Trauma Therapy: What It’s Really Like with Dr. Jacob Ham and Elizabeth Ferreira

Hello and welcome to Being Well. I'm Forrest Hansen. If you're new to the podcast, thanks for joining us today. And if you've listened before, welcome back. I am so excited to tell you about today's episode. I have been really looking forward to this. Today we did something that we've never done on the podcast before. Elizabeth joined me for a guest conversation. She was a little nervous about it. She did fantastic during this whole thing. And if you're not familiar with her, Elizabeth is an associate somatic therapist and she's also my fiance. And we were joined by a very special guest, Dr. Jacob Hom, who is an incredible expert on trauma and complex PTSD. I mostly got to be a fly on the wall. Wow. Dr. Hom and Elizabeth talked about being a trauma therapist. What does it like to sit with clients? How have they been changed by the work that they do? What are some of the major themes that tend to come up over and over again? They really talked a lot about establishing relationship and what it's like to be in that relationship with another person who is processing some of the hardest things that a person can process in life. And I think that this is a conversation that, of course, you will get an enormous amount out of if you're a clinician or if you're interested in therapy in general. But I also think there's a lot here if you're just a person who's trying to deal with this kind of material in your own life. I'm not a therapist, but I feel like I learned a lot from Dr. Hom and Elizabeth today. And this was just such a cool experience. It was a very unique conversation. They have kind of a similar vibe and they really just sat in it with each other. I don't know if that's their nature as people or if that's the way that this kind of work changes you. I suspect that it's a little bit of both. And I was pretty quiet for most of the conversation. Episodes of the podcast are typically edited for clarity and length. And this episode is mostly unedited in part because there was just such a natural flow to the conversation that I wasn't even really sure where to put the edits. It was extremely organic. And I just really hope you enjoy it. So here is my conversation with Dr. Hom and Elizabeth. So Elizabeth, how are you doing today? I'm really anxious, but I'm hanging on. I'm grounding down. You're staying in my body. I'm really excited for this. We've never done a guest interview with Elizabeth before. But today we're joined by one of my all time favorite guests on the podcast, Dr. Jacob Hom. Dr. Hom is a licensed clinical psychologist and associate clinical professor in the Department of Psychiatry at the Icon School of Medicine at Mount Sinai. And he's also the director of the Center for Complex Trauma there. You might also be familiar with Dr. Hom if you read Stephanie Fu's bestseller, What My Bones Know, a Memoir of Healing from Complex Trauma. Dr. Hom was the clinician that you worked with in that book. So Dr. Hom, thanks for doing this with us. How are you doing today? It's so good to be back. Thank you for having me again. And I too am super nervous for some reason, but I think it's going to be good. Yeah, it's really interesting that both of you have been like mentioning that as part of this process where Elizabeth expressed some nerves to me even over email you did. I don't know, do you have any idea why that is? Was Elizabeth, were you nervous before I said I was nervous? Yes. Interesting. Yeah. I think part of my nerves is like I still feel pretty young in my work as becoming a therapist, but also working towards specializing in CPTSD. And I've been really lucky that in basically all my associate journey so far, that's the population I've been able to work with. And so I feel like I've just been sort of in this big bubble of it. And I think part of why I'm nervous is because the longer I've done this work, the less I feel capable about talking about it. It's almost like I struggle more and more to really define or find words that fit in what is like happening in the room. And I think part of my nerves is, oh my God, we're supposed to talk about it. That is really cool to me because it should be really hard to describe what happens in the room. I think we're not trained very well for that. And that's all I've been doing. So we'll have to, I would love to talk about that kind of stuff because my area of focus is really on what happens in the room moment to moment. And I think that's where all the work happens. But it's hard to be trained in it. And it's hard to understand it too. That's why I'm really excited about this training community that I'm trying to launch this year at some point. Because all we're going to do is just practice moment to moment material with each other. And it's not, it really is practice. There's no shortcut to figuring out how to do this. And I didn't feel like I got it until more than 10 years after I started, like 10 years after where you are in your career. And even when you do get it, like part of when Forrest and I were talking about what to talk about, part of the things that I was thinking about talking about, though I don't know how yet, is how exciting this past year has been for me as a therapist, because I've learned so much new material from the work. I feel like the thing that helped me to get so, to learn faster and faster is to, one, let my mistakes beat me up and hurt a lot. And to not let them make me tight in what I try to do in the room too. But you also need a lot of support and you need a shoulder to cry on after you mess up. Yeah. And you need to feel like it's normal stuff to happen. And you almost have to forget everything you've learned. Because in the room, you shouldn't be thinking about that stuff. Yeah. You should just be in the moment. And then you'll start to organize what you've learned into very, very practical moment-to-moment material that I can hopefully, maybe we can get to some of that stuff, but it's really hard to explain. And what I would also encourage you to do is to start writing. Oh, I do. Okay, good. I write a lot. Like journaling about it? Or what do you mean by that? No, write to your clients. I do that. Okay. I have a secret space that I write all the things I wish I could say. How interesting. And then I look at it and I see what can I actually say in real life? What's funny is that in my supervision of people, usually after they tell me what's going on in the therapy, then the answer is you should just say that to them. And the more and more you trust what comes up for you. And the more you hone that craft of speaking and what you're saying in a way that is helpful, the work becomes liberating, energizing, because you're using your whole self. I think that we get tired because we're holding ourselves down or compartmentalizing ourselves. But if you learn to hone all of yourself as part of the tool to use, then you're just energized and flowing. I'm excited. Yeah, no. This is really affirming because I've been in my own bubble thinking I'm just like a kook, like cooking and I'm like, I have no idea what's happening here, but it seems to be working. Yeah. So I'm very open about this, but I also have complex trauma. And so there are parts of me that can almost always relate to people I'm working with. And it feels like those parts of me kind of show up in the room that resonated like the same experience with my clients. And it creates, not just I understand you cognitively, but like I know what this feels like in this experience. And the more and more I've done this work, the more I've been, I disclose that in the room, like I kind of join and I share. And it's been a journey because I can get very activated or triggered depending on what shows up. And my practice has