Latest / Mind & Medicine - A Behavioral Health Podcast by Sentara / The Power of Systems Thinking with Dr. Juan Turon, LMFT - Episode 2

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The Power of Systems Thinking with Dr. Juan Turon, LMFT - Episode 2 · Mind & Medicine - A Behavioral Health Podcast by Sentara

• 0:00
  Speaker: Hello and welcome to Mind and Medicine, a Sentara podcast. I'm Tommy Bateman, your host, and today we will be meeting with Dr Juan Turon to talk about the power of systems thinking. But before we begin, some important CME announcements. This episode is accredited for AMA PRA Category 1 credits. For full accreditation, designation, and disclosure information, please refer to the show notes and now the show. So with all that, yeah, it seems like systems level thinking really runs against the grain of how care is delivered right now.
• 0:35
  Speaker: First off, it's it's individualized.
• 0:37
  Speaker: Um insurance doesn't allow you to do it as a system necessarily.
• 0:41
  Speaker: I know it does, but you know, you know what I mean when I'm saying you're you have an identified patient.
• 0:45
  Speaker: So how do you apply this to the individual level when you have one patient in front of you?
• 0:49
  Speaker: That's all you have.
• 0:50
  Speaker: And how do we apply uh systems thinking to that one person in that moment?
• 0:56
  Speaker 3: I'm gonna answer that in two ways.
• 0:57
  Speaker 3: First as a politician, and then as a therapist.
• 0:59
  Speaker 3: As a politician that I'm not, I will say that's a wonderful question.
• 1:03
  Speaker 3: When politicians you ask them many questions, they'll say, that's a wonderful question, and then they'll they'll give you props about your question.
• 1:10
  Speaker 3: All jokes type.
• 1:12
  Speaker 3: So I talked to you about Douglas Flemonds.
• 1:14
  Speaker 3: Um this idea of hypnotherapy and Milton Erickson, and in at Nova Southeastern, we were trained in brief systemic therapy, and brief systemic therapies also applied to individuals with a system thinking approach, right?
• 1:28
  Speaker 3: Right?
• 1:28
  Speaker 3: So the idea is that there are different ways of thinking about the problem that change the problem.
• 1:35
  Speaker 3: I specialize in two areas in my practice.
• 1:39
  Speaker 3: One of them is couples and families systems.
• 1:43
  Speaker 3: The other one is the treatment of anxiety.
• 1:48
  Speaker 3: I don't work with anything else outside that's all I focus on.
• 1:53
  Speaker 3: And when it comes to anxiety, I work with individuals outside of the system of the family, unfortunately.
• 2:02
  Speaker 3: I deal with the reality that I'm dealt with.
• 2:05
  Speaker 3: Towards the end, we start talking about the family, but it's not systemic therapy because the family is not there, it's not present.
• 2:11
  Speaker 3: We're talking about the family.
• 2:13
  Speaker 3: That's an area where postmodern models of family therapy and I disagree.
• 2:18
  Speaker 3: The idea of postmodernism family can exist in the mind and it will be considered systemic.
• 2:22
  Speaker 3: I don't believe that.
• 2:23
  Speaker 3: I believe that change happens in between, not with it.
• 2:27
  Speaker 3: But with anxiety, when it comes to panic attacks, for example, I treat anxiety from a context-based approach.
• 2:37
  Speaker 3: And the maxim of my interventions is simple.
• 2:41
  Speaker 3: It's a quote that says, When you change the way you think about things, the things that you think about change.
• 2:50
  Speaker 3: And my goal is to find meaningful ways of repurposing the symptoms so it can become useful.
• 2:58
  Speaker 3: Not good, happy, favorable, likable, enjoyable, but useful.
• 3:02
  Speaker 3: Once the symptom becomes repurposed into something useful that means something to the patient, then the symptom changes the way it's experienced.
• 3:13
  Speaker 3: I can give you a very, very brief example of that if you like.
• 3:16
  Speaker: I was thinking, I was thinking like a mother worried about her child.
• 3:19
  Speaker: Or you tell me, tell me.
• 3:20
  Speaker 3: That's exactly that.
• 3:21
  Speaker 3: I had a marine biologist who was highly intelligent, the doctor who discovered something that helped to clean the oceans.
• 3:28
  Speaker 3: Um, he was traveling everywhere.
• 3:30
  Speaker 3: Beautiful little girl.
• 3:31
  Speaker 3: Yeah, she has, and um a husband who was emotionally removed to the point where he will kind of push the little girl away when she tried to sit on his lap.
• 3:41
  Speaker 3: And so she came to me because she was driving with her daughter, small family, just them, not happy in her relationship.
• 3:49
  Speaker 3: And when she was driving with the daughter, she got re-arrended by a car.
• 3:53
  Speaker 3: Nothing too harsh, but enough to scare her.
• 3:57
  Speaker 3: And then she started thinking, what happens if I get into a car accident and I'm with my daughter and something happens to her?
• 4:03
  Speaker 3: Or something happens to me and then she's left behind with dad, and that is not an emotionally connected person.
• 4:08
  Speaker 3: And she started thinking, what if and am I?
• 4:11
  Speaker 3: The language of anxiety, by the way, therapist take notes, the language of anxiety is what if and am I, right?
• 4:16
  Speaker 3: Clients will always say that.
• 4:18
  Speaker 3: And she started having this type of thinking, and she got to a point where she could no longer bring herself to drive, to the point where she will go into panic by walking by the keys, the car keys.
• 4:30
  Speaker 3: This led to a ramification of issues where she couldn't teach anymore because they wouldn't do the virtual thing, and she was teaching in person at the university, so she was put on leap for six months, and she came to me upset.
