in Bremen Empfohlenes Headset von Beyerdynamic uniball Kugelschreiber Podcast kam, sah und verlor Die Welt des … Weiterlesen →

in this episode, Cate and Erik look at the 3rd DSM criteria "Often does not seem to listen when spoken to directly". We discuss the difference between internal versus external symptoms, and how what LOOKS like not paying attention often times is exactly the opposite- ADHDers paying attention REALLY HARD, and how frustrating it is to be told you're "doing it wrong'. Find us on TikTok and Instagram at: @catieosaurus @heygude We also stream daily on Twitch: https://www.twitch.tv/catieosaurus https://ww.twitch.tv/heygude Cool new listener email: ask@infinitequestpodcast.com Media/Business Email: infinitequestpodcast@gmail.com Find all of our links and cool stuff at: www.infinitequestpodcast.com Get your own podcast by visiting anchor.fm --- Send in a voice message: https://anchor.fm/infinitequest/message Support this podcast: https://anchor.fm/infinitequest/support

Welcome back to Season 2!  To kick off our return to the airwaves, Minji and our wonderful guest, Abe Kim, explore their perspectives about men, feelings, and therapy. They discuss longstanding societal pressures that have formed our ideas about male identity as well as the brutal impact of conditioning men not to feel.  You'll hear about how Abe got started in therapy, finding the right therapist, the work that goes into "the work", the financial aspect, and more.  There's no time to waste y'all, let's dismantle the stigmas and get healing!  Follow Minji On:Twitter (@minjeeeezy)Instagram (@minjeezy)Clubhouse (@MinjiChang)▫️ Music featured in this episode include "Uzutrap" by Uzuhan and “Tough Guy” by Uzuhan  ▫️ Follow the show on Instagram and Twitter and support our Patreon▫️ This podcast is part of Potluck: An Asian American Podcast CollectiveProduced by @marvinyueh & @AnnaSunSupported by @JulianaDeer00:00:00 - Welcome to Season 2 of FOA!00:01:51 - Intro'ing the episode and hyping the guest 00:06:20 - Starting therapy and the great resistance00:11:37 - Internalized beliefs about men and feelings 00:15:52 - How being Korean-American and religious shaped their views00:22:54 - What MTV, Saved by the Bell, and Band of Brothers teaches about men 00:27:43 - Minji and Abe are sick of this shit00:29:13 - Abe's starts therapy and gets a diagnosis00:33:36 - Human reaction to guard and avoid  00:39:48 - [Break] (plugs Marvel & Makeup Pod)00:40:46 - Jumping back in00:43:00 - Talking about therapy when you're in it 00:48:29 - So, should I get into therapy? 00:55:19 - Matching with a therapist and dating01:00:31 - How to make the money piece work01:08:25 - Also celebrating the external work that Abe is doing  01:12:03 - closing out with 3x questions for our guest 01:18:50 - Outro + Tough Guy by Uzuhan + potluck podcast collective(01:21:27 - Plugs Saturday School Pod)

The “I'm not sick enough” narrative is a common one that comes up with those who have hypothalamic amenorrhea or disordered eating. It can often happen if you feel you don't perfectly fit a diagnosis of disordered eating or an eating disorder, the comparison trap of others being "worse than you", or disordered behaviours being normalised by society. In this podcast we breakdown: The main reasons you may not feel "sick enough" What to do if your symptoms don't fit into the DSM-5 criteria for an eating disorder The misconception of weight or BMI being a representation of how much you are suffering when struggling with disordered eating or compulsive exercise Why early intervention is so beneficial to recovery 5 key steps to break down the "I'm not sick enough" mentality so you can get the help you need and deserve to recover guilt-free . ❤️ Join my newsletter list for weekly motivation and inspiration and you'll also receive a FREE copy of my eBook "31 Ways to Boost Your Body Image" ❤️ Ready to get your period back? Join the next round of Healing Hypothalamic Amenorrhea! This 8-week, hybrid group and 1:1 coaching program is designed to help you recover your period while improving your relationship with food, exercise and your body. Find out details and sign up here: https://sarahlizking.com/healing-ha/ ❤️ Looking for a supportive recovery community? For all the support, resources and strategies you need on your recovery journey, join us in Recovery Club today! ❤️ Work with me and my team to improve your relationship with food and exercise by heading to www.sarahlizking.com and filling out the contact form. ❤️ If you enjoyed this episode please leave a 5⭐️ review and share a screenshot on Instagram by tagging myself @sarahlizking and I'll be sure to reshare.

How to Understand and Treat Psychosis: An interview with Maggie Mullen, LCSW Curt and Katie interview Maggie Mullen, LCSW, a national trainer on culturally responsive, evidence-based care for psychotic spectrum disorders. We talk with Maggie about her anti-racist and disability justice framework of psychosis, understanding psychosis on a spectrum, what to do when psychosis enters the treatment picture, assessment of psychosis, and treatment using Dialectical Behavior Therapy (DBT). We also talk about how society defines “normal” and pathology, exploring cultural differences in these definitions. Interview with Maggie Mullen, LCSW Maggie Mullen, LCSW (they/them) is a clinical social worker, national trainer, community activist, and author of The Dialectical Behavior Therapy Skills Workbook for Psychosis. Maggie specializes in culturally responsive, evidence-based care for psychotic spectrum disorders, trauma and PTSD, the LBGTQ+ community, and formerly incarcerated people. As a training director at Kaiser Permanente, they take great pride in mentoring, training, and supervising the next generation of social workers. You can find them online at www.maggiemullen.com In this podcast episode we talk about looking at psychosis differently We started the conversation on psychosis when we were looking at conspiracy theories. We know that folks who believe in conspiracy theories and those who have a diagnosis of psychosis are different, but knew that we needed a deeper dive into how to understand and treat psychosis. We dig deeply into this conversation in this week's podcast episode: Maggie Mullen's anti-racist and disability justice framework of psychosis “People with psychosis [are] being overly institutionalized… over medicated or highly focused on medication as the sole treatment. And particularly for our… black, indigenous, and folks of color experiencing psychosis, and people who are being shot and killed by police… when they're out responding to their symptoms in a public way, or being incarcerated and not receiving treatment.” Maggie came from a community organizing background Inequity and lack of resources for people who experience chronic psychosis The focus on medication rather than other forms of treatment for psychosis BIPOC individuals being shot by police when psychosis shows up in a public space “Psychotic spectrum” versus the segregation of psychosis as “other” “We are often the least prepared to deal with our most acute clients” The continued segregation of psychotic disorders Cultural considerations when determining what is psychosis or other types of experiences The lack of inclusion of psychosis in the research Psychosis is not “other” but is actually a spectrum of behaviors and are very common The symptoms of psychosis are not constant, they fluctuate for every individual The importance of following the model and voices of the disability justice movement Including education on the treatment for psychosis, rather than allowing therapists to opt out Folks with psychosis are often not included in the research, which needs to change What to do when psychosis comes into the treatment picture for our clients “The reality is there are wonderful outcomes, I think, for people with psychosis, when we look at it from a different perspective. Which is to say – what if some of the work might be on changing your symptoms themselves? But what if part of the work is actually on accepting your experiences so that you can just experience less stress with them?” We need more training on psychosis to feel confident Normalizing the experience of psychosis Helping to make peace with psychotic symptoms (i.e., making friends with the voices) to decrease distress Looking at treatments beyond medication How to identify psychosis and assess for impact and impairment The myth that all elements of psychosis are distressing and bad Why Maggie Mullen is using Dialectical Behavior Therapy (DBT) to treat psychosis “People with psychosis deal with emotion dysregulation, actually more so than the average person…that's where we know DBT is really effective” We frequently underestimate the ability to help folks with psychosis Using DBT skills for emotion regulation concerns that frequently come up in psychosis Psychosis and PTSD oftentimes occur together and aren't always diagnosed Trauma can influence the onset of psychosis AND psychosis can be traumatic Maggie's pilot program with DBT for psychosis The concrete and straight forward nature of DBT skills make them very accessible Understanding psychosis differently, including the cultural differences of what is “normal” How to identify what is “real” and what is psychosis How do you define what is normal for someone? What do we decide what we pathologize? Breaking up the binary of normal or not normal – reframing as “experience” The importance of understanding what is negatively impacting the client and how to keep clients safe Take the lead of your client and trust that they know themselves best The tension between taking the lead of the client and mandates and requirements as a therapist The Dialectical Behavior Therapy Skills Workbook for Psychosis by Maggie Mullen, LCSW Maggie wrote a book to democratize DBT skills Using DBT, but making the skills more concrete and accessible Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Buying Time LLC Buying Time is a full team of Virtual Assistants, with a wide variety of skill sets to support your business. From basic admin support, customer service, and email management to marketing and bookkeeping. They've got you covered. Don't know where to start? Check out the systems inventory checklist which helps business owners figure out what they don't want to do anymore and get those delegated asap. You can find that checklist at http://buyingtimellc.com/systems-checklist/ Buying Time's VA's support businesses by managing email communications, CRM or automation systems, website admin and hosting, email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly. With a full team of VA's it gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available. Book a consultation to see where and how you can get started getting the support you need - https://buyingtimellc.com/book-consultation/   Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! Maggie's website Maggie on Instagram The DBT Skills Workbook for Psychosis by Maggie Mullen, LCSW   Relevant Episodes of MTSG Podcast: Conspiracy Theories in Your Office Fixing Mental Healthcare in America: Serious Mental Illness and Homeless Fixing Mental Healthcare in America: Psychiatric Crises in the Emergency Room Fixing Mental Healthcare in America: Peer Support Specialists   Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: www.mtsgpodcast.com www.therapyreimagined.com https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group   Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated): Curt Widhalm  00:00 This episode of the Modern Therapist's Survival Guide is sponsored by Buying Time   Katie Vernoy  00:04 Buying Time has a full team of virtual assistants with a wide variety of skill sets to support your business. From basic admin support customer service and email management to marketing and bookkeeping, they've got you covered. Don't know where to start, check out the system's inventory checklist, which helps business owners figure out what they don't want to do anymore and get those delegated ASAP. You can find that checklist at buying time. llc.com forward slash systems stash checklist.   Curt Widhalm  00:31 Listen at the end of the episode for more information.   Announcer  00:34 You're listening to the modern therapist survival guide where therapists live, breed and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.   Curt Widhalm  00:49 Welcome back modern therapist. This is the modern therapist Survival Guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast for therapists about all sorts of stuff and just my continued ability or inability to introduce episodes well here but   Katie Vernoy  01:06 yes, yes.   Curt Widhalm  01:07 Recently, we had an episode on conspiracy theories. We very, very briefly talked about the difference between people who are following conspiracy theories and psychosis. We did an almost barely adequate job of talking about it and decided that we needed to follow up with somebody could who could help us talk about psychosis a little bit more deeply. And so we have a guest today, Maggie Mullen LCSW w. And they are a fantastic resource when it comes to working with psychosis and very glad to have them with us here today. So thank you very much, Maggie, for joining us.   Maggie Mullen  01:49 Thanks so much for having me, Curt. And Katie.   Katie Vernoy  01:51 So glad to have you here. Like I told you before we got started, we needed somebody to talk about psychosis saw that you had sent in a little pitch to us. And we're like, oh my gosh, this is perfect. We're so excited. And I can't wait to kind of get to meet you here on the podcast. But let's, let's have everyone meet you and say what we always say to all our guests, who are you? And what are you putting out to the world.   Maggie Mullen  02:12 As Curt mentioned, Maggie Mullen, LCSW I use they them pronouns. And I am an author and trainer. And what I am working right now to put out into the world is an anti racist and disability justice approach to working with people experiencing psychosis that really focuses on centering their experiences and needs. And one of the ways that I'm really going about that right now is by offering DBT informed treatment to people who are struggling with psychotic spectrum disorders like schizophrenia, schizoaffective, disorder, bipolar disorder, etc.   Curt Widhalm  02:43 You get into this work, that a lot of therapists have their own stories that just what's your story as far as getting into working with psychosis, and really having this level of passion for it?   Maggie Mullen  02:59 So I come from a community organizing background, right, a lot of the work that I was doing before grad school was really centered around how do we bring communities together to fight for change. And I chose a path of social work, because I really wanted to have the opportunity to do both that macro kind of bigger level practice, but also help individuals because I was somebody who was able to connect with people pretty well and really enjoyed that part of the work. And as I was in grad school, learning more about mental health and kind of being in that part of the field, the thing I kept seeing over and over again, was the inequity and really lack of resources for people who are experiencing psychosis in a chronic way. And the way that, you know, that kind of shows up and at least at US, US society is, you know, seen people with psychosis being overly institutionalized, you know, really over medicated or highly focused on medication as the sole treatment. And particularly for our, you know, black indigenous and folks of color experiencing psychosis, and people who are being shot and killed by police, right when they're out of responding to their symptoms in a public way, or being incarcerated and not receiving treatment. And for me, that just felt like a call to action to say, I want to get involved in this area that really needs to be expanded. And I think one additional piece is if you look at almost any piece of literature in our field, right? So if you're like nerd like me, you want to go and do research about something. If you look into almost any psychotherapy treatment, you'll see that there's a rule out for participants who experienced psychosis. And that's really widespread across almost all therapies. And I find this odd because the same type of like what we used to call delusional beliefs we now call distressing beliefs or distorted beliefs, those same types of things happen in other diagnoses, right? We see this in eating disorders, right? People who have such distorted beliefs about their bodies to the point that they're willing to, you know, encounter significant health issues in order to engage in certain behaviors, right or even with depression, right, where we have distorted beliefs about your self worth to the point that you're willing to hurt yourself. but we don't exclude people so aggressively from treatment as we do with psychosis. And for me, that's really kind of a question that I kept coming on grad school, like, why this group? Why are we segregating them in this kind of way that's leading to, you know, high rates of suicide, high rates of incarceration, all those things that I mentioned before, that are just poor quality of life issues for these folks.   Curt Widhalm  05:20 So to ask maybe an obvious question here. Why, why what have you found out and asking this big question, what is our system have against psychosis? Is it fear from treatment professionals in the past? I'm sure that you've come up with some at least explanatory answers here.   Maggie Mullen  05:41 Yeah, there's not one right answer, I think is part of this, right. Like, if we went back really far in history, one of the things that we would see is that across cultures, right, there are really different approaches to psychosis, right? We see in a lot of indigenous cultures, the idea that people with psychosis are actually, you know, accessing other states of reality, and that scene is a strength, right? And something that's really valued, right, like people who are medicine are healers. And we don't see that particularly in white society in the US, right, where we're really have kind of more colon colonized mindset. But I think a lot of this comes from fear, right? Just the idea that I don't understand maybe what's happening to this person, they're behaving in a way that's, you know, erratic in my eyes, when it can't really get into their, you know, headspace and understand what they're experiencing. And I think that's part of how our field is responded, because if we look back at Dr. Aaron Beck, right, the creator of CBT, who just passed recently, he was doing trials of CBT, with people with psychosis back in 1950s. And for some reason, and I don't know all the reasons why his research kind of stopped around that point, right, kind of hit a dead end. And then we just kind of started offering these things to people with more like depression, anxiety, etc. I think part of this is just again, that fear that you mentioned, Curt, more than anything, unfortunately,   Katie Vernoy  05:45 when we look at this, there are folks who try to exclude psychosis from their practices, especially private practices. But we can't always exclude it. Right? Like there are times when it comes into our office, we've an established relationship with the client, and we can't always exclude and I'm not saying that we should always exclude it. I think that's part of the problem. But when we don't when we actually start working with psychosis, because it is so... I don't even know what the right word is...kind of fringe, maybe to our profession. I mean, I even think about I know you do DBT for psychosis, I've talked with DBT centers that say if they have psychosis, they shouldn't be doing DBT. I mean, like, there's, there seems like there's not really guidance, when whether you invite or exclude psychosis, when it shows up in your office, it seems like there's there's an opportunity for us to really do it wrong. And so I mean, typically, we asked what a therapist get wrong. So I guess I'm asking that question. But I, I'm trying to sort out kind of even how to get to the correct question, because it seems like part of what we get wrong as we exclude these folks from our practice. But if they show up, I imagine there's stuff that we're really getting wrong in the room and in the treatment planning.   Maggie Mullen  08:18 Yeah, I think part of this is that combination of we need clinicians to have more training across the board and treating psychosis. And again, I think with these newer wave therapies, like CBT, for psychosis, act for psychosis, more DBT skills kind of approach that are really emerging as very strong in the literature and really effective for people. And that are offered, but just not I think, in a very widespread way, again, at least in the US. And so I think part of it is we need clinicians with more training, so they feel more competent. And I think part of where we get things wrong, is that we think of psychosis as like these people over there, right? We kind of again, like you said, kind of put them in like a box segregated in some way. And the way that we really approach psychosis now in a kind of more modern or progressive sense, is that there's really a spectrum of psychosis. Right. On one end of the spectrum, we see people with less distressing less bothersome experiences of psychosis. And that for like, for me, for example, that looks like I'm on call for my work every once in a while, and I My phone has to be on 24/7 because I might be calling the emergency room to do an evaluation. And what will happen to me occasionally is I will think I hear my phone rang, and I will look down and I'll see no miss call, right? And I'll like say to my partner like hey, did you see Did you hear my phone ring? And they're like, No, that's an experience of an auditory hallucination, right. I've just had experience of psychosis. And on the other side of the spectrum, we have more of these distressing chronic life impairing experiences like psychosis that are more common for people who get diagnosed with schizoaffective sorta are psychotic spectrum disorder of some kind. And people who experienced those diagnoses fluctuate on the scale in the same way, right? That they are doing better at certain points, or their symptoms are not as distressing, etc. And part of the reason we frame it in this way now is to normalize the experience of psychosis that at some point, almost all of us will have some experience of psychosis. And I think when we look at it from that perspective, it feels less scary to approach psychosis. And I think also it can instill some hope that I think a lot of therapists don't have when they work with psychosis, right? We feel like, it feels hopeless, nothing's going to change, things are not going to get better. But we get training, I think and experience in that way. And the reality is there are wonderful outcomes, I think, for people with psychosis, when we look at it from a different perspective, which is to say, what if some of the work might be on changing your symptoms themselves? But what if part of the work is actually on acccepting your experiences so that you can just experience less stress with them? Right, so how do I make friends with my voices? So they don't bother me in the same way? Or how do I have to, like, do education with somebody's loved ones and families or societies to accommodate the fact that this person may need to, you know, do certain things to manage their psychotic symptoms, right. And that's just a normal part of their experience, rather than a pathologized experience. So I think these are ways as therapists that we have been getting things wrong historically. But we also know that there's plenty of ways that we can shift that with training with education, to make ourselves feel more confident doing this work   Curt Widhalm  11:37 The longer that we do this podcast more than I recognize that maybe my graduate training was not the greatest. And I'm trying to recall back to the way that we were educated on it. And it just seems to have been like one class in like the the psychopathology class that was just kind of, here's defining what it is. And if you ever end up working on it, then you'll get trained at your site. And it really kind of allowed for opting out of even having to learn about it. And my experience across time has been that it still shows up in my office that clients still present with this kind of stuff. Where do you see, you know, if my experience is really bad, where do you see graduate education needing to go as far as removing some of this fear or other ring of psychotic spectrum as a thing that needs to be feared?   Maggie Mullen  12:43 I think it starts with following the model and the experiences of the Disability Justice Movement, right, I think the thing that we can do first and foremost, is bring in the voices of people who experience psychosis themselves, right, have this lived experience, into our education or classroom settings. Because it's one way that we, I think, with any kind of stigma, right, that's out there is that through more dialogue and experience with people who are living with this, you know, whether we call it condition or experience or whatever, the more comfortable we get with it, the more normal it becomes to us. And so I think it's starting there and in the education and kind of classroom settings to reduce that kind of othering. And then, in addition to that piece, I think, again, it's the part of actively including, and teaching the treatments for folks with psychosis, and not acting like we can opt out of it. I think one thing I find, with therapists, not across the board, but oftentimes, is that we are often the least prepared to deal with our most acute clients, right? So we are often trained really well to work with people with, you know, garden variety, depression and anxiety adjustment issues, etc. The word Well, exactly right. And we don't get a lot of trained, I think that is very quality for people who are chronically struggling and dealing with things that are acute and very difficult for them very distressing. And I think that's part of where our education and our schools needs to change is to shift away from, you know, exclusive treatment of worried well, and really integrate the bigger spectrum of mental health and well being overall,   Curt Widhalm  14:20 to maybe even further add to this is not necessarily treating psychosis as something that just needs to be medicated away, which has been historically just kind of where well, you ship them to a psychiatrist, and that'll take care of the voices.   Maggie Mullen  14:38 Absolutely. Yeah, I hear that even for my colleagues, right, who work in my clinic have the idea that like psychosis is actually easy to work with because it's on the psychiatrist right to do that work. It's not really on us. We're just chasing them around getting them on medication. But as you've probably experienced in doing any of this work yourselves, many people with psychosis struggle with medications as an intervention, right? That can be life changing. For a lot of people, and for other folks, the side effects that come with them, you know, are so impairing that they're like, I don't want to do this right or, or I'm scared to do this or whatever it is because they can really change your life, your health outcomes, and even just the longevity of your life. So when we rely exclusively on that stuff, it really denies people the ability to build a life worth living, but isn't just, you know, kind of circled around medications as the only treatment   Katie Vernoy  15:26 Well, even in and how you're talking about psychosis, it just really puts a different flavor of it for me with this whole idea of a spectrum of psychosis. And to me, I mean, if we're really looking at auditory hallucinations, like hearing the phone ring, but it hasn't really wrong, or, or even, you know, kind of some of these really distorted thoughts that come up and these delusional beliefs that we have about ourselves that happen in, you know, even kind of garden variety, depression and anxiety, it seems like assessing psychosis would actually be much more complicated. If we're really looking at the full spectrum of the experience. What is your advice as far as identifying, you know, kind of what, what requires or what would be helped by this knowledge around psychosis?   Maggie Mullen  16:16 Can you answer a different way, Katie?   Katie Vernoy  16:19 Yeah, I guess I'm just asking, basically, how do you assess psychosis when it's not kind of this florid psychosis? How do you how do you actually assess psychosis with this idea of a spectrum of psychosis and psychotic experience?   Maggie Mullen  16:38 I think it's really dependent on the level of distress and impairment and causes in somebody's life. Right? Like with all things, when I think about if you're doing really good assessment for any mental health issue, and psychosis is no exception. It's like, how is this interfering with your goals? And the things you want to be doing with your values, your ability to do what you love? How is this in terms of the emotional side of it, right? Like, how much distress how much upset is this causing you, etc. And getting a really clear picture from clients around those pieces, I think can tell us whether we what level of intervention we need to kind of do. Because again, I think one thing that providers often do is we also kind of do the other extreme, which is to assume that if you have any experience of psychosis, it is distressing, and it's bad, right? Like we need to get rid of it. And I think a lot of people who have lived experience of psychosis will tell you, I actually find that there's some very comforting parts of my psychosis, right? Like, maybe I hear the voice of my mom talking to me who passed away or some other loved one, right, or, you know, something that can feel like it's just reassuring to them. And so when we need to when we're doing these assessments, we want to also be integrated in what's the problem and what's actually quite adaptive and works for your life instead,   Curt Widhalm  17:51 So why DBT for psychosis   Maggie Mullen  17:54 So in thinking back to the part about like, where researchers and mental health people got it wrong. So for a long time, providers assumed that people with psychosis didn't experience emotions in the same way as people who were maybe more neurotypical because they weren't expressing their emotions through their effect or their body language, right. And a lot of that has to do with negative symptoms, which are part of that spectrum of psychosis. And what we now know is that people with psychosis deal with emotion dysregulation, actually more so than the average person, right? So they're dealing with overwhelming emotions, that are sometimes triggered by their symptoms, right. So if you have a critical voice telling you, you're a bad person, that's going to cause emotion dysregulation, we're going to get emotional, sure, and kind of the cycle that can happen where then you might experience more psychosis, right? More symptoms, because of an increase in emotions, so kind of becomes a cycle. And what we know to be true is that people then cope with that emotion dysregulation the same way that somebody with, you know, BPD, who's in treatment for DBT, like do which is self harming suicide attempts, substance use, etc. And so that's where we know DBT is really effective, right, based on both the literature, the research, but people's lived experience around it. And so the idea with how we use DBT skills, and I say DBT skills, because we're taking an informed treatment approach, we're not necessarily doing a full DBT treatment program, although that is appropriate for some people with psychosis. We're thinking, let's break that cycle of again, emotions and symptoms kind of escalating each other by using something like distress tolerance skill, or an emotion regulation skill or mindfulness to help break things up and help reduce your distress.   Katie Vernoy  19:44 It seems to be completely logical that that would be the case like and my experience of working with some clients that had different different diagnoses on the spectrum of psychosis, and I also in my experience, if in any way was was aware of oftentimes trauma histories as well as is that? Is that relevant to this conversation?   Maggie Mullen  20:09 Absolutely. Yeah. Thanks for bringing it up. So one thing that I think is, or I don't think I know is very common amongst people with psychotic spectrum disorders is PTSD. So not just experiences of trauma, but experiences of trauma that are continuing to impact our life in a really significant way. And right now, we think about a third of people with schizophrenia have PTSD, which is a very high number. We actually think it's probably higher, though, because clinicians tend to not assess for PTSD very commonly. And clients don't tend to also report those symptoms very actively when they're not asked. So when we think about, again, what clinicians might be missing, it's important that we assess for that and, and part of how we think about trauma with psychosis is that it's really common for people with a psychotic spectrum disorder to have, you know, childhood trauma, so some kind of trauma from growing up. That might be one of the contributing stress factors in the development of psychosis over time. And we also know the experiences associated with experiencing psychosis are traumatic, right. So for example, we talked about the idea of like being incarcerated or being taken by the police in handcuffs to go to the hospital, right, that's a traumatizing experience for a lot of people, particularly for people of color. We also have, you know, being mistreated in hospitals kind of being warehoused there for long periods of time. And then certainly just the experience of psychosis itself, right, when you're just oriented and you're, you know, kind of separated from reality that can be really scary for people, right, we might do things that are out of character for ourselves. So trauma is a common experience, I think, for people with psychosis. And secondarily, there's really great treatment for people experiencing PTSD who also have a psychotic spectrum disorder. But it's really uncommon for providers to offer it because of fear, I think, again, to what we were talking about earlier. And we know, I think more so part of what we see the literature and research changing is that we are including more people with psychosis and studies now than we used to before. So for example, we see a lot of the new prolonged exposure, which is, you know, one of the gold standards for treatment of PTSD, that if somebody has relatively well controlled psychosis, so they might experience some active psychosis, but it may just not cause strong levels of distress. They're a great candidate for PTSD treatment. And same thing for cognitive processing therapy or CPT as well.   Curt Widhalm  22:31 Over the couple 100 episodes or so that we've done, we've had plenty of guests who come in and speak very well about their their target populations. But I don't think that we've had people like you who've actually piloted programs that back up that this is just beyond kind of the here's something that I've experienced a lot in my office and done well with, can you talk about what you saw as an opportunity with the program that you piloted?   Maggie Mullen  23:00 Sure, so I was trained as a DBT clinician, that's like my bread and butter as a therapist and working in a fully intensively trained DBT program. And I like live and breathe DBT, like, I am one of those DBT nerds that you hear about in grad school. And I think I felt like I was working, you know, as a DBT therapist, but also working a lot with people with psychosis in a in a kind of a treatment program. And there was this weird separation where we saw like, these two worlds being again, just very disparate, and not a lot offered between them necessarily, even though again, for people with borderline personality disorder who are really well treated by DBT. A lot of them actually experienced psychosis as part of their symptoms. And so what I did, essentially, with the encouragement of my colleagues was to say, why don't we just try to offer some of these skills to our clients and see how they do with them, see if they're practical enough, if they're concrete enough, which is, you know, important for people who might be experiencing chronic psychosis to be able to use them. And I really did this in conjunction with cognitive behavioral therapy for psychosis, right. CBT for psychosis has a really strong evidence base. And so I felt like, let's address this cognitive piece that CBT is really good at, but also integrated behavioral piece of DBT. And our clients loved it. Like it was actually kind of overwhelming the response that we received, as well as the outcome studies that we were doing around clients talking about how they were using those skills, and what that what that was shifting in their life, essentially, to feel like, not only do I know how to shift my thinking, but I can do something differently about it. And the thing about DBT skills that maybe no one will tell you is they're very straightforward, right? There are a lot of things people are already doing. Right? So self soothing, right? Many of us self soothe in many different ways, right? we distract ourselves, right? We use all of these skills, I think in many adaptive ways. And part of the work I think of integrating DBT skills is saying, Okay, do that intentionally now, right like don't just Do it as a background thing, but like think about what do I actually need right now that I'm feeling distressed? Because of the voices I'm hearing? You know, do we need to practice? You know, tip, right, which is a common skill in DBT when somebody is really distressed? Or do we want to practice opposite action here, because you're feeling some unjustified emotions, for example, and really just getting people to practice those in a more active way.   Katie Vernoy  25:20 I guess I keep going back to this notion that psychosis is not something that is separate, although I think there are programs where folks end up that are separate, like a day treatment program, those types of things, but oftentimes, even in those programs, it's folks that have had pretty intense emotions, intense suicidality, you know, there's, there's a reason that they're there, it's doesn't always mean that every single person in these day treatment programs have psychosis. But regardless, I think that the, the thing that I keep coming back to is this idea around looking at psychosis differently. And when we do that, it opens up all these other treatment options, because we look at as folks who have this element, and not "them", when you were talking about the way that other cultures look at psychosis, and the ways that folks who are having some of these experiences are, are seen as whether it's a medicine person, or someone that has insight in a different way. Or there's, there's different things where, you know, people are in touch with different parts of reality. I think about religion in the United States, and the similarities with that, and how people will hear God, they'll they'll, you know, they'll see signs, there's, there's a lot of things where there are pieces of things that are kind of acceptable, and culturally appropriate. And there are things that are seen as other and I'm just curious, because you talk about kind of your your background and the way that you're perceiving psychosis, and it seems like it would be very hard. And maybe this is what I was trying to get to earlier with the assessment question, but it seems like it's very hard to identify, in some cases, what is real? And what is psychosis? And so the question I have is, again, kind of like, how do we sort through that? How do we sort through? Is this a cultural experience? I mean, I think earlier, you said it was more around, you know, kind of distress. But sometimes having these things that are culturally appropriate are very distressing, you know, you get messages from God, or you get messages from other sources that are very distressing to you. And so how to how do you grapple with that when you're really trying to honor the experience of the person and sorting through whether it's psychosis or whether it's something else?   Maggie Mullen  27:48 I think one of the questions that you're kind of getting at is the question of like, how do you define what's normal for somebody?   Katie Vernoy  27:55 Yes.   Maggie Mullen  27:56 Yeah. And I, this is a question. I think that is when we like really backtrack as mental health professionals to the idea of like, what do we pathologize? And what do we consider normal? It's really hard to do our jobs to some extent, because the DSM is, right, kind of almost based on the idea that there are certain things that are not normal. But   Katie Vernoy  28:17 yeah,   Maggie Mullen  28:17 normal is really relative, right, based on culture based on history based on so many different parts of our experience. So it's, it's a little bit hard to answer that question, because it's a real philosophical one, in a way.   Katie Vernoy  28:28 Yeah.   Maggie Mullen  28:28 I think that is what informs our approaches, different providers is like, where do we come from? And our background of how we approach this type of stuff, again, of the idea of like, is there anything that's normal. And so I think when I see like this disability justice pushing around this piece, that's the part that really aims to sort of break up that binary of normal or not normal and say, like, this is all just experience. And again, the part that becomes how we assess things as clinicians is when somebody tells us this is a problem for me, or this isn't normal for me, right? Or this is scaring me, for example. And that's when we treat things with that kind of lens. It's complex. I think, in many ways, though, because for example, if I have somebody who is experiencing mania, they're not going to tell me something as a problem, oftentimes, right, you know, kind of, again, is a kind of generalization. When people experience mania, oftentimes, they feel amazing, right? They feel very on top of the world, not all the time, but for many folks. And they don't want an intervention at that point. And the thing that I'm always weighing right is the idea of, can you be safe at this point, right? Like art, what kinds of risks are you taking, for example? And what are ways that like, I need to intervene to help you just live your best life but take more of a harm reduction approach here, right like to keep you on track so that you're doing okay, the least amount of harm happens. But it's I think it's very tricky because so much of this stuff is relative and I honestly don't know if I have a great answer to Your question because of how murky things get around this piece. And so I think maybe my best advice around it is to say, take the lead of your client and know that they know themselves best and will inform you if something's an issue.   Katie Vernoy  30:12 Yeah, yeah, I think the the thought process that I've heard a number of different times and in my travels and learning about psychosis, is being able to inhabit the world where your client is, and then kind of slowly assess what is real and not real with the client from the clients perspective. And, and to me, I feel like that can be very, very challenging, because I think there's so much bias that comes into how we perceive the world that it's can be hard to truly take the lead of the client, do you have advice on how to how to do that when when it's not like, Oh, you have a different opinion for me, but it's like, Oh, your, your reality is different than mine.   Maggie Mullen  30:54 It's tough. It's really, it can be very challenging, because again, we have two different systems of training, right. So like, I have my beliefs around strengths based approach, following the lead of the client, like they are the expert on their own life that we get. And then there are things like being a mandated reporter, right, and like, needing to assess for risk and safety and things that my agency requires. And those are often at odds with each other, I think with a psychosis with the idea that I approach that really, by trying to be as transparent as possible with my clients coming into treatment around what their experience might be like, and maybe the way that I'm documenting things in my notes, right, and like trying to more educate them and say, Okay, so your doctor is going to talk about your delusions, your ideas of reference, etc. Here's what that means. Now, what's the language that you and I are going to use to describe that type of stuff that is affirming to you, and that is recognizing your experience as unique? And I try to take a bit of that perspective around all of this, because I think we can't necessarily fight the existing system. We have without I think, like working around it in that kind of way. So I don't know if that answers your question. Exactly, Katie,   Katie Vernoy  32:07 Yeah, no, that totally answers my question. Thank you.   Curt Widhalm  32:09 And I think your last couple of answers have really demonstrated why the DBT approach to psychosis fits so naturally, yeah. And I think is where your book probably just came very naturally in this whole process.   Maggie Mullen  32:27 It did it well. And I'll tell you, I didn't start out to write a book. Because I don't know, I didn't ever think of myself as somebody who's a writer, or even frankly, like training. But I got recruited to write a book because I was doing something it was a bit more innovative in this approach to working with psychosis. And the funny part is, one of the things that came up really frequently, just as kind of an aside is getting messages about people with psychosis don't read, right? There isn't a market for this. And it first of all, that's, that's very discriminatory. Yeah, for lack of a better term wrong. It's awful. And I think part of the reason people assume that A is because of stigma, and you know, wrong beliefs about people with psychosis, but also because there are literally aren't any other books written for people that are self help books for somebody with psychosis. And, you know, we have a wonderful books on the market for loved ones, or families or mental health providers working with psychosis, but almost nothing that is geared for the experience of somebody with a psychotic spectrum disorder to say, you take control of your own experience, right, you get to be educated and learn and be offered skills. And I think in particular, with psychosis, the other thing that we know is that most people with psychosis don't get mental health treatment, right, they don't either have access to it, they don't want it or they don't have providers who are, you know, competent in providing, as we talked about before. And so this book, obviously, is not a substitute for therapy. But it's a way to really, I think, democratize these skills to say, I want to get these out to you in a form of offering that's less than $20. And so I always encourage people to seek treatment as part of that book. But this is just one way to kind of get that message out there. So that's part of kind of the journey that led me to writing the book is just wanting to make sure people had access to these skills one way or the other, essentially,   Katie Vernoy  34:16 are there differences and how DBT skills are used when you are learned when you have psychosis as part of the the makeup.   Maggie Mullen  34:25 So the actual skills themselves are really identical to Marsha Linehan's work, right. And I really respect her work. And for me, I did not want to stray away from what the model is because the model is really effective. We're seeing more research now around full DBT treatment programs serving people with psychosis, but that's still kind of emerging literature. And Marsha Linehan, and her book actually even talks a bit about that. But to go back to your question, I think, part of what we do need to do when we're kind of, you know, adapting or kind of shifting. The way we teach DBT skills for these clients is to do a few things. One is to make them really concrete. so that there's just really straightforward information, there's not a lot of psychological jargon, right? Things that are just very straightforward. We also want to make sure that whatever we're offering is accessible. Because, you know, as we talked about a little bit before, you know, rates have been on, you know, for example, like SSI, so like being on a fixed income are really high amongst people with psychosis. So people don't have a lot of money. A lot of folks are marginally housed don't have stable housing or food access. And so we want to make things that are really accessible, right? You know, there's a DBT skill about going on a brief vacation, for example, we have to talk about, what does that actually practically look like in the life of somebody who has who's getting 700 ollars? a month, right? Like, what does that look like? So we want to adapt the examples to actually be a reflection of their personal experience as part of that as well. But otherwise, I think the skills really kind of match on well to the experience of psychosis.   Curt Widhalm  35:53 We've mentioned your book a couple of times, I think it's fair for us to actually name it. So dialectical behavior therapy skills, workbook for psychosis. We'll put a link to that in our show notes. But where else can people find out about you and the work that you're doing?   Maggie Mullen  36:12 So first is my website, which is Maggie mullen.com. I'm on Instagram. I'm working on building that following. It's Maggie Mullen, LCSW W there. And those are the main pieces you can contact me and reach me my direct contact information is there. I really am trying right now to put the work out again of this more progressive approach to treating psychosis into the world and doing a lot of consulting and training with agencies. So that's definitely something that I'm always excited about doing with new folks.   Curt Widhalm  36:40 And we will include links to Maggie's websites and Instagram handle over in our show notes. You can find those at MTS g podcast.com. And you can follow our social media come and let us know about your experiences and getting trained or poorly trained in working with psychosis. Come in and be a part of our Facebook community, the modern therapist group, and until next time, I'm Curt Widhalm with Katie Vernoy And Maggie Mullen.   Katie Vernoy  37:10 Thanks again to our sponsor, Buying Time   Curt Widhalm  37:12 Buying Time's VAs support businesses by managing email communications, CRM or automation systems, website admin and hosting email marketing, social media, bookkeeping and much more. Their sole purpose is to create the opportunity for you to focus on supporting those you serve while ensuring that your back office runs smoothly with a full team of VAs gives the opportunity to hire for one role and get multiple areas of support. There's no reason to be overwhelmed with running your business with this solution available.   Katie Vernoy  37:41 book a consultation to see where and how you can get started getting the support you need. That's buyingtimellc.com/book-consultation once again, buying time llc.com forward slash book dash consultation.   Announcer  37:57 Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.

