[HEARD] It’s never too early to start thinking about tax season. Heard is the financial back office built specifically for therapists in private practice. They combine smart software with real humans to help you manage your bookkeeping, taxes and payroll. Regardless of whether you’re a seasoned clinician or are in the first year of private practice, Heard will identify areas of growth and streamline best financial practices for your business. When you sign up with Heard, you’ll connect your bank accounts so your transactions will automatically be pulled in and categorized. My favorite thing about Heard is their allocation guide, what helps you decide how much to pay yourself each month and how much to set aside for taxes. You’ll also receive financial insights such as profit and loss statements and personalized monthly reports. You can say goodbye to pouring over spreadsheets and guessing your tax deductions or quarterly payments. Focus on your clients and Heard will take care of the rest. Heard always has transparent pricing with no hidden fees. Sign up for a free 15-minute consult call today at joinheard.com/partners/joe. Again, that’s joinheard, like I heard it, not like a herd of cattle, joinheard.com/partners/joe. [JOE SANOKA] This is the Practice of the Practice Podcast with Joe Sanok, session number 829. I’m Joe Sanok and welcome to the Practice of the Practice Podcast. I am so glad that you are here today. If you are just starting a practice, you are in the right spot. If you are growing a solo practice or moving into a group practice, you’re in the right spot. If you’re growing a group practice, you’re in the right spot and if you’re leaving a practice and moving into things that are beyond doing the direct clinical work, you’re in the right spot. We help people to start, grow, scale and exit their private practices and just so excited that you’re here. If you are at that very beginning phase and you want to get our free email course all about starting a practice, you can get that over at practiceofthepractice.com/start. If you’re growing a group practice and you want some extra training, you can head on over to pillarsofpractice.com. We have a really robust free e-course for you over there. If you need some extra help beyond this podcast, we have lots of things that you can get some help in. Well, it’s the end of the year. We’ve got less than a month until 2023 at the time of this release of this recording. It’s a time to reflect back on the year to think about what trainings you want to get next year, saying how am I going to level up in 2023? How am I going to keep the momentum that I started this year? How do I also maybe slow down a little bit around whatever holidays you celebrate around this time of year, spending time with your family or your friends. So I just want to encourage you to take some time to just chill out a little bit. I always take from my birthday December 22nd off until just after New Year’s every single year because we have so many family events and it’s just nice to have that time with my girls when they are on their Christmas break. However, that looks for you at the end of the year, hope you are sorting that out so you can take a little time off as well. Well, today we have Rebecca Kase with us and Rebecca is a force of nature. Her warmth and authenticity make her a natural leader and teacher. She’s an LCSW, a yoga instructor and EMDR trainer and consultant. She owns Kase and Company, an EMDR training and consultation business. Her expertise is in EMDR and polyvagal theory and supporting therapists becoming experts in EMDR therapy. Rebecca, welcome to the Practice of the Practice Podcast. I’m so glad that you’re here today. [REBECCA KASE] Hey Joe, I am so grateful to be here. Thank you so much for having me. [JOE] Yes, and I didn’t add that last line that you live in Washington state with your husband and four fur babies. Tell me about the fur babies. [REBECCA] Yes, I have four forever two-year-olds. So I have two sweet kitties and two very high energy border colly dogs. [JOE] Wow, that’s a handful, but I’m sure it’s wonderful. Well, we are talking EMDR today and I would just love to hear what’s your story in regards to how you got into EMDR and then we’ll dig into some of the nuance around it. [REBECCA] Yes, so I got trained in EMDR when I was still in graduate school back in 2006. That was before EMDR was recognized as an evidence-based practice, so it was still considered pretty controversial and woo-woo, but I had a supervisor at my internship who was trained in EMDR and the internship I was practicing at everybody just really embraced EMDR. I was really specializing, in grad school on trauma therapy and becoming an expert in trauma therapy, so of course, EMDR was in my world of awareness. I went and got trained in 2006, started my training rather, and I’m so grateful I did because it forever changed my clinical practice I feel in this really powerful way because EMDR really teaches you to conceptualize common presenting symptoms and themes and complaints that our clients come to us with through the lens of the nervous system. How can we make sense of this clinical complaints