• 4:42
  Speaker 3: The symptom was that the fear was the fear of driving, but we started exploring what was most meaningful to her sense of self.
• 4:51
  Speaker 3: First move.
• 4:52
  Speaker 3: When we identified that the most important thing, meaningful thing to her was being a mother and being alive long enough to raise her daughter until she could fend for herself.
• 5:02
  Speaker 3: I told her that I couldn't help her because she was asking me to eliminate the only thing that could keep her safe.
• 5:10
  Speaker 3: That whenever I found myself in the passenger seat of a vehicle, I would be the most scared when I was driving with people who had no anxiety.
• 5:19
  Speaker 3: And they did their makeup at the light, they showed me YouTube videos uh while driving, they look in the glove compartment for things while driving, holding the steering wheel with their knee, meaning they had no anxiety anymore.
• 5:32
  Speaker 3: And that she was asking me to remove the only thing that could potentially keep her safe as a driver, and I told her from Haley, Jay Haley, I assigned the problem.
• 5:44
  Speaker 3: I said, do not go anywhere near your carcass unless you're anxious.
• 5:51
  Speaker 3: And a few weeks later she was driving in the intertwater.
• 5:55
  Speaker 3: The symptom she was trying to eliminate was meaningfully repurposed into something that became a resource that she didn't know existed.
• 6:10
  Speaker 3: That's where our training um in the work of Milton Erickson is useful in finding uh a very mercenary way of working with um psychological disorders.
• 6:27
  Speaker 3: Right?
• 6:28
  Speaker 3: So I think that that's nice, and that's the way I approach from a context I approach individual pathology, but I don't think that that's systems thinking, right?
• 6:42
  Speaker 3: And I don't think that that's systemic therapy.
• 6:45
  Speaker 3: Right?
• 6:47
  Speaker 3: Um I think that the system is an interactional thing.
• 6:52
  Speaker 3: My motto is to search within and to change between.
• 6:57
  Speaker 3: I think that when when people try to search within themselves and change within themselves, ignoring the system in which they exist, meaning when a husband or a wife or a child work on themselves in therapy, and then they come home and they don't try to implement that change within the way in which they interact within the system, it's wrong because they're changing alone.
• 7:28
  Speaker 3: In capital therapy, it's even unfair because they're leaving somebody behind.
• 7:36
  Speaker: I see.
• 7:36
  Speaker: I I was thought to think that though, if one person changes in the system, the whole system gets changed, right?
• 7:43
  Speaker 3: Yes, that's an idea that comes from Mary Bowen and Michael Kerr, the multi-generational um theory of change.
• 7:52
  Speaker 3: That is from a book titled Family Evaluation.
• 7:56
  Speaker 3: And that is that is correct.
• 7:57
  Speaker 3: That according to Bowen, when a client becomes self-differentiated, um it changes the system that he he wants to live in.
• 8:09
  Speaker 3: Um it affects the system and the system begins to change.
• 8:14
  Speaker 2: Right.
• 8:15
  Speaker 3: And that's why Mary Bowen didn't mind, he had a lot of family members in the room.
• 8:20
  Speaker 3: He always had a board to write.
• 8:22
  Speaker 3: But a lot of times Bowen had just one member, and then he his way of being systemic was by having um a genogram drawn about the family, right?
• 8:32
  Speaker 3: I also don't think that that is systemic.
• 8:37
  Speaker 3: My view on systemic family therapy is that the family is in the room.
• 8:44
  Speaker 3: Okay, and that it's not a cognitive thing.
• 8:49
  Speaker 3: The family is more than a cognitive construct.
• 8:52
  Speaker 3: Because from that perspective, you could also argue that psychoanalysis is family therapy, because Freud talked a hell of a lot about the family, right?
• 9:01
  Speaker 2: Right, yeah, yeah, yeah.
• 9:02
  Speaker 3: With an individual patient in the room, but an individual patient thinking and talking about the family is not family therapy to me.
• 9:09
  Speaker 3: To me.
• 9:10
  Speaker 3: To a lot of people in my field, it is, and I understand that they think that way and I respect it.
• 9:15
  Speaker 3: And I disagree.
• 9:16
  Speaker 3: I think that to my knowledge, individual systemic family therapy has to do with changes that are happening in the process of.
• 9:26
  Speaker 3: I do systemic family therapy today because I only do telehealth.
• 9:31
  Speaker 3: I only do systemic systems, uh, family therapy with a couple when the couple is in the car or in the house.
• 9:42
  Speaker 3: Because I have done sessions where the couple starts a session in the front seats of the car, and then when I notice that the wife or the husband shadows overshadows the the other partner by talking over them, I ask the other partner to open the door and I say, keep talking.
• 10:06
  Speaker 3: Can you can you open the door and sit in the back of the car, please?
• 10:10
  Speaker 3: And I ask the person who talks over the partner to keep talking.
• 10:14
  Speaker 3: And then I point out, do you notice that your husband or your wife doesn't mind continuing to talk about their truth, even if it means that they leave you behind?
• 10:25
  Speaker 3: Sometimes I even ask them to leave the car completely.
• 10:29
  Speaker 3: I create a discomfort that forbids them from continuing to function in the same way without thinking about it.
• 10:38
  Speaker 3: I create a systemic change through an interaction.
• 10:42
  Speaker 3: I move people around, I do things to move the system, and I'm hyper-aware of my role in that system and their role in affecting me.
• 10:50
  Speaker 3: To me, that's systemic family therapy applied to a couple.
• 10:54
  Speaker 3: Um I will never ask a couple to meditate individually, but I will ask them to sit down, hold hands, make eye contact for five minutes of silence.
