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Clinical Resiliency: Strategies for Preventing Burnout in Therapists
Episode 1115th November 2023 • Embark Sessions • Embark Behavioral Health
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In this episode, Rob discusses clinical resiliency with Katie McCoog, LCSW and clinical director of Embark Behavioral Health in White Haven, Pennsylvania. Katie and Rob define resiliency as the ability to respond to one's environment and bounce back from challenges. They emphasizes the importance of recognizing progress, setting boundaries, and seeking support from supervisors and therapists. Rob also highlights the concept of flow state, where therapists feel a sense of fulfillment and engagement in their work. Additionally, Katie and Rob address the impact of vicarious trauma and the need for self-care in the helping profession.

About Katie

Katie McCoog graduated from Marywood University with an MSW degree in Social Work, with a concentration in Behavioral Health. She has been working in the field for 15 years and has been acknowledged internationally as a certified trauma therapist. Katie has provided family and individual therapy, substance abuse, and behavior modification to a wide variety of populations such as children starting at the age of 5 to adults 60 and over. She has treated individuals diagnosed with autism, mental health illnesses, intellectual disabilities, and comorbidity.

About Rob

Dr. Rob Gent, who has a doctorate in psychology, is the vice president of clinical development and training and one of the founding members of Embark Behavioral Health. Rob has been with the company for 15 years and has led the Embark organization in clinical development and growth of numerous programs. He is the lead developer of the proprietary CASA Developmental Framework, which is pervasive throughout Embark’s programs.

Through his dedication to advancing clinical development, practice, and research, he has become a nationally recognized expert in the field. His specialization in clinical development is enhanced by his therapeutic expertise and has yielded such accomplishments as the development of; The CASA Developmental Framework, Vive Family Intensive Program, Calo Preteens, Canine Attachment Therapy-Transferable Attachment Program, and other specialized programs.

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Have a question for our experts? We want to hear from you! Submit your questions to: askatherapist@embarkbh.com

Transcripts

Rob Gent:

Welcome, everybody to another podcast Sessions of

Rob Gent:

Sessions. Happy to have everybody as listeners, you know

Rob Gent:

that we take time to be able to dive in and hear the stories.

Rob Gent:

And clinically, we really get to investigate. And I personally

Rob Gent:

love to hear from people who are professionals in the field to be

Rob Gent:

able to talk about their experience and be able to glean

Rob Gent:

that and help others out, who are other professionals or

Rob Gent:

parents listening. So really excited to have Katie McCool.

Rob Gent:

Today, join us, who is a clinical director at I'll let

Rob Gent:

her introduce herself more, but she's one of our Clinical

Rob Gent:

Directors at one of our short term residential centers in

Rob Gent:

Pennsylvania, is that correct? Katie, tell us a little bit

Rob Gent:

about exactly where you're at would be great. Sure.

Katie McCoog:

So I am located in White Haven, Pennsylvania. That

Katie McCoog:

is more like northeast PA, northeast

Rob Gent:

PA and it's short term residential, maybe just give a

Rob Gent:

description of what is that level of care versus other

Rob Gent:

levels of care.

Katie McCoog:

So short term residential, I like to call the

Katie McCoog:

sweet spot, it's usually we like to be the medium before you have

Katie McCoog:

to step into a higher level of care. Or if you're at a higher

Katie McCoog:

level of care, it's right before you are discharging home to the

Katie McCoog:

community. So our short term is somewhere between 75 and 90 days

Katie McCoog:

stay. And it is intensive therapy. But we really use life

Katie McCoog:

coaches and the staff to practice this experiential DBT

Katie McCoog:

skills and other modalities that we have.

Rob Gent:

Great. The reason I wanted you to talk about it is

Rob Gent:

because I mean, for the average person hearing like the, the

Rob Gent:

actual the clients come and live there, like they're there 24

Rob Gent:

hours a day, that is really intensive, maybe it's talk a

Rob Gent:

little bit about that. It's a pretty captive audience, I would

Rob Gent:

imagine. It is,

Katie McCoog:

um, it sounds really intensive. However, I

Katie McCoog:

think that like our environment here is very homey. And we do

Katie McCoog:

have like Coach staff that are here to support our students.

Katie McCoog:

They're here 24 hours a day, seven days a week. And then we

Katie McCoog:

have therapists here to help with individual and family

Katie McCoog:

Sessions and group Sessions. It feels intense sometimes. But

Katie McCoog:

really, once you start building those relationships with the

Katie McCoog:

students and their families, it feels more like a family.

