Latest / The Trauma Therapist / Episode 807: Trauma-Informed Intake: The Questions with Doreen Hills

Transcript

Episode 807: Trauma-Informed Intake: The Questions with Doreen Hills · The Trauma Therapist

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  Trauma Therapist Podcast. Plus listeners can listen to episodes early and ad free right
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  now. Become a Plus listener by going to Apple Podcasts searching for the Trauma
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  Therapist Podcast and signing up today. All right, welcome back to the Trauma
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  Thepist podcast. My name is Gamiferson. My mission is to help trauma therapist
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  be their incredible selves, to be human, to be real, not just
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  a clinician. I'm a big believer in who we are is more important than
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  what we know, and this requires cultivating authenticity, genuineness, and vulnerability,
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  and that requires intention. Can learn more about my courses and workshops by going
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  to the Trauma Therapist Project dot com. That's the Trauma Therapist Project dot com.
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  Let's get started. So five four, three, two and one,
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  our folks, welcome back to the podcast. Very excited to have back.
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  Doreen Hills, Doreen, welcome back, Thank you for having me. Super
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  excited to be here. So. Doreene is the founder director at the Center
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  for Healing Trauma and Attachment. Their mission has to provide cutting edge treatment approaches
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  in healing traumatic distress and they're committed to finding ways to provide quality and affordable
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  therapy and to be the pioneer in healing trauma in the North East region.
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  Duran has been a mental health provider for over twenty years and has worked in
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  various settings in New York, Philippines, Colorado. Her background includes intense,
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  immersed experiences working with poverty stricken fishermen in the Philippines, orphans that were severely
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  neglected and abandoned, as well as Muslims in India. Doreen, We've had
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  to hear several times and today we're gonna talk kind of like a part too.
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  Last time we were here, you share your insights on the trauma informed
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  intake and what that means. So today we're going to do uh kind of
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  a part two to that, which is really interesting. So take it away.
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  Let's bring us up to speed. Yes, I think it's so important
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  to really understand and have strategies in you know, doing your intake. And
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  again, you know this this part here will really focus more on, you
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  know, what type of questions that clinicians can actually you know, utilize and
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  these you know, these questions. I've developed some of this and then some
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  of that I derived on, you know, on the wisdom of Bessel,
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  vander Coke and other trauma experts and then just weaved it into my work.
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  So I wanted to just kind of bring up this piece here where, you
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  know, I think in the in the e world, like the techy world,
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  we tend to you know, to just be we get we start to
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  get comfortable with you know, what is what is? You know those what
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  what what's offered to us. So let's say it's already lined up. It's
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  easy, you know, clients can use that, which you know overall is
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  pretty helpful. But then if we really wanted to understand attachment, you know,
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  attachment between caregivers and even the generational attachment patterns and complex trauma, we
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  need to weave what you know, what the words of wisdom from others have
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  given us. And so I think it is important today to really dive into,
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  you know, those strategies, those questions, and yet very mindful of
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  the you know, of the of the person's story. Not interrogative, you
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  know, like a detective, you know or not. Well, we're all
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  detectives, but we're you know, like not too too much, not too
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  interrogating. So I would love to share that with the listeners today and I
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  think I think I would like to focus on the adult version first and maybe
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  in the future we can dive into the other versions. That sounds awesome,
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  Okay, I love what you're saying here. So you're just in some way
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  in a sense, you're saying there's a lot of online versions of evantakes,
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  and you're you're kind of suggesting or advising they're good and they have their place.
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  But dot Okay, So what are some questions we're talking about here?
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  Yes, and so I would like to start first with you know, every
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  time you see clients, you are a detective. You're trying to understand and
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  learn their stories. So here we go, guys, I think you know,
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  pen and paper here and listen to the Trauma Therapist Project to just get
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  those information. So I would like to you know, ask as people,
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  as our clients, you know, the impact the impact of the presenting issues
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  on the relationship, on their relationship within themselves, you know, and the
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  immediate and extended family. So it is I mean, you can weave it
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  any time when it's you know, when it's that right time and right moment.
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  I think it is important to not only focus on the symptoms, but
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  also what is the impact of those in their relationship with others? Okay,
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  So let's say you're asking me that question, what would you say? How
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  might you ask that? So I will ask you guys. Okay, so
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  you're saying that you're having the difficult time you know, with anger or even
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  having those flashbacks or even you know, just the ability to connect with others.
