And we worked together for a year. He came every week and by the end he was no longer having the nightmares, he was no longer having flashbacks or intrusive memories. All of those PTSD symptoms that he had been experiencing had gradually gone away, and he did the hard work.

Hello and welcome. I'm your host, Bill Emeiser, and you're listening to Mental Health U, the podcast dedicated to demystifying and destigmatizing mental health issues. So if you or someone you know is struggling with depression, anxiety, trauma or some other mental health issue, then this podcast is for you. This episode is proudly sponsored by Unison Health, dedicated to making lives better through compassionate, quality mental health and addiction treatment services. Learn more at unisonhealthorg. I feel extremely privileged and excited to have Leanne Cox, a specialist in trauma and EMDR, with us today. She brings a wealth of expertise and experience helping individuals navigate the complexities of trauma. I'm glad that you're here today and hopefully you're feeling good and ready to talk all about trauma.

Yeah, I am.

Let's start with a little bit with your professional experience. Tell me a little bit about how you got into this business.

I was working in banking, of all things, and my kids were in high school and I was realizing that I wasn't fulfilling my purpose. So I really felt driven to go back to school for my master's degree in social work, which I did at Spring Arbor University, and then I came to Unison. I started work as a case manager, which I loved doing, and then, once I graduated and became licensed, I moved over to the adult therapy team From there. As soon as I was hired into the adult therapy team, I wanted to tackle the big stuff. I became trained in EMDR. I tackled domestic violence group, which is a lot of trauma as well, and I just really was fulfilled by that. I did that for a few years and then I moved on to working with kids and families and now I am the manager of the kids and family therapy program.

A lot of people consider themselves wounded healers.

I don't know if you see yourself that way, so when I was, when I first became a mom, a lot of my trauma my childhood trauma came forward and really started impacting my life. And one of the ways that I helped myself was I started facilitating a group for women survivors of rape and sexual abuse rape and sexual abuse and that was just like an amazing experience for me to be able to help others and, in that way, helping myself. And we did that for seven years and I'm still friends with many of the ladies that were in that group. But it was just like that calls to me, like other people who are have experienced trauma. It just pulls at me and I want to help and that's what drives me.

Can we make the assumption that not everybody knows even what trauma is Like in your own words, when you describe trauma to folks who might not have a clinical background, how do you talk about it, how do you think about it? How do you help people process it?

So I asked them you know what are the really significant things that have happened to you in your life? Tell me a little bit about you know. When you experienced that, how old were you, how long did that happen and who did that to you? And that's mostly when talking about, like childhood neglect, abuse, sexual abuse, those kinds of things. So I just want to understand you know what happened to them, so that then we can have a framework to start to heal that trauma.

How does therapy actually assist somebody in managing and overcoming their trauma?

So when you're doing talk therapy, you're processing out loud what happened to you. You're saying the things that maybe you've never had the courage to say because your therapist is a safe place, at least hopefully that's true, and that takes a lot of courage for someone to talk about something that hurt them. There's talk therapy, and then there's also EMDR. There's other for kids, there's trauma-focused CBT. There's other therapies, but my preference, of course, is EMDR.

Yeah, why do you like EMDR so much?

I like it because it resolves the trauma. When you do talk therapy for your trauma, it's still going to be painful. It might be less painful, but that pain never quite goes away. It's always there somewhere and with EMDR you just have this ability to heal it to where it happened. Of course we can't ever take away that it happened, but it allows that to not be painful, where you can think about it and be like I'm really sad for that person that went through that trauma.

I'm really sad for that little part of me that experienced that when something bad happens to us and we don't have the capacity in that moment to process what has happened to us, our brain doesn't file it away. So when everyday things we do, everyday things when it's no longer needed, it's not necessary to keep that. It gets filed away in our brain and trauma. If you're not able to process through it and have some sort of feeling of I've thought this through, I feel better about it and you file it away some trauma. You can't do that because in the moment you're overwhelmed with I don't know how to handle this. So triggers will cause those memories to just keep replaying over and over for years, and so that's why we like to do EMDR with that.