been to always make sure I'm a few steps ahead of whoever I'm working with. So if something shows up and I feel my own material really coming into the room, I go, ooh, that's kind of interesting. And how do I hold that? And how do I hold the other person? And how do I kind of even use that as a part of the tool? Yeah, you spoke it very clearly. That's the art. Every time it happens, you have to ask that question. And there's no right answer for that. And I've spent years playing with more disclosure and less disclosure and seeing what it does to my attention, whether it's with the client still or whether it, whether I become distracted myself. And again, there's no right answer because each moment requires a different thing. And certain people want more disclosure and other people really don't want it because it interferes. It does feel like you're taking your attention away from them. And so the only real solution is to keep wondering, is this the right move? Is this working? And to invite them to be wondering too. So it's completely consensual moment to moment and co-created what's happening. That's how I describe it. It's co-created. And I tend to ask, like, I will be like, Hey, I'm noticing something. I could talk about it. Do you want to know? Like, I give them the opportunity to kind of define how much of me do you want to show up in the room right now? Yeah, I do the exact same thing. But what I also know is that no one is ever going to say, no, I don't, I really don't care what you have to say. So they always politely say yes. So I don't know what to work around for that. I've had people say no. I've had people go, maybe later. That's cool. That's when you really know that the work is good and the relationship is strong. Because, and like, I will be on the wrong path and they'll be like, no, that's not what I'm talking about. This is what I really want you to pay attention to. And then it just grounds me in. I don't want to interrupt your guys flow here because you're just in such a good spot. But you said something a second ago, Dr. Hamdad, I was really interested in and really curious about. You talked about the feeling of having made a mistake and needing like somebody to talk to or I forget what your exact phrase was, like, you know, a shoulder to cry on or whatever it is after you feel like, ah, I just really messed up in there. I don't know if I've ever heard two therapists talk to each other about that feeling of like messing up with a client in that kind of a way and having it be a really emotionally meaningful experience for them and processing around it or thinking about it relating to it. I mean, I just think that for people who go to therapy, it could be kind of meaningful to hear for starters that their therapist care that much to be impacted in that way. And yeah, I don't know if that's something that you want to want to talk about or share about or you guys could kind of explore together. But I just thought it was a really interesting thing to say. I can say that in training, we really encourage it. We have like students at all levels of training that come through our hospital system. I will tell them in the beginning of the year, if you like try to impress me with all the amazing work you're doing, then I'm going to want to knock you down a few levels. But if you come in and tell me about what you're struggling with, then it's going to make me want to root for you more. And so I encourage them to actually talk about their growth edges, I guess. And then when we start supervision, especially in a group format, we will, I'll say, okay, what are the highlights or heartaches for this week? And we'll start, we'll figure out what moments or clients need our attention from what pulled us emotionally, whether to celebrate or to feel bad. That's where all the learning, that's where all the work is. That's where the ruptures are happening. That's where the trauma is showing up. Yeah, I'm a bit of an anarchist. I feel like I strive for the mistake. Like the way I think about it is I'm in my associate ship. I work under my supervisor. I'm the safest I will ever be right now. So why not swing big and try to make as many mistakes as possible? And what I have found is that when I just accept that, like, I'm going to make all of these mistakes and how exciting that I get to make a mistake is that's when the work gets really alive in the room, even with the client. And then, you know, inside of myself, it gives me a moment to even notice what is important that I look at inside of myself when it's like, oh, I made a mistake. Like, oh, what's happening here? And then how do I show up? Because I think for some people, at least people who I work with, there's not that much experience of somebody owning the mistake of saying, oh, yeah, that was me, my bad. Like, how do I understand you better and understand how to be with you better? Yeah, those are beautiful moments because the repair feels so good. It makes me think about how the opposite experience when someone's demanding an apology. And there have been times when I will say, I honestly can't give you one. It doesn't feel right to me to give you one. It feels like I'm colluding with something. And then I will say, no, I could be wrong because I could be so defensive right now that I'm intellectualizing and going clinical on you. Or it could be that there's really something here that we should be looking at. And so in my book, I've been playing with this visual of like, therapy is like playing a card game or poker. But at every turn, we just lay all our cards down on the table and try to figure out what the best move is. And the goal isn't to win, it's to just keep the game going for as long as possible. Yeah. You said something that I'm, I was like, oh, and now I'm having a hard time remembering it. Oh, this is funny. This is why I'm forgetting it. So what you just named is right at my clinical edge at the moment is when the client's demanding an apology. And I'm like, oh, and I tend to dissociate because that's also a very tricky place for me with my own trauma. So when I'm being confronted, younger therapist, Elizabeth would just be like, oh, yeah, I'm so bad. Yeah, I fall on the sword. Like, yeah, I'm, I'm, you pissed apologies. That was my fault. And now I'm, I'm noticing I'm at the like shaky edge of I don't really want to give you an apology, which is spooky to say. And then why do I not want to give the apology? And then I, I still get pretty fuzzy. Like I can get pretty dissociated even just holding it. And yeah, like, I'm always, we might like, we play with powerful forces in this space. Yeah, it's happening. Like, it's so cool as I talk about it. My going away part starts to show up and I'm like, who? I think we're at the heart of working with CPTSD right now. It always gets hairy. The trauma always comes into the room. Yeah. And no amount of training, no manual will ever teach you what to do in this moment. And it really is as simple as helping some helping the therapist stay where you are, like the way that you are doing right now, not dissociating and just trying to feel as much as you can. And then figuring out a way to name what's inside of you, or what's inside of them, or what's happening between the two of you in a way that's heartfelt, a little heartachey, and still fighting for the connection to persist instead of like disappearing on each other. And that's really hard to do. Yeah, you're, you're naming my stuff very accurately, which is my clinical edge at the moment is to be able to lean in and confront that really uncomfortable moment of like, I hear you demanding something from me and I, there's a part of me wants to slow down so that we really pay attention to why this demand is showing up. But yet for me, the past infiltrates the present for