• 11:06
  Speaker 3: What I call the silent treatment.
• 11:08
  Speaker 3: It's the only technique I use in couple.
• 11:09
  Speaker 3: That helps them to reconnect with one another.
• 11:12
  Speaker 3: It's a collective meditation.
• 11:13
  Speaker 3: They're doing something together, they're giving themselves the gift of silence and reflection for five minutes.
• 11:20
  Speaker 3: When they have been told by other therapists a lot to talk, talk, talk, talk, talk, talk, talk.
• 11:25
  Speaker 3: When all they do when they talk is make things worse.
• 11:28
  Speaker 2: Right.
• 11:29
  Speaker 3: As a systemic thinker and practitioner, if I work with individuals with anxiety, I have my approach, contextual approach, is extremely useful.
• 11:38
  Speaker 3: But when I work with couples and some families, not too many, I need the family system together.
• 11:46
  Speaker 3: Couples say, do we need to be there together?
• 11:49
  Speaker 3: Do we need to be there from the same location?
• 11:50
  Speaker 3: Absolutely, yes.
• 11:51
  Speaker 3: Yes.
• 11:51
  Speaker 3: And ideally, you should do things.
• 11:53
  Speaker 3: On October 15th, I think I'm supposed to talk about what to do, right?
• 11:57
  Speaker 3: But yes, I so that was my example of the woman, in which how do I treat people um as individuals, as a family therapist?
• 12:06
  Speaker 3: And I tell you, I draw from my experience with um Flemons um and um and the ideas of Milton Erickson.
• 12:14
  Speaker 3: If anybody wants to to read a good book, I think a good book for that is of one mind by Douglas Flemons.
• 12:23
  Speaker 3: Yeah, excellent book, excellent book.
• 12:26
  Speaker 3: Um, and if they want to learn more about context in therapy, that would be a great book.
• 12:31
  Speaker 3: Um, and then and then I know that that's not family therapy, right?
• 12:36
  Speaker 3: Right, it's individual systemic therapy, but it's not systemic family therapy.
• 12:41
  Speaker 3: Um, I'm working on a manuscript now for the contextual treatment of anxiety, and I'm working in another book that is called titled couples, very simple, that talks about how to work with couples in a physical way, how to get them to do things differently.
• 12:57
  Speaker 3: Does that answer the question?
• 13:01
  Speaker: Absolutely.
• 13:01
  Speaker: And so then that leads me to since a lot of a lot of the people listening to this are those that treat physical conditions, right?
• 13:09
  Speaker: They don't they don't do therapy.
• 13:11
  Speaker: I'm a counselor, they don't do what I do, they don't do what you do.
• 13:14
  Speaker: But let's say you were supervising a medical practice.
• 13:18
  Speaker: How would you bring this into a medical practice to help alleviate the diabetes?
• 13:23
  Speaker: The I mean, we don't have to go into whatever whatever medical issues they're having, but how would you ask the medical profession to start approaching their patients?
• 13:33
  Speaker 3: You know, the um couple therapists and medical professionals, we deal with the similar problem with patients.
• 13:42
  Speaker 3: From this is from conversations I had with with with acquaintances who are in the medical field, surgeons, uh medical practitioners.
• 13:51
  Speaker 3: That patients and couples uh they come to us in demanding an appointment the earliest possible, willing to pay any money.
• 14:04
  Speaker 3: And then once they feel a little better, they go on to not change.
• 14:10
  Speaker 3: Session after session, they come unprepared, wanting to talk about the weather, canceling sessions, not showing up, showing up and prepared, not having done anything in between.
• 14:22
  Speaker 3: And what I know, the limited knowledge I have about the medical profession, is that one of the difficulties that medical practitioners struggle with the most is medication management.
• 14:32
  Speaker 2: Right.
• 14:33
  Speaker 3: And and and patients, those who are surgeons, patients when they feel a little better, not doing stupid stuff and not doing more than they should.
• 14:43
  Speaker 3: And that a lot of patients, for some reason, refuse to take their medications.
• 14:48
  Speaker 3: The medical medical practitioner says to them, they gotta take this, and and they don't.
• 14:55
  Speaker 3: And mind you, that in the medical profession, just as in psychotherapy, they teach us everything except how to run a practice, right?
• 15:06
  Speaker 1: Yeah.
• 15:06
  Speaker 3: In psychotherapy, we know very well that you do an associate's, a bachelor's, a master's, a PhD in the best of cases, two years of state licensure, and there's not a single course on money management, administrative management, running a practice, how to open your private practice.
• 15:19
  Speaker 3: None, nothing, nothing, nothing whatsoever.
• 15:21
  Speaker 3: Medical practitioners are no exception.
• 15:24
  Speaker 3: So not only do they have to juggle with um learning how to make what they know profitable because they work at a hospital first and then they can go on and open their own uh doors.
• 15:36
  Speaker 3: So they're dealing with all the adversities of taxes, hiring people, learning that people are not reliable, um, all the trials and turbulences, but they're also subjecting themselves to an academic rigor that is much, much, much scrutinous than ours.
• 15:53
  Speaker 3: They have to go many nights without sleep, they have to uh deprive themselves of a social life a lot of times to be able to pass tests that you can only take one time, and if you don't pass them, you're out.
• 16:08
  Speaker 3: And so by the time they become medical doctors, meaning interns at a hospital, my under this is my understanding, the the audience can can correct me.
• 16:16
  Speaker 3: I don't I'm not a medical practitioner, but then they become interns, they're exhausted.
• 16:20
  Speaker 3: And then they have to put out with people they work under uh and their social skills have suffered.
