Trauma-Informed Supervision: What Training Programs Get Wrong

Welcome back to Therapist Voices with Reach Link. My name is Jessica Herurwitz. I oversee Reach Link's network of amazing providers. Today I've got a really exciting guest. Amanda Martin is a lot of things and I'm going to let her introduce herself because you will see when you when you go to her website. We'll be linking all of her resources at the end of the episode here. quite a few specialties that are really really exciting and important. Amanda, if you could tell us a little bit about yourself and and some of the specialties that you provide with your group. Awesome. Uh yes, thank you, Jessica. So, I provide several different types of specialties in uh the counseling office um and also at a couple of ecoin sites. My background started I have a PhD in family therapy and then I'm dually licensed as well um as an LMFT supervisor and an LPC and then I'm also board certified in neuro feedback and I'm um agala certified as a mental health professional.

Some of the things that I provide is I do uh counseling for individuals, families, athletes typically using modalities of ecoin therapy, symbolic experiential if I'm working with um groups and collaborative problem solving if we're working on analog to work on like dialoguing on communication skills. In addition to that, I provide neuro feedback for people that are needing help with a variety of symptoms. is it works very very well with anxiety helping people feel more regulated when medication is not getting that job done OCD depression a lot of different things sleep it's fantastic for and then with that I also do a lot of work um with animal assisted work including ecoin therapy so I have a an emotional support dog that's an office that comes and helps people regulate all day long we get into the the power of animals and that connection as well but I I would say the main modality that I get integrated in that pairs very well with any of these approaches is EMDR.

I am most known for working with more complex cases. And so having the variety of these trainings, I'm able to create that individualized treatment plan to help someone not have to go to like five different clinical providers outside of like medication, which I don't do, to be able to kind of stage in the things that will work with them to help them reach their goals. Amazing. It's that's exactly what I was thinking when I was reading your website. It seemed like everything was focused on the more complex situations, which I think is such a breath of fresh air, honestly, cuz I think so many people, regardless of their their issue they're dealing with, whether it is incredibly complex or to them it is, that's sometimes a doubt for people of is this person going to be able to address what I'm dealing with?

Oh gosh, is my issue so complex that that it'll be, you know, new territory for someone? So, it seems like you are somebody great for people to seek out when something really especially significant is going on that's really detailed, especially with those those things that you specialize in. I'm really glad that we'll be able to talk about EMDR because it seems like there's something attached to EMDR, if you will. you probably have a better term for it with your peak performance service. I wanted to to talk a little bit about that and hear about that service. I wondered if first you could tell us um I know most people listening are are familiar with EMDR, but if you could give us just an overview kind of a 101 of how EMDR works, so then we can get into the really kind of nitty-gritty of that service.

Sure, absolutely. So, and if I don't do a well enough overview, please let me know. I'm happy to to go through it more uh clearly, but with EMDR, that is an evidence-based modality. Um it's recognized in the therapy world, but it is specific to helping identify the experiences that people have been through that are creating the symptomatic pattern of response. Meaning that if we grow up and we had an experience of having maybe a a negative experience with a math teacher, I don't want to pick on anybody that teaches math, but maybe a negative experience and we lost confidence in that subject. And then now every time we go in, we have this sense of, oh, I'm not going to be good at this. And then we automatically our system will kind of go into an anxious state where we don't learn as well as where if we go into a topic that we feel like we've had some positive experiences and we have a natural confidence where we're able to generalize that information cuz we're in a calmer state and our systems learn all the time.

I mean literally how we are wired and how we learn to regulate starts from conception through our whole life. So with EMDR, we're starting to identify these experiences of when did this response pattern that's problematic for you now? It was helpful in the moment, but problematic now. When when did when did that start? And then what in the daytoday and how we learn how to relate to others is maintaining that response pattern? Because our nervous system is just going into a state of threat. Our mind is remembering things from the past even though we're not always aware that that's what's coming up. there's a felt sense to it. When we identify these experiences, we can reprocess those with EMDR. Most of the time when people, you know, they're coming back, they're reflecting, I want to respond this way, and every I don't know why I just didn't.

