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Joe Sanok 00:00:00  You're someone with a vision for your practice, for your side hustle, and for your personal journey. But when it comes to establishing your path and how to get to where you want to be with your practice, things get a little messy. You're also someone who'd prefer to go in person instead of to groups and listening to everyone else's story. To me, it sounds like you could benefit from one on one consulting with our experienced practice of the practice consultants from 595 a month and up. You can work with a consultant that will give you more direction and practical, tried and tested tips matched to you and your goals. For more information, visit practice of the practice. Com forward slash apply. Again, that's practice of the practice. Com forward slash apply. This is the practice of the practice podcast with Joe Sarna session number 1178. I'm Joe Santos, you're hosting. Welcome to the practice of the practice podcast. We have been doing series every month. just talking about different things. So at the beginning of the year, we did the even Better Year series.

Joe Sanok 00:01:19  And so the idea was small steps in the right direction. instead of, you know, we're going to make these big New Year's resolutions to just say, what are some small steps in the in the right direction. So a lot of really interesting things there. Back in episode 1157, we talked about like, where do I belong? Healing trauma from the Asian American identity perspective. we talked about psychedelic medicine at the end of life. We talked about non-obvious thinking. we talked about how do you create evidence based content for your clients? So, so many different things that we covered throughout that month. And then in February, we had Marketing Month. So we talked about digital marketing. we talked about mental health awareness. We talked about the rule of 26, all sorts of things to help you grow your private practice. And then this month, we're doing the Better Mental Wellness series. So beginning of that month we talked about psychedelic assisted therapy. We talked about self-compassion, deeper mindfulness, working with chronic illness.

Joe Sanok 00:02:16  And today we have on the show Shawn Interpretation, who is DSW, LCSW and autistic psychotherapist and researcher through Mayo Clinic Health System. He regularly trains healthcare professionals to be more confident when working with people on the spectrum. Sean, welcome to the practice of the Practice podcast.

Dr. Sean Inderbitzen 00:02:35  Hey Joe, thanks for having me.

Joe Sanok 00:02:37  Yeah, I am so excited about this topic. I'm excited about the just growing awareness in regards to being on the spectrum. I remember I was down in Asheville and there was this store there that was entirely curated by people on the spectrum. And so they had tables where, like different art that just an individual was really into. when you walked in, they had a big sign that said, if you need noise canceling headphones or if the music's too loud, like, please let us know. It was just such a wonderful, sensitive place that felt like we should be doing this. Because like when I saw these curated tables, it felt like the world had been missing out by seeing the world through that lens of these individuals.

Joe Sanok 00:03:21  And it just I feel like the growing awareness around autism and being on the spectrum and all that that brings to our community is just so wonderful. So I just want to start with, I am so excited to have you on the show today.

Dr. Sean Inderbitzen 00:03:32  Oh, I'm excited to be here. I mean, you do a really cool thing for practitioners. It seems like by giving them space and just content for how do they how do you support like growing your practice, which is so hard in private practice?

Speaker 3 00:03:47  Yeah.

Joe Sanok 00:03:48  Well, I want to start with, tell us your story of diagnosis.

Dr. Sean Inderbitzen 00:03:52  Sure. So I grew up and I didn't actually get diagnosed till I was 18. so I grew up not knowing. I mean, I have notes, medical notes, right from when I was three and they're like, he's likely autistic. But it took my parents about 15 years to get there. which is a pretty common thing, right? Because there's all kinds of legal defenses you can raise, but also discrimination you can receive because of that diagnosis.

Dr. Sean Inderbitzen 00:04:18  And in the 90s, right, when I when this first medical note appeared, right, like there was a lot less acceptance of autism to where now like they actually call it April Autism Acceptance month. and so like it's really changed and it's kind of been like, I'm old enough now. I'm having more and more of these experiences where I'm old enough to remember when it wasn't, and I'm kind of moving into when it was. And so it's interesting to see how short memories are. But when I got diagnosed, it was because I was facing some legal charges. And, they got dismissed. But I had had a car wreck and I left it and they were like, you probably should have stayed. And I was like, I turned myself in inevitably, but, and and I only was like, gone from the scene for about an hour, but still was enough to raise for a legal charge. And part of what right was the legal defense was like, look, you didn't get the very obvious social cue of you stay at the scene of the accident.