Tuvalu's former prime minister, Enele Sopoaga, says he's been caught off guard by a government backed plan to explore deep sea mining in the country's waters.

What's the difference between an anxiety attack, a panic attack, and panic disorder? This is important because people sometimes use these terms interchangeably, they both have a lot of overlapping symptoms, but the treatment for each of them is different. So in this episode we'll talk about the difference, in the next episode we'll talk about good and bad advice for treating them, and in the third episode we'll talk about how to stop panic attacks. Okay, so what's the difference? First, definitions vary because the DSM-5, the diagnostic manual of mental health disorders, doesn't define an anxiety attack. Anxiety is defined as a feeling of worry, physical discomfort, and fear. Anxiety attacks usually come in anticipation of some event. You might have work stress or a family event or financial trouble or all three, and the stress becomes overwhelming. Anxiety builds over time until it reaches a breaking point. While anxiety may build over hours or days, anxiety attacks usually last less than 30 minutes. Panic attacks are defined in the DSM-5. Around one in three people will have at least one panic attack in their lifetime. With panic attacks, a sense of overwhelming fear comes on suddenly. They are more like a balloon popping. There are two types of panic attacks: unexpected panic attacks which seem to come out of nowhere, and expected panic attacks which come in response to some kind of phobia. For example, if you're afraid of snakes and suddenly come across one, that may trigger a panic attack. Both panic attacks and anxiety attacks include a sense of fear, discomfort, and the FFF response triggers physical symptoms like fast heartbeat, shortness of breath, tightness of throat, dizziness, nausea, sweating, dry mouth, shaking) etc. Looking for affordable online counseling? My sponsor, BetterHelp, connects you to a licensed professional for $65/week. Try it now for 10% off: https://betterhelp.com/therapyinanutshell Support my mission on Patreon: https://www.patreon.com/therapyinanutshell Sign up for my newsletter: https://www.therapynutshell.com?utm_medium=YTDescription&utm_source=YouTube Check out my favorite self-help books: https://kit.co/TherapyinaNutshell/best-self-help-books Therapy in a Nutshell and the information provided by Emma McAdam are solely intended for informational and entertainment purposes and are not a substitute for advice, diagnosis, or treatment regarding medical or mental health conditions. Although Emma McAdam is a licensed marriage and family therapist, the views expressed on this site or any related content should not be taken for medical or psychiatric advice. Always consult your physician before making any decisions related to your physical or mental health. In therapy I use a combination of Acceptance and Commitment Therapy, Systems Theory, positive psychology, and a bio-psycho-social approach to treating mental illness and other challenges we all face in life. The ideas from my videos are frequently adapted from multiple sources. Many of them come from Acceptance and Commitment Therapy, especially the work of Steven Hayes, Jason Luoma, and Russ Harris. The sections on stress and the mind-body connection derive from the work of Stephen Porges (the Polyvagal theory), Peter Levine (Somatic Experiencing) Francine Shapiro (EMDR), and Bessel Van Der Kolk. I also rely heavily on the work of the Arbinger institute for my overall understanding of our ability to choose our life's direction. And deeper than all of that, the Gospel of Jesus Christ orients my personal worldview and sense of security, peace, hope, and love https://www.churchofjesuschrist.org/comeuntochrist/believe If you are in crisis, please contact the National Suicide Prevention Hotline at https://suicidepreventionlifeline.org/ or 1-800-273-TALK (8255) or your local emergency services. Copyright Therapy in a Nutshell, LLC 

Intentional Pleasure with Masturbation & Vibrators   Masturbation is a touchy area! Dr. Carol Queen informs and entertains as she talks about masturbation and vibrators. She is Staff Sexologist at Good Vibrations, a nationwide chain of sex toy stores. Since 1990 Dr. Carol has enjoyed a unique platform to focus on sex education and women's pleasure. She is also the historian and curator of GV's Antique Vibrator Museum in San Francisco. Her sex education is published in The Sex & Pleasure Book: Good Vibrations Guide to Great Sex for Everyone. This is the ultimate how-to, why-to, what-to book about sex!   Dr. Carol the Historian: Masturbation therapy for women is not altogether new. Genital massage was a common medical treatment for sexually frustrated women going all the way back to Hippocrates' day. At the time, the doctors lacked batteries and so had to make do with fingers (or, often, those of a midwife). Electricity came along and by 1917 there were more electric vibrators than there were appliances! “Pelvic massage” for hysteria persisted all the way through the Victorian era and into the twentieth century. As a medical diagnosis, “hysteria” was removed from the DSM in 1980.   Dr. Carol and Dr. Diana discussed pleasure – our birthright – and how little focus there is on it in our sex education, in our culture, and among our medical practitioners. Because there is little attention to pleasure, arousal is not addressed. Sex toys can really assist with arousal! Excitement is higher partly because there is more blood flow to the genitals. The group of toys called the “clit suckers” are really HOT, and amp up the intensity!    2022 is just around the corner. What are your sexual intentions? The Sex and Pleasure Book ends with this:  “Forty years ago Good Vibrations dreamed of a radical life where pleasure was your birthright.  …  (you) desperately want to experience their authentic sexual selves … What do you think the future of sex will be? How do you see your own sexual future?”  

Slam the Gavel welcomes back author Kenneth Gottfried. He discusses his upcoming fourth book, the school system in regards to the non-custodial parent and the next steps with the FBI. ACES Scores are so very important that no child should rank a 4 or higher However, if a child ranks a 4 or higher, they are thirty-times likely to commit suicide as well as have major health problems. When a child/teen is kept from the other parent, they end up hating half of themselves with a shared persecutory delusion, Depression and Anxiety. This issue at hand is that psychologists are not reporting child psychological abuse V995.51 in the DSM nor V61.20 Parent-Child Relational Problem, 309.4 Mixed Disturbance Of Emotions And Conduct to the proper authorities, which makes these psychologists a big part of the problem. Ken spoke about documenting, video taping the meeting with the teacher, principle and law enforcement when discussing these issues that are so greatly affecting the psychological health of our youth today that will haunt them for the rest of their lives. A child should just be living the best time of their lives of being a child or teen, not placed under the pressure of being lied to about the Target parent by a vengeful parent/grandparents. Ken talks about discussing all of this with the FBI with no response. We discussed a little bit about Ken's fourth upcoming book.....More to come..... How to reach Kenneth Gottfried: https://www.childabusivejudges.com/ https://www.childabuserswearblackrobes.com/ https://www.amazon.com/Kenneth-Gottfried/e/B088P6462L/ref=dp_byline_cont_pop_ebooks_1 Support the show(https://www.buymeacoffee.com/maryannpetri) http://beentheregotout.com/ https://monicaszymonik.mykajabi.com/Masterclass USE CODE SLAM THE GAVEL PODCAST FOR 10% OFF THE COURSE http://www.dismantlingfamilycourtcorruption.com/ Music by: mictechmusic@yahoo.com

    Slam the Gavel welcomes back author Kenneth Gottfried. He discusses his upcoming fourth book, the school system in regards to the non-custodial parent and the next steps with the FBI.    ACES Scores are so very important that no child should rank a 4 or higher  However, if a child ranks a 4 or higher, they are thirty-times likely to commit suicide as well as have major health problems. When a child/teen is kept from the other parent, they end up hating half of themselves with a shared persecutory delusion, Depression and Anxiety. This issue at hand is that psychologists are not reporting child psychological abuse V995.51 in the DSM nor V61.20 Parent-Child Relational Problem, 309.4 Mixed Disturbance Of Emotions And Conduct to the proper authorities, which makes these psychologists a big part of the problem.    Ken spoke about documenting, video taping the meeting with the teacher, principle and law enforcement when discussing these issues that are so greatly affecting the psychological health of our youth today that will haunt them for the rest of their lives.    A child should just be living the best time of their lives of being a child or teen, not placed under the pressure of being lied to about the Target parent by a vengeful parent/grandparents.     Ken talks about discussing all of this with the FBI with no response.     We discussed a little bit about Ken's fourth upcoming book.....More to come.....How to reach Kenneth Gottfried: https://www.childabusivejudges.com/https://www.childabuserswearblackrobes.com/https://www.amazon.com/Kenneth-Gottfried/e/B088P6462L/ref=dp_byline_cont_pop_ebooks_1     Support the show(https://www.buymeacoffee.com/maryannpetri)http://beentheregotout.com/https://monicaszymonik.mykajabi.com/Masterclass  USE CODE SLAM THE GAVEL PODCAST FOR 10% OFF THE COURSEhttp://www.dismantlingfamilycourtcorruption.com/Music by: mictechmusic@yahoo.com   Support the show (https://www.buymeacoffee.com/maryannpetri)

------------------Support the channel------------ Patreon: https://www.patreon.com/thedissenter SubscribeStar: https://www.subscribestar.com/the-dissenter PayPal: paypal.me/thedissenter PayPal Subscription 1 Dollar: https://tinyurl.com/yb3acuuy PayPal Subscription 3 Dollars: https://tinyurl.com/ybn6bg9l PayPal Subscription 5 Dollars: https://tinyurl.com/ycmr9gpz PayPal Subscription 10 Dollars: https://tinyurl.com/y9r3fc9m PayPal Subscription 20 Dollars: https://tinyurl.com/y95uvkao This show is sponsored by Enlites, Learning & Development done differently. Check the website here: http://enlites.com/ Dr. Joel Paris is Professor of Psychiatry at McGill University, and Research Associate in the Department of Psychiatry at Sir Mortimer B. Davis-Jewish General Hospital. His research interests include developmental factors in personality disorders (especially borderline personality), and culture and personality. In this episode, we talk about current issues in psychiatric and psychotherapeutic practice. Topics include: historical fads in psychiatry, and what lessons can be drawn for the present; attempts of current theories to carry out biological reductionism; the dominance of medication in practice; the proliferation of psychotherapies; the belief that the most important psychological risk factor for mental illness is trauma; the idea that mental disorders are mainly due to social and political problems; we talk about overdiagnosis in conditions like depression, bipolar disorder, ADHD, and PTSD; problems with the DSM system of classification of disorders; the therapeutic relationship, and its importance in psychotherapy; and if psychiatry is well-equipped to preventing suicide. -- A HUGE THANK YOU TO MY PATRONS/SUPPORTERS: KARIN LIETZCKE, ANN BLANCHETTE, PER HELGE LARSEN, LAU GUERREIRO, JERRY MULLER, HANS FREDRIK SUNDE, BERNARDO SEIXAS, HERBERT GINTIS, RUTGER VOS, RICARDO VLADIMIRO, CRAIG HEALY, OLAF ALEX, PHILIP KURIAN, JONATHAN VISSER, JAKOB KLINKBY, ADAM KESSEL, MATTHEW WHITINGBIRD, ARNAUD WOLFF, TIM HOLLOSY, HENRIK AHLENIUS, JOHN CONNORS, PAULINA BARREN, FILIP FORS CONNOLLY, DAN DEMETRIOU, ROBERT WINDHAGER, RUI INACIO, ARTHUR KOH, ZOOP, MARCO NEVES, COLIN HOLBROOK, SUSAN PINKER, PABLO SANTURBANO, SIMON COLUMBUS, PHIL KAVANAGH, JORGE ESPINHA, CORY CLARK, MARK BLYTH, ROBERTO INGUANZO, MIKKEL STORMYR, ERIC NEURMANN, SAMUEL ANDREEFF, FRANCIS FORDE, TIAGO NUNES, BERNARD HUGUENEY, ALEXANDER DANNBAUER, FERGAL CUSSEN, YEVHEN BODRENKO, HAL HERZOG, NUNO MACHADO, DON ROSS, JONATHAN LEIBRANT, JOÃO LINHARES, OZLEM BULUT, NATHAN NGUYEN, STANTON T, SAMUEL CORREA, ERIK HAINES, MARK SMITH, J.W., JOÃO EIRA, TOM HUMMEL, SARDUS FRANCE, DAVID SLOAN WILSON, YACILA DEZA-ARAUJO, IDAN SOLON, ROMAIN ROCH, DMITRY GRIGORYEV, TOM ROTH, DIEGO LONDOÑO CORREA, YANICK PUNTER, ADANER USMANI, CHARLOTTE BLEASE, NICOLE BARBARO, ADAM HUNT, PAWEL OSTASZEWSKI, AL ORTIZ, NELLEKE BAK, KATHRINE AND PATRICK TOBIN, GUY MADISON, GARY G HELLMANN, SAIMA AFZAL, ADRIAN JAEGGI, NICK GOLDEN, PAULO TOLENTINO, JOÃO BARBOSA, JULIAN PRICE, EDWARD HALL, HEDIN BRØNNER, DOUGLAS P. FRY, FRANCA BORTOLOTTI, GABRIEL PONS CORTÈS, URSULA LITZCKE, DENISE COOK, SCOTT, AND ZACHARY FISH! A SPECIAL THANKS TO MY PRODUCERS, YZAR WEHBE, JIM FRANK, ŁUKASZ STAFINIAK, IAN GILLIGAN, LUIS CAYETANO, TOM VANEGDOM, CURTIS DIXON, BENEDIKT MUELLER, VEGA GIDEY, THOMAS TRUMBLE, AND NUNO ELDER! AND TO MY EXECUTIVE PRODUCERS, MICHAL RUSIECKI, ROSEY, JAMES PRATT, MATTHEW LAVENDER, SERGIU CODREANU, AND BOGDAN KANIVETS!