me because when I used to do that as a child, like confront, it meant disconnect. So this is why this is such like the edge for me clinically. And I'm, I'm kind of in this, like I have to dig my way through all of this sort of jello to kind of get, get to the other person. Right. And then in your own, in your own self, the next steps would be two possible paths. One would be to do the inner child work with the timid, the scared girl who still has this desire to stand up for herself. And even the work confront is very interesting. But I don't want to get too linguistic about this. But the flavor of it is still, there's aggression or fear of conflict in it. The other path after you help reintegrate her, it's, it's this, the difference between fighting against versus fighting for. And when you have this strong parental maternal sense of like, no, we're going to do this because I'm not willing to lose you. So you're going to, we're going to have a hard conversation right now. So it's not confronting. It's like, it really is like advocating, championing for something that you really care about. And you can't force that reframe. Yeah. I think if every one of us has to do both at the same time or whichever one needs more attention, maybe you can just snap into, no, you, this, this matters. We're not going to let trauma interfere with our connection right now. Or if it's here, we're going to, you know, look at it, but it's not going to take over. That's like a firm limit setting that if you work with kids, families or couples, you learn to do more because they're, they come in and they want you to be strong enough to maintain safety for them. Yeah. I find that I know what you're talking about because with couples, I can do it with couples. This does not really show up as much as it's interesting, but it shows up more individually because the like attention or the focus is like all on me. You are the couple. I am the couple. Yes. And then it's like, ooh. And so, but I know what you mean about like the being within the kind of in pursuit of maintaining the connection and like I'm not going to let either of us run away from this moment. Like, no, let's, let's go for it. Let's, I'm gonna hang on to you and you hang on to me. Yeah. I think this is a nice moment where we can like bring in the general, the clients who are listening in, in these moments when someone might feel the need for an apology. Then what I tell my clients is that we're not trying to say it's either or that it's your stuff or what's really happening. Like I really made a mistake or it's your stuff coming up. But I feel like there has to be a sequence of actions taken. First, we have to inquire about whether your stuff is activated and we have to do the work to kind of mend or hold that stuff. And it takes some of the edge off of what's happening in the moment. And then we can do the repair that still needs to be done in the present moment, but it'll be done with more grace or clarity or compassion towards each other. Otherwise, you're just on a war path to try to right wrongs that you've experienced your whole life. And even an apology now won't necessarily satisfy the depth of that hurt that's been activated. It's really hard. It's hard. It's hard for people, especially when they're so used to fighting for their lives, fighting for a voice. And so it can take, I have people where it takes a year of fighting until they're like, wait a minute, are you, is this one of those moments when you're saying that maybe it's not just something that just happened between us? Like it could be so hard. And it feels like reality is taking off from underneath their feet. Like they can't trust anything they see anymore. It makes them feel more unsettled and unsafe. Because they don't know where the enemy is anymore. We'll be back to the show in just a minute, but first a word from our sponsors. It's easy for life to feel like a big puzzle with a bunch of pieces that don't quite fit. You've got your relationships, your job, your finances, and hopefully enough time to have some fun and explore your passions along the way. It is a lot already. And finding great healthcare shouldn't be another piece that you're just struggling to jam into place. That's where our sponsor ZockDock comes in. ZockDock is a free app and website that helps you find and book high quality in network doctors so you can find somebody you love. Whether you're looking for dermatology, dentistry, primary care, or urgent care, you can find in network appointments with more than 150,000 providers across all 50 states. When you're ready, you can see their real time availability and click to book instantly. And while you're on ZockDock, you can view thousands of verified patient reviews. I think those reviews are one of the best parts of the site. Stop putting off those doctor's appointments and go to ZockDock.com slash being well to find an instantly book a doctor you love today. That's Z-O-C-D-O-C dot com slash being well ZockDock.com slash being well. Thanks ZockDock for sponsoring this message. Now, back to the show. I'm really lucky because some people I'm working with have been for three or four years. So our relationship, the clinical relationship is really strong. And there is this really wild, chaotic space when they come in in that moment of I don't know what up is down, I feel so unsafe, there's something I need to communicate with you. And there's enough of their own awareness to even kind of be where I'm at a little bit at the moment of like, oh, I can feel my stuff and yet I feel the stuff I need to do. And sometimes I've been in the moment with people I work with where we both get to own, yeah, this is really scary. And I'm okay with it being scary. I'm still here. I'm not going to jump out of this. So we're both scared. Now what? I think you've already reached the end. Because it's no longer you versus me anymore. It's like we're both like feeling overwhelmed. And then there's nothing to do but to grieve at that point, to feel the heartache of that moment. That's what I'm always afraid to actually name when people ask me about the work is the grieving part. Like, I cry with my clients and they cry with me. And it's funny, there's a part of me that's wanting to show up to be like, but I don't put my stuff on them. But no, there's, there's, there've been moments where I feel I'm really seeing the other person. And the only way that happens is when they really see me in return. Like, there's an opening that happens. So as much as I'm seeing them, they're also seeing me. And at times we grieve for each other. There were two different threads there. The first one, when you said that little guilty critical part that says that you're putting your stuff on, patients, clients, and then the co-experience of humanity, shared humanity. Which way do you want to go? Let's go into the guilty part. Let's go where I'm having the hardest time staying present. That's perfect. Because that's always the first guardian at the gate. Yeah. In the hardest one to pass. My first gut reaction was a little railing against anger about the way that supervision and training happens. Because it's very fear mongering. It's all about like, it almost feels like policing. And it, it makes you so tight. And as a trainee, I was, I was so distracted by the image or the sense of my supervisor watching over my shoulder. I, most of my mistakes, and I made a lot of mistakes as a, earlier in my training was because I was trying to impress my supervisor who wasn't even in the room. And supervisions would be about talking about what happened the week before. And then they would give some suggestions about how to look, how to think about it. And then I would be so eager to implement those the next week. But it's like that river's already passed. Like