• 16:28
  Speaker 3: They have suffered, mainly because they have had none while they studied, and mainly because at the hospital they're asked to do something impossible, they're asked to treat more people than it's physically impossible to do as interns and then as medical professionals.
• 16:43
  Speaker 3: And so by the time they see their patients in their practice managing all these difficulties, they have to deal with resistance to change.
• 16:52
  Speaker 3: Meaning the area where you, Tommy, and I converse with medical practitioners is how to deal with our patients' resistance to change.
• 17:00
  Speaker 3: Right.
• 17:00
  Speaker 1: Right.
• 17:01
  Speaker 3: Right?
• 17:01
  Speaker 3: Simply put.
• 17:02
  Speaker 3: They're coming to us when in need, willing, and then uh negligent towards themselves.
• 17:08
  Speaker 3: And I don't know if medical doctors have the same luxury of time that you and I have with our patients.
• 17:15
  Speaker 3: We see them weekly for an hour.
• 17:16
  Speaker 3: Medical doctors don't.
• 17:18
  Speaker 3: Um, to be able to help them to see the importance of doing what they need to do.
• 17:24
  Speaker 3: But I think that that's one area where sometimes medical practitioners can benefit by reading journals about how to help patients to see the importance of self-care, taking care of themselves, be you know, taking on the medical care in their own hands and so they can become better patients.
• 17:43
  Speaker 3: People often complain about this president or that president, but we have to ask ourselves, are we governable as citizens?
• 17:49
  Speaker 3: Are we easy to govern, right?
• 17:51
  Speaker 3: Or are we doing everything wrong and expecting somebody in the White House or Pink House in my country to do everything for us?
• 17:57
  Speaker 3: The medical practitioners probably go to something similar where like they might complain about the doctor, but are they good enough patients?
• 18:04
  Speaker 1: Right.
• 18:04
  Speaker 3: Right.
• 18:04
  Speaker 3: And so that's where I think that where um medical practitioners can learn um from us.
• 18:11
  Speaker 3: If they learn from me, it will be very very their their practice will become more difficult because they will have to invite families into the room.
• 18:19
  Speaker: Well, and that's and I think there's a a good point to that.
• 18:22
  Speaker: So let's continue, please.
• 18:23
  Speaker 3: That uh they they will no longer have to tell the person um if somebody says an Uber family therapist with a medical practitioner, he will never, she will never.
• 18:34
  Speaker 3: Um I think today you say date them too.
• 18:37
  Speaker 3: So I'm gonna add that.
• 18:39
  Speaker 3: That it will they will never accept that a patient uh came to the practice to be seen by a medical practitioner in an Uber, a lift.
• 18:48
  Speaker 3: But where's a family?
• 18:50
  Speaker 3: Family therapists are known for in public for two things.
• 18:54
  Speaker 3: One of them is you can tell a family therapist in the room because when he's talking to you, he's looking at other people to see how other people respond to how you react to what I say to you.
• 19:04
  Speaker 3: And the other thing is that family therapists always pay attention to who's not in the room.
• 19:10
  Speaker 3: So medical practitioners would probably benefit if they want to become more systemic in how they treat their patients by asking themselves who is the patient not talking about, who's not in the room, especially for you know talking about pediatric um medical practitioners, right?
• 19:28
  Speaker 3: Who's not in the room, if mom brings the the baby all the time, and you know where's that?
• 19:34
  Speaker 3: You know, if dad brings the baby all the time, where's mom?
• 19:36
  Speaker 3: And so on and so forth.
• 19:38
  Speaker 3: But beyond that, there are very different things.
• 19:41
  Speaker 3: They're very different things.
• 19:43
  Speaker 3: Um because oftentimes medical practitioners are become fire extinguishers.
• 19:51
  Speaker 3: The people are very happy, as soon as they heal, they forget.
• 19:55
  Speaker 2: Right.
• 19:56
  Speaker 3: And if they have to do any work beyond that to make sure they don't end up there again, they don't.
• 20:01
  Speaker 3: A lot of times.
• 20:02
  Speaker 3: And maybe I'm generalizing based on my experiences with medical practitioners.
• 20:06
  Speaker 3: I mean, I guess the audience can then determine if this is true or not, their experience.
• 20:10
  Speaker 3: But the difficulty is how to how how to get clients to have a patient to have a different understanding that they're also part of their own treatment.
• 20:21
  Speaker 3: They're also part of their own treatment, and that they have a lot less time than we therapists do to convey that message.
• 20:27
  Speaker 3: Right?
• 20:28
  Speaker 2: Right.
• 20:29
  Speaker 3: Again, having grown up in a very, very small town in Argentina, it's a little different because my pediatrician was my mom's pretty much.
• 20:38
  Speaker 2: Yeah, yeah.
• 20:38
  Speaker 2: Right?
• 20:39
  Speaker 3: So it's the same person, very old, very tired, working as a system.
• 20:43
  Speaker 3: You see them at the supermarket, you see them everywhere.
• 20:45
  Speaker 3: It's just a different idea, it's a more of a collective unit.
• 20:49
  Speaker 3: But um yeah, medical practitioners have a very difficult job.
• 20:53
  Speaker 3: They're often superbly misunderstood, not to mention their own families that they have to come come to and be dedicated to.
• 21:01
  Speaker 3: Um, and they deal with a lot of difficulties, insurance as being one of them.
• 21:05
  Speaker 3: The the role that insurance has in the way we practice medicine and psychotherapy is huge.
• 21:11
  Speaker 3: It's huge.
• 21:12
  Speaker 3: It's very significant there.
