Ask The Why with Dr. Ingrid Boveda

WEBVTT
00:00:00.160 --> 00:00:00.959
Hello folks.
00:00:01.120 --> 00:00:13.919
Thanks for joining us on Head Inside Mental Health, featuring conversations about mental health and substance use treatment with experts, advocates, and professionals from across the country, sharing their thoughts and insights on the world of behavioral health care.
00:00:14.320 --> 00:00:19.839
Broadcasting on WPBM 1037, The Voice of Asheville, Independent Commercial Free Radio.
00:00:19.920 --> 00:00:24.399
I'm Todd Weatherly, your host, therapeutic consultant and behavioral health expert.
00:00:24.640 --> 00:00:26.079
With me today is Dr.
00:00:26.239 --> 00:00:27.679
Ingrid Bovita.
00:00:27.839 --> 00:00:28.079
Dr.
00:00:28.160 --> 00:00:40.560
Bovita received her master's and doctoral degrees from the University of Utah and specializes in assessment and diagnoses in clinically complex cases, particularly those involving during developmental differences.
00:00:40.719 --> 00:00:56.960
She is the founding psychologist at the Hive Psychological Services, a premier and neurodivergent-informed psychological testing practice, as well as the co-founder of Cogenuity, which provides QEEG and neurofeedback services nationally.
00:00:57.200 --> 00:00:57.520
Dr.
00:00:57.679 --> 00:01:08.239
B, as she is often called, identifies as neurodivergent, and much of her work is rooted in helping clients and their families better understand their unique profile of strengths and struggles.
00:01:08.480 --> 00:01:14.719
Understanding that some of these struggles need to be contextualized in societal norms of nor of normality, Dr.
00:01:14.879 --> 00:01:19.280
B personally understands what it feels like when all the pieces do not connect.
00:01:19.359 --> 00:01:34.319
Despite trying one's best, she is intent on shifting society's paradigm of how we help neurodivergent individuals and is passionate about working with families and educating providers, educators, and support persons toward these efforts.
00:01:34.719 --> 00:01:35.040
Dr.
00:01:35.200 --> 00:01:36.640
B, welcome to the show.
00:01:36.799 --> 00:01:37.519
Thanks for joining us.
00:01:37.840 --> 00:01:38.560
Yeah, thank you.
00:01:38.719 --> 00:01:39.519
Thanks for having me.
00:01:39.920 --> 00:01:51.840
The thing I was going to ask you about in working with people on the spectrum, because you and I both presented at the last uh the last autism symposium conference, uh not symposium, but the autism research symposium.
00:01:52.000 --> 00:01:53.120
There's a difference between those.
00:01:54.719 --> 00:02:06.000
And one of the things that I talked about in mind that you you hit on, and I thought I saw hit on in a few different places, was that how you know mental health treatments really failing people on the spectrum a lot.
00:02:06.239 --> 00:02:10.319
Because we, you know, a lot of people have been treating them the same way, you know.
00:02:10.560 --> 00:02:12.719
And they're they've got symptomology that's like that.
00:02:12.879 --> 00:02:18.080
They've got, you know, they they've got symptoms that look like OCD or they are OCD.
00:02:18.159 --> 00:02:24.000
They've got symptoms that look like personality disorder, which are kind of misdiagnosed, actually.
00:02:24.240 --> 00:02:24.479
Yeah.
00:02:24.879 --> 00:02:29.840
Um they might even have symptoms that people think are thought disorder, but they're not.
00:02:30.159 --> 00:02:34.960
They're just very deeply rooted in kind of their process and their rigidity and those kinds of things.
00:02:35.199 --> 00:02:41.759
And then they try treating them in these kinds in and what I refer to at times as pressure cookers, you know, the clinical pressure cookers.
00:02:41.840 --> 00:02:46.400
It's like group all day and uh, you know, individual therapy twice a week and all this other stuff.
00:02:46.479 --> 00:02:49.520
And and and it's too much for them.
00:02:49.759 --> 00:02:50.000
Yeah.
00:02:50.240 --> 00:02:52.080
Like a lot of them, it's really too much.
00:02:52.240 --> 00:03:01.439
And for others, like they can track the content and they can like they can uh they can teach DBT skills, but they can't use them at all.
00:03:02.639 --> 00:03:03.039
Yeah.
00:03:03.360 --> 00:03:03.599
Yeah.
00:03:03.919 --> 00:03:09.680
When on the assessment end, how are you like how are you dealing with that?
00:03:09.840 --> 00:03:27.039
Like what is your how are you putting a grip on that in terms of not only understanding this person's clinical assessment, but also like bringing it to families in a way that they can understand and bringing it to whoever consultant they may be involved with so that they place accurately and put them in a program that can give them the right resources?