there's no way it would be an artificial misattuned intervention. One of my trainees said that one of their supervisors had told them this incredible thing that I have now taken for myself, which is that in supervision with me, what I encourage the trainee to do is to follow their instincts. And then supervision is for trying to make sense of why that was the right move. To really trust that your body's much wiser than everything you've learned in grad school. And then to just, you're just honing your instrument. That's all. And making it more therapeutic. So even this co-experience of grief, there are ways that I've done it where I did have, I would share my stuff. But then as I got better at it, I would say, you have no idea how much I relate to this. And then I would just leave it at that. And I would be acknowledging that it's here, but I wouldn't necessarily have to say it. Yeah, that moment of crying, in them, I'm thinking about what that's like for me. And I so want them to see it. But not in an artificial way, but in a way of enhancing the safety of the moment, because it's so vulnerable. It's also really interesting because people will get uncomfortable. They might, some of them will say like, they'll feel like taking care of you, or they'll feel that, so they'll try to take care of you, or they will feel it and want to resist it and say like, enough, like whatever. And that becomes interesting material too. But then with other people, they're so grateful for that form of witnessing. And you really do have to be tracking whether or not, well, no, it's not whether or not. It's both when your stuff comes up and you hold your inner child in your arms as you're gazing upon your patient or your client. And so it's just adding more and more layers of complexity to your experience and more ability to hold layers of complexity in your experience. Also, along with crying, the other thing that I've added to my repertoire of shared humanity is literally dry heaving, like literally throwing up in the sessions when we're going over incredibly difficult gnarly abuse stories that are like beyond the pale of what anyone should ever experience. And it will make you nauseated. And this woman, one of the first times I did it, she's like, oh my God, thank you so much. And I'm like, like, wiping my mouth. Yes, it was like that, right? It was gross, right? What happened? Yeah, what I can add to that is I'm having a moment of feeling pretty grateful for my own supervisor, because I don't feel like I have to impress her. I feel like I come in raw and bleeding, and I'm like, here's all my that's coming in, and I did this and, and maybe I can name something pretty vulnerable for me, which is I feel like my training and my supervisor really encourages me to return to my gut feeling, to kind of trust what I'm doing. And the guilty part or the parts that can be like, are a part of my own way that I have protected my own self. So it takes me actually a great deal of effort to allow somebody else to really see me and to allow my authentic emotional expression to come out. So at times I feel like I am digging through something to really be able to meet in that moment. And for me, sometimes there are two processes happening at the same time. I am holding the agony of my client, and then I am holding my own agony in, in how to remain relational and remain connected. I still have those moments too, especially when hard things are happening in my life. So it never goes away. It's not just because you have a history of it. It's just because you're going to have hard times in life to do. And you do get better at it. It's so, it's so anxiety-provoking to be in the beginning of this because it's so harrowing, like complex traumas. It means that the relationship is going to be super messy and either explosive or full of ruptures and withdrawals and difficulty getting them to engage with you. And people are always impressed that this is the kind of work we like to do. I don't want to console you about this. There is a pull, like a natural pull, to be like, oh, you'll be fine. You'll be okay or whatever. But I like how you're holding it now. There is a, there's the right level of tenderness towards the process that you're in, it feels like. So the, like the seeds have been planted in the right soil and there's just patience to let that grow. That feels right. There's no need to rush this. How's that as a response? It feels good because that's something my supervisor says is we're just planting seeds, like we're planting seeds right now. And I don't feel there really is something to be soothed. I've entered this seed as becoming a therapist almost exactly at the same time I started to do my own trauma work. So it has been a consistent parallel process for me. So my own inner work is a part of the work. And even though at times I'm confronted with things where I go, holy, this is, I get excited about it because I've had the experience of as soon as I learn to hold myself better and with more accuracy and attunement, the better I can do that with somebody else. And I get excited because it's like, oh my God, like another entire like world has opened up. What's in here? So I'm driven more by the curiosity of it rather than the discomfort of being in it, if that makes any sense. You're lucky to already have that attitude. And like I didn't get that way until much later, I don't think. And even with that attitude, like I get the, I don't know if I can swear here. I get the s*** out of me on a regular basis. And it happens in waves. It happens in like three month cycles. And right now I'm in a consolidation cycle where the last year was brutal, but I learned so much from it. So I do, I try to welcome the growth that's about to happen, but it still is devastating. It's so hard. It's so hard to feel like you, you failed, you've hurt someone, you disappointed someone. Like you think it's bad being a new therapist, try being a known therapist where people come and expect like something better than average and then you mess up or you disappoint and like it's a longer fall. But then I learned that it just burns off more stuff. You know, like whenever I, at some point, whatever notoriety I was getting made my ego way too big and it was, it really messed up my practice. And then letting that hurt or letting those mistakes purify me made me so much better. And I was so grateful to have had that chance to burn off more egoic stuff. But it's still like, you know, 9000 degrees, 9000 degree crucible. It's like the best way to look at it. It's a crucible, you know, that tempering of steel to purify it. And I do wish that I had a support system around me where we could all just commiserate about how hard the work is. I didn't. But I'm mindful of you, Forest. I feel like we've been locked in. I mean, there's so much here. For starters, this has been totally great for me. And to be just a fly on the wall for you guys to talk about this. And I think it's been, certainly for me, just fascinating to hear. What's standing out to me as you're talking is just what you said when we first started this, Jacob, how attentively, how closely you're listening to what's happening in the moment with the person in front of you. And how that's really, I don't quite know the right way to put it, but I guess like the focus of the work. Because most of the time when you, particularly when you read, and this might get a little too abstract here, but when you read about therapy, or you read about therapeutic approaches like, you know, act, CBT, IFS, whatever somebody's doing in the room, there's a lot of talk about the therapeutic relationship and how important it is. But the way it's often framed is the therapeutic relationship is what lets you get the treatment in. And the treatment is the CBT