Latest / The Trauma Therapist / Episode 805: Individual & Conjoint Therapies for PTSD with Candice M. Monson, PhD

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Episode 805: Individual & Conjoint Therapies for PTSD with Candice M. Monson, PhD · The Trauma Therapist

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Trauma Therapist Podcast. Plus listeners can listen to episodes early and ad free right
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now. Become a Plus listener by going to Apple Podcasts searching for the Trauma
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Therapist Podcast and signing up today. All right, welcome back to the Trauma
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Thepist podcast. My name is Gamiferson. My mission is to help trauma therapist
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be their incredible selves, to be human, to be real, not just
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Let's get started, Hi or three, you and a one, our
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folks, Welcome back to the podcast. I am very excited to have with
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Mike Us today. Doctor Candace Monson, Candace, welcome, Welcome to you
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as well. Thanks for having me. You are welcome. Appreciate that so.
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Doctor Monson is professor of psychology at the Toronto Metropolitan University in Toronto.
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She's one of the foremost experts on traumatic stress and the use of individual and
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conjoint therapies to treat PTSD. Doctor Monson has published over one hundred and fifty
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per review publications, seven books, and forty book chapters on the development,
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evaluation, and dissemination of PTSD treatments more generally. Wow, that's all.
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That's pretty amazing. Look, I'm tired. Welcome to the podcast. Thanks
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so much for being here. Yeah, that's great to do. What's your
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dog's name. My dog's name is Oliver T Bear. Oliver T Bear.
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Okay, I'm sure there's a story behind that. Thank it's my teddy bear.
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Awesome, awesome. So, before we get going Kanadas shore with the
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listeners, where you're from originally and where you are from? Yeah, so
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I was born in Ulysses, Kansas, which is in southwest Kansas in a
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small town, and did my academic training in the Midwest before then moving to
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the East coast and then eventually, as you mentioned in the opening, to
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Toronto in Canada. Okay, all right, let's get into this here.
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What I mean, a really impressive background. How did this start, this
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interest start for you? How did you get into this Mmm, that's you
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know, gosh, I would say that it was really in the latter part
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of my training, when I started working with veterans in a hospital that was
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focused in a veterans hospital and really hearing veterans stories of being an incredibly compromising
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situations and enduring some tragic situations and being privileged to hear their stories. But
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then also by like systematically working with them and watching people transform over a relatively
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short period of time, that I caught the bug honestly of hearing people's stories.
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And really, to this day, over twenty five years since I graduated,
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I feel like the luckiest person in the world to actually get the opportunity
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for people to let me into their lives and trust me to walk along in
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journeys, to share some of the most vulnerable, intimate details, and to
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be someone who gets who gets the right to hear that based on their permission,
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but then also to watch them become better versions of themselves, like it's
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it's incre I have tremendous gratitude for what I get to do. So you
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said it wasn't until the latter part of your training what kind of consumed you
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in the earlier part and even what drove you into the field, And we're
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talking about your training of what psychology what I'm trained as a clinical psychologist,
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and I would say what probably brought me into psychology was I was born later
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in life and surrounded by a lot of women who were always talking about,
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you know, people in their lives and their relationships. And because I was
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kind of surrounded by that, probably just became better aware of and capable of
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kind of reading people so just and interested in people's stories. I am very
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rarely bored by people. It happens, but it's rare because people and their
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stories are just really very intriguing to me. And you know, I think
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as a psychologist and social worker, psychotherapist, et cetera, we all are
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doing a little bit of research, right, so we have our own adversities
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that we're working through, and so I think, you know, I'm part
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of that club in all honesty of you know, searching, searching self and
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learning about self, but obviously with the goal of trying to help a bunch
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of other people as well. So when you initially got into the field,
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did you have a specific interest M Well, okay, so this is an
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interesting part of the story, speaking of people and their stories. So I
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started undergraduate. I'm a first generation undergraduate. So my dad was a truck
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driver, my mom was a housewife, and I went to school to be
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an accountant because I was really good at math, and as an accountant,
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I could always have a job like that was that was the sensibilities of where
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I came from. And what I quickly realized is that accountants, the people
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I was surrounded by, were kind of like relatively boring. They probably were
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my people. And what I really loved was putting numbers to human behavior.
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So there was a term where I was taking like cost accounting, tax accounting,
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abnormal psychology, and developmental psychology, you know, all at the same
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time. And I think that's like I think of myself first as a clinician,
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but I'm a clinician who loves math, like putting the metrics and the
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statistics to what we do and making it a science in terms of how we
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understand human behavior. So that I think that's part of the story too.