The January 2022 Surprise of Good Faith Estimates Requirements Curt and Katie chat about the No Surprises Act, specifically how to navigate the requirement for clinicians to provide Good Faith Estimates to clients. We talk about the impact of Good Faith Estimates on the intake process, potential complications when providing these estimates to your patients, and suggestions for how to simplify and systemize this requirement.      In this episode of the Modern Therapist's Survival Guide we talk about the No Surprises Act and the Good Faith Estimate Requirement When we heard about the planned implementation of these new requirements, we decided to dive into the legislation and articles from professional associations to understand what we actually need to do starting January 1, 2022. What is the No Surprises Act and the Good Faith Estimate (GFE) Requirement? “Some folks don't have a clear sense when they come into therapy, how long they're going to be there for.” – Katie Vernoy The goal of the No Surprises legislation is to avoid surprising patients with large medical bills There are benefits and challenges with the requirement to provide good faith estimates to our clients The Good Faith Estimate requirement is to provide the estimated cost of services (fee times number of sessions) at the beginning of treatment (if asked) and at least annually, if needed How will the Good Faith Estimate Requirement impact the Intake Process for Therapy? “These are not contracts; this is not guaranteeing the therapy is going to end after that many sessions.” – Curt Widhalm We are required to determine whether someone is hoping to get insurance reimbursement We must communicate the ability to obtain a written good faith estimate from providers We are required to estimate the number of sessions and total cost of treatment We talk about when you may need to provide a new good faith estimate (and explain changes) We provided a suggestion to start with a GFE for the intake session and then provide a second GFE after that initial session Potential Complications Curt and Katie see for Therapists Providing Good Faith Estimates The requirement for diagnosis very early in treatment The requirement for a diagnosis written on paper – both for folks who don't know or have not asked before, as well as for folks who do not want a written diagnosis Concerns related to putting forward the total cost of therapy for the year The elements of bureaucracy that could negatively impact the therapeutic relationship The No Surprises Act legislation isn't finalized and may have additional components or changes Our Suggestions to Systematize the Good Faith Estimate (GFE) Requirement for Therapists “There are certain aspects of this that I think - while onerous as far as communication with our clients - have the potential to make us actually talk with our clients about their treatment more frequently.” – Curt Widhalm Consider coordinating the timeline for updating GFEs, treatment plans, frequency of sessions, progress in treatment, and a reassessment of the sliding scale Think through how you talk about diagnosis and treatment planning ahead of time The idea to create some sort of mechanism for folks to either decline a GFE or to request an oral versus paper GFE Use recommended language to create your notice for your office as well as on your website Create your own template to simplify the process, including a boiler plate GFE for your intake Create a template for GFEs for on-going treatment Our Generous Sponsor for this episode of the Modern Therapist's Survival Guide: Simplified SEO Consulting Simplified SEO Consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO Specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings. These days, word of mouth referrals just isn't enough to fill your caseload. Instead, most people go to Google when they're looking for a therapist and when they start searching, you want to make sure they find you!  That's where Simplified SEO Consulting comes in. Founded and run by a private practice owner, they understand the needs of a private practice. They can help you learn to optimize your own website OR can do the optimizing for you. Visit SIMPLIFIEDSEOCONSULTING.COM/MODERNTHERAPIST to learn more and if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO Courses using the code "MODERNTHERAPIST" Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance! APA Article: New Billing Disclosure Requirements Take Effect in 2022 Suggested Notification Language for Good Faith Estimates Template for a Good Faith Estimate Good Faith Estimate Legislation Language from the No Surprises Act Federal Register: Requirements Related to Surprise Billing; Part II CMS.gov: Requirements Related to Surprise Billing; Part II, Interim Final Rule with comment period Relevant Episodes of MTSG Podcast: Should Private Practice Therapists Take Insurance? Make your Paperwork Meaningful   Who we are: Curt Widhalm, LMFT Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making "dad jokes" and usually has a half-empty cup of coffee somewhere nearby. Learn more at: www.curtwidhalm.com Katie Vernoy, LMFT Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt's youthful energy, so that she can take over the world. Learn more at: www.katievernoy.com A Quick Note: Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We're working on it. Our guests are also only speaking for themselves and have their own opinions. We aren't trying to take their voice, and no one speaks for us either. Mostly because they don't want to, but hey. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: www.mtsgpodcast.com www.therapyreimagined.com https://www.facebook.com/therapyreimagined/ https://twitter.com/therapymovement https://www.instagram.com/therapyreimagined/ Consultation services with Curt Widhalm or Katie Vernoy: The Fifty-Minute Hour Connect with the Modern Therapist Community: Our Facebook Group – The Modern Therapists Group   Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano http://www.crystalmangano.com/   Transcript for this episode of the Modern Therapist's Survival Guide podcast (Autogenerated): Curt Widhalm  00:00 This episode is brought to you by simplified SEO consulting.   Katie Vernoy  00:03 Simplified SEO consulting is an SEO business specifically for therapists and other mental health providers. Their team of SEO specialists know how to get your website to the top of search engines so you get more calls from your ideal clients. They offer full SEO services and DIY trainings.   Curt Widhalm  00:21 Stay tuned at the end of the episode for a special discount.   Announcer  00:26 You're listening to the modern therapist Survival Guide, where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.   Curt Widhalm  00:41 Welcome back modern therapists. This is the modern therapist Survival guide. I'm Curt Widhalm with Katie Vernoy. And this is the podcast where we talk about things that affect therapists, our practices, the ways that we practice the ways that we interact with clients and stay I'm going to start by talking about back when I was in high school, I had to take chemistry class, and studying the periodic table.   Katie Vernoy  01:08 Where are you going with this?   Curt Widhalm  01:10 My favorite element at the time was tungsten because will W on its butt over time, my new favorite element is the element of surprise.   Katie Vernoy  01:26 Surprise!   Curt Widhalm  01:27 I think actually, a lot of providers are surprised at the no surprises Act, which we're actually talking about today, going into effect January 1 of 2022. And many people have been over the last couple of weeks, speculating on what this means for their practices, what actions that they need to take. And it's seeming to get to be a little bit of a game of telephone out there in therapy land when seeing everybody talk on Facebook groups and this kind of stuff. So Katie, and I have done an adequate job of diving into this. And how to   Katie Vernoy  02:10 Adequate is the right word, I think.   Curt Widhalm  02:13 So we wanted to be able to talk about the big scary aspects of this, the not so scary aspects of this, and the parts of this that are TBD, because it's not even fully out there yet. And much like the Spanish Inquisition, nobody knows when it's coming. So. So we are going to include some helpful things in our show notes, you can find those over at MCSG podcast comm. I'm sure we'll be doing a follow up episode to this a little bit later, we will also include a whole bunch of very boring and dense government regulations in those show notes as well. So that way, you know that we at least can link to other things in our show notes.   Katie Vernoy  03:09 We've already started off great, very adequate Curt, very adequate.   Curt Widhalm  03:13 Yes. So probably the best resource out there, at least as far as condensing down a bunch of   Katie Vernoy  03:22 At the type of recording.   Curt Widhalm  03:24 Yes there is an article from the American Psychological Association originally created December 10 2021, that outlines what this means for psychologists. But if you are a healthcare provider of any other status, and you are operating within your license or your credential, this article pretty much applies to you too. So we're going to go through this, we're going to add little bits here in there and also make some suggestions that aren't included in this article. And continue to listen to the show and join our Facebook group for further updates on any of the stuff that we're talking about here today as we find important stuff to share. So now, actually, to the content of the show, if you haven't left yet, but the no surprises Act was part of a broad package that was signed into law during the Trump administration. This was a bipartisan bill. And this was really to be a very consumer friendly bill that prevents patients from getting surprise billing. Now, if anybody's ever been in kind of an emergency situation before, what you'll know is that you don't get a whole lot of time to be in the hospital and ask every single provider Hey, are you in my insurance network? Is this going to be covered that it's kind of just who you And not every person who's working on you is necessarily in network, not necessarily an employee of the hospital. And so what ends up happening is that all of your your treatment stuff gets submitted to insurance companies. And then, like Spanish Inquisition, surprise, there's bills that show up in the manual. And this is generally not seen as very consumer friendly, because people don't know what's coming. Yes. Having been on the receiving ends of those kinds of treatments myself in the past. Now, I kind of like where this bill is going, being a healthcare provider, in my own little practice, not liking where this is going. Because there is a lot of regulations that are being added into this that while intended very well, for kind of emergency situations are fields a little bit different.   Katie Vernoy  06:03 Yes. And I think that for private pay providers, there can be times when folks are surprised, not by Oh, the anesthesiologist wasn't in your network. And this extra special treatment that happened because of you were under sedation, cost $27,000. But it is something where some folks don't have a clear sense when they come into therapy, how long they're going to be there for. I think, as a profession, I think we're very good at making sure someone understands the fee before they come into the first session. They know what they're going to be charged when they sit down with us. I think the part that feels both, I guess positive, but also onerous is having to say like, Hey, this is how long your treatment is going to be. This is what it's going to cost and, and giving so much information. I mean, it's it's a lot of information that you're having to provide very early in treatment to a client. And they basically will hold you to it, and then they're given information that they can hold you to it if if it does shift, too, dramatically. So I see that I see the point. But I also see that it's going to be a lot of work. Especially I think just to set it up, I think that there's a way to systematize it. And we can talk about that when we have our kind of discussion around suggestions later. But to begin, it's going to take some work.   Curt Widhalm  07:32 And so the main crux of what you're talking about here is providing clients with a good faith estimate. Yes. Before we get into what the good faith estimate is, let's talk a little bit about the intake phone call with clients. Because I think certain aspects of this, many providers are doing in one way or another where in many jurisdictions were required to discuss our fees with clients before they come into our first session. Yes, it's, you know, no surprises. It's not that they're showing up in our office, it and then all of a sudden being like, wait, what that we yeah, do provide that, usually verbally in an intake phone call, what that good faith estimate now adds to our work is in that intake phone call, we need to start having language around, are you planning to submit a claim to your insurance company for the services that you're going to receive for me, those of you who are in network with insurance companies, that's all to be determined in the future. As far as how that works with insurance companies, we're really talking to those cash paying clients, those out of network therapists, those who provide super bills, if you have a hybrid practice, half, listen to this, turn off the insurance side of your brain. But in that initial phone call, you need to ask clients, are you planning to submit this for a claim? Now, the way that most of us are already doing this is around this language Trooper bills? Hey, do you want a super bill for our services?   Katie Vernoy  09:11 And I also do "Do you want me to do courtesy billing" and actually take the reins on, you know, kind of getting insurance information and that kind of stuff? So I think those of us who are that have a sizable portion of our practices that are private pay, navigate this, but there are some clients that come in never discuss insurance. And I think that the the shift that I'm going to make us I'm going to ask that directly versus kind of allowing it to organically happen in conversation because if somebody comes says, What's your fee? I say $200. They say okay, like, I don't necessarily take that extra step. All the time about that. I mean, sometimes they'll say, you know, do you have insurance benefits? And do you want me to do courtesy billing or would you like a super bill, but I've not been diligent about For folks that don't seem interested, so at this point, we have to ask the question, we have to know about that. I don't know what we do with that information, but we just have to ask, we have to know, that's probably more of the to be determined.   Curt Widhalm  10:12 Well, so from the APA article, what we do after asking if they intend to submit a claim to their insurance is inform them, that they can get a good faith estimate of the expected charges, and that we can provide it to them in a written document if they want. And that needs to include things like a CPT codes, the the billing code for those service sessions that you're intending to do, it needs to include information about the client on it, and the anticipated number of sessions. Yeah, and I think that this is a part where I'm seeing some of the chatter in the therapist community around. Some of the conversations are well, what if people hold us to, you know, you said, this was gonna take 20 sessions, and it took 40. These are not contracts, this is not guaranteeing the therapy is going to end after that many sessions. And I suggest being clear with clients about that, that, yes, as far as I can tell from this vantage point, if you follow treatment, if things go, Well, this should take X number of sessions.   Katie Vernoy  11:27 And then I think the other piece, if you truly think it's going to be 20 sessions, I think, put down 20 sessions, if you think it's going to be longer term treatment, I think you you know, you have to do this, it needs to be a good faith estimate for the next 12 months, I think you do it as an annual or to the end of the year. And maybe you do all your good faith estimates in January. But each new year of treatment for each client, you have to do a new good faith estimate. And each time you change the fee, or the cadence of treatment, the way I'm reading it is that you need to then do a new good faith estimate. So if somebody increases the number of sessions, like they go from once a week to twice a week, or they shift from twice a month to one month, you know, like you're gonna want to adjust down. It feels onerous. And I think that there's probably a way to make this pretty streamlined if you have a form and you just are changing that number and that number. But the part up front that I get worried about is that it's supposed to have the clients diagnosis. And we're talking about an intake call where people can request these good faith estimates. And so I'm assuming you put at that point to be assessed or to be diagnosed at the first session or something like to me, it seems like some of the information requested doesn't really hold up when you're just getting a good faith estimate from a potential client.   Curt Widhalm  12:51 Sure. So I'm gonna go back two points that you made and then come to where you're talking about here.   Katie Vernoy  12:57 Okay. Okay.   Curt Widhalm  12:59 Some of us have clients who are lifers, that   Katie Vernoy  13:02 yes, they are Yes, both you and I are in that category.   Curt Widhalm  13:05 So what I intend to do with those clients is, hey, you generally come 50 weeks out of the year, here's your fee for 2022.   Katie Vernoy  13:17 Done,   Curt Widhalm  13:17 Done, there you go.   Katie Vernoy  13:19 Yeah, I think it's supposed to be in a form. But we can argue if it can be verbal, or if it has to be that whole form.   Curt Widhalm  13:27 I'll give them a form. To your second point. I wonder if the implementation for a lot of therapists is very standard going to have the first session be, actually to Bill 90791 as an actual diagnostic interview for your first session, that would have your appropriate rates, go back to our CPT code episode and hear us talk about most therapists don't actually bill for that one. Yeah. But that, I think, actually, if I step back, this whole process might actually make us follow through on things that we're supposed to be doing a little bit better if we're not having formal diagnostic first sessions, if you're concerned about putting a good faith estimate out to a client that you've talked to for about five minutes on the phone, and four minutes of them are about what a good faith estimate is that you can actually create a space to say, here's a good faith estimate of what this first diagnostic session is going to costs. And you'll get a new good faith estimates for our sessions after that session based on what comes out in that diagnostic interview.   Katie Vernoy  14:49 So, private pay providers are now going to have to act a little bit like insurance providers and diagnose in the first session and predict how much treatment is going to be needed.   Curt Widhalm  15:01 yes.   Katie Vernoy  15:03 Welcome!   Curt Widhalm  15:05 well into your other points is, if you, misjudge or if services need to continue, it's not like your relationship with the client just has to stop, you do get to provide new and updated good faith estimates   Katie Vernoy  15:22 Yes   Curt Widhalm  15:22 as anything changes, like you said, if you're going to more sessions a week, if you change your fees mid year, if any number of different things changes, potentially even diagnostics, then you're going to want to provide good faith estimates that are updated. And I would recommend that you put language on those updated ones that this replaces the previous Good Faith Estimate from whatever the previous date is.   Katie Vernoy  15:52 And it does say in the language, and I don't know if this is in the APA article or the actual legislation, but it does say that when you provide a new Good Faith Estimate, you do need to identify what is different. And so if it's, hey, everything's rolling along, same fee, same number of sessions next year, I think it's saying, this is continuing. And it's you know, there's no changes in the fees, no changes in the predicted number of sessions this year, this is for this year. I think for folks where you're changing fees, or dramatically changing the cadence of sessions, I think that would be an important thing to put and definitely like your language of this replaces the previous Good Faith Estimate. One thing I'm thinking about with this is that if you've got a niche that that generally you know, or your lifers that generally have this is how many sessions you have per year. And so maybe it's 48, or 27, or whatever it is, you know, depending on the cadence of their treatment, shifting from every other week, to once a week back to every other week to once a month, like assuming you're kind of still in that number of sessions per year, I think you probably are fine. Changing fees, definitely a good faith estimate. But like if you've said, This is what you're what we were looking at this year. I think that could I think that could work. What do you think?   Curt Widhalm  17:15 I'm not a lawyer?   Katie Vernoy  17:18 Yes, nor am I.   Curt Widhalm  17:21 It's probable, and, you know, any challenges to this are still to be determined. This is all, you know, this is what regulations are going into effect. The HHS has not you know, had any opportunities to enforce any things yet. So we'll wait for somebody to get punished, and then we'll be able to tell you what they're doing. But realistically, it seems like a good faith estimate is exactly that. It's good faith that Yes. Hey, you know, you typically come to three out of four sessions a month, in case you come to more, you know, some months you do make a ball. So good faith, I'm going to put that you're gonna make all of the sessions over the next like five months. And we can evaluate at that point, you know, what's needing to be changed. There are certain aspects of this that I think well onerous, as far as communication with our clients have the potential to make us actually talk with our clients about their treatment more frequently? Yeah. And I think that that's part of what's scary to a lot of therapists is that clients are gonna see, I spend how much on therapy each   Katie Vernoy  18:40 year? I know, that's the part that I'm like, oh, yeah, that's gonna be rough. Most people don't want to think about it.   Curt Widhalm  18:49 I could buy several cars for this. Right? I think if you know, you're not wanting to sticker shock your clients on January 1 With, here's your good faith estimate of 50 sessions at $100 per session, or 200, or 300, whatever your fee is, yeah, that they can see some therapists breaking it down and say, Alright, here's only six months of anticipated treatment. And I'll just put out a new good faith estimate when that one runs out. But I think that that makes us be able to talk about clients progress, as far as what do you think that you need is continued services going forward and to actually review your treatment plans with them more frequently?   Katie Vernoy  19:37 Yeah, I think it's actually a good process to to align this with a treatment plan. I think process wise, I see it as being something like every January 1, I put out my good faith estimate. But I think there's an element to that where, you know, someone coming in in December and then giving a new one to them. January feels silly. So but I do think talking to folks at their treatment plan anniversary, or every six months or whatever your timeline is, and then talking about cadence talking about, you know, how they're feeling, you know, what they're thinking about. I think that's a good process. And I know when I was working in community mental health that was, you know, like, you talked about termination. From the beginning, you know, and I feel differently in private practice, like you might a lot of my clients are lifers, but I think it is, it's really easy to get complacent, when you're just kind of meeting every week, and you're not actually taking the time to look at what are we actually working on? What are you getting from this? You know, what is your financial situation compared to what we're talking about? I mean, for folks that do sliding scale, this could also be an opportunity to SPSS sliding scale and saying, okay, you know, my fee is going to be x January 1, and, you know, this is what you've been paying, you know, is that still appropriate? Are you able to increase towards the, you know, can you decrease the subsidy, so to speak, you know, like, you can have those conversations, it's just a money conversation that a lot of people don't like to have. And so I think this kind of thoughtful, you know, kind of transparent conversation about number of sessions length of treatment, Cadence. And money is important and needed, but pretty uncomfortable for a lot of folks   Curt Widhalm  21:27 being the optimist that I occasionally am, that I think that there are some providers out there, especially when it comes to things like sliding scales, who don't know how to bring the conversations back of, yeah, hey, you got a job. And now you can afford the fee that we had agreed upon before. This does provides those clinicians with an opportunity to have a better touch point, as far as renegotiating some of those sliding scale things.   Katie Vernoy  22:01 It's a natural benchmark. I think the other thing that is interesting on what's being required in these good faith estimates is the client diagnosis. We mentioned it kind of like, you know, do the diagnostic session separate and then a good faith estimate for ongoing treatment. But for some of my clients, they may never see their diagnosis unless I do this, right. And so for folks that don't do super bills, or don't talk about it, don't request their records. And so I think that's another thing for folks, you know, before they provide their first Good Faith Estimate, you may want to be ready to have that conversation because it does show up on the billing, or does show up on this form. And so being able to make sure that your clients understand how you diagnose why you've diagnosed, what you've diagnosed, and what it means how it's impacting treatment or not, it does mean that we need to diagnose our clients. And I think some folks are unlikely to do so when they're completely private pay.   Curt Widhalm  23:06 And I think for people who provide super bills, if this worries you, you're already doing this. It's just you're now with the potential of a more explicit conversation with your clients. And helping clients as Katie just mentioned, to understand what this process is. And, again, this is all very good spirited as far as being consumer friendly. And that's, you know, where it does put some of these onerous things on our behalf. But I think it has the potential because of all of these extra contact points in talking about treatment, and talking about monies impact on treatment, that clients are going to get better outcomes, which maybe I was gonna say if clients get better outcomes, that's good for you as the therapist.   Katie Vernoy  24:02 Sure, sure. I think there's, there's, there's an element of this that feels very paperwork and could take away from the relationship, you know, like, if you have to explain a tough diagnosis that that, you know, wasn't something that was in the regular conversation that can that can impact the relationship. If you have to really dig deeply into some of this. I think it's life. I think it's it's therapy, it's good therapy, but I don't know that it's necessarily I'm not going to just, you know, rainbows and sunshine about like, hey, you need to do this, because I don't know, I think that there are ways that you can make a benefit your client, I don't know that it's necessarily designed to benefit outcomes. The thing I was thinking about, which is an open question, there are folks who do not take insurance because they don't want a diagnosis and they don't want to have anything on record around diagnosis, whether it's based on their job, whatever some reason, they don't want to have a diagnosis. My assumption I'm not reading anything in here that you have to have a full DSM diagnosis, you could do a V code, you could do something that was subclinical. Is that how you're reading it? Or is this an open question where we have to determine like if people want to refuse a good faith estimate, written in good faith estimate? Are we allowed to do so?   Curt Widhalm  25:18 So for those people who are not in network, and if you know, the diagnosis question is a thing. If people, you still have the obligation to ask people, if they are planning on submitting their claims to their insurance company, sure, sure. If they are, you're still required to provide the proper diagnosis to them, you're not not just one that is reimbursable. And so if you are treating somebody for a Z code, if you are treating somebody for something that is traditionally not reimbursed, that is still the diagnostic code that you're supposed to put on there, that has not changed that is already in place. And if you're not doing that, that's insurance fraud. Spanish Inquisition is coming after you.   Katie Vernoy  26:07 Okay, so you didn't answer my question. But all of what I said, What you said was, I agree to if someone does not want to submit any claims to insurance, doesn't want a super bill barely wants a record? Can they decline one of these good faith estimates?   Curt Widhalm  26:24 Absolutely.   Katie Vernoy  26:25 So that they don't have any diagnosis on any paper anywhere?   Curt Widhalm  26:30 Absolutely.   Katie Vernoy  26:31 Okay.   Curt Widhalm  26:33 You as the clinician still need to chart your treatment plans and what it's based on and all that kind of stuff, whether your clients want a good faith estimate or not?   Katie Vernoy  26:42 Are we required to diagnose a client?   Curt Widhalm  26:44 you need to have a reason for treatment, and you need to have a treatment plan that is based on something other than a client just showing up? And you started a session with? Where do you want to start today and ending it with? You're where you need to be? That?   Katie Vernoy  27:03 That may be a whole other conversation. But   Curt Widhalm  27:05 I mean, that that is acting within the scope of your license that   Katie Vernoy  27:08 Sure, sure. So we can have a conversation about diagnosis, but from what you're reading, we could either put a non clinical DSM code and for this Good Faith Estimate, or someone could decline it if they don't want to have a piece of paper with their diagnosis on it.   Curt Widhalm  27:28 Sure, yeah.   Katie Vernoy  27:30 So we may also, at some point, need to put together a, I am declining a Good Faith Estimate form that people sign,   Curt Widhalm  27:38 you know, that's a great idea. You know, it's not like a subpoena where you have to, like, throw it at a client if they're running away from you. Anyway, there are   Katie Vernoy  27:50 Oe I would prefer for an oral, Good Faith Estimate versus a written faith, Good Faith Estimate. I think these are the things that are kind of the to be determined, we'll wait and see if anybody gets sued or or in trouble. But I think there are probably some some reasons why these would not be customer friendly, or consumer friendly, right, is all I'm saying. So we'll we'll table that for now.   Curt Widhalm  28:14 So there are some other requirements that I think are important for everyone to be aware of. You have to prominently post that clients can and are entitled to a good faith estimates. And this needs to be put on your website. It needs to be prominently displayed in your office. I'm I'm on Amazon right now, ordering one of those neon like scrolling things, just put it up behind me in session.   Katie Vernoy  28:46 Oh, that sounds awful.   Curt Widhalm  28:50 Or really just posting a paper a piece of paper that says you're entitled to a good faith estimates.   Katie Vernoy  28:57 And the APA article has both samples of the good faith estimate itself as well as notice the language for the notice. And it has instructions on it. Well, we'll link to those in the show notes. But I think it is big enough that it might be not quite a poster, but still a piece of paper on your wall. And then for your website. I think my suggestion What if you have a section on fees, this may be a reason to post your fees on your website. People have different feelings about it. And I think that would be the appropriate place to have it listed. is in that that section of your website.   Curt Widhalm  29:36 To be clear. You don't need to put on your website. Just a general I expect people's treatment to last 25 sessions   Katie Vernoy  29:46 No   Curt Widhalm  29:47 the language that you need to put out there is   Katie Vernoy  29:51 You can request a good faith estimate.   Curt Widhalm  29:52 Yes, exactly.   Katie Vernoy  29:54 And that's in that APA article. I think the other thing that I was starting to get to get in the weeds and I think this is is more kind of standing questions that will be to be seen. There are a difference between convening providers, which is the person providing the primary service and CO providers, from what I can read the convening provider is the person who has been asked for this good faith estimate. And maybe it's a primary provider, maybe it's just the person they thought to ask. And if there are co providers who are providing treatment with you for the identified patient. So for example, you've got a an eating disorder treatment group that, you know, you've got different folks either in your group practice, or that you do a lot of work with, you may end up having to put together kind of this full package of good faith estimates where everybody's services are on there. I think that's a little bit more detailed than we need to get for today's conversation, I think typically, you're just going to be doing your own services. But for folks who have group practices that maybe share an identified patient with another provider, or have a little complexity, you probably are going to want to reach out to your professional association or legal counsel to identify how best to take care of those good faith estimates is my opinion.   Curt Widhalm  31:10 Yes. If this sounds like a lot of extra steps, you're right. And some of the things that I'm seeing across the healthcare industry is that this does impact smaller businesses a lot more than group practices and agencies, because it is a lot of extra steps and does have time deadlines that oftentimes you're going to need to provide this in writing to clients who want it within one business day. And if you have a very, very busy schedule, this is something that you're going to deed to accommodate, you're going to have to get these systems in place. And you know, our friends over at simple practice that we've seen some chatter in the simple practice community requesting that some of this stuff be added to their platform, I hope that a lot of the EHR systems, we'll be addressing this so that way, it does help to streamline these things. But this is stuff that whether you like it or not, it's here. And, you know, we're trying to give you just a even if this is a, hey, I have to go and look at this stuff. And I need to make some changes now go and make those changes, because this is things that our world is changing, we have to adjust to as providers and our clients are going to be overall probably better for it even if that means that we're not.   Katie Vernoy  32:47 So I want to just before we close up, I want to talk through what I see as a potential path to try to make this as efficient as possible. And so I'm stealing one of your ideas, and then putting together the rest. So I think what   Curt Widhalm  33:00 your plan is everybody quits and go find retirement early on some cheaper cost of living base.   Katie Vernoy  33:09 No, everybody become coaches... Um, no, the plan is, I really like this idea of having a boilerplate, good faith estimate for your diagnostic session. So your 90791 I think the difficulty unless there is like some sort of a form created in your electronic health record, you may have to create this separately, but putting together that good faith estimate. So it is sent over with all of your intake paperwork. And it's part of the the process. So this is the fee, this is the service. I think that the nuance and you can have all of your information, the nuance is the clients name and those types of things. And so I'm going to look in simple practice myself to see if I can figure out a way to do it if if they don't fix that themselves, or don't put that together themselves. But I think even creating, you know, a form that you can upload and send to them where you can, you know, kind of do that that becomes with your intake paperwork, it goes out immediately you're in compliance. I think the next stage is having that good faith estimate that is for ongoing treatment, has all of your information already in place has all of the services and fees in place and then it goes into you know, there's a little bit that you have to fill out for each client that has their information, their diagnosis, and then the number the expected number of sessions, and that goes out after the first session.   Curt Widhalm  34:43 I think it's brilliant, until they change things and that's addressed. In some future episodes. We do know that there is language that is written into this no surprises act that even four out of network therapists might be needing to submit some of this paperwork directly to a client's health insurance company. That part of the law or the regulations has not yet been written. We just know that it's coming. It's reserved in there. And that's what some of the future languages for your member professional association, check out any guidance that they have, as those regulations continue to roll out, we will almost guaranteeing an episode in the future on what that means, especially for those of us who aren't used to talking with insurance companies and what kind of mean now, so we kind of want to hear you lamenting these kinds of things. I can share your thoughts with that in our Facebook group, the modern therapist group, and share it with us on our social media. We'll include links to all of that in our show notes. And until next time, I'm Curt Widhalm with Katie Vernoy.   Katie Vernoy  36:02 Thanks again to our sponsors simplified SEO consulting.   Curt Widhalm  36:05 These days, word of mouth referrals just aren't enough to fill your caseload. Instead, most people go to Google when they're looking for therapists. And when they start searching, you want to make sure they find you. That's where Simplified SEO consulting comes in. It's founded and run by a private practice owner who understands the needs of a private practice, and they can help you learn to optimize your own website or they can do the optimizing for you.   Katie Vernoy  36:29 Visit SimplifiedSEOconsulting.com/moderntherapist to learn more. And if you do decide to try your hand at optimizing your own website, you can get 20% off any of their DIY SEO courses using the code MODERNTHERAPIST. Once again, visit simplified Seo consulting.com/moderntherapist and use the code modern therapist all caps.   Announcer  36:54 Thank you for listening to the modern therapist Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter. And please don't forget to subscribe so you don't miss any of our episodes.    

Hannah Walker talks to British Champion and inspirational young talent, Pfeiffer Georgi of Team DSM on growing up in a cycling mad family, her standout year with Team DSM, becoming National Champion and DSM's road captain at a young age as well as aspirations for the future. This episode is supported by Rapha.

Un episodio donde te aporto una visión (muy) crítica en lo que tiene que ver con los diagnósticos, el uso que se hace de ellos y cómo el manual DSM y todas sus variantes han perjudicado la salud mental más que haberla ayudado, tal como se pretendió en su origen. Y te hablo de dos libros que argumentan la linea de reflexión que aporto, cuyas lecturas te encomiendo especialmente si te interesa la temática. Espero tus impresiones en los comentarios.

Gordon Parker suggests changes to the DSM-5 criteria for bipolar disorder, and unveils a new screening instrument that aims to separate hypomania from normal happiness.CME: Take the CME Post-Test for this episodePublished On: 12/20/2021Duration: 16 minutes, 07 secondsReferenced Article: “How to Diagnose Bipolar Disorder,” The Carlat Psychiatry Report, November/December 2021Chris Aiken, MD, Kellie Newsome, PMHNP, Gordon Parker, MD, PhD, DSc, and have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.Got feedback? Take the podcast survey.

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This week, Jennifer Peve, managing director, and head of strategy and business development at DTCC, joins Wei-Shen on the podcast. They discuss how tokenization could help solve some of the challenges in US private markets and how the Digital Securities Management (DSM) platform that DTCC aims to launch in 2022 can potentially help. 3:00 – Jennifer joins the podcast and gives an overview of the challenges in the private markets and how a tokenized solution can help. 7:00 – Then, she walks through how DSM looks to achieve. 10:30 – What does “good control location” mean? 16:00 – Jennifer details the genesis of Project Whitney and how it led to DSM. 18:00 – She then points to how the transaction consent engine paired the public blockchain and DSM can restrict unvalidated transactions. 22:00 – DTCC could extend DSM to other use cases in the future. 27:30 – There's a bit more work to do before DSM launches. 30:00 – Jennifer gives her thoughts on how blockchain projects have developed in the past year.

