WMH Season 3 Ep 11: Changing the Game in Therapy

This is a transcript of Watching Mental Health Season 3, Episode 11 which you can watch and listen to here:

Katie: Welcome to watching Mental Health, where we break down the stories, stigmas and research in mental health. It's time to have an open conversation, so let's talk about it. Hi everyone. Welcome to another episode of Watching Mental Health, and I'm so excited to be here today. We are live every first and third Wednesday of the month, and I'm going to be live today talking all about therapy, which I know is a big conversation in the mental health space. And people often wonder, is it for me? What's it about? And my guest today is really just an expert in this area, and his name is Andrew Darby. He's the executive director of Darby Integrative Counseling, a premier psychotherapy group practice that serves clients across dc, Maryland, Virginia, Florida, and California. So all over the country renowned for boutique and deeply personalized care. Andrew and his team integrate things like E-M-D-R-I-F-S, mind Body Work and Advanced Trauma work to help clients heal from anxiety, addiction and relationship challenges.

And Andrew is a leader in the mental health addiction space and he also provides specialized coaching for other professionals and therapists in the space nationwide and practice owners. And so really is quite a leader in the space. And so I'm so excited today because we're going to be talking about therapy, but we're also going to be talking about his upcoming podcast, resilient Use. So he is going to talk more about that and really how he's on a mission to transform how therapy is experienced. And I'm just excited because I'm on a mission and he's on a mission and together we're going to really, I think, impacts some people. And so with that, let's bring Andrew to the show.

Andrew: Hello.

Katie: Thank you so much for being here.

Andrew: Thank you so much for having me. I'm really excited to be here.

Katie: Absolutely. Well, I mean, I gave a little bit of a bio, but I always ask all of my guests to just start off with telling me in your own words a little bit about you and why mental health matters to you.

Andrew: Absolutely. So mental health is of course such a broad subject, and so I'm so glad that you asked that question. For me personally, in my own personal journey, it's been incredibly helpful to help me to change my life really. And so part of why it's so important to me is that I know from a deeply personal perspective that therapy works and a focus on mental health. So it doesn't just have to be therapy. It can be our supports in the community, whether those are spiritual or religious, whether those are family friends, whether those are recreational activities. I see mental health as a very broad brush stroke and samhsa, the Substance Abuse Mental Health Services administration talks about this and kind of the pie chart of what mental health looks like. And so if you haven't checked it out, I encourage everybody on this podcast after this to check it out, but that's why it's important to me, both personally, professionally, I'd say it's important because of course, it's my line of work. I really appreciate all the work that all the clinicians at my practice do, and we help folks to heal from their traumatic situations and history and to live a better life. And so that's the goal.

Katie: Yeah, yeah, absolutely. And it's important to have therapists in the world, but I love what you said about mental health is it's a broad brush stroke. We all have mental health. Maybe we don't all need therapy at all times in our life, but we all need to take care of our mental health. And I know for me, mental health's always been such a big part of my life. I always knew I wanted to go into it, but I didn't think I could have the capacity to be a therapist. I find that therapists are very special people and because your ability to take and be a safe space for others and to hold their pain is powerful. And so I just want to ask, did you always think that you were going to be a therapist or wind up in mental health, and how did you wind up in this role?

Andrew: Great question. Well, first, thank you so much. I think that's so kind and such a, it's a loving way to see us as therapists. I'd say that we all have our own gifts that we can help other people. So even if it's not therapy, I did want to become a therapist at a very young age. I had some really difficult life experiences that led me to want to be a therapist growing up. I used to want to be a firefighter and a police officer when I was very small. And that kind of shifted and changed as I grew. But I knew I wanted to do something to help other people, and I really accredit that to my mom. My mom is a helper at heart and she really taught me a lot about helping other people, loving other people, giving back to the community.