Rob Gent:

Yeah, I appreciate you saying that. I love that family

Rob Gent:

aspect. It's homey and, and some of the realities are is that

Rob Gent:

because some of the behaviors, and the emotional illness is

Rob Gent:

somewhat intense and acute, especially might, the behaviors

Rob Gent:

might exceed being able to keep them safe at home. And so they

Rob Gent:

actually need to be able to have that environment and immersion

Rob Gent:

into that environment. And I guess the reason I wanted I like

Rob Gent:

to talk about this and bring that up is there's lots of

Rob Gent:

therapists like yourself, who it's it can be a very daunting,

Rob Gent:

I should say, it's incredibly rewarding, I imagine but there

Rob Gent:

it's it's a lot. It's a lot all the time. It's not like you see

Rob Gent:

him for an hour, and then they then they go home. Yeah,

Katie McCoog:

correct. I really feel like residential is its own

Katie McCoog:

entity. It's not like outpatient at all. I mean, there are

Katie McCoog:

intensive outpatient, right and PHPs. But every time you walk

Katie McCoog:

into work, your students are here. You're living and growing

Katie McCoog:

with them. So it is it can be pretty intense sometimes,

Katie McCoog:

especially if one student is really struggling one day for

Katie McCoog:

any reason. It can set off, you know, another student or we can

Katie McCoog:

just be rallying around them like a community to help support

Katie McCoog:

them as well.

Rob Gent:

And plus, you're doing individual Sessions, you're

Rob Gent:

doing family Sessions, you don't group Sessions. I know they go

Rob Gent:

to school there, they do a bunch of things. And yeah, the reason

Rob Gent:

I wanted to mention that is because our topic today is

Rob Gent:

really talking about clinical resiliency. And talking about

Rob Gent:

that's important because as you can imagine, we there's a lot of

Rob Gent:

therapists too, and we'll talk about this word a little bit but

Rob Gent:

use the term burnout. Burnout I know you've had I'm sure you've

Rob Gent:

had some experiences with with that. So let's go ahead and

Rob Gent:

climb in. Thanks for setting the stage. Katie, I really

Rob Gent:

appreciate it and knowing that you're certainly an expert in

Rob Gent:

understanding hi hi case loads intensive being a therapist with

Rob Gent:

intensive students and wonderfully we have very

Rob Gent:

involved parents. So that becomes its own can be a

Rob Gent:

stressor in its own. Right. So if we can let's let's clinical

Rob Gent:

resiliency we talked about this term resiliency is kind of out

Rob Gent:

in the world. I don't know that it's defined real well people

Rob Gent:

hear it but I So what are your thoughts on what? How would you

Rob Gent:

define the term resiliency?

Katie McCoog:

It's interesting that you asked me to define it.

Katie McCoog:

In the midst of researching what resiliency really is based on

Katie McCoog:

all of these different studies that have already been conducted

Katie McCoog:

for multiple years. And then each person has their own

Katie McCoog:

definition of what resiliency is, I find resiliency is the

Katie McCoog:

ability to respond to your environments, or simply put,

Katie McCoog:

like, the bouncing back part of it. So you have a situation and

Katie McCoog:

what's your ability to kind of think about respond and then be

Katie McCoog:

able to function through it?

Rob Gent:

Oh, I like that definition. I appreciate that.

Rob Gent:

So just building on that, I would agree with you, Katie,

Rob Gent:

that there's been a lot of research on some of the research

Rob Gent:

base that I've done in looking at I love this definition that

Rob Gent:

they talked about resiliency, if you imagine that it is this sort

Rob Gent:

of cycle, that if we move from a place of baseline of positive

Rob Gent:

effect, that we can rely on that baseline as our Yeah, that's our

Rob Gent:

baseline. And then as we experience negative effect, we

Rob Gent:

actually circle through that and we get, we don't stay there. And

Rob Gent:

then we can go ride that through and experience it. And it

Rob Gent:

doesn't necessarily compensate us or dysregulated us to the

Rob Gent:

point where, you know, we're disabled in some sort of way, or

Rob Gent:

it's affecting our daily lives. And then we circle full back and

Rob Gent:

return back to that positive baseline of effect. I like to

Rob Gent:

use that term when talking about doing therapy with kids, because

Rob Gent:

oftentimes we think about kids is we want them to be resilient,

Rob Gent:

and how can I send my kid to you, and you guys really build

Rob Gent:

their resiliency? And I always like to say, Well, if we use

Rob Gent:

that definition, we end it is about a bouncing back and being

Rob Gent:

able to do that. Oftentimes, we have to assess what is the

Rob Gent:

baseline? Do they even have a baseline of positive effect or

Rob Gent:

stability or regulation? I wonder if you have noticed that?

