[BLUEPRINT] Providing great therapy day after day can be challenging even for the best of us. At Blueprint, they believe that nothing should get in the way of you doing your best work, which is why they created a platform that provides therapists with an array of clinical tools, things like therapy, worksheets, intervention ideas, and digital assessments that are designed to help you and your clients stay connected and confident throughout the care journey. Even better Blueprint helps streamline your documentation so you can spend less time on your notes and more time on the things that matter. To learn more and request a 30-day free trial, visit blueprint-health.com. Again, that’s www.blueprint-health.com. [JOE SANOK] This is the Practice of the Practice Podcast with Joe Sanok, session number 865. I’m Joe Sanok, your host, and welcome to the Practice of the Practice Podcast. All this month and next, we are going to be diving into real life therapists, counselors, MFTs, social workers, their specialties. So it’s really exciting about all that we’ve been covering. So far we’ve covered attention span, we’ve covered Gottman Level 3, couples work, LGBTQ care, financial stress, and actually in the next session after this one we’re going to be talking about ACT, CBT and mindfulness regarding anger and anxiety work. So a lot of really interesting work that therapists are doing out there that are in our communities. Today I am so excited we have Donna Hunter. Donna Hunter has a group that specializes in trauma and difficult and toxic families, and they provide face-to-face and telehealth at Global Therapy Inc. They’re aware that life can often be challenging, and that it seems as though you’re tackling it solo, they’re here to come and help you out. Donna, welcome to the Practice of the Practice Podcast. Really excited to have you here today on the show. [DONNA] Thank you. [JOE] Well, let’s start with, as you started your practice, did you know right away that you wanted to have a focus on trauma and toxic families or was that something that sort of emerged over time? [DONNA] I think that in the beginning I was like most therapists that I just wanted to get clients. So I wasn’t terribly focused on exactly what I wanted to do but my practice up until that point had been mostly in agencies where you did see very difficult, troubled families. And my last employment space was being a program director for a program called Choices for Change and it was substance abusing, women whose children were at risk or in the system. And so we were working with very difficult families at that point. So dealing with difficult families, substance abuse, trauma just came very naturally to me and then one of my very first clients that I had for 11 years until she died was someone with multiple personalities and so I learned so much from her about how to deal with families, how to deal with people’s perception of their family. I learned a lot about, I didn’t know it then, but I know now was learning about internal family systems and so it’s just taken a dive from them. [JOE] Wow. So then when you decided to dive more into internal family systems and trauma work were there particular trainings that were helpful for you to learn that work? [DONNA] You know, I didn’t go to any particular trainings I read. Colin Ross I think was one of my biggest influences because specifically I was working with multiples at that time. I have gone to trainings with Frank Anderson MD and the internal Family Systems group and that has been very helpful. One of the things that was very helpful to me was I had the opportunity because this case was very involved. She ended up in the hospital numerous times that I actually went to timber, what was it called, Timber Lang, Timberline in Texas. I went to the River Oaks in Louisiana, and this was when I was still down in Florida and I went to McLean Hospital just to see what the program was like. Because she had been hospitalized so many times before and the family didn’t want to, well, they didn’t want to spend the money, but they also didn’t want to have her endure going through a treatment program that wasn’t going to be helpful. So I put on my social work hat at that point and agreed to go to these places to get a sense of what that level of treatment was about. [JOE] Now, as you started the practice, how did you, and you’ve grown it, how did you make sure that your perspective and the DNA you wanted to create for that specialty area was really embedded in the way that you do business? [DONNA] Well, the practice first started out just being me for quite a long time. It was that structure, that business structure I used to be able to insulate myself for malpractice reasons and tax reasons and everything else. In the years that I’ve had it, I’ve gone from Florida to Arkansas to Idaho, back to Arkansas. So I’ve traveled quite a bit and it wasn’t until the past few years that I basically thought to myself, it’s time to go bigger, go home. So I have brought in clinicians that I have known personally and I have worked with personally that really have my mindset because I think that therapy is not so much of a science, but an art and it’s