Dr. Sean Inderbitzen 00:05:17  But in the Pennsylvania Dot manual, nowhere in it does it say stay at the scene of the accident, because there's not a literal rule. And so very I mean, I had to do the 802, which is the Autism Diagnostic Observation scale, and I got diagnosed and then I've had it ever since. And it has served me, I mean, as I've made a career out of it. And it's also been used against me as it's been used against me in court proceedings. And so it kind of cuts both ways.

Speaker 3 00:05:47  what.

Joe Sanok 00:05:47  Do you think for your way that autism manifests her is experienced. What are some of the things that is helpful for you?

Dr. Sean Inderbitzen 00:05:58  Well, I find it helpful to have people be honest with me. and it it makes the clarity much more helpful. Like, I have a friend who's a surgeon, and in that friendship, she is just pretty direct. And so I appreciate that. So most of my close friends are pretty direct with me. And so they kind of know, hey, like, I don't have to hold back with you, Sean.

Dr. Sean Inderbitzen 00:06:25  And that's not to say they shouldn't be sensitive, but sometimes the nuance gets lost on me. And so my friends kind of come to learn as they get to know me, like, hey, you're missing some things. And the best examples? I have this coworker and we're newer to each other, and so she has a son who has on the spectrum. And so I think she gets it. but she had these cheese puffs and so I unwittingly just walked in there, took my hand, stuck it in there and, you know, took some cheese puffs. And she didn't react in her very therapist way. But a couple of weeks later, she was like, you know, that really freaked me out. It's like really? And so, like when you're in a state of like when your autism shows up, like, I think about autism in sort of these poly vagal terms and state specific ways. So like in that moment, I was probably just on autopilot, probably sympathetic and activation and just completely not taking in like what are her boundaries about consent? Like, what about consent of me sticking my hand in her food? What does she think about germs being spread? Right, like all these things that matter that just kind of go by the wayside.

Dr. Sean Inderbitzen 00:07:33  And so being friends with me, to your point, right, I think is a challenge, but also a blessing like it comes. It cuts both ways. I miss things, and I just sometimes I'm not fazed things, but other times I mean, I have a really honest, deep connection with people, so it goes both ways.

Joe Sanok 00:07:53  Now when did you decide to be a therapist.

Dr. Sean Inderbitzen 00:07:57  So I had a therapist about five years ago after I'd finished my masters. and I had actually done my master's in Social Work to study social policy, but I wanted to stay in my kids lives and I'd been divorced. So in order to keep placement at where it is, presently, I had to stay where I live and live within 100 miles of it. But really, when you know about placement, right? Like you can't, you live in the same school district as your kid in Wisconsin and their parent, right? So we picked Rice Lake. That's where we live. and so I had a therapist at the time who was like, you know what you'd be really good at? Because I had no idea what I'd be good at, because the thing I went to school I could not do, she was like, you could be a therapist for people with autism.

Dr. Sean Inderbitzen 00:08:43  So I was like, all right, I'll give it a go. And so it's just been this process of like, hey, I have autism and I do therapy. Cool combo. And people have been just kind of jumped at it.

Joe Sanok 00:08:54  Yeah.

Speaker 3 00:08:55  Now,

Joe Sanok 00:08:56  Tell me about.

Speaker 3 00:08:58  Being.

Joe Sanok 00:08:59  Open, about being on the spectrum and being a therapist. one of the things that I really believe is when you have a niche, you're going to attract the people that you really want to attract, and you're going to repel the people that you really shouldn't be seeing anyway. How has that been true in being so open about your story?

Dr. Sean Inderbitzen 00:09:17  I mean, so that's that's kind of worked both ways, right? Because so I work in community mental health. So unlike most of your audience who's in private practice, we take whoever comes through the door. as I have grown and trained right, and become a trainer. So doing things like the motivational interviewing training series and then becoming a trainer trainer of my products, by doing sensory motor psychotherapy training.