• 21:14
  Speaker 3: Insurances are instrumental in organizing the very fabric of what we do as therapists.
• 21:19
  Speaker 3: It's true.
• 21:20
  Speaker 3: It's true.
• 21:20
  Speaker: It it forces uh uh a business model on practitioners to turn as many as possible, not because um they necessarily want to, but because that's the only way to keep your doors open.
• 21:32
  Speaker: And but I can imagine though, you know, to for lack of a better way of putting it, heal diabetes or heal high blood pressure, that's usually a behavioral change, specifically around food and exercise.
• 21:43
  Speaker: Um, not always, but I'm speaking generally generally.
• 21:47
  Speaker: Um, but if we treated it as a I'm I'm talking to a system thinker here.
• 21:51
  Speaker: Um if I treated that diabetes on the individual basis, hey, you need to eat better and and and move more, but then send that person back to the system that they We're in the likelihood of that succeeding is very low.
• 22:03
  Speaker: And so perhaps some systems thinking, even with things like that, because I mean a lot of our medical issues are behaviorally based or behaviorally treated.
• 22:12
  Speaker: So how do we how do we most effectively have to change uh perhaps changing the system that's surrounding your patient?
• 22:18
  Speaker 3: You know, the idea, again, let's go back to the beginning of system thinking that the idea of systemic family therapy is that the symptom is within the system.
• 22:26
  Speaker 3: So a medical doctor, again, we have to go through a lot more work than they have time for.
• 22:29
  Speaker 3: And there's the reality of time.
• 22:31
  Speaker 3: You know, um, we see patients weekly for an hour, and medical practitioners, as we know, that they cannot afford that.
• 22:37
  Speaker 3: Um, but a medical practitioner who wanted to go through the burden of becoming more of a systemic um practitioner will tell the patient who has diabetes, please come with your loved one.
• 22:52
  Speaker 3: Please bring your loved one.
• 22:54
  Speaker 3: And will challenge the loved one to be accountable, to be an extension of her as a medical practitioner and at home.
• 23:03
  Speaker 3: And to say, you know, if if if an example would be if we're dealing with a patient who's diabetic and just learn that, and the medical practitioner says, I want I want you to know that the diagnostic can be that back and you're diabetic.
• 23:23
  Speaker 3: And I need you to bring your partner.
• 23:26
  Speaker 3: If you don't have your partner, bring somebody who's the closest to you.
• 23:30
  Speaker 3: And if you see that the partner is severely obese or obese, overweight, um this shelter, all the things that we assess when we assess for mental health status.
• 23:44
  Speaker 3: Yeah, the idea as a practitioner who has a systems lens will be to challenge them as a system, to say both of you have diabetes, but only one of you is expressing it medically.
• 23:55
  Speaker 3: Both of you have to go to the gym, and both of you have to keep each other accountable, and both of you have to watch the diet and change the diet together because if she is changing her diet and you're eating donuts from 7-Eleven, even though they're delicious, it is bad.
• 24:10
  Speaker 3: Change happens as a system or it doesn't happen.
• 24:13
  Speaker 3: Right?
• 24:14
  Speaker 3: So that would be one way, but it will require time that medical practitioners by by decree don't have.
• 24:21
  Speaker 3: And it's not because they don't want to, it's because they can't.
• 24:23
  Speaker 3: So we need to refer to you.
• 24:25
  Speaker 3: Who do we help?
• 24:26
  Speaker 3: Yeah.
• 24:27
  Speaker 3: Yes.
• 24:28
  Speaker 3: Or they will have to agree to see less people in a more systemic way so they can do what they do for longer.
• 24:37
  Speaker 2: Yeah.
• 24:38
  Speaker 3: Right?
• 24:38
  Speaker 3: Um, a lot of people that I work with who have diabetes or pre-diabetes, they go to the medical to their PCP alone.
• 24:47
  Speaker 3: HIPAA is organized around that, also.
• 24:50
  Speaker 3: Medical insurances.
• 24:52
  Speaker 3: We know that when we see a client through insurances, we have to um write an intake, of course.
• 24:58
  Speaker 3: We also have to write a treatment plan that shows what are your goals, meaning therapy.
• 25:04
  Speaker 3: When you set goals for treatment, means that the goal of therapy is to fix.
• 25:08
  Speaker 3: And so you have to have goals and objectives that have a certain date by when you think that you're going to meet that.
• 25:16
  Speaker 3: Meaning that um people who have the same diagnostic are all the same, and you can put a time frame on the fixing of the treatment.
• 25:25
  Speaker 3: And it's leaving out the idiosyncrasy of individuality in the human being, meaning that we are all different and we all respond to things differently.
• 25:34
  Speaker 3: Medical practitioners know this precisely well because every patient they have deals differently with the same medical diagnosis.
• 25:43
  Speaker 3: And everywhere else in the world that I know, therapy has the goal of under thickening understanding.
• 25:53
  Speaker 3: In the states, therapy is organized by government and an insurance, and so the goal is to fix.
• 25:59
  Speaker 3: Rarely do people in the states come to therapy for under thickening understanding.
• 26:04
  Speaker 3: When you message your clients, they often, therapists watching, they often, when you see them for a while, they often say, Well, I don't have much to report.
• 26:12
  Speaker 3: Meaning therapies is a place where people report weekly events.
• 26:16
  Speaker 3: Therapy becomes a place where um they try to fix a problem.
• 26:22
  Speaker 3: And when they don't want to see you anymore because they're tired of talking about the same things, because there's been no change towards understanding yourself better, creating uncertainty.
• 26:33
  Speaker 3: They let you know by saying things like, I think like I'm doing pretty well.
• 26:39
  unknown: Yeah.