Rob Gent:

Even with therapist do we have? Is that a helpful construct even

Rob Gent:

for therapist,

Katie McCoog:

I think I think therapists kind of set higher

Katie McCoog:

expectations for themselves than they do for their own students

Katie McCoog:

and families. And oftentimes, it's unrealistic, because they

Katie McCoog:

just find themselves that they have to have a higher standard,

Katie McCoog:

right? Like I'm the professional in the field. So I should be

Katie McCoog:

able to fill in the blank. When really That's That's not fair.

Katie McCoog:

Setting, what we teach and preach to our families and our

Katie McCoog:

students, we should be able to absorb for ourselves. And

Katie McCoog:

something that I love so much about resiliency, is that it's

Katie McCoog:

it exists in every single culture and population. It's

Katie McCoog:

just, it's spoken in a different language, maybe it looks

Katie McCoog:

differently, but the the essence of resiliency is it's there,

Katie McCoog:

it's present for everybody. But what does it look like for you,

Katie McCoog:

and you should be the person that defines your own

Katie McCoog:

resiliency? Interesting?

Rob Gent:

Yeah. Like, I liked it. It's a universal concept.

Rob Gent:

Yeah. And I also want to highlight what you said that, as

Rob Gent:

therapists, they think we have these expectations of ourselves,

Rob Gent:

to be able to endure and be there for everybody. And I mean,

Rob Gent:

we're going to talk about vicarious trauma in a second,

Rob Gent:

but you're constantly absorbing, especially if you're a

Rob Gent:

relationally, attuned therapist, where there's a tremendous

Rob Gent:

amount of empathy, and that that can certainly inhibit it. And I

Rob Gent:

guess my point is, I wonder how much supervision do you have to

Rob Gent:

do where you talk to a therapist and say, how do you have this

Rob Gent:

baseline? How do you know how to get back to the baseline? Are

Rob Gent:

you even familiar with the what the baseline feels like? And

Rob Gent:

maybe that baseline I would, I would use the term rep

Rob Gent:

regulation to be able to return to this baseline. But yeah,

Rob Gent:

wonder your thoughts how much how much of your supervision

Rob Gent:

with therapist, so

Katie McCoog:

with my team, specifically, I really like to

Katie McCoog:

do like weekly supervision, where it's the structured you

Katie McCoog:

sit down, and you talk about it. However, building relationships,

Katie McCoog:

I think, is incredibly important for any human being to be able

Katie McCoog:

to function through any event in their life, right? I mean, we

Katie McCoog:

are meaning makers, and we thrive on relationships, and

Katie McCoog:

that's developmentally what we need to grow and learn. So with

Katie McCoog:

my clinicians, I love having any reason if their doors open, I

Katie McCoog:

pop my head in and just say, Hey, how you doing? I need a cup

Katie McCoog:

of coffee, want to go for a walk? So there is this

Katie McCoog:

structured supervision that's very essential for them to be

Katie McCoog:

able to break down and process like countertransference. If

Katie McCoog:

there's vicarious trauma, like yes, we have all that and pull

Katie McCoog:

them out of that element, and let them know I see you as a

Katie McCoog:

human being, and you're allowed to be a huge and being with me.

Katie McCoog:

So let's let's get out of this environment, so we can really

Katie McCoog:

get to it. Sometimes I feel like people might deflect because

Katie McCoog:

they have that unrealistic expectation of themselves like,

Katie McCoog:

I'm the therapist, so I should be able to well stop being a

Katie McCoog:

therapist for a second. People and let's just talk. Yeah,

Rob Gent:

love that. And then how do you notice? Let's just be

Rob Gent:

overt about the word. I hear this from therapists all the

Rob Gent:

time. I'm feeling burnout. Yeah. And burnout. And I'm always

Rob Gent:

curious, what is what is that mean for you? And what are your

Rob Gent:

thoughts about that term?