Dr. Sean Inderbitzen 00:09:42  It's really kind of evolved my practice. Like at the beginning of my practice, I got a lot more kids with autism who are pretty aggressive, a lot of aggressive young boys, and actually found quite a bit of skill in that. But I have a lot of stuff around childhood, and so a lot of their laughter and just smiling would be enough to sort of trigger me in some ways. And so like kind of over time moved out of working in schools and with that population and really have moved towards more of a family therapy model for ages six to 10 or 12. And really, I kind of I'm pretty like careful about do I think I'll be a good match with people in that age range? I tend to work more now with teenagers and adults, because they tend to be able to take in some of the concepts and skills that ESP, really sensory motor psychotherapy really demands, like body based awareness. Mindfulness, like I used to get really exhausted from working with like inattentive clients. But now it's a lot more about redirection and reframing and just coming back to and kind of being sensitive and aware to where somebody is in the moment, but really to like, tune into their body and tune in to their pain.

Dr. Sean Inderbitzen 00:11:02  And so it's a lot less of a struggle working with convicts now working with, and when I say convicts, I don't mean like just stole something. I mean, like put people in the ground and murdered people kind of convicts. And I get a lot of those and I get a lot of veterans now. And so I get a lot of people who sort of fall into that question of, do I have antisocial personality disorder or not? And a lot of people saying to me, I don't feel and I'm this unfeeling monster. And so I've just kind of naturally moved into it, which, you know, I'm good at it and it comes with some real risk.

Joe Sanok 00:11:38  Yeah. Now talk to me about this shift into doing more training and working with the Mayo Clinic.

Dr. Sean Inderbitzen 00:11:44  Sure. So I have become a trainer over time because I was first in my second year of practice when Covid hit, I was discovered by the UJA Federation in New York City. basically, I wrote an article about autism and Covid and somebody in New York read it and they were like, you know, we should really have him on a panel.

Dr. Sean Inderbitzen 00:12:06  And then I did that, and I applied to work at PSC to do some trainings on motivational interviewing and autism, because I, I came up in the state Department of Vocational Rehabilitation, where me was a regularly bought product by the government to train their staff and so noticed that people made careers at being consultants. And so that's why I did the motivational interviewing networks of trainers training. and then I've done my trainer trainings, through the state of Oklahoma SAMHSa division. And as far as Mayo goes, that kind of happened when I got my doctorate or right around the time as I was getting it from Tulane School of Social Work. And, have been able to pursue, like studying my own presentations, through Mayo Research dollars because I taught at the university, which the university is a pathway to work with Mayo Clinic researchers and providers to create tools. And so we created a curriculum that increases confidence and statistically significant degrees. in, in a decent effect size. Right? I mean, and we used a standardized measure to measure that impact.

Dr. Sean Inderbitzen 00:13:21  And we started with eight, we ended with three. So we had a pretty small sample size. But it was enough to get Mayo's co-ownership of this product that we sold to Naughton. So one of the cool things we're doing right is, Norton is actually bought and purchased. We still have yet to sign on it because Mayo is super protective of their brand. And then there's another third party that the university I'm affiliated with. and I sort of all own this copyright to this curriculum. And so this curriculum, really, when Norton rolls it out, will be a product for medical educators. so I think doctors at med schools or psychiatrists or schools of social work, right or left programs that want to start an autism certification program can use this product. And I mean, there will be a process for that. But that's coming out from Norton. so I'm pretty psyched about it. So working with Mayo has really been about developing educational products that really move therapists from being not so confident to working with autism, to more confident, to working with autism.

Dr. Sean Inderbitzen 00:14:25  And the really strong way that we can show mathematically.

Joe Sanok 00:14:29  And what what are some of the principles that you cover?

Dr. Sean Inderbitzen 00:14:33  Sure. So some of the things we cover are the history of autism. the need to be person centered and part of the pedagogy and how we train people to do this is very influenced by motivational interviewing. Right? So kind of looking at doctors as people. Right? So like they might not be super willing to work with someone with autism and seeing that ambiguity as sustained talk and really looking at, well, what does it do? Like what can we do around that to kind of move towards change. And so we cover a variety of topics, some CBT, some motivational interviewing strategies, some game theory, some alexithymia topics related to autism in that product. And so people go through that. So they go through a two hour lecture and then our trainers that we're going to train. So like if you're a teacher right. And you want to use this product, you have to go through a training.