• 26:40
  Speaker 3: Meaning, I wasn't doing well, I came, now I'm doing well, I'm out.
• 26:43
  Speaker 3: Medical practitioners, I think, should experience something similar.
• 26:49
  Speaker 3: When the patients are feeling better, they forget to come to the appointments, to make follow-up appointments, to stay on track with the things they need to stay on track with, and then they bring they come back.
• 26:58
  Speaker 3: Um, that's called, you know, it's homeostasis.
• 27:00
  Speaker 3: They come back, people come back.
• 27:01
  Speaker 3: It's a human condition.
• 27:02
  Speaker 3: But uh, I think that that's the parallel that has to do with the resistance to change.
• 27:06
  Speaker 3: Milton Erickson is probably most beneficial for them to read if they wanted to read anything useful.
• 27:12
  Speaker 3: And Common Therapy is a great book of one mind by Douglas Flemonds because it talks about never going against the grain of um resistance to change, that all patients show resistance to change, and that the worst thing you can do is to go against the grain of that.
• 27:29
  Speaker 3: So yeah, you have the anecdote of Milton Erickson.
• 27:33
  Speaker 3: Well, by the way, he hypnotized a room full of medical students, the most, probably the most skeptical group that you can ever find.
• 27:40
  Speaker 3: Right.
• 27:40
  Speaker 3: Erickson wanted to hypnotized an entire audience of them.
• 27:44
  Speaker 3: Um Milton was young, he suffered from polio, he was a handicapped child, and he lived uh up in the farm farm areas with the place escaping, I think it was Nebraska, somewhere there, with his father and family and uncle.
• 27:58
  Speaker 3: And he observed from the room, the bedroom, that his father and his uncle were trying to pull a donkey into the barn, right?
• 28:05
  Speaker 3: Pulling the halter, right?
• 28:06
  Speaker 3: Trying to pull if anybody knows anything about donkeys, they're the most stubborn animal you can find.
• 28:10
  Speaker 3: And when a donkey decides to not do something, he doesn't do it.
• 28:13
  Speaker 3: It wasn't going, and the more they pulled, the more the donkey pulled back.
• 28:17
  Speaker 3: And Milton, when they gave up, young Milton with great difficulty came downstairs to the barn and started pulling for the donkey's tail, and the donkey went into the barn.
• 28:26
  Speaker 2: Yeah, right.
• 28:27
  Speaker 2: Yeah.
• 28:28
  Speaker 3: And and and aside from being very funny, um it really illuminates the way Milton Edison understood the mind cognition, that resistance is something you never go against.
• 28:43
  Speaker 3: He always utilize that to create something, right?
• 28:48
  Speaker 3: He understood that the mind, the subconscious mind of the donkey was to go against.
• 28:54
  Speaker 3: So if he pulled the tail away from the barn, the donkey's mind will also work to his mind.
• 28:59
  Speaker 3: That's how hypnosis works.
• 29:00
  Speaker 3: If you like, I can do um maybe in the 15th I'll do it.
• 29:07
  Speaker 3: But but that's how the way in which systems thinking can relate to medical practice would be on how to read more about how to deal with resistance to change.
• 29:20
  Speaker 3: When you have a diabetic, pre-diabetic patient who is resistant to change, how to maybe utilize some of these ideas to to influence the minds of patients in a different way.
• 29:31
  Speaker: Yeah, I think and and part of that, the resistance thing.
• 29:33
  Speaker: We you've heard of motivational interviewing, they talk about rolling with resistance.
• 29:36
  Speaker: So yeah, I think I think someone stole motivational interviewing people stole that concept from Milton.
• 29:42
  Speaker: But uh, one of the things you mentioned before, um, though, was that your pediatrician was also your mother's doctor, also someone you would run into the community.
• 29:54
  Speaker: But I'm I'm tying that together with your thought of the therapist and systems uh therapy becomes part of the system.
• 30:01
  Speaker: Should that be any different for a doctor or medical personnel?
• 30:08
  Speaker 3: Yeah, I think doctors, and and then I guess the audience will know because I'm not a medical practitioner, but I guess medical people in the audience um I think nice medical doctors can see a family, you know, they'll see the father and they'll see the kids over time, and they they already know the family.
• 30:25
  Speaker 3: You know, Virginia Beach is a very unique place because we have a lot of military, so people move a lot, right?
• 30:30
  Speaker 3: So medical doctors might not get the chance to see a patient for longer than a year before they have to go on deployment and then move somewhere else.
• 30:36
  Speaker 3: But in other states, I think there are a lot of medical practitioners um often get the benefit and the pleasure of working with it with more than one family member over time, especially pediatricians, right?
• 30:48
  Speaker 3: That um that they get to work with one baby and then the brother or the sister, right?
• 30:53
  Speaker 3: And then pediatricians are perhaps the ones that deal more closely with the human fabric of things because they have to do with parental anxiety and a lot of things like that.
• 31:02
  Speaker 3: A lot of the pediatricians do become therapists that tell the mother your child cries in daycare because you're taking too long to leave them.
• 31:10
  Speaker 3: And so they're picking up on your anxiety, right?
• 31:13
  Speaker 3: Any pediatrician watching this will say yes, exactly.
• 31:16
  Speaker 3: So uh see, it's such a family element there, right?
• 31:19
  Speaker 3: Like how connected we are.
• 31:21
  Speaker 3: Um yeah, it happens in the medical practice, I think, more than in therapy.
• 31:26
  Speaker 3: We also um again, therapy is organized by government.
• 31:30
  Speaker 3: So this idea, you know, we have the board of counseling, of course.