Katie McCoog:

Again, I like to just a conversation, because if

Katie McCoog:

we were to go by definition, it almost presents is like you're

Katie McCoog:

done with the field. burnt out means I'm done. And I can't even

Katie McCoog:

bring myself. But what is what is your burn out? And can we

Katie McCoog:

define it? And can we rephrase it? I am a big believer that

Katie McCoog:

language really helps. You're where you are mentally? And so

Katie McCoog:

if you're using burns out, well, then how am I supposed to help

Katie McCoog:

you come back around? How are you going to walk into work

Katie McCoog:

today, and be present and show up for yourself in the fro your

Katie McCoog:

clients? If you're tired? If you need a break? If you need me to

Katie McCoog:

step in, like let's start defining and giving that a

Katie McCoog:

different language and a different vocabulary than just

Katie McCoog:

burns out because burn out to me means you're, you're completely

Katie McCoog:

done and you're walking out my door. Instead of Katie, I really

Katie McCoog:

need a break. I need help. What do I do I feel lost, I feel

Katie McCoog:

detached. I don't know what to do with this case. Like, we get

Katie McCoog:

very complex cases. And for you to feel that you just don't know

Katie McCoog:

what to do is also okay, maybe you're not burnt out. Maybe you

Katie McCoog:

just really need support.

Rob Gent:

Well, it seems like I like I really value that you're

Rob Gent:

using the term burnout, like I'm picturing this piece of wood

Rob Gent:

that literally is burned up and it's got no life left in it. And

Rob Gent:

you said, I'm done. And it's interesting how not just

Rob Gent:

therapists but I think as people in general, when they're feeling

Rob Gent:

this burnout, we have these interesting patterns to kind of

Rob Gent:

make the burnout worse, to perpetuate the burnout, rather

Rob Gent:

than knowing how to like, step out of it. Yeah. Yeah, maybe

Rob Gent:

speak a little bit about have you noticed that before? You

Rob Gent:

know,

Katie McCoog:

I have, um, I feel like you get stuck. It's almost

Katie McCoog:

like tunnel vision, like you can't picture any other way. And

Katie McCoog:

maybe the intensity that you are experiencing is burnt out is

Katie McCoog:

describing it all in one word. But really, it's so much more,

Katie McCoog:

there's so many more layers underneath what the burnt out

Katie McCoog:

is, but because you're fixated on burns out on burned out, it's

Katie McCoog:

almost Well, what does that mean to you? Are you now I've had

Katie McCoog:

some of my clinicians feel like, I'm burned out, I'm a failure.

Katie McCoog:

I'm not good enough. What am I doing here? Can I really handle

Katie McCoog:

this? And it's, well, yeah, you're a human being, and it's

Katie McCoog:

okay to be affected by this stuff. How do we protect

Katie McCoog:

ourselves emotionally, which we don't often think of when you go

Katie McCoog:

into Sessions, and you hear this complex trauma all the time. So

Katie McCoog:

again, like supervision is really important. And sometimes

Katie McCoog:

it's your supervisor that has to pull you out of it, because you

Katie McCoog:

get stuck, which is very normal.

Rob Gent:

You do get stuck. Yeah, we, we've certainly

Rob Gent:

noticed that people get stuck and I use the term they

Rob Gent:

perpetuate it, they kind of just stay in this burnout mode.

Rob Gent:

Oftentimes, we noticed that there's this interesting

Rob Gent:

projection of resentment, like my caseload is too high, or it's

Rob Gent:

the company or the expectations, or it's the parents or it's, the

Rob Gent:

clients are too acute and too demanding. And it just becomes

Rob Gent:

this. I would always say that that's a good indicator that you

Rob Gent:

know, you're headed towards being overwhelmed or

Rob Gent:

overstressed. Personally, I don't. I'm with you, Katie. I

Rob Gent:

think you're saying this. I don't like the term burnout.

Rob Gent:

Because it does mean there's some finality to it like, I've,

Rob Gent:

I've burned up all my fuel, and nothing's left, right. Like,

Rob Gent:

actually, I don't think that's actually the case. How do we see

Rob Gent:

it as maybe you got overwhelmed or overstressed? And then how do

Rob Gent:

we devise ways to mitigate that? And I one thing I wanted to say,

Rob Gent:

and I think you mentioned this, was that oftentimes we have this

Rob Gent:

expectation that we can perform, and we shouldn't get burnout and

Rob Gent:

do this. And we take it as some sort of moral failing. Like,

Rob Gent:

it's me as the as the therapist, I just, something's wrong with

Rob Gent:

me. I can't do it. And then it gets really convoluted with that

Rob Gent:

sense of self doubt. Maybe even shame turns into this

Rob Gent:

resentment, and I've heard this and maybe you have to, well, I

Rob Gent:

just need a better work life balance.