00:03:27.199 --> 00:03:31.439
What is it, how does it look from your end, the assessment end, dealing with that?
00:03:31.840 --> 00:03:32.400
Yeah.
00:03:32.719 --> 00:03:43.439
So um, and I just I literally just finished uh a meeting with a consulting group and parent where we were discussing exactly this.
00:03:43.680 --> 00:04:06.560
So we have a few different things in it, but it at the end of the day, um, someone's test scores actually are kind of the lesser thing we talk about or the thing that is kind of we'll discuss it at a 30,000-foot level, um, unless there's something clearly significant about, for example, someone's cognitive profile.
00:04:06.879 --> 00:04:18.639
Um that's usually what I end up not spending a considerable amount of time discussing when I when I you know do a review of findings.
00:04:18.800 --> 00:04:28.639
Um I want the family treatment team, consultants, um, and depending on the client, the the client themselves, to understand why.
00:04:28.879 --> 00:04:39.680
Um, because it, and this kind of goes to the point that you were making, um, that we tend to we do a great job identifying what the behaviors are, right?
00:04:39.839 --> 00:04:52.000
They're being uh defiant to requests, or they're refusing this, or they push people away, then pull them back in, or their mood is labile and kind of all over the place.
00:04:52.160 --> 00:04:57.040
And we can think, as I mentioned these, we can think bipolar, BPD, right?
00:04:57.120 --> 00:05:00.079
Like all these different di oppositional defiant disorders.
00:05:00.160 --> 00:05:02.560
Like we can think about all these diagnostic labels, right?
00:05:02.720 --> 00:05:03.680
PDA, right.
00:05:03.920 --> 00:05:16.560
And then as soon as we, you know, in our minds, even kind of assign that label when we think about that person, we immediately look at them from the lens of that diagnostic profile.
00:05:16.959 --> 00:05:30.720
Um, what we tend to not look at, and this is where the why comes in, is you know, nervous system-wise, what is going on, medication uh interaction-wise, what what is going on?
00:05:30.879 --> 00:05:44.399
I mean, we we are seeing research just as a minor example that says that someone who is autistic, the way that medications interact with their brain is different.
00:05:44.639 --> 00:05:51.839
And that makes sense to me because the story tends to be they've been on all these meds, none of them seem to really work right.
00:05:52.079 --> 00:05:56.560
Um, and they tend to create side effects or cause secondary problems.
00:05:56.879 --> 00:06:00.879
Um, so immediately I'm like, yep, that that tracks, right?
00:06:01.199 --> 00:06:05.439
Um we are seeing behaviors and we're not thinking about why.
00:06:05.519 --> 00:06:09.360
So just, you know, and this was what part of what I had discussed today.
00:06:09.680 --> 00:06:22.160
When someone refuses something, is it, you know, we we can assume, oh, it's because they are lazy or they want to test boundaries or they want to assert control or whatever.
00:06:22.319 --> 00:06:39.040
Um, we're not thinking, well, perhaps there's something about the request that that has completely overwhelmed their nervous system to the point that um it's not that they want to be defined, it's that they cannot, there's something about the request that that is overwhelming to them.
00:06:39.279 --> 00:06:47.279
Um case in point, I worked with an adolescent female um a couple of years ago that uh went, was in treatment.
00:06:47.519 --> 00:06:49.519
All she wanted was friends, all the things.
00:06:49.600 --> 00:06:51.519
She's on the autism spectrum.
00:06:51.759 --> 00:06:55.680
Um, and there was somebody sitting next to her that was talking very loudly.
00:06:55.839 --> 00:06:58.639
She had her headphones on and she could still hear them.
00:06:58.879 --> 00:07:02.720
She took her headphones off and said, Could you shut the f up?
00:07:03.839 --> 00:07:09.519
And she great great, you know, great self-advocacy, right?
00:07:09.680 --> 00:07:10.319
Um, number one.
00:07:10.560 --> 00:07:11.439
Did you miss a beat?
00:07:11.680 --> 00:07:13.120
Yep, did miss a beat.
00:07:13.279 --> 00:07:17.839
Um, the kid did shut up, um, but she got in trouble.
00:07:18.079 --> 00:07:27.360
And when the therapist was processing things with the family and with me, because of course I did the testing, and it's like, help us understand why she would do this if she wants friends.
00:07:27.600 --> 00:07:45.199
Um, the therapist said, Well, you know, um she is pushing people away and she is doing this because she wants to, you know, she had this whole uh thought-out conceptualization for why this client had told this peer to shut the f up.
00:07:45.519 --> 00:07:56.000
Um, and and implemented consequences and decisions for that student um in in line with that conceptualization, which was rather punitive.
00:07:56.240 --> 00:08:00.480
So my question was, is this what the client said they were trying to do?