And so around my teenage years, I started to realize that that's what I wanted to do. I had a really traumatic incident. My uncle died of a heroin overdose, and that led me to want to become a drug and alcohol counselor, and I didn't really even know what that was at that time. And later on I kind of developed and realized I wanted to help a wider range of folks and really specifically in trauma. And having been through that experience as a child and worked through it and been to a lot of therapy myself, I realized that that was my life's goal. And so I really credit that incident, that really traumatic incident to have developed me into who I am today. And so while a horrible, tragic incident, it really was a pivotal moment in my life that has helped me to help other people.

Katie: I find that a lot of people in the mental health space, I mean, I think we all have a story is kind of what I like to start saying, because yeah, sometimes they're really hard, difficult situations that have happened. And I really like that you have focused in a lot of ways of talking around trauma and talking about trauma because I think that a lot of people assume like, oh, I don't have trauma. I wasn't in the military. I didn't see somebody die in front of me, so therefore I can't claim that I have trauma or that I'm suffering from that. But I just think that there's so much to unpeel there because it's almost like a lot of our mental health conditions that pop up later in life in some ways can be stemmed from that trauma. And so I just want you to talk a little bit more about your expertise and your findings around trauma therapy.

Andrew: Absolutely. Yeah. Trauma is interesting, right? Because life has a lot of curve balls that it grows at us

Often in the field. We talk about now big T traumas, so similar to what you were discussing about having been to war and kind of the old school, what we used to call shell shock long, long ago that our military veterans came back with. And so realizing that that was kind of the beginnings of what we understood about PTSD and now what we understand is that big T traumas that as well as little t traumas such as falling off of our bicycle at a young age and just not having an adult there to help soothe us. Or maybe the adult was there and they had their own reaction that bypassed us as little kids, and we can call that a little T trauma, whereas our emotional states are not taken care of in that moment, and we're not taught how to manage that. So that can really stick with us from both as somatic and our bodies experience.

So later on, that can develop into things like panic attacks, difficulty sleeping, nightmares, remembering events, or it can also develop in ways that are impactful in our relationships, such as problems in communicating, regulating our emotions, going from zero to a hundred or not being able to communicate at all, going mute, shutting down, having difficulty in managing long-term relationships or developing those that can also be a consequence of trauma. And so trauma really shows up in so many different ways in our life. And then you bring in other mental health disorders that present and that can also be highly traumatic for us to experience in our lives and not being able to get the resources that we need, whether that's in our personal lives, our professional lives, and just at our community level. Trauma is a really, as well as mental health. It's so large and there's so many ways that we can have trauma in our lives.

Katie: Yeah, that's so true. And I think a trendy term these days is generational trauma. So talk to me more about generational trauma and then can trauma be healed? Is this something that we have to carry with us our whole lives? Can we set it down at any point?

Andrew: Yeah, thank you. I'm so glad that you brought up intergenerational trauma because it is an experience that people can have from generation to generation that actually neurobiologically gets passed down into our bodies as we are developing in our parents' bodies. So it's really important to identify that sometimes the trauma that we experience neurobiologically actually comes from generations of being in the womb. And that trauma that then turns on different neurobiological markers within our system to then present in our communities and in our lives. Does it go away and can it get better? Also a great question. Yes, it can get better. We don't get rid of our trauma. So the point of trauma work is not to say it did not happen, it is to be able to live with the experience in a way in which it doesn't negatively impact our lives moving forward. It is not that we don't still have grief or loss around the traumatic event or the historical trauma that communities have experienced is about recognizing and learning to heal from and live with the traumatic events in our lives. And the beauty of that that we get is that then that can give us meaning and purpose in our life. And part of trauma work is to find the meaning and purpose similar to what I talked about in my journey. That event in my life could have taken me in a very different direction,

And it did for a while. I'm actually also someone who's 16 years in substance abuse recovery. I haven't had a drink or a drug in that long, and I'm really grateful for the experiences that I had both out of recovery help me to relate to folks, which also I would say are traumatic incidents and also the time in recovery to grow and to learn and to be grateful for that. So yeah, we definitely heal from trauma and we are able to grow from it, and that's the beautiful thing. We don't have to forget it. Sometimes we don't remember the trauma and we can still heal from trauma that we don't remember or that wasn't ours

Katie: To be done. Yeah. Oh my gosh, I really glad I asked you that question because oftentimes people are like, oh, just set your trauma down and it feels hard to take that for certain types of trauma losing a child. You can't just ask somebody to set that down, right? Yeah, and it's hard, and you've touched on this a little bit, but tell me a little bit more about what trauma therapy looks like, and then you also mentioned addiction therapy. I know that in your practice you really specialize in these kind of harder subjects to broach and to do it with people who maybe are struggling with identity along with it. So tell me more about what trauma therapy looks like and the other therapy practices that you have.