through the lens of your client’s neurobiology? So I got trained in EMDR, went on to continue practicing. It got a lot of pushback when I was new in the fields with EMDR because again, it wasn’t recognized or fully accepted and then sometime around 2010 it was embraced in the community as an evidence-based practice. Now, I mean I think most therapists know of EMDR. I’ve heard of EMDR. It’s becoming a pretty common and well-known psychotherapy practice. I went on to become, get certified in EMDR, which is the level of credential in which you have additional skills and so much practice and training. Then I went on to become a consultant and then went on to become a trainer, which was never really my plan, but the universe just took me in this direction and I’m so grateful for it. [JOE] Well, before we started recording, we were talking a little bit about some of the myths around EMDR and the idea that most people are familiar with it around trauma. Will you dig into maybe that myth that EMDR is just for trauma and other myths that maybe, or misconceptions or maybe even expansions that you’re seeing yes, EMDR is effective say with trauma, but also we’re seeing that it expands in these other areas. What are misconceptions, myths, or areas that you would expand EMDR’s focus? [REBECCA] Yes, great question. EMDR is evidence-based for PTSD. Yes, it’s most well-known for the treatment of trauma and trauma-related symptoms but EMDR is really based on the processes of neurobiology and memory consolidation and how when our memories consolidate maladaptively, that leads to clinical complaints like anxiety and depression, addictions, grief, complicated grief, performance anxiety, chronic pain even. Those are all conditions and symptoms that EMDR is not necessarily evidence-based for, but studies and research show that EMDR can have effectiveness with those super common clinical presentations. Essentially, I think of EMDR as an amazing, powerful therapeutic approach. It’s a whole therapeutic orientation, not just a tool in your toolbox. That’s another myth is that people think it’s just an intervention, it’s just the eye movements. Just think about what hurts and follow my fingers with your eyes. That’s one phase of EMDR. It’s a whole therapeutic orientation. So EMDR can be used with everyone on your caseload. It can be applied to every client, there is no rule out for EMDR, in fact and EMDR is really beneficial for stuff that I say is stuck and causing yuck, stuff that’s stuck causing yuck [JOE] Stuck and causing yuck, I like that. [REBECCA] Yes. So our nervous system is constantly integrating and processing and digesting information just like your digestive system is digesting what you put into it. But sometimes your digestive system gets overwhelmed and stuff gets stuck. Like you eat too much food on Thanksgiving or you eat too much at the party or you have way too much cake one night when you’re home alone, bingeing on Netflix and we have symptoms then. So we feel bloated or we feel nauseous or we have pain and cramping and it’s because your digestive system, all that food got stuck. It couldn’t process and integrate all the stuff that was going into it. Your nervous system is the same. It’s always integrating information, but sometimes things get backed up. Sometimes things cannot integrate because they’re traumatic, because they’re overwhelming, because they’re incredibly stressful, because maybe we were too little to make sense of the experience, because maybe we were sick or we were hangry or we were tired. Any of those things that can affect you functioning on all cylinders can impact the storage of memories and when our memories are maladaptively stored, they show up, they get activated, they get triggered by present day experiences and things that we come into contact with in our environment and we start to relive those memories through our autonomic nervous system. We feel anxious or we feel depressed or we feel isolated or shut down or we feel urges to use or binge or we have flashbacks or nightmares. Those are all examples, all symptoms that are examples of experiences that have gotten stuck in the nervous system, stuck in the brain and we experienced that yuck in the present day. [JOE] Back in June of 2022, I did the How I got Through It Series and I think I had 16 or 20 interviews and people that have just been through so many difficult situations. But I kicked off the series talking about how I became a single dad and how I’m raising my daughters pretty much on my own and just like wanting the best for them, but also like just the uncoupling and all that happened through that. I’m just going to be selfish in this interview because I have an EMDR expert with me, when I think about being a positive father for my daughters who have been through a lot that I would say no kid should have to go through, what would you say would be the lens around EMDR or around like the polyvagal theory or, I know you’re a yoga specialist as well.? What lens would you have in regards to just trying to be a good parent that helps your kids maybe not take unnecessary baggage into their future? [REBECCA] Well, I hear that EMDR could be beneficial