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Episode 796: A Trauma-Informed Intake with Doreen Hills · The Trauma Therapist

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Right. Welcome back to the Trauma Therapist Podcast. My name is Gamiferson.
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My mission is to help trauma therapist be their incredible selves, to be human,
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to be real, not just a clinician. I'm a big believer in
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who we are is more important than what we know, and this requires cultivating
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authenticity, genuineness, and vulnerability, and that requires intention. Can learn more
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about my courses and workshops by going to the Trauma Therapist project dot com.
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That's the Trauma Therapist Project dot com. Let's get started. Here we go.
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So five four, three, two and one, our folks, welcome
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back. Super excited to have back. Dorian Hills Doreen Welcome, hello everyone.
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So. Doreen is a founder director at the Center for Trauma and Attachment.
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Their mission is to bride cutting edge treatment approaches in healing traumatic distress and
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they're committed to finding ways to provide quality and affordable therapy and to be the
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pioneer in healing trauma in the North East region. Durene has been a mental
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health provider for over twenty years and has worked in various mental health settings in
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New York, Philippines, and Colorado. Her background includes intense and immersed experiences
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working with povery, stricten fishermen in the Philippines, orphans that were severely neglected
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at abandon as well as Muslims in Manila. The experiences given her immense insight
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to trauma, resiliency and healing during Welcome Back. Excited to talk to you
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today about our topic. But first, for those listeners maybe who haven't checked
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out the previous episodes, give us a little bit where you're from originally and
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where you are currently. Yes, So hello everyone, and happy happy Friday
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to the listeners. So I came from the Philippines, and we all know
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that Philippines is, you know, sadly a beautiful area, beautiful country,
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yet we are considered the third World country. And I came from came from
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the Philippines, and I was able to provide a lot of volunteer experience there
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with regard to working with poverty. And then I also and then I moved
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to New York and then now I developed the Center for Hitting Trauma and Attachment
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here in Colorado. I've been a provider for over for over twenty years.
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So I love what I'm doing. And you know, as long as I'm
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breathing, I will continue to, you know, to do this to serve,
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you know, to serve those who are I need. What are the
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things that I have really grown to appreciate about you is your persistence, your
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resilience, your vulnerability. You know, you speak from the heart. You
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In our previous episodes we've done, you shared a lot about uh, how
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you learned and your your openness to learning and your openness to helping not just
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clients but other therapists as well. You know, it's really inspiring to me.
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I mean, that's what this podcast is all about. So I don't
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know, I just wanted to say that before we could go in here.
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You know, there's it's kind of when you're saying that, it reminds me
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of let's say, you know, holidays, right, And then there's that
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receiving and giving. I think there is a powerful healing component when we give.
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And the thing about this is why why hold on to something that you
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have when you can give it and spread this to the people that you serve.
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And also you know clinicians that can benefit and contribute, you know,
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benefit from from what I have and so pass on the legacy. And I
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think this you see this so much with trauma experts. They share what they
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know because eventually, at one point will be gone, Eventually, at one
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point will no longer to be, you know, practicing anymore. And you've
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got to share that legacy. You've got to share the gifts that's been that
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you've you've got, you've gotten, And it's kind of like a library.
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You know, you don't want it dusted library. You want that library.
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You know, if let's say there's a Greene library, I want that being
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used. I want some of them actually give it to providers. So yeah,
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well said, so all right, today we're talking about an informed trauma
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intake. Yes, okay, what does this mean? What does it mean
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to you? You know, I will go back to that four pillars of
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trauma informed care, which are the four hours realizing, you know, realizing
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that everybody can be impacted by trauma, including us responding to those triggers and
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warnings, including for us responding appropriately, you know, in a safe and
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secure environment. And the fourth one is resisting retraumatization. Now, how are
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we going to weave that in a trauma informed intake? I wanted to point
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out this this thing to everyone that it's not the first session that makes a
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difference. It's not the first session that will let your clients or come back
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to you. It is actually for me now I'm just speaking for me,
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it is the first three to five minutes, the first right, the first
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three to five minutes is the most critical and impactful time that you can you
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can share with the client. Why is that? I will go back to
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what I've learned from Bonnie bad Kinock in her book It's the I wish I
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remember. It's kind of the I think it has. The title is about
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the heart of trauma. She said something about when our clients, this is
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what I got from it. When our clients reach out to us, it's
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kind of like they are willing to bid for trust. It's a bidding.