or the act or the IFS or the whatever. And the relationship is the container that lets you deliver that treatment. That's like the structure of it. That's not how you guys are presenting the work that you're doing. You're presenting it as like the relationship is the treatment, for lack of a better way of putting it. How you're talking about the repair moment and the moment where you fall apart with your client, and they see you cry or you dry-heave in front of them or whatever it is that you're doing. And it's because you're just kind of there with them to some extent as they're going through it. And we were doing that, you know, around a campfire 10,000 years ago or whatever. So there's just something in that that's really standing out to me in how you guys are talking about this. And I don't know if I have access to like quite the right language to describe it, but it seems so distinctly different from the way when I talk to an expert and one of those other modalities, that they kind of talk about the technique of the work. One framework I have is that all those manualized ideas are actually deeply embedded in what we're doing. And I probably could pull out the threads of the techniques that are in the moment to moment material. But I also think that it's important to think about making a manual. Like who makes a manual? What's the process of making a manual? One, you're usually like someone who's been doing the work for a long time. Well, there's a couple of ways. And so the first way is from doing the work for a long time. And you're like, oh my god, I've learned so much. And I want to be able to share it with the next generation. And here, what are the things that I see that I'm doing that I haven't been able to put words to, like Elizabeth was saying. But then once you do that, then it becomes dogma and it's stiff. It's not built into the bones of your work. You're learning it from the outside. And you're trying to give someone a shortcut to practicing the right skills. But it should be, I think that it has to be in the interactions, although more behavioral therapies try to avoid the relational part and just give the knowledge. And I really do feel mixed about that. Because I can see the merits of that for some people, the more dogmatic, didactic forms of therapy. And then the other ways that I've seen people make manuals is the industrial commodification way where they've been trained in a bunch of things. And they're like, oh, I like this from this and this from that. And then let's just rearrange it and repackage it and call it something else. And that is also valid. I feel like even in my work, I carry of like five or six different schools of therapy that I really like and that fit my personality. And I feel like it's the therapist's job to be upfront about how they work and how they like to practice so that they can draw in the right kind of clients and patients who fit how they want to heal to or grow. And if I think about who's listening, it does make me want to answer this other question, which is that a lot of people reach out and say, hey, where do I find either someone who works like you? And what exactly do you do again? Or they ask like, I'm looking for someone who does EMDR plus a little IFS and a little somatic work. Do you know anyone or as if that's going to be the answer? And so in a way, I do want the world to stop doing that. And at the same time, it still is useful, but it's not the real thing. But then I don't know what the real answer is. And if I don't know if we talked about MMA and UFC before. I don't think so. Last time, I don't think we used it as a metaphor. It might have crept in there. But I do that. Yeah, go ahead. Totally. In the early days of the UFC, it was always like, you know, fighter one who's like studies jujitsu versus fighter two who studies judo and let's see which style is going to win. And then like maybe the UFC 50 plus, I don't remember when they stopped doing that because everyone was, you know, a little tie boxing, a little striking, a little grappling, a little wrestling. And then it just keeps growing. It just keeps morphing. Like it's such an alive thing. And everyone gets to witness it. I wish that therapy had that forum for practice. I mean, we have it individually, but then we can't share what we're learning. And that's the hard part. The other lesson I learned from that is that once you get to a black belt, that just means you're qualified to compete or not even some guys were like purple belts, but it just gives you the quote, it gives you like a ticket into the ring, but it doesn't mean that you're going to be that good at it. And so like, just because someone's been certified or trained in a certain way, doesn't mean that they're good at it. So stop privileging the model and work with the person that's in front of you. That's why you have to just go try them out and see if they're good enough for you. They don't have to be the best. They just have to be the right person for you at that stage of your growth. And it's okay to outgrow them and move on to something else. And I have plenty of patients who come and they will see me and they'll add a EMDR person or a somatic person or hypnotherapist or do all kinds of other stuff on top of what they're doing with me. I totally agree. And the way that I can talk about this is through metaphor, I think. Being a therapist, I view it as you're a painter. And why would you limit the amount of colors you have on your palette? Like CBT is a color, IFS is a color, like there's all these different mediums you can, you have access to. But the art of therapy is the style of the painting that you create. And people can make copies of Van Gogh and all of that, but they're not enjoying the process of creating that painting. The only way you can move the brush in just that way. And I find it almost impossible when people reach out to me over email and go, who works like you? And I'm like, I have no idea. For one, I'm still figuring out what my style is. I'm just throwing stuff at the wall. I'm figuring out how I work. Yeah. I don't know. It changes every three to six months. So it feels very challenging, that question. And also the image changes depending on who I'm with. The style is slightly different. Some people I work with, we barely do any somatic work at all. Other people I work with, that's the whole thing. And I think with trauma, what I've learned is you have to stay flexible. Like you have to remain open and willing to learn a different medium or a different style. Because then you practice being unlimited. And what I've experienced in tiny, tiny amounts is if I get too committed to, I'm a somatic therapist, whatever that means, I don't know. Now, I can't see as much of the other person because I'm trying to put it all through this, that one tiny frame. But if I let that go and I'm like, well, there's all these other frames that you could also apply to this. And then the technique kind of disappears. And if I go back, I can do a session and then I could tell you all the kind of, this is here, this is what I did here and blah, blah, blah. But in the room, it's not, I'm not thinking about it. It's not, the technique isn't present. And what you said reminds me of how like nowadays I've become so either reductionistic or essentializing that I feel like all my work is just about helping people not be tight. Because even asking, do you do like what kind of work do you do? Like what's the technique? That's a tight question. And if you can just become supple and open, then the next bit of your own work is right there in front of us. It's always the next step that needs to be taken. And it's really pretty simple. And then it's not about the framework. It's about like, okay, how do I know how to help you to take this next