179 Transcript

[00:00:00] Dr. Sharp: Hello, everyone. Welcome to The Testing Psychologist podcast, the podcast where we talk all about the business and practice of psychological and neuropsychological assessment. I’m your host, Dr. Jeremy Sharp, licensed psychologist, group practice owner, and private practice coach.

This episode is brought to you by PAR. The TSCC and TSCYC screening forms allow you to quickly screen children for symptoms of trauma. Both forms are now available through PARiConnect, PAR’s online assessment platform. You can learn more at parinc.com.

Hello, and welcome back to another episode, everybody.

Today is part two of the trauma-informed assessment with Dr. Julia Strait. If you did not catch part one last week, I would strongly encourage you to go back and listen to that episode first. We really set the stage last week for this episode. [00:01:00] Last time we talked through the basics of trauma, definitions of trauma, what we consider trauma. And like I said, really lay the groundwork for everything that we’re going to talk about in this episode.  So, if you haven’t listened to part one, I would strongly encourage you to go back and check that out before diving into this one. But this is part two of trauma-informed assessment.

I’ll tell you a little bit about Julia. I’m not going to do a full introduction because I did so in the last episode and it’s in the show notes as well. If you are curious, definitely go check those out. But Julia is a licensed psychologist, of course. She’s in private practice. She has a long history, extensive training in trauma-informed care. She’s done training across the country for schools and other [00:02:00] professionals on trauma-informed care. And you can tell that she is incredibly passionate about this topic. She is quite accomplished and has been doing this work for years and years. I’m so thrilled to have her back on the show here and talking through these important topics.

Today’s episode is really aimed at the assessment side of trauma-informed assessment. If you think of the two episodes, last week was the trauma-informed. What is trauma? Defining it, that sort of thing. And now we’re really digging into the assessment process. We talk about everything from the beginning. What does the intake look like? What does testing look like in terms of appropriate measures and a room set up and interacting with kids and parents where [00:03:00] trauma might be a factor. We talk about the feedback report and any number of other things related to trauma-informed assessment.

We do, of course, talk about separating trauma from other diagnoses or not. That’s a little teaser. And talk through how trauma comes into play for so many kids’ lives and how we consider that from a diagnostic perspective. This is another kind of action-packed episode. There’s so much information here and I think you’ll want to listen to this one a couple of times, or at least have a pen and paper handy to take some notes. There are extensive show notes for this episode and for the first part. So you can always go back and check out those resources as well.

Before I jump to the conversation with Julia, I would invite any beginner practice owners who are [00:04:00] launching a practice in 2021, or just launched perhaps in late 2020 to come and check out the beginner practice mastermind group. This is a group coaching experience that provides group accountability and coaching of course, and support to help make sure that you are launching your practice in a way that will work for your life instead of the other way around. You can get more information at testingpsychologists.com/beginner and schedule a pre-group call to see if it would be a good fit.

So without any further delay, let’s jump into this discussion on trauma-informed assessment with Dr. Julia Strait.

[00:05:00] Dr. Sharp: Thank you so much for talking through all of the background and sort of the definitions of trauma, but I would love to transition to the assessment process. So, you tell me, Julia, where do we start in this whole assessment process?

Dr. Julia: So, how I usually conceptualized the kind of nuts and bolts piece is what that stands for definition. So I mentioned the event, the experience, the effects. And I think there are ways to assess all of those things. So, I can go through that for you. But I think this is maybe a good place to put this before we start. You had asked me before about when the child or person, I’m talking about adults too, comes into the office or on Telehealth now, but you had asked me before, like, are there different things you would do or different ways to approach that person that’s more “trauma-informed or trauma-sensitive”? So [00:06:00] maybe this is a good place to talk about that when you meet the person and before you even jump into the nuts and bolts part.

Dr. Sharp: Yeah. I love that.

Dr. Julia: Okay. I think I joked with you before. I do a lot of yoga and I take some training on trauma-informed yoga. I got my psychologist judgy mind. I’m always in there like, oh no, no, that’s a little…, I just want to put out there first, there’s so much pseudoscience about this. So there’s so much. I was in a yoga thing the other day and the lady was saying when you teach yoga students you have to avoid saying any personal stories or anecdotes because you could be talking about your kid and then it could traumatize someone.

And I just thought that is a good example of what we were just talking about with the concept, right? I think that you’re treating people a little too, like they’re not going to break, right? Like, there’s this concept, kids are kids, and adults like anti-fragile. Like, we actually need some [00:07:00] stress, not that they need trauma, but like, it’s actually good too in therapy, like we would talk about the trauma. And not that you should do that every time, but I think that there’s a big fear of like, oh my God, this kid’s coming to my office. They have trauma. I have to tiptoe and I have to serve them sooner.

I don’t know, like, there’s this whole other thing because that buds were like trauma-sensitive, right, which I don’t remember. I do think it’s super important to be sensitive to things and to open your mind to like, oh I hadn’t thought about that before. So just to give an example, like in the yoga world, there’s this big controversy over being touched, right?

So like, do you touch someone when you’re trying to adjust them or whatever? And I think in therapy too, do you hug someone that’s had trauma? And I think that, again, just like the answer at the beginning where we talked about the philosophy of what is trauma and you know like, it totally depends. Obviously right now during COVID, it makes it a little easier to answer the physical touch question because we’re not going to do that. But I know a lot of people to say like, Oh, should I [00:08:00] maintain a distance? I don’t know that those things are as important as just the general approach that you take.

For example, of course, I want to make sure they know it’s a safe space, it’s welcoming.  But I think that I’m doing that more through my actions, in my words than letting incense or whatever. It’s definitely easier I think to make people feel at ease when you have a real genuine relationship or a genuine wish to help and they can see that rather than trying to be some bubbly, soft-hearted large necklace wearing therapy idol who… I’m like, I’m just coming to these stereotypes of like, we don’t all have to be that kind of person to be trauma-sensitive. And so I think whatever your personality is, that genuine relationship particularly kids like they are so used to being lied to and manipulated themselves. 00:09:00] My number one rule is always I’m super transparent, especially with my trauma kids, right?

Like, “Hey, did anyone tell you why you’re here today?” And you’d be surprised. Very often, they’re like, “No, I have no idea.” So talking to them about that, like, why are you here?  We want to help you. We want to figure out how to help you. And I’m sure everyone has their steel for that, but I think that’s super important because they’re sitting there. Like if you put yourself in their shoes, they’re just sitting there staring at this “professional” who in Memphis, kids used to say, we had this one kid who was like, we said, “What are you nervous about? Are you okay?” He wouldn’t come into the office and he said, “Hookies”. And he thought, because we were doctors, we’re going to give him a shot.

Dr. Sharp: Yeah.

Dr. Julia: So, like he had no idea or like some of the parents would think that we were part of DCS and we were going to take their kids away.

Dr. Sharp:  Sure.

Dr. Julia: They’ll just like clarify like, which depending on your setting but just clarify, hey, this is why you’re here today. This is our goal. And then I loved a couple of weeks or, well, probably a few months now, but like that therapeutic assessment series that you all [00:10:00] did. I actually went and got some training in that afterward because I thought it was such a great collaborative approach, but not that you have to do this full model with them, but like, involving them in the questions of the assessment, like, what do you want to know about yourself? Is there anything I can help you with?