• 31:34
  Speaker 3: Um, we're all respectfully afraid of that place, right?
• 31:38
  Speaker 3: But the idea is that if you work with um an individual, you cannot work with their partners as a couple later on.
• 31:46
  Speaker 3: You can start out as a couple and then go as an individual in therapy for medical practitioners.
• 31:50
  Speaker 3: If you don't know this, in psychotherapy, you can start out as a couple and then the couple therapy doesn't work, and one of the members says, I want to stay with you as an individual, and they can do that.
• 32:00
  Speaker 3: It's not recommendable if you've done it for over 10 years, you can because you know how to do it, but otherwise don't.
• 32:05
  Speaker 3: It's better that they go to another individual therapist because there's a bias.
• 32:10
  Speaker 3: So there are a lot of elements outside of therapy that organize therapy.
• 32:14
  unknown: Yeah.
• 32:15
  Speaker 3: That yeah.
• 32:16
  Speaker: Good.
• 32:17
  Speaker: Good.
• 32:17
  Speaker 3: Um I think I think Tommy, when I said when I said that the the the in systemic family therapy, the individual the therapist is part of the system, um, it means that we're influencing the system and we have to be aware of how that system is influencing us in the process of therapy.
• 32:34
  Speaker 3: One one disadvantage of family therapy is that when it family therapy, for those of you who don't know, stamped many decades ago, but not that long ago, as a direct challenge to psychoanalysis.
• 32:47
  Speaker 1: Right.
• 32:48
  Speaker 3: And in that process, therapists need family therapists who were mainly psychiatrists, by the way, medical psychiatrists who who a lot of them had gone to war.
• 32:57
  Speaker 3: Minucci himself had been a therapist for children who survived the Holocaust.
• 33:02
  Speaker 3: And they came to um the states to fill it in New York, and they found that psychotherapy was mainly individualized and mainly available for individuals who were middle class, who had the luxury of sitting down and interpreting their dreams.
• 33:17
  Speaker 3: But when Milucci started working with delinquent children from minorities in Philly, he had a mother with six children, and he realized that therapy had to become a therapy of action.
• 33:28
  Speaker 3: He could no longer sit down and tell the mother to interpret her dreams because that was the last of her concerns.
• 33:33
  Speaker 3: And the children will terrorize the therapy room.
• 33:35
  Speaker 3: So he started developing techniques of family therapy, and the family therapy starts to happen.
• 33:41
  Speaker 3: But the idea is that family therapy had to be aggressively opposed to psychoanalysis.
• 33:50
  Speaker 3: One time a psychoanalyst asked Minucin a question, and Minucin answered in Spanish, and what the psychoanalyst said, I don't know what you're saying.
• 33:57
  Speaker 3: Minucci answered, you speak your language and I speak mine.
• 34:00
  Speaker 3: They're different languages.
• 34:02
  Speaker 3: And the problem with that is that family therapy needed to do that to set itself apart from psychoanalysis and individual therapy, but it also left out a lot of things from psychoanalysis that are useful.
• 34:16
  Speaker 3: And Minucci spent the last years of his life shedding light on the importance of bringing that back to supervision.
• 34:24
  Speaker 3: Two of those concepts are transference and counter-transference.
• 34:30
  Speaker 2: Right.
• 34:32
  Speaker 3: The way in which families affect us or patients, in the way in which we affect them.
• 34:37
  Speaker 3: That I in one of the research papers that we're working on publishing now, we talked about that.
• 34:43
  Speaker 3: The first one we published had to do with the differences in supervision from academic, uh, case management supervision, um, state licensure supervision, and then minutia supervision, which was developmental, focusing on ourselves.
• 34:58
  Speaker 3: I noticed that when the clients become defiant, you cower and you lower your intensity.
• 35:04
  Speaker 3: Right?
• 35:05
  Speaker 3: These are things that focus on how people affect each other.
• 35:09
  Speaker 3: And I think that there's a great deficit in that in family therapy.
• 35:14
  Speaker 3: And now we're hoping to start shedding more light into the importance of bringing that back into supervision, looking at how at ourselves as part of a system, and vice versa.
• 35:24
  unknown: Yeah.
• 35:24
  Speaker: I'm liking this.
• 35:25
  Speaker: Uh I used to practice a thing called Tukon, um, which is a Korean martial art.
• 35:30
  Speaker: And uh what they did was um they would bring the best out of all the different disciplines rather than you know, this is the way we do things.
• 35:40
  Speaker: And I see that it, of course, it developed out of taekwondo, the the Korean thing, but then it they're like, okay, actually, you know, um Krav Maga does a really good job with this particular thing, jujitsu does a good thing with that, and we're bringing that in, and it does it better than we were doing it, so let's let's incorporate that into it.
• 35:56
  Speaker: And I'm hearing that the family, the family, um, marriage and family therapists are starting to, or have been for a while, and Maduchin's kind of leading the way of let's bring back all the all the things that worked, you know, cognitive behavioral therapy and you know, the stoic rational mode of behavioral therapy has some things at work that we need to bring back in um instead of just completely separating ourselves from it in a certain way and saying strictly um to a theory.
• 36:21
  Speaker: Is is that what I'm hearing as well?
• 36:23
  Speaker 3: No, yeah, I think in this particular case, transference deal directly with the idea of system thinking, uh, meaning the observer is part of what's being observed.
• 36:34
  Speaker 3: And that what's being observed affects the observer.
• 36:37
  Speaker 3: And so it's not becoming eclectic.
• 36:39
  Speaker 3: What you're talking about is eclecticism.
• 36:42
  Speaker 3: You're talking about bringing, drawing different things from different places.