step? And it's often about like, it's often just about like, can I breathe? Breathe? Can I allow, accept, tremble, cry, see my whole self? And then people get overwhelmed and tight and they're like, okay, now what do I do? Because this is too much like, how do I like come back from this? How do I, what do I do? What's my homework? How do I recover? And then again, okay, breathe, relax, ask your body what it wants next. And it'll say ice cream or chips or a bath. And you're like, good, it's not rocket science. It's really just about constriction, which makes us want answers and clear solutions and then supple, surrender to, I don't know, process the universe, whatever your inner intelligence is telling you is, is to happen next. Back to the show after a quick break. Now back to the show. I'm, I'm going to ask a what helps question, which, you know, the last time we did this, Dr. Got me into a lot of trouble. So I'm ready. I've been answering it, I promise. No, no, no, it's totally great. I'm not trying to create like a universal theory of anything here. But I think that what you were saying there about that feeling of like openness and relaxation is, is such a cool way in to so many of the little things that I feel like you guys have been talking about. If you think about going all the way back to when you were talking about like an asking for an apology, or like a really pointed request from somebody, or when Elizabeth was talking about, okay, we had this repair moment. And early on, I felt like my only option was to just go belly up or to not repair at all to be like, you know, screw you. Like those are the two choices. It's very like black and white thinking in that way. Or last time, years ago, when we talked about this, we talked a lot about cognizing and the problems with abstraction and those kinds of like very technical top downy models. I think all of those things have a bit of a shared feeling of like kind of tightness or contraction or forward pointedness, you know, that feeling of like really sitting forward in the chair as opposed to kind of sitting back in the chair. And so maybe that's, I don't know, I'm not trying to like explain to you guys what you do. I'm really more asking here. Maybe that's kind of part of what you're looking for is just that, how do we increasingly sit in a way where you feel kind of more open and more flexible. And maybe there's a little bit more of like a don't know mind kind of associated with it. I'm sort of feeling that too in it. And maybe that's actually sort of the, I don't know, target's not quite the right word. But what you're looking for, what you're trying to get to? I think that's all it is. Now, as soon as I say that with conviction, then the counterpoint that I always come up with is not everyone's ready for that. And people are at an earlier stage where they do need training wheels. They need the how to's and the structure. And I don't know whether that's true, actually. And then I was going to say that then usually I suggest they go somewhere else with to find someone who likes giving tips and skills. But then I think about my patients who, who keep arguing with me, because I will say, no, I'm not going to tell you what to do. And then they will say, no, you need to tell me, I really need to know what you think. And then they do it in such a sweet way, like, like some people will say, like, my mind just needs something concrete, which is such a loving, self-aware way to ask for a need to be met. Then I know that it's the right thing. And then I say, okay, let me break it down for you. This is what you're doing. This is what you're missing about, what you're seeing. And I think this is what you should be doing with your life. Or this is the decision I think you should make. And then they're like, thank you. And then they're like, I disagree with you, but then they still want to make their own decisions. So it doesn't hurt to give the advice, because it just becomes part of the fodder of the process for them. So you don't have to, we as therapists don't have to be afraid of even going in that route. You just have to be open to whether or not it's landing for them or whether they're like, now please stop giving me advice or tell me what to do. Yeah, I know what you mean. There's always the moment where they're like, well, just tell me, Greg, or how do I fix the fixing part rolls in? Okay, what am I supposed to do with it? And I really make it difficult, I think, for them to get a straight answer from me. It has to be said to me in a specific way for me to go, oh, okay, I'll say it. But I always preface with, but you're probably not going to remember this next time when we meet. And then I say it. And then they're like, oh, and it just passes by. Yeah, it's a very rich moment. And the more we slow down and really understand where it's coming from for them, it's so beautiful sometimes. Like sometimes it becomes, I didn't ever have parents who cared enough to know what was going on in my life and give me advice. And other times it is just, I'm so anxious, I can't even think straight. Or it's like, I just need to feel like someone's with me in this process. And then to try it and say, okay, what was that like? I just gave you the advice you asked for it. Was that, did it feel good? And I will say, did that feel right to me too? And then we fold it into the way we work. How do you guys feel about answering a question from a listener? Oh, wow, cool. Yeah. So I think that this could actually be a good way in here. We've talked a lot about the practice of therapy. And I think that there are things in here that hopefully are helpful for people in terms of thinking about their own process with whatever it is that they're dealing with. But also what you guys mentioned is that it can be difficult to sometimes talk about things because you want to protect your clients and you don't want to get too specific about any individual case. So sometimes the question is kind of helpful for this because it gives you something to just explore together. And I'm really curious to hear you guys do that. So here's the question. I'm 50 years old. And I'm still trying to figure out how to let go of some old stuff. I'm also reaching the period in my life where you just start losing everybody. I'm afraid to open myself up because I've been hurt in the past. And I know that more grief is to come in the future. I try telling my therapist to just brainwash me. They think I'm kidding, but I'm kind of not. I want to dump my garbage and be less empathic actually and less sensitive. And it sounds like a joke even as I'm writing it. But I don't feel like these are traits that are serving me. So my question is how can I brainwash myself? The feeling of that question is sweet and adorable. It's not a real question. It's a very complex question actually because I don't think they mean it literally. They know there's a little self-effacing facetiousness in it. But there's still this real poignant yearning to be free of all the suffering that they can't be free of. So I want that person to sit in the felt sense of asking that question first for as long as they can tolerate. And oh, I know what's going to happen next. There's going to be a pull towards grieving more, but then the desire to be done with it. They're going to be right back in that dilemma. I've suffered enough and it doesn't seem to end. I'm tired of suffering. And you stay there and you stay there. And at some point, clarity does come. At some point, if the fatigue is the true self, then the body will just say, I really need a break. And it'll be said with such poignancy that there's nothing to do but say, well, let's go. Let's go to King Spa together. I don't know if you guys have a King Spa out there. I don't think we do out here. But I've never been