I’ve had lots of kids who are very insightful, right? Like some of them will be like, well, I want to know my IQ. Like, okay, well I can answer that? Or like, I want to know why my mom’s crazy. Well, we talk about that later, but involving them in that process, like where is it going?

I give kids who I know have a trauma history, a lot more autonomy and choice in what we’re going to do and structure and routine. I might do this for a lot of kids, but especially, I just make sure to be on my game about like, Hey, I’m going to give you a poster that has the 10 things we’re going to do today. Like, to some extent, do you want to start on the iPad or do you want to start on the computer? Do you want to play with toys first? So that they feel like they’re in it. And then another way of doing that is with older kids, like I said, I’ve been incorporating more personality types of assessments because I think the [00:11:00] self-reports are so nice.

Like., hey, you have a voice, tell us what you think so that we’re not just sitting here saying, well, I think she’s depressed I think that… and so what I’ll usually do is actually give them like that voice through the report measure. But then, and this is getting into methods a little bit, but then later I follow up as suggested in therapeutic assessment with an extended inquiry of like, Hey, let’s talk about this report because very often it’ll come up with things like manipulative, whatever, and like, hey, what, what really actually makes sense for you? And can you explain some of these answers rather than just… sometimes like in the school setting, we were forced to work so quickly that there was no following up? It was just like, well, you put this on the basket. So you must be having hallucinations. I’m like, “Tons of people put that.”

Dr. Sharp: So many kids to answer that question.

Dr. Julia: Yeah and so many kids are like no, I just like saw my grandpa’s ghost or whatever it is.

So yeah, so we’ve, I do a lot more follow-up with them, a lot more qualitative information. I think that having them have more of a voice, [00:12:00] being transparent, being structured, like telling them when they’re going to get a break, saying if you need to use a bathroom like just sounds silly, but the more control I think they have the better. They’re probably so used to going to, well, maybe not quite, but a lot of them are used to going and just doing whatever their parents say or whatever. And even the adults too, like we all think about this like therapy settings, but that might be the first time I’ve ever interacted with a mental health professional or they might’ve had like some “little t trauma” from previous interactions with like residential settings or other settings where they’re expecting you to be like really negative and ask them to just go on and tell me about all your terrible things right now, kind of a longer runway. Maybe not the first day you meet them talking about all that, but a longer runway.

So all those things, I think that’s a little scattered, but those are the things I think about when I’m seeing one of those. All people of course, but like, just make sure to [00:13:00] be on my, A-game when I’m testing kids and young adults who have histories of trauma.

Dr. Sharp: Sure.

Dr. Julia: And comforting their parents. Sorry.

Dr. Sharp: Well actually, yeah, I’ll differ back to you. Did you say comforting their parents?

Dr. Julia: Yeah. Well, in private practice, we see a lot of adoptive parents or foster parents. And talkie again, it goes back to that shift of like are they manipulative or can we like shift the context and help you understand?

I think that the therapeutic assessment model has a lot of potential for those parents because of the family intervention. I haven’t fully implemented that yet. So I’ll let you know. I’m sure there are people who are doing it. In fact, I think there’s a clinic in California that does it. But yeah, talking to them about realistic expectations from the evaluation as well. Like we’re not going to be able to tell you, yes, her mom was crazy and did drugs when she was pregnant.

And so [00:14:00] I feel like the adoptive mom, and of course, like you consider they’re feeling really protective and they’re feeling like they want to save this kid. Like that’s often a dynamic that you see. And that is so laudable, but how can we also have perspective and talk to them about what’s realistic.

Well, that’s a realistic question to answer in the assessment. I’m like, am I really going to be able to say like, yeah, if his mom hadn’t done drugs, he would be 10 points higher. No, I can’t say that. So I don’t know, that’s really, really hard and I’ve still not figured out a great way to do it, but you just often get adoptive and foster parents who mean so well. And they just so feel so strongly about the bio parents or that they give a really, really negative view. And I don’t know. I also make sure I separate so that we’re not talking about that in front of the child because of course, that’s not good. You don’t want them listening to this tirade about their mom, right?

So that’s [00:15:00] just a sidebar, but yeah, parents often, or just parents in general who may be their kid like went through something and it is their biological child, but maybe they just found out that like their brother abused their daughter. We’d often get cases in Memphis where it was like fresh like this just happened.

Dr. Sharp: Wow.

Dr. Julia: And so just be a little more mindful of how we speak and how we act and how quickly we kind of move through our clinical process. Like checklists, we’ve got to get this done. That might be something that I’ve had to teach myself to slow down. I don’t have to get it all done right now.

I might have to call you back later. You might have to come back again. Like that’s okay. Because we’re getting really good information. We’re making you feel comfortable. And at the end of the day, it is going to be more efficient because if you’re making everybody feel more comfortable and open and you’re going to get better information and it’ll probably be easier to do the feedback than if you just decide on your own that you have this disorder and here’s what I’m going to push on you.

Dr. Sharp: Of [00:16:00] course. Is there anything to say about the timing of a trauma assessment since you brought up that idea of something being fresh or not? Does the timing make any difference in how you approach it?

Dr. Julia: Yeah, well, I think there are separate maybe questions like what is… more of a diagnostic question of like, how much is this impact? And of course, like there’s the timeline like one month, six months, whatever. But maybe an underlying issue or question is, okay, so maybe an ethical one like, I, for example, will not evaluate someone who has not finished their CPS investigation. So if something just happened and you are still in an ongoing investigation, I will not see that child for an assessment because I do not want to mess up what they’re telling the person. And I also don’t want to get called to court because I’m not a CPS investigator.

Dr. Sharp: Right.

Dr. Julia: So I think that’s like a huge thing. If you have kids that are… I often get calls from former students or student is in the schools and they’re like, well, I think this kid [00:17:00] was abused, but like, okay, well here’s the thing. You’re not a CPS investigator. So if you really have enough suspicion that you are concerned then you have to report that, right? But if you’re just digging and almost in a gossipy way, we’re not going to search. I’m not going to press. Most of the kids I’m talking about today that I assessed, there’s already a known history and everybody knows that, right?

Dr. Sharp: Yes.

Dr. Julia: I’m not going to go digging. And again, if it rises to the level where I actually do suspect abuse that hasn’t been reported, of course, I report that. I’m mandated to report. But I’m not going to go do some five-hour shot to try to get at some repressed memory that they don’t have. So I think that’s important too.

We’re not assessing “trauma” in the sense of we’re digging for something that happened.  We are saying, given that we already know something happened, what are the effects? That’s a really important distinction, I think is, I don’t know.

Dr. Sharp: Yeah, it is. [00:18:00] Yeah. Thank you for making that explicit. I wasn’t even thinking about that difference. No, but that’s an important distinction. Yeah. I mean, it’s not like we’re trying to dig in there like you said.

Dr. Julia: Yeah. Well, I think at first it’s almost really intriguing. I could figure out if that and especially with adults, like, Oh, is there something here? Well, I keep quoting this therapeutic assessment because I just want that training, but like if that’s not a door that they have opened, I’m not going to barge in there.

Dr. Sharp: Yeah. I love that model. Yeah. I did want to ask just a little as we were talking about the sort of approach and ways you might do assessment differently. Anything around just like physical proximity or the way you set up the room or doors being open or not just little things like that, is that different with you?