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  How is that impacting your relationship with your loved ones, with the people
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  with your cowork and you know, I don't know how how you're going to
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  respond to that, but that can be a very good, rich conversation as
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  to you know, the impact of those distress in someone's system. Well,
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  I would say it's impacting a lot. I mean, the flashbacks are uh
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  kind of interfering with my ability to communicate with my partner. I don't know,
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  sometimes I don't know what's real and what's not. You know, I
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  feel like I'm not even sometimes I feel like I'm not even here right And
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  so what a what a good conversation, And it it threads into okay,
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  are we dealing with you know, is this something that the client would like
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  to focus on their goals, you know, to be able to communicate being
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  you know, communicate with my friends and loved ones in a present way,
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  you know, being mindful, so that you can, you know, you
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  can weave it in that goal, the goal or treat and planning. So
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  oftentimes we have I mean, our clients come to see us because their relationships
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  are affected by trauma, and so I think it is important to understand,
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  you know, get into the impact of it some of the things too.
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  And again this is more of the relationship with you know, with their attachment
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  figures, typically on the child you know, on the childhood, on their
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  childhood, who took care of you growing up? Who was your support system?
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  Who was the one that you feel safe and secure with? And leave
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  it as a really good conversation, you know, between the two of you.
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  Now, let me let me so, why what kind of plain devil's
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  advocate here? Why is that important? Why? Why? I mean we
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  you know, we know what trauma is important, or attachment rather is important.
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  But within this context, uh, why is that important? Well,
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  it is, it's very important. So let's say you are dealing with with
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  a client that has children, and this gives us a good picture or maybe
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  a snippet of Let's say I asked you that I asked that question, or
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  I asked that question the person said, I don't have any I'm alone I
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  or they might say nobody is you know, nobody is a safe person to
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  me. So what happens is when they have that, you know, when
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  they have that perception or that experience, how are they taking care of their
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  kids? What kind of attachment style you know they kind of lean into,
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  you know, is it disorganized? Is it or is it ambivalent? Is
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  it insecure attachment? So what and oftentimes in complex trauma, it is the
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  disruption between the child, the disruption, the disruption between the child and the
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  caregiving system. So when we have a glimpse of what happened to them growing
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  up, who took care of them, you know, it gives us an
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  idea of what kind of attachment style they are running into or what you know,
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  what's blocking them, what's making them resilient, what makes them flourish?
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  Or let's say, who took care of you? And they might say,
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  well, I have aunts and uncles and grandpa and grandma that really really loved
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  me, And do you still have connection with them? Absolutely? And how
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  are they you know, how are they playing in your in your roles as
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  parents as a parent. Now, I mean, boom, what a rich
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  conversation, and you're getting an idea of Okay, here's this individual that has
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  support system and so when they're having a difficult time, they can run to
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  those to those folks. So does that make sense? M h Yeah.
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  It opens up a lot, It opens up a lot. Yeah, yeah,
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  yeah, okay, awesome. Continuing on here, and another question,
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  let's say, yes, another question again in the in the context of that
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  attachment as what was your parents you know, what was your parents discipline style
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  look like, you know, and they might well they're pretty lax, or
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  some folks like you know, some folks may say, well, they're authoritative,
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  authoritarian, they're very nurturing. Again, it's giving us a glimpse of
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  what the attachment looked like. And oftentimes, when let's say, as kids,
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  we you know, I mean I came from I came from the Philippines,
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  and my parents were you know, they're very strict, they're very you
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  know, they're very disciplinarian, and you know, I kind of again in
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  my in my caregiving system, I you know, I default to that because
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  that's what I've learned growing up. And so I have to tweak it,
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  and you know there's pros and cons on that. So it gives again and
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  that kind of a question, how how your parents discipline? What is that
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  like for you? How is that? How did that affect you before?
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  And how is that affecting you now? You know, it gives us a
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  picture of how they are in relation with their kids and you know, with
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  their children. So that's pretty powerful in terms of someone you know, you're
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  doing an intake in terms of someone who's experienced trauma. Let's say I'm the
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  client and you're asking me about my parents? Uh was it disciplinary style?
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  Or how how were your parents treated you? So moving along down that that
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  question line, what are you looking at in terms of how I'm experiencing my
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  own trauma? What are you thinking about in asking that question in terms of
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  looking at how I'm dealing with my trauma? Yes, I'm you know,
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  I look at I pay attention to body language. I don't know if I
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  answer your question, but I you know, sometimes when we again, how
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  how we how we ask the questions? And again it's you know, very
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  very strama sensitive care, you know, paying attention to how the body is.