Dr. Sean Inderbitzen 00:15:25  And that training will allow will teach them how to do consults. Right. So it's two hours of actual didactic learning, and then 2.5 hours and half hour increments, or however people want to structure it. Right. of actually like working with clinicians on real questions. So it might be a med school professor and his med students, right, for doing a rotation and a developmental disabilities wing or a psychiatric inpatient unit. And they need to learn about developmental disabilities. And so it gives the trainer so that med school teacher the tools they need to be able to educate those med students who are doing those medical grand rounds and rotations and working with patients with autism, right. To be patient centered, like one of our Mayo physicians that went through it said. Part of what made a difference to me about going through this training was like, when I started, I didn't really know how to talk to somebody with autism, but I had this client establish care with me as an adult. And so this guardian comes in the room And it starts to rattle off things and I stop her and I go, I you're I'm glad you're here.

Dr. Sean Inderbitzen 00:16:36  And I appreciate your insights, but I'm really here for this adult here who you're the guardian of. So I need to hear from him what he wants. And so to me, that's really what we're trying to do with this tool is really this Norton tool, this autism educational program, really give create trainers who believe in using person centered practice, which is just best practice.

Joe Sanok 00:17:08  Listen, I didn't take insurance in my counseling practice because I had no idea how to handle it. The process of accepting insurance outside of a group practice can be tough, but most people looking for mental health care want to use their benefits to pay for sessions. If you're like me and you feel a little scared about taking insurance, or you just want to make it easier on yourself. And you're interested in seeing clients through insurance. Alma can help. They make it easy to get credentialed with major insurance plans at enhanced reimbursement rates. They also handle all the paperwork, from eligibility checks to claim submission and guaranteed payment within two weeks.

Joe Sanok 00:17:43  Plus, when you join alma, you'll get access to time saving tools for intake, scheduling, treatment plans, progress notes and more in their included platform. It's going to make it so much easier for your team so you can spend less time on administrative work and more time offering great care to your clients. Visit. Hello alma com slash Joe. That's. Hello al McCombs Joe, to get started. Now, if you could just embed in every grad school program maybe like five points, three, 3 to 5 points that you feel are just baseline what every therapist should know about working with people that are on the spectrum. Like, what would you say if we just did like a brief master class for folks? What would you want to make sure? Okay, here are some of the core things that at this point, we should have embedded in our knowledge as therapists.

Dr. Sean Inderbitzen 00:18:40  I mean, I'm a little biased because I wrote a book with Stephen Porges, but I would say autism is a biobehavioral condition that is reflective of state conditions.

Dr. Sean Inderbitzen 00:18:50  Really, that's a fancy way of saying autistic people are more likely to have fast heartbeats. And so if you're gentle with them, they're less likely to become defensive and move into states of threat. And when you do that right, you create more flexible people to work with and you create more social connection with someone. And so that would be point one. Point two would be if you met one person with autism, you met one person with autism, right? because autism is historically for diagnosis and it's been rolled into one with a qualifier. And so that would be 0.2. And then 0.3 would be really just that if you want to make change in a, in the life of a person with autism, you need to see them as a person who may exhibit some change talk and some sustain talk. And if you approach that ambivalence with kindness and generosity and gentleness, you're going to get way further and working with them.

Speaker 3 00:19:50  Well I want.

Joe Sanok 00:19:51  To dig into each of those. So tell me more about that biological side of like.

Joe Sanok 00:19:56  I mean that to me. I had heard some of that, but you know, even just higher heartbeat, you know, be gentle makes it easier. Like, makes total sense. But then also like, tell me more about that research and tell me more about that concept.

Dr. Sean Inderbitzen 00:20:10  There's about 15 studies starting in the 80s. that look at how heart rate variability tends to be lower or and really what that translates to his people have a faster heartbeat, which is confusing because HRV heart rate variability is the distance between heartbeats. so people with autism tend to have higher heart speeds. we see it in children. We see it in adult patients. It it is just this anatomical thing that happens. And it's not it's not ruled as medical fact yet, but I mean, 15 studies over five decades across different countries to me, right, is kind of that how does a hypothesis become a theory process? Because these are people independent of Steven Porges, who are doing this research and arriving at the same thing. Now, there's some criticisms of this, but really the impact of that is if you meet a person with autism, you're more likely to encounter them in a state of threat.