• 36:47
  Speaker 3: And what I'm talking about is about learning to become a self-observing instrument of change.
• 36:54
  Speaker: I see.
• 36:55
  Speaker: Okay.
• 36:56
  Speaker 3: That I see myself as I'm interacting with you, and I think about how I affect you and how you affect me.
• 37:04
  Speaker: How do you bring that into um let's say you're working with a uh you're working with a counselor and they don't they don't see it, or how do you teach that to a green counselor?
• 37:17
  Speaker 3: It starts with the way in which counselors introduce themselves in supervision.
• 37:21
  Speaker 3: Um anytime I have a new member coming to the supervision group, right now we have a beautiful group, four people, and it's perfect.
• 37:32
  Speaker 3: But recently had a new member, and when a new member comes in, I ask them to introduce themselves.
• 37:39
  Speaker 3: And I also ask the members in the supervision group to introduce themselves to the new person.
• 37:46
  Speaker 3: When they present their case, I ask them to present the case before they talk about it by introducing the case.
• 37:55
  Speaker 3: And when they introduce the case, when they do a case uh uh synopsis, I pay attention to see if they include a description of themselves.
• 38:05
  Speaker 3: Rarely do they do that, they have not been trained to do that.
• 38:13
  Speaker 3: Whether you study uh cognitive behavioral therapy or any form of individual therapy, or family therapy, or couple therapy, or social work, they don't train you on how to include a description of yourself and how you are affected by the system that you are describing.
• 38:30
  Speaker 3: And that is a dead giveaway.
• 38:32
  Speaker 3: So then I shed light into that obscure corner of the development.
• 38:37
  Speaker 3: I I know I ask the the rest of the group if they're aware of what's missing.
• 38:42
  Speaker 3: Right?
• 38:44
  Speaker 3: They describe the system as if the system had no effect on them, and as if they had no effect on the system.
• 38:53
  Speaker 3: And then I teach them to see outside of that.
• 38:58
  Speaker 3: I teach them to see themselves as insiders who are affecting the thing.
• 39:03
  Speaker 3: So next time they present, they will say things like Mom is a 32-year-old woman that when she talks, it makes me feel sad about her situation and makes me relate to this, and who has two kids who are this age and that age, and when they do that, and they begin to weave in a systemic description of the system they're working with, how it affects them, how he how she or he or they them affect the system.
• 39:32
  Speaker 3: Does that make sense?
• 39:34
  Speaker: It does, it does, yeah.
• 39:36
  Speaker 3: It's difficult because I'm telling you what I do in supervision, right?
• 39:39
  Speaker 3: Um, but that's broadly how it works.
• 39:43
  Speaker 3: Okay.
• 39:44
  Speaker: Yeah.
• 39:45
  Speaker: I want to do another hour and a half on this, but we're reach we're reaching the last few minutes of our of our time together.
• 39:55
  Speaker: Um if you could take a minute and uh we we we kind of took a journey uh an excursus around the world just now about a variety of things and and did some speculation and and uh and whatnot, and that's fine.
• 40:10
  Speaker: But what's what's something you want to leave the audience with uh bef before we before we part if the audience is the audience of therapists, um I'll say that if they want to do family therapy, they should read family therapy a little bit.
• 40:31
  Speaker 3: They should know they should have a map um along which they can navigate the territory.
• 40:37
  Speaker 3: I'm quoting Gregory Bateson, of course.
• 40:39
  Speaker 3: Right, right, right.
• 40:40
  Speaker 3: Um cybernetics.
• 40:42
  Speaker 3: And the idea is that the map is not the territory, but that they in this case they can have a map um that will help them to not become family therapists, but I understand but to understand the settle differences and be able to start to invite families to the healing process, and that to do that they need to do it, and and there's a specific way, right?
• 41:06
  Speaker 3: Um I think that you know, I'll answer the question because I have barely time with an answer that I gave to a patient of mine from Florida when I had to move to Virginia, he's he called me once and he said, just tell me what to do to heal.
• 41:23
  Speaker 3: I can heal.
• 41:25
  Speaker 3: And he caught me by surprise because I didn't know the answer.
• 41:28
  Speaker 3: I thought I've been practicing for so long and I don't know the answer.
• 41:31
  Speaker 3: I guess it's a very unfair question, right?
• 41:33
  Speaker 3: And I started thinking about it, and it came to me from reading and everything, and really thinking about this question.
• 41:39
  Speaker 3: And I um I called them and I told them, and this is a statement that is um extreme.
• 41:48
  Speaker 3: But I think I would like to leave the audience with an idea of mine, a belief of mine that is a result of having practiced license since 2013 and before then, and having read some about philosophy and and anthropology and and family therapy and literature, and having seen clients for a long time.
• 42:12
  Speaker 3: I think that we only and this is where people can disagree, the word only I think we only heal through the way that we treat others that requires that we become responsibly tribal That we begin to invite our partners to the table and be kind, that we begin to shoot the kids out of the bedroom and bring them to the living room and spend time with them and be nice, that we begin to buy that cup of coffee that we know our co-worker likes and take five minutes to see how their day is.
• 43:06
  Speaker 3: I think that I would like to leave the audience with this notion that we only heal ourselves through the way we treat others, by putting out there what we want to experience within ourselves.
• 43:20
  Speaker: You've been listening to Mind and Medicine, a Sentera podcast.
• 43:23
  Speaker: As a reminder, please check the show notes for details on how to claim your continuing education credits as well as any resources mentioned in the episode.
• 43:30
  Speaker: That's it for now, but keep an eye out for another episode and more evidence-based education for healthcare providers on the go.
• 43:37
  Speaker: You welcome.