for everyone in that share. Thank you for your vulnerability and leading with such authenticity. I just really deeply respect that. For you specifically, Joe, if those experiences, that adversity that you had to navigate and find your way through, if you notice that maybe there are thoughts sometimes that pop up or nag you, like, am I being a good enough dad, am I a good enough parent, have I failed my children, am I enough, am I worthy, we can get stuck with those negative distorted cognition and those can often be an indicator of, hey, there’s some stuff to maybe process and digest here that EMDR could be really helpful with. Divorce is traumatic and separation and changes in your family are traumatic and stressful and overwhelming. So if there are specific experiences as you navigated that hard time in your life, those could also be prime candidates to target with EMDR. Then for kiddos who are going through changes in their caregivers and family life, EMDR can also be helpful to supporting their little nervous systems digest experiences that they probably can’t make sense of depending on their age. If that’s dad left because I’m not lovable or mom isn’t here anymore because I’m bad a little kid, we might say like, of course that’s not true but when you’re little, you internalize everything. When you’re really little we internalize everything to be about us because we don’t have that separation from our caregivers and our parents. So EMDR is also shown to be really effective with kiddos, with adolescents. Actually, EMDR is shown to be effective with any age, even infants Joe. Oh my gosh, there’s some people who specialize in EMDR with infants because we all have neurobiology. We all have this nervous system that’s processing information and processing experiences. Again, some of it gets stuck because it’s confusing or overwhelming or it’s too much for us to make sense of given our developmental age and some of it’s just traumatic. Some of it’s just adversarial and extremely stressful. So when we bring in polyvagal theory and align it with EMDR, or rather integrate it with EMDR, I love integrating polyvagal theory with EMDR because combined these two models give us this really robust conceptual framework to understand not only the storage of memory, but also how the autonomic nervous system interacts with the storage of memory. Because you don’t just think your memories, you feel your memories. [RECEPTIONIST] When I had my group of practice, I was so sick of running to the lobby to see if my next appointment had arrived, or even more awkwardly to have a bunch of therapists run to the lobby when we heard the door open. Maybe you want a more discreet, stress-free way for your clients to check in. Take a deep breath. The Receptionist for iPad empowers your practice to create a zen-like check-in experience. This episode sponsored by The Receptionist for iPad, it’s the highest rated digital check-in software for therapy offices and behavioral health clinics used by thousands of practitioners across the country, including many who are just getting started. [HEARD] The Receptionist for iPad is super simple. It’s an inexpensive way to allow your clients to discreetly check in, to notify providers of a patient’s arrival and to ensure your front lobby is stress free. The software sends an immediate notification to the therapist when a client checks in and can even ask if a patient information has changed since their last visit. Start a 14-day free trial of The Receptionist for iPad by going to the receptionist.com/practice. Again, that’s the receptionist.com/practice and when you do, you’ll also get your first month free when you sign up. [JOE SANOK] For people that maybe they heard about polyvagal theory in grad school, autonomic all that, let’s back up and just give some definitions and some big picture education before we dive into some of my other questions, just to make sure the listeners are on the same page, how would you conceptualize the theory and like all the different aspects of it? [REBECCA] Yes, so polyvagal theory, the originator of polyvagal theory is Steven Porges and then Deb Dana has really championed this theoretical model into how do we apply this to clinical practice? Polyvagal theory is a really robust theoretical model. It’s not just one hypothesis. It’s based on decades of research on heart rate variability in the autonomic nervous system and it has a couple of key components to it. So polyvagal theory is a great theoretical model to help us understand the functioning of the autonomic nervous system. The autonomic nervous system is where the processes fight, flight, freeze, collapse, and the window of tolerance live. Most psychotherapists are familiar with that language. We have our window of tolerance, which is one of the circuits of our autonomic nervous system, understood as the ventral vagus that can be understood as a neurobiological mechanism behind the window of tolerance. So when we’re in the window of tolerance, when we’re to connected to our ventral circuit, we feel really regulated and calm and we feel safe and peaceful, and we can focus and learn. We’re grounded. Now when our autonomic