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  So when they're sharing that with you, is there incongruency that's happening you
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  know, Oh yeah, yeah, my you know, my my dad beat
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  me up. And then there's much a lot of people have that affect too
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  when they talk about that. Yeah, right, and that can be a
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  very good, you know, a very good point for clinicians to not that
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  time yet, but something to where they can they can they can pay attention,
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  they can make the client aware of it later on in sessions to where
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  hmm, I noticed that when you talk about, you know, about this
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  stuff, you're smiling. Now you're looking into more of you know, paying
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  attention to I mean that sense of self awareness. You know. So paying
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  attention to the incongruency, the congruency of the body as well as the affect
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  can really you know, it's really helpful when you are doing trauma in form
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  care. I love that. So it's in addition to kind of asking questions,
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  there's also the observation. Absolutely lovely what's going on to observation of the
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  body language and so forth. Ngruency. Yeah, that's awesome. I noticed
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  too while we're talking, since we're talking about congruency, I noticed people will
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  you know, they will hunch or even their you know, their shoulder starts
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  to tighten, or even their you know, I call it the ballerine or
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  the tipital, you know, your feet. You know, it feels like,
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  okay, what is happening? And you can sense it? Do we
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  feel like we're getting flighty here? And I when I sense that with clients
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  or even sense that with me, okay, and it's okay. There's something
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  I want clinicians to remember. It is okay to pause and let them know,
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  Okay, I'm sensing a little bit of you know, a little bit
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  of something in me, you know, like we're feeling like we're getting disconnected.
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  Are you feeling that? And they might oftentimes they will say, yeah,
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  I think I need to take a little time out. Okay, so
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  let's just take a moment. Let's plant our feet again. Let's take a
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  deep breath. You and I doing this together, you know, So in
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  that way, they don't feel like, okay, well, you know I'm
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  going crazy here because Doreena is not even participating with me. Nope, you're
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  going to join them now. You are going into the coregulation and the atonement
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  while you are understanding and learning their story. But then when they leave your
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  office. The key to successful I do BELI the successful session is them leaving
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  the office. Your office regulated super important. So when you notice that,
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  when you feel like their feet is kind of like they're doing the ballerine or
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  the tipito help them plant it again with you being there, with you joining
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  them. This is so much going on, Oh so much. I mean,
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  there's so many different levels that you're operating on. You know, we
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  started out, Okay, we're going to talk about questions. Well it's not
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  just questions. There's so many things going on. One of the things that
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  you know, in speaking with you on the many occasions that I have that
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  I really admire about your dream is you just have this grounded sense and presence
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  about you. Now, let me ask you this. When you're working with
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  someone, how much of your own experience do you share typically? Are you?
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  And yes, it's different with every client and we want to do it
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  ethically or with boundaries and so forth, But is that something that you do
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  typically do you bring in your own experience of you know, that's a beautiful
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  question, guy, because I ran into this just last week and how I
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  usually handle that like that self disclosure again right time and right moment, and
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  your instinct will tell you again, when you practice the sense of awareness and
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  presence and just being attuned with them, your instinct will align with that.
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  And so what happened to me last week was you know, okay, oh
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  this you know the theme? Right now? I can share something. Now,
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  what's the most critical thing here to ask yourself is is this going to
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  benefit the client? Or this is just more of a rage you know,
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  raging or you know, not raging, but is it just more to share
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  it? The biggest key here in self disclosure is how is this going to
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  benefit the client? And so again permission, I asked them, I have
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  not too similar of a story with you know that you're sharing right now,
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  but there's a theme that's kind of you know, joining me with you.
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  Can I share it? Is it okay? And it's not going to take
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  too long. I'm talking about just a few seconds. And if they said
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  yes, sure, we would love to. I would love to hear that
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  and then yeah, this makes sense. Oh it's it's great. So what
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  you're doing there is a couple of things right You're asking permission and what does
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  that do That gives them some control, some lets them know they're in they're
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  with you in a sense in that moment. Yes, not just Doreen leading
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  the session, and it's it's you're asking permission, You're bringing them into the
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  weight of the relationship in a sense. Yes. Always And you know you
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  and I talked about this on the first on the first episode that Okay,
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  this ship is theirs. They they think that it's somebody's you know, another
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  captain has to run that ship. Right, My very first session is no,
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  you can be You are the captain of your ship. You know your
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  story. I am just beside you. I'm just listening to what's happening.