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Yeah. Yeah, Where was it when that you first encountered or had your
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first experience working with veterans. So my first work with veterans was in nineteen
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ninety seven at the Boston BA Hospital, a n ATRI center for PTSD I
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had definitely encountered people who had been traumatized because trauma is endemic, and had
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worked. I was a volunteer for the Rape Crisis Domestic Violent Shelter, that's
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what it was called at the time, carrying a pager, meeting victims at
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the hospital. So definitely definitely had an early interest in trauma. But I
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was a bit more interested in perpetrators a trauma early on in my graduate career,
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and then when I started working with victims and watching that capacity to change
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is really what hooked me, and I became really focused on how do we
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build interventions that actually can work and then get clinicians to deliver them, Like
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that's been my life work. What was it about perpetrators? It just reminds
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me someone reached out to me on Facebook about a month ago and said,
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how come you don't have people talking about the perpetrators on your podcast and actually
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have, But what was your interest specifically around them? So? I was
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interested in perpetrators because I think, honestly, if we want to solve the
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problem of domestic violence and all kinds of assaults, like we have to figure
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out the perpetrators, and we've got to figure out who's amenable to treatment,
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and then what treatment to do. So that's how I got into that,
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and I went to the University of Nebraska that's really well known for forensic psychology,
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so that was part of it, and I still do some work in
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that area, but became much more interested in the victims and those who have
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PTSD in order just because we can it's very treatable, like people can get
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better, and so it's an area where talk therapy really wins out over medication
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as well, and so that was compelling. One thing, one project that
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I'm doing that has been super interesting is treating those with PTSD in prisons who
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actually including people who have PTSD related to having perpetrated aggression and then after the
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fact, you know, like working with some one who, for instance,
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is part of a gang and part of gang involvement actually killed a family member
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and you know all of the guilt and remorse and shame that goes along with
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that kind of experience. So I think this idea that there are victims and
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perpetrators is actually a misnomer. You can be both at once. They're not
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orthogonal, and you know, people who have been victimized going to be perpetrators
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and people who perpetrate can be victims. So it's probably it's probably full hearty
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to think of them as two different things. That's a very interesting statement.
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So I'm thinking about the people who are listening, who are maybe thinking,
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well, you know, I've been sexually abused, I'm a victim. I'm
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not. I mean, I maybe I could at some point be a perpetrator,
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but I'm not a perpetrator. Now what are you saying? Yeah,
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And it's true that being a pertrator does not require being a victim, like
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I want to be clear about that, or that if you're victimize you're destined
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to be a perpetrator by right. I take more of an exception to the
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idea that these things are so clearly like an identity that it's a simple thing.
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People are way more complicated than that, right, right, in terms
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of their histories, and then you know what they can go on to do,
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right right. So, you had this experience or series of experiences with
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veterans, You're you're thinking to yourself, you're drawn to this. How did
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things unfold such that you started writing these books? And you mean, obviously
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you're you're you got so involved in it. How did that unfold? How
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did that progress? Dumb luck? I mean, there is some dumb luck,
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right, right, But it's one thing to to you know, be
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a therapist or a psychology just to be working with people, and it's another
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thing to be writing books and chapters and articles and doing research. Right.
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Well, it's probably my overachievement, my over achievement problem that needs to be
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fixed. You know. Here's here's one part of the answer, I guess
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is that I do love to learn. So you know, it's funny.
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As a young kid, the play I always did was teaching. I was
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always a teacher, and I think from an early age I was good at
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school. I love to learn, and I am genuinely just a very curious
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person, and so I think that very innate part of me then led me
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to just be attracted to people who are asking some of the best questions and
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doing the best work. And like I always felt like I might not have
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been the smartest person, but I can work hard, and so I probably
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I found really smart people and I learned like trying to work with them and
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learn from them, and then attracted people. It's like a snowball, right,
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and you're acting people who are super smart and building teams of really smart
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people. But you know, one thing I've learned in this process is that
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you know smart dime a dozen. There are lots of smart people in the
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world. It's really the good people. Finding really good people to work with
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with a passion for what you do, that then makes it possible to be
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productive. Right, So it's not about I never went into it thinking I'm
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going to do this many publications, this many books like that was never It
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was almost like that was incidental to the process of loving what I was doing.
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I love what I do, and now everyone gets not everyone loves what
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they do. That is certainly true. When you started out and you had
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mentioned you know that PTSD is very treatable, you saw improvements. How were
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you working with your clients at that point and how did your understanding and your
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knowledge of treatments progress. Yeah, that's a really good question. So keep
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in mind this would have been ninety seven, ninety eight, So I started
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graduate school in ninety three, at twenty one twenty two. I think I
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saw my first client at twenty two years old, which is like baffling,
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and at that time, so like say ninety seven ninety eight in VA Hospital.