Katie McCoog:

Yeah, sorry I did. I've said that before in my

Katie McCoog:

earlier days. Being a therapist. So I don't mean to giggle, but

Katie McCoog:

it's like, Oh, it's great for I have definitely felt that

Katie McCoog:

before. Like, I need to be more balanced. Okay, but what does

Katie McCoog:

that mean? What does that actually mean? You know, is it?

Katie McCoog:

Is it the work? Is it? Are you burnt out? Are you blaming and

Katie McCoog:

projecting? Like you said, Rob? Or is it I need better

Katie McCoog:

boundaries, and I need to feel not as much guilt when I

Katie McCoog:

implement my boundaries, because we're teaching other people to

Katie McCoog:

have boundaries, we should have been for ourselves too.

Rob Gent:

And that's something, certainly if you're a therapist,

Rob Gent:

or your clinical director, that should be something that's

Rob Gent:

coming up in supervision, yes, to be able to discuss, you know,

Rob Gent:

our understanding of Yeah, where, where are our boundaries?

Rob Gent:

Why are we feeling overstressed? I? I like the analogy, what

Rob Gent:

somebody said to me, people like to say, need a better work life

Rob Gent:

balance, but I've rarely ever heard that it's, man, I really

Rob Gent:

need to spend way less time with my children or my family, I need

Rob Gent:

to spend less time I took way too much vacation this year.

Rob Gent:

Right? What? You never hear people say that, what do they

Rob Gent:

always say, oh, I need to cut back on work. I need to do that.

Rob Gent:

So I like to think about that. Like you're saying maybe it's

Rob Gent:

not about balance. It's reconceptualizing. What am I

Rob Gent:

doing? what's meaningful? What are what what's exceeding my

Rob Gent:

boundaries? Is it creeping into some time that I have away from

Rob Gent:

work or parents? Somehow? am I allowing myself to get in

Rob Gent:

meshed? Lots of times that comes up, especially when you have

Rob Gent:

really demanding high acute kids and parents? Well,

Katie McCoog:

I'm what am I? What am I actually in control

Katie McCoog:

of? Because sometimes it's if you're here, and you're

Katie McCoog:

constantly working, then to have control of the situation, that

Katie McCoog:

kid will do better, or the parents will understand or the

Katie McCoog:

team will start doing this practice. And it's trust, you

Katie McCoog:

know, what are you actually in control of and trusting your

Katie McCoog:

team and trusting yourself that you've put the work in and

Katie McCoog:

you're doing, you know, really good foundational work with your

Katie McCoog:

students and your families that you actually have to give them

Katie McCoog:

the opportunity to now practice it themselves beyond you just

Katie McCoog:

being there? Take a step back, it's okay to do that.

Rob Gent:

So let me ask you, if I'm a therapist, what should I

Rob Gent:

bring to my we talk about supervision, super important.

Rob Gent:

Having regular meetings with a supervisor, you know, certainly

Rob Gent:

if you're in a clinical setting, whoever's your manager should be

Rob Gent:

able to approach some of that stuff with you. If you're a

Rob Gent:

therapist, what I don't want to do is just a rah, rah them into

Rob Gent:

like, oh, you know, here, just try harder and change. I don't

Rob Gent:

want to do that. What and I don't I know, you don't either.

Rob Gent:

If you're a therapist, what are some things that you might be

Rob Gent:

looking for, to recognize that you might be coming?

Rob Gent:

overstressed? Or you might be coming, developing some sort of

Rob Gent:

overwhelming feelings? Or what are the indicators, some of

Rob Gent:

these indicators? If I'm a therapist, or a new therapist?

Rob Gent:

What do I look for?

Katie McCoog:

Okay, so I will do my best to give some because

Katie McCoog:

again, I think that it's, it's really on the individual, but

Katie McCoog:

any change in thought, so if you're usually going to work,

Katie McCoog:

and you're in a good state of mind, um, most of the time, and

Katie McCoog:

then you start kind of dreading work, or you're fixated on what

Katie McCoog:

you have to do or worried about how the milieu is going to be

Katie McCoog:

today, or I've got a lot of work or, you know, I would pay

Katie McCoog:

attention to your thought patterns of that, honestly,

Katie McCoog:

because that it's so easy to fall in to it without

Katie McCoog:

recognizing it. And so self awareness of how you're even

Katie McCoog:

thinking on your way to work is really important. I would like

Katie McCoog:

you to remember to eat, it's really really important to eat

Katie McCoog:

your lunch if you need a snack, eat

Rob Gent:

a healthy lunch. A healthy lunch

Katie McCoog:

works. You yes, if you're a coffee drinker or water

Katie McCoog:

drinker or something like realize if you've gone a couple

Katie McCoog:

of days without eating your lunch. Okay, so what does that

Katie McCoog:

say? Because now you're actually neglecting what you need for for

Katie McCoog:

your body to function and for you able to do therapy and be

Katie McCoog:

present for it. You know, I and I say it because I've actually

Katie McCoog:

missed lunch a bunch of times, you know, in a week, so pay

Katie McCoog:

attention to like, what are your habits? What are you doing? How

Katie McCoog:

are you speaking to other people? You know, what are the

Katie McCoog:

words you're using? How do you feel on a client? Can you talk

Katie McCoog:

about it with your supervisor? Do you feel uncomfortable with

Katie McCoog:

this client or talking about it or ask Do for help? Or how are

Katie McCoog:

people responding to you?

Rob Gent:

Those are, those are great ones. I like one that you

Rob Gent:

mentioned up is recognizing. I always use some Carl Rogers type

Rob Gent:

of mindset if I'm shifting out of unconditional positive regard

Rob Gent:

for people. And I noticed that I'm getting a little bit short,

Rob Gent:

or I'm having inaccurate expectations, or this is coming

Rob Gent:

up. For me, I always like to tell therapists, well, if that's

Rob Gent:

happening for you, boy, well, you need to talk about because

Rob Gent:

that's one of the stepping stones, the gateway into this

Rob Gent:

term that you're going to use. I'm, I'm burnout, or if I'm

Rob Gent:

leaving work, and I'm slightly resentful, like feeling like,

Rob Gent:

ah, that Darren paperwork is just, I know documentation isn't

Rob Gent:

fun. Right? But when it's just like I'm behind, and I'm

Rob Gent:

procrastinating, I'm not staying on top of it. That's just part

Rob Gent:

of the job. Right? Oftentimes, that that's something too

Rob Gent:

that's, you're going to, you're going to use the burnout word or

Rob Gent:

have that mindset.

Katie McCoog:

Yeah, absolutely.

Rob Gent:

Great, Katie, those are good ones. I appreciate

Rob Gent:

that. So I you talked about relationship, I'd like to bring

Rob Gent:

up we'll talk a little bit about flow state, but in your mind,

Rob Gent:

how does the therapist mitigate and see that this is reward? How

Rob Gent:

do I have more investment than I do withdraw? In my clinical

Rob Gent:

practice?

Katie McCoog:

Recognizing progress, no matter how big or

Katie McCoog:

small and who the progress is, where it's coming from, I think

Katie McCoog:

it's those little wins in life that really keep you going. And

Katie McCoog:

you have more little wins than grands ones, right? But

Katie McCoog:

recognize the progress. And understanding that if you've if

Katie McCoog:

you've worked with a family or a client, and or you're working on

Katie McCoog:

yourself, and you've been making all this progress, and then all

Katie McCoog:

of a sudden you stop, well, is it plateauing? Or is it

Katie McCoog:

stabilization, and really think about that, because plateauing

Katie McCoog:

could give like a negative thought to it. And stabilization

Katie McCoog:

is, well, you're finally not in that negative behavior pattern

Katie McCoog:

anymore, regardless of who that is. So recognizing that any

Katie McCoog:

progress can be good progress.

Rob Gent:

I'm gonna ask a little bit of provocative question,

Rob Gent:

because I'm gonna reflect the work of Scott D. Miller, Dr.

Rob Gent:

Miller and his group is that how does the therapist and a

Rob Gent:

supervisor, how did they actually know that they're

Rob Gent:

making progress?

Katie McCoog:

Is it the same? What's the same? When I, I like

Katie McCoog:

to use data with my clinicians, because they are a little bit

Katie McCoog:

more black and white thinkers. And if they listen to this, I

Katie McCoog:

love you guys. But they are so they really respond more to like

Katie McCoog:

data. And so any movement in our data, if it's moving forward, or

Katie McCoog:

if it's not moving backwards, but it's been the same for a

Katie McCoog:

couple of weeks, then let's bring that out. And any change

Katie McCoog:

that is moving forward for the client or the families is

Katie McCoog:

helpful. So

Rob Gent:

maybe define I love that you're using the term data.