I I I know to do it this way now and I didn't. That is that memory coming up, that felt sense coming up. And then those feedback loops play through. We're going in, we're reprocessing those experiences. So that way when we recall things, our system recalls things. It doesn't come up with that charge of distress and we're able to stay more calm and regulated to have access to I have more options on how I want to handle these things and we can respond differently. And so EMDR like any other therapeutic modality is still getting a history. It has phases to treatment for teaching regulation first and then working on those experiences, working on the triggers to the responses that are still coming up. now that should lessen after we work on some of those past experiences. And then also, how do you want to do things moving forward?

Visualizing yourself doing something well, being the person that you're striving to be is incredibly helpful. I like it to um why do we teach people why do we do fire drills? Because we know that's a stressful situation if that ever occurs. And when you teach people how to respond even in times of stress that may never occur in their life, they are more likely to exit that safely. And so I don't know what will happen in the future. They don't know what may happen in the future. But through this these phases of treatment, they are able to work on the past, work on the current stressors, and then now have a plan in mind of that felt sense of how they want to handle things moving forward. Thank you. Dr. Dr. Martin, is it typical when people come to see you, do they typically know, have they identified what that past event has been, what that what that situation has been, or are you often in a position where you are really needing to start from the beginning and help them identify it?

I I would say it goes both ways, honestly. I have some people that are coming in, they've done some research. Um, AI does a lot to help people now with figuring stuff out. It really does. So, some people will come in and say, "I I heard about this service or I I I learned about this or someone referred me for this and I I" and when they've done a little bit of digging, they'll start to kind of think through some of those things on their own. Other times, people are just coming in because they recognize their experience, their life is not going the way that they want it to go. They they've exhausted some other things. They're in pain and they want it to be better. and they can be, you know, quite surprised on where their system takes them when we start to find these areas that are still getting activated that create this distress response.

So, and sometimes people, you know, we think we know what it is. We're going to the most recent thing. We don't always think back to like these early earlier events because often times we don't try to pull on the felt sense of something. We feel that we're distressed, but once we hit a certain level of emotional reactivity, we kind of lose a bit of awareness on being able to reflect in the moment of what's that about. And then after the response, there's this shame that we want to avoid experiencing. And so we'll just kind of move forward. And so often times even tracing back to kind of find these these moments that can be impactful can be surprising for people, but usually once they get there then it makes sense because it feels so similar um and they're able to kind of connect the dots and that can be pretty powerful.

It probably I would imagine is so powerful to see. I mean, I know you're so established in this work, so it's probably pretty typical now for you, but I can imagine practitioners just being able to see all those dots connect and be able to help facilitate that work is is probably pretty powerful, I imagine, for everyone involved. I'm amazed every time. Um, not that I don't ever I don't question that it will work, but there is something that is absolutely beautiful about being able to sit with someone and work through this experience and not only see the dialogue that they've been carrying for so long shift, but their whole body shifts into a more regulated state. And it that is always just such a beautiful thing to be able to witness and be a part of seeing someone be able to feel that distress go away.

And that I'm sure that level of comfort that someone needs to feel. I'm just picturing being being in this situation as as a patient. how I might feel knowing that that I'm about to be so vulnerable. Especially how you were saying that some people may have thought that they identified what the incident or whatever the issue has been and then it might end up being something different. That is such all I can think of is vulnerable, such a vulnerable place to be. So being with someone like you, I'm sure is so important to feel that comfort. How many sessions or is it is it always very different? How many sessions does EMDR typically span? So, it it can be different. In my experience, I do find that it trends the same way with what the research has shown um and even the most recent meta analysis as well that came out last year.

But typically, if it's more uh what they call single incident trauma, meaning like I was everybody has stuff that they go through in life, but they don't always need therapy, but maybe they stopped at a gas station and there was a robbery or something, right? And that now they they don't feel safe anymore. That's a single incident trauma. Other times you can have people that have more complex histories and that have have you know over and over in their life there are different types of traumas that have occurred during their developmental stages relational that you'll see patterns in throughout life as well. And sometimes it can be situational, right? Like if you have a job that's really difficult or if you were in, you know, if you were an athlete and you switched coaches and you went from having someone that really got you and was okay with you doing the warm-up that you needed, maybe not the structure that you've created for the whole team and now you're expected to do what everyone else is doing.