Of course you can do talk therapy. Of course you can do other therapies and those are equally as helpful, but they truly do with EMDR. They truly do resolve where you can actually think about something and it doesn't bother you and it doesn't bother you. I worked with this gentleman who was a first responder and he had just years of seeing awful situations and he came to me for.

EMDR. He was not. He wasn't a therapy guy, he'd never been to therapy. So this was because he was desperate. He was feeling desperate like he needed to heal this, and we worked together for a year. He came every week and by the end he was no longer having the nightmares, he was no longer having flashbacks or intrusive memories. All of those PTSD symptoms that he had been experiencing had gradually gone away, and he did the hard work. He did the really hard work.

What do you see in your clients when they are experiencing trauma, before they come through therapy or before they would resolve their trauma? What are some of the impairments that you see because of the symptoms of trauma? Where do you see that impacting their lives?

A lot of times people with PTSD may end depression and anxiety all rolled up into one, because you can't have just one. They often experience difficulty with relationships. They often experience difficulty with work. Some people have not been able to work because their functioning is so impaired by the symptoms that they are dealing with. They may have trouble with family relationships. They may have trouble going out in public. They may become agoraphobic or very socially impaired, so they may not have close relationships with friends. So it makes a big difference in someone's life and it also may cause somebody to not seek therapy because it's so overwhelming to think about all of their trauma and they're pretty good at avoiding, so they're going to avoid having to talk about it, which is one of the great things about EMDR is you don't have to talk about it.

Yeah that's an interesting idea. So I come from the world of exposure, right? So, which is one of the great things about EMDR is you don't have to talk about it. Yeah, that's an interesting idea. So I come from the world of exposure, right? So this is one of the things that I have a hard time wrapping my mind around, because in exposure, it is In our minds, though the kind of the way that we approach it it's. There's no way around, under or over. You got to go through it, which means you actually have to talk about the thing and do the things that are uncomfortable. So how does that work with EMDR, where you're like you don't necessarily have to get into that, relive that past experience to resolve that trauma?

Right, when you're doing talk therapy, you need to understand what the person has gone through. You need to understand what the person has gone through. So they must tell you. In EMDR they know what they've gone through. No-transcript I'm facilitating the eye movements and I don't have to know what you experienced. If you don't want to tell me, you don't have to because that's re-traumatizing when you think about it. We don't want to do that. We want to heal. We don't want to re-injure someone.

Mental Health? U is brought to you by Unison Health. Unison Health making lives better. So let's pretend that I witnessed a horrible car accident right and I was traumatized by it. My functioning has impaired. I meet the criteria for PTSD. I come to you for EMDR and I tell you this is what I saw, but I really don't. I don't want to ever talk about it again. Walk me through a typical session where you're actually doing EMDR.

Sure. So after all of that preliminary stuff, I would write down what is the thought or image that represents the most distressing part of that memory, and then I write that down. And then I ask you about what is your negative belief about yourself? Because there is a part of us that thinks negatively about ourselves related to an event or a traumatic experience. And then I ask what is your, what would you like to believe about yourself related to this event? And then I ask you how, how strongly do you believe that, that positive belief about yourself? And that gives. And then I ask the last thing is I ask how distressing is it for you right now? And we measure that zero to 10. And 10 is the most distressing and zero is it doesn't bother me and that is entirely your decision about how distressing it is to you. That is not for me to decide. The depth of that trauma. Not up to me, that's up to you to measure.

And then we would start with bilateral stimulation or eye movements. There's several different ways that we can do that. You can follow my fingers and I move them for a certain amount of time, and then I ask you what you noticed when you were watching the finger movements and thinking about what had happened. And then we just do that and you move through it and you can tell me what you're thinking or what you're noticing, or you can just say, let's keep going, and we can do that and I have done that for a couple of people that's. It's really important to respect somebody's limits yeah.

And they can stop anytime. If it's too much, you can say I need to stop and we'll stop, okay.

So my brain constantly goes back to the exposure stuff. It feels like you're actually doing exposure. They're just not verbalizing it because they are thinking about it right. So they don't have to verbalize it, so it's a less intrusive way to do the exposure, right. So I just have to think about it and then I do the eye processing exercise and through that exercise and through noticing and making that and you stop me if I'm wrong here but noticing that difference between what I believe about myself and what I want to believe about myself, right, it changes as you're processing.