the art of relationship. And when we’re talking about toxic families, we are talking about very broken relationships with others and a broken relationship with ourself. So I’ve always hung on to a quote from Carl Young that says, “know all the theories, master all the techniques, but as you touch a human soul, just be another human soul.” I think too often in therapy, and what I saw in agencies was the focus on well, we have to have this treatment plan done in 90 days, and we have to have a specific diagnosis and we have to meet all these requirements of particularly Medicaid or different insurances that we forget that we’re talking to people and that people really just want to be able to connect. That is the most healing piece. I think that, oh gosh, it was years ago and I listened to a presentation from Scott Miller, and it really validated to me what I always felt that I think it’s like 70% of good therapy is that relationship. It’s that you feel like you have not only had that click with the client knowing that this is someone that you could work with, that you have expertise, that you could actually give them something, but that they have to feel that click as well. They have to feel as though they can be vulnerable enough with you to reveal themselves and to reveal what has happened to them in their lives. [JOE] Now, when you think through toxic families and trauma what are some of the core elements that you would say every therapist should have a working knowledge around? [DONNA HUNTER] Well, it’s more than just a diagnosis of PTSD or chronic PTSD. It’s understanding those family systems, understanding how a “healthy” family works and at the same time, being able to parallel how this particular family is working. Understanding that early childhood development and attachment is incredibly important and most of the time people come to us when they’re either in their 20s and they’re just getting out of their family or in their 40s where developmentally, they’re just sort of looking at what it was, and they’re also looking at what they would like things to be like. So I like to say to my adult clients, part of what I do in this process is, because many of these people still have relationships with their family, they want to have relationships with their family, even though every time they go to Thanksgiving dinner, it’s a nightmare for them. I like to teach people how to put on their hazmat suit. What I say to them is that you didn’t choose to be brought up by the toxic waist dump but when you become an adult, you get the choice as to whether you’re going to leave it, leave it permanently or stay there. And if you’re going to leave it and come back and visit, you need to have that suit of armor that allows you to take in the parts that are good, the part of the connection that you want to maintain, but you don’t let the toxicity continue to affect you. I think that, for me, it’s easy to think that way because I’m very visual, so I can see those pieces being put on, whether it’s coping skills or the ability to communicate clearly, to not take things personally, to recognize the different aspects that are going on in the family that are toxic and being able to walk away from it, not out of anger or sadness and not emotionally being able to, or emotionally where you’re falling into it, but being able to just consciously saying you know what? This isn’t really good for me right now. It was good to see you and I need to leave. [JOE] So knowing those techniques in teaching clients and metaphors like the hazmat suit? What else would you hope that the average clinician, even if they’re not specializing in trauma or toxic families, what else would you want them to understand in doing this work? [DONNA] Detachment. I think that it was about two or three years in I had already gotten burnt out and I left the field for a year and cleaned houses. It was because I wasn’t detached enough from what is going on with my clients. So what I’ve had to work, especially early on is to really learn that their story is their story and it belongs to them, that I am not there to fix it. I am there to give them tools, I am there to listen, to support them emotionally as they go through the process, but that I don’t have to take it home. So learning how to set boundaries, because these are folks that they don’t come in with a lot of boundaries and setting those boundaries right from the very beginning, it may sound harsh in a way but that they know and that they feel safe, that this is the therapeutic container and that you call your therapist if there’s an emergency, here’s some resources to deal with other things, to deal with your emotions throughout the week. [DONNA] I think that that’s a really vital, vital thing because too many therapists, I think, burn themselves out very quickly because they get very involved in the story. [JOE] I have a question about that. So you said setting boundaries around yourself, don’t take it home. What are some practical techniques that you use personally to, when you have these volatile families or tough situations or really tough sessions that you use personally to cleanse your brain as you go back into your personal