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Like our understanding of PTSD, he was growing right by now it was
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actually a recognized diagnosis, and there was there were some systematic attempts to develop
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treatments and test them, but a lot of the treatment in the VA Hospital
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was what I would say is palliative care like stress management, anger management,
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interpersonal skills, a lot of polypharmacy like trying to basically relief suffering and minimize
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the symptoms. And I had a supervisor, doctor Barbara Niles, shout out
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to her who was like, Hey, there's this therapy, cognitive processing therapy
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that Patty Rezek has been testing with female sexual assault survivors. You know,
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maybe we should like try it with veterans, and you know, I'll supervise
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you. And then you know, this is what I mean, like it's
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one of those incidental try Let's let's try this therapy and see how it goes.
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And then that you know, struck a whole line of research on cognitive
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therapies and the idea that actually people could get better. Like at the time,
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it was like you have a life sentence. This is like you're going
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to always condition. Some people do have the condition forever. Like I don't
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suggest that like everyone goes into remission, but a lot of people do get
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better and some people do, you know, lose their diagnosis. And I
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think I think I was one of many people who are a part of that
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reformulation of PTSD as a treatable condition and that it's about recovery from events,
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not a disorder that develops and stays forever. So that that I think has
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been interesting to observe. Now, you know, one of the topics I
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talk a lot about is being careful not to fragilize our clients by being afraid
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to talk about trauma and being afraid to have them go back and systematically go
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through those experiences to come out the other side, because we're if we say,
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oh, you're not ready or you know, we're afraid that you could
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get worse, like we're kind of sending the message that there's not mastery and
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competency and capability. And that's been one of the things that I've really as
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part of kind of anti stigma and hope is to really talk more about our
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clients being way more capable than we give them. I mean, with the
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understanding that everyone is different, there are you know, there's there's a lot
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of talk out there that it's not necessary to review or or even talk about,
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you know, what's occurred. Where does that come into the mix here?
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Yeah, I think several things about that. One is that there there
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are improvements that people have from therapies that do not involve going backward, like
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non trauma focused therapies. The effects are not as big generally in terms of
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improvements. But you know, you can't force anyone to you can't force anyone
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to treatment, let alone a certain kind of treatment, right, Like,
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there's always respect for that, and it's all about inform consent, you know,
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like you can choose what you want to do. I think what's interesting
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is that there are there are a number of ways to go back if you
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choose to go back. Sometimes people have this concept that to go back is
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to go back at a really thinly sliced site, sound, smell, sensory
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experience, And there are treatments that work that take you back, but it's
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not at that kind of thin sliced that seem to work. So there's there's
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different roads to roam. Sure depends on the path you want to take.
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So I guess in general I just get concerned about messaging people they shouldn't talk
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about their trauma. That that that's the part that concerns me because it does
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seem like people talking about it in a supportive environment is helpful, whether that's
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with a professional or a loved one. And you know, we just don't
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want to instill this idea that you're going to like somehow taint people or not
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get better by talking about it. We've been You've mentioned, you know,
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working with veterans and PTSD with In that context, are you talking about trauma
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in general, the benefit of talking about it in general, or you're specifically
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referring to talking in terms of veterans and their experiences. When about my statements
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about kind of talking about the trauma is helpful, Yes, yeah, I'm
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I'm in general. I'm talking more, not with particular populations in mind,
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got it, got it? Okay? Yeah, Now I wouldn't recommend wholesale
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disclosure. Sure, you know, like there are people that you know,
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like a trusted person who is going to receive information in a positive way is
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important too, right, It's also how you disclose, where you disclose,
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who you disclose to that I think be a part of healing. That's really
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important. Yeah, I mean I think that's very interesting because I think there
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is is obviously a sentiment about use the word fragilizing, and I like that
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word, and you're saying, well, let's look at this a different way
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here. I mean there's something very empowering about that. Yeah. Yeah,
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I mean it's part of if I can riff for just a second, of
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course, this is this is what this is about. I think it's also
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part of my concern about trigger warnings, that we've kind of become a bit
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like traumaphobic. And while I think it's I think it is respectful to say,
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you know this, what you're about to watch could be troubling or distressing,
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Like some preparedness is good. I think if we are constantly treating people
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as if they shouldn't here see experience things, we're also kind of taking away,
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stripping of stripping that person of their capacity to do it, like kind
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of devaluing them and their ability to handle it. So I think it's I
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think it's especially when trauma is endemic. You know, it's like over five
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percent of people have trauma, So just being careful about what message are we
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sending by saying don't talk about what happened to you, or you know,
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for us to sanitize conversations when it's like, no, really, this is
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what's happening in the world. Right. If it's too sanitary, it's like
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we may not fully appreciate the impact of what's happening. So I think these
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are some of the nuances that I that I've observed in my career. It's
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very interesting that you bring that up. There was a recent article I think
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was in The Times about how certain UH colleges at the elite level, I
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know they were talking about we're wondering whether they need to put trigger warnings in
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the literature that certain Did you hear about this? I did hear about this.