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It's a bidding moment to them. I'm like, okay, I'm willing to
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I'm bidding for trusting someone again. And so when someone opened and when they
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opened the door to therapy, when they come in and enter your place,
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that is the most critical moment really, when you come and greet them in
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the waiting area, your way, the way you the way you perceive yourself
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to them, the way they see you, the way they feel you can
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really make a significant impact if they will continue with you the next session.
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So it is actually the first three to five minutes when you visit with them,
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and we're not talking about paperwork here, We're just visiting like that greeting
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moment with them. So I don't know if that I don't know if you've
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heard about this, but this is what you know. I've witnessed this when
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I'm working with people. Well, I mean I've heard previously people say,
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you know, the relationship starts with the phone call, you know, that
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first touch point. Given that, you know, I mean, people are
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probably wondering, Okay, so what does that mean? Uh? Hi,
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obviously not you know, but so how do you engage? How do you
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interact? Are you when you're when you're going out to meet someone, you're
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doing this quick scan to see what their temperament is, where they're at.
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Obviously you want to kind of meet them where there are, where they're at,
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right to a certain degree. Yeah, So now again this is my
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this is just based on my experience. It actually starts before you meet your
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client. How prepared are you? Did you get did you get enough sleep?
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You know the night before? Were you listening to really horrific sad stories
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and the new you know and the news or you know, did you get
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did you get some sleep? Right? Sleep good? You know, good
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breakfast and all that, because all those can can impact the way you're you
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know, you present yourself to them. Have you done your breathing? Did
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you use the bathroom before you you know, before you meet them. So
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I for me, you know, the preparation phase to where you know before
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you see the client can really help you be a regulated individual, be a
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regulated provide provider because we all know that we can be we can be the
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co regulators of our of our clients. We are the you know, we
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provide the attainment and so it may sound so simple, right, but it's
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very powerful because oftentimes we run into burnout or secondary trauma when we don't take
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care of ourselves. You know, we we schedule people like let's say you
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see you see John from nine to ten, and then you see Mary ten
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to eleven, and you see Edward eleven to noon. Do we have time
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to take care of ourselves? Have you have you read the intake paper?
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Do you know what is what are your what's you know? What what you're
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looking forward to? Do you know there, you know, do you know
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where they're coming from? So I think that is part of a trauma informed
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care, to be able to respond to my triggers, to be able to
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respond to my to attune to my self care and resisting the trauma, because
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I think, I think it is really important for us to prepare ourselves.
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And one way of doing that is, you know, taking care of our
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taking care of ourselves first. When you okay, so let's move on from
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there. How do you what do you do when you after you bring after
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that person comes into your office in terms of we're talking about a trauma informed
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intake because I know people out there, clinicians out there listening to this who
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you know, haven't been doing this for twenty years and they want to hear
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what exactly do And obviously it's different each time, but of course give us
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an example. Yeah, so I prepare my office. You know, I
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will be I'm not going to be scrambling and just trying to rush everything.
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I would actually a day before, if I you know, a day before
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or thirty fifteen to thirty minutes before I see someone. I prepare the office.
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I make sure there's clinics, I make sure the you know, the
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little waste basket is not full. I make sure the room is well lighted.
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And in fact, on my intake form, are they you know,
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are they kind of sensitive on the set? I need to know that because
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again people are different. We look at at the trauma center, it's individualized
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care. And so when I sit with them, you know, again paying
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attention to where they're at the more hyperioris or maybe you're so welcoming or you're
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so friendly, that might be. You know, you might have a pushback
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there, or you might be too slow, you know, like that slow
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mode that might be. So you've got to pay attention to where the energy
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of your client is. And then when I visit with them, I got
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to tell you this, and I tell this to my interns. Know your
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intake history, know your intake forms. You know, if you can memorize
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what's in there and you get comfortable, see, you know, knowing the
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sections of your questions, and you don't have to have the paper in front
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of you. So in my book, the way I do intake, I
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don't have the paperwork with me. I have the person right in front of
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me, and I give them one hundred percent of my eye contact, my
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energy, and my you know, my discussion, my inquiry towards them.