Andrew: Absolutely. Trauma work is pretty broad. It depends on what orientation that we show up from a psychological perspective, how we've been trained. So the different types of trauma worker start with that, whether we come at it from a more cognitive standpoint or a more somatic or body-based standpoint. But the goals of each of those is always to start with helping a person who's coming in or a system like a family who's coming in with a traumatic event or traumatic events or just having problems in their life that maybe they don't even know are attached to trauma and it later comes out. But the goal of trauma therapy is to first help that person or that system of people find a way to ground what they're experiencing, a traumatic event or have experienced a traumatic event. So it always starts grounding. We always start with finding resources in the community within the person to be able to help them to ground. Before we even broach trauma work, what we then do is depending on the different orientation that we have, we might go and do something like EMDR where we use bilateral stimulation. So whether that's through our ears and hearing or it's through eye movement as many people typically think about EMDR, it can be about tapping on both sides of our body. And what that does is that rewires our brain and it keeps us in the present moment while we think about the traumatic event. So keeping us stable in the present moment,

Katie: Oh, I never understood why nobody explained that to me. Okay, that makes sense. Thank you. Okay, yeah, I can see that being powerful.

Andrew: Yeah, it keeps us present, which is so important when we are having a traumatic experience and memory, it feels like it's happening in the here or now, whether that we can remember that trauma or we can just feel in our body something doesn't feel right.

So it's so important to think about where am I right now and what room am I in and who am I around and do I feel safe in this moment? So all trauma works starts with safety, safety first, feeling safe in the moment. So that's EMDR, and we do a lot of EMDR work at my practice, Darby Integrative Counseling. We also do other types of trauma work, cognitive processing therapy, which takes more of a cognitive approach, looking at beliefs and the ways in which those impact our traumatic experiences and a lot of other mind body medicine based trauma work. So that was using different types of therapies such as narrative therapy. So writing out the story and writing out our trauma and reading that out to somebody might be art therapy and what that trauma visually looks like to us. And it is exactly what happened to us per se.

It might simply be colors on a piece of paper and then explaining what that means to us. So that's an art therapy approach to managing and finding a way to heal trauma. And there are a few other ways such as mindfulness, like I talked about, finding presence in this moment and in our bodies, somatic experiencing is another type of trauma work that we do. Somatic experiencing is really just being present in this moment in our bodies and allowing our bodies to naturally go through the cycles of healing. And to do that, we have to again, find ground first, and then as we experience the ups in our body that we become dysregulated, agitated, fearful, we can get back to that ground and notice that there are these waves that happen in trauma and that will never stay at the top of the wave. It always comes down, but we just need some skills to do it. So all trauma work is finding skills and experiencing a different way to see or feel the traumatic situation and how to move on in our bodies but not move on from the event.

Katie: And it seems like a lot of therapy work in general is around that finding tools and skills and working through the challenges we may be experiencing. So let's talk more about that on a mission to change the game in therapy and to change how we think about it. We assume that it's only people who are in trauma or only people who have mental health challenges that go to therapy. But I personally think that the world would be a better place if everyone had to go to therapy, if everyone that was one of our school classes basically in high school was to do a good therapy session. I just think anyone can benefit from it. And I feel like you are probably have a similar mindset because you've expanded your practice, you're east to west coast. So tell me more about your thoughts on therapy and what you're trying to do and why anyone can use therapy.

Andrew: Yeah, absolutely. It is so interesting in our culture how we see therapy as for people who are either having an issue or there's a stigma against going to therapy. This comes from, again, intergenerational beliefs that have been passed down, that therapy is in some way for people who are broken or weak, right?