Dr. Sean Inderbitzen 00:21:09  Right. And so I see autism as this modifiable modifiable condition over time. Right. So our historic definition, the one that Medicaid uses, the one that the CDC uses says autism never changes. And it's why, right? If you go for Social Security and you have an autism diagnosis, you're way more likely to get it. You're not guaranteed, but your odds increase drastically because we look at these as neurodevelopmental. And the truth is like genetics and neurodevelopment, I don't actually think really matter to improving the quality of life for a person. Right. And that's why I like in my own experience, right? I have friends who are like, you're autistic, like I've had people come up to me and be like, you're not autistic. I'm like, fraid I am. But yes. So like, but but you that fit.

Joe Sanok 00:21:59  Into the category I think of, you know, however they've thought through it of the one person they've seen in movies or the one person they've seen in real life. Yeah.

Dr. Sean Inderbitzen 00:22:07  Well that or I think. Right. Like the idea that you can have autism one day and then if you do and cultivate strategies to become more flexible, to be less rigid, right to be able to be more fluid with in your inner world. Right. Less rigid and. And you cultivate connection and vulnerability, right. Like you live a deeper, richer life and you might not meet criteria for autism anymore. Now, granted, the fetus has some early childhood development, things that have to be present. But like I think for me, the rise in rates of diagnosis for autism has very little to do with the diagnosing of autism, and a lot more to do with faulty diagnostic measures like the two. There are three studies that sort of say the two has a 25 to 35% error rate for diagnosis. And so I do this as part of my work. I diagnose people, and so much of what I do is really about like trying to parse out as this PTSD, OCD or autism, it can be all of the above, right? But it becomes a much more murky picture.

Dr. Sean Inderbitzen 00:23:18  If someone's got OCD and a lot of anxiety tendencies, and then you treat them with like, say, ERP, and then they don't look autistic anymore. And so it to me, like what we call autism is really this reflection of a nervous system that is in a chronic state of threat. Because really, when you think about chronic threat, like if you think about fortune 500 companies, people aren't creative because they're under threat. Like it. I think how to say it like people are rigid, they're scared. Right. So when you're afraid, when you're defensive, it's a really hard thing to go for change. Right. And so I think right, when it comes to people with autism, as we understand it, we're looking at people who are using a lot of fight flight and a lot of collapse system. The technical terms for those are dorsal, vagal and sympathetic. But really all that is a fancy way of saying is people are less connected and more in defensiveness. And so there's a lot of debate around that.

Dr. Sean Inderbitzen 00:24:21  But to me that's a modifiable thing, like whether whatever you call it, PTSD, OCD, autism, right. Like the DSM is really our best attempt or our longest attempt to trying to name a thing that happens in the body, but to the body, there's no such thing as diagnosis. Right? And so really like the book I wrote, Autism and Polly Vagal Terms with Norton, is about giving people the tools they need, specifically giving therapists the tools they need to help autistic clients with a lens that really familiar with. Right? We all know political theory from trauma therapists and the trauma world, so why can't we apply it to people like me?

Speaker 3 00:25:02  Yeah.

Joe Sanok 00:25:03  Now, you kind of touched on your second point about if you've met one person with autism, you've met one person with autism. can you talk a little bit more about just that changing like you talked about kind of change as a person. coping skills. being less rigid, what's been specifically helpful for you both, you know, for yourself, but then also with the clients that you work with in helping build that, those adaptation skills.

Dr. Sean Inderbitzen 00:25:29  So I had this fiance named Stella that left me, and so much of why she left me is because of how rigid I was at the time. I was very dead set on creating this career I have now, and I did right. But like, she really loved our small life in rural Wisconsin. Didn't really imagine, like, wanting to, like, travel to Anaheim and Raleigh and all these places because that was overwhelming for her. Right? And I just completely missed it because I was so dead set on achieving this dream that I could not take in the ability to, like, empathize with the fact that somebody might not want this life, right? Because it has pressures. It has conditions. I've turned over a lot of control of my life, and I'm only going to continue to do that as this grows, to people I trust. And so what has been helpful in that area post her leaving? I mean, so for me, it's really been two things running in yoga. so I taught I have a chapter on exercise and biofeedback.