You're not allowed to do what feels good for you, that ritual that gets you into that zone and that flow state. That can feel very discouraging. And then when you're not able to perform, people start to question, right? And athletes, I think, are specifically sensitive and performers to this because they dedicate so much of their day to this. And whereas, you know, I can have a hobby that I can go do for an hour, two hours a week. I can like exercise, but I don't identify as the fitness queen. And my my livelihood is not dependent on it. How people see me is not dependent on it. And so even people that want to support their athletes and performers, they are often going to the that topic to talk about. They're not saying like, "Oh my gosh, your hair looks really good today." It's, "Hey, are you excited about the upcoming event?

Are you ready? What do you think about this? Did you see this? Did you see this new thing?" Everything becomes revolving around that. And again, I think a lot of our support systems are wanting to support us, but what that focus does is often times create the identity of them in that role as their main sense of who they are. And so when they're not when they have just a hard day, when they have an injury and they don't know if they're going to come back from it, if they start coming back and it doesn't immediately go back into a really solid performance or they start to feel a little bit of pain and they don't know if that's okay or not, they can get into that panic which you're not going to perform well in panic. So I think any of those areas can be key in trying to work with someone and they can be a bit more complex.

Athletes don't always have complex trauma, but they can be complex situations because their system and how many people are are keeping the status quo involved is quite extensive. As a clinician, you don't always have access to the entire system and expecting the athlete to start redirecting each of those areas can also be hard, especially when they've lost confidence in certain areas of their ability to do what they need to do. This is a perfect I'm glad you used this example of of athletes. It's a perfect segue into something else I wanted to ask you about related of course to EMDR. I know that you've got a service that you offer or kind of a specialty of EMDR and peak performance. Talk to us if you could a little bit about what that is. I suspect that that's a bit of what you were just talking about.

I would love to hear more about about what that is and what that entails. So I still follow the same phases of treatment with EMDR uh when I focus on peak performance, but it is the focus of it is on finding the areas of concern that they have with their performance. So I'm looking at times that they were able to perform really well. I'm looking at their patterns that they're using right now. And most athletes and performers do have rituals of how they get ready, of how they prepare or don't prepare, right? Some of them have kind of systems around like if I do that too much that doesn't go well. What do they do in moments when things happen that are unexpected? Their support system that's involved which can change and evolve throughout the course of their career and times that have created those moments of concern.

Whether it be a couple of performances where it it just didn't go well. Maybe they got some feedback that really started making them question how they're seen because they are very visible. And so when people start saying like, "Oh," they can start to question whether or not that one piece is true versus really looking at their standing as a whole and the pattern as a whole, they can kind of singularly focus in because they they apply a lot of pressure to themselves and this is how they're viewed. So whereas, you know, I think we've all had an experience where someone says something, we're like, "Uh, that's just one time I don't have to put that much focus on it." This can be different for them. So, I'm finding those experiences specifically, but also the times that it's been that beautiful, what I call ballet, right?

It just flowed. I want to enhance the connection to those experiences so they can recall what that feels like that it's still there. Often times, our nervous system and our mind will focus in on the fear of what could go wrong to try to create a plan to prevent it. But our focusing in on that fear state, we train the fear state to stay, which puts us in more of an anxious state versus it's going to be fine. I can regulate everything, right? With choice, this is really what I want to recall. This is really where I want to be. And really focusing in on that's what we want to call on command, not the whatifs. And kind of what I'll I'll say is that any what if that's already happened, you've dealt with it. So, let's just focus in on what you're actually trying to recall and strengthen. And those are those are the best things, those best moments, that feeling of it.