What is the common ground for modern psychotherapy? - Professor Stefan G. Hoffman, Professor Jacques P. Barber, Professor Paul Salkovskis, Professor Bruce E. Wampold https://english.swps.pl/eaclipt The field of psychotherapy has developed from different roots, and many clinicians and scientists still consider psychotherapy as a collection of unconnected groups of theories and associated interventions. This approach prevents a cohesive development of the discipline and a holistic treatment of patients. During the webinar, Professor Stefan G. Hofmann from the Philipps-University Marburg, Germany and Boston University, USA will talk about process-based psychotherapy, which takes the view that mental health problems are assumed to exist as systems of inter-connected elements. The keynote lecture will be followed by a panel discussion on finding the common ground for evidence-based psychotherapies. KEYNOTE LECTURE: PROCESS-BASED PSYCHOTHERAPY For decades, evidence-based therapy, such as Cognitive Behavioral Therapy (CBT), has been defined in terms of treatment protocols focused on syndromes as defined by the DSM and ICD. These psychiatric classification systems assume that psychological problems are expressions of latent disease entities. However, there is little evidence to support this restrictive assumption. A process-focused approach (Process-Based Therapy, PBT) is now emerging. This approach does not rely on the assumption that psychological problems are expressions of latent disease entities, but it does not rule it out either. Instead, mental health problems are assumed to exist as systems of inter-connected elements. As is true for many complex networks, such a change can occur abruptly once the network reaches a tipping point. PBT directly links treatment techniques to processes in the individual client, thereby linking classification to treatment based on functional analysis and complex networks. This offers a less restrictive and more externally valid alternative to the latent disease model, while offering exciting new directions for future research in psychiatry and is in line with personalized medicine. KEYNOTE SPEAKER Stefan G. Hofmann, Ph.D. – is the Alexander von Humboldt Professor of Clinical Translational Psychology of the Philipps-University Marburg, Germany, and also Professor of Psychology at the Department of Psychological and Brain Sciences at Boston University. He has been president of ABCT and IACP, and is editor-in-chief of Cognitive Therapy and Research. He has published more than 400 peer-reviewed journal articles and 20 books. He has been included in list of a Highly Cited Researcher by Clarivate and Thomson Reuters since 2015, among many other awards, including the Aaron T. Beck Award for Significant and Enduring Contributions to the Field of Cognitive Therapy by the Academy of Cognitive Therapy. His research focuses on the mechanism of treatment change, translating discoveries from neuroscience into clinical applications, emotion regulation, and cultural expressions of psychopathology. For more information, see: www.bostonanxiety.org. PANEL DISCUSSION Is psychotherapy just a collection of different approaches? Searching for the common ground for evidence-based psychotherapies

Entrevista com Juliano Sabella - Diretor de Marketing do Negócio de Ruminantes da DSM sobre o Censo de Confinamento 2021

Goga junto a Marisol Toro repasan:

Super famous Oscar-, Emmy-, and Tony-winning actor Jeremy Irons sashays through this week's wonderfully messed up episode of SVU--S12E13, Mask. He attempts to reckon with his out-of-control Cape Cod Summer o' Sex two decades prior. Of course, if it comes up in the course of an investigation on this program, you know the effects are still being felt of his indiscriminate adulterous boning of everything that moved in Falmouth, and this time, they've gotten his daughter and her lover attacked. This gleeful voyage into the world of sexual addiction is fertile ground for plenty of discussion about such subjects as: parsing the paradoxical simultaneous adoration of Tony Blair and loathing of George W. Bush, tattoo critique, teen boys having pervdar, the strange ol' days of Spice, summers on the Cape (and the corresponding nighttime water temps), the Kamadeva, and the broad, beautiful spectrum of paraphilias. Turns out, there's tons of fun to be had when Jeremy Irons is a recovering sex addict trying to get his addiction codified in the DSM-5. [Note: Apologies for the hints of static intermittently creeping into Josh's audio channel. As much was filtered out as was possible without making him sound like an alien. Such are the perils of recording in foreign environs.] Music: Divorcio Suave - “Munchy Business” 13:35 - Hindu Love Gods - “Wang Dang Doodle” from Hindu Love Gods (1990) 30:30 - the Smashing Pumpkins - “Lily (My One and Only)” from Mellon Collie and the Infinite Sadness (1995) 46:51 - R.E.M. - “Nightswimming” from Automatic for the People (1992) Next Week's Episode: Season 12, Episode 23 “Delinquent”