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  And so anything that I share with them self disclosure. Again, it's for
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  the service of the client. It has to be serving a purpose. Everything
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  has to be intentional, not just you know, I just wanted to share
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  this because I want to. Right, So we're talking about here intake questions,
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  generally for for adults, trauma informed intake questions. Let's continue on what
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  other ones? What are the questions? Uh, do you want to point
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  out? Oh, I also ask them this is this is not something that's
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  on just the typical intake, Right, how do you handle stress? What
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  do you do to take care of yourself. How do you cope with difficult
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  emotions? How effective are those tools? How is that working for you?
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  How is that not working for you anymore? What emotions do you find that's
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  you know, that are more difficult to manage? So it gives us an
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  idea of how you know how they are in terms of coping skills and their
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  calming strategies. I also I also use this really cool tool. You guys
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  are you're probably familiar with Captain America's shield, right you know that, you
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  know it's all circle and so it's it's got different you know, different levels
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  and what I tell clients, and it can be the third session, it
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  can be during the you know your nine O eight three seven, your your
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  therapy session. I asked them, can you you know I do have the
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  graph and you can do it yourself. You have a graph of that.
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  You know that that that shield, and I will tell them, can you
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  show your your support system using this graph, using this using this tool?
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  And so the closer they are so in the middle, the closer those people
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  are, you know, those are the ones that are close to their support
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  system, and what you're doing there is understanding their tribe and you might be
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  surprised that you might be on the first you know, on the first level,
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  like wow, you know, and what made you think you know?
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  Adding me there now? Well, because I feel like I can trust you,
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  I can talk to you about stuff. So which is a very good
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  way of now for folks that are doing E M d R. This is
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  already you're already introducing the resource installation here, you know, like those resource
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  development AREDI. So now these people, you know, the clients can identify
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  here are the people that I feel safe and secure with, and most of
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  them are probably Yeah, I like them, but you know, they're not
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  quite there yet. So this is a powerful question that you can you know,
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  well, this is an inquiry, you know, to how many folks
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  they have in their secure system. Wow, I love that one that that
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  can be. They're revealing too, because oftentimes sometimes people can say, well,
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  yeah, you know my sister, I'm really close to my sister.
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  Well then why do you have her all the way out here? Exactly?
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  Well, you can't really tell her share things with her or whatever she triggers
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  me or whatever exactly, And so it is it's it's good to have that
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  because they can tell you who are triggering. Yes there is still support supportive,
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  but they're triggering. But it's it's already giving you the idea, the
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  template of Okay, when we are doing those resourcing, we can include these
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  figures, these people in their lives. So it's it's you know, it's
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  more than just a pen and paper or a computer. Between the two of
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  you, you are already understanding their template, their story by just asking those
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  simple, simple and yet powerful questions right right right, and also as you
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  talked about, you know, maintaining this observation, watching their body language,
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  watching the congruency or incongruency, so very powerful mm hmmm mm hm, and
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  so utilizing again. My suggestion to providers is be creative. Do not you
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  know, don't take creativity in your intake in your sessions. You know,
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  it is important to it is important to use art. It is also important
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  to you know, bring the element of art. People tend to have a
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  good idea when they're writing it in paper, when they can actually see it
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  visually. You can use sandtray, you know, for those of you who
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  are fascinated with sandtray, you can you can do it in the second session
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  or third session, even the first session, create your you know, create
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  your resource your support system world. And they can create, you know,
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  put objects means something to them. And so we need to not only again,
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  we need not only to look at the symptoms and the problems, we
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  also have to look into those positive resource system because eventually, this is what
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  this is what we wanted to do, right that is the goal of trauma,
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  of trauma therapy. It's for healing and for recovery and for resiliency.
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  And so you're already gathering this information. You may not use it right away,
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  but you're putting it in. You're putting it in a box, in
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  a very important box that once Oh well, let's say a client, I'm
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  struggling right now, I don't know who can help me. Let's pull away.