00:08:00.800 --> 00:08:05.120
Push someone away, um, be mean, whatever the conceptualization was.
00:08:05.279 --> 00:08:10.240
Um and then she said, Well, no, but this person has a history of X, Y, and Z.
00:08:10.319 --> 00:08:12.160
And I said, No, no, did you ask?
00:08:12.319 --> 00:08:14.079
And the answer was again, no.
00:08:14.319 --> 00:08:21.920
So I said, Well, why don't we ask this client what their intent was, what they were trying to accomplish, right?
00:08:22.240 --> 00:08:31.519
Um, so the client, you know, we asked the client, she's 15 years old, and she said, I just wanted her to stop talking so loudly.
00:08:31.759 --> 00:08:39.200
Now, of course, it didn't come out right, you know, and so there is some coaching around intent and impact kind of matching up.
00:08:39.440 --> 00:08:45.200
Um, but the intent wasn't to hurt or to be mean or anything um nefarious.
00:08:45.440 --> 00:08:50.000
It was just, I'm trying to listen to my music and calm down.
00:08:50.159 --> 00:08:54.080
And there's this really loud talking, and I just wanted her to stop.
00:08:54.879 --> 00:08:58.240
Um the way we work with that, the why, right?
00:08:58.320 --> 00:09:00.000
Therefore, is very, very different.
00:09:00.159 --> 00:09:10.000
And I just see that clinicians, we do this where we make these assumptions instead of asking what sounds like a stupid question, right?
00:09:10.159 --> 00:09:12.799
Because, you know, oh, the the the reason is obvious.
00:09:12.960 --> 00:09:14.480
No, it's not always obvious.
00:09:14.720 --> 00:09:15.200
Why?
00:09:15.440 --> 00:09:16.960
What was the intent?
00:09:17.279 --> 00:09:29.440
Um, and so I that's what I try and get people to understand is is what the why of the behavior, um, and how do we how do we work with that?
00:09:29.600 --> 00:09:32.559
Um, as well as like some of that nervous system stuff.
00:09:33.120 --> 00:09:42.240
Clinicians, they have a bit of a problem sometimes, I I think with Occam's razor, you know, the whole like simplest explanation is probably the right one.
00:09:42.879 --> 00:09:43.200
Yeah.
00:09:44.720 --> 00:09:46.320
Why did you do this?
00:09:46.879 --> 00:09:48.639
Because I wanted him to be quiet.
00:09:48.879 --> 00:09:50.639
Because I wanted him to be quiet, right?
00:09:50.720 --> 00:09:52.320
And we're overcomplicating it.
00:09:52.399 --> 00:09:56.960
Like this is part of the attachment, or this is part of the you know, whatever.
00:09:57.120 --> 00:10:00.159
And it's like, no, she just wanted them to be quiet.
00:10:00.399 --> 00:10:04.720
Um so getting getting everyone to understand that.
00:10:05.279 --> 00:10:15.039
Well, I think that um, you know, the and to a certain extent, uh, you know, a clinician's value is around their ability to assess things that they're not necessarily told or not necessarily out of it.
00:10:15.279 --> 00:10:15.679
Sure.
00:10:15.919 --> 00:10:16.159
Yeah.
00:10:16.480 --> 00:10:28.480
You know, it's like if you're always using that as a mechanism, you know, that you're making determinations and putting behaviors in boxes and explaining them or deducing what they mean and so on without asking, it becomes a practice.
00:10:28.639 --> 00:10:35.919
And I I think this is where you know individuals on the spectrum have gotten a bit of a raw deal in treatment.
00:10:36.480 --> 00:10:48.799
Is that they, you know, we've already assigned we've assigned a lot of values and some clinical assumptions around uh what explains certain behaviors.
00:10:49.120 --> 00:10:52.159
And and you know, that might really that might apply.
00:10:52.399 --> 00:11:02.720
Um, as a person who's a diagnostic diagnostician, uh, and all clinicians are supposed to be that to a degree, you know, you you you go back to the boxes.
00:11:02.879 --> 00:11:11.600
It's like, well, a person with these behaviors, you know, this one, this one, this one, this one, it fit inside this box, that's this, that's you know, that's got this label and it means these things.
00:11:11.679 --> 00:11:19.200
And so I'm using a diagnostic profile mechanism that causes me to understand the root cause of some of these behaviors so that we can diagnose and treat.
00:11:20.320 --> 00:11:25.440
Except for the fact that none of it fits the person that you're dealing with.
00:11:25.919 --> 00:11:26.320
Yeah.
00:11:26.639 --> 00:11:26.960
Yeah.
00:11:27.200 --> 00:11:29.200
Um and then you forget to ask.
00:11:29.840 --> 00:11:30.559
You forget to ask.