Intro: Boz deserves a seat at the table, life coaches, let's be directLet Me Run This By You: Gina versus plots - is it just ADD? Interview: We talk to Kate Dugan about living in Morocco, her playwriting program,  Sandy Shinner, Victory Gardens, shooting yourself in the foot, being ready or not to take advantage of opportunities, Outliers, regret, Sandra Delgado, the Bad Boyfriend years, Austin Film Festival, Ola Rotimi, Actor's Training Center, Meisner, Erica Daniels, Bikram yogaFULL TRANSCRIPT (unedited): 1 (8s):And Jen Bosworth from me this and I'm Gina Polizzi. We went to theater school together. We survived it, but we didn't quite understand it. 20 years later, we're digging deep talking to our guests about their experiences and trying to make sense of it all. We survived theater school and you will too. Are we famous yet? Not a whole hell of a lot. I mean, I'm, I feel I'm right. I just real, really excited to like level up my, my work life game. Like, it doesn't even mean that I, it just means that, like, I actually feel like an adult, like I just feel at 47 right now.1 (55s):I'm 47. I feel at 47. Like I'm ready. Oh girl. Wait, am I 40? No, I had a birthday. October four. Yeah. You turned 40 you're you're you're desperate to be older apparently. Oh, I've been telling people 47. Okay. So what year were you born? 75, but I'm terrible at math for 46 years. Okay. So what was I saying about being the wrong age? Oh, I just feel like at 46, right? That's my age at 46. I am finally ready to get a job, like, okay. I need a writing job, like a, B a real job, a real job of like, of like, I feel like I finally deserve, I just, I'm starting to feel like I finally deserve a seat at the table.1 (1m 47s):I love that. Yeah, I definitely do. Yeah. I mean, I just do deserve it, but like the world needs for you to have that seat at the table. Thank you. And I finally feel like that is a possibility, you know, it's interesting. And I was going to ask you about this. So there are all these Clem coaches in Los Angeles. Oh, that's funny. I was going to ask you if something about coaches, but go ahead. Okay, great. So, so God bless him and I can just see everyone is really trying to earn a living, right? So like, everyone I meet is trying to help. I know a lot of hustlers, right?1 (2m 28s):So coaches now have this language. It's fantastic. First time a coach uses language with me. I thought it was so cool. And I was so special. They all fucking use this language. Good ones, bad ones, whatever. Okay. So they get to the part. I had a free introductory session with a woman who was wonderful, nothing wrong with her. I'm talking about specific coaching language around payment and charging people talking about the fee. Okay. So therapists my in my, you know, the way it was, well, I also worked for a social service agency. So I could like just people please, my way out of it and say, well, the agency charges this, you know, all of this. Okay.1 (3m 8s):But for all the people I've seen as therapists, they're pretty straightforward. They're like, my fee is 180 an hour. This is how much your copay would. I looked up your insurance, whatever coaches have a whole nother situation where they say things like, I don't usually do this. This is what they say more than one coach say this to me. I don't usually do this, but I'm going to do something I don't normally do, which is I'm gonna let you set your fee. How much is this worth to you?2 (3m 36s):Oh God. Oh fuck you. What kind1 (3m 39s):Of invest?2 (3m 40s):$7 and 50 cents.1 (3m 42s):What kind of investment are you willing to make in your future? Whatever, whatever they get. And then2 (3m 51s):If you low ball it, it's like, well, I guess you're not recommend it to your future,1 (3m 54s):Right. Or, and you must not value. You must not yet. Right? You must not think that you're abundant enough to bring it the way. So the first time someone said this to me, I was like, this is brilliant. Like I totally, and I bought in and I was like, and I, and, and I didn't know. I was like, okay, you know, $80 a session. And then she later, and then we did that for a while later, she told me that she charges like $2,000 for, oh my God. Like a packet. And I was like, what? Okay, so right. Okay. This person did not do this the other day. I had a free introductory session. And she said that, you know, when she's a woman of color and I really adore her, but it was the same language.1 (4m 38s):And it's not, it's what they're trained to say. And so I just am, so I was so naive. I thought this was like such a cool thing. And now I'm like, wait, everyone's using the same thing, which is, I'm going to let you set your fee to tell me how much you are invested in yourself. And I'm like, wait, that's manipulative. Just set your fucking fee. And if I just said fan, and if I don't pay it, I don't pay it. And we don't work together because otherwise2 (5m 7s):You're setting up the road. I mean, setting up the dynamic where somebody is going to feel resentful, right? Like if, if you're the coach and you're not charging what you, what you think you're. I mean, what about that? Why wouldn't you turn it back on them and say like, well, I really rely upon providers to tell me what they think they're worth by having an established fee. I mean, this is, it's so crazy. It's, it's like saying actually I've had this before with, I can't think maybe babysitters, like how much you charge. Well, whatever you feel comfortable with, I don't know what to do with that. Like, I mean, I feel comfortable paying you nothing. Does that mean that's what you want to,1 (5m 48s):Right? This is what we get in trouble with when, whenever there's a barter situation as well. Like I remember, oh my God, my dad is a anyway. I remember a psychologist getting into huge trouble at a friend, my dad's friend for bartering with therapy.2 (6m 7s):Oh my God. Like, make me homemade tofu or something like1 (6m 11s):Similar, like out, like you do my yard work. I'll do. I mean, I mean, like you get into trouble. It leads to trouble. I think it's better to be out of vagueness, set your fee and not, and just say, this is my fee. And if someone wants to have a conversation about the fee and do you lower it, and then you have a further conversation, whether you decide to lower it or not is up to you. But like, yeah, I don't like this, this,2 (6m 39s):No. And let's just be direct. I mean, this is another problem that we have, like with just, I don't know, globally with communication. I just feel like people are so darn indirect and it doesn't help. I'm not, I'm not suggesting that like, I can't use more, you know, finesse or be half softer or whatever. But like at the end of the day, I just want to know what it is. You're trying to say to me, you know, and I don't want to guess about it because I'm going to guess wrong. And then you're going to feel a type of way about it. And it's unnecessary.1 (7m 12s):It's unnecessary. And I do, you know, as much as, as much as I, I always think back, I had a therapist at the, at Austin Riggs in Massachusetts and Stockbridge and Dr. Craig Pierce. Right. And he, it was interesting. I wanted to call him Dr. Craig. And he was like, no, that is not my name. And, and I was like, this guy is such a douche, but really he was setting a boundary saying, no, no, no, no, no. I'm not your friend. I'm actually not your dad. I'm not your, this isn't, we're working. We're doing serious work here. And it's either Craig or Dr. Pierce, but you can't. And at the time I was like 21 or something. I don't know what I was, but I thought what a douche, but now I'm like, oh, he actually was, was trying to help me.2 (8m 1s):Let's just get this out of the way. This is how I expect to be referred to this is how much I expect to be paid. My thing about coaches recently is I feel like everybody is doing this group delusion about, like, we can't go to therapy. So we have to say, I mean, we could pay more for a coach than we might for a therapist. We could be more revealing with a coach that we were therapists. It's just turned into the stigma of like, well, I don't want to go to therapy, but you know, I want to have a coach. And the problem with that is it's so wildly unregulated.1 (8m 34s):Yes,2 (8m 34s):Exactly. If anybody can call themselves a coach,1 (8m 37s):Right. And even this, this coach that I saw was like, yeah, it's wild Lynn regulated. And I understand that, you know, so, so there are some, you know, weird coaches and she's lovely and she's trying to make a living. The other thing that is so clear to me is everyone is trying to make a living. So there is right. Everyone's trying, I give them points for trying, like you she's trying to have a coaching business. So, so right. I don't fault her for it, but I did. I was like, so shocked that the language, I was like, oh, here we go. She's going to say the exact thing that this other coach said. So, duh, there's all kinds of like classes that for free structure that could the coaches taste.1 (9m 24s):Are you going to see her again? I mean, I'm not, no, no, no, no, no. I told her, I was like, you know, I'm just really not in a position to do coaching right now. And I'm not, I have a therapy. I have a new therapist. Let me just pay the therapist who told me what our fee was. So it was interesting. The other thing that I think was interesting is like I took, the reason I met this coach was I took a workshop on a free workshop on imposter syndrome, which is another like thing that people are really throwing around now is imposter syndrome. And self-sabotage those kinds of phrases. So I took an imposter syndrome workshop, lovely workshop. And then they said, you know, we're going to have a raffle and see who gets a free coaching session.1 (10m 5s):Well, we all, did. We all won the RAF. I mean,2 (10m 14s):Oh my God. I mean, is everything a play Like a performance piece in Los Angeles?1 (10m 24s):Yeah, it is. It is. And it's so, it's so funny, but like, so yeah, I was talking to my friend, I'm like, who went to the workshop? I'm like, oh, I won the I wasn't coaching says, she goes, so did I? And then I talked to someone else who I met when I networked with like soda. I was like,2 (10m 40s):I really respect how much it seems like people in LA are devoted to self-improvement. I really, really respect that in a way that I just feel like people out here aren't or if they are, they don't talk about it. Maybe it's what it is. But it does seem, it does seem like people in LA are either they're on a health kick or a mental health kick or they're, you know, getting sober or I just feel like there's a lot of, there's a lot of1 (11m 5s):Types here.2 (11m 8s):And I appreciate the fact that everybody talks about that openly. Because if, if people are into that stuff around here, they don't talk about it. So I ended up feeling like, you know, I'm a weirdo.1 (11m 19s):I feel like it's like, like literally like old money versus new money. I swear to God it's like old, old paradigms versus new paradigms. And like, yeah, it's out in the open here, everyone's on some kick, but at the same time, it's also lessened because everybody's talking about it all the time and it becomes like the, like a F like a farce, like not sacred in any way. It's like,2 (11m 47s):Yeah. And I bet there's a lot of people who are doing the most, like in terms of self-help and they're just still the biggest, or they're just lying to themselves about the fact that they're, they feel like they're getting better, but they're really just haven't changed at all. Yeah. I mean, I think that like, living anywhere is a problem. Well, let me get out of here. I feel like, wow, you can really feel the Puritan vibe. I mean, it's yes. You really it's like, we don't talk about feelings. We, we talk about things on the surface. We don't reveal, you know, very much about ourselves. Wow. Yeah. Keep everything. It's all, it's very buttoned up.2 (12m 27s):Wow. When I first moved here, I really appreciated that, you know, I've done some wild swings geographically, like yeah. Growing up in Sacramento was kind of one sort of thing unto itself that doesn't relate that much to California. Yeah. And then going to Chicago was like, oh, okay. I like this. These people are really down to earth. You know, then I got kind of sick of that. And then I moved to back to California, to the bay area. And I really was into that for awhile. And then I felt like, oh my God, this is all. So this is all bullshit. Like talking about everybody was an imposter. I felt like everybody was low key. So aggro. And then just this hippie, you know, talking about free level the time.2 (13m 8s):And then we moved to New York and I was like, oh, people will just get right to the point here. I really appreciate that. And I never got tired of that, but then we moved here and I thought, oh, this is new England. This is what the pilgrims they've decided a way to be. And it's very buttoned up and they haven't changed in, you know, 300 years. For, you know, have like a little ideas folder in my notes where I just make it little snippets of ideas and write them down. And I've had like six or seven that I realized are all circling around the same idea, which is, I want to have a movie or some, or some type of a script where it's a superhero, but the superhero, their power is that they can interact through some type of magic.2 (14m 8s):They can intervene in somebody else's life when they're making bad decisions. This is sort of romantic coaching and like, Hmm, maybe it's virtual reality, but they, they can kind of put themselves into the body of the person who's making the bad decisions and then help them. You know, it's like, it's basically like the therapist having none of the barriers to, you know, wellness or whatever, and just kind of getting right in there at the same time as this is a comment about how we look to other people to tell us how to behave. Anyway, the superheroes name is psyche and I love it. And, and I'm, I'm it, I'm it.2 (14m 49s):I want to kind of continue with this idea, but I am woefully terrible with plot, as I think we've talked about before. I don't know if you're talking about the podcast before and it's such a, it makes perfect sense that my given my own psychology, that plot would be the hardest thing,1 (15m 11s):Because more that,2 (15m 13s):Well, my, my mother is the first person to tell you, she's never done anything with a plan. She's always just reacted to whatever has come her way. In fact, the idea of like having a goal and working towards it was literally something I never learned until I met my husband. Wow. When like a week, a day. And he was like, what are you going to do today? And I said, oh, I think I'm going to sit out in the sun. And he said, what? I thought you were trying to be an actress. I thought you were like, well, you don't have any time to sit down and do anything. Like you have a goal. And that, and that's been my thing is like, I, I have these vague undefined or have had vague undefined goals yet that in some ways I'm working towards, but because there's no sort of master plan or not a conscious one, if don't know how to get from a, to B to C I know everything about what it looks like as you're traveling from a to B to C, I had to describe it and everything like that.2 (16m 10s):But as far as charting a course of like, this is where I'm starting, and this is where I'm going to end up. That's pretty new to me. And I feel like that's why I struggle with clot. Cause I just don't have like a lot of idea of how something unfolds.1 (16m 26s):Seriously. Literally just ADHD. Could that be,2 (16m 30s):Oh, maybe you have ADHD.1 (16m 33s):Did we talk about2 (16m 33s):This? I have add1 (16m 36s):Or add. So if you have that, this is when I talk to writers who have add that this is their exact situation. Oh, okay. Excellent. With dialogue, excellent. With everything except the actual plot pointing to a, to B, to C you just, I think you just need a class in some add meds. Like I'm serious. I, I don't think, Hey, this is not a, this is, this could be a very practical thing. So, so my father had some big problems, but was a brilliant man in a lot of ways, right? His dissertation, he could see the whole thing where it was going to end up.1 (17m 16s):He knew what he wanted people to feel when he read it. He knew he could not write the thing. So my mother ended up writing it for him. Please don't take your degree away possibly anyway, because he couldn't do the, the actual thing. So I I'm wondering, just like my thing was kind of practical of finding a coworking space and not getting a divorce kind of a situation like yours is literally like, could be a physiological response to too much stimuli going on and how to get to, to your vision. So, and maybe2 (17m 54s):I need a coach.1 (17m 56s):Well, Gina funny, you should bring that up because I was going to say to you, how much is it worth for? You know, I tried to tell you as being your coach on our pocket,2 (18m 6s):That would have been so slick. That would have been like, you're like, I, wasn't going to mention this to you, but I'm actually becoming okay.1 (18m 12s):I'm actually a coach now. So anyway, that is my 2 cents. When you start saying, when you start talking about that, I was like, wait a second. This is not a psychological problem. I don't think,2 (18m 25s):Okay. I mean, you know what? That sounds right to me.1 (18m 29s):Well, it makes a lot of work. You're not lazy and you're not, it's not like you don't have ambition. That's not true because you we've talked a lot on the podcast about how, like having some sense of power is really important to you. Maybe not fame, but power, the power that comes with that. So I'm like, all right, so that's not someone that has no ambition, right? So that's gotta be a different mechanism in the brain. That's not connecting in some way because you're also a people pleaser. So if someone, so my guess is if I w I would wonder if we did an experiment, like if you were in a class, right. And the class person was the teacher, the person in authority was like, and you trusted this person or mentor, whoever writing group, whatever the higher power is in that moment said, she said to you, Gita, you must do, you know, act one must be written by this date.1 (19m 18s):I wonder if you do it,2 (19m 20s):I would, I totally would. In fact, that's a part of me has been like, should I try to get into an MFA program? I don't think that's the answer. I class first just take a class,1 (19m 31s):The script anatomy, there's all these classes that like, that we can talk about later, but like take a class. I know I should have taken a class and not enrolled in an MFA program. Like that was what I, I mean, it was,2 (19m 44s):Can I tell you one of my favorite slash least favorite things in the world is when I have a big problem. And the answer is like, something really is. I both love and hate that. I hate it because I think, wow, why didn't I think of that? And why have I spent so much time just like ruminating and cogitating and wringing my hands about something that has like a pretty straightforward answer. Yeah.1 (20m 6s):And a lot of times, a lot of times us, I think kids that weren't really, for whatever reason, didn't get what they needed, emotionally, make all these things. Our brain works overtime to try to figure things out when this solution, like, I remember, like when I started having panic attacks, I thought I had schizophrenia. I thought I went to the doctor. He's like, you have a panic disorder, take this pill. And I was like, what? Yeah.2 (20m 31s):How could it be that easy? How could it be? How could it be? I feel like in that if I were in your shoes, I would think, no, no, no, I don't just have something that everybody else has. I have a truly unique, right. Is that what you were feeling?1 (20m 44s):Yeah. I thought I was going to end up in a state run nursing and I had a panic disorder. It was so I couldn't, and I think it gets wrapped up in shame and wrapped up and I should be able to, I could be, you know, all that shit, but yeah, it, it, it was like, he was like, no, no, no, no, you have something called a panic disorder. It's in this book and it was a DSM. He was like, it's in this book. And he read the, the stuff, the criteria. And I was like, I had that. He was like, no shit. Which is why I'm telling you to take this pill, the Zoloft. And I was like, wow, it didn't even cross my mind. The other thing is, nobody tells you about it. Like a lot of the struggle that we have, I think at, or at least that I have is internal. Right. So I don't, I'm not sharing it with people, which is why I think the podcast is good because maybe someone's listening to the podcast going, oh fuck.1 (21m 29s):Maybe I just have a panic disorder or maybe I have add, or I need a class instead of my life is over.2 (21m 36s):I'm terrible. I'm fundamentally incapable of getting any better. Yeah. Yeah. Totally. Totally. Well, thank you for that. What a gift1 (21m 42s):You gave me? Well, yeah, that's just what came forward. I'm like, wait, this is not a psychological weirdo, psychological pathological emotional problem.0 (21m 55s):Well,4 (22m 0s):Today on the podcast, we're talking to Kate, Dougan a playwriting major from DePaul theater school who currently lives in Morocco, where she teaches English. She is also a performer and has some interesting stories about her road from wanting to be a performer to deciding, to be a writer. So please enjoy our conversation with Kate Dougan2 (22m 27s):Oh my God. You haven't changed you one1 (22m 30s):Tiny bit. Let's say.3 (22m 34s):Thanks. Wow. Nice to see you girls. Do you guys look the same? I can't believe it. 30 years almost, right?2 (22m 41s):Yeah. Don't say it like that.3 (22m 43s): sorry. It's been 30 years since I graduated from high school. 25, since I graduated from college.1 (22m 53s):It's a long2 (22m 54s):You go by Kate.3 (22m 55s):Yeah. I go by Kate now. I grew up from Katie. Yeah. Yeah. That's great. Yeah.2 (23m 3s):Well, Kate Dougan congratulations used for five to theater3 (23m 7s):School. I did. I did.2 (23m 10s):You are now in of all places, Morocco, what the heck's going on in Morocco?3 (23m 15s):I'm teaching a high school here at an American high school. Yeah. My husband is Moroccan. So that's how we ended up here. We met in Chicago, worked together and in 2018. Yeah. We just decided it was, you know, he, his parents are, you know, getting a little older and he had not lived in Morocco for about 20, 25 years. And so he decided, you know, he wanted maybe try to come home for a little while. And so he got a job at an American high school. He's a teacher, he's a math teacher. And so we came and then I, I started sort of in one job that didn't really work for me.3 (24m 2s):Cause I initially thought like I was coming to teach theater. Always. The reality is never quite the same as what everybody says is gonna happen. And so, but when we got here, so I tried to teach a theater class, it didn't school wasn't quite ready for it. Then I sort of morphed into teaching English as a second language. And then last year during, well, during 20 19, 20, 20, I got my teaching accreditation to teach high school English. So I teach English language and literature. So yeah. Yeah. How cool do you like it? I do, actually.3 (24m 43s):I like it a lot. I, you know, everybody says the teaching is the hardest job and in many ways, teaching really is the hardest job. Like you, it's a lot of work and it's kind of, it's almost like doing like five shows a day, but you have to write all of your own material and learn all of your own material. And you know, it, it, you have to sort of, you have to really be ready for like a group of high school kids. I mean, these are, you know, they, they want to be engaged and they want to be entertained and they want to, you know, and if you can do those things and talk to the kids and be real with them, then you know, it works.3 (25m 28s):And on days that you're not quite up for it, it's a little tough. But yeah, I do like it a lot. I mean, I think that if you like to be in the room with the kids, then, then you you're, you're going to win, you know? Yeah. There's, I think that there's unfortunately, a lot of teachers who don't necessarily like children. And so you kind of questioned that sometimes. I'm sure we've all had experiences as students in that kind of situation. But yeah, I liked the kids. I liked being with high school kids, you know, they're alive and interested and you know, they haven't given up yet.3 (26m 11s):It's true. There, there, I read something to them the other day about, yeah, they're not dead yet. They're still alive. So that's, that's what I like about it.1 (26m 21s):The other thing I was going to say is that my, my mom was a teacher and she used to say the first year of teaching, like full-time was the hardest year of her life. And she like cried every day after school and it was the most rewarding. And so I, yeah, yeah.3 (26m 39s):I mean, my first year was 2019 or 20. So 2019 to 2020, I was doing my accreditation and I was teaching part-time and that was March, 2020, obviously it was all online. And then September, we started back, it was my first year teaching full time. And, you know, we had one class that was online and then everybody, you know, the kids had the option to be online if they wanted to. So there was one class online and then there were students in school and yeah, you're just trying to, you know, learn, figure out what you're doing and teach yourself the material and, you know, stay alive and handle whatever it was.3 (27m 20s):It was, it was a very stressful year. Last year I got to the, I got to June and I was really tired and really stressed out. And I just, you know, the good part of that is I have declared this year. I will never let myself get into that state again, you know, whatever I have to do to maintain my balance is really important to me. And so far it seems to be working. I I'm feeling much more on top of things this year, so. Oh, good. Yeah. Yeah.2 (27m 55s):So beef, let's talk about the period of time you decided to go to theater school. You did, you caught up on the east coast.3 (28m 7s):Yeah. I, well, not exactly. I'm from Pittsburgh, Pennsylvania. I know. I always thought of it as east coast. And then years later I was like, I think Pittsburgh is really Midwest. Like, I mean, it's, it's like this close to Ohio where I was from was like this close to West Virginia. So there's a whole other element going on. So it almost, you know, it is east coast, I guess, officially, but it has sort of a Midwest sort of feel like blue collar, you know, town, but yeah, so I grew up in Pittsburgh. I, I don't know.3 (28m 48s):Do you guys just want me to do grow2 (28m 49s):Performing and I do high school plays3 (28m 52s):And stuff. Okay. So not, not as much as I would've liked. I knew from a very young age that I did want to go into theater. We, we lived up the hill from a small college Washington and Jefferson college. I'm from Washington, Pennsylvania. And you know, they built a new like art center one year. And I remember going to see my first theater show there and it had just opened. And I think it was the Rainmaker. I think my dad knew the guy, the place Starbuck, and I just, you know, like, so we want to see the play and it was just the whole experience of it, you know, going to the theater and sitting in the audience and the lights and the people.3 (29m 36s):And I just remember like when the lights went down at the, at the end, I was just like, that's what I wanna do. I wanna do this, you know, how old were you? I was eight actually. So I, yeah, it got me at an early age. I wish I had gotten set on something else a little bit. But1 (30m 0s):Why Did the theater break your heart?3 (30m 5s):Ah, did the theater break? My heart? Well, I mean, it's, you know, it's, everybody's journey is different. Yeah. I mean, in some ways it's not that it broke my heart now. I feel like I just wish I had no, of course. I mean, I wouldn't change anything. I wouldn't change the trajectory. I wouldn't change that love, you know, like that feeling. But I think just like when you experience something like that, it's such a young age, like your mind gets like really set on that thing. And like, I think it's important to grow and change and you know, obviously I've done that and I've done other things.3 (30m 46s):It just, I don't know. No, because I don't wish it was really different. So I, but I, you know, we all have our moments, right. I'm sure. Of course.1 (30m 57s):Yeah. That's what this whole podcast is about where we were like, what the fuck was that? And theater broke my heart over and over again. I thought it was going to be one thing or the business and I, it was not that thing. So I, for me, it's been a off and on heartbreaking experience with the theater. And that doesn't mean that there hasn't been intense love to, you know what I mean? Like, I think it's all part of the same, but yeah. So you, you, from a young age, you were like, you saw Rainmaker and you were like, that's it? Yeah.3 (31m 25s):So that's what I want to do. And so, I mean, but like I said, it was a small town there wasn't like a whole lot going on there. I never really took any acting classes or anything until I was in high school. You know, I went like there was a, there was an acting teacher at my high school. And I just remember like going to her class and being like super excited to finally like, get to do this thing. And like, you know, she asked everybody to kind of give a spiel like about what they want to do. And so I talked about it. I was like, this is really what I want to do with my life. I'm really excited about it. I, I just, you know, this is it for me.3 (32m 6s):And, and I just remember her, like, it wasn't necessarily that day, but like at some point she just kind of looked at me and she was like, oh, you're the one that wants to be an actress. And it was like that first, like, I'm sure you guys have experienced this. It was like that first experience of like, oh, I guess like me being excited about it, isn't necessarily going to get people to be positive with me. There was certain that there was an element of bitterness, I guess, which I think happens to people, you know, and I think it happens justifiably.3 (32m 53s):And so I think, you know, it's very important to me that I don't become bitter that I, and I'm glad I haven't, but I, I felt it was a very, it was like that first experience, like, okay, this is somebody that I, I, this is something I want to do. And this is somebody that can help me. And she was just not very enthusiastic about being helpful to me, you know, like, yeah. Who knows I was, it was kind of a weird year for me. So maybe I, you know, wasn't a very good student or something, or maybe she,1 (33m 25s):She, she, that's a shitty you you're probably right on. No, no, because I know because I've done that to people. Actually, I, I feel like I've dampened peoples. I do this with my husband all the time where I rain on his parade. And she rained on your parade a little bit. I'm not saying it's not that she doesn't have good reason to rain grades, but she did. And that, that is sort of, we hear it a lot. So I would think for someone to either either blatantly or inadvertently reign on a youngster's parade in terms of their artistic dreams.3 (33m 57s):So like at high school, I wasn't really that, like, I, I think I, we did like a play for my English class or something. So I don't know. I, I try, like I was in speech and debate and I went to one meet. And let me tell you like the power of the mind. Like I got laryngitis that day. Like I got laryngitis on the bus on the way to the meet and couldn't talk all day. And then on the bus on the way home I was able to speak. And so, you know, I think, you know, there's, yeah. I mean, that's a, that's a whole other . I mean, does that mean you1 (34m 37s):Didn't keep going with speech and debate3 (34m 39s):Or you had no, I don't think I did. I don't really remember. I obviously it was not a huge part of my life because I think at some point I was like, okay, this is not the person that's going to help me. I'm not getting feeling very positive vibes here. And so I'm gonna try to, you know, do other things. So then I started taking acting classes.1 (34m 60s):Did she wait to interrupt? Did she run the speech and debate thing too?3 (35m 3s):Yes, she did. Oh, no.1 (35m 5s):So that's, I mean, there you go. I mean, that's3 (35m 8s):How my mom1 (35m 9s):Running.3 (35m 11s):Yeah. Who knows. Anyway, so then I started going to like taking acting classes in downtown Pittsburgh. There was the civic light opera, and they had like an academy of, it was musical theater, but I just took straight acting classes. I was never like really a singer or anything like that. And that was a really positive experience for me. I had a great teacher, Jill, and, you know, we did a lot of scene study and she was, she was the opposite, you know, she was a very positive person, very loving and sweet. And, you know, really, you made me feel good about what I was doing and what I could do.3 (35m 52s):So, you know, there are those people as well that, you know,2 (35m 57s):Who suggested that you could pursue it for college.3 (36m 5s):I mean, I think it was never, for me, it was just never a question like, but I long story, I didn't, I didn't, I wasn't in the acting program at DePaul, I was in the play. I was in the wait. I was in the, I was in the playwriting program. Yeah.2 (36m 27s):Why do I remember you as being in class with me? But I feel like I remember you as being one of the actors. I remember seeing you on Steve.3 (36m 38s):No, I, I, I doubt it. I, I, unless2 (36m 42s):Were you in a play onstage?3 (36m 44s):I don't think so. No. I mean, unless it was like some kind of workshop for one of my plays or something like that, but no,2 (36m 54s):I mean, do you remember me at all? I3 (36m 56s):Do remember. Yeah. I remember you guys. I remember you completely. I just, so I think I graduated. I was a year older than you guys. I think. When did you graduate? I graduated in 96. Okay. So yeah, one year older. You will, so, okay, go ahead.2 (37m 14s):Awesome. Yeah, that happened. What the hell?3 (37m 19s):Well, let me, let me dial back to, to where, cause you asked me if my teacher wanted me to go to college and for me, like there was just no other, I was going to school for theater and there was no stopping me. You know, it was funny. I've listened to some of your podcasts and, and I listened to Caitlin Kiernan's and she was just like, you know, I was 18. Like, what do you, you know, like what did I think? I don't know, but I just, this is what my mind was set on. So, so I'm sure she, she, I remember her telling me that that acting teacher, she was like of all of my, you know, she put me aside and this one other girl, Heather, who I think has actually done pretty well. I think she lives in LA and you know, there's not a lot of TV work.3 (38m 0s):And she was like, you know, she's like of my students. I think you guys have real potential to make something in this business. So she was very positive. So then I started auditioning. I auditioned for probably not enough schools. I should've heard DePaul and like Carnegie Mellon and I think some other, a couple of other schools. And so then I kind of had my mind set in Chicago. My brother lived in Chicago for a couple of years and I had gone to visit him. And I just really like fell in love with the city. And I always knew that I wanted to go to school in a city. So I kind of got my mind set on Chicago. I was like, well, if I get in the car to Carnegie Mellon, I'm from Pittsburgh obviously, but I didn't.3 (38m 45s):So then I auditioned for DePaul and I didn't get in my first, I didn't get in. And so I decided to take a year off and try again, which my dad was not super happy about, but I just had my mindset. I was like, no, I'm going to take year off. And then I'm going to try it again. I'm going to audition again. And that's it. And it ended up being, you know, I think taking your off was a good thing for me. I auditioned again and I didn't get in again. And so, you know, it's funny, like listening to these stories of you guys, like, and all the struggles that you went through and it's like, well, you know, well, at least you, you got in what's true.3 (39m 33s):Like there are different struggles. Yeah. There are different struggles for sure. But then so, and I, when I didn't get in the second time, I was just, I don't know. I think I was just set on Chicago. I was kind of set on DePaul. They'd offered me a place in theater studies program. And so I took it and then I, I decided when I was there to do join the playwriting program, and this is 1996 or 1992. And I was like, at that point I was like, literally like the only person in the playwriting program. My first year, there was like one person who was like a sophomore.3 (40m 14s):I think it was like the second or third year that Dean Corrin was there. He had just been taken on to start this program. And so, yeah. And then as I went through like a few other people joined like Diane Herrera and I think Adam Matthias was also in the writing program. And so while I was there kind of grew a little bit. Yeah. So I, it was, you know, I mean, I don't know. You just want me to keep talking? I feel like2 (40m 51s):I was just ask a question about the theater studies program, because I don't know that we've ever really talked about that program and, and how you just described it, made it sound like that's where people can go to figure out what non-acting thing they want to do in theater.3 (41m 9s):I mean, I think I, to be honest, you know, I mean, let's not kid ourselves college is about making money. Right. For, for most people it's, for-profit, it's private school. I think that they wanted to build the program and yeah. I don't know what it was. I mean, I think I did pretty good on my SATs. My grades were decent and I don't know, maybe my audition was okay. And so it was sort of, yeah, like, you know, they offered it to people like, you know, if you want to come, you're not invited to the acting program, but if you want, you can come to the theater studies program. And so I said, no, the first year, and then the second year I was like, I'm ready to go to school. I mean, sometimes I think I probably would've been better off like going to like a smaller school that didn't necessarily require an audition or something like that, but say levee.3 (41m 57s):Right. And, and so, yeah, I was like, well, I guess I'll do playwriting. And I, I, I mean, I'm glad I did it for many reasons. It was not, it ended up being a really good choice for me. I mean, I think like listening to you guys talk about the competition and, you know, sort of like, I don't do well with rejection. You know, I think you really, I don't, I don't necessarily like love to be the center of attention. And I think like, as an actor or at least to be successful on some level, you have to want that attention.3 (42m 42s):I mean, you guys do, do you feel that you like being the center of attention? She does.1 (42m 49s):Like, I love, I am constantly and mine is, if you listen to the podcast, like we talk about the psychological stuff. Like, I, I still, you know, feel like I wasn't treated right as a kid. So I'm constantly, I'm so transparent about it. I'm constantly trying to get the approval of my mother. Who's dead by the way. So yeah, I, I can say that, like, I want to belong and I want someone to say you are special and I pick you. That's like my dark sort of shadow side. And it always will be for me. I think even if I work through it, I think we all have our shadow sides and that's, and that's mine. And I think it transformed into, oh, maybe if this school likes me, that will give me that sense, but I never got that from DePaul because, you know, one it's that set up for that too.1 (43m 37s):People are bitter and weird and three it's an inside job. Yeah.3 (43m 41s):Yeah. For sure. Yeah. I mean, I think for me, like part of it was, I am the youngest of four and so I think it was like that craving for attention. Like I totally get what you're saying there. So, I mean, I like to be on stage, but like, I don't necessarily like the auditioning part of it and I don't necessarily, you know, like have to be the center of attention to parties or any of those things. But I did, you know, I really did enjoy, I really do enjoy acting like I, I do like it, but so1 (44m 12s):You, you,3 (44m 12s):You were doing a playwriting BFA. Yes. Okay. Yeah. Yeah. You did.1 (44m 18s):And your plays got workshopped.3 (44m 21s):Yeah. I mean, you know, the, the program was still very fledgling and I think because, you know, I wasn't in the acting program, you know, I had a little bit of a chip on my shoulder, I think admitted,1 (44m 43s):Wait, I just have to say, like, there's something really fierce about auditioning twice for the program and then going to theater school, studying theater studies, look at your, at a young age to say, you know what? I fucking want to go to school. So I'm going to, I mean, talk about, I, I see it as, you know, I hate calling people brave, cause I think it's kind of sending, but I think it's fierce to say I'm still going to go to this school. I mean, of course you had, I would have a chip on my shoulder so big. I wouldn't go. Yeah. You went and got an education for God's sake in a degree.3 (45m 16s):Yeah. And I, I, I got a really good education, you know, that's part of what was really positive for me. And I'll go back to the question about workshopping in a second. But what was positive for me is that the theater school had this glitch in their, in their system in because the acting students had to take so many classes cause you guys had yoga and movement to music and scene study and whoever knows what else. So like as part of your tuition, you could take up to 24 credits. And so what I did is I then got a really great liberal arts education.3 (45m 57s):I took poetry writing classes. I took like performance of literature. I took video editing. I took intro to film. I took like,1 (46m 10s):We'll do you could do that Kate? Like, how did you figure out like, oh, I have 24 credits. I'm going to use these.3 (46m 15s):I really don't. I don't know that anybody told me, I think I just figured it out at some point. And I was like, okay, well I guess I'm going to get my money's worth and I'm going to go take these other classes and these other schools and learn how to write and learn how to make films and do intro to film and learn, you know? So like I really loved college. I don't, you know, the theater school was, I don't have anything negative to really say about the theater school either. I knew what I was getting into. Like I said, I sort of had that chip on my shoulder to begin with about being part of the theater school about feeling like Jen, like you said, like about feeling like an insider, but you know, all my friends were in the theater school.3 (47m 2s):I, I love theater people. I really enjoyed that experience. But, but part of my good college experience happened outside of it in many ways, just because I kind of took the reins and I was like, okay, I'm gonna, I'm gonna have some fun with this and get a good education and, and play. And I, I loved it. I loved school. I loved learning new things and try new things. I even, I even took like a leave of absence from the theater for theater school for one quarter. Cause I did a, an overseas, I went to Ireland for a quarter.3 (47m 43s):So, and to do that, I had to take a leave of absence from the theaters. Yeah. Does that seem familiar? Yeah, probably Kelly was crying because I was supposed to be her roommate, but I never got which Kelly Kelly and Mick Adams. I was when I came back from Ireland, we were supposed to be roommates, but I never called and she just got her own apartments. And then I was like, oh my God, I don't know where I'm going to live. But yeah. So I, you know, anyway, so back to my theater school experience, so was, was positive also for playwriting. I, I don't know. I mean, I, you know, Dean Corrin was great, you know, we took like dramatic criticism we had yeah.3 (48m 30s):You know, another, another theme that I have, you know, listening to your podcast and you guys talked about it a little bit is like self-sabotage or not taking advantage of the opportunities presented to you. I feel like, because I kind of had that chip and I wanted to be an actor. Like I didn't necessarily take advantage of the opportunities, like playwriting opportunities, which came easier of course, because cause that's the way it goes, because if you want something it's not going to be, you know, it's not going to be easy, but if you're kind of, sort of like, well maybe, maybe not then the opportunities roll in, but yeah, like we had a poetry or a playwriting workshop class with Sandy Shinar she worked at victory gardens at the time.3 (49m 18s):Yeah. And she was good friends with Dean and like he had her come in as like a guest teacher one day and we were going to work my play and he'd given it to her and she had read it and, and I was just, I don't know. I, I just was like, oh God, I hate that. I really don't want to work on it. Do we have to do this? Can we do something else? And like how we shoot ourselves in the foot, you know, like what an opportunity really? And because I was insecure and scared, I'm sure like whatever psychological, you know, thing you want to come up with that, that, that we, we do to why, why we do these things for ourselves.3 (50m 1s):So, you know, and I, I had other opportunities like that along the way that I didn't necessarily take advantage of. But1 (50m 8s):Did you pull your play or did you work3 (50m 10s):On it? We didn't work on it. No, because there was somebody else in the class who was much smarter than I was and was like, oh, well here's my play. We can do my play. We can work on mine today. Yeah. I know. That's really that's.1 (50m 26s):I mean, I totally relate. And I think it, it just speaks to many things, but like, you weren't ready for that and that's it. And I, I'm starting to look at things like ready versus not ready versus good and bad. So you just weren't ready to have that experience. And we can look back and, you know, I listened to Gina and I talk to people on and we're like, we blame ourselves for that, but you just simply didn't have the emotional resources to take in that experience. And that sucks. But,2 (51m 1s):And when you're not ready, it, people could say anything to you. That person could have said, we want you to be the new resident playwright, a victory gardens. You would've said, I don't think so.1 (51m 13s):I could've gotten the laryngitis again. Like it it's, we couldn't stop.3 (51m 19s):That's so interesting. I mean, I agree with you. I think you're, I think you're right. And that's, that's hearing it come from you. It, it, it's nice Rather than me saying it to myself or trying to figure out, like, why, why do I do these things to myself?1 (51m 37s):And it's interesting having done all these podcasts, Kate, we see it over and over again. So we have the data to tell you that people have, we've heard like so many people like with these ICTs being offered these things and being like, no, I'm not going to move to LA because you know, I have an apartment in Wrigleyville. Like I'm not going to be a movie star. And people are like, what's the D we all have that. I think that's part of growing up. And I also also think it's part of expecting young people to really handle a lot of things we cannot handle.3 (52m 11s):Yeah. They're one of the books that I, I teach my students is called outliers. Have you guys read it? It's Malcolm Gladwell. And he, you know, there's a section in where he talks about practical intelligence and you know, how some people, the people that are successful, you know, they grow up with a certain family life, or, you know, maybe it's about money. It's about education. It's about these things. But it's also just knowing how to handle yourself in certain situations and knowing how to take advantage of the opportunities that are presented to you. And I think if you aren't, if you don't have that, or you're not taught that it is hard sometimes to, you know?2 (52m 50s):Yeah. And what, I just heard you, I mean, when you said, it's good to hear that from us, that made me think, oh, you've been beating yourself up about this for 25 years to yourself. Why did I squander this opportunity? Which, I mean, whether or not you did it, it's completely human. That, that you might occasionally have that thought, but have you spent a lot of time in, in regret?3 (53m 18s):I mean, I don't think so. I think I don't spend a lot of time in regret. You know, I definitely had moments over the years. I, well, a few years back, I sort of had like a little bit of a, not a breakdown, but like, I think of my midlife crisis started and like my, you know, I have two kids and my daughter was, you know, eight and my son was four and it was just kind of like, you know, you know, when kids are babies, it's just baby, baby, baby, baby. You don't, you don't have time to think about yourself. So who cares? And then like when you start to get back to yourself a little bit, it's just like, okay, I'm, you know, I'm 42 or, you know, whatever, and what have I really done?3 (54m 8s):And you know, what am I doing? And you know, is this, this, this it, I mean, I, I was teaching yoga. So, I mean, that's also a part of my journey. I mean, like I, so when I got out of school, like I did acting for a while, like, I've done some very bad independent films. Do you guys know Sandra Delgado? Oh yeah. Yeah. She, I like, we did a really bad film together in the early two thousands. And, you know, like I did like a horror film and I was like, had some small parts as mother independent films.3 (54m 52s):And, you know, I, I was trying to act and auditioning and auditioning and auditioning and like I did a couple of plays, but it was just never, you know, I just could never get to a certain point. I really just, I would have done theater and crappy theater and whatever, but I just, I couldn't, you know, for whatever reason, you know, I have the, that decade that I called the, the bad boyfriend years, so which we can all relate to on some level, which I, you know, where we all waste a lot of energy on people who don't deserve it. Oh yeah. Yeah. And then, so, so then, yeah, like a few years back, so it was kind of not in a good place.3 (55m 39s):And I was like, okay, well, I guess it's now or never. And I, I finally finished the play, so I went back to writing. Yeah. That's huge. That's awesome. You know, I finally cause I, I was like, okay, I guess if I'm going to try, I guess I gotta try. And, you know, I, I really discovered a few things. I discovered that I like writing. I, I feel good when I'm doing it. You know, there's a lot of positives to it in that way. I finished the play. I, it got, it got into like the second round at the Austin film festival.3 (56m 19s):So that was, yeah, that was pretty cool. I guess, since it was just like my first foray out of doing anything in theater in quite some time, and I had a stage reading in Chicago and then it sort of, you know, petered out after that. I, I was sending it out, sending it out, but no, no, no hits after that. But so, you know, I'm kind of gearing up to write again. So, no, I don't, I don't have, I don't, I haven't been beating myself up about it. I think that, you know, life takes a course and you can only do what you are doing in the time that you're doing it.3 (57m 0s):You only have the information that you have. You only have the life skills that you have. You only have the resources that you have. And so I think regret, I don't waste a lot of time on regret. I have enjoyed listening to the podcast and sort of like you said, Jen, like everybody's story is the same, a little bit. And that, you know, a lot of people who, you know, I've looked up to and had a lot of respect for and were really good actors and good at what they did. It just didn't happen for them. And so that's, that's like, I, yeah.2 (57m 37s):So I'm still just trying to, I'm still trying to wrap my head around why I just remember you as being an acting student, maybe it had to do with that. You were friends with Kelly and maybe because of your friendship with Kelly.3 (57m 54s):Yeah, probably that was it. Yeah. I mean, I was, I was friends with all the apartment three crew. I, yeah.1 (58m 2s):So I mean, I like, I like that even like deeper in my brain, I was like, what if I was taking on your desire to be an actor? I saw you as an actor because it was so strong that you wanted to be an actor. Like, I literally have an image of you on stage, but I actually can't3 (58m 22s):Be somebody else. Yeah. I1 (58m 25s):It's your face. It's really weird. So, anyway,3 (58m 27s):I mean, I guess at one time, like I had a play that maybe I did a stage reading of with Darryl Dickerson at school and maybe some other actors, maybe Kelly was in it. I don't know. But that would have really been like in a classroom. Yeah, yeah, no, I not an actor or, I mean, I am an actor, but none of the theater school. Yeah.2 (58m 54s):So these days, I mean, when you're talking about the work of being an English teacher, it reminded me actually, ironically, just a few days ago, I ran across a notebook that I haven't opened since I was a teacher of social studies and drama. And I re remember that I used to take for social studies. I used to write my lesson like a monologue kind of, and sort of not memorize it exactly, but almost like repeatedly rehearse it because it was not information that I already knew. I was learning the lesson right before I taught it. And teaching is so performative that during that time I was doing theater at the time.2 (59m 35s):But even if I weren't, I think I would have felt fulfilled in a performance way. Do you have that feeling about being a teacher? That it feels like a performance?3 (59m 50s):I guess what I, I do like the exchange of energy, like, like you would get from say a live audience or something like that. I don't know that I necessarily look at it as a performance, but I do feel like, yeah, you, obviously you have to be ready. You have to know what you're going to say. You have to know the material. And like, even if it is you just learning it that day or getting, you know, I feel that exchange, like, I feel good after class, like after talking with the kids and being with the kids and talking at them and, and teaching them, it does feel that way, like a little bit like that exchange of energy that you get from an audience a little bit.3 (1h 0m 35s):Yeah.2 (1h 0m 37s):Do you otherwise feel a kind of a need to do, do you have a need for any other type of creative outlet or your guys you're doing it because you're kind of getting back into3 (1h 0m 48s):My goal is to, yeah. To start writing again, like, I, I don't know how, what your, how you guys write. Like, I don't know what if you're constantly writing all the time or for me it's, it's like, I tend to sort of get inspiration and then work on something, you know, in a, in, in a period of time. Or if I create the discipline, like when I finished this play, I was getting up at like four 30 every day. I was teaching yoga at the time and the kids were, you know, still pretty young. And so I knew that the only way it was ever going to work is if I was disciplined enough to, you know, set that time aside, this is my time, my time to write.3 (1h 1m 33s):And so now, you know, after, like you said, you know, that first year is so hard, so now I'm starting to get my legs again. And I'm hoping to, yeah. Maybe start working on something I have, I've like dabbled in screenwriting before a little bit. So I'm thinking about, maybe I'm getting too into that a little bit.1 (1h 1m 57s):I have a question for you when you took playwriting. So this is interesting because it was such a young program, right. Was there any actually teaching of writing at the theater school, Like how to write a play?3 (1h 2m 12s):You know, it's funny about that. It's funny because I mean, like, I, it feels like we would write and we give it the stuff to Dean and we had deadlines and things like that. And he would give us feedback on it. You know, it's the funny thing is, is like the only, I feel like the only piece of practical writing advice that I ever got, and I, this is nothing against Dean. It's just what I remember. So Dean was awesome. I loved him. Well, we had a visiting playwright from Nigeria all over TIMI. I don't know if you remember him being there. He was there for like one quarter and he basically just like, kind of taught me to, to write a bit, you know, he's like, he's like, you have this scene here.3 (1h 2m 57s):And the guy he's at the cafe and he wants his coffee, but the waitress isn't giving him his coffee. He has to keep asking for his coffee over and over again. And it was just like, oh, you mean, I have to create like a little bit of dramatic tension in the scene, what a revelation. Right?2 (1h 3m 16s):Like it just a Mo create3 (1h 3m 17s):A moment. I felt like, you know, he gave me some real practical advice. It was just like, okay, you just have to, you know, these two people are here and you have to kind of, he wants his coffee and she won't give him his coffee and that's where the comedy comes in. And so, yeah. I don't know. I, I don't know how much, you know, they taught me about writing. I feel like I could have used a little bit of more help, like in practical matters, you know, listening to Kate's thing when you guys all went out for your showcase and that kind of thing. Like if somebody had talked to me more about submitting my work, maybe that would have been helpful.3 (1h 3m 58s):I mean, it's so weird though, to think of it at that time. I mean, I was, we were sending out headshots through the mail. We were sending out work through the mail. I mean, you have to go ,1 (1h 4m 14s):You'd have to go to what was called Kinko's then print out your play and then, and then mail it in an envelope to theaters or drop it off in person.3 (1h 4m 24s):And there was like that, like one place where you could get your headshots downtown, like the one like photography place where you could go and get like your headshots in bulk and you'd have to go pick them up. And like the blue2 (1h 4m 35s):Box. I remember the blue box.3 (1h 4m 37s):Yes. I still box exactly. You know,1 (1h 4m 44s):I think, or2 (1h 4m 45s):Yeah, something like that. So. Okay. So then let's talk about the period between graduating and we're where you are now. So you, well, you said you were auditioning,3 (1h 4m 57s):So I graduated. Yeah. And then after that, I, I, you know, I would go in spurts of productivity, you know, where I would audition a lot. You know, I was always looking at performing, you know, once again, trying to, I took a lot of classes in Chicago. I, I took classes at the actor's center. They had a lot of Meisner there. I did Steven, Steven. I have a villages program. He had a studio in like Wicker park. And so he had like a, like a, I think it was like a nine month program or something. So you would, you know, go and you'd be with the same group.3 (1h 5m 40s):And I went through a program there. I took classes downtown at, I forget what it's called now, the audition studio, or, you know, and I remember taking like an on-camera class with Erica Daniels. And who was the other, who was the lady that she always worked with? The casting director. Do you remember she was blonde1 (1h 6m 8s):Phyllis at Steppenwolf?3 (1h 6m 9s):No. It was like a casting director. Her name began with an ass. I want to say it was like Sharon or Sally, or, I dunno, she was like a big casting director at the time. So I took like an on-camera class with them, you know, I, Yeah. I don't know. It's funny cause like you, you, there's these moments where you realize like you're trying to be funny and it just, isn't funny and it just ends up really awkward. And that was one of those moments with them, you know, you're trying to impress somebody and, and she, I was sort of like chubby in high school.3 (1h 6m 57s):And so I think that as with most women who have issues with body issues, like you, you have those body issues forever. It takes a long time to shake them off. And I remember they gave me the scene. It was, the character was played by Sarah rule. Yeah. So, you know, she was a little overweight at the time, you know, and I remember kind of making this off-color joke about how, oh, I guess I see you gave me the, the part of the fat girl or something like that. Like really like probably not appropriate, but I, I meant it to be self-deprecating, but I wasn't really fat at the time.3 (1h 7m 37s):So it was didn't come off as self-deprecating it was another one of those instances where it's just like, and the woman just like hated me after that, you know? And Erica was pretty cool. I think she kind of realized that I was just nervous and awkward. And with the other woman, I remember seeing her like outside after, and she crossed the street to like, not talk to me. And I was like, oh my God, I'm such an asshole. Like, why did I say that? I didn't mean it. You know? And so I'm even blushing now I think thinking about it,1 (1h 8m 10s):You said what probably a lot of people were thinking when they would get that.2 (1h 8m 15s):Honestly, you can rest assured that absolutely every person who was there was just in an internal monologue about their own body issues. I mean, that's, that's the thing that comes up over and over again, when we feel so much shame about something like that, it's like, those people would never remember it. A and if, even if they did, they'd say with the benefit of hindsight, they might say, oh yeah, well, that just brought up for me. You know, my feelings about myself. And3 (1h 8m 44s):I mean, you know, I think, yeah, it just, it, so I took classes all over the city. I auditioned a lot, like I said, I did some independent films and then, you know, like I was still auditioning kind of in spurts over time, I think. And then I discovered yoga. And so I started doing Bikram yoga. It's just the hot yoga. I hear you guys talking about cults and cult leaders a lot on here. He's, he's one of those guys. He's a, he's a cult leader, a guru now downfall on by sexual harassment.3 (1h 9m 26s):But I started doing the yoga and that was like 2007, I think. And, you know, I had a friend who really kind of pushed me to go do the training and I wasn't really sure, but I decided to go do it. And you know, it kind of, I think, I don't know if you guys have ever done yoga, but it is sort of, you know, it kind of, it gave me something that I had been missing in a way. I think, you know, it is that, that mind body connection, I think I had been very detached from my body for many reasons, you know, abuse and all that.3 (1h 10m 7s):Like not physical abuse, but other kinds of abuse. And, and so like, I think that people get detached from their bodies. And so I think I was really connected to it in a way, and I felt good, you know, in a way that I hadn't felt in a long time. And, you know, I think that's the hardest thing. Sometimes when it goes, when you go back to theater, it's like you put so much energy into it and so much time. And I took so many classes and, you know, I enjoyed the classes and, but I just, you know, I really wanted to get on stage and it was just like, I just couldn't get there. And I think like at a certain point, you're just kind of like, what positive am I getting from this thing that I'm giving all this time and energy and love to like, what's the positives that I'm getting out of this.3 (1h 10m 55s):And I'm not, I'm not really seeing it anymore. You know, you know, I, I would get calls from people. We loved your audition. It was lovely. Please come audition for us again. So, you know, there, there were positives, but it just could never, it just really came to fruition. And so then I started doing the yoga and I, I felt really connected to it and I felt really good and in a way that I hadn't felt. And so then I started teaching yoga and I did that for like 10 years while I was having babies and raising them. And then like, yeah.3 (1h 11m 36s):So then 27 16, I started writing again.2 (1h 11m 40s):I did, I did Bikram yoga for like two years and you're just making me re remember that part of what I liked about it. It was kind of like rehearsal. I mean, cause you just go and you do the same, whatever it is, 26 poses. And the set is the same and the smell the same. And it is kind of like, it's very rich of all the nuggets, like really ritualistic.3 (1h 12m 8s):It is very ritualistic and you know, I haven't been practicing here in Morocco. Sometimes I, you know, close all the doors to my kitchen and I turn on t

In this episode, Dr. Virani and her guests, Dr. Qayyum and Dr. Conrad, focus on the impact of Adverse Child Experience (ACE) and Adverse Early Life Experiences (AELEs) on mental health and provide some insights through case discussions about the downstream impact of these experiences. Subjects discussed Inability to trust and build safe relations by victims of early childhood experiences The effect of trauma on the social determinants of mental health as an adult Post-traumatic growth Unpredictable behavior of parents The power of close good relationships for a victim of ACE. This episode is the second in a series covering the social determinants of mental health. Dr. Zheala Qayyum is the Training Director for the Child and Adolescent Psychiatry Fellowship Program and the Medical Director of the Emergency Psychiatry Services at Boston Children's Hospital/Harvard Medical School. She also serves as an officer in the United States Army reserves medical corps Dr. Rachel Conrad is a Child and Adolescent Psychiatrist at Brigham and Women's Hospital. She is now director of the Child Psychiatry Track in the BWH/ HMS Psychiatry Residency Program.   Listen to this podcast on your favorite podcast platform or here Other APA podcasts Social Determinants of Mental Health book  