nervous system through a process known of neuroception, neuroception stands for a perception without awareness, it’s like your internal surveillance monitor that’s always scanning your environment for cues of danger, so if your autonomic nervous system perceives a cue of danger, it will activate survival responses of fight or flight, which are functions of the sympathetic nervous system. They’re mobilization responses. If you are being chased by a vicious kitten, I try and use no shock value examples whenever possible, so you’re getting chased by this vicious rabid kitten, and you go into fight or flight mode and you have this mobilization of energy, you feel this flood of energy to be able to move and flee. Your heart rate speeds up, your breathing gets more shallow, your thoughts might be racing. You’re really focused on the moment. You’re hypervigilant. That is all going to help you survive this attack by a kitten. Now, your autonomic nervous system in fight or flight is going to try and help you survive that moment but then let’s say this kitten is on top of you, it’s tearing at you with its claws and its little tiny teeth, and you’re like, I can’t survive, I can’t run away or fight, flee from this. So you go into the dorsal vagal circuit, which is where collapse lives, that’s an immobilization response. That’s where we collapse inside of ourselves. We go into this space of dissociation and feeling numb and checking out. Everything in your body slows way, way, way, way down, because that’s like your last defense of survival. I am going to slow you down so much to save your life possibly, is the intention of the autonomic nervous system. So polyvagal theory explains those three circuits of the nervous system so that we can really befriend our nervous system and understand everything. All of our symptoms are really attempts of the autonomic nervous system at survival. They’re not our enemies but the problem is, when maladaptive memories constantly chronically hijack the autonomic nervous system, so your nervous system perceives these cues of danger when the danger’s over it’s in the past or it’s not as dangerous as your nervous system is perceiving. You watch a commercial on TV of a kitten and for cat shower or something, and all of a sudden, your nervous system is in full fight or flight and you’re having flashbacks, and it’s like, there’s no danger. That’s the kitten on tv, but your autonomic nervous system perceived it as a danger and it’s having a response. So polyvagal theory and EMDR combined help us to really understand those processes because when we can understand what’s happening with our neurobiology clinically, we can get really attuned and intentional about interventions, which is what it’s all about. [JOE] I really appreciate that. It just puts us on the same page as listeners and just to make sure we’re all thinking about it in at least the general working knowledge. Now, what would you say in regards to how the average person or the clients people are working with, are living their lives that trigger a lot of that fight, flight or freeze? Are there things that you would argue need to be changed in our environments and the way that we think and the way that we do our schedules that would be healthier to position people to better live lives? [REBECCA] Well, from the lens of polyvagal theory, we think a lot about how do we increase our access to ventral or how do we increase our connection to the window of tolerance. Those survival circuits aren’t bad. Like they’re good. Like you need sympathetic energy to wake up in the morning and get out of bed and you need some dorsal energy to go to sleep at night, to slow down. Those responses aren’t bad. We really need them but when we’re feeling hijacked or activated or triggered, whether or not there’s a real threat I mean, we live in this world where we’re constantly bombarded by social media and the news and therapists are feeling overwhelmed with so much need and few resources. Those all become cues of danger to our nervous system. The to-do list that won’t quit and I’m behind on my notes and I need to catch up on all these emails and I have to follow up on that CPS report or what have you, those are all cues of danger to us when they become too much. So becoming mindful of what your specific cues of danger are, or cues of discomfort we can also think of, like for me, one of my cues of discomfort is when there’s just piles of clutter in my office, I absolutely can’t stand it. It makes me really stressed and anxious. So we have to think about how do I increase my connection to ventral? How do I increase my connection to my window of tolerance? That might be cleaning up the piles of clutter, or it might be setting intentional breaks in your day to step away from the cues. I’m not just like constantly in my email trying to catch up. The importance of, I mean, this is where we talk about in the therapeutic community, self-care, which self-care I know can be a cue of danger for some people in and of itself because self-care so often is talked about in this really disembodied way from people in positions of power, like practice self-care, go get a massage, go on a