00:11:30.960 --> 00:11:31.600
Why did you say that?
00:11:31.679 --> 00:11:32.799
Oh, because I wanted to be quiet.
00:11:33.120 --> 00:11:35.120
It's like, well, you know, yeah.
00:11:35.519 --> 00:11:38.639
Let's do some coaching about ways you could ask for that differently.
00:11:38.960 --> 00:11:43.360
Not saying that that's not a need or an invalid need of yours, but let's come up with some ways.
00:11:43.519 --> 00:11:48.879
And then all of a sudden you're not treating a malady, you're just coaching some language.
00:11:49.039 --> 00:12:13.360
You know, it's like, one, it's far easier to do what we're talking about than it is to do all this other these machinations around what is it, a treatment profile and a and you know, um a plan, a treatment plan that's going to exercise around this particular condition, all of which is erroneous because no one asked, or just be like, let's use some different words, and I think you get a better response from people.
00:12:13.679 --> 00:12:14.080
Right, right.
00:12:14.159 --> 00:12:14.320
Yeah.
00:12:14.639 --> 00:12:17.360
Let's match the intent with the impact a little bit.
00:12:17.519 --> 00:12:32.639
And I feel like, you know, diagnostic labels are are helpful because to your point, right, like you can then say, okay, here's the profile of a person, but it it it also I think collapses people into overly simplistic ways of looking at them.
00:12:32.799 --> 00:12:42.639
So if I told you, um, you know, so-and-so is autistic, you don't know really what that means because you know the spectrum is so broad, right?
00:12:42.720 --> 00:12:47.440
And it really is about understanding that person's profile of strengths and struggles.
00:12:47.679 --> 00:12:50.879
Um, versus we might go in and say, okay, autistic.
00:12:51.039 --> 00:13:02.159
So here's my understanding of their struggles around relationships, their sensory profile, their engagement with their interests, and none of those things might be relevant for that person.
00:13:02.480 --> 00:13:06.320
Um, you might take ADHD and say that person can't pay attention.
00:13:06.399 --> 00:13:16.720
And I'm often educating people and saying ADHD is not a disorder of inattention, it's a difference in how the brain regulates attention and allocates its cognitive resources.
00:13:16.960 --> 00:13:32.240
And when you put it that way, it opens the door to discussing why they're so tired or why sleep is disrupted, or why sometimes they don't pick up on social cues because they've got their own thing that they're focused on.
00:13:32.320 --> 00:13:36.480
You know, it explains so many more things than you're inattentive.
00:13:36.799 --> 00:13:41.519
Um so it's kind of like um, I heard it at one point, right?
00:13:41.600 --> 00:13:45.919
Like, I think about diagnostic labels a little bit like stereotypes.
00:13:46.080 --> 00:13:55.039
And there was an awesome TED talk many years ago that I saw that said, you know, the problem with a stereotype is not that it's untrue, it's that it's incomplete.
00:13:55.360 --> 00:13:59.519
Um so that's how I approach a diagnostic label.
00:13:59.600 --> 00:14:11.840
It's it's a good start, but if I told you this person has autism or this person has ADHD, there's a benefit to like, okay, I kind of have like a you know script for what that means.
00:14:12.000 --> 00:14:22.639
The drawback is you run the risk of making that thing that may not even be that thorough, uh, their whole the everything about them, their whole story.
00:14:23.120 --> 00:14:23.759
Identity.
00:14:23.919 --> 00:14:24.320
Yeah.
00:14:24.559 --> 00:14:25.039
Yeah.
00:14:25.279 --> 00:14:25.840
Yep.
00:14:26.559 --> 00:14:32.399
You know, and I I I'm working with someone right now and he said something I thought was really interesting.
00:14:32.639 --> 00:14:38.559
Um, you know, an individual in the spectrum, uh, an adult who's been kind of dealing with this you know, older.
00:14:38.879 --> 00:14:52.799
Um, and he he said part of the issue that he deals with is that whenever he's whenever somebody is interfacing with somebody, he doesn't have anything to rely on.
00:14:52.960 --> 00:15:06.720
You know, if you walk out in the world um we and you pick up on social cues, and you're a person who doesn't struggle with these things, and you can, you know, walk in and start up a conversation and uh, you know, and talk about some general things and walk out and everything else.
00:15:07.200 --> 00:15:10.480
We have some we have some shared content that we can rely on.
00:15:10.879 --> 00:15:20.080
We have uh some shared understanding around the way the world works, we have some shared ability to pick up on social cues, we have some, you know, or even verbal cues.
00:15:20.159 --> 00:15:24.639
It's like, you know, this is the beginning of the conversation, and this is the part where we talk about stuff that's not really all that important.
00:15:24.720 --> 00:15:27.519
This is the part where we say goodbye because this conversation is over.