Yeah, and every once in a while we might. If you, if we're doing eye movements and you hit a plateau where nothing is changing, I might say, hey, I want you to go back and think of that image again and then I say what are you noticing now? Because it will change as you're processing through. It's gonna change and it will become less intense, less distressing, and sometimes that can happen in a session or two, depending on, like, the severity of the traumatic event or experience. Or it could take weeks, it could take a year.

It just depends on how much trauma, how many events are happening Like with childhood trauma, that can be like Going through each one. You're probably not going to be able to do that. That would not be very, that wouldn't be very good for the client and it would just be tedious. So what we sometimes, what we do when we have, if somebody has a particular person that harmed them, we can focus on that person rather than the event that happened and, as a collective, all of those memories related to that person then start to disappear from your memory and it starts healing that gradually over time and people will go. I can't really picture him now or I don't really remember, I can't bring it up and it's magical the way it happens and how I know that somebody is you know how it's working is they'll say I feel lighter and it's so wonderful.

Because then I know, oh, they hit that place and it might still be at a three or a four, but it's not a eight or a nine or a 10 anymore and there is no better feeling as a therapist than to have your clients go from their walking number is seven and eight and down to now their walking number is a two or a three and that's a great testament to the work that the client's doing in therapy and working towards that resolution of that trauma. Now I'm hearing lots of components here. I've always been told there's a. I don't remember who did this study, but someone did a study. They looked at all of the evidence-based therapies and EMDR was included.

Trauma-focused CBT, exposure, all kinds of different evidence-based therapies and what they said is there were certain components that were true of all of them. Now some of them have extra components, like EMDR with the eye processing right, that piece, but they all have some component of these or some of these components, and I've heard already you talked a little bit about some cognitive restructuring, about how you perceive yourself, so that was one of them. One of them is exposure, and I know you said it's not technically an exposure therapy, but I think there's some exposure.

Oh, I agree, I agree with that.

Involved. They say that all of them teach some kind of self-soothing, self-relaxation strategies.

We have one.

I was going to say. What does EMDR use as far as like a skill to help self-soothe or self-regulate emotions and discomfort?

So one thing, that two things that I always do even if I'm not going to do ongoing EMDR therapy is when I have a client, I will number one, I will do safe, calm place, which is we call it a resource it's another name for coping skill and we do slow eye movements and we have people identify where do you feel safe, like completely safe, like nothing triggers you. And now I want you to tell me what do you hear when you're there, what do you see, what do you smell, what do you taste? All of your senses and I melt into a very low tone of voice, very soothing, and people are like very low tone of voice, very soothing, and people are like are you hypnotizing me? No, I'm not, but I have them really experience. I have them close their eyes because it's easier for people to go into themselves and be in that safe place. And then I have them do tapping for themselves. If we're doing it over telehealth or if they're in person, I'll do slow eye movements and that installs that safe place for them, and then so we might do that a couple of times the eye movements them just being in that safe place, and then I have them choose a word that represents that place. And then we do some more eye movements, real slow ones, and then we test our safe place.

I always ask people to imagine something that annoys them. You stub your toe, or you spilled your coffee or something like that. And I, they tell me whatever it is and I have them think about it for a second. I say are you recognizing? Can you feel that irritation? Where are you feeling that irritation? And a lot of times people feel that in their chest or their head or something like that. And once they, or their head or something like that, and once they, when they get that, I say okay, I just want you to say your safe place word to yourself. And so they, they pause and they say it to themselves. And then I say what are you noticing in your body? And they're like it went away. The irritation went away.

Wow.

That annoyance feeling went away, the irritation went away, that annoyance feeling went away. So it brings down irritation or it brings whatever you're feeling. Whatever that emotion strong emotion is it can bring it down a little bit. It obviously doesn't bring it from like a 10 to a one or anything like that, but it bring it down a notch so you can start using your prefrontal cortex, so the front of your brain, where you can reason and think logically, because when you're in a lot of emotion you have a hard time thinking with your logical brain.