Today, we take a note from our friends with the DSM handbook to help us determine what certain things trigger flare-ups! Remember, DRINK YOUR WATER! --- Support this podcast: https://anchor.fm/beyondthepointmr/support

We can't believe we've just completed the second season of our podcast. We have enjoyed this beautiful, encouraging, supportive ride, and are excited to offer up our season 2 finale.In this episode, we'll break from our usual roundtable format. We thought, what better way is there to end the year than to include in this final episode as many voices from our Plume community as possible? The result is a beautiful range of poetry, fiction, and creative nonfiction from 15 of this season's featured writers, roundtable participants, and members of our Plume community. This time of year is one for reflection and gratitude, and we are beyond thankful for how this wonderful community has continued to come together and grow in 2021. We hope you enjoy it, and we look forward to bringing you new episodes next year!CW: sexual assault, death, grief, suicide, cutting, mental illness, Covid-19 Writers sharing their work, in order of appearance (reverse alphabetical order):Elsa Valmadiano – “Diwata” (poetry), originally appeared in NOMBONO: An Anthology of Speculative Poetry by BIPOC CreatorsMelanie Unruh – excerpt from essay-in-progress titled “Natalie” (nonfiction)Samantha Tetangco – excerpt from the novel-in-progress titled Bug (fiction)Cynthia Sylvester - “The Monsters of Cherry Street.” (fiction), originally appeared in ABQ in PrintDawn Sperber – “Inoculation” (fiction), originally appeared in Daily Science Fiction (https://dailysciencefiction.com/science-fiction/biotech/dawn-sperber/inoculation) Suzanne Richardson – “I Was Thinking About the Ocean” (poetry), originally appeared in dialogist (https://dialogist.org/poetry/2021-week-35-suzanne-richardson )Rhea Ramakrishnan – “One Line Play” (poetry)Cynthia Patton – “House of Sea and Sky” (poetry)Cassie McClure – “To See It All” (nonfiction), originally appeared in McClure's column, My So-Called Millenial Life (https://www.creators.com/features/my-so-called-millennial-life) Nari Kirk – “Jenn” (nonfiction), originally appeared in October 2021's Digital Plume.Julia Halprin Jackson – “Soloist” originally appeared in Fiction 365 (http://www.fiction365.com/2013/03/soloist/) (fiction)Brenna Gomez – Excerpt from “Sienna” (fiction) Jameela F. Dallis – ekphrastic poems “What is Holy,” “A Tangle of Desire,” & “Clay Lungs Obscure Intimacy” (poetry) Marlena Chertock – “Dayenu, Hebrew for ‘It would have been enough',” “Where the Quiet Queers Are,” which was originally shown in a gallery in Brussels called Lesbian Now, & “Nasty Beauty,” which originally appeared in Lesbians are Miracles Magazine (poetry) Arlaina Ash – excerpt from hermit crab essay, “Annotating the DSM 5 Entry on Schizoaffective Disorder” (nonfiction)

Warning: Explicit Conversations About Politics, Culture, & Sexuality Navigating between the nice and nasty parts of Naughty November in the wild worlds of sex, politics and bonobos, F.D.R. rolls merrily down the tracks, through the Tunnel of Love and into the Great and Quivering Unknown… High (and low) points include: --Capt'n Max (still Birthday Boy through Naughty November) lurks under a rock, Scorpio-style, stewing over our lovers' quarrel, then turns into a tiger! But we “make like bonobos, not baboons,” and out of the tiger's snarling mouth steps my handsome prime mate, brimming with wit, wisdom and stories galore. --MAGAt Insurrection Fist-Pump Dude Josh Hawley is pumping his little fist at feminism(!) for driving “manly,” ammosexual men to porn and video games; so we attack him back, which is easy, because Naughty Hawley's such a posturing sissy (with apologies to sissies), though his misogynistic, anti-porn fascism is not funny at all. This sparks a naughty chat about Nudist Magazines and the Venus of Willendorf. --Joining the anti-porn brigade from the opposing flank, Gwyneth Paltrow and Jada Pinkett-Smith say “porn is harmful to women.” Not only do they harm sex workers, but what rank hypocrisy coming from Princess Paltrow, born-into-Hollywood-privilege, who's made movies where women are viciously murdered, and Pinkett-Smith, whose tales of her active sex life are click-bait porn.  --Christo-fascist, QAnonsense-spewing General Michael Flynn, proclaimed that “one nation under God” really means “one religion under God,” and we all know which “one religion” Flynn means: the so-called Christian one where the cross is a sword, and Jesus open-carries an AR-15.  --Stop calling Travis Scott's Astroworld horror “Satanic”!  If anything, it was Kardashianic. And Kylie-Jenneric. Don't drag Satan—the Church's *evil* depiction of the great horny, horned, Greco-Roman goat god Pan, Lord of the Wild and patron saint of bonobos (pan paniscus)—into that awful, human-error-riddled tragedy.  --Dave M., who thanked the Therapists Without Borders of the Dr. Susan Block Institute for “saving [his] life” last Saturday, how his other therapists have erroneously labeled his “hypersexuality,” aka sex addiction (NOT a valid DSM diagnosis). Dave fantasizes that Max and I emerge from Superman's Bizarro World to wage guerrilla war without weapons against anti-sex capitalism, saying “important dangerous things,” though (he imagines) we are “unattackable”… which is the most Bizarro part, since we're constantly being attacked. --“Sock Job” Gabriel stops pretending to have a girlfriend, and now just wants tips on solo sock jobbing. Moving on to stockings, high heels and bare feet, the foot fetishists flock to this show like a Loubotin and Savage X Fenti sale, and I trample them (virtually) with love (and a little glitter)… sporting shady shades, from pineapple (eat it for better-tasting semen!) sunglasses to Mammon Dollar Eyes.  --Britney is FREE—yay! Finally, she can get married and do what the f*ck she wants. Now FREE ASSANGE! At least Belmarsh prison gave him permission to marry his partner Stella Moris, the mother of his two sons, at the prison. Yay! We may be Bizarro, but we love marriage… for people who want to get married. --Kyle Rittenhouse's blubbering performance in the Brett Kavanaugh tradition of lying male ammosexual self-pity, coupled with the judge's blatantly racist rulings, might just get that little crying killer off the hook for the crimes he committed that we all have witnessed. Yikes! --The new Dune remake is a beautiful bore (I wanted more worms!), but it's nice to know that we are all welcome to have public sex in the Spanish Canary Island dunes. Just please don't leave your used condoms in the sand. Speaking of sand, we are sinking into Capitalogenic quicksand, going down deeper and faster every day, mentally (peeps be going nuts), physically (the nuts be killing the rest of us) and in terms of climate change. The sands of time are pouring in on us, but we're too busy staring worshipfully at celebrities like Kylie to hear truthtellers like Greta. Of course, that's the way the billionaires like us to be. --Some commenters express support for our struggle with the City of Arcadia inspector and disdain for their continuing harassment of Bonoboville. What a travesty of zoning justice! What Mattress Madness! More developments developing soon… --In this week's orgiastic throwback, Capt'n Max's Bday & Bonobo Way 3rd Anniversary 2017, sexy Onyx Muse spanks Chimesmaker Jacob, & the amazing Goddess Soma turns Miss Antoinette into a human birthday candle. #GoBonobos for Hot Wax. Happy Friendsgiving and have a nice (not too nasty) Naughty November. Read more prose and watch the shows (that are too kinky for Youtube): https://drsusanblock .com/fdr-naughty-november Need to talk PRIVATELY about something you can't talk about anywhere else? You can talk with us… Call the Therapists Without Borders of the Dr. Susan Block Institute anytime: 213.291.9497. We're here for YOU.

Par peur de ne pas réussir à être en couple, Aline cherche à se « réparer » en allant voir une psy. Elle se demande si elle n'a pas refoulé un traumatisme qui la bloquerait. Dans cet épisode, Aline revient sur la pathologisation de l'asexualité et ses conséquences sur la santé mentale et physique. Angela Chen et David Jay, une figure historique du militantisme asexuel aux États Unis, lui expliquent que l'asexualité est encore largement perçue comme un trouble à guérir et non une orientation sexuelle. Pour recevoir le script de l'épisode, contactez nous à l'adresse contact@paradisomedia.io Une série originale Paradiso Media Écriture et Voix : Aline Laurent-Mayard Intervenants : David Jay, Kate Wood, Sarah Andres et Angela Chen Production : Suzanne Colin Réalisation, montage et mixage : Théo Albaric
 Assistante de production : Lucine Dorso
 Chargée de production : Claire Français Stagiaire édito : Emma Bouvier
 Doublage : Judith d'Aleazzo, Jérôme Sandlarz
 
 Musique originale : D.L.i.d Musique pré-éxistante : Freed from Desire, Gala / © 2007 Do It Yourself Multimedia Group S.r.l. Unipersonale (Italy), Mollyville Publishing S.r.l. Illustration : Super Feat Extraits : Film "Pas d'amour sans amour", Évelyne Dress, Artédis, 1993 / Lecture de "Suis-je asexuelle ? Gonzague de Larocque vous répond." Réponses d'experts. FAQ Conseils Anorgasmie/Frigidité. Psychologies. 3 novembre 2009. Producteurs délégués : Louis Daboussy, Lorenzo Benedetti et Benoit Dunaigre Bonne écoute ! Abonnez-vous pour être informé de la sortie de nouveaux épisodes. Retrouvez tous nos podcasts ici et nos actualités sur Instagram | Twitter | Linkedin

John welcomes EpicThunderCat, a rising NFT artist with deep ties to both the art community and mental health outreach. As an artist and licensed mental health worker, her new project "Monsters of Mind" aims to spread mental health awareness through digital artwork, more commonly known as NFTs. The discussion is wide-ranging and covers a lot of interesting topics, including ... DSM and the inherent corporate bias of psych labels Wrong meds; unmet expectations Pill shaming and stigma Diversity in the NFT space Difficulties in on-boarding new artists The Fear of Change The Fear of Financial Freedom Narcissism in Society Epicthundercat's Origins Story The Art Process Opensea and Objkt Companies have roadmaps; artists have vision maps The Monsters of Mind Collection Shoutout: Conrad at Outcastverse Diversity in NFTs; hiding behind your PFP Shoutout: Guttercat Gang Getting Over The Hump Give it at least 12 months Epicthundercat breaks through social anxiety and fear of speaking! Cover art for this episode is a cropped portion of EpicThunderCat's "Love - 13" trading at .35 ETH when this podcast was uploaded. Learn more at EpicThunderCat.com Follow @johnemotions on Twitter

Conversations around the conceptualization, development & implementation of diagnostic frameworks around mental illness often generate more questions than answers, but are endlessly fascinating in their ability to pull on a number of diverse & interesting threads of inquiry.  Clinical psychologist, professor & former president of the Canadian Association for Cognitive & Behavioural Therapies (CACBT), Dr. Andrea Ashbaugh, C.Psych returns to Thoughts on Record for a discussion of diagnostic frameworks for mental illness.  In this conversation we cover:thoughts on the conceptualization of mental illnessthe functional utility/evolutionary significance of mental health "symptoms" - even when frequent and/or intensecultural expectations around the experience of psychological pain advantages and challenges of current diagnostic symptoms (e.g., DSM 5, ICD-11)mental health consumer expecations around receiving a diagnosispotential benefits and harm that can come with a diagnosisthe emergence of potential dimensional models of diagnosis (e.g., The Hierarchical Taxonomy of Psychopathology (HiTOP))  transdiagnostic treatment of psychopathology, with a special focus on managing comorbidityconsideration of some common diagnostic conundrums e.g., severe symptoms in high functioning clientsAndrea Ashbaugh is an associate professor in the School of Psychology at the University of Ottawa, Director of the Centre for Psychological Services and Research, and is a licensed clinical psychologist in the province of Ontario, Canada. She obtained her master's and Ph.D. in Clinical Psychology from Concordia University in Montreal, Quebec, Canada and completed a post-doctoral fellowship in the Department of Psychiatry at McGill University and the Douglas Mental Health University Institute, in Montreal, Quebec, Canada.She is director of the Cognition and Anxiety Studies Laboratory (CASL) and the Sex and Anxiety Research Group (SAX-RG). Her research interests as part of CASL centre around understanding the causes and developing treatments for anxiety and fear-related problems. She has recently started a program of research to understand the causes and psychological effects of experiencing traumatic and non-traumatic events that transgress one's moral beliefs (Moral Injury) in military personnel and veterans. Her research in the context of the SAX-RG centres around the impact of beliefs about arousal sensations and context on the interpretation of arousal, and its impact on sexual interest and functioning. She has received funding for her research broadly including from Natural Sciences and Engineering Research Council of Canada and the Social Sciences and Humanities Research Council of Canada.Dr. Ashbaugh regularly supervises CBT training and teaches courses on psychopathology and clinical psychology at both the graduate and undergraduate level. She has served on the Editorial Boards of Psychological Assessment. She is currently an Associate Editor for the Journal of Behavior Therapy and Experimental Psychiatry and editorial board member for Behaviour Research and Therapy. She is a former president of the Canadian Association for Cognitive and Behavioural Therapies (CACBT) and was seminal in the development of national CBT training guidelines that were released by CACBT in May 2019.

This free E-Book is full of tip sheets and ideas to assist support workers in looking after adults on the autism spectrum. This E-Book also compliments perfectly a brand-new book by Anna Tullemans and Sue Larkey: A Manual to Provide Support and Care for Adults with Autism Spectrum. ✅ Why we have written this new book for Support Workers, Participants, and their Families/Carers ❤️ The changes we have seen in Disabilities Services and Autism Spectrum. From Institutions to Individualised Programmes – From Autism being considered part of Schizophrenia to having separate diagnosis in DSM 3 in the 1980s to today where we use the term Autism Spectrum Disorders. ⭐️ Why Switching Tasks can be Challenging and what you can do to Support Participants

We welcome back Joe Zaccai for the first time this season, in a fun episode full of predictions. Tonight we looked ahead to the postseason and chose who would come out of each round. Listen through the end for our finals predictions and for this week's trivia game winner. Follow us on instagram to participate in the game and for updates on the next episode @sportingdsm. Visit our merch site sportingdsm.com for all kinds of sporting DSM clothing. If there's anything that you'd like to see on the merch store that isn't already there, or just to talk basketball, please shoot us a message on instagram. Thank you for listening to Sporting DSM.

Daphne van Paassen liep afgelopen weken mee met The Climate Miles, een klimaatmars van Groningen naar Glasgow, waar de klimaatconferentie COP26 van de Verenigde Naties momenteel plaatsvindt. Ze vertelt over de tocht, de diversiteit van het publiek en wat haar ertoe bracht om mee te lopen. Ook hoor je Luuk Sengers en Evert de Vos. Zij maakten een top tien van Europese bedrijven die hun CO2-uitstoot aanzienlijk hebben verminderd.  Zo gebruikt Heineken momenteel als enige een elektrisch binnenvaartschip. Zij tonen een enorme bedrijfstrots. Wat kunnen de anderen hiervan leren? En wat zou de overheid moeten doen? Productie: Kees van den Bosch & Paola Leijssen 

On this week's episode, we discuss the social media spectacle of Megan Fox and Machine Gun Kelly's whirlwind romance. We analyze the Spiritual Bimbo archetype, dabble in feminism as we reflect on the misogyny of 2000s Hollywood, and consider the timeless appeal of dating a boy in a band. Biz comes out as a burnt out Megan Fox truther, we psychoanalyze Megan's outfits, and together we phone in a request to get ‘dickmatized' included in the DSM-5..・。.・゜✭・.・✫・゜・。..・。.・゜✭・.・✫・゜・。..・。.・゜✭・.・✫・゜・。..・。.・゜✭・.・✫・゜・。..・。.・゜✭・.・Links:Image references for this episode (essential viewing!!!): https://pin.it/adAWRaUMegan Fox and Machine Gun Kelly profile in GQ: https://www.gq-magazine.co.uk/culture/article/megan-fox-machine-gun-kelly-interviewTransformers crew open letter to Megan: https://deadline.com/2009/09/transformers-crew-talk-back-to-megan-fox-15879/

Europese landen krijgen het coronavirus maar moeizaam onder controle. In China geldt hetzelfde, en als gevolg daarvan is de eerste Chinese miljoenenstad alweer in volledige lockdown. "Als het in China misgaat, ondervindt de hele wereld daar hinder van", concludeert Etienne Platte van het Antaurus Europe Fund. "En dat is niet uit te sluiten, want de Chinese vaccins bieden minder bescherming dan de Westerse vaccins", weet Olaf van den Heuvel van Aegon Asset Management.Maar het is natuurlijk niet allemaal in deze aflevering van BeursTalk. Zo is er waardering voor de resultaten van DSM en NXP. En zelfs als aandelen én obligaties én vastgoed hard onderuit gaan, dan nog is er een schuilplaats voor beleggers. Je hoort dat bij de tips. Luisteren dus!Ga voor de nieuwsbrief naar www.beurstalk.com.

In this episode, Dr. Charles Scott addresses some of your unanswered questions from his presentation on cannabis and violence.    Dr. Scott is Chief, Division of Psychiatry and the Law, Forensic Psychiatry Fellowship Training Director, and Professor of Clinical Psychiatry at the University of California, Davis Medical Center in Sacramento, California. He is Board Certified in Forensic Psychiatry, General Psychiatry, Child and Adolescent Psychiatry, and Addiction Psychiatry. Dr. Scott has served as a forensic psychiatric consultant to jails, prisons, maximum security forensic inpatient units, California Department of State Hospitals, and as a consultant to the National Football League (NFL) providing training on violence risk assessment for NFL counselors.   His research interests include the relationship of substance use to aggression among criminal defendants, on the quality of forensic evaluations of criminal responsibility, child witness testimony, malingering, and assessment of posttraumatic stress disorder. He lectures nationally on the topics of malingering, violence risk assessment, juvenile violence, substance use and violence, the assessment of sex offenders, correctional psychiatry, DSM-5 and the law, and malpractice issues in mental health.

Post-traumatic stress disorder may develop (either immediately or delayed) following exposure to a stressful event or situation of an exceptionally threatening or catastrophic nature. According to DSM-5, it is characterised by 4 groups of symptoms: intrusion symptoms, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity. These symptoms must impair function for a diagnosis to be made. In this podcast, Mathew Hoskins, Consultant Psychiatrist and Clinical Teaching Fellow, Cardiff University, gives us a clinical overview of the disorder. For more on PTSD, visit BMJ Best Practice: https://bestpractice.bmj.com/topics/en-gb/430 - The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.