00:15:27.919 --> 00:15:28.639
That kind of stuff.
00:15:28.799 --> 00:15:31.039
A lot of stuff that many people will take for granted.
00:15:31.440 --> 00:15:38.720
And he said, you know, the thing is that every time I begin interfacing with somebody like this, I start from scratch every time.
00:15:38.960 --> 00:15:45.360
I have to build a framework for understanding every person and every scenario that I deal with.
00:15:45.519 --> 00:15:46.639
And it's exhausting.
00:15:47.519 --> 00:15:48.879
That's a lot of data.
00:15:49.279 --> 00:15:49.919
That's brilliant.
00:15:50.320 --> 00:15:50.960
I know, right?
00:15:51.120 --> 00:15:59.360
Like if you if like if all of a sudden it's like you walked into a different country all of a sudden, you didn't speak the language, you didn't know any of the customs, and you know all that other stuff.
00:15:59.440 --> 00:16:04.799
And every day you woke up, you woke, you woke up in a different country and you had to figure it out all again.
00:16:04.960 --> 00:16:06.879
It's like that would be exhausting.
00:16:06.960 --> 00:16:10.720
And that's how they feel when they walk through life.
00:16:11.120 --> 00:16:19.600
Um and then you put them, you put them into treatment where this is their experience of the world, uh, and what they're doing is walking into a group and talking to people all day long.
00:16:19.759 --> 00:16:22.000
It's no wonder they get fried from that experience.
00:16:22.080 --> 00:16:23.279
They don't want to do it anymore.
00:16:23.440 --> 00:16:24.639
They refuse to go to group.
00:16:24.720 --> 00:16:26.399
Oh, they're they're not engaging in treatment.
00:16:26.480 --> 00:16:31.679
It's like, no, you've overwhelmed them and they can't benefit from anything that's here.
00:16:32.159 --> 00:16:35.840
Um feel better, and more importantly, they don't feel safer.
00:16:36.000 --> 00:16:39.519
And I I think that that was another theme that we stuffed that we hit upon.
00:16:39.600 --> 00:16:48.000
It's like it a lot of a lot of what a person on the spectrum is dealing with is it's safety.
00:16:48.960 --> 00:16:49.279
Yeah.
00:16:49.679 --> 00:16:57.840
They're their nervous system is on this, is on hypervigilance all the time because they're they can't pick up the cues, they're not sure what to expect.
00:16:58.000 --> 00:17:07.839
Suddenly they're being judged or they've done something wrong or they said something, and everybody, you know, they have this kind of trauma, you know, repeatedly traumatizing experience every time they interface with the world.
00:17:08.559 --> 00:17:11.039
Um, and they just don't feel safe.
00:17:11.279 --> 00:17:21.680
So if I can get you to a place where you feel safe, then we might be able to do something that looks like training and coaching and and being able to interface with the world.
00:17:22.079 --> 00:17:25.680
How does that show up in an assessment in your view?
00:17:25.759 --> 00:17:30.720
Like when you see somebody, like when where does it show up in the places where you're looking closely?
00:17:31.839 --> 00:17:36.880
Well, there, you know, and this kind of goes with what you were saying.
00:17:36.960 --> 00:17:42.880
Um, when I think of an autistic person and I think of safety, I think about predictability.
00:17:43.200 --> 00:17:48.480
Um, and when you don't have predictability, right, you don't have trust.
00:17:48.640 --> 00:17:51.119
Um, now that we can we can argue, right?
00:17:51.200 --> 00:17:53.440
Oh, well, that's the case with non-autistic people.
00:17:53.519 --> 00:17:54.319
And sure, right?
00:17:54.400 --> 00:17:56.000
We all were there for the pandemic.
00:17:56.160 --> 00:18:04.799
We suddenly our predictability and you know, the world and people dying, and you know, say like all of these things were arise.
00:18:05.279 --> 00:18:05.920
Can I go somewhere?
00:18:06.079 --> 00:18:06.880
Can we fly yet?
00:18:06.960 --> 00:18:09.200
Can we wait a minute, can we go home or should we go stay home?
00:18:09.279 --> 00:18:10.319
I don't know what we need to do.
00:18:11.039 --> 00:18:12.079
Yeah, when will this end?
00:18:12.240 --> 00:18:12.960
I don't know.
00:18:13.200 --> 00:18:27.599
Um, and so you know, I I think about that because our sense of prediction, our predictive systems were no longer functional for us, they no longer were something that we can rely on.
00:18:27.920 --> 00:18:41.599
And so this goes with what you're saying with that person you were talking about, that you know, if you don't have that script where you have to start over every time with everyone, you don't have predictability.
00:18:41.680 --> 00:18:46.400
You don't have something that you can say, well, this is how I expect this interaction to go.