Rob Gent:

If, if I'm just a clinician, I'm doing the standard practice, and

Rob Gent:

I'm not gathering a bunch of data. What are mechanisms that

Rob Gent:

you use when you use the term data? What are you really

Rob Gent:

referring to? So

Katie McCoog:

there's data that I like to use for progress with

Katie McCoog:

my clinicians, specifically for like, their job roles? So I do

Katie McCoog:

like chart audits. And what if we're really struggling to get

Katie McCoog:

our notes done on time, because maybe we are feeling

Katie McCoog:

overwhelmed. And I do weekly chart audits with them. And I

Katie McCoog:

can actually point out like, Okay, last week, maybe you were

Katie McCoog:

only 89% on time, but this week, you're doing 98%. So let's talk

Katie McCoog:

about the things that worked for you. When it comes to client

Katie McCoog:

data, that we we have a lot of surveys that go out that the

Katie McCoog:

clients and the families actually answer. And it's their

Katie McCoog:

perception of how they're doing and with their symptoms and

Katie McCoog:

functioning in their family, at school in their community. And

Katie McCoog:

so it'll give us a number. And it's the movement of the number.

Katie McCoog:

So do you want me to get into details of each one, like some

Katie McCoog:

numbers, you want to be high in some numbers, you're actually

Katie McCoog:

you're doing golf, you want them to be low? And so when these

Katie McCoog:

specific surveys are showing us like, well, this is where the

Katie McCoog:

clients coming in at their baseline, and then what's the

Katie McCoog:

movement happening after they've been with us for a little bit?

Katie McCoog:

So that's the type of data that we collect.

Rob Gent:

Yeah, I appreciate that. And just giving some

Rob Gent:

specificity to it is, for an example is where you would

Rob Gent:

administer Depression Inventory, or you would do in anxiety and

Rob Gent:

these are validated instruments, be it the PHQ nine or the GAD

Rob Gent:

seven or Even a measurement of well being like the WHO five,

Rob Gent:

you're administering this, while youth outcomes questionnaire you

Rob Gent:

actually have the parents do them as well. Yes, yeah. So

Rob Gent:

actually, what I'm hearing you say, Kate is, those measurements

Rob Gent:

give the client a voice. And that's a really great way to see

Rob Gent:

it on number of actual data on progress. Because let's let's be

Rob Gent:

real. Sessions can be hit or miss. And we think they went

Rob Gent:

really well or really bad. And the actual client might have a

Rob Gent:

different experience, or the parents might have a different

Rob Gent:

experience.

Katie McCoog:

What I love so much also about the service that

Katie McCoog:

we use is, very often we have people come to our program that

Katie McCoog:

they, they feel a certain way, and they don't know how to put

Katie McCoog:

it into words. And so how do you then find a baseline? How do you

Katie McCoog:

then know what we're going to work on? How do we know what the

Katie McCoog:

dysfunction of the family is and how to help like healthier

Katie McCoog:

attachments and relationships with mom or dad or, you know,

Katie McCoog:

whoever the caregiver is, and you don't know how to

Katie McCoog:

communicate it, because maybe you've never learned it, which,

Katie McCoog:

okay, that happens. So this survey actually gives us a

Katie McCoog:

really great picture of, oh, so with a PHQ nine, which is your

Katie McCoog:

depression survey, this person might have an elevated number

Katie McCoog:

nine, which is like suicidal ideation is fleeting, or it's,

Katie McCoog:

it's there, it's very present. But you don't know how to tell

Katie McCoog:

anybody, because you just never learned it. Maybe you just felt

Katie McCoog:

so awful that like it's you're blocking the ability to even

Katie McCoog:

understand and absorb what you're learning in the past. So

Katie McCoog:

it gives us a really good picture of understanding like

Katie McCoog:

maybe where they're at. And then we start there, and then help

Katie McCoog:

teach them how to communicate their thoughts and feelings

Katie McCoog:

through that.

Rob Gent:

I'm really smiling, because it's such a beautiful

Rob Gent:

thing that I don't think most people think it's

Rob Gent:

counterintuitive, like actually, using objective data will

Rob Gent:

actually help to reduce this term burnout. Like, it's

Rob Gent:

actually objective, it takes some of this objective, am I

Rob Gent:

doing good? Am I not? I mean, it is just really amazing that we

Rob Gent:

actually can use that objectiveness to weave in to

Rob Gent:

increase resiliency, because now we can see it more objectively.

Rob Gent:

That's about Katie, really, really, I love that we got into,

Rob Gent:

like, wow, using using data, and we actually, there's actually a

Rob Gent:

therapeutic alliance scale that's used to maybe talk a

Rob Gent:

little bit about that. Why? Why would that help therapists,

Katie McCoog:

so the therapeutic alliance scale, we have students

Katie McCoog:

fill out their own survey, and we have, um, each caregiver

Katie McCoog:

involves fill out their own survey from their perception.