Dr. Sean Inderbitzen 00:26:37  So the first year she left I was running like two miles a day, max, one mile more than likely, and I'd be running 2 or 3 times a week the second year through to like 3 or 4. And I started going to yoga. and so the third year, right, has really been like I did the whole summer for Marathon Prep. And so I did like yoga once a week. And I was doing I've been doing like probably 30 miles a week on my body because I have a marathon in Tampa. I'm going to run in January And I'd have days where I would do 20 mile runs. And so like moving from a place of doing only like 14 miles a week to 30 plus miles a week, right? It makes for a different outlook on the world, like just by running and having a process of being mindful, like listening to music while I run in my AirPods and just kind of zone out for hours on end. Right? Like really makes you slow down. Like I can see now, if Stella were here today how she might not want a life like this.

Dr. Sean Inderbitzen 00:27:43  And so it would really be about being more flexible with that partner or whoever would be there. Right. And so like cultivating that flexibility and that connectedness is kind of like this ongoing journey of like really encountering myself and my own parts. I did ifs to heal a lot of my own trauma. And so that has been a really effective tool, though, to become less rigid, to become more flexible because it really requires examining my own motives, right? And not just letting them free rein. Right. Because it's really about bringing my brain out of threat and bringing online that prefrontal cortex so I can mindfully observe my own experience. And that's really what these tools and autism and vagal terms are all about.

Joe Sanok 00:28:30  So awesome. Well, the last question I always ask is if every private practitioner in the world were listening right now, what would you want them to know?

Dr. Sean Inderbitzen 00:28:37  I would want them to know that they probably already have the tools to help someone with autism. And legal theory is a great way to do that.

Joe Sanok 00:28:46  So awesome Sean, if people want to follow your trainings, if they want to learn more about your work, where should we send them.

Dr. Sean Inderbitzen 00:28:52  so you should send them for my trainings to Polyvore Institute. it's going to be autism awareness next month. And our goal here in quarter one was to put out an autism training on political theory. So if you want to get trained, more should look there. My Instagram and my LinkedIn are in are going to be in the program description is how I understand Joe. Correct me if I'm wrong, but yeah, I mean, I think that's the way to really connect to me. because that's where there's a form in there, a survey people can fill out that's really helpful. Or you can just message me directly.

Speaker 3 00:29:30  So awesome.

Joe Sanok 00:29:31  Sean, thank you so much for being on the practice of the practice podcast.

Dr. Sean Inderbitzen 00:29:34  Thanks, Joe.

Joe Sanok 00:29:42  You know, finding the things in our own lives that, make us different than other therapists, I think is one of the the best ways to grow, our practice, to even just, you know, whether it's, you know, being forthright with I'm on the autism spectrum or to even just talk a little bit more about just our personal lives, what we enjoy.

Joe Sanok 00:30:05  those are the things that help us connect with our ideal clients and help us shift conversations in ways that that maybe we couldn't if if we weren't as straightforward. And I think that in grad school, sometimes we're encouraged so much to to really think through, self-disclosure and all of those things that are needed but often stand in the way of clients saying, oh my gosh, I totally want to work with that person. you know, the fact that my therapist, my own personal therapist that I work with, that his practice is called middle path counseling, that he takes a very kind of Buddhist Daoist approach to, to therapy that, he's as much someone that meditates as he is a social worker. those are all things that attracted me to working with him, because that's what I was looking for. and so I want to encourage you to think about what makes you unique, that maybe you haven't disclosed on your website, that you haven't disclosed on your Facebook page, your Instagram, those sorts of things in your marketing.

Joe Sanok 00:31:02  And, you know, finding new clients is often a struggle. and alma can help you with that. Almost supports clinicians in building a rewarding practice. They help with simplifying the insurance credentialing in under 45 days. They help with getting enhanced reimbursement rates and a guaranteed two week payback. So you get your money way faster. you could get supported by alma right away over at hello, alma Camacho again. That's. Hello alma.com/jo to learn more. Thank you so much for letting me into your ears and into your brain. Have a great day. I'll talk to you soon. Special thanks to the band Silences Sexy for that intro music. And this podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. It is given with the understanding that neither the host, the producers, the publishers or guests are rendering legal, accounting, clinical or other professional information. If you want a professional, you should find one.