either. But it's this outrageously enormous building of Korean spa. It's like a Disneyland spa treatment or something. I don't know. I'm thinking about going. And as the break, the need for rest is acknowledged, then the need for grieving can also percolate. And they take turns. And then in each moment, you just have to know which one is more alive and then see whether you're willing to do the thing that's most alive with as much love as you can. And either way is great when a person says that they've been hurting for so long, and it doesn't seem to end. To me, I don't believe that. That feels like what the mind says when it's trying to convince the body to be done with this process. And it also signifies that the pain is feeling overwhelming. But it could be overwhelming because they're clenching too tightly as it's happening. And if they just were to relax into it, that it would pass through them faster. So that's the complexity of the moment that I'd be thinking about. And I wouldn't know how it would land. But I'm ready to see it move one way or the other. And then feel whether or not it feels right and resonant with the person's true self. And I would just ask them to stay there as long as we can until their body knows which way to go. Did that make any sense? I think so. That piece in particular about I want to be less empathic and sensitive. And that's something, Elizabeth, that I feel like I've heard you mention occasionally, both in your own life and also in work with clients, like the desire to feel less in that way. And I don't know if you have any feelings about that or if there's anything that that kind of wakes up for you. Yeah. But with that question, from my own experience, I think there's some pain that is so big. It takes two bodies to hold it. So there's a big grief that I'm hearing can't be grieved alone. And so my kind of thing is like, okay, how do we make the grief so enticing? Like, how do we make this space so fun and playful and interesting that you want to play with me in it? Like, you'll let me play with you with this grief, with this sensitivity, with this suffering until you play with it so long that you realize, oh, this isn't so bad. It hurts less, actually. And in that, you let me take some of it with you. And in there, we can get curious about the weight of being so sensitive and giving a space to talk about all the things you really feel that maybe you feel too silly or odd talking about. And so it's easier to be like, just hypnotize me and cut it off so I don't have to feel it. It's like, well, okay, well, I'm interested. What's the taboo and all of that that you don't want to actually like talk about? And in there, I find a lot of play. Like, I kind of, I think that's sort of what it's growing into me as my therapeutic superpower is I can always find the play in something absolutely terrible. In the middle of the experience of the grief, it is, there's no shortcut. There's no way around how brutal it is. And so there are some times when it's just flooding through and overwhelming, and you're right that it takes two bodies to hold. That's a beautiful phrase. And it reminds me of this other experience I had where I was porously processing someone else's grief and someone else held me as that was happening. And I was able to let it course through me. And then afterwards, I heard this voice in my head start to sing, you have to be held to behold, be held to behold over and over and again. And it made me appreciate that my needs have to be met to I to take care of myself as I'm taking care of others. Like, there's just this infinite layer of like holding and be holding that's happening between us all in this jewel net of Indra of idea to if I'm going to use a Buddhist idea. What was the other thing? Oh, the playfulness thing. The image that I often have is that there are some people who are just deathly afraid to go there. And I too am still afraid to touch some traumas in my life. And I brace and when I'm with patients who are kind of very ambivalent about entering that they the image that I often see is that we're in the in the entry entrance to a hedge maze. It's like the minotaur's maze. And for some reason, they start talking about how lovely the hedges are or like how square it's been cut or whatever. And sometimes I will say you're talking about the hedges again. If I feel like pressing kind of pushing them into the maze. And then other times, I will say it, but not to push, but to acknowledge that this is hard and this is enough, even standing here is enough. And we can either stay here or we can change topics. And you can feel if you are the other beautiful thing about co-miserating with people is that you can feel when they have had enough because you've had enough. And then you can go on to something light. And it's a it's like a little bit of a you're holding hands and winking at each other as you're moving there. Like decades ago, I had this girl who we would alternate sessions where one session would be hard conversation. And then the other session, she was like a teenage girl. We she would ask me, what do you think about this person? And then she would like Google bags. And then I would try to give her my best advice about handbags. And it was so sweet because I knew what she was doing and she knew what she was doing, but we didn't have to say it. And it was like, okay, yeah, we can do this. This feels regulating. And there was such agency and implied agency in the fact that she was like, okay, I got to ask you about this bag. And it can happen more quickly than, you know, alternating sessions, it can just happen in moments. And then I say, you know, you just change topics. And she's like, I know, leave me alone. I'll just like, I want to keep talking about this. And I'm like, okay, that's fine. It's sweet when it's so collaborative. I think that as we wander toward the end here, unfortunately, and you know, I feel like we could easily do this for another hour or two here. As something that I'm curious about, because we've mostly focused this on people who who do this work are kind of like peeling back the curtain on what you're thinking about, or exploring or feeling or relating to as you're there with another person who's doing something that's very difficult. And it's, to some extent, kind of the unexplored country in therapy, we've learned a lot more about these things over time. But it just feels more artistic to me when you guys talk about it, then when I hear people talk about therapy in general. And one of the things that I was really wondering about, and maybe it's a place where we could end today is how do you feel like you've been changed yourself by doing this? I think that the Buddhist were right that the whole like polishing the mirror metaphor. It's nothing but a destructive act of ego, destroying the ego. It's brutal becoming a good therapist is brutal. If you don't hide from the real work. But in that, what's left is presence, polished presence, aliveness, like really being able to mirror an experience that is so universal and so individual at the same time. What's changed for me, I feel like I've realized my purpose in life in a way that I fought for many years. Like if I think about how I left the monastery or chose not to go into the monastery because of my immigrant needs to be a doctor, I ended up still being a monastic by the end. The practice, I'm not on a mountain top, I'm just in an office. But it's easier for people to reach me than having to climb the mountain. It really does feel like like a meditation practice. Like it's like a not a sitting doing nothing meditation. It's like a walking and breathing and connecting while being nobody meditation or being everybody in it or and anybody meditation. It over trains my ear and not and my mouth is a little