vacation, and we have like these leaders and experts who clearly do not embody self-care. But self-care, while it’s a billion-dollar industry and can evoke images of privilege and elitism. Self-care really from like a polyvagal theory lens is about intentional self-regulation time and can y’all imagine what a different world we’d be in if everybody practiced intentional self-regulation a couple of moments a day? That’s how we build resiliency in our nervous system. So that helps us to be more flexible on how we respond to those cues. When we get activated, when we get triggered, when we have more resiliency in our nervous system, we’ll be more likely to flex back towards the ventral circuit, back towards the window of tolerance. This is true for you therapist and for your clients. That’s why we teach coping skills. When we teach coping skills, we’re teaching people to flex in their nervous system. How do you flex back towards your window of tolerance when you’re triggered and activated? But it’s also really important to think about the role of intentional self-regulation and building resiliency in your autonomic nervous system as a helper, as a healer because what’s the number one most important thing for positive clinical outcomes? The relationship. We know that it’s the therapeutic relationship and the reason the therapeutic relationship is so effective is because when we’re well regulated and we have a wide solid window of tolerance, we loan out our window of tolerance. We loan out our resilient nervous system to our clients when they sit with us. So if you want to loan out a healthy regulated nervous system, you got to do the upkeep. You got to take care of it. [JOE] I’m wondering, with your own personal private practice, but also the way you live your life, how do you make what you’ve learned in EMDR or polyvagal theory? How do you clinically use that and how do you use it in your own life to approach life differently than maybe you would if that wasn’t in your life? [REBECCA] I incorporate this stuff every day, every moment into my lived experience because I believe in being embodied and I believe in talking the talk and walking the walk and practicing what I preach. So I become really aware of what my cues are and what’s going on in my autonomic nervous system throughout the day. When I notice my mind starts racing and I’m thinking about, oh, I God, do this and don’t forget to do that, when your mind is just chatter, chatter, chatter, chatter. In yoga, we call that chita, the chita of the mind, the chatter of the mind. So in my chita, when the chatter in my mind gets really loud, I recognize I have a little too much sympathetic activation right now, and it’s distracting. It’s not helpful. It’s really overwhelming me. So this is a moment that I need to bring in a skill or something to flex back to my ventral circuit. That might just be stepping away from my computer for a moment and going and playing with one of my dogs. It might be going for a walk, it might be sitting down and meditating, but when you can start to notice, oh, there I go, oh, I lost it a little bit, oh, I’m a little too activated, one, those are opportunities for discernment. So we can identify what am I going to do to flex back towards the window of tolerance to increase that ventral connection? But it can also be an indicator from the EMDR perspective of, oh, I got some work here to do, what’s activating me? I was in a training last month and there was something that came up in the team’s clinical discussion as we were just processing and exploring some things that trainees had asked about and what they were needing. There was something that came up there that I noticed I got a little activated about, and I felt really ungrounded. For me, I was able to take that moment as I noticed my neurobiology getting fired up. I got curious and I thought, what is this about for me? What does this go back to? That’s the EMDR lens. Is this reaction right now, is it just about the current moment or is there something deeper? It totally was about something deeper for me. It went back to something related to my family of origin. So I was able to identify in that moment of, oh, that’s something to work on in EMDR so that when that thing happens and I get activated in the present, it actually doesn’t activate it. It’s no longer a trigger. So those are some of the ways that I really embody this work and incorporate it because understanding EMDR and understanding polyvagal theory isn’t just for your clients. It really starts with you because the more we can study our own neurobiology, the more we understand neurobiology. Your nervous system is your greatest study guide. [JOE] The last question that I always ask is, if every private practitioner in the world were listening right now, what would you want them to know? [REBECCA] I think going back to what I was saying about resiliency and loaning out your nervous system. Think about the last time you took a vacation and you were searching for a hotel room or maybe a rental and you’re scrolling through options and you’re looking at price, but I bet you also look at the pictures and I bet that the pictures and the