Yeah, it shuts that part of the brain down right, yeah, it does so with a lot of anxiety or with a lot of discomfort, a lot of that, that trauma, that fear, response oftentimes is about. It's about survival, not about problem solving not about processing, not about thinking, not about long-term rewards. Those kinds of things are all diminished when you're feeling that overwhelmed with emotion.

So, yeah, that's great stuff and it just okay. So that's that strategy. That would fall under, obviously, that component. So we've had three of the four components that I heard that all trauma therapies have. The last one, I suspect, is important to EMDR and that's relationship, the relationship between the therapist and the client. Can you talk a little bit about what that's in an EMDR setting?

I actually think the relationship is the primary goal. First People come for treatment and they're like I want to be better. But first we have to establish rapport, we have to establish trust. You're not going to want to share with me anything if you feel like I'm not fully with you present or if I don't, if I don't seem like I care about what you've gone through. This is like the most important part of any therapeutic relationship is that how you and the client relate to each other and and can work together, and you should get a feel for that within the first few sessions.

What would you recommend? You're not. That's what I going to say. Yeah, you're ahead of me here. What would you recommend? Let's say somebody comes in for therapy and they're looking for EMDR, but they just don't click with the therapist. What would you tell? Somebody who experiences that. What should they do?

Yeah, so I always advocate for people to if the therapist that you're matched with doesn't match with you, if you don't vibe with them, ask for a different therapist, and no therapist is going to be upset about that. We all understand that you're not the one for everybody, and you really need to mesh well to work well together, so I advocate for people to speak up and say this isn't working for me. I don't think that I'm doing well Often what people do, though, instead of saying that, they just drop out, don't they?

They do. They just they don't schedule or they cancel whatever they've scheduled and they just they don't respond to outreach, they don't, they don't answer your calls or anything like that, which makes me sad because they're missing the opportunity to heal. And my goal as a therapist whether you see me or somebody else is for you to feel better, for you to not experience like those symptoms every day, that impairment in your functioning every day. A lot of people every day go through their days feeling less than feeling very impaired, and I just I want to, I like want to take care of everybody, which is probably not a good thing because I can't do that, but I'm driven to do that.

Absolutely. There's so much research out there that shows, like you said, the relationship is the most important thing, and I think it's Scott D Miller and there's a lot of other folks on the Invert and a lot of other folks that have done some research on this, but they say that the relationship alone between you and your therapist accounts for the bulk about 30%, about a third of all positive outcomes can be attributed to the relationship, the therapeutic bond between that therapeutic rapport between the therapist and the client. And if you're not feeling it, you need to speak up. And, by the way, if you're a therapist and you're listening to this, or a provider, we should probably be asking our clients like inviting our clients for that feedback to say, hey, how are things going? Am I the right match for you? Because if not, I don't take offense to that. I want you to get the best care you possibly can. I'm not always going to be the best person for everyone. There's no way right, you, I don't care, you could be the best therapist in the world and there's going to be some people that you just don't connect with them and the thing is only the client can tell that right.

So I think inviting them. To have that conversation can be uncomfortable for us as therapists, but we need to be the ones to step up and ask that question so that we don't have dropout rates and we can get the client to the therapist that can connect with them and can help them. Yeah, it's good stuff. Hey, I need to switch gears just a little bit on you. Let's talk a little bit about your program. You are now running a program for children and families, correct? Doing outpatient therapy.

Yes, I'm also an infant and early childhood mental health consultant as part of that position as well. So we have very talented therapists on our team. We have somebody who does trauma-focused CBT, we have me doing EMDR. We also have have been trained in child parents psychotherapy and we have four clinicians, myself included, trained in that and that is trauma treatment for the very young, the zero to five.

Wow, yeah, so if somebody wanted to learn more information about Unison or maybe get a referral to you, would they go to unisonhealthorg?

Yes, unisonhealthorg. Or give us a phone call. We're happy to help in whatever way we can. There's many ways to reach us.

Fantastic. I have really enjoyed our time together. Leanne, Thank you so much for being on the show today.

Thanks, it was great being here.

This podcast has been brought to you by Unison Health. Unison Health is a nonprofit mental health agency dedicated to serving the Northwest Ohio community for the past 50 years.