SUMMARY:  There is nothing I love more than sharing the success stories of people who are using ERP to manage their OCD and intrusive thoughts.  In this week's podcast, I interview Taylor Stadtlander about her OCD recovery and how she used ERP School to help her manage her intrusive thoughts, compulsive behaviors.  Taylor is incredibly inspiring and I am so thrilled to hear her amazing ERP Success story. In This Episode: Taylor shares how she learned she had OCD  Taylor shares how she created her own ERP recovery plan and the challenges and successes of her plan  Taylor shares how she used ERP School to help her put her ERP recovery plan together and how she now uses her skills in her own private practice. Links To Things I Talk About: Taylor's Private Practice: https://www.embracinguncertaintytherapy.com/ Taylor's Instagram: https://www.instagram.com/acupofmindfultea/ ERP School: https://www.cbtschool.com/erp-school-lp Episode Sponsor: This episode of Your Anxiety Toolkit is brought to you by CBTschool.com.  CBTschool.com is a psychoeducation platform that provides courses and other online resources for people with anxiety, OCD, and Body-Focused Repetitive Behaviors.  Go to cbtschool.com to learn more. Spread the love! Everyone needs tools for anxiety... If you like Your Anxiety Toolkit Podcast, visit YOUR ANXIETY TOOLKIT PODCAST to subscribe free and you'll never miss an episode. And if you really like Your Anxiety Toolkit, I'd appreciate you telling a friend (maybe even two). EPISODE TRANSCRIPTION Kimberley: Welcome. I am so excited to have here with me Taylor Stadtlander. Taylor: Yes. Thanks. I'm so excited to be here. Kimberley: Oh, thank you for being here. I am so excited about this interview. You're someone I have watched on social media, and it's really cool because out of there, I realized you were someone who had been through CBT School and I just love hearing the story of how you things get to me. I love that story. So, thank you for being on the show. Taylor: Of course. Thank you so much for having me. Kimberley: Tell me a little bit about you and your mental health and mental wellness journey, as much as you want to share. Tell us about that. Taylor: I'll start with, I am an OCD therapist right now. And I start by saying that because, honestly, if you were to tell me when I was in high school, that I would have become an OCD therapist, I would have laughed at you because I, at that time, was really when my OCD started in high school. Of course, now, knowing what OCD is, I can look back and I can see definitely symptoms back as young as eight or nine years old. But when I was in high school, it was really when I had my sophomore year, pretty intense onset of compulsions. And then, of course, the intrusive thoughts, and it really was all-consuming. But the interesting part, and I'm sure a lot of people can relate to this, is it was something I kept very hidden, or I at least tried to. So, a lot of the earliest compulsions I had were checking compulsions. So, it was these intense, long rituals before I would go to bed, checking that the door is locked, the stove was off, all safety things. I felt this immense amount of responsibility. And I remember thinking like, where did this come from? One day I was just so concerned with safety and all these different things. But no one would have known other than, of course, my family, who I lived with, and my sister, who I shared a room with, who of course saw me getting up multiple times at night to recheck things. But from the outside, it looked like I had everything together. I was the A student, honors classes, volleyball captain, lacrosse captain, and just kept that façade of that picture-perfect high schooler. I did end up going to a therapist and she wasn't an OCD specialist, but I have to say I got very lucky because I actually have some of the worksheets that she used with me back when I was 15. And it is in a sense ERP. So, I was very lucky in that sense that even though I wasn't seeing a specialist, because I don't think any of us knew what was going on, to even see an OCD specialist, I did get to-- and it helped. And that's where I was like, “Okay, you know what, I'm going to go to college and become at least major in Social Work.” So, I went to college, majored in Social Work, got my Master's in Social Work, and my OCD pretty much went away and I thought I was cured or whatever that means. And I thought that, “Okay, that was a chapter of my life. And now for whatever reason, I had to go through that. Now I'll become a therapist and help other people.” I say that because I had no idea what was coming. My first year out of grad school, I began working and I had the most intense relapse of OCD ever. It came back stronger than ever this time. We call it “pure O.” So like mainly intrusive thoughts. And I had no idea what ERP was. It's sad because I went through grad school for Social Work and we never talked about that. I remember this one day, and this is circling back to even how I found you, I had stayed home from work because I was just for like a mental health day, and I didn't want to be on my phone because going on social media was triggering, watching TV was triggering, all these different things. But I was like, you know what, I'm sitting at home. I might as well turn on the TV. So, I turn on the TV, and an episode of Keeping Up With the Kardashians is on. I am a fan of that show, so shout out to them. And I remember watching and I was listening half not. I think I was trying to take a nap. And one of the family members had this OCD specialist on the show. And I remember pausing the TV because they had the name of the OCD specialist on the TV. And I wrote it down and it was Sheba from The Center of Anxiety and OCD. So I was like, “Okay, let me Google that.” That was the first time I've ever even heard of an OCD specialist. So, I stopped watching the show, went on my phone, Googled her name and her Instagram came up and I just started scrolling. It was like my world, my eyes were just open and I was like, “Oh my gosh, other people have OCD, and there's a treatment, ERP.” Then I just kept scrolling. And then funny enough, I came across your page, Kimberley. And through that, that's where I discovered CBT School. Anyway, long story short, at that time, I wasn't able to afford an OCD specialist. So, I was seeing a therapist, a different therapist from high school because now by this time I was married, on my own insurance, trying to navigate that. In the back of my head, I knew that I needed to see an OCD specialist. I just, again, couldn't afford it. So, I had a conversation with my husband. I'm like, “Look, I'm going to pay for this, the CBTS course.” And I said, “I know it seems like a lot of money, but it's really not. If I was going to see an OCD specialist, this is probably what one session would cost.” And that's how I learned about ERP. That's your course. It's how I learned about ERP. So, it honestly traces back to Keeping Up With the Kardashians. I love telling that story because it's so weird. And honestly, that changed my life because learning ERP, it finally clicked that, okay. Because I was just applying CBT techniques. Like, think of a red stop sign when you have an intrusive thought, thoughts popping, and things like that. And as we know, that was making it so much worse. So, I just dove into your course and taught myself through your course what ERP is, which then led me to seeing that at work, and then wanting to specialize in ERP, and now working with clients who have OCD. So it's really been an amazing journey, to say the least. Kimberley: I'm nearly in tears hearing this story. Oh my goodness, how funny, your story has gone from reality TV to here, and that's so cool. That just blows me away. Taylor: Well, and it really goes to show. I know that there can be negative sides, like technology and Instagram, but for me, most of, if not all of my education, initially about OCD and ERP was from Instagram accounts, like yours or Sheba's. And it was like, again, I knew that, okay, this can't replace therapy, but it was such a good in-between for me, especially being in the place where I was, where I was trying to navigate. Because it can feel like you're stuck when you either can't find an OCD specialist or you can't afford it. And I know what that feels like. So, to have that in between, not as a replacement, but just as a bridging point was so helpful for me. Kimberley: Wow. And for the listeners, I have not heard that story. This is new to me. So this is so cool. So, actually really, I'm so curious. So, when you took ERP PA school, were you like, “She's crazy, I'm not doing that”? Or what was your first take on that? Taylor: I think I was at the point where I was so determined to find relief, I was willing to do anything. And I had researched about ERP before I took your course. I wasn't like, “Oh, I'm just going to trust this randomly.” Kimberley: Random lady. Taylor: Right. So, I did do my own research obviously. And again, I'm in the field and I have a degree in Social Work. It's just so interesting to me that that was not discussed, and I think that's lacking in a lot of programs. So, once I researched it myself, I was like, “Okay, this is the evidence-based treatment. This is the gold standard. It looks like I got to do this.” I just remember I would come home. I was working at the time at a partial hospital program and I would come home from work. And that would be my routine. I would get my little notebook out, I'd pull my laptop out, and I treated it as if I was-- again, I know it doesn't replace therapy, but I treat it as if I was in an intensive program. I would spend an hour or so going through your videos and then printing out the worksheets. And that's just what I did. And I just started to do it. I had had before that a brief, very minimal understanding of exposures. And I think I was trying to do them on my own. But through your course, I was able to understand the response prevention piece. I was just exposing myself to all these things and then leading myself in a tailspin. But yeah, I see this again, even in my own clients now that there's just I think a certain point that you reach, that yes, it's scary to take this step, to start ERP, but because we're so determined to not feel the way we're feeling, it makes it so worth it. Kimberley: Wow. Oh my goodness, I'm seriously close to tears listening to your story. So, thank you for sharing that with me. I mean, wow, what an honor that I get to be a part of your journey, but how cool that you were the journey. You deal with these works. So, what was that like? Okay, so you said you would come home from work and you would sit down and you would go through it. Tell us a little bit about how you set your own. Taylor: I think I mentioned this, I was still seeing a therapist. What was funny is, I would come to my sessions and be teaching her about ERP, because in a way I was becoming this mini expert. And as I think a lot of our clients do, because it is such a unique treatment, you do have to become an expert. So, yeah. I mean, I remember using that worksheet where, okay, identify the what-if fear then list out the compulsions. I remember at the time I was like, “All right, I need to print out 10 of these because I have so many themes right now.” I remember doing that. And then, yeah, I would just pick away-- I would write them and then go through the whole process really as if I was going through ERP treatment. That's what I was doing. Like the same process I do now with my clients is just what I did. And I'm so lucky and blessed to have a background in mental health to have that. And even the resources that I could have had self-taught myself ERP because I know that that's not everyone's situation. And then what was really helpful, and I think this is really important to mention, is my husband. And I think a lot of people can relate to this. We all have our one person who we seek reassurance from. So, when I was still living at home, that person was my mom. Once I got married, it became my husband. And so, he had to learn a lot about OCD treatment and ERP and not providing reassurance. So, the poor thing, I would have him sit down and watch your video, and he would. And he is amazing and just the best support system. But that was really helpful because again, even if you are in therapy and doing this as a supplement to therapy, to be able to have those resources to watch again and again, once you buy the course, you have it. And I still reference it to this day if I am for myself or even if I'm working with something with a client. So, that piece was huge because then I could say, “Hey, look this is the science behind what I'm doing. This is why you can't give me reassurance and things like that.” Kimberley: Right. This is so cool, and it's so cool that he was able to watch it and wasn't intimidated by the whole process. I mean, he probably was, but he still went through with that, which was so cool. Taylor: 100%. Yes. This was about two years ago almost to the date actually. And because now I can look back on it, I think I do lose the anxiety that I had with starting it. And I'm sure him wondering, “What the heck are you doing?” But I think that's so important to have your partner or just your support system understand ERP because it can be very confusing to the outside. If you're doing exposures. What was very upsetting and hard for me that I really had to come to accept is, a lot of my harm obsessions were unfortunately targeted around him. So, I'd be writing these scripts and I would feel this guilt, this horrible amount of guilt and shame, similar to what I felt back in high school when I was trying to hide my compulsions. Here I have this amazing supportive husband and I'm writing these scripts. So, I would want to try and explain that. And him understanding it, I think made the whole process so much easier, for sure. Kimberley: Yeah. And those scripts can be hard, right? I even remember-- Taylor: I think that's the hardest part for me. Kimberley: Yeah. I even remember recording that and looking into the camera and saying, “You need to write a story about this.” And I do these with my patients all the time, but thinking like, “Why would anyone trust me?” That's a hard thing to do when you haven't-- so that's really amazing that you did that. The good news, and I'll tell you this, you're the first person to know this, is we just renewed the whole imaginable script module. They're three times as long now. Taylor: Oh, amazing. Kimberley: Yeah. So, you're the first to know. By the time they start, everyone will know, but yeah, we tripled the length of it because people had so many questions about that process. Taylor: In fact, I had a session yesterday with one of my amazing clients and she's fairly new in the treatment and we were introducing the idea of scripts. And you're absolutely right. When you're describing it, you're like, “What am I saying? This sounds horrible.” I was like, “All right, we are going to pretty much write out your worst fear coming true in as much detail as possible.” And she was like, “What the heck is going on?” And sometimes I have to take myself back to that starting point, especially with working with clients, because now I'm like, “I have an intrusive thought come up. All right, I know I have to go write a script when I get home.” So for me, it's become second nature. But I think remembering how painful it was the first several times to actually write down those thoughts and then not only write down them but say them out loud and look into them, that-- I was reminded yesterday, I can't lose sight of how painful that is initially, but then how rewarding it is once you realize it works. Kimberley: Yeah. You get so much bang for your buck, don't you, when you use those. This is so cool. You're obviously a rockstar. So exciting. I can't tell you how much this brings me such joy to hear. What would you say to somebody who's starting this process? What was important to you? What got you through? Tell us all your wisdom. Taylor: I think the biggest thing would be to know that you're not alone because I remember that was the biggest thing for me. Before I knew what OCD and ERP were, I thought that I was the only person on the planet experiencing these intrusive thoughts, these horrible, violent images or sexual intrusive thoughts or whatever it was. So, first and foremost, knowing that you're not alone, that there are so many of us who have experienced this, not only experienced the pain of it, but have gone through and are now in recovery. And that you don't have to let fear dictate the choices that you make because that's how I lived my life. I avoided things because of my OCD. So, I wouldn't be triggered. I let fear make the decisions for a lot of my life. And when you do go through ERP treatment, you get to be in control again and you get to live again according to your values. For example, I've always wanted to be a mom and I've always dreamed of having kids. And I remember so many times OCD in so many different ways that I can't even get into, say, “Oh, you could never do that.” Actually, I'm in my first trimester right now, which is so exciting and has been such an incredible journey. That's a completely different topic for another day. I'm handling my OCD attached to that. But I was thinking and reflecting about it the other day of just like, wow, I now get to live life according to my values and not let fear and OCD make the decisions. Even though the treatment seems so scary and weird at first, it is so worth it because it works. And that's why I wanted to become really a specialist in this specific field because I fell in love with the treatment. I fell in love with the fact that it gives people their lives back. And that's so cool to witness. So, you're not alone. You're also not a bad person because of the thoughts that you're having. And I'll briefly share, I'm a Christian and I know that a lot of the thoughts that I've had for a long time, I just thought, okay, I'm a horrible person, or I'm a sinner. And whatever your faith is, whatever spirituality or anything, whatever morals you have, just know that you're not your intrusive thoughts. You are just a person with thoughts and that's it. Kimberley: Yeah. That's so powerful. So, number one, congratulations. I just love when people say, “I have OCD about it, but I did it anyway.” Taylor: I know. Talk about facing your fears, it's like-- Kimberley: Right. And then the second piece where you're really, again, speaking from a place of values, even your religion, I'm sure got attacked during that process. And it's really hard to keep the faith when you're being harassed by these thoughts. So, I just love that. What motivated you to keep going? Besides you said just the deep wish to be better and well, how did you keep getting up? Was there lots of getting up and falling down or did you just get up every day? Taylor: Oh my gosh. In fact, there's times where I still feel like I am picking myself up because-- I'm so happy you brought that up because that was something that I wasn't prepared for, the feelings of relapsing I call it, where you feel like, oh my goodness, my symptoms have gone away, whatever. And then it hits you like a ton of bricks. And I always find that it comes back so strong. And it can be really discouraging at first. And I've even experienced that with the first couple of weeks of this pregnancy of just like, “Wow, I thought we were over this.” Even themes coming back from when I was 15 or 16 and like, “Okay, looks we have to deal with this again.” I'm able to laugh about it now, but in the moment, it's really hard. And so, I think the biggest thing for me that I try to keep myself reminded of in those moments where I do feel like I'm-- because it feels like you're taking a step backwards in a sense sometimes. And I always try to remind myself that so much can change in a matter of a day and that this is temporary. And even the worst moments of my ruminating or obsessing or the nights where I would literally spend hours completing compulsions, they always passed, if that makes sense. It sounds so cliché, but the sun always rose again. I always got another chance. And I would say that I am a naturally driven and motivated person. So I think that definitely did help me. But that's not to say that there weren't times where it's a hopeless feeling when you are living in your own personal hell of intrusive thoughts. The way I remember describing it to the first therapist I went to is that I was, and I don't play tennis by the way, but I was like, I pictured myself in a tennis court with a tennis racket and someone just throwing balls at me. And those are the entries of thoughts. And I walk one away and another one comes back. It was exhausting. But being reminded that-- And also now too, and I wrote this down, I definitely wanted to talk about this, was you have to find the community support and that has been so vital for me. And again, thank you, Instagram, I've been able to connect with so many people who have OCD or a related disorder who I text or DM and are now some of my closest friends. And we hold each other accountable on days where it's like-- because OCD can be really weird sometimes. And it's really nice to have people who understand and have been there. So, that's really helpful for me too on days where it's like, man, it just feels like I can't pick myself up. Kimberley: Yeah. It's so important. In fact, I'll tell you a story. A client of mine, who I've been seeing for a while, could do the therapy without me. And she knows it as well as I do. And we hit a roadblock and it kept coming up. I just feel so alone. And not having support and other people with similar issues, it was a game-changer for her. And I think we're lucky in that there are Facebook groups and Instagram and support groups out there that are so helpful. Taylor: Yes, totally. And that's one of the reasons I actually decided about a year ago to create a mental health Instagram because I knew how much Instagram and using that platform helped me. I literally remember saying, “Even if it helps one person.” And at first, it was really scary sharing some of the things, talking about the more taboo themes and different things like that, and thinking like, oh man, what are my coworkers thinking of me or my family members when I post this. But what's been so rewarding is countless people have reached out to me who either I know and I've either grown up with my whole life or people across the globe really of just saying, “Hey, thank you for letting me know I'm not alone.” And to me, that makes it totally all worth it. So, it's so important to find that connection. Kimberley: Yeah. And is there anything else that you felt was key for you? Something that you want people to know? Taylor: I think that it's so important to-- a huge piece of it too was incorporating act, like acceptance and commitment therapy, which I also believe I learned from one of your podcasts. So, thank you. And that was a huge piece for me too, because again, I think that-- to be very honest, I didn't even say the words “OCD” until two years ago. I knew in my head that I met the criteria in the DSM, but I never-- that label for me was so scary. I don't really know why, looking back, but maybe because it was just so unknown. So a lot of the work that I've had to do personally that's been really helpful is just acceptance of any emotion really, especially learning that acceptance doesn't mean that you have to love something, and it ties into tolerating uncertainty. Tolerating, I was talking about this with a client yesterday. Tolerating is not an endearing word. If someone says, “Oh, I tolerate that person,” that's not a compliment. We were not being asked to love uncertainty or love the fact that we have OCD or whatever we're struggling with, but just learning to sit with it and tolerate it has been an absolute game-changer for me. As much as the exposures and response prevention was so new to me, that whole piece too was a game-changer. Kimberley: Yeah, I agree. I think it's such an important piece, because there's so much grief that comes with having OCD too, and the stigma associated. I've heard so many people say the same thing. They had to work through the diagnosis before they could even consider-- Taylor: And I also had a lot of anger in two ways towards the fact that I had to deal with this. I always thought, and of course, I think a lot of us think this about anything else, I was like, “If only I just “had” anxiety and not OCD, or just had depression, that would be so much easier to deal with,” which I know is ridiculous. But in the moment, it's like, I think whatever we're going through seems so impossible. And then the other piece of the anger was just the misuse of people saying, “Oh, I'm so OCD,” or seeing it displayed on TV or on social media in the wrong way. And I'm like, “Oh my gosh, if only you knew what OCD was, you would never say that.” So now, it's been cool because I can turn that frustration more into advocacy and education, but that was a huge hurdle to jump to. Kimberley: Yeah. Well, especially because you're over here tolerating OCD. And then other people are celebrating and it just feels like taking the face. Taylor: Oh my gosh, yes. Kimberley: Yeah. I love all of that. Thank you so much for sharing that story. Number one, it brings me to tears that we get to meet and chat. I think that that is just so beautiful and I'm so impressed with the work that you're doing. So, thank you. Tell me where people can hear more about you or follow you and so forth. Taylor: Sure. So, my Instagram is acupofmindfultea, and there you can also find-- I definitely share my personal story, but just also ERP tips. I'm also very big on holistic findings. So, obviously, medication has been a huge part of my story as well and helpful, but I also love finding natural ways and different ways that have helped my anxiety and just building my toolkit. So, I share a lot about that on there as well. So, yeah, I would love to connect with you guys on social media, for sure. Kimberley: Yeah. I would have to admit, when I saw your pregnancy announcement, I was with my kids and I was like, “Woo-hoo!” And they were like, “What?” And I'm like, “Oh, it's just somebody I've never met, but I'm so excited for her.” Taylor: Isn't that so great? I know, I love it. I feel the same way for other people. Kimberley: Yeah. Well, thank you so much. Number one, thank you for coming on the show. I love how that creates itself organically. And number two, thank you for sharing this because I think this will hopefully give some people some hope. We were overwhelmingly encouraged to have people with stories of their recovery. So, I think this is a really wonderful start of that. Taylor: Awesome. Well, thank you so much. I've been listening to your podcast for two years now, and it's been such an encouragement for me and such a huge form of education and help. So, this was truly special. So, thank you. Kimberley: Thank you.

Are we using the wrong criteria to diagnose mental illness? The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the gold standard used by healthcare professionals as the authoritative guide to diagnose mental health conditions. But is it the best tool for clinicians to use? Were you even aware there are other options?  Today's guest, Dr. Margaret Chisolm, a professor at Johns Hopkins University School of Medicine, tells us all about the “Perspectives Approach,” a method of evaluating a patient using multiple perspectives of their lives and experiences.  This method has existed for over 40 years and is taught and researched at the world-renowned Johns Hopkins University. Dr. Chisholm will explain how this method is superior, and some limitations and flaws of the DSM.  To read the transcript -- or learn more -- please visits the official episode page here. Guest BioDr. Margaret S. Chisolm, MD, FAMEE, FACP, FAAP, is vice chair for education, psychiatry, and behavioral sciences; professor of psychiatry and behavioral sciences; and professor of medicine, at Johns Hopkins University School of Medicine. She directs the Paul McHugh Program for Human Flourishing, which fosters a humanistic clinical approach to patient care. Find out more at MargaretChisolmMD.com. Inside Mental Health Podcast HostGabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, "Mental Illness is an Asshole and other Observations," available from Amazon; signed copies are also available directly from the author. Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can't imagine life without. To learn more about Gabe, please visit his website, gabehoward.com.

Since the mid-twentieth century, there has been an ongoing quarrel over the definition of mental health: Are disorders like depression, OCD, or schizophrenia biologically determined or are they socially constructed?In this episode of “What Is X?,” Justin E. H. Smith talks to Danielle Carr about the history of psychiatry and the politics of madness, from 1930s asylums and the DSM to the antipsychiatry movement and Elon Musk's newest hobby: neural implants. They discuss the big business of mental health in our therapeutic society—evident in the popularity of mental wellness apps, the proliferation of SSRIs, and Silicon Valley's fascination with brain chemistry. But could the extent and prevalence of everyday unhappiness point to problems that medicine and technology can't solve? Do they call for changing the social conditions that contribute to these feelings of loneliness and immiseration? “Mental health,” Carr argues, “is a terrain of struggle over the question of what human flourishing is and how to achieve it.” Does Justin agree?

How does one reconcile the facts that DSM diagnostic criteria for Autism Spectrum Disorder includes pain insensitivity and a high pain threshold,  while these children report that their clothes feel like sand paper and their fingers while shampooing feel like sharp metal?  Join me in this episode to look at where the truth lies, with emerging evidence that helps us better understand the relationship between pain and ASD, what if anything is different about pain among children with ASD, and how we should approach pain issues amongst these children!   Takeaways in This Episode What constitutes Autism Spectrum Disorder Prevalence of ASD Historical beliefs around ASD and pain, and contributing factors for those beliefs  Current and emerging literature  around ASD and pain What Stimulus over-reactivity is and how that plays out in ASD Genetics evidence around ASD and pain Summarizing ASD and pain among children and considerations for accurate assessment and effective treatment   Links Listen to other helpful and related podcast episodes - Episode #84. Post-Concussive headache and Symptom Management in Children with Dr. Windsor Episode #63. Integrative Pediatric Pain Management with Dr. Lonnie Zeltzer Episode #81. How to Choose the Right Pain Treatments Episode #72. Real vs. Fake: The Look of Pain Episode #75. Role of Gut-Brain Axis in Pediatric Pain Proactive Pain Solutions Physicians Academy Clinicians Pain Evaluation Toolkit Proactive Pain Solutions