life? [DONNA] I walk a lot. I have my dogs and my family. I make sure that my office is at a minimum 20 minutes away from home. I don’t do well working from home because you’re walking basically from your office into your family, and there’s no break. If it means that I’m driving home and I need to stop at the park for a few minutes just to clear my head, I do that. I do a lot of writing in order to sort of process myself out. I have been involved with 12-step work and I am a very grateful member of Al-Anon. That’s really where I learned the most about detachment and how to separate the issues of others from what I’m dealing with. I think that having friends and people to talk to and call, whether it be other therapists to talk through issues, I consistently stay in supervision and I’ve been doing this work for almost 40 years now. But having just friends and families that you can talk to about stupid and silly things to just sort of get your mind off of it. I think that we have to regularly practice something that helps us move on and know that we have a life independent of our clients’ lives [THERAPY NOTES] Is managing your practice stressing you out? Try Therapy Notes. It makes notes, billing, scheduling, and tele-health a whole lot easier. Check it out and you will quickly see why it’s the highest rated EHR on Trustpilot with over 1000 verified customer views and an average customer rating of 4.9 out of 5 stars. You’ll notice the difference from the first day you sign up for a trial. They offer live phone support seven days a week so when you have questions, you can quickly reach out to someone who can help. You are never wasting your time looking for answers. If you’re coming from another EHR, they make the transition really easy. Therapy Notes will import your clients’ demographic data free of charge during your trial so you can get going right away. Use the promo code [JOE], J-O-E to get the first three free months totally free to try it out, no strings attached. Remember telehealth is included with every subscription free. Make 2022, the best year yet with Therapy Notes. Again, use promo code [JOE] to get three months totally free. [JOE SANOK] So maybe what’s one other thing that maybe around, like referring out, when would you say that a therapist that doesn’t really specialize in trauma or toxic families should really look at referring out to other folks? [DONNA] I think that if you have a client, and I have always felt and believed that our gut never steers us wrong. It’s that DBT sense of where our rational mind, our emotional mind come together in that Venn diagram that our wise mind, and if our gut is saying, I can’t deal with this, or this is hitting too close to home, then definitely refer. If we have a client that is consistently breaking boundaries and we can’t seem to get a handle on that refer. If somebody’s coming in and on intake, they’re talking about issues that we’re not comfortable dealing with refer. That’s why in that first session, I find it so important to talk about the therapeutic connection and that it has to work on both sides. I ask them at the end, I’ll say, “Okay, did this feel like a click for you? Because this is where I’m at with it.” And there are clients that I will say, “I’ve heard your story and I don’t think that I’m going to be your, the best fit. Let me get you to somebody that I think that you can fit with better.” Because not only is it the client’s time, but it’s their money, and it took so much for them to make that phone call for them to walk into our office. And sometimes we might be looking at it more with well, I just want to keep my caseload full. Your caseload is always going to be full. The people will always come, but we have to come at them with a really clear heart about whether we are going to be effective with them. [JOE] Yeah, I love that. And the idea of when you take on your ideal client who feels good that you know that you can help that it just, overall is just aligned, those folks are more likely to refer other people like them, rather than when you take people that you have a little check where you’re like, ooh, I don’t know about this person. [DONNA] And honestly, I’ve had the experience of people that I have said no to, they have referred people to me because I was honest with them, and I got them to where they needed to be. [JOE] Well, and that’s, I mean, even with Practice of the Practice whenever I do pre-con consulting calls with people, I often say, we have enough people applying to for help at every stage of practice. There’s no reason for us to squeeze you into anything. I frequently will say like, paying a thousand bucks a month for consulting is overkill. Like, just join our Next Level Practice for a hundred bucks a month and like once you get to a certain point, then you can do consulting with us, but it’s just not going to get you the ROI that you need. So I think people appreciate that when they come into a call thinking, oh, it’s going to be $600 to $1,000 a month, and then it’s like, no, just join one of our communities. You’ll get all that stuff out of there. [DONNA] Exactly. [JOE] Now, we talked about general therapists, what you would