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  Let's take a moment here. How about your great aunt that's close close
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  to you that she seems to be so there in your heart that every time
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  she just you hear her voice, she just calms you. I could not
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  and even think about her. But you're it's more than intake, it's more
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  than paper. You are already giving them because again you're giving you're the guide
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  for them, You're a witness and a guide for them, like remember this
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  time when you were you know, when you're when you're having a difficult time,
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  this is the this is what you're telling me that you're good at this,
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  blah blah blah. You know, personal strengths and resources. Do not
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  forget to share or to ask those questions? How do you get where you're
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  at now? And I'll give you an example on this, so you know
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  how you're Let's say I'm asking you you know, geez, you know you've
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  gone through so much adversities in life, you know, and it feels like
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  it's it's like all all coming, you know, all at once. But
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  there is also always that crack in the you know, crack, like little
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  slim crack there to wear maybe a sign of hope. But what do you
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  do to keep going? You know, you're here now, sitting with me,
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  talking with me, So what is you know? What? What are
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  you? What get you where you're at? And they may take a moment
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  and I tell them take a moment to pause. I wanted you to just
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  to just kind of chew on this, you know, chew on this inquiry.
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  And people might say, hope, I'm not giving up hope, or
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  they might say prayers, or they might say I need you know, walking,
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  you know this distance. So what's happening there which is so beautiful is
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  you're they're already giving you strategies their ability to be resilient in difficult times,
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  you know. Or maybe they might say, I just remember my grandma and
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  grandpa telling me to never give up. So when you're when when you're getting
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  this information, you can use that when they're having a difficult time. Remember
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  the time when you were telling me that you know you're not losing, you
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  don't want to lose hope. How can we use this now for you?
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  And again it's not those you know, the question is so gentle and at
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  the same time, you know, so in attuned to who are you as
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  an individual? What an you know? Who are you as an individual?
• 27:30
  And it's not just a question of what is your strength? What are the
• 27:33
  things that you're good at? It's not like those black and white right right
• 27:37
  right, that makes sense though, it makes a lot of sense. It
• 27:44
  makes a lot of sense. It's it's so inspiring to me. There's there's
• 27:48
  a you know, you supervise clinicians also correct and as we kind of wind
• 27:56
  down here, I want to kind of close with this. Do you sense
• 28:00
  in younger clinicians is there a uh, how are they fearful of interacting with
• 28:11
  people who've experienced trauma generally speaking? Because what you're talking about here is kind
• 28:18
  of like a fearlessness. It's a respect, but it's a moving into their
• 28:23
  world. And sometimes, I mean a lot of times trauma can be frightening,
• 28:30
  and I think for a newer clinician it can be scary even though they
• 28:33
  want to help. Of course, yes, so I think it's that's the
• 28:38
  nature of And I've been there, you know, all of us been there,
• 28:42
  Like you're afraid if I ask this question, am I re traumatizing them?
• 28:47
  Or if I actually right something something related to lethality or risk of suicide,
• 28:52
  am I going to you know, to push them to do that?
• 28:56
  You know? And I think it is. Here's here's my take or my
• 29:03
  suggestions to new clinicians. Be open to asking questions. Your supervisor is there
• 29:12
  to help you. And if you feel like I need more, you know,
• 29:18
  again, from being fearful to fearless, you know, I think it
• 29:23
  is important for people to for clinicians to ask and ask and ask seek supervision,
• 29:30
  seek you know, like mentor not shadowing, actually shadowing shadowing providers that's
• 29:37
  been doing this over and over again, and be okay to make mistakes.
• 29:42
  I mean I've made mistakes many times, you know, when I was when
• 29:47
  I was new. And so for us to for us to be fear fearless,
• 29:52
  we just have to practice it and again combining it with good supervision.
• 30:00
  So oftentimes I think this is what's and this is my experience. We get
• 30:06
  so caught up with the theories, we get so caught up with what we've
• 30:11
  learned in you know, in the universities, that this is just the black
• 30:15
  and the white. And again it's it takes some time. So before giving
• 30:22
  of you be kind to yourself. You know. I I've learned to just
• 30:27
  ask questions. There are no stupid there are no stupid questions. And I
• 30:32
  tell this to my you know, to to my supervisors. Just ask me
• 30:36
  anything. And if I don't know, you and I are going to research
• 30:40
  it. So to from become from fearful to fearless. That's my you know,
• 30:48
  that is my suggestion for new Cless. Awesome. Awesome, all right,
• 30:52
  Duran, awesome. So what's the best way for people to reach you
• 30:56
  and learn more about what you're doing. Yes, so oh. People can
• 31:00
  reach me you on our website. It's c H T A I n C
• 31:07
  dot org, or they can give us a call at ninety seven oh three
• 31:11
  nine seven four six zero nine. Okay, we'll have that linked up at
• 31:15
  the show notes page here at the Trauma theaverorspodcast dot com. During always awesome
• 31:21
  and inspiring talking to you, we'll have you back. Thank you so much.
• 31:26
  Thank you all right, Thanke, youre