Dr. Julia: I try to think of [00:19:00] it, like all kids because they’re all squirrely, so it really is individual, but of course there are some principles. I always just go back to autonomy and choice. Like if I’m not sure, I ask them, Like do you prefer… I always tell them to pick a spot. That’s part of my thing.

Right now during COVID, we have these long six-foot tables and I’m always like, okay, there’s a cheer on either side. Which one do you want to sit in? But I do know there are people who don’t like to sleep on the side of the bed, that’s by the door, or don’t like to sit in the chair that’s backed up to the door.

And I think that can be true. But if in doubt I’ll ask them. And if it’s a small child, I guess I’ll just default to… you can see the door. In our clinic right now it’d be hard to have everyone’s door open, but we do have white noise machines and stuff if they’re really uncomfortable. And sometimes I’m really big about like, Hey, your mom’s right here. Let me show you the room she’s going to be in. She’s going to be [00:20:00] right here at any time you want you can go and talk to her. So yeah, the physical. It’s weird right now because of COVID because like I said, we default to six feet and a mask. So it’s a little easier.

Dr. Sharp: Yeah.

Dr. Julia:  Because it’s everybody.

Dr. Sharp: That is true.

Dr. Julia:  So I think that’s awesome to be mindful of all those levels, right? Like conversationally, physically your body language. I try to talk to them like a person and not like a clinician. I mean, I try not to be too doctory.

Dr. Sharp: Yeah, a little more informal. Certainly.

Dr. Julia: Yeah, we used to train… in Memphis we had a couple of interns that would come and they would wear these giant diamond rings and we’d be it’s up to you but the population you’re working with, you really got to think about do they trust you and think of all the people they’ve encountered that have really nice suits and high heels. Not that’s bad. You’re totally welcome to do it but just think about obviously the SES level and their comfort level with you. And if you’re with kids, like, I [00:21:00] wear like jeans I get on the floor, you know? I think it depends definitely or if I have like a super educated family just adopted I’ll put on my blazer that day or what, so the parents feel more comfortable. But it’s a case by case, I think that’s the take-home with trauma, especially. There’s no blanket recommendation. It’s just being very aware of all levels of communication.

Dr. Sharp: Yeah. Well, I think that’s important. We talked in our chat a little bit earlier just about being flexible and a lot of these cases. And I think that’s a good rule anytime when you’re working with kids or adults for that matter. But just being flexible and willing to adapt if you need to and reading the room and not coming in with sort of a rote approach.

Dr. Julia: Yeah. Like I said, I can’t have a standard. I mean, I have my go-to which we’ll get to that hopefully, people listening for like, come on, tell me the tests. [00:22:00] But it’s really hard to have a standard battery, right? Like it’s constantly evolving and we’re also just getting new research about this stuff all the time. So it’s hard to keep up with.

Dr. Sharp: Right. Well, let’s talk more nuts and bolts. I think people are probably interested in that. So just right from the beginning, are you interviewing the parents first or the kid first? Are they together or are they separate?

Dr. Julia: I didn’t even know this was a thing until, so when I was in academia for about four years before I went into private practice we were part of a clinical school combined doc program. And it was so interesting because we have an on-campus clinic where we serve the community. And I learned so much about like, this is how I was trained to do this. For example, in school, psych, we were always trying to interview the parents separately first, and then we would do the kid, but clinical, they’re like, oh no, we always see the family together so I think people have preferences.

When there’s a history of trauma, particularly if it’s a younger child, I definitely at least want to talk to the parent first to [00:23:00] see what is the trauma? What’s the deal? Of course, you can get records. I know when I worked in Memphis or in the schools, I think it’s really important to get a ton of records because you may not have the accessibility that I have more in private practice to actually talk to the parents. In a school it’s like, well, I don’t know. They’re not going to come up here during work hours. So maybe I need to get more records to support my stuff. But yeah, I’m usually interviewing the parent first right now on Telehealth. I know that you guys say all the time, you do two-hour interviews and I’m working like. I don’t know how to fit that into my schedule yet, but I usually have to break it up where I’m going to talk to the parent for about an hour. I might have to call you back at some point this week.

And I usually interview the kid in person if I can wait. Right now during COVID we basically do an interview on Telehealth. I have them fill out a ton of background stuff like forms. I tell them before we even talk, I want you to send me all your records. Like anything that you have. And so I try really hard to [00:24:00] have a really good idea before I even interviewed them. Like what the records say.

Dr. Sharp: Yeah. And what are you asking on those forms? Is it really digging into details around this family?

Dr. Julia: No, no, no. Usually, the… well, I guess I can’t say usually because it’s a case by case, but if the trauma is a big question it’ll be on their intake. Like we have SimplePractice, so we have people intake what…, and I’ve put in there the TA, what questions do you want to answer? And so trauma is a big piece of that usually, I’ll see that pop-up. Every now and then it’s slipped in. And we actually have one question on her intake that says, has your child ever experienced any trauma? We give a few examples, like abuse, neglect, shootings, violent incidents. And some people will leave at Blank, which is usually okay, I’m going to follow up on that. Or they’ll just write something really quick. Like sexually abused by grandpa, like, well, what?  And other people will write like three pages.

But [00:25:00] I do like to have that question in there just to see what I’m looking for because I shouldn’t say a lot of the cases that I see now, especially in private practice, like they’re not coming in for “trauma” right? Like it’s just like a by the way, also this happened. So yeah, we get some information.

There was a time in our clinic at the university where we were screening everyone for ACEs because, at some point that was the guidance, I think maybe five years ago. I stopped doing that because now there’s some information saying I don’t know if you’ve heard the mammograms, you’re over screening and you’re sending a lot of people through a lot of testing that they don’t need.

And so we were over screening and I think so we don’t do that anymore. I just asked very vaguely, is this a question? And then in the interview, I don’t start with that. Right. We go through the developmental history as we go through all the kind of normal stuff that you would ask anyway.

And then the trauma thing I leave for the middle-end if that makes sense. If they’ve already felt a little more comfortable with me. [00:26:00] If we haven’t gotten to it, but I think it’s important and I’ll say. Hey, would you come in? Would you mind if you and I talked a little bit before I tease Jimmy or whatever? Sometimes they’re more comfortable.

I’ve had adults lean over on Telehealth and be like, I don’t want to say right now because my parents are home, but I’ll talk to you when I get there. I also always tell like older kids and adults, Hey, I’m going to be interviewing today. Just so you know, confidentiality is different from an assessment.

I do write things down on the report. If there’s ever anything you’re talking about that you do not want me to write down, please tell me. And I was afraid to do that at first because I thought, well, what if there’s a really important, whatever. But actually, it hasn’t been a problem like people… Like, I had one girl recently who like, doesn’t mind about the actual trauma stuff.

She just didn’t want me to write down her opinions of how her mom handled it, which is fine. Right. Like that’s not that doesn’t need to be in there. Like she was really unhappy with her mom’s [00:27:00] view of it. And so I’m not going to put that in there, but should I just make them aware, like I’m writing this down and so they know.

Dr. Sharp: Yeah. Again, that full disclosure, just making sure that they know what to expect.

Dr. Julia: yeah, when I’m writing a report.  Can I imagine this girl who’s eight now reading it when she’s 18, is she going to be like, wait, what? So try to make it a little sensitive.

Dr. Sharp: That makes sense.

Dr. Julia: Like what you need to know about it. What’s it called? You need to know the basics. Yeah. Like if it’s not something that’s absolutely necessary, I try not to put too much Interpretation in there.

Dr. Sharp: Yeah, sure. I think that’s something that I personally forget and have to constantly remind myself that these kids are going to grow up and even though they’re seven now when they’re 18 or 20, they might look back.

Dr. Julia: Yeah, I know me too. I’m always like I’ve gone in and rewritten pull reports right [00:28:00] before feedback cause I’m like, Oh my God. Sometimes I just get that I wrote in my template, whatever I’m feeling super awesome about all the amazing things I’m saying. And then the next day, like, oh my God I don’t need to say all that.

I just need to say, this is why they need the criteria. And then I’ll talk to them verbally about some other things. I might have some side notes, but it’s hard to remember your audience when you’re sitting in front of a computer at 3:00 AM or whatever.

Dr. Sharp: Right. Yeah, I’m sure there’s nobody out there that can identify them. Right. So how about the battery? What does that look like?

Dr. Julia: This is something really exciting to me. So when I was in academia, one of my specialties was measurement, so I get really excited about the section.

Dr. Sharp: Oh, you’re one of those kinds of people?

Dr. Julia: Yeah, I know, right? So like I said, that was the alluring part of grad school was like, Oh, measurement.

I remember one of my first assignments, my advisor Scott Decker at USC was like they want us to update this IQ test called the WJ. And like, would you help us with the questions? And I was like, [00:29:00] wow you’re you want me to help you with like IQ test questions? So I always get a little excited. Isn’t that cool? It turns out I was just an RA, low level. It wasn’t as exciting as you think, but anyway, just to say this exciting and I’m also a collector of scales. So I like to recommend a bunch. But I’m going to break it down by the event, the experience, and the effect.

I usually start backward with effect because I always say, this is the stuff you’re collecting anyway, like the functional impairment, the stuff you get from the interviews. In schools, we were taught like RIOT- So record review, interview, observation, testing, not that that’s the order, but like you should be getting something from all those categories.

Within each of the Es’ the event, the exposure, the effect, try to get RIOT data for each of those things. So for effect, if I’m looking at records, right? [00:30:00] Like for a kid is the impact on their grades? Is their family fighting? Are there arguments at home? Socially, how are they doing with friends? And then interviews will tell you the same thing.

Observation, how are they with me? And then there’s testing, the stuff we already do, like IQ testing, achievement some of the personality tests, what are the… even I think comorbid stuff kind of goes in this thing too, like in the effect category because maybe they have depression, anxiety on top of some of the other things they’re dealing with. So that’s first because that’s what we already know. And I guess that doesn’t mean like chronologically first, but necessary. So it’s just something I think about first because I’m already collecting this data anyway. So there’s nothing different I’m doing for any of that really.

The two pieces that are pretty specific are the event and the experience. So I think of that as the event, being an exposure, that criteria A, what is this event? Tell me more about [00:31:00] it. And that like you said, it’s mostly like the interview. I as a rule as well in a setting I’m in now, when I was in a setting where we were contracted with DSP, I would go into more detail because we were privy to it because we had the DPS, whatever your state calls it, the department of children’s services.

We had those records, but now I don’t get any more detailed than I need to know you have experienced something that was really scary, right? And this was the general nature of it. This isn’t therapy. So I’m not going to make you sit here and process your entire trauma. I think that’s important, but there’s a couple of standardized ways you can get at that too.

Dr. Sharp: Yeah., can I ask a question about that that you might be ready to answer or about to answer? How do you balance that sort of general discussion of the event with sort of need to document it [00:32:00] in enough detail to either reach a diagnostic threshold or inform intervention?

Dr. Julia: Yeah, if it’s the parent or a collateral source, I honestly let them tell me as much as they would like. And if it’s very brief or they’re avoiding it… That’s actually rare than I would think when I started. But I try not to pry, but I will say at a bare minimum, I just need to know what happened with whom not the names, but was it someone related?

And the reason is that I’m guided by that research that says, which we haven’t gotten into, but these mediators, right? So if a child or a person experiences a potentially traumatic event, there are certain factors we know that will make it more or less likely that they are having PTSD symptoms. And some of those are like being a girl. Yes, be a girl already having an existing mental health condition, having household dysfunction. [00:33:00] There are some pretty specific ones for like physical abuse if it was chronic. And then for a sexual abuse trigger warning, but if there was penetration or someone they trusted and loved and knew that typically leads to worse outcomes.

Those are the things I’m trying to get at just to evaluate the risk level. How far do I need to go? And then definitely how old were they or when it started and stopped, just so I can see developmentally what the timeline is. I think the general things you look forward of it, onset duration, all that stuff.

But, yeah, that’s usually about as far as I go. I do not put other people’s names in the report. Again, I’m not the CPS person. I document Barey Hep so special when we were in Memphis, we learned document very heavily where I got each piece of information according to records, according to mom, because very often, let’s say like foster mom gives you a story that you’re not sure if you know, well, mom used to crack and have it. I’m not sure if that’s true. So I’ll just say, according to mom, [00:34:00] there was drug use during pregnancy. And then I just stopped. I’ve learned to like, just period. There’s like this inclination to like, explain that, but it’s just like, period. Okay. She said that I’m not arguing with it. That’s what she said.

Dr. Sharp: Yes.

Dr. Julia:  So, yeah, that’s about as far as I’ll go. And then we have some exposure measures, so there is a variety. I’m a big fan of using free things. There’s this great article and I forget the author, but it’s called free, brief, and validated. And it’s a big modern analysis of all these freely available measures for everything for youth and adults, for anxiety, depression, but trauma also. So I try to like pick from there as much as possible, not as much in private practice where you have resources, but my people in schools and forensics, or wherever else, it’s nice to have those. So there are some that are valid. 

The best two places to go to get measures in general for this stuff for adults is the PTSD [00:35:00] center site and they have all the different life events scale that talks about exposure and they also have symptom measures. For children, it’s NCTSN- the national child traumatic stress network. They have in-depth reviews of all the measures like how many items, is it appropriate for or do you have to pay for it? So those two. The ones I usually use with kids used to be the Northshore. It’s got a really long name. It’s like the Northshore New Jersey health systems… but it’s basically a big yes-no thing. And it’s worded like a checklist. Like you could just hand it to someone, but I use it as an interview. So I just say. Hey, a lot of times scary things happen to people. I’m going to ask you these questions.

And I’ll do this, even if I know, or the parent told me what the event is just because I want to see what the kid says. Because they’ll often be like, Oh, well, I was bit by a snake and they’ll report all these things. So at the end of exposure measures you want to… before we [00:36:00] go to the symptoms, you have to pick an index traumatic event.

So like, when you’re asking questions about symptoms like flashbacks, or you talked about being in the hospital, right? What is the index event? And for a lot of complex trauma, it’s like, I don’t know, my whole childhood. But it’s funny. They’ll usually say like the snake bite or whatever, because to them all the other stuff was normal because it was happening all the time, but that’s a long way to say you’re getting at the exposure even if you already know, just to see like what the person themselves feels is the most… because that’s the experience piece. How did they experience it? How did the people around them react? Which we know is a big predictor for kids. Like when your kid falls down and they wait to cry until they look at you and then they’re like, how is she seeing this? Oh, okay. Must not be a big deal. That’s huge like. Did people believe you when you first said it? Did you have to go downtown and do 50 investigation interviews? That can be really… So all those events are on this little form.

[00:37:00] So the North Shore and then there’s another, well, there’s a bunch that I’ll send to you, but there’s a bunch of exposure measures you can use. And some of them are connected to the symptom measures. The CPSS is another one, the child post-traumatic stress syndrome scale, and that one has the exposure and the symptoms and it’s free. I don’t know of any exposure ones that are actually standardized and paid for because I think that’s the more subjective piece.

So exposure, check, we got that. All right. We know you’ve been exposed to potentially traumatic events. You’ve met this criterion which we talked about, like philosophically in the report. I’m very brief. And I put it in the measure section. This person was administered this measure, they endorsed being bitten by the snake, blah, blah, blah. And I try to word it as clinically and being inexperienced for physical abuse from ages three to five from their father or whatever. And then I just leave it at that. Then the next section I say, because of this reporter exposure, [00:38:00] we did some symptom measures and there are also free ones that have kind of cut scores like the CPSS.

And it’ll give you an overall cut score for… and this is for PTSD, but it also is really nice to score qualitatively to see, even if they don’t meet criteria or whatever, I don’t meet the cutoff. It’ll have the categories, which I think is helpful. Like how many intrusion symptoms are they having? Like intrusive thoughts, reenactment through play, those kinds of things. How much arousal and hyper or hyporeactivity are they having? Cognitions and mood alteration all of the different symptoms, avoidance is the other one.

So it splits them up really nicely. You can talk about it in the report, and with the parents that these are the four categories that we think of as post-traumatic stress. And like your child is really showing a lot of avoidance, but maybe not some of the other ones. So although they don’t technically meet the criteria, they are showing some symptoms. And I usually word it by the way like PTS symptoms, rather than [00:39:00] PTSD symptoms, just a small wording change. But just to say I don’t know because I think when people see in the report, Oh, you’re looking at this disorder, then later, it’s harder to explain if your diagnosis on the page…

Dr. Sharp: Doesn’t make sense.

Dr. Julia: It’s more of a qualitative, like yes, you’re having these symptoms. And that might be just a remnant of when I was in the schools that we weren’t allowed to say PTSD. So symptom measures would get those four categories. I was laughing because I heard like the podcast is sponsored WPS, and I did not get money from them at all, but like we always have used their measures so that the trauma symptom checklist for young children, TSCYC is one of the only ones I know of that is a symptom measure for PTSD that also has norms. So the CPS doesn’t…

The other one I forgot to mention is the UCLA PTSD reaction index which is now I think a paid measure, but those are cutoff scores. And [00:40:00] they give good qualitative information, but to really get standardized scores that TSCYC is great. That’s the one that’s the apparent report I think like younger ages. And then I think 8 to 18 maybe can do to self-report version. There’s a little overlap. So that one’ gives you all four categories of PTS symptoms and also like an overall PTS score. But it also gives you a score for anxiety, depression, anger, and aggression, dissociation, and sexual concerns.

So it’s like all this extra nice stuff that you get. And you can actually say. Hey, we know that she didn’t meet the cutoff, but look compared to other kids she’s like having this 99th percentile of women’s symptoms. So that might be something to look at.

Dr. Sharp: Sure, sure.

Dr. Julia: But yeah, those are my favorites.

Dr. Sharp: Well then. And I’ll just mention that as an aside because they would kill me if I didn’t. Our podcast is sponsored by PAR and just to make that clear and [00:41:00] they do offer that TSCYC and the TSCC as people will hear in the ad rolls.

Dr. Julia: To think at some point in my life I wanted to work for a text publisher. They just might recruit.

Dr. Sharp: Well, maybe WPS will call you. I don’t know.

Dr. Julia: No, no, yeah. but it is good. Those measures are good. And they’re from the 90s. So they haven’t been rewarmed in a while I’m hoping they’ll update them soon, but it’s like all we have. And they’re good. They’re solid. Like I said, those are the only ones for kids that I know of that are normed.

Dr. Sharp: Let’s take a quick break to hear from our featured partner.

With children currently exposed to conditions, including a global pandemic, social injustice, natural disasters, and isolation, you need a trusted tool that can screen for symptoms of trauma quickly. The TSCC screening form allows you to quickly screen children ages 8 to 17 years for symptoms of trauma and determines a follow-up evaluation and treatment is warranted.

[00:42:00] The T S C Y C screening form does the same for children ages 3 to 12 years. Both forms are available in Spanish and support the trauma-informed care approach to treatment. These screening forms are now available through PARiConnect- PAR’s an online assessment platform which provides you with results even faster. Learn more at parinc.com/tscc_sf or parinc.com/tscyc_sf.

All right. Let’s get back to the podcast.

Dr. Julia: I know on the MMPI you can get a PTS score too. So that’s something that is newer to me because of the adult population. But you can definitely get some standardized scores to… again, I just think that’s helpful to explain to parents or to the adult themselves, whether or not you meet these criteria you are having these symptoms that are associated with that, and that can inform treatment, even [00:43:00] if you don’t have that diagnosis because that means you need to do some maybe processing of that trauma like in therapy even if you don’t have “classic PTSD”.

Dr. Sharp: Right, yes. I love that.

Dr. Julia: Those are the measures. I know I’m probably leaving a billion things out because that’s like a large part of what I train a lot of school people on what measures to use.

Dr. Sharp: Can I ask about the role of more cognitive measures or neuro-psych measures? Is there any utility in bringing those measures into a trauma assessment?

Dr. Julia: Yeah, I think they’re not diagnostic, which again, like my big fantasy in grad school was that. And I think my advisor says to we did a lot of EEG stuff and it’d be great if we could just put the EEG on you and then we could say, oh yeah, you definitely traumatized. I think there probably researchers out there who would say we’re going to get there. I don’t know philosophically if that’s possible.

Dr. Sharp: Well, in that I’m going to go down this rabbit hole because you [00:44:00] brought it up, but isn’t that the whole thing with QEG, Neurofeedback, Brain Mapping, all of that? I don’t think I’m overstepping to say that there are people out there who think they are doing brain mapping and saying, this is a trauma brain, right?

Dr. Julia: Yes, and I don’t want to…

Dr. Sharp: The question of whether it’s valid or not, is what…

Dr. Julia: Yeah, there’s a local one. I won’t name names, but there are like I said, I think in autism and in trauma, I think those fields or those topic areas, it’s like, people are so in need of help and so desperate. And like I said, they just want to help so bad, including parents. But that creates this vacuum where there’s a proliferation of junk. It’s almost like the barometric chamber of trauma. Because like autism, another thing that I do a lot. And so I spent a lot of time with that explaining the different evidence-based treatments and again, I do therapy.

I’m not one of these, it’s like you have to do every [00:45:00] protocol exactly right. But I do have a heart for these kids, especially maltreated kids. I’m going to get all emotional, but they deserve the best we have. I know that it’s hard because it’s hard to find people and everyone says they specialize in it, whatever sidebar philosophically, don’t all mental health people have to because in some way everything is true. But yeah, there are people…Okay. So I want to be careful because one of my best friends is a neuro-psych and she did her dissertation on neurofeedback, but for ADHD. So it was separate.

But for trauma, there are people here locally, there’s a large private Institute where they will take your $6,000 to train you on “brain mapping for trauma” And  I two years ago inquired about that trying to figure out for research like, “Is this something we can do?” [00:46:00] And through exchanges, very non-transparent exchanges with the people who really wanted to charge me a lot of money, I found out that the way they do their brain mapping is actually they just interview people and then they code the interview for what part of the brain I think that would go to. But really the thing that makes me very angry is that they present to parents a colorful brain map of all the symptoms and they never explain.

Dr. Sharp:  Oh yeah, I have seen those.

Dr. Julia: Yeah, they never explain like, actually, this wasn’t from brain data at all. Or even if it was like, we actually can’t say the level of specificity that they’re assuming. But it’s really sad because that’s an opportunity cost. It’s like a hope cost. Like if you’re a parent and you’re going, Oh, I know what they need. I always joke with my students because, on those reports, the reason I learned about is that someone in a local school sent me one. I was like, “Have you seen this before? What is this?” And we looked at it. Well in that report, they have these problems with the cerebellum [00:47:00] and therefore they need to participate in drum circles.

And it was like, Yeah, I love music. Like I have no doubt that that’s fun, but what’s the time cost there that you could be getting other services that we know are a little more effective. I want to be careful not to disparage people from trying new things because sometimes with the trauma you do have to think outside the box, but I think it’s really a disservice to convince people that we know more than we do.

So that’s something that… I guess I’m getting a little emotional about that because it just really can be frustrating. And I know probably even the people that designed it really want to do the best and they want to help, but it can be something that’s very frustrating especially when you get a client who’s been through those things and they’re like, we did this, we spent $8,000 on this and metronome treatment. And then that didn’t work and it’s like, Okay. Well, has anyone told you maybe just talk therapy is what you need? That’s [00:48:00] probably the best we have.

So anyway, I don’t know if that answers a QEG question. I’m not as familiar with cause that’s what I thought that would be.

And then it turned out to be coding from an interview, but I think there are people out there who are doing that. And in 10 years, if you all come back and say that worked out well. That’s great.  But I think in the world of autism, we don’t want to oversell our confidence in things, especially as professionals like we’ll lose trust, right? Like, it’s not a gamble I’m willing to take.

Dr. Sharp: That’s fair. Well, the phrase that stood out to me from all of that was hope cost, and that’s pretty powerful, just something of a powerful thing to consider that parents don’t get invested in kids at a certain age, I think they probably know enough to get invested in something they think might work. And if that’s the best path and we have a responsibility to steer down a different path.

Dr. Julia: Yeah. For sure. It’s not to say [00:49:00] like, Oh, you shouldn’t do that. I mean, you’re the parent. That’s up to them for sure. But I’m always like, let’s do addition and subtraction. If you like that, keep doing it. If you have the money. Great. But let’s also add on some things that we know are effective like TF CBT, or other trauma-focused therapies that we know to be effective.

Dr. Sharp:  Sure. Well, now we’ll get into intervention a little bit more as we go along, but thanks for taking that detour. This is a thing I think we all want neurofeedback to work.

Dr. Julia: Yes, it’ll be so great.

Dr. Sharp: We all want it to be as amazing as some folks say it is, and maybe I hope that it will be at some point.

Dr. Julia:  Yeah. I’m with you.

Dr. Sharp: At least right now.

Dr. Julia: I hope they come back later and say supplements actually do cure autism. I’ll be like, good. Now we have a cure but I’m a little doubtful.

Dr. Sharp: So we haven’t talked a whole lot about differentiating trauma from other concerns. I get that question a lot from my supervisees and [00:50:00] even the other psychologists, our practice, podcast, Facebook group. It’s everywhere. It’s like, how do you separate between trauma and ADHD or trauma and autism or trauma and depression. And I would love to dive into that with you.

Dr. Julia: Yeah. I’m thinking so many things. As you say that question I’m thinking about, yes. I have a friend who will call me sometimes and she’ll say, listen, I’m a neuro-psych, I got this kid with trauma. Oh my God. Like she’ll freeze. I don’t want to go any further. And it’s like, well, you’re not going to mess them up. So I think there is a strong, as we talked about in the beginning, like the temptation to kind of separate everything out, parse out. We love that we’re in grad school, we’re going to parse these things, parse this. And like, unfortunately, I have a regression equation for individuals.

I think to me, I’ve grown to address that concern more by actually I want to integrate it more. Like instead of thinking of separating things out, which is probably not really reflective of [00:51:00] reality, trying to integrate things. So there’s that part of it, like the watercolor idea, right?

Like everything’s going together, but again, I know we have to do our boxes.

So as bad as the DSM is in some ways like there are nice little algorithms and pointers. And so our criteria are really descriptive. So if you’re talking about a criterion and sense use that system as bad as it is. So, if I have a kid or an adult who meets the criteria for PTSD, then they also meet the criteria for a major depressive episode. I’m probably going to give them both. So like they meet that criteria. It’s not a rule-out, that’s a big thing in schools too. Trauma cannot rule out other things. Just because they have trauma doesn’t mean they can’t be depressed. In fact, it probably makes them more likely to have all these other issues.

But that’s tough because I know we all want the most [00:52:00] parsimonious explanation we want. This is just trauma and everything can be explained by that, but I think we have to be careful about overshadowing of, Oh, we have PTSD so we can explain everything in your life. I see that a lot with autism. So strangely, like you wouldn’t think autism, but there is some overlap with both the social-emotional part and sometimes the repetitive behaviors, the rigidity and if they have both, I’ll talk about both.

I have a Venn diagram that I made a couple of years ago for people in schools to look at the overlapping symptoms of autism and trauma, which again, you wouldn’t think that is a thing. But it is and especially with people coming out and talking about girls and autism, like, oh my god, how much overlap does dad have? I’ve had a couple of girls now that had both complex trauma and autism. And again, we were talking about uncomfortable too. Like how do we tease this apart? And it started making more sense to me to not tease it apart.

Let’s just say for the purposes of insurance billing, you have PTSD and autism. And then when [00:53:00] I go talk to your mom and to you, we’re going to explain what that means. And we’re going to inter,…that’s the time to integrate it. Maybe you don’t need that in your report. Even maybe you don’t need that in the insurance billing, but how did one lead to the other? Maybe we can’t say. The timeline, of course, if it’s a single incident trauma, I think that makes it a little easier because of the timeline. Right? So COVID right now in our schools locally, we’ve been training people. There’s a UCLA COVID screening measure for COVID-related trauma. I don’t know if you’ve seen that? It’s free.

Dr. Sharp: No, oh, someone else mentioned that in a previous podcast but I never looked it up. Thanks for the reminder.

Dr. Julia: I feel like I should know the answer because I listened to them all. But yeah, there is a measure. And I’ll send you the link, but there’s one for COVID specifically and there’s almost exactly the same one but for just “regular trauma” on their website. Now, they have the full measures but these are just screeners.

And so those can be really helpful and one thing we’ve been telling people in schools is when you give the COVID screener [00:54:00] measure and it asks about specific things, like, has someone died, have you been quarantined for long periods of time? Various specific things but then we look at the timeline of their symptoms.

So if you’re being referred for ADHD, okay, well, did you have any symptoms before this? And the annoying thing is that maybe you did, but no one noticed until now, but now you’re at home all day and your mom’s like, oh my God, you are so hyper and I never knew it. Or like online school is exacerbating it. I think that is maybe a question that we can’t answer yet, but certainly, I’m excited to see all the research specifically COVID that comes out, but there is a timeline with the complex trauma course, it’s harder to tell this timeline.

But I hate to identify with this, but If I go back to behaviorism at heart whenever I’m posed with this like, what box do I put them in? if we’re going to be super logistical about it, then let’s just be logistical. So do you meet the [00:55:00] criteria? Okay. Yeah. You have depression and this other thing is good.

I think what comes up for people is you have the same symptom and you’re trying to figure it out. For example, irritability or hyperarousal, which is another name for irritability sometimes, right? That’s a trauma symptom and it’s a symptom of bipolar disorder and it’s a symptom of ODD and it’s a symptom of depression. And so, yeah, I think that’s where it just becomes I’m going to take the psychology professor way out, just like that’s where your multiple sources and multiple pieces of data come in because you can’t look at that one symptom and say like, well, that’s definitely from trauma because we can trace it back.

But I will ask teenagers a lot. I’ll sit there and do a lifetime line with them like I would in therapy, like, okay what happened then? And what happened then? And how are you feeling at that time? And when would you say the concentration stuff started?

I have a client right now, I’m trying to figure out what the chicken or the egg. And I might not be able to answer that question and I think [00:56:00] I’ll have to be comfortable with that uncertainty. And I’ll have to, at the end of the day, make a diagnosis that fits behaviorally and descriptively, and then explain to the parents and the child.

One thing that helps with that as well is that when I’m doing these kinds of assessments, I always have a little more couching, a little more caveat in the wording than I normally would. I often have a paragraph for younger kids especially, please note the symptoms of ADHD and trauma can overlap. And so sometimes we’ll almost suggest a test by the intervention like coming back after a year of stable caregiving, or intervention.

And if the ADHD symptoms have gone away with the trauma, then we know we have our answer, but if they’re still there, then we’ll do some more assessment. And maybe we’ll do more ADHD, specific things. We did that a lot of like. Hey, come back sooner than you normally would because there’s so much that’s changing across development [00:57:00] anyway.

And then add on the trauma piece add on if they’ve just changed homes or they’re having visits with their bio parents or something like that, that can really mess it up. So I’m learning to become just more comfortable with it. We’re not really sure right now, but here are the possibilities and follow up sooner than you might want to.

I’ve been offering parents or when I do these trauma ones you want to come back six months from now and let’s talk about how she’s doing and see if there’s more testing needed. You don’t have to go through the whole intake again, let’s just follow up. I think that it’s really hard to do in practice because of the logistics, but super important to follow up because they… especially kids, Oh my Gosh, so many kids that have ADHD and PTSD diagnosis as a five-year-old and then as they grow up, if they get stable caregiving, there’s so much research to suggest that one or both of those things can definitely go away completely. So you don’t want them to be stuck with that if it’s [00:58:00] not accurate.

Dr. Sharp: Right.

Dr. Julia: I have some Venn diagrams I can send you. For the people out there that want the diagram, I have one or two. I have one for ADHD and autism that just shows like, what are some common symptoms and at the bottom, it’ll say like, where do you look for this? Do you look in the records? Do you look at the test? I wish there was a nice differentiating test that could just tell you.

Dr. Sharp: Still working on it.

Dr. Julia: That’s right. On my next life.

Dr. Sharp: Well, you mentioned a couple of things in there that I just want to highlight because they’re things that we do as well. One is the testing by intervention and just the implicit message in there is just that it’s okay to not know. It’s okay to not specifically know, but as long as you’re pointing someone down the right path to try, you’re not going totally off in the wrong direction. Sometimes you got to work on the first layer before the next layer emerges [00:59:00] and that’s totally okay. Right?

Dr. Julia: Yeah, like I said, I’m every day working on comfort with uncertainty, but especially with these guys. I think even more so with adults too because you got this whole history that I have no idea how deep it goes. And like let’s just work on this first. Like maybe your depression is the most salient thing for you right now. So maybe let’s go work on that for what I’ll refer you to some resources. And then later if you’re still… I had one, a couple of weeks ago, an adult who scored real low on that PTSD scale even though I knew she had significant trauma, and she basically gets drawn out by all the other worries. So, okay, at this time, you don’t meet that criterion but come back later and maybe once you’ve addressed some of your other anxiety, that would be something to look at.

Dr. Sharp: Yeah, absolutely.  Well, let’s see. We have covered so much and I wonder if [01:00:00] we might talk a little bit about the feedback. How you might deliver some of these results to parents or kids. And if there is more to touch on in terms of intervention, we can do that. But I am really curious just about the feedback, particularly around just hard feedback. So just delivering, like, “Hey, this is a traumatic experience, this is PTSD or…” I think about what happens when parents are somehow implicated in the trauma. How do you handle that? Or, either directly or indirectly by neglect or something. So there are a lot of questions in there, but I’ll let you take it wherever you’d like.

Dr. Julia: Yeah, this is the most complex question.

Dr. Sharp: Saved the best for last

Dr. Julia: So I think I’m going to give an aspirational, right? So I’m [01:01:00] not by any means saying that I always do these things, but these are the things that I would try to do.

One thing is that I always when I started my postdoc in this, I was so terrified of that very thing. Like, Oh my God, I’m going to have to tell someone that like their kid was abused and now they’re going to have a… but to be honest, I’ve rarely come across where I had to give like that big of news.

So either they already know about whatever the situation is. Mostly, the hard part is maybe they don’t understand how significant that could be or that the behavioral effects could be part of that. So I never say it’s absolutely certain that the trauma causes, but a lot of these kids you mentioned earlier that come out like ODD CD, they’re very overmedicated with like anti-psychotics and things like that. Sometimes not so much now in private practice, but more Memphis, like talking about all these things that you see as manipulative or oppositional, [01:02:00] think about trying to get them in their kid’s head, think about your internal world. You’re growing up these things happen to you.

You don’t think you can trust anyone. You have very poo delayed discounting. So you want things now. Does it make more sense to you now that they’re stealing food? Often most parents and guardians are I think less reactive than I always expect them to be. They’re always like, we want the best. And so usually they’re like, oh yeah, that makes more sense. And the most common reaction I get is, oh my God, that makes so much sense. Right? It’s like when you give someone a diagnosis like autism and they’re 21 and there, oh my God, my whole life makes sense.

I find that a lot, especially with parents. I’ve had a couple where the child was maybe abused and they found out about it later and the parent was still dealing with that, which I think you alluded to earlier. And so sometimes you get a lot of tears and like, oh my gosh, how [01:03:00] did I not know?

I always recommend so not always but I’m thinking of several moms I’ve had who just broke down and they just could not stand the thought that they let this happen. And of course, then you need your own therapy. That’s not going to go in the report, but I really encourage you this is something that you’re going to need support for. So that’s huge getting your own help trying to help them understand that. I know different schools of thought are different on this, but I’m actually huge on psychoeducation that transparency, right?

I’ll even quote stats to parents. We know that 80% of the people that go to therapy are better off than those who don’t, who have the same thing. So I try to sell it a little bit. And then also a lot of reassurance, in the report I’ll even put any, I learned this in Memphis from my supervisors there, but at the very bottom we’ll put like Mr. So-and-so is to be [01:04:00] commended for The gentle way he has approached this child, the things he’s tried to teach them, just like really reinforcing those things that they are doing really well. Like, hey mom, you’re actually… from the amount of concern I see in your face, I know you’re a good mom.

I know you’re trying your best. Just that reassurance, that human connection again, I’m not here to just read out your report to you. It is a little therapeutic, right? It has to be sometimes. I know that this is really a hard thing to deal with and man, look at all the things y’all have been through, how have you managed to cope so far? And they’ll say like, well, I guess I am helping her with her homework every day. So just kind of like highlighting all the things they’re already doing that they should keep doing and how important that relationship is. That’s huge. 

I think my most common rec on kid reports these days of any kind is the special time spending time with your child. Sounds so easy. But as a parent I [01:05:00] know is not always easy, but yeah, just emphasizing that piece of it. Like, Hey, we’re going to give you a bunch of concrete recommendations, but even if you never get to any of these things or none of them work, we know from research that the number one most important factor is a supportive relationship with an adult.

And so at the end of the day, if you can give them that and continue to give them that. And we didn’t get into rad, but reactive attachment, even a lot of parents will come to me wondering about that. A great article about that. That’s a questionable diagnosis in our field, but even with that, you see these awful news stories, they’ll never have attachments.

And actually, the research says that after about a year, obviously, this is variable, but there’s actually no kid that still shows symptoms of “rad” after they’ve had a long time in a stable caregiving environment. So we don’t actually think that’s a death sentence. I think [01:06:00] on media and stuff, you see these awful stories of this kid in their room with a knife, and like, he’s never going to be able to have relationships. Well, that’s true, there’s something else going on because most of the stuff that happens with kids with maltreatment. Our Intervention and relationships are so important and as long as they get into that stable, responsive caregiving system, can overcome tons of this stuff without thousands of dollars and on whatever you want to spend your money on. I think that could be reassuring, right?  It’s just your human nature. You’re being a good mom. You’re being a good dad, supporting her.

Dr. Sharp: Yeah. Well, and there’s maybe a side message in there too. I think about the kids in the foster system where at least in my experience can be rare for kids to have a year of stable placement and just how that’s just doubling down on.

Dr. Julia: Yes. [01:07:00] That’s the flip side. As I said, look it’s so easy to just have one year of school placement which is not in the cards for some people. So that’s hard. But I guess the hope is we do know that it’s reversible. All this, even the brain level, right? all this stuff now, a trauma in the brain. I guess that’s true. But also neuroplasticity and relationships build up the brain. And we know that. And so it’s not like your brain has atrophied. There’s this famous picture that I used to use in my training and I don’t anymore but you might’ve seen it.

It’s a brain next to a little brain. And it says that this is childhood neglect and this is a normal child. And so startling and I see it in training all the time, if you do a little digging, which I did, you find out, we actually don’t even know where that kid, it’s not from a study or anything, it’s it was presented in an article as a display which the person in the article is related to the things that I talked about earlier.

[01:08:00] But you see these pictures of like, Oh my God, its doom and gloom. And I think it’s really important to Change that narrative too, right? It is a horrible thing. But there are also really effective things that we can do. And your natural inclination is extra resilience and a much bigger percentage of people than you would think.

In fact, the majority of people who actually experienced abuse or neglect, most of them do not develop PTSD. And so the resilience is the default, which I think we forget because that’s so terrible. That motivates us to be compassionate, but also having the hope of we can definitely do something we don’t want to say. Oh yeah, too bad. It’s over for you.

Dr. Sharp: Right.

Dr. Julia: That’s really depressing.

Dr. Sharp: Well, I think that is probably a nice note to close on. A hopeful note that there are [01:09:00] things that we can do, and there is certainly a path out of trauma or at least to a better brain place for kids.

Dr. Julia:  Yeah. Just like integrating it with the rest of life. And I love the DVT approach of like you can have this and other things. What does that quote, you contain multitudes. Like you can have this and you don’t have to get rid of it, but you have it. And you can also have these other traits and these other amazing things in your life. Addition, not subtraction. I love that.

Dr. Sharp: Yeah. I like that as well. Gosh, there’s so much. I feel like we can keep talking. There are so many questions. I’m like things we didn’t even touch on, but maybe this is round one. We’ll see. But I really appreciate your time and all your energy. I think it sounds like the show notes are going to be pretty extensive for [01:10:00] this episode. That’s great. We need those resources. If people do want to find you or reach out for whatever they might need in this area, what’s the best way for people to find you?

Dr. Julia: So I have mental health on Instagram is @drjuliatx. That’s my professional page. And then if you just Google Julia Strait, the website for our practice will come up. We’re Stepping Stone Therapy in Webster, Texas outside of Huston. I have a blog on psychology today called This Emotional Mind. And I guess Your audience is mostly psychologists. So I’d give out my email address and be okay with that. But it’s straitje@gmail.com

Dr. Sharp:  Well [01:11:00] thanks again. It was great to connect with you. Great to connect with a fellow Gamecock alumni. 

Dr. Julia: Thank you so much. This is great. I really appreciate the opportunity.

Dr. Sharp: Okay, everybody. Thank you. Thank you for checking out this episode. I really enjoyed talking with Julia. She knows her stuff so well, and I hope that you took away as much helpful information from this podcast as I did. It’s always a cool experience. Honestly, I have never really talked about this, but this is a great example of just learning through doing. So I go back and listen to these episodes myself because I feel like at the moment I don’t have the working memory. Maybe it is to remember everything that we talk about during the podcast and actually apply it. So this was one of those that I am really excited to go back and listen to, and actually take more [01:12:00] detailed notes and implement some of these strategies in my practice.

There are tons of show notes, tons of resources. So make sure to go check those out. Now, like I mentioned, in the beginning, if you’re a beginner practice owner and you want to launch a practice in 2021, I would love to help you with that. I’m launching the beginner practice mastermind group starting in March. And this is a group coaching experience for folks who are right in that beginner stage.

We’ll provide accountability and support and guidance as you launch your practice and really try to help you dial it in so that it is the practice that you want to have. So we’ll talk about marketing and efficiency and scheduling and finances and business pieces that are really important in the beginning.

You can get more information at thetestingpsychologists.com/beginner, and apply for a pre-group call. You don’t have to apply for the call. You’ll schedule a pre-group call, and then we’ll talk about [01:13:00] whether it be a good fit for you. So check that out. Spots are filling up. I have lots of calls on my schedule. So if it’s interesting to you, I would say jump in quickly and try to get something on the books and we can figure out if this is the right way to support you as you launch your practice.

All right, everyone, pleasure as always. I will be back. Let’s see, I’m trying to keep in my mind what’s coming up next.

I think I’m still doing EHR reviews on Thursday. So look for that. And then we’ll be off to another clinical topic the following Monday. So thanks as always for listening and take care.

The information contained in this podcast and on The Testing, [01:14:00] Psychologist website is intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment.

Please note that no doctor-patient relationship is formed here. And similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.

Click here to listen instead!