So, you know when your body's there or when it's getting there, and you can feel when it's starting to shift away from it, so you can use your tools to get back. So, we're going to reprocess. We're going to create the connections to the positive states and those positive experiences to strengthen that and remind them of that. Most of the time, by the time they come to counseling, they've stayed in states of anxiety for for a long time. and that's more prevalent and they wanted it better yesterday. Right now they've got pressure and so we're going to come back to the good stuff. We're still going to get that history and then we're going to start working in on reprocessing those negative experiences that are that when they come up it activates that those nerves where it now prevents them from being able to settle enough to get back into those states well or quickly enough.

And any of the triggers, right? If some people that give feedback in a way that just doesn't feel good to you, how do you want to handle that? We're going to reprocess those and then we're going to go into those future templates of what they want to do. We are going to look at their rituals and some of the things that they're using is probably still really helpful. Some of it may not be. So, I want to replace what's not working with something that feels better and then they're going to try that out. Most of the time this can be done in office. I do do some contracts for action, meaning going to the sites uh where they perform or compete, practicing using their tools, coming back and reflecting after a performance and checking in on any areas that may have come up that like still led to some areas of distress.

I don't mind some stress because I think when you perform that is normal, right? It matters a little bit more in that moment versus when nobody's watching or nobody's keeping score. But I want it to be one that you can still focus and stay in a connected state to to be able to perform versus it overwhelm your system and not feel safe. Occasionally they'll have me go I'll go with them to maybe a site where we can do the processing at site. Uh, and sometimes, you know, that can be helpful and needed as well, just so they can if they have a hard time recalling and getting into that state when I'm not there, then sometimes we practice using the protocol at the site and then it creates an experience of it being at that site. If you care deeply about mental health, whether as a therapist or someone seeking support, this message is for you.

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No commute, no waiting rooms, just real support when you need it. So whether you're ready to start therapy or ready to offer it, Reachlink is here. Download the app or learn more at reachlink.com because better mental health should always be within reach. Wow, that's really impressive that I didn't know that that would be part of it. Is it often athletes? I know that's just an example, but do you do you work with lots of athletes? Is it just across the board different kinds of people in performing roles? What are some major types of categories that you work with that people are are in? Most of the peak performance stuff that I'm doing with people are going to be athletes right right now just because I'm um well I've always only been licensed in Texas. So once they get to the college level and they're looking for those D1 colleges, they're moving often times out of state.

So I can't transition with them unless they they come back and do the service here. Um, so usually we'll do a handoff to another clinician. So a lot of the times I'm working more with kids that are in like middle school, high school. I also will work with performers, usually singers, just, you know, kind of like I said, whether they've had some vocal issues or things like that and they're wanting to get back into it or they're wanting to try out some new venues or maybe they're switching into something else. So those are kind of the main areas that I'm I'm working with with that kind of stuff. And my goal is is and I love that age range as well because we don't do a great job yet. I think we're ever evolving and I think we will eventually. We don't do a great job of teaching about what anxiety feels like or what that is until it becomes a problem.

And kids are so resilient that until it becomes a behavioral problem, nobody really recognizes behaviors come from states of feeling distressed and unsafe. Not just because they woke a kid doesn't wake up and like I'm going to be a jerk today. That's just not how they are. They're precious and they want to do a good job and they want to be liked and they want to be accepted. And so it's usually through those referrals from like, hey, this isn't going well. And they've already gotten a lot of feedback on that it's not going well before anybody really uncovers like, oh, maybe they're scared. And it's not just physical safety that makes people feel unsafe. And then you have a lot of kids that, like I said, we don't really teach about like our thought patterns and how to recognize how we think about things.

Uh, and so as adults, sometimes kids will come in and they'll be crying and, oh, this friend said that I can't come to their birthday party. And to us, we're like, h, that is not a terrible thing. But in their world, it very much is a symbol that they are not accepted and that that they don't belong and they're not wanted and therefore it must mean that something's wrong. And that can, you know, and if that if they are those overanalyzers, right, that kind of internally hold on to these things and it's not caught, you'll see them later typically because nobody knows how to come back and say, "Man, that sounds really tough." But I wonder about all the people that do invite you and what does that feel like? And you know, what do you do to help yourself feel better? What have you done these other times that make you feel better? like how do you help them redirect versus kind of being a bit dismissive because you recognize as a parent or whoever's involved this isn't life-threatening but it's a building block right it's a moment in time that could be impactful do you think that there are such then moments that we're missing as parents perhaps of of younger children where we could take a situation like that and respond differently than we normally would exactly how you said it's a birthday you know bigger bigger fish to bigger fish to fry.