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So I don't have the laptop. I don't have the laptop. I think
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that is a barrier. And I don't have a paper, and I you
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know, and that's how I do intake. You know. Sometimes from time
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to time, I will have a notepad and I will tell clients. So
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I'll give you a fictitious name. So let's say, you know, I
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might tell Johnny, you know, what is it? Okay, this is
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very important for me to remember, so I will have you know, can
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I write this down? And they said absolutely. But I don't have the
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whole intake. You know, the whole intake form. I memorize it and
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I've been doing this for quite some time, so I'm familiar with it.
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And oftentimes, in our clinical setting, we folks a lot of presenting symptoms,
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right, presenting concerns, the symptoms, why they're coming to see us.
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I incorporate the element of resiliency there. I ask them, what are
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your hopes, what are your goals? How do you learn better? Are
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you more of a tactile person? Are you a visual person? Are you
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an auditory person? So show me, you know, tell me how you
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learn, how you learn better, or how you learn, how you can
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absorb information, because this is you know, for me as a clinician,
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this is important for me to know to know where you're at. So I
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ask them hopes, goals, dreams, you know what you know, how
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did you get where you're at now? Because I'm wanting to understand, you
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know, their bridge. You know, you're they're dealing with something difficult,
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but they're here in front of you, sitting in front of you. There
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they're telling you how the you know, the triumph of being in this session
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with you. Well, I got here because I you know, I was
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able to you know, I took my kids to you know, to the
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babysitter, and so you can see that there's some form of organization they can
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schedule their time. And so I bring that in those intake because we want
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to know their strengths. Some folks use the miracle questioning, the miracle,
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the miracle questioning, the miracle interview, and so I, you know,
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I don't only focus on the presenting symptoms and problems. I focus on there,
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you know the other side of you know, their the other story,
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and that gives me an idea of Okay, so this person is a visual
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person, this person is a tactile, then we can incorporate the appropriate activities,
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the appropriate homeworks if they wish, they like homework and be part of,
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you know, part of their treatment plan. What are some of the
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ways that you're able to discover whether someone's been traumatized or not. I pay
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attention a lot on the body, posture, the energy that they bring.
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It's it's those subjective you know, what you notice, what you observe about
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them. But I also I also incorporate really sound screening screenings and I can
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share a few that I use. Besel vendor Coke created this this screening.
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It's it's a traumatic stress screen I wish I it's it's a traumatic stress screening.
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You can look it up, you can google it and it will actually
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show you what he's what he's got. And there's also this thing called the
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d s M five d s M five t R screener, which is a
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very good screener that is available free and online. And I also use the
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pc L, which is the post Traumatic Checklist, and it's just you know,
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these are just some of the few forms I use. But Again,
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it depends on you use them based on the appropriateness of you know, of
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that to your to your clients. So I use those screeners. I also
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pay attention, definitely pay attention to the you know, to to the body
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language, what they say, their theme, you know, the themes of
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the conversation m And that really gives me a good solid, you know,
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information about you know, what this person is struggling and what this person is,
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you know, what the person's strength is. Another thing that I use
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is the same tray which maybe we can you know, talk a little bit
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about that in you know, future you know, future podcasts. But I
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tell them create a world, create your current world, and that gives you
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so much information of what is happening because you're working with symbols there. You're
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you're working with their Olympic system. So I use the I use the art,
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you know, the art approaches to understanding you know, the people that
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I work with in terms of, you know, when you're sitting down with
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a client for the first time, in addition to the intake form and this
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and the screenings, and do you give all those particular screens in that procession,
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No, okay, In terms of talking to someone. What are some
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of the language you might use, uh that would that would help you maybe
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determine if someone has experienced trauma? Mm hm. So I asked them again,
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I give them that informed consent, you know, share share that about
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me. You know. We start with that, and I asked, I
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just asked them, tell me about your you know, growing up, how
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was that like for you? So we start, I start with very general
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and then we get into the detail, like tell me who you know who
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provided you safety, security, love and care, Who supported you in times
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of needs? Who who seemed to be you know, stand offish or you
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felt like a little you know, scared you know. So I kind of
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poke and prade a little bit, not like going you know, going full
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scale, full blown, because you don't want to be You don't want them
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to be leaving the session running and disregulated. So I asked that, and
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people will talk to you, people will tell you, And I asked,
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I also asked them about you know, have you had you know, your
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experience Some of them already have experience with their therapists, and how was that
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like for them? And some of them experience E. M D R.