00:18:46.799 --> 00:18:54.400
Um so you can't, you know, you you then are approaching every situation with a fundamental lack of of safety.
00:18:54.640 --> 00:18:59.519
Um, and in in an assessment room, it's it's very much the same thing.
00:18:59.680 --> 00:19:02.240
I recognize that I am a complete stranger.
00:19:02.559 --> 00:19:10.880
Um, some people don't have a script for, you know, testing, some have had testing before, and that's that's great.
00:19:11.039 --> 00:19:17.279
Um, and oftentimes their experience of testing was at best, it was really boring.
00:19:17.519 --> 00:19:26.960
At worst, I it was, you know, I don't want to say traumatic, but but unpleasant for whatever for whatever reason, right?
00:19:27.039 --> 00:19:30.799
And and so I I care about doing it differently.
00:19:31.039 --> 00:19:49.279
I think that there are ways of getting information um that don't involve constantly grilling somebody or um, you know how, you know, just just the way that that they they're engaged with testing just for long, long periods of time.
00:19:49.599 --> 00:19:53.119
Um, and all they want to do is find a connection point.
00:19:53.359 --> 00:20:04.720
And I used to do this where I would meet with somebody I knew what, you know, some of their interests were, and they would bring something up and I would essentially be like, oh, that's great, and let's move on back to testing.
00:20:04.799 --> 00:20:10.400
And then when I realized like this is how this person is trying to connect with me, which they totally don't have to do.
00:20:10.559 --> 00:20:13.920
They could just be like, this is a, you know, I don't like this.
00:20:14.079 --> 00:20:28.079
Um, when I realize that this is a way that is structured and predictable and more comfortable, uh a more comfortable way for them to connect with me, I, you know, it really changed the way that I do assessment.
00:20:28.240 --> 00:20:41.680
Um, because that that for me is is is crucial, not just for the quality of the data that that you get, but you actually get so much more in in outside of the questions you ask or the test items you administer.
00:20:41.839 --> 00:20:49.119
It's like I let parents talk on and on and on, not because I'm like, oh, I don't care, you know, I'm just gonna let their mouth run.
00:20:49.279 --> 00:20:55.440
It's because I actually get so much more valuable information outside of my structured questions from parents.
00:20:55.680 --> 00:20:58.480
Um, and it's the same with with clients.
00:20:58.960 --> 00:21:05.519
Um, but you know, I try and create as much predictability as possible.
00:21:05.680 --> 00:21:09.519
Here's what you can expect, here's what's expected of you.
00:21:09.920 --> 00:21:19.920
Um, but also that there are going to be some things that I'm not gonna be able to explain why I gave this or what the correct answer is or whatever, and there's a reason for it.
00:21:20.079 --> 00:21:23.039
So if I tell you, oh, I can't tell you that, right?
00:21:23.440 --> 00:21:25.359
Now you understand why.
00:21:25.839 --> 00:21:45.200
Yeah, I I mean that's I think that for, you know, and as consultants, we look for assessment folks, and you know, as evidenced by you being on the show, it's like we look for people who can they can provide us with something that is greater than the sum of its clinical data.
00:21:45.599 --> 00:21:45.759
Yeah.
00:21:46.079 --> 00:21:46.799
You know what I mean?
00:21:46.960 --> 00:21:50.720
Like and and people will do this, and you see parents do it all the time.
00:21:50.880 --> 00:21:59.759
They'll dig into the scores and they'll try to understand what the scores are and try to, you know, try to put something to together that looks like their own understanding of what this.
00:22:00.319 --> 00:22:14.559
Is a person who can do a good assessment can do exactly what you're talking about, which is find different ways to information that's going to be really valuable to feed into what this assessment is and can speak to it.
00:22:14.880 --> 00:22:24.559
And it's like, I don't have a measure for this, but I let me point out something that I thought was really, really, you know, important in the time that we spent together.
00:22:24.799 --> 00:22:34.960
And, you know, these features came out or these responses came out of this person, and it occurred to me that, you know, that this was important or they didn't feel safe with this or whatever it was.
00:22:35.200 --> 00:22:51.440
And that's gonna be really critical wherever they go get care because those fa those people are gonna have to pick up on the same thing, figure out a way to like honor it with this person and give them, help them feel safe and move forward.
00:22:51.519 --> 00:23:01.680
Because if they don't have this, they're just gonna, they're gonna put up the same barriers and they're gonna not benefit from anything that's there, and they're gonna, you're gonna come away with diminished results, if any results at all.
00:23:01.839 --> 00:23:04.160
Sometimes it's worse when they come out, right?
00:23:04.799 --> 00:23:19.119
Yeah, and and I see, and I see with like um, and I'm sure you've seen this too, like when a clinician makes a treatment plan, they include like, I don't, I couldn't even, like, many, many goals.