Dismissing their experience. Could we do a lot more work uh as parents and mentors to reframe that experience for them earlier on so they're not having to sit across from you at at 40? Thinking back about that birthday party. Yeah. Uh I would I would love for it to be in in all arenas. Honestly, I would love for schools to teach, you know, about what those different arousal states feel like and how each kid experiences that in their body to create awareness. I would love hospitals that have just uh they're releasing parents with a newborn to actually talk about what this feels like versus them just being like, "Sleep when the baby sleeps and feed the baby and we'll see you in two weeks for this test, right?" Like I would love for these things to be taught more so people can recognize it versus just trying to get by and then when it becomes an issue.

Uh I think it should I think there's always moments as parents and I I don't want parents to take this as parents we want to try to do everything right because this matters the most. I don't want parents work very very hard and nobody is going to be present all the time and they're not going to catch every opportunity. The opportunities you're aware of. Do the best you can. Love them. Know they're going to figure it out. Right. sometimes just offering that ongoing support kids will they're quite resilient uh without just beating yourself up over it, right? I because I don't want them to beat themselves up. So, I have to model what I'm I'm trying to teach. I would love for it to be in classrooms. I would love for organizations that employ people to mean it. Not just to say, "We want you to take care of yourself," but to mean it.

For there not to be a consequence of someone says, "I need a personal day and I'm sorry. It just it hit me really fast and I don't have a lot of time to tell you." I want them to mean it when someone's saying like, "This is a really tough situation and I need a break or I need help to provide the aid versus being like,"Well, we don't have it. Figure it out." I would love for those things to eventually be worked into all arenas. I was amazed when I used to run a treatment center that sometimes just bearing witness to somebody's pain as they're describing the things that are happening and they're talking about all the problems without becoming involved in it of like that's not true or think about it this I don't have to do that. I can hear it and then wait until I figure where is one area that maybe I could be helpful and offer that.

I can't fix any of the other things. But even being able to bear witness to it, to hear it, and then to offer something that they have a choice to choose can really bring that down and then they can start figuring out the areas it when they calm down, they'll realize I can't change some of the things in their life. I don't have power to do that. But they still have choices. But in the moment of distress, we feel like we don't. And when people try to minimize it or shift away from it or redirect it, that doesn't feel validated, that stuckness. And so I I would love, you know, in a perfect world that we're able to teach these things from birth to grave is what I would like. How close are we to even how close are we to coming close to bringing some of that to to our school systems to different facilities?

Are is that very far off or is this something that is being incorporated in maybe different school models that you've seen? Yeah, I I I definitely think it's doable. um at the treatment center that I used to work at um we had a charter school and um the last couple of years we were able to get to a place that there were no expulsions which I thought was just amazing uh and if we found that if when in tracking the data right there's a lot that's involved in creating change and also identifying what's working versus what you just put money into and you want to work there's a difference and so you do have to track your data this takes energy it takes buy in it takes passion and it also it takes people's ability to have permission to for things also not to work but to keep trying to find a way uh and not just to take on like well that didn't work so we're just going to go back to what we know so I do think there are areas where we are continuing to evolve and to come along some more than others but I think some of that's also based on these different arenas have different areas of priority and need some are more impacted than others by different um systems uh in how they're funded did in the direction of the fields and also I mean funding really impacts everything in my opinion.

I think schools would love to have a way to teach every kid but they can't fund it. They would they it's not that they don't recognize the classroom size is really large but they can't fund or house a way to break it up into even smaller. We were fortunate with our charter school and just the, you know, the last principal that I was working with just did a great job in creating like in being able to listen and to recognize that what we're trying to accomplish is very hard, but it's worth trying and and we can track even the small things that we make change on to see what is going to be better. And so what they found and everybody has to live that. And so even they would if they if we had a kid that just never really felt safe in the classroom if you know they were like hey if we could prevent them from choosing to go back choosing to go home and we could keep them in school we had a much better rate of them staying engaged or re-engaging doing something versus nothing um and having more attendance throughout the year.