atrophied. So I'm not good with people outside of a therapy context. I imagine my homunculus and it's like this whole ear and heart. No cocktail, whatever part of the homunculus represents the cocktail version of myself is completely atrophied. I'm so grateful for it. We can't help but grow through the through the work. I was just imagining whoever's listening to this and I was in a moment praying that this conversation helped them in some way. I had a supervisor, one of my first supervisors, like give me this phrase, it's a reflection and it has stayed with me throughout my entire process so far, which is he told me he's like, you dance in the chaos of creation and I feel like this work has made me a much better dancer. I've become more liberated in my kind of excitement and play that can kind of come up. I find the maze and the minotaur to be the playful thing. I'm like, oh, how fun we're about to be destroyed and then what's going to happen? Because I've done it so many times that I'm like, oh, this is going to be great and they're going, what? And I'm like, oh, don't worry about it. So it's made me, I think, even inside of myself, even when things are absolutely terrifying and I'm in my own parts that can sometimes say something like, are you freaking kidding me? Another growth moment and to have a louder side of me go like, yeah, and how exciting life's about to get so much bigger. There's going to be so much more that you get to dance in. It's so cool. That would be the ideal supervision for you. You know, like someone who's just like, can't wait to see what dance move you pull out next. Or that's the spirit you should surround yourself with as you learn to grow. This has been really fantastic for me. I hope that you guys have also enjoyed it. I've loved listening to everything that you've been talking about and Dr. Helm has always said, really, you know, appreciate your time. Thanks for doing this with us. Thank you. I really do hope it's useful for your listeners. I try to forget about it as we're doing it because I want to just get lost in what's happening. I knew that you were watching over us too. So thank you for that. It's very sweet and I really appreciate that. I love today's conversation with Dr. Jacob Holm and Elizabeth. And to be honest, I really don't know how to recap this one. It's very difficult to look back over my experience of it and give you this really clearly defined narrative thread that pulls it all together with some nice takeaways for the future, particularly if you're somebody who is yourself working through some of the things that they talked about today. And there were some moments during the conversation that for me were really just deeply touching and very emotional. Like when Elizabeth was talking about that desire to have less sensitivity when she was talking about being a sensitive person and relating to that with a client. And it was just very touching. It was very affecting. And I think that that's most of what I'm going to take from this conversation is the feeling of it. Kind of like I said during that moment with Dr. Holm, how it feels like so many of the themes are tied together by this idea of creating openness and curiosity and less this or that thinking, you know, less I have to either go belly up when I repair with somebody, or I have to fight them about it and more ability to live in the middle. And it's funny how even as I'm doing this recap right now, I'm noticing myself like watching myself more and not wanting to generalize so much. I think that that's some of like Dr. Holm coming in and sort of floating over my shoulder as I'm recording this. But thematically, what you often see with people who've gone through these kinds of experiences is that there isn't so much of that hanging out in the healthy middle. There was more polarization inside of the family system, or they weren't allowed to express themselves at all. So repair was just only belly up. Elizabeth talked with me a lot about that in terms of her experiences when she was growing up. She only had one option, which was to just kind of submit. And I think people can really empathize with that. And it's hard to appreciate how difficult it is to gain a new relational move with another person, to gain the move of hanging out in protest for a little while, or saying to the clinician, no, I disagree with that, or expressing hurt and frustration related to something that happened in the room, something I was occurring to me during the conversation, and there wasn't quite the right moment to mention it, is that there are a lot of people who have never been able to say that to the person that they feel wronged them. And so just the opportunity to express that can be such a powerful moment in a person's life, and it can really help them reclaim the sense of, oh wait, I'm allowed to do that. And that's part of why that relational dynamic with the therapist is so important in trauma treatment. Because you're creating a space where somebody can risk this incredibly scary movement with another person. They can risk relationship, where for most people who have complex PTSD, relationship is how the hurt got in. And so it's this incredibly brave move on the client's part to open themselves up to that kind of vulnerability with a therapist. And as I hope that people really got and heard from Dr. Ham and Elizabeth, therapists really value that. They appreciate that. They understand the poignancy and the vulnerability and the responsibility of the seat that they're in. And it messes them up. I don't know another way to put it. I've had so many experiences with Elizabeth where she comes home after a day of working with people and she is so affected by the work that she's been doing. And that's real. And learning how to process the feeling of, wow, I really messed up in there. Or like, wow, I wish that it had gone differently with the client. And I hope that people listening to this really take that feeling of like common humanity. You know, your therapist is a person too, and they're thinking about all of this stuff too. And it's actually leaning into that relational space that often makes the work go go so much better and be so much richer and creates a lot of opportunities for people to really get a different experience. I hope you enjoyed the conversation. Something that Dr. Ham mentioned again, after we stopped recording to Elizabeth and me, is how he is trying to put together this training platform for clinicians. It's a little unclear the exact form that it'll take. He's still working on it. And he said something like it'll be about six months from when we post this episode, that that is going to be live. But as we learn more about it, we will pass it along to people who listen to the podcast. I know that that's something that a lot of clinicians would be interested in. And I think it's great that he's offering tools to give people more support who do this work. Also, I just want more like Dr. Ham content in the world. I wish there was more of his stuff that was out there, because he just has such a unique perspective and is such a unique person doing this work. If you've been listening to the podcast for a while and you would like a way to support us, hey, you can just subscribe, piece of cake. You can listen on Spotify or Apple, you can watch on YouTube, you can also subscribe on YouTube, that helps us out. Leave a comment on the podcast rating and a positive review. Hopefully we really appreciate it. And if you'd like to support us in another way, you can find us on Patreon. It's patreon.com slash being well podcast and for the cost of just a couple of dollars a month, you can receive some bonuses like transcripts of the episodes and add free versions. So until next time, thanks for listening and I'll talk to you soon.