Please Subscribe For More Episodes!   iTunes: https://apple.co/30g6ALF Spotify: https://odaatchat.libsyn.com/spotify Stitcher: https://bit.ly/3n0taNQ YouTube Channel: https://bit.ly/2UpR5Lo Be sure to follow me on Instagram for daily inspiration: @odaatpodcast and @arlinaallen   Connect with Jolene Park Visit Jolene's Website: https://grayareadrinkers.com/ Follow Jolene on Instagram @jolene_park Watch Jolene's TEDx talk: https://www.healthydiscoveries.com/tedx-talk/      The Lightning Round    Book recommendations:  Drinking, A Love Story, by Caroline Knapp Many Roads, One Journey: Moving Beyond the Twelve Steps, by Charlotte Kasl Favorite Quote: “This too shall pass” Regular Self-Care Practice: Grounding - walking barefoot on the beach, breathwork, somatic work, and healthy eating. Transcript:  Arlina Allen  2:56   Jolene, thank you so much for joining me today.   Jolene Park  3:03   Thanks for having me I'm I'm really looking forward to chatting with you and getting to know you a little bit more in the studio.   Arlina Allen  3:09    Listen, I appreciate somebody who has done their own work and who has a lot of credibility. Can I just say that to you?   Unknown Speaker  3:20   Thank you. I received that and appreciate that and feel the exact same way so I'm with you. Yeah,   Arlina Allen  3:27   we were just okay, I'm not gonna go into a rant, but maybe just a tiny little soapbox. You know, little cautionary tale. There's, there's a while I love how open people are being with their recovery. I just really appreciate people who have done their own work, right? So and you'll hear it I listen, I can sniff it out in two seconds. If I'm talking to someone who has not done their own work. And I've listened, I've listened to your TED Talk, your other interviews, there's lots of really good quality stuff that you've been putting out that I really appreciate. Because you are rooted in logic, which is nice. You got a lot of science going on. I love me some science. So we'll talk about all the stuff all the things, but just for fun. Do you hear my dog barking? Yeah, one second. I'm so sorry.   Unknown Speaker  4:54   Oh, I think you're still muted. Ah, here we go.   Arlina Allen  5:02   Okay, I had to go. Let my I have an English bulldog named named Teddy had to let him out. Did you know that Dr. Andrew Huberman has an English bulldog?   Unknown Speaker  5:11   I mean, his dog is no castellet. Well, long videos watch. Yeah, yeah. Costello was Costello   Arlina Allen  5:18   okay. Yeah. Yeah. Okay, so we were totally   Unknown Speaker  5:23   embarrassed that I know that but I might make you vermin fans.   Arlina Allen  5:27   Me, too. Oh my God. He's talking about him all the time. I digress. Sorry about that, I will have to edit that little part out. What I where I thought we would start is just kind of a fun little lightning round. It's a fun little icebreaker. When you first started your journey to do you call it do how do you refer to it your alcohol free journey, your sobriety journey?   Unknown Speaker  5:53   alcohol free is what I use most. But you know, I'll interchange sobriety here and there, but in general, I, you know, I'll the term alcohol free is what I'm most comfortable with.   Arlina Allen  6:05   Okay, cool. Yeah. I mean, it's so interesting, you know, over the years, you know, when people were first talking about getting sober, it was all about alcoholism. Right. And you and I know now that the DSM five doesn't even recognize that term anymore. It's alcohol use disorder. So which I appreciate because that sort of speaks to the spectrum. Right? There's an Oh, you're going to talk about this too. I'm not gonna steal your thunder here. But um, but yes, so when you started your alcohol free journey, were there particular books that you found really helpful?   Unknown Speaker  6:42   Oh, what a fun question.   Arlina Allen  6:45   I am obsessive when it comes to books.   Unknown Speaker  6:48   Yeah. Because you know, when I started my journey, and Anna Grace's book was not out. Oh, okay. Unexpected joy of getting sober. You know, all of these these books, the sober diaries by Claire Pouliot. None of those. They all came after I quit drinking. Yeah, me too. So yeah, this is a really fun question. Kind of, you know, pre this big Instagram boom, about talking about alcohol free. I definitely read Carolyn naps book, the drinking love story. Have you? Have you read her memoir?   Arlina Allen  7:20   I haven't. That also came out after I got sober. I heard that people read the books that came out when they got sober, or became alcohol free.   Unknown Speaker  7:31   She wrote her book. I think it was in the 90s and the 90s. Yeah, okay. Yeah, she was an early, early one. And her writing is just exquisite. I mean, it's so visceral and it pulls you out. I mean, it almost it's called drinking a love story. And she really romanticizes the drink and she had an absolute 100% you know, drinking problem, but her writing is just mesmerizing. So I read her memoir a couple times. But you know, who I knew about early on to was Charlotte, I think it's castle, k s L, I never know how to say her last name. And she wrote the book moving beyond the 12 steps, many roads one journey,   Arlina Allen  8:18   I think wow. And   Unknown Speaker  8:21   and so she took a she looks at the physiology, which is you know, is a real core piece of my work and you know, potential things like blood sugar and, and allergies to alcohol and, and she, you know, she knew about that side as a psychologist, but, but were her work really, where she really anchored it was looking at the language of the bill Wilson's 12 steps. And so she wrote the 16 steps and more of a feminine kind of empowered approach, you know, she just turned the language and so I enjoyed her work and kind of her take on things. And I think that you know, her book came out probably in the 90s as well   Arlina Allen  9:03   in the 90s that is so interesting. So I grew up in the church where I was accustomed to reading patriarchal language of the Bible and things like that. And and I was accustomed to reading things and then interpreting it like I didn't realize I was I had like this interpretation filter, so that you know, when I got sober in 94, all there was really was the 12 steps. And I was so desperate to be different and I just happened to know some people who were going and so I just kind of got they call it getting Eskimos in the cold, I guess. Um, and so that that worked for me. But it's so fascinating that there were so many women that are just like, I'm not okay with this, like this whole patriarchal thing and, and so it's so interesting to hear that Charlotte was able to sort of translate To the 16 steps I'm totally gonna have to check that out so that was a book that you read early on as well   Unknown Speaker  10:06   it was because I I appreciated her comprehensive approach which is very much resonated with me about looking at the biochemistry looking at the emotional components and today's you know language around that is the somatic work the polyvagal work which Charlotte wasn't you know that's newer research but she was aware of that of that bigger comprehensive approach around the codependency is another you know term that was more traditional but that emotional sobriety and then the spiritual piece of it too and there's all different you know, currents to ride with that and and she helped me you know, have an appreciation too I've always been very neutral with with 12 steps I've been in and out of meetings you know, throughout the years and I certainly see from a nervous system standpoint the huge benefit of the community so being in a room with other human beings where you can be heard and seen and witnessed and you know, that your story is held and that's very healing to the nervous system. I understand the criticisms and I have you know, I respect you know, it's everybody has their different preference but speaking strictly from a nervous system standpoint community and the predictability the regular meetings the the support that that you know, there's a lot of dynamics in there that are very supportive to the nervous system now we can find them in you know, in churches or spiritual groups or movement groups like yoga communities or more knitting communities it doesn't have to be a recovery based community but in general community that's part of my acronym nourish uniting with others so   Arlina Allen  11:55   I thought we're gonna get to that I wrote   Unknown Speaker  11:58   and power code   Arlina Allen  12:01   is so good it okay so I don't want to jump ahead but I'm just I'm gonna ask you about all that cuz I was listening to and I was like writing this down I was like, Oh my god, how did I not hear about this before? It's so interesting that we can sort of sort of like package or position information in a way that is so consumable and easy to remember your whole nourish, and that a knack? Is it an acronym my does that sound weird? acronym, acronym? Sorry, dear, I laugh at my own jokes. Bear with me. Um, okay, so the books these are, these are really good books. Okay, so drinking a love story, and then moving beyond the 12 steps, which I totally appreciate. Like,   Unknown Speaker  12:45   let me let me throw one other in there that was very emotional. And we can as we get more into kind of the biochemistry of the book, seven weeks to sobriety was also very influential. And I can dig more into that but but the author, she has her PhD in nutrition. And she was inspired to write the book again in the 90s, I believe, is when it came out, because her teenage son, I think it was late teens, early 20s, went into to to traditional treatment, around the you know, mid 90s, and stayed sober, but was miserable. So emotionally, he came out of treatment and was still very depressed and he didn't drink but tragically then took his life because the alcohol had been removed. But the other pieces is like he didn't feel better, even though he was following you know, the program. And so his mother then said, there's something else we're not even talking about the physical side, there's this whole biochemical side and she got very interested in the nutrients and the amino acids and went on for her PhD to really learn that and then opened a treatment center in Minneapolis, called the health Recovery Center wrote a book called seven weeks to sobriety. And so that was an influential part as I was studying and learning functional medicine about that biochemical piece and and Charlotte wrote about that too. She understood some of the biochemical side but she really looked at kind of that psycho emotional spiritual. So those those were influential books to me while I was drinking like the you know, because I'm a I'm a nutritionist I'm a health coach, I have been for 20 years and so that stuff was always interesting to me. And I would read it and kind of chew on it and be like, this is kind of fascinating. It's a little bit off the traditional path. I still drink but it was planting seeds of where ultimately got me to my final stop what I used when I stopped and now what what I use in my work was was those early seeds.   Arlina Allen  14:41   Yeah, so good. I mean, listen, there's a period of time like I lived in this barn, the Self Help section at Barnes and Noble trying to like think my way into right living as they say. And just because I had as I want to ask you about this a little bit later, but once having the information wasn't like applying them formation is kind of my current obsession and so we'll talk about how to apply it and but I think that's really important that we'll we'll talk about that Do you have a sort of go to mantra or quote that you live by   Unknown Speaker  15:17   this too shall pass   Arlina Allen  15:18   whoo that's fine   Unknown Speaker  15:20   yeah or another one is you know all as well which comes from a Christian mystic in England Her name is Julian of Norwich. Yeah, I I like the Christian the feminine Christian mystics I draw a lot of wisdom from and that was that was one of her really well known quotes is well as well   Arlina Allen  15:43   yeah. I love that Oh, you know what I'm what I like is that just popped into my head was in the end everything will be okay. And if it's not okay, it's not the end.   Unknown Speaker  15:54   Yeah. Yeah. I often post that around New Year's, you know, turning up the calendar and kind of New Year's Eve and it feels like the end but it's you know, we're beginning   Arlina Allen  16:10   Yes, every and has a beginning. I love that. Let's see, do you have a regular your own personal self care routine? Like do you like a daily practice a weekly practice,   Unknown Speaker  16:24   I have a whole menu of nourishment that I have a bag of nourishment that goes Borg and self care. I'm admittedly i'm i'm not great about you know, hitting every single day. But I certainly have really favorite practices that and it changes you know, with different seasons, the time of the year as I grow and evolve and what my needs are, sometimes they're more physical, sometimes they're more emotional, sometimes more spiritual. So it shifts. Right now I'm in Charleston, right outside Charleston, South Carolina on purpose to be very close to the beach because walking barefoot on the beach scene at the beach regularly for me is a huge daily practice and regulator. So that's a biggie. Um, I like breathwork. So that's also very regulating and calming to me to do some kind of some. It's a little bit of Wim Hof. But it's not total Wim Hof.   Arlina Allen  17:26   Half every morning like Monday through Friday. We host this little it's like a 25 we do Wim Hof for 10 minutes and then Tara Brock reign meditation for 10 minutes. No chit chat. No messing around, in and out. Love   Unknown Speaker  17:39   Yeah, yeah. And so I find a grounding for me like literally feet on the earth and then kind of active breathwork both are very settling and soothing to me. And I like those a lot. So those are kind of my my key things saying, you know, really hydrated, sleep, regular, predictable bedtime and wake time is helpful for me. But yeah, you know, there's when I quit drinking, I was using more herbs. There's all kinds of stuff. I mean, we can all   Arlina Allen  18:13   I know that. Yeah. Do you know I am just so glad that you highlighted that there are many tools that you don't do them every single day, like super hard, like you're not militant about it, and that there are different things for different seasons. Because often I talk to people, I even the clients that I coach, they're like, Oh, I didn't do this every single day. And it's like, you don't have to do it every day because our needs actually change and fluctuate. And so it's okay to be flexible, right? And just pay attention. Yeah, pay attention to what your needs are that day. And I have a client who called it her smorgasbord of things. But she you know, she did she put a time limit on it. She's like, Okay, I'm not gonna spend more than an hour, right? She's retired, she's like, I'm not gonna spend because then it becomes this other thing you beat yourself up with, like, all different things. So I like I like the flexibility. And I think consistency can be viewed, let's say over a month period of time, right? If you did, if you did something like 20 days out, that's pretty consistent. Right? You don't have to do something every day to be that's extreme thinking of consistent. We're so funny.   Unknown Speaker  19:30   Yeah. And you know, he's a core philosophy of mind for myself and how I work with others, especially with women. I'm very interested in you know, the cycles and the rhythms. So in our own body within this is noticing nature, so noticing the seasons in nature, but we also have that those seasons within our own body. And so it's very linear and masculine, the masculine archetype to kind of a 24 hour cycle where it's like every morning, do a spin class. And there's nothing wrong with that. But more of the feminine Yin cycle is there's different times of the month depending if we're relating bleeding coming into oscillation, you know, out of our bleed time, our energy cycle is different. And even if you know women listening are menopausal had stopped bleeding or not bleeding for whatever reason, our bodies still sync with the moon. And so there's just times with whether the moon is full or dark a new moon, are as women, our bodies really sink in with that, and it's more about peak energy time versus a low energy time. And so it you know, you don't even have to let get militant about the moon or the moon. You know, this is my work of I'm always cueing clients of notice what feels really nourishing right now, not because you should or you have to, or somebody posted about on Instagram, but does it just feel nourishing to like, take a nap. And, and noticing that and giving yourself permission. So that's so much of my work of tracking, instead of beating ourselves with a whip, really noticing what can   Arlina Allen  21:11   we Yeah, I love that you are not shame based, I can already hear it, you know, it's more nurturing and supportive. And you It's really cool. You know, a lot of the stuff, I know that you're like in the corporate world, like you're very corporate friendly, like palatable. And when I was listening to a lot of your stuff, I was thinking of my friends, you know, I'm from Silicon Valley, I did, I was corporate for a very long time. And in sales, tech sales, and so very, like male dominated very robotic, I would say, and very, like, absent of feelings. It's like, No, no, we don't talk about failing, they can talk about, they'll talk about stress, like, but that's about it, like tired or stressed. Like, the language is very limited. And so it's so it's so interesting that you have it seems like a very unique capability, capacity for being able to speak the corporate language, right, meet people where they are, but then also introduce very practical ideas, you know, paying attention to, you know, the moon and stuff like that, that that was not I did not expect that. And I think it's so refreshing when you're able to sort of live, you know, straddle the, you know, the corporate world, which is so robotic and so shot like, shallow is that I don't know if that's fair. But you know, people are trying to survive in this very, you know, a, a type driven accomplishment, don't feel anything environment. Right? Yeah. I don't know, where alcohol   Unknown Speaker  22:45   comes in. Like, it makes so much sense then, when we drive ourselves at that level. Why alcohol is also so prevalent in   Arlina Allen  22:52   the corporate world. Yeah, big time.   Unknown Speaker  22:55   Yeah. You know, and that's where I really feel like I learned how to corporate minds love physiology. And they, they're fascinated by how the brain works, and that peak performance and, and how to manage stress, you know, that those are buzzwords. And so bringing that in, in kind of a fun inspiring, like, a little bit of a different angle. It's that's where I learned to, to really speak to this, that that was kind of a universal message. And so, you know, I certainly wouldn't lock in talking about the moon. I have, I have found that weird. You know, I'm interested in those aspects that I've found by building the rapport and laying the groundwork of when there's this gut brain connection and what the bacteria in your gut is doing. And this there's this nerve in the back of the cranium called poly vagal nerve, when it's not toned. And this dysregulation, like, which I mean, I level that too. I'm fascinated by it. I you know, I love kind of that logical, yeah, give me that, you know, what is this? Like? How does it work? Why does it work? And then building that rapport where people can be like, that's so fascinating. And then it's like, oh, and do you also know that it's our bodies are 70% water and the moon regulates the tides that the ocean water? Our body is also you know, there's a thing to that it's responding to it. Yeah. And so when we set it up in the physiology which all of this can can be backed in physiology, there's data for all of it, and then it doesn't sound so Whoo. And like, well, this is just nuts.   Arlina Allen  24:43   It's like well, I love how science is explaining why woo is so fascinating, right? It's like there are those of us that less I'm pretty open minded. You know, but I need some science behind it to, but I am I almost missed the whole we should highlight the fact that Do you really like this gray area drinking expert right that's that's really how I came to know you and I thought you know that is meeting people where they are in the corporate world like in the corporate world these people are so driven and there's this perfectionism that happens in the corporate world it's like don't show any of your any of your flaws you know it's like this very robotic it's pushed yourself you know endlessly this 80 Hour Workweek is celebrated and you know they claim work life balance but you know I would be on at sales you know, quarterly business reviews where the VP would be out drinking until like, you know six in the morning and show up for the eight o'clock meeting still a little bit drunk I'm I would imagine and so it's so interesting to sort of gently like we're avoiding words like alcoholism which you know, we don't we understand that that's not really a thing anymore. There's a spectrum but the gray area drinking seems to be seems to be a very nice entry point Can you explain to the listeners like people listening they're like what is this gray area drinking because I think once you explain it everyone goes Oh, yeah, I totally know what that is. Yeah, so   Unknown Speaker  26:15   I was teaching I was doing a lot of contract work from 2004 to 2011 in corporate America trip flying and traveling around the whole United States doing on site workshops being contracted to come in for exactly what you're speaking to us Can you come do these training programs for the employees on this work life balance, they're really stressed they're you know, we're watching the biometrics we're doing these health fairs and we want to have blood pressure kind of overall more in range and their cholesterol and their BMI and we realize it's more of a comprehensive approach so when you come teach them so that you know that was that's my foundation and the work I was doing and what we never talked about around blood pressure and weight and sleep issues and stress was alcohol but you know, bringing in then these resources these regulating resources of around food and around sleep and really practical things to do some regulation in the body which which employees loved and because you know, a lot of people would come into the workshop saying I know this stuff, I'm a marathon runner, you know this it's my hobby and and then we do these workshops and they're like, I didn't know this like I didn't know that about you know, grounding and what like the omega three fat actually does in my brain with my neuro chemicals and so again, people I work with, they're very well read, they're very smart they like this information, they're already reading books listening to podcasts, but then when we can apply it to peak performance and the challenges that come up because of the you know, the corporate deadlines and and a lot of people are drinking heavily and we're not talking about it. And so I would come in from the angle of your craving brain whatever your brain is craving. Here's some ways to you know, because you don't hang the hang the poster seven come to the alcohol class in the boardroom at noon, like people are not going to be alone, right? People are not going to you know, trip over themselves to get to that boardroom but when we talk about the craving brain and ways that you can regulate and work with you know, your innate body's rhythms and cycles and systems in the gut in the brain, people were really really fascinated by that. And then to your question about you know, what is gray area drinking it's that space where people are functioning really well my clients tell me this all the time, I saw it all the time in the corporate world, people function and they drink really heavily. And if they didn't fall into that those traditional definitions of like end stage, just kind of rock bottom the wheels fall off our life but they also weren't every now and again drinkers where they had a drink or two a couple times a year, they were in between this and it was this gray area where again slipping through the cracks it was the white elephant in the room that is how everybody was drinking and nobody was talking about it. And it's how I was drinking and teaching wellness you know, it's like I love this stuff I love about functional nutrition and with the body and regulating the body and then on the weekends I'd be out with my friends drinking like everybody else around me It's how we all drank but it was just you know, and then I would stop many many times and I can't keep drinking like this and I was able to stop it wasn't a problem for me to stop what was more of the problem was after a couple months saying why am I being so restrictive I can have a drink so I would go back to drinking this the staying stopped the same stop which is very characteristic of gray area drinkers because people will say you know, I don't drink every day I you know, go weeks and don't drink. I'm like that's really characteristic. But the hard thing is Sticking with that because it's this gray area of like but nothing bad has happened like I don't have this external kind of proof that there's a problem yet it's the 3am wake up the dry mouth that mentally beating ourselves up but nobody hears that conversation except us in our own head and then going through the gymnastics of okay I'm now I'm just going to drink on the weekend I'm not going to I'm not going to drink again I'm it's this whole thing that goes on for months and years that nobody ever talked about   Arlina Allen  30:31   this it seems there there's this whole other layer of insanity that goes around trying to manage it right like oh well I'm just gonna drink a glass of water between drinks or I'm gonna have a glass of water by the bedside with electrolytes in it so that when I wake up in the morning in the middle of the night just totally dehydrated or you know having the Advil and the by Xen and the charcoal things and the oh my god I'm exhausted just thinking about it right it's like this whole insanity to make make it okay from for the drinking part and it's the whole back and forth that is was so exhausting I wonder so and we were talking a little bit about like just having the information is not enough it's about applying the information but don't you feel like there had to you had to like make a decision like at some point you got sick of the back and forth and you what what was there like a tipping point for you that you were just like this is that I'm done for good this time?   Unknown Speaker  31:29   Well that was December 14 2014 which was the the solid in my bones resolute I'm done. This is it and you know, it wasn't a Cavalier decision It wasn't easy. Alcohol is a problem for me you know, it was very typical for me I'm just gonna have a glass I can just you know, I want to just open a bottle at home pour that glass and then I would drink it and be like, ah, screw it I'll have enough it was very easy to do you know finish the bottle that was that was my kind of typical pattern and knock on wood. Fortunately nothing you know, half bad happened like I didn't have a DUI or anything like that, but there was so much of that. That's how I drank and then I would stop many many times over the years under the wellness umbrella I'm going to do a paleo challenge I'm I'm doing a yoga you know challenge I I'm just not going to drink and people get used to that and and it worked because they knew I was in wellness they knew I was and it's like oh that makes sense like you're doing so I never really it was it I flew under the radar with it. But then I would say oh I can you know be a social drinker. I want to be a social drinker. So it really to your question, it was just so much of that back and forth which is exhausting. It never changes I would go right back to where I left off whether it was one month or seven months it didn't matter and it was just this resolute because I had bad you know back and forth so many times of just I'm tired of this. I don't want to keep doing this. I've been through different seasons with it I've been through different experiences with it. You know what I've been dating not dating really high stress with work or whatever, it just doesn't change and I had that real conversation with myself December 14 2014 going through those scenarios of like you know what if I go on this romantic holiday like what if and I was like no no, I'm just I'm done. And that was seven I'm coming up on my seven year anniversary this December.   Arlina Allen  33:40   Oh my gosh, that's so exciting. Congratulations that is not easy. That is not easy. Yeah, so Okay, so you know what I love about what you do is that the science behind it the science behind like the addiction of alcoholism or alcohol the science sort of depersonalized is that right? And so it takes out the shame takes out the gill and it's like well of course you're getting addicted to alcohol Look what it's doing to your brain right and so you talk about three the neurotransmitters and a way that I thought was so good it was like oh, that's why right so you talked about GABA, serotonin and dopamine and you're gonna be able to explain it much better but when I heard you talk about it the first time I was like that as the shit Oh my god, like people need to hear this. So what is your What is your explanation behind those three neuro chemicals and how they make us feel that sort of drive the compulsion to drink   Unknown Speaker  34:46   well, so that you know there's there's four major neural chemicals I hit on three of them in my TED talk, but there's four major ones. So two are the gas pedal for our body and then two are the brakes for us. So the gas pedal dopamine and serotonin. So dopamine is the drive that shapes that with the motivation to to move. To get up out of bed and produce we need that we need to be motivated. And then the acetylcholine is the other kind of gas pedal. And that's about focus and memory. And then serotonin and GABA are the brakes. So GABA is that relaxation feeling where the mind shuts off. And there's just that feeling of kind of that downshift. And serotonin is just the feeling of happiness, bliss, life is good, I'm not really needing or craving anything to fill a void right now I'm just I'm content I'm good. And so we need the balance of gas pedal what you know, we need to move and stay motivated and produce and we're, you know, accomplish and have that drive. And we need memory to have that memory bank and our focus and like these are, you know, important things just to biologically function. But then we need to balance that with rest and relaxation, and some happiness and some bliss and just contentment. And so when you know, those get out of balance for all kinds of reasons, sleep, you know, not sleeping, well, eating a lot of processed food and sugar, drugs and alcohol, trauma, stress, so all of those things can open up the valve, where's those neural chemicals just flush through us much quicker, because we're inside that's like who there's stress, there's, you know, all this sugar, all this alcohol. So we need to compensate open the valve and then all of a sudden, it's like, we're really depleted now and gabbeh or something, you know, we're going through that scenario, and the body just can't do the uptake enough to replenish and make it quick enough to fill it up. So we're the dumping it too fast, or not making it fast enough. And so when we come into baseline, the body can do what it knows to do, it can make adequate chemicals through real food, like omega three fish oil, you know, through the amino acids, those are the raw materials that then make these neural chemicals. And we can we can hold on to our neural chemicals and not just flesh them through our system so quickly, by you know, some different practices and movement and rest and good replenishing sleep. And so to me, it's it's where the rubber meets the road with all of the practices, exercises, theories, techniques, because you spoke to it a minute ago about how we can just kind of get into like this militant, like I need to do it, I should do it. I heard it's good. I heard it's bad. I heard it's like, no, it's about noticing, what are you needed to replenish right now what's deficient and depleted. And so the body's just trying to keep us in homeostasis, and that, and then we reach to alcohol. So it's like when we understand the physiology, it's like, Oh, interesting, something's depleted and deficient, physiologically, not psychologically. And so the body's just trying to compensate. So alcohol is a physical substance, our physical body is depleted, we and our physical body, and we get a physical effect very immediately. So the body's like, keep doing it, like i don't i, this, it seems to work immediately. So and that's been where that addictive loop gets in. So where I then work is, let's lift the hood, what's depleted in the first place, biochemically, emotionally, energetically, and let's replenish what's truly needing to be replenished. It's not because you're a bad person, or you did something wrong. It's just like going to be in the body detective, the body whisperer, which I love doing. And, and often, it's just, you know, it doesn't have to be really complicated. It's just going back to the basics. And I'd find this in the corporate world all the time, too. We want the shiny, you know, stuff, the shiny next thing, and nobody's hydrated. Nobody's sleeping regularly. And this is where the application comes down. Because it's, it's like, yeah, yeah, yeah, I should drink more water should get better slide,   Arlina Allen  39:12   isn't it, nobody wants to hear that.   Unknown Speaker  39:17   It's not sexy. It's not glamorous, and we're out the other. I'm the same way I get it. But what's really cool about this work is when you have the actual experience. So when you actually have a 10 hour night of deep restorative sleep, it's mind blowing, it's a 180 it's the same way with, you know, sewers,   Unknown Speaker  39:36   or certain things. And so I'm always working with clients of like, it's not about getting a gold star from me and checking the box and doing all these things to perform and achieve. That's what makes us want to drink because we're, we're exhausted. So now it's when you put something in when you add it in, what happens because when we drink something happens and so if you're not noticing an effect that's really Positive that you can, you know, like, again, when I do breath work, there's an effect. Like, I feel that I mean, there's this bliss and this calm that moves through my body by by, you know, consciously doing different practices with my breath. So it's like I want to do that again, like that almost feels like I just had a glass of wine, what I did with that breathwork so that's the work and it's it's exciting, it can be really inspiring. And it's very empowering to go back to the physiology because that's where all the secrets and the magic are. And it puts aside the psychological shame that we've kind of gotten tangled in that's really unnecessary. Yeah,   Arlina Allen  40:40   you know, you hit on something that kind of sparked a light me which is about adding in, because a lot of recovery is about taking away, right, we're taking away the one thing like listen, when I was still drinking, and I smoked a lot of weed. Taking I was I loved those things, those were the things that receiving me, right and I crashed and burned early, I was done at 25. Because I did not manage, because not managing well. But to let them go was so hard because it was I felt like the thing that was bringing me like that was saving me so to let it so deprivation, I you know is a big thing for people that are you know, going alcohol free, or getting sober or whatever. And I love the idea that you're presenting which is adding in, right, let's add in the things that give you the feeling that we wanted from the drugs or alcohol in the first place. So it's a totally different mindset instead of deprivation. It's about adding I love that idea.   Unknown Speaker  41:46   Yeah, I do too. deprivation doesn't work for me. So I'm not going to try to talk with somebody else or coach somebody else through deprivation, like I don't want to be deprived who does. Nobody wants that. It doesn't work. So I would   Arlina Allen  41:58   be there we would be broken alone.   Unknown Speaker  42:02   And we know from behavior change from behavior, psychology, that deprivation, it never works now, but I can put it back in the physiology. So what we're dealing with is the amygdala and the animal brain, the animal brain only concern it has one concern as to keep us alive, right? And so if there's a sense of deprivation, that signals it's a biological signal, we're gonna die. So who's gonna win? Is that animal, right? Every time. So we've got to give the message then to the amygdala, that alarm center in the body that we're not in this deprivation, like we're not going to die, you're, we want to give that animal something. And, and that animal kind of limbic brain, it doesn't understand language. So this is why you know, saying, Just relax.   Arlina Allen  42:51   Don't ever tell an angry woman to relax? Yeah,   Unknown Speaker  42:54   well, it's like, it's literally like saying to an animal, just relax. They don't understand words our animal brain does literally doesn't understand words. But what it understands is sensation. And so alcohol gives us sensation in the physical body, walking barefoot on the beach gives a physical sensation. If I take a gamma boosting herb, it gives us sensation. And so that's where it's like the rubber meets the road with these practices of what we're doing is we're working on the physiology to give us sensation, that then travels up the spinal cord from the body into the brain saying, Oh, that feels good. And the animal brain is like, Okay, I'm not deprived, I feel this comfort, I feel soothing, I feel contained, which is what we're ultimately looking for. So it's not you give up alcohol and jump off a cliff and just hold your breath and hope for the best. It's, you make a decision to stop alcohol, and then open up this door and explore all of these really cold processes that give a physiological effect that no one ever taught us. But   Arlina Allen  43:59   exactly nobody ever taught us that's why we're using reaching for things that are not good for us because you know, that's what's available. We don't know about all these other things. And this is really speaks to the I want to get to the nurse thing, don't let me forget. But I wanted to also point out something that you highlight, which is it used to be that we would talk about the brain first and then the body and you flip that around, you're talking about addressing the somatic experience and and you hit the nail on the head when you're talking about experience and feelings. Right? And so talk to me a little bit about how we you're we're looking at this differently now we're looking at somatic and then neuro chemistry.   Unknown Speaker  44:45   So you know, that's the latest neuroscience, where Bessel Vander kolk, who wrote the bought the book, the body keeps the score. Oh, Peter Levine, who is the grandfather of somatic experiencing. This is the current research and it's not their opinion. It's I mean, the data is there.   Arlina Allen  45:02   Yeah, there, we have empirical data, we've got the   Unknown Speaker  45:05   data, they're doing the studies, they're you know, they're measuring gabbeh levels, then they have a group of people do 60 minutes of yoga, and then they measure their data levels again, so they're really watching this kind of stuff. But where all of this kind of somatic new neuroscience, what they find from research, not opinion, is that it's bottom up, not top down. So we work with the body, which is kind of all the stuff I've been talking about when we shift the body and the body can start to feel a sensation of calm, and soothing and grounding. That message goes up the spinal cord to the brain. And then the brain can say, the animal brain can say, okay, we're, we're okay with that. Because, again, that animal brain doesn't understand language. So we can't talk to the animal brain. We have to have feel that sensations in the body in really practical ways. This is not esoteric. Whoo, whoo, whoo, whoo.   Arlina Allen  46:01   I like blue. But this is science.   Unknown Speaker  46:03   Yeah, yeah. So that it's, you know, it's where the neurosciences and so that's where I work I work with with physiology with   Arlina Allen  46:11   physiology. Okay. And that makes perfect sense. And that maybe this is a good segue Can we talk about your acronym for nourish because it was all   Unknown Speaker  46:21   good, thank you. So as a as a functional nutritionist, my just really kind of, to pick a word that embodies my work over 20 years, it's it's nourish, which is my strength, and also my shadow, because the work for me is continually nourishing myself and not just food. So what I teach is what I also learn and keep practice. Yeah, so I'm always you know, it's not like I just quit drinking and now I've arrived and tell everybody else what they need to do. Constant practice, alright, but but the word that anchors that for me is nourish and then I created an acronym out of that for for my TED Talk. And so and is notice nature. Oh is observe your breath. You is unite with others are replenished with food. I initiate movement. s sit in stillness, and h is harnessed creativity. And I'm working on my book right now all about that, oh, there's numerous, numerous options and resources and things within each of those categories. But it really brings that whole comprehensive approach biochemical, somatic, emotional, energetic routines, that different things work for different people for regulating and nourishing the nervous system.   Arlina Allen  47:51   You just said something in my eyes lit up, because everybody is different, right? There's so many different paths to this sort of recovery, sobriety, alcohol free life, right? Not there's no one solution that works for everybody. And I think that's largely what's so confusing, is, there are so many, like everybody is so different. And there are so many different tools, but I like the idea that this nourish actually can be applied no matter what your specific situation it is. Your situation is. So what are some of the you mentioned, different supplements and things to sort of regulate those? You know, the GABA, serotonin, dopamine, acetylcholine? What if someone's curious about like, what they should be using? Do you have a resource on your website? Or maybe you can just rattle off a few things that people might try?   Unknown Speaker  48:50   Yeah, yeah, I'm happy to kind of talk through some of those pieces. So I work with clients one on one to really customize this piece. And kind of piggyback on what you just said, I really work with biochemical individuality. So I can rattle off some things, but it surrounds snowflakes,   Arlina Allen  49:06   unique snowflakes, right? It doesn't   Unknown Speaker  49:09   mean everybody out there then needs to take this particular supplement or eat this particular food. And B, this is my functional medicine background of what is individual for your biochemistry. And there's different ways to test that. And we can do lab testing and things. But But you know, the easiest, most inexpensive way is when you eat something, when you take something when you do something, notice what happens next, and three things happen. And it can be a really profound like, wow, that helps so much. My mind is blown right now. Or it can be kind of a neutral, like didn't really feel anything one way or the other. Or it can be I hated that, and I don't like how I feel now. And so I'm always cueing people back to that and the more kind of regulated and grounded we are in our body when the body is Calm, and there's practices and ways to do that, the easier it is then to kind of notice, like, what just happened here. Whereas if we're always kind of up in our head and just running and you know, in that intellect mental, it's hard to be like, I don't even know if I liked it. I mean, I just did it. So that's the argument of kind of somatic work. But um, but going back to just kind of some things, you know, I recommend, so biochemically whole food is king is golden. eating real food is is a great place to start. So did it grow from the ground? Can you pick it? berries? You know, bananas off the tree? Can you know, can you hunt it? If you eat meat? Can you gather it like gathering fish, or eggs or cream from the cow. So actual real food, that there isn't a list of ingredients, you know, 43 letters long and a whole paragraph. Real Food. And this is what I would teach in corporate all the time is, it's actually really, really fascinating. You know, one of the most fascinating lectures I ever heard in functional medicine, was a medical doctor who lectured about broccoli for an hour, it was fascinating. Because the chemical breakdown in broccoli, and every fruit and every vegetable, some of that we are still discovering. Because it's like, yeah, yeah, eat your vegetables. But when you really break it down, it's mind blowing, like what that, again, it's physical food and our physical body, what that does. So going back to the basics of whole food, if there's anything I can inspire people with is eat real food. That's in season, it's local, it's colorful, if possible, sometimes that's not always possible. But starting there, you know, eating regularly, because then the body breaks down into amino acids that are the raw materials for the brain. When you eat real, healthy fats, those break down into the omega three fats, some of our omega six fats, those are those necessary fats, again, for the brain, you know, good vegetables, even fermented vegetables, like sauerkraut, that's that good bacteria that goes into the gut. So there's just, it's just endless. The benefits of, you know, the exciting, like, mechanisms within food. And so I like to start there and try to you know, inspire people, and you don't have to, like clear your cupboards. It doesn't have to be radical. Yeah, I'm never radical about any of this. But the idea of adding something in instead of trying to take a bunch of stuff out, add in real food,   Arlina Allen  52:39   and real food, that isn't it? Yeah. And I think you were, I think I heard you say that the amino acids and the proteins are the building blocks to these neuro chemicals that we need. And like, at the end of the day, when maybe your gamma is low, or serotonin, or whatever it may be, all of them are low at the end, is that true that it's low at the end of the day?   Unknown Speaker  53:00   That's a good question. Um, I think it's more kind of over time, you know, like a 30 day period, a snapshot of like, what are we, you know, kind of dumping in that period, although there are urine tests that we do a 24 hour urine collection, and they are seeing like, how much of the neurotransmitter were dumped into our urine in a 24 hour period. So I think it's both you know, just kind of seeing like, the pattern that the body is on but also it's interesting, like what happens over over a longer period too.   Arlina Allen  53:32   Yeah, the reason I asked about the end of the day because I feel like that's like the witching hour for a lot of people, you know, but I think it speaks to meeting like we're so jacked up all day trying to get stuff done, that in the evening we're trying to do was deregulate down regulate to regulate, yeah, just just regulate, yeah, emotion management thing.   Unknown Speaker  53:56   So biochemistry is a huge part of it, our neuro chemicals, our blood sugar, our you know, our thyroid, our gut bacteria, our adrenal function. So adrenals are closely connected with dopamine. So if we're running on cortisol and adrenaline, then we're also pulling down on dopamine as well. Every neural chemicals connected with a hormone. So progesterone and gabbeh are connected, which I find a lot of women who are in this gray area struggle with wine are low and progesterone and low and Gabba. And you know, a common kind of symptom complaint of those two chemicals being low is anxiety and difficulty sleeping. And so a lot of women that are reaching to wine to help them sleep and to help manage their anxiety and when we lift the physiological hood, it's low gabicce, low progesterone. So there's all of these kind of physiological pieces, we can start with food, there's different nutrients that can i Find a lot of women are low and gabbeh. Dopamine is the sexy neuro chemical that everybody's like, oh, the dopamine hit the dopamine hit but but in reality, if we're really trying to boost dopamine, we tend to be more interested in things like cocaine, ecstasy, espresso, a pot of coffee, where if we're cocaine or coffee is more low gabbeh, which I'm certainly have that predisposition to be low gabbeh that's been more reaching to things like marijuana, Cannabis, alcohol to hit that off switch. So it's interesting what people you know, reach to so that's the biochemical side, there's some herbs or some nutrients to boost GABA boost dopamine, but then there's also what you're talking about kind of the witching hour, at the end of the day, that then goes into some of just the nervous system fight flight freeze response. So it's not always biochemical, but they're all interconnected, they all work together. If we're in a constant flee response, we're going to be dumping a lot more, you know, of our gas, the dopamine they see, so it all connects. But the but the fight flee freeze response. And if we're, if that valve is always on, if we're always kind of in a flee or in a fight, or we've just in that frozen kind of immobilized, protective state, that's exhausting. Any of those states if the, if the on switch is always on. So by the end of the day, it's hard to continue, we're exhausted holding that dysregulated state. So now we want to regulate it with alcohol to kind of let the valve off constantly, you know, we're fleeing, we want to move we want to, and it's like, I want to stop and slow down. So it could be some of that polyvagal kind of stress response, as well. And then there's, you know, the, the energetic side of things. So this is acupuncture, you know, they talk about, like how the energy moves in the body. So, if there's an area that's, that's more stuck, or moving really fast, and that's where body work comes in acupuncture, you know, working with the energy system, so there's no one size fits all, but I work with people to get kind of the full story. And it's like, where do we want to kind of start here with what might be a missing piece? And what might be depleted? And it's so   Arlina Allen  57:17   good, how do people connect with you if they want to reach out and work with you.   Unknown Speaker  57:23   So gray area drinkers calm is my sites where all my info is, you can email me I work with clients, one on one, I have a coach training where I train other coaches on the nourish method. And my TED Talks, there are lots of interviews I've done. And then I have did a podcast as well called edit, editing, our drinking and our lives. And so all of that on gray area drinkers calm.   Arlina Allen  57:48   That is amazing. I leave all leave links, ever. I know people are probably taking notes or driving or whatever. So I'll leave all the links in the show notes. But this has been such a fascinating conversation. I could easily talk to you for the rest of the day. So many questions. And I just think this was so helpful. Thank you so much for joining me today. Thank you so much for having me. It's fun to meet you and chat with you. Thank you. Yeah, definitely. Thanks so much. And I'll leave all the show notes, links in the show notes how people can get a hold of you.   Unknown Speaker  58:20   Wonderful. Thank you.   Arlina Allen  58:22   Thanks.  

Autism didn't appear in the DSM until 1980 or as a disability category under IDEA until 1990. Meet the woman who began building the autism advocacy movement on Staten Island in 1981. Donna Long is a dynamic Staten Island community leader who has been advocating for the needs and services of individuals with intellectual and developmental disabilities (I/DD) and autism since the early 80s--and her impact is still felt today. She is recently retired as Executive Director of The GRACE Foundation, a non-profit that works with individuals and families impacted by autism. Donna currently serves as Director of External Affairs for Crossroads Unlimited Inc., an agency that provides comprehensive services for individuals with I/DD. To read the transcript of this episode, visit www.includenyc.org/images/uploads/content/Before_We_Knew_Autism.docx.pdf.

This episode explains the "narcissism continuum" from the DSM definition of Narcissistic Personality Disorder, Pathological Narcissism, through healthy self-esteem. There is a discussion about subtypes, mostly covert and overt but I mention others, misconceptions about female narcissists, a bit of a deep dive into the differences between male and female narcissists and reasons why studies on female narcissists are scant, and on part C I discuss the narcissistic relationships of Chris Watts and Chris Coleman which led each to murder his wife and children.

This episode explains the "narcissism continuum" from the DSM definition of Narcissistic Personality Disorder, Pathological Narcissism, through healthy self-esteem. There is a discussion about subtypes, mostly covert and overt but I mention others, misconceptions about female narcissists, a bit of a deep dive into the differences between male and female narcissists and reasons why studies on female narcissists are scant, and on part C I discuss the narcissistic relationships of Chris Watts and Chris Coleman which led each to murder his wife and children.

This episode explains the "narcissism continuum" from the DSM definition of Narcissistic Personality Disorder, Pathological Narcissism, through healthy self-esteem. A discussion about subtypes, mostly covert and overt, misconceptions about female narcissists, a bit of the differences between male and female narcissists and reasons why studies on female narcissists are scant, part C I discuss the narcissistic Watts and Coleman affairs and murders.

Día de montaña con una escapada que logró pelear para la victoria de etapa. El corredor francés Romano Bardet del equipo DSM fue el más fuerte de los fugados y consiguió este triunfo parcial. En el pelotón, solo hubo un ataque al final de Miguel Ángel López, pero sin grandes consecuencias. El danés Odd Eiking sigue en primera posición en la clasificación general.