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There are cases where they did not find that helpful. In fact, it
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harmed them. And it's not the approach, but it's how you know,
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the timing and pacing and so you understand you got to you get to understand
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it. So with regard to a complex trauma, I asked them about the
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family of origin, what was that like for them? You know, who
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took care of them? So I you know, I followed them. You
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know, I followed Bessel vendor Coast guideline in terms of you know, understanding
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the family system. This is this is awesome. I just want to remind
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everyone we're speaking with Dorain here and we're talking about trauma informed intake. Doreen
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Hills is the founder of the Center for Healing Trauma and Attachment and we'll be
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back in two seconds. Hang on. What what I love about what you're
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saying is you haven't even mentioned to the client this trauma. You haven't even
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mentioned abuse. No, you've you've invited them, excuse me, to share
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what their childhood's been like, who's provided safety, who's provided comfort? And
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all those questions are invitations to open up, right because a lot of times
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when you if you ask someone you know that they experienced trauma have they been
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trumping like, no, haven't been raped, haven't been the war, haven't
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been into a car accident. I'm good. But when you start asking those
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questions that you said, who's provided safety, who's provided comfort, that's a
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whole different way in and opens up a world. M hm. It is
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because they will tell you when they're ready. Even if they even if they
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come here and they say I'm ready for therapy, it doesn't mean that they're
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going to the divulge the whole thing. You've got to take it easy.
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And I think this is this and I've learned over you know, many years.
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You know, it's you cannot force it, take your time, slow
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it down. And again I always ask, okay, so I'm noticing right
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now, in the very you know part of first I'm noticing that you're kind
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of you know, you're short of breath. Can we take a moment?
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Can we take a pause right now? So at the very first session,
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they're already learning window of tolerance and regulation. So I incorporate that, you
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know, I incorporate that at the very beginning of you know, of treatment.
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So let's take a moment, let's ground ourselves. And when you do
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that, the likelihood of them leaving your session. This regulated is very slim,
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slim to none, because you're already giving them tools, not just asking
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them questions. Because again, trauma informed care is a relationship. You know,
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I am getting something from you, but I'm also giving something to you.
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I'm already providing you tools that you can actually start implementing. You know,
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before you leave the office. One of the things that I'm hearing from
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you and sensing from you is this to trust, This like embrace of trust
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you're giving and providing to your client. You know, I can feel it,
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and you're allowing them. You're not You're clearly not coming into this with
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you know, I'm the expert and I have all this knowledge, and this
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is what we're doing. You're allowing. You're providing a context for the person
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to express themselves, to share what's going on with them in a very comforting
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way. It's a whole different way of doing it. They are the experts,
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whether we like it or not, and they're the ones who's going to
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tell us. They are the ones who's gonna uh, They're the ones who's
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going to tell us when and when not to get there in a very you
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know, It can be subjective, it can be something you know, outspoken
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and we are they're the I tell people, they are the captain of the
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ship. They're just allowing us to get in there to be with them.
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And I think it is again when you're working with complex trauma, trust is
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so important because that is the number one thing that was ruptured in their relationship.
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So again I'm going back to that first critical moment of you know,
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the first three to five minutes, you know, so we start there to
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develop that trust at the beginning, you know, before you even start the
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intake. When as you've been doing this, what are some of the things
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or experiences that and I mean, you know you've been doing this for a
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long comment and sure there are many, but what are can you can you
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pull out maybe one or two things that have and be surprised you in your
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experience of working in this field of trauma with people, you know, I
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would go, I would go to this place where the first session for clients
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is the most critical. I mean, I'm trying to process this and say
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it, you know, so I can articulate it well. That moment of
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bidding I remember I had this, I had this kind of also back in
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the first session meant so much to them that I felt, we felt that
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we already it's not intake anymore. The very first session you already got in,
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you already dove into the trauma and you were not even you know,
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I did not even expect that. You know, they they just let you.