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Yeah, it was a very interesting article bringing up a lot of what
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you're talking about. And of course there were two sides to that story.
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And I think that the fact that let's have a dialogue about that, Like
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I am throw dialogue right, yeah, Like, in fact, I wish,
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you know, we had more of that dialogue. But I think for
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me, where I end is this idea that that there is value in serving
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things up realistic as they are to fully understand the impact right now. Let
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me I want to talk about other treatment modalities, but I want to go
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back when you first started, uh, you know, really encountering or engaging
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with people who'd experienced trauma. How did that land for you? Okay,
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So this is something I think about a lot when i'm because I'm selecting students
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and I'm training people. I think there is a lot about becoming a trauma
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therapist that is more about the selection process than teaching people how to hear hard
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stories. And I think for me, one of the things that's very protective
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is that I am not a very good imaginer. So you know, some
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people, if you hear a story, then it's all of a sudden you
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have like a very embellished version of it in the mind. I don't at
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all. So I think that's protective for me in terms of hearing people's stories.
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Now that said, there are stories that I've heard at certain points in
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mind life that we're really hard to hear. And you know, I'm not
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immune or other people are immune. I think as a therapist one of the
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things that's also protective is that I'm thinking I come to that situation with a
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certain goal, which is, how do I help this person. So,
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yes, the story is going on and I'm hearing this story, but I'm
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also thinking about, Okay, how do I make this person better given what
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they're telling me? And so you have your mindset on a certain goal.
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That goal, which is also probably you know, puts a protection on it
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as well. But mostly I said this before, I'm repeating myself a little
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bit. I just feel like for someone to tell me the most intimate things
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that have happened to them, in parts where they felt like maybe they did
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the wrong thing, or they reacted in a way that they're ashamed, or
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you know, like wow, like how can you not be there and be
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present and honor that. I think that's mostly my experience about it, Like
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it's like it's a gift, Like it's a precious gift that not everyone gets
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right. Right, can you share an early clinical error? Oh? MANI
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yeah, pick one? Ah wow? Okay, So the topic of self
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disclosure is always an interesting one, right, and a lot of training programs
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are you know, rightfully so very I would say, I'm going to use
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the word dogmatic from the perspective of like there's only one right answer, which
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is never self disclose. And yet I think there are times where self disclosure
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can be incredibly important. And so I was working with the same sex couple
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and they were feeling like the system in which they were operating was being very
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perseconatory of them, which in that era probably was true. Anyway, we
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happened to get on they took the wrong elevator. It's one of those weird
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situations. They took the wrong elevator went up, so they came back down.
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So I got on the elevator to leave at the same time, and
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they were like, are you are you going home to see your husband?
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And I said, I'm going home to see my wife. And they didn't
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know that I was in the same X relationship at the time, and I
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thought, oh, that will be joining, you know, like I don't
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think I get them more, and now that they know this piece of information
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about me, it'll increase the working alliance. It had the opposite effect of
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Oh my god, like, you're in the same sex relationship and you're working
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in this organization and you're going to get persecuted. They'd like had a very
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protective, preoccupied response to the whole thing, and like I mean, probably
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in the end the air, like all ruptures and repairs that we do in
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psychotherapy. Was probably very helpful because I was able to say, you know,
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actually that's kind of not my experience and to you know, to talk
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about that more and to bring that into the room. But I think it
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was an because I wish I would have been more intentional at that disclosure.
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It was one of those like popped into the elevator someone it yeah, and
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I totally went with it, and I wish I would have been more intentional.
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And that's what I would say in general about myself as a therapist.