Katie: It's no, yeah,

Andrew: No, definitely not. And that the experience of therapy is an insightful experience about finding the ways and means to live In our lives. It is about connecting with other human beings. It is about learning about ourselves, about our cultures, about the interplay and relationships within ourselves, within our communities, our families, learning about the ways that all of these things overlap and impact us, and ways that we can just grow and do better in our lives, be healthier. And so while some of us might experience more mild symptoms or maybe no symptoms that we really experience at all, therapy can always help us to look at and have more insight into our lives and grow. So it used to be that we had medicine men and we had shamans, and some cultures still do in the western tradition. We have medicalized that. So mental health has become a medicalized treatment rather than a spiritual and community-based just wide practice of going to your local shaman or going to your local medicine and getting care, being cared for, going through a journey. And we have gotten away from that. So part of changing mental health and is getting back to ground,

And we're that within the mental health community, we're getting back to more somatic based interventions that are meant to ground us both as professionals and also our clients, make the world better to make it more connected. And goodness in a time right now where there's so much division and so much difficulty in the world, trouble talking to other people and not being able to connect and being afraid of one another. It is so important for us to heal within ourselves because that's how we show up in our communities. And if everybody went to therapy, that would be of utmost help to us. So it's often those who need therapy the most, who end up not coming unfortunately. But that doesn't mean that the ones who come don't get something and don't change their own lives and their communities at large. So it's a beautiful thing no matter who ships up.

Katie: Yeah, absolutely. And therapy has really helped me in my life. I can say from personal experience, it was there when I was at my lowest, and I know that if I ever reach that again, that I have that and before I reach my lowest, I think it's important to reach out for help before you reach the burnout. And I think as hard workers, as entrepreneurs, as business owners, we struggle with that burnout. And so I know that you're really taking an approach to that too with trying to help professionals to breathe to ground. I just love that you come back to grounding.

Andrew: Yeah. Yeah. And that's another core component of what I do is I work with a lot of professionals through coaching as well as psychotherapy. I work with my staff at Darby Trip Counseling to help them to find ways to work best with clients and to learn, of course, new techniques, but it all starts with self-care. We as therapists need self-care just like anyone else, and to be able to do the best work that we can, we find ways to help ourselves to heal our own traumatic wounds or our own difficulties in life so that we can show up for our clients the same way for coaching and for helping professionals. The upcoming podcast that I'm starting with…

Katie: I was going to ask. Yeah, tell me more.

Andrew: Yeah, so the Resilient You Show is all about helping professionals, entrepreneurs, people in the mental health spaces as well as professionals in other spaces, doctors, lawyers, accounting professionals and executives of many types, and how to manage the work-life balance, how to find that inner strength that we all have that can be really difficult to find, and sometimes it takes getting some help, or it might take listening to a podcast or it might take talking to a good friend. And so the goal of this show is to really bring mental health concepts and coaching concepts into a show where folks can get that without necessarily having to go to therapy, but maybe they choose after listening that maybe therapy might help or coaching might help 'em. We plan on bringing some great guests to talk about different things that might be really important to folks in the coaching communities as well as those in the executive and professional development communities and how to help our staff. Sometimes the hardest thing for us as we grow into our different positions and we open up a business or we get promoted within a business, is learning those skills, those soft skills about how do you lead a staff, how do you get people engaged, how do you stay grounded? And moments where really big things are happening, very scary things can happen in the business setting that we're not really a lot of times trained for. And so when we don't have those skills, we want to be able to remember, we need to come back to ourselves and we need to get the ground within ourselves to then be able to lead other people. And so that's what the show is meant to do, is to help people to do that.

Katie: That's so exciting. So when does it launch and how can people listen?

Andrew: Yeah, so we plan on launching in the next about two months. So we don't have a soft date right now, and we're going to be on all the podcast platforms, so the Apple Music and Spotify, et cetera. We will be streaming on those as well as our Facebook, Instagram, and yeah, we're looking forward to being able to present that very soon.