descriptions and reviews, they give you a sense of, is this place well kept? Is it tidy? Is it clean? Is it organized? Does it have what I need? You’re probably not drawn to, I would imagine the places that have the reviews or have pictures that give you the sense that this place feels dirty and it feels pretty disorganized and it doesn’t seem like it’s been tended to. You don’t want to rent an inhospitable room or hotel room. You don’t want to loan out in inhospitable nervous system either. You’re drawn usually to the rentals that looks really clean and look at the light. Oh, and it seems really well organized and well cared for. That’s the place you want to rent. So think about that as it applies to your nervous system as a helper, as a therapist. What a nervous system are you renting out and loaning out to your clients? Then we can start to see that self-care or intentional self-regulation time is more of an ethical obligation, an ethical imperative than just something you do on the side and you can roll your eyes at and brush off. It’s super important for the work we do. So take care of yourself because that’s the best way to take care of others. [JOE] So awesome. Well, if people want to follow your work, I know you also have a free EMDR worksheet that you’re giving away to the audience, tell us a little bit more about that and where they can connect with you. [REBECCA] Yes, so Rebecca Kase and Co is a training business. We provide EMDR training and advanced training. We also have a consultant training program for folks who are already trained in EMDR and want to become consultants. We offer EMDR certification and we also have a bipoc scholarship for our EMDR basic trainings and a monthly speaker series. So we have a lot going on. You can check us out at rebeccakase.com. My last name, Kase is spelled K-A-S-E, so rebeccakase.com. When you go to the site, there will be an opportunity if you want to download a free worksheet that is an EMDR inspired worksheet that I use all the time with every client in my practice. Would also love to offer your listeners a special discount code for 15% off any of our live training or on demand events, so that’s 15% off any of our trainings or events. You can use the code Practice22 when you register to get that discount on any event you want to attend with us. [JOE] Well, thank you so much, Rebecca, for being on the Practice of the Practice Podcast. [REBECCA] Thank you so much, Joe, for just being in the world and putting, putting this thought, this thought leadership out there. Appreciate you. [JOE] Yes, I think it’s always interesting to think through people taking their clinical work and then going beyond their clinical work. I wouldn’t say there’s, in saying beyond it’s different, it doesn’t mean that it’s better, it doesn’t mean that it’s higher than, but to think through the clinical work you’re doing, is there an opportunity to teach other people how to do what you do? Is there an opportunity to create courses or community or memberships or a podcast? There’s so many ways that you can take the things that maybe you do intuitively and systematize it into something else. Just seeing people like Rebecca who think something that she was really good at, individually, individual sessions and think, I’m going to become a trainer, I’m going to grow this, I’m going to advance this type of work in a new way. If that’s something that you’re interested in talking through with me as to what that might look like, just even to just brainstorm you can apply to chat over at practiceofthepractice.com/apply. Would love to talk with you a little bit more if you have ideas that I’ve just been sitting there and you know it’s time to take some action. At the end of the year you start to think, okay, what’s next year look like? If you might want to take some action on your big ideas, I would love to have a conversation when I’m back from my break to just chat through how you want to change the world. Also, we couldn’t do this show without our amazing sponsors, and The Receptionist is one of those sponsors. I mean, it is the product I wish I had when I had my group practice. The Receptionist for iPad is the highest rated digital check-in software for therapy offices and behavioral health clinics. The Receptionist for iPad is a simple, inexpensive way to allow your clients to discreetly check in, notify providers when they arrive, and to ensure the lobby is stress-free. I mean, I remember when I had my practice, the door would open and it was like four therapists would all just pop their heads out and it was awkward. You don’t need that anymore when you have The Receptionist for iPad. They’re actually giving away a 14-day free trial over at thereceptionist.com/practice. When you do, you’re also going to get a month for free when you sign off in addition to that. Again, that’s thereceptionist.com/practice. Thank you so much for letting me into your ears and into your brains. Have an amazing day. I’ll talk to you soon. Special thanks to the band Silence is Sexy for your intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the producers, the publishers, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.