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Sometimes I just go with it and then later I'm like, uh, you
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know, I need to I appreciate you sharing that. It's want to remind
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everyone I'm speaking with doctor Candice months and in the in the bio, I
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referred to conjoint talk about that. Hmmm. So part of my background was
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thinking about how we use couple and family therapies to treat individual problems, so
29:49
that I was like part of my training. My major advisor was trained as
29:56
a couple researcher anyway. So when I got to the VA, one of
30:00
the major things that people would say about why they actually got to treatment was
30:07
their relationship with their partner, and pretty much all mental health conditions will put
30:15
a lot of wear and tear in relationships, and so I was kind of
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born out of that, like a history of training, but then realizing,
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wow, this is a major part of what's not working in people's lives that
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actually brings them It's like where it hurts. And so then in two thousand
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and one started building Coudee behavioral conjoint therapy for PTSD. And yeah, now
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twenty two years later we have had let's see how many trials now, five
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clinical trials and a bunch of case studies and some uncontrolled trials and been testing
30:56
it alongside MDMA as an intervention for PTSD. And it's probably in terms of
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my contribution to the field one of my proudests, like in terms of being
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creative. And at the time people were like, are you crazy, Like
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do you really think you can do trauma processing and a couple therapy context.
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It's like, yeah, let's clear that, So how does that? How
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does it work? I mean yeah, yeah, yeah. So the a
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lot of it is like communication skills and teaching couples to be able to communicate
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better with each other, but the other part is a lot of these couples
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with PTSD are very avoidant and so trying to overcome the avoidance. You know,
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people place these situations and the partner oftentimes is also accommodating those symptoms,
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and so to work together as a system as a unit to push against PTSD
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and by approaching so is the understanding here that both partners have PTSD. No
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one or both can have PYTSD. Yeah, one or both can HAPPYTSD,
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but they're joining together to work against it, whether it's in one or both
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of them, work against it, meaning perpetua against the disorder. Yeah.
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So what we do is even in the conceptualization is externalize the disorder. It's
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not someone that's something that's in you, it's something that's living between us.
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Wow. Yeah. And then once we improve the couple's relationship is then we
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do cognitive work together, like exploring the cognitions that may be problematic about how
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the person who has been traumatized has made sense of their trauma, but also
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potentially how the loved one who's participating may also have some problematic thoughts that are
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operating. And so we're kind of teaching them critical thinking skills to work together
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on in order to address whatever thoughts that we think are maintaining the disorder or
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causic disorder. Wow, I don't think I've ever talked about that specifically on
33:28
this podcast. Oh, we should talk more about that. Yeah, I
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think I'll have to bring you back. I would love that. Can you
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tell yes for a different episode, let's can you direct our listeners to perhaps
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a book you have that would maybe help them in that field in that topic.
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Yeah. Yeah, So the particular treatment that I was talking about is
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Cognitive Behavioral Conjoint Therapy for PTSD and is published by Guildford Press. So if
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they google my name and Conjoint Therapy for PTSD, I'm sure they would find
34:12
their way to it. Okay. And that's harnessing the healing power of relationships.
34:16
That's it. Okay, I will have that linked up. Yeah,
34:20
I should say to your to those who are listening, it is a clinician
34:25
treatment manual. So some of it, I mean, there's nothing that a
34:32
patient or a loved one couldn't read, but it is geared toward the readership
34:38
is for clinicians. There are some amazing resources on the National Center for PTSD
34:50
website that is specifically about couples and families and PTSD and loved ones and care
34:58
care givers courts. So that's VA dot PTSD dot gov. Okay, that
35:07
would be another amazing resource. And there are like some whiteboard videos about the
35:13
treatment and just some fact sheets couples and relationships and PTSD and trauma. Okay,
35:22
I'll link that up as well. Candace, you are amazing. I'd
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love to have you back. Like I said, I would love to love
35:31
awesome. Awesome. There's obviously so much to talk about. What's the best
35:36
way for people to get in contact with you? Yeah, I would be
35:38
delighted for people to contact me. Do you want me to give my email
35:43
here or no? I can link it up you. Yeah, they can
35:47
absolutely contact me via email if they also go to my website candas monson dot
35:54
com. There's a contact page as well as a strategy of getting a hold
36:00
of me either either either that email or the contact us page on my site.
36:07
Would be great, all right. All the other thing I could I
36:09
could just quickly mention is that we have started a North American online like virtual
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mental health center focused on stress and trauma for people who are looking for different
36:23
options of treatment for PTSD. Wow, it's called Nellie Health. So just
36:30
to put a plug in for Nellie as well. Okay, where is that
36:34
on your website? I don't think there's a link from Candace Monson dot com,
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but nellyhealth dot com, my eHealth dot com. Okay, Nellie help,
36:50
I'll put that here too. Awesome, Candace, thank you so much.
36:53
It's the pleasure, my pleasure again. It was awesome than here.
37:00
Okay, lokay Bye.