00:23:19.279 --> 00:23:22.400
And all of these goals have are are important, right?
00:23:22.480 --> 00:23:25.839
Like we could argue, I I don't disagree with these goals.
00:23:26.240 --> 00:23:27.119
So many goals.
00:23:27.440 --> 00:23:28.720
So many goals, right?
00:23:28.799 --> 00:23:31.440
But that's another point of overwhelm.
00:23:31.680 --> 00:23:45.680
Um, you know, I I just finished working with a young adult um in a in a transition program that to his credit, incredibly motivated, wants to figure himself out, wants to get better.
00:23:45.920 --> 00:23:53.200
Um, but you know, he had these five goals, and each of them have these sub goals that he himself made.
00:23:53.359 --> 00:24:01.920
So his therapist was like, This is great, you know, like thank you for giving me these goals, and now I'll write them in clinical jargon and we'll satisfy that requirement.
00:24:02.160 --> 00:24:13.359
Um, and it's like, you know, and and the talk that that this client and I had was this is all great, absolutely, but you've got to focus on one, maybe two of these while you're here.
00:24:13.759 --> 00:24:19.759
Um because otherwise, like you're learning something new, you're trying to do something different.
00:24:20.000 --> 00:24:35.920
Um, and it's like people the the what I sort of compare that to is like January one, people join the gym, they completely overhaul their diet, uh, 180 degrees, they start taking the supplements, they start setting their timer to go to bed early and wake up early.
00:24:36.000 --> 00:24:43.519
Like they're making too many changes that that risk yeah, that risk it not being sustainable.
00:24:43.839 --> 00:24:48.559
Um, and so you can't focus on on all of those different things.
00:24:48.799 --> 00:24:54.960
Pick one, maybe two, um, and start there and get that get that going.
00:24:55.119 --> 00:25:03.279
Um well, and try not try not to look too far down the road, like, you know, like be here now, man.
00:25:03.359 --> 00:25:04.160
You know what I mean?
00:25:04.240 --> 00:25:05.119
Like, where are we at?
00:25:05.200 --> 00:25:07.039
Let's be where we're at.
00:25:07.279 --> 00:25:09.680
And it's obvious that we're trying to get somewhere else.
00:25:09.759 --> 00:25:32.000
But don't I think one of the mistakes that you see um that lots of people make, not just, you know, not just professionals in this field, but probably frankly in any field and people make for themselves is they they they put you know the goals as you say, but they've put this image of themselves or potentially the image of someone else that they're working with in a box.
00:25:32.640 --> 00:25:38.480
Here's this box of the person that I see that is successful having completed all of these goals.
00:25:39.039 --> 00:25:41.599
And and then and then you get attached to it.
00:25:42.640 --> 00:25:55.599
And then and then when it starts to not go at the pace you want it to go or diverts, you kind of get hung up um about like, oh, we gotta do something else.
00:25:55.680 --> 00:25:57.599
And we we we gotta move a little faster.
00:25:57.680 --> 00:26:08.960
And and then and then the person's work centers around them being impatient with how slow they're going towards this mark that they've established, this benchmark, or this box this person's supposed to fit in when they get to the end of it.
00:26:09.039 --> 00:26:11.920
Yeah, instead of just being with the person.
00:26:12.559 --> 00:26:24.640
Um, and I and this happened to me early on in my time in the field, and I had somebody, he was an older adult, uh, you know, a lot of medications, he was very social, like people.
00:26:24.799 --> 00:26:30.640
It's like, well, you could do things like be a Walmart greeter, or you could do, you know, volunteer down at the such and such or whatever.
00:26:30.720 --> 00:26:36.960
He's like, I really just want to be, and he, I mean, you know, this person was, you know, 50 plus at the time.
00:26:37.119 --> 00:26:40.880
Um, I really just want to be, you know, in a nursing home.
00:26:41.519 --> 00:26:44.480
Because in a nursing home, they did activities.
00:26:44.720 --> 00:26:50.240
They had they had medical, they had a nurse that he could see all the time because he spent a lot of time trying to go to the hospital.
00:26:50.319 --> 00:26:51.200
Something else was wrong with him.
00:26:51.279 --> 00:26:52.160
He was one of those guys.
00:26:52.319 --> 00:26:52.559
Yeah.
00:26:52.960 --> 00:26:56.160
Um, and he they also had lots of people.
00:26:56.400 --> 00:27:01.519
So there were people around that wanted to have conversation with people that didn't have a lot of people filling their lives.
00:27:01.680 --> 00:27:09.440
He knew it was an environment that he would probably thrive in, but everybody kept going, no, you know, you could live independently and you can have these goals and you can do these things.