Katie McCoog:

And it also helps kind of tell the story. Honestly, the the

Katie McCoog:

outcome tools that we use is like a storyboard for me so I

Katie McCoog:

can understand. So you know, you could have a drop in therapeutic

Katie McCoog:

alliance, meaning how well do I feel like I am heard or

Katie McCoog:

connected to my therapist or the staff at the program? And if

Katie McCoog:

there's a dip after, it's been pretty great. To me, I like to

Katie McCoog:

look at that and talk about it, because the therapists often

Katie McCoog:

think, oh, my gosh, what am I doing wrong? They don't like me?

Katie McCoog:

And will. When do you have your family session? Because I'm

Katie McCoog:

looking at these other tools? And did you? Did you hit a

Katie McCoog:

button that maybe they haven't uncovered that topic before?

Katie McCoog:

Because that could be? Oh, like, that's the nicest way to say it,

Katie McCoog:

the family could feel like, why don't like this therapist, and

Katie McCoog:

then they do drop in it. But maybe you're actually onto

Katie McCoog:

something. So you don't actually want the therapeutic alliance

Katie McCoog:

score to be high all the time. Because then we're not really

Katie McCoog:

doing our job, we, we need to push the envelope and help them

Katie McCoog:

discover what the core issues are. And in order for actual

Katie McCoog:

healing to happen, you don't want to mask it. No band aids,

Katie McCoog:

what's really going on? Let's get to the core of it. I told my

Katie McCoog:

families, if you don't tell me you hate me, at least once, I'm

Katie McCoog:

not doing a very good job.

Rob Gent:

But if you don't have the maturity of the experience,

Rob Gent:

or the objective data to know that you as a new therapist, you

Rob Gent:

might take it personally and like oh, everybody, everybody

Rob Gent:

hates me. My job's terrible. I'm not doing a good job. I thought

Rob Gent:

it was all about, you know, making people feel warm and

Rob Gent:

fuzzies. And you're saying, Actually, that's not it. This is

Rob Gent:

a different paradigm shift. Let's use objective data. And if

Rob Gent:

I'm hearing you, Katie, you're also saying that whole process

Rob Gent:

of doing surveys and all of that gives us a clear roadmap when

Rob Gent:

we're looking at treatment. So it actually gives us a more

Rob Gent:

accurate prescription and a more accurate roadmap that actually

Rob Gent:

is incredibly impactful for the therapist to have confidence and

Rob Gent:

not feel like it's this willy nilly subjective thing and I'm

Rob Gent:

bearing all the responsibility of it. Yeah. So, wow, one

Rob Gent:

incredible way to work on resiliency is to use the

Rob Gent:

measures and use more objective means to be able to do that.

Rob Gent:

Really terrific. Yeah. I really appreciate that. Well, along

Rob Gent:

those lines, I wanted to mention that doing therapeutic alliance,

Rob Gent:

I mentioned Scott Miller before and when we talk about

Rob Gent:

resiliency is often or reward or feeling burnout is often linked

Rob Gent:

to therapist overestimate their effectiveness by somewhat like

Rob Gent:

over the last 40 years, almost 85%, we overestimate our

Rob Gent:

effectiveness. And at the end of the day, it really is about

Rob Gent:

looking at patient outcomes long term, okay. And Scott Miller's

Rob Gent:

work and his colleagues in particular, all of their

Rob Gent:

research indicated that the therapeutic alliance was the

Rob Gent:

greatest percentage and greatest variance for actually affecting

Rob Gent:

that, that change, it wasn't specific to, I think the

Rob Gent:

modality in the intervention was less than 1% of the variance of

Rob Gent:

change. So I'm just pushing on the fact that knowing the

Rob Gent:

numbers, but really examining the relationship has the

Rob Gent:

greatest impact, not only in client outcomes, but I would

Rob Gent:

imagine for the therapists sense of success and competence, as

Rob Gent:

well.

Katie McCoog:

Yeah, I agree. It's funny, because we we use

Katie McCoog:

modalities, I find a lot of our families ask us, you know, the

Katie McCoog:

modalities that we use here at the program, and I understand

Katie McCoog:

why, because to them, it's like a comfort of trying to

Katie McCoog:

understand what's going to help their child and it, the

Katie McCoog:

modalities are important, right? We want to teach these skills,

Katie McCoog:