So if that meant that the principal is like, "Hey, I'm actually going to be in office today doing these things. If you want to sit at the desk to the side and do your work and that would be okay with you, you could do that." That kid graduated and went to college. That's pretty amazing. We had a time that a kid got upset and the kids at our center could be aggressive at times. Um, and they had one of them assaulted the principal. Later on after we did that repair and all of that kind of stuff, um they discovered that, you know, they they felt like a complaint they had made, a request, they had made something around that had not been met in the same timely manner as somebody else and they just, you know, they they became disregulated to something um that was harmful. But the principal got that even though they were the ones hurt and they later had lunch with that child alone.

Seems like an amazing principle. I mean, like I said, this is that you find those people that can kind of live this dream and know that we're going to get there. They they you know, they um this child was able to help be like one of the um open house, let me just show you the classrooms. I can't remember what they called them, but I mean, just really amazing to really see beyond the behavior. And I think that's really what we're trying to do with everybody. I want to see beyond the behavior or the distress. I want to recognize the distress as that pain, as that fear. And this is not always a choice to just behave in a way that we're saying is unacceptable. And I think when we can meet that, it naturally settles a little bit and now we can actually start to problem solve in whatever modality you want to try that with.

I just find EMDR to be effective and fast and to finally get back to the initial question of how fast. Most of the time um with complex cases um we will start to notice a significant change in the rating uh with some assessments of their symptoms within five to six processing sessions. Um, I have a lot of people people that are literally having panic attacks like multiple times a day that we can be really far where they're not having panic attacks in two months in 12 to 15 sessions single and and that really trends with research where they won't meet the criteria for PTSD after about five to six processing sessions, sometimes up to nine for complex trauma. With athletes, I find the same number, but the time frame can extend because they usually have a harder time getting in every week because of their their schedule.

And so being flexible, a lot of people love to work with athletes, but you do have to be flexible because man, they get up at like an insanely early time, not a time that I'm awake, and they start working and then they have to do whatever they have to do in the day and then they are still finishing up with other because they all do more than one thing on more than one team as they continue this. And I think about the amount of energy that takes, the amount of feedback that they get, um, and the amount of attention they have to pay to that body, very different than my day-to-day. So for single incident, you'll see a shift within usually uh, three sessions, sometimes as soon as 1 to two. I knew that that the research was there on obviously how effective EMDR is. Um, I know how high those numbers are.

I didn't know that it could be that quick. Especially when you are I appreciate that you touched on this when you are dealing with people that might not have the day that I have where I'm working at home. you know, I've I've got a job, but I am also not a professional athlete or an athlete or a singer or someone with this additional pressure to put it mildly. and professionals like you that are available that can meet them where they are literally where they are around that schedule is pretty amazing cuz I suspect that people when they're thinking about getting help in this way I'm sure back to what we were saying at the beginning even thinking that someone might be able to help and something might be able to help there's that whole other element of well I don't have the avail I don't have the time I'm already doing this I couldn't possibly get help for the for my issue.

I'm too busy having my issue impact me. It's just incredible that that people like you are here and that you are really you really a motivating person with what you're saying and where you see things changing and how you've seen them change. the story about the principal will stick with me and I hope that person is is gonna be listening and and feels the credit because that's incredible and those are the people that we need for our kids. So thank you so so much for for doing this. I have so many more questions to ask you. So I am going to bother you to come for a part two. Um, I feel like I have more to ask you about EMDR per the peak performance, also neuro feedback and the ecoin therapy and the animal assisted stuff. So, we might need about four parts, but if you're up for it, we are. Thank you so so much, Dr. Martin, for being here. We're going to link all of your information at the end of the episode here. Um, how to get in touch with you, your website, uh, different engagements that you've been in. So, more to come. Thank you so so much. Anyone looking for some EMDR, you know where to go. Thank you, Amanda.