00:27:09.839 --> 00:27:17.039
We we beat our heads against a wall for a year trying to have him fit inside of this mold we had created.
00:27:17.440 --> 00:27:20.480
And when finally we were like, okay, nothing we're doing is gonna go.
00:27:20.640 --> 00:27:23.519
And maybe he's right, he just needs to go to an assisted living.
00:27:23.759 --> 00:27:26.960
He went to a he went to assisted living who's happy as a peach.
00:27:27.200 --> 00:27:27.680
Yeah.
00:27:28.000 --> 00:27:34.960
And he did actually end up going and doing some things that were different than what he would ordinarily do, but he had he had the base established.
00:27:35.119 --> 00:27:37.599
He knew what he needed, and we just didn't listen.
00:27:37.759 --> 00:27:38.559
You know what I mean?
00:27:38.720 --> 00:27:42.079
Like it was a huge lesson for me in general.
00:27:42.400 --> 00:27:48.720
Yeah, well, because we we always think that we're the ones with training, we know better than our clients.
00:27:49.039 --> 00:27:51.519
Um, and I'm guilty of that sometimes as well.
00:27:51.680 --> 00:27:56.559
And and sometimes it's like a lack of trust in that particular person, right?
00:27:56.799 --> 00:28:07.440
What if what you want is not what you need, or what if, you know, and we we see this a lot with adolescents where it's like, I just want to be home and you know, do all the things and leave me alone.
00:28:07.599 --> 00:28:14.799
And in those cases, you're like, no, no, like I need you to trust that that I I do know better about what what you need.
00:28:15.920 --> 00:28:16.079
Right.
00:28:16.480 --> 00:28:19.839
You need you need something other than being a basement baby.
00:28:20.160 --> 00:28:25.680
Um and so, and so you know, but there are other clients, yeah, exactly.
00:28:25.759 --> 00:28:28.240
Like the consensus is is you know clear here.
00:28:28.559 --> 00:28:35.839
But like, but yeah, there are clients where it's like, you know, they they know what will make them happy.
00:28:36.160 --> 00:28:40.000
Um so it is, it's a it's a balance, right?
00:28:40.160 --> 00:28:46.480
Um, where we're not assuming we know better every you know, in every way, every time with everyone.
00:28:47.039 --> 00:28:51.119
So we're not we're not saying they don't need help co-creating whatever that is.
00:28:51.440 --> 00:28:51.680
Right.
00:28:51.839 --> 00:28:56.319
It's just that exactly, you know, there's the saying in Nami has is nothing about us without us.
00:28:56.400 --> 00:29:03.359
It's like, you know, it like they need to be a part of this process so that they can help guide the thing because it's coming from them, you know.
00:29:03.519 --> 00:29:05.759
So they need professional help.
00:29:05.839 --> 00:29:12.400
We're not doing we're not arguing that, but some of that professional help needs to also know how to listen and you know, take different information in and everything else.
00:29:12.559 --> 00:29:21.920
I um I I think that uh we're looking at a transformation of the field, you know, with a lot more information.
00:29:22.079 --> 00:29:27.440
And I hope that that's gonna translate to a different way that that clinicians get trained as well.
00:29:27.759 --> 00:29:40.960
But you know, yeah, probably slow, but you know, when they get the world of the you know, wilderness and private pay and and those kinds of things, I kind of see a different model, and I think that that's probably where it all begins.
00:29:41.119 --> 00:29:46.160
But um Ingrid, thanks for being on the show.
00:29:46.720 --> 00:29:48.559
Yeah, of course, happy to be here.
00:29:48.960 --> 00:29:49.200
Dr.
00:29:49.359 --> 00:29:53.519
Ingrid Brovita joining us on Head Inside Mental Health Today.
00:29:54.160 --> 00:29:56.079
I'm Wedding Lee, your host.
00:29:56.400 --> 00:29:58.240
Look forward to seeing you folks next time.
00:29:58.400 --> 00:29:58.880
Take care.
00:30:14.720 --> 00:31:16.240
I've not been the pick up, I think the pop in the pick up, too picking the pop, I've not been up there, I've not been a pick up, not picked up, it became a pen, not picked up, it beat up, beat the pillow and the pillow beat the dots, it beat the pick up, it's not beat the dots, it beat up, beat the pick up, not every pick up, the pick up beat up, and I picked up it, I don't know.
00:31:23.759 --> 00:31:36.240
I'll feel so no be the last thing I can need to find our way on their so no need to last in here, need to find my way home.
00:31:37.839 --> 00:31:42.960
I feel so lonely and last in here, I scalp me on, need to find my way home.
00:31:43.119 --> 00:31:52.160
I want I feel so lonely and last in here, I scalp me on, I need to find my way home, I'll find my way home.