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And the first session is already like it feels, it feels like you're
27:26
already doing sessions with them many many months. And so so my point is
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setting a healthy self, setting a trusting framework can make so much difference,
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so much difference because client is you know, like I'm ready now, I'm
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you know, and sometimes you have to like, whoa, I remember having
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clients like I'm ready to go in there? Why did it get there?
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Because you already developed that trusting relationship with them? Mm hm. So I
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think that's what and I have not and knock on board, right. You
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know, people love to you know, at the end of the first session,
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they will say I will come back, I won't, or will I
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will come back, I will come back, yeah, yes, yes,
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And so you know they look forward to that already that it's not you know,
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this person is not going to ask me really serious or super scary questions.
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This person is actually willing to understand my story and able to and able
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to. Yeah, but again we have to be as clinicious. We have
28:38
to prepare ourselves. That's you know, that's my formulae. I've got to
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prepare myself before I see an individual, before I see a client, and
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that is to take care of myself too. Did you ever experience a situation
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where you realized you hadn't done enough to take care of yourself? Hmm?
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What was that like? Well, it was, you know, it was
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god wrenching. And I know I was not myself. I was not myself.
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I actually remember I had this really cool mentor and I wanted to be
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like him, and so I wanted to be kind of like Allah, you
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know Allah, this person, and I wanted to be him. My my
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style was not me anymore. And I felt that and I said, I
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cannot, I cannot pretend that I'm this person. I got to be me
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because oftentimes we kind of run into this, you know, like I wanted
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to be like this person and we pretend that we're we can't do that.
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I mean, for me, you know, I felt fake. I felt
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awful, so so that's you know, that was my experience. I have
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to go back to who am I? You know, during who are you?
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What are your you know, what are your roots? And yeah,
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I have to remind myself that this is my style and all the techniques that
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I'm learning is actually just a gift that you know, people are sharing with
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us. But it still goes back to who I am A superprovider. Yeah,
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I mean I love that. I think that's really good sound advice for
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the other therapists who are listening, because it's it's easy to not trust ourselves,
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you know, to feel that we're we're not good enough, we're not
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as knowledgeable as this other therapist who's written all these books, or this other
30:34
therapist who's on all these whatever summits and conferences or whatever. But what you're
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saying, I think really goes to the heart of it is and really your
30:45
whole your general message is one of this is my interpretation. You value so
30:52
much the importance of the therapists taking care of themselves, trusting themselves, honoring
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who they are, and the therapeutic relationship is contingent upon that. Yes,
31:08
exactly, we all share mirror neurons. Right when we accept when we take
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care of ourselves, we can, we can emulate that. We can share
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that with our clients. Our clients know. Our clients know when Okay,
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this person is real or this person is just you know, it's just I
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just don't feel They can they can sense that, and in fact, you
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know, sometimes they overly sense that because they've been through you know, a
31:37
lot of times, they've been through help, so they you know, they
31:41
they're more hyper vision and they're more hyper sensitive. So it is it goes
31:45
back to us. We cannot we are. Our purpose is to be the
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coregulator to our people, and we can start doing that by the you know,
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from the first time we see them. That is the INDA process.
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All right, Doreen, Wow, another inspiring session from you, my God.
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Share with our listeners how they can reach you, how they can contact
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you. Yes, so you can reach us at www dot c h t
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A Inc. Dot org, which guy has if you wanted to reach to
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him, and our phone number is ninety seven oh three ninety seven for six
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zero nine. We'll have that linked up here at the show notes page at
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the Trauma Theavispodcast dot com. Once again, that's UH Center for Healing Trauma
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and Attachment. That's c h T A I n C dot org. And
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you have a bunch of resources on your website, links to programs, your
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workshops you're putting on and so forth. Mh okay, awesome, what was
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by phone too? Okay? Dorian awesome, Thanks so much. We'll be
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in touch. Thank you so much. All right, bye bye,