want them to know. When you think about trauma therapists that are doing work with toxic families, what are some core competencies that you would suggest people develop, have as sort of a checklist? Are there certain modalities that you think really, you really need to be well versed in these areas or even like read these books? Like what for you is the checklist of I want to be like Donna? Like give us the Donna checklist of becoming a trauma therapist that works with toxic families. [DONNA] Being very familiar with obviously CBT, DBT, I find that Internal Family Systems is very helpful. I am certified in EMDR and I am certified as a trauma professional. Those things, EMDR in particular, I have found to be incredibly, incredibly helpful. [JOE] Now, when you think about EMDR, I know that right now that’s a modality that lots of people are familiar with, lots of people are getting trained in, when you think about individual clients, what has EMDR done to help move forward the therapeutic progress differently than before EMDR? [DONNA] Well, before EMDR, it was talk and a lot of talk and some more talk, and it lasted a long time. I don’t generally do EMDR until at least midway through the therapeutic process. But when we get to the point of EMDR and really processing the trauma, the trauma moves so fast and people who are able to emotionally contain it find that it’s gone. The emotion has been separated from the thought and so they’re not having the constant racing thought about something that may have happened. They’re not having the nightmares. They’re not having the overwhelming dread of every day when the trauma is just sitting there and out in the open. But prior to you have to do a lot, your toolbox has to be very big in terms of helping someone learn how to regulate their emotions, how to be able to give themselves boundaries and be okay with separating themselves from others, understanding what is healthy in relationship versus what has been problematic and unhealthy in relationship. Those are things that are psychoeducational pieces, but we have to be very expansive in those areas because not everyone will be able to use the same five coping skills. I probably send out, I start out with 99 that I will send in the first week for people to just look at so that they can look at those things in the week between sessions but then you start to really work through different ways of coping, different ways of regulating emotions and say, okay, this is a tool that works for you, we put it in your toolbox. So you can always refer to their particular toolbox when they’re going through something in session and say, okay, how about we try to take some deep breaths because I already know that that works for you. People. [JOE] But tell them, go ahead. [DONNA] No, people unfortunately will try these things. They’ve read a magazine and they say, oh, these are the 10 ways to deal with anxiety, and none of them work and then they feel like failures because it was in a magazine and it was supposed to help them. [JOE] Well, if every private practitioner in the world were listening right now, what would you want them to know? [DONNA] I would want them to know that this is a journey, that there is always something to be learned and that you are going to learn the most from your clients. So being open to what they have to say and their experiences will benefit you and your growth in terms of being able to move forward. [JOE] Awesome. And Donna, if people want to connect with you, if they want to read more about your practice, where’s the best place to send them? [DONNA] To read about the practice would be global-therapy.com and we have a contact page so you can get ahold of me directly. [JOE] Awesome. Thank you so much for being on the Practice of the Practice Podcast today. [DONNA] Thanks so much, Joe. [JOE] What an awesome discussion about working with toxic families and trauma and just diving into these clinical skills that a lot of us just need a working knowledge around. Some of us are going to decide to go in even deeper into some of these conversations as well. We couldn’t do this podcast without our amazing podcast sponsors and Therapy Notes is the sponsor of today’s podcast. Therapy Notes is the best electronic health records out there. They will help you transfer from whatever EHR you’re in into Therapy Notes, totally for free, and you get two months for free when you use promo code [JOE] at checkout. If you’re in any of our communities such as Next Level Practice, Group Practice Launch, Group Practice Boss, Audience Building Academy, if you’re new to Therapy Notes, they’ll actually give you an extra four months so you get six months for free. Therapy Notes does a lot to help our communities and to really help you stay organized with all of your finances and EHRs and billings and all that stuff that most of us just want to do therapy honestly. So again, that’s therapynotes.com and use promo code [JOE] at checkout. Thanks so much for letting me into your ears and into your brain. Have an amazing day. I’ll talk to you soon. Bye. 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. It 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.