Katie: That is so awesome. I'm excited. And it's about changing the conversation. So we need people, we need professionals, we need experts like yourself coming in and changing the conversation, and these are important conversations to have. So I'm just so stoked for you to be here and to just see the show really take off. We have a couple of minutes left. I'm going to make a little bit of a turn. I'm going to ask you about your experience running therapy in different states. So do you have therapists that are in different states and is that how that works? Would it be virtual, would it be in person? So anyone who's listening in, who's maybe in one of those states, what does that look like for them?

Andrew: Absolutely. So right now we have a physical location in Silver Spring, Maryland where we see clients from dc, Maryland, and Virginia, which are close by to that location. We're right over the bridge from Virginia, and we are literally less than a mile away from the border of dc. So many of our clients come physically from the district. They also come from across the river in Virginia Falls, church area, Arlington, Alexandria, et cetera. We also have telehealth clinicians who are seeing clients online, both in dc, Maryland, Virginia, Florida, and California. Then there will be some counseling compacts, fingers crossed very soon, that will allow us to see clients in most of the United States. So that's up and coming. It'll probably be in about the next year. Many of our clinicians will then be able to see clients via telehealth across the United States as long as the state in which they're in has signed the compact. And then over time, our plan is to also open a practice here in California. I'm over in West Hollywood, and so I manage the practice in Silver Spring, Maryland virtually. I go back a few times a year to check in with the staff, and so the plan is sometime in the coming years to open something up here in Los Angeles. So super stoked about that.

Katie: That's amazing. Again, it's you revolutionizing the therapy game by making it more accessible because I don't know how much you want to talk about this, but I find that working with insurance companies to be very difficult on a mental health front, the parity laws exist, but they are not effective. The insurance companies find ways around them and they have ghost lists. And here in Nevada, we have some of the lowest reimbursement rates in the country. And I know that you probably, because you have experience in all these different states, have seen pretty awful reimbursement rates as well and kind of challenges with working within that system. And so you made a change earlier this year to come out of that system, and I think because you made that change is why you're able to be more flexible moving forward. Am I right in saying that?

Andrew: Yeah, absolutely. The insurance systems are set in place. It's kind of a backwards system where if you are in network, you are unable to really make a working wage. And as a business owner being able to pay staff a working wage, what they are able to actually make a living wage on that is reasonable. And so we went out of network earlier this year to be able to have our staff be able to continue to see clients for a living wage really, and even have enough money to retire something. And the insurance system is set up, so in-network is paid at a lower rate and out-of-network is paid at a higher rate. And so it doesn't really make sense the way the system is set up, but that is the way it is. We also partnered with a company called thriver, and Thriver helps clients to access their out of network benefits to seek and obtain quick reimbursement for sessions that they attend. And in addition to that portal, we also offer clients assistance with single case agreements. And what those are is if a client has no out-of-network benefits. We work with that client to help them write a letter and advocate on their behalf to utilize their in-network benefits on an out-of-network basis with our company. And so we have tried to really expand out the ways in which we can continue to offer services and an affordable way, and it's really kept it so that clients can continue to see us, and we are also able to do the great work that we do and take care of ourselves as therapist.

Katie: Yeah, absolutely. Yeah, thank you for touching on that. It is a problem that a lot of therapists are going through mental health providers. Just that idea of making a living wage is such a challenge given our current system, but we have so many people who are struggling, and it's just this epidemic almost of mental health challenges that really just flourished after the pandemic. And so I don't think we've been able to come back down, even though we were struggling before then struggling then it feels like it's hard for people. And with the political climate, it's this constant stress and tension in the air. So just to know that people have more options. I know for us, we try to find therapists in our insurance and we wound up just going out of network because we had to. And so I just want to encourage anyone out there who's maybe struggling to look at your options. There's more than insurance if your insurance company is giving you a hard time because resources and therapists like yourself, they're out there. And I like that you've added in these different options. You're trying to really help people get around the system in some ways.

Andrew: And it's difficult. It is difficult even as providers to it's just get paid by the insurance company. That was one of the reasons that we also left, is there are a lot of laws with the insurance companies that they can come in and do something called the clawback where they can require the provider to pay money back that they have paid. So thereby, all of those sessions that were seen and worked are not actually paid for by the insurance company if you're in network. And so we've had some of those really difficult experiences, and that is again, another big reason why we left and a lot of providers were leaving, but the important thing is that we continue to be able to provide our services. And so we really wanted to find a way to help clients. A lot of out-of-network practices simply give a super bill, and that super bill is then submitted by the client to their insurance company. We wanted to do a step beyond. We wanted to add something else. And so we decided to do what a lot of other Outof network practices are also doing, which is to assist clients so that they don't have to do the work and still can get the reimbursement from their insurance company.

So I'm so grateful to have learned about Thriver, and I think they're a great company. I highly recommend them.

Katie: Yeah, absolutely. Yeah. Well, thank you so much for explaining that a little bit more and just kind of the benefits, pros and cons of being in network versus out of network and just a little bit more freedom that we have as clients, as people who are struggling and maybe looking for help. So with that, tell people who might be interested. What's the best way to get ahold of you or to get ahold of your practice and just how can people reach out?

Andrew: Yeah, absolutely. So Googling us is typically the best way you can find our Facebook, our website, it's Darby Integrative Counseling, and if you look up Maryland, Darby Integrative Counseling, Maryland to pull us up in all of our profiles up, you can reach out there. There are links all over our website, all over our Google page, et cetera, Facebook as well. You can also reach us at 3 0 1 9 6 0 8 6 9 4. That's our direct line to be able to get access to a therapist. And one thing I wanted to say is that I forgot, was we really focus in on Thet plus community and the Bipoc community as well as a wide range of different therapists at our practice who come from different backgrounds. So we have clinicians who are older, younger, we have folks who are cisgender, transgendered, we have folks who are gay straight. We have folks from all different swaths of our society. And so that is a really great option for a lot of folks in me.

Katie: Yeah, absolutely. Thank you for saying that because yeah, it is really important that people get culturally competent care, and you're actually one of the very few therapy clinics that I know, or groups that I know that have that diversity factor. And so a lot of people really struggle to find a Bipoc therapist or somebody who understands gender identity. And you have a lot of that. You understand that the weaves and fabric of our society are different and everyone matters. And so I really think it's very, very cool that you've made that a focus of yours to have that diversity imprinted in your practice so anybody can come and you can and easily match them up with somebody who will be more understanding. And it's so powerful. So powerful.

Andrew: Yeah. Yeah. It is often hard to find representation even in the mental health space for folks who come from backgrounds that are not the majority. And so a part of my work was to figure out how to find therapists from all different walks of life so that when clients come in, they can find somebody who they really connect with and they feel safe with. And I'd say as a therapist, all of us are trained how to be a safe space for our clients, even if we don't have the same background. But that always isn't maybe the first therapist that somebody wants. If it's their first experience with therapy, maybe they don't feel that or know that. But I would like to say no matter what our background or who we are, all of us are trained in being able to help folks who may come from a different background. And my job as a therapist and my experience as a therapist has been to, even with the therapists that I've had that are different than me, to be able to have them walk beside me and hear my story and show up in a loving, compassionate, validating way has been sometimes even more helpful than being with people who are just like me. But again, sometimes it starts with getting into therapy and our first therapy experience. Maybe we want somebody like us so that we feel safest, and

Then we learn, okay, maybe my next therapist I'll have somebody who's a little bit different, and I know I can trust them. I know that I can trust them with my story.

Katie: Yeah, absolutely. Beautifully said. That's exactly, that's perfect. Yeah, and it's so true. It's important to have options, to have someone who you can understand and who can be that safe space, but then also someone who can come in from a different perspective and still be that safe space and show us. Anyways, I can keep talking to you for days, but we got to end it here. We are live every first and third Wednesday of the month at 3:00 PM Pacific Time. But you can catch all of our episodes at katierosewaechter.com, and then of course on Spotify, Apple, YouTube, all of your podcast platforms, and just catch us at Watching Mental health, and we'll see you next time. We'll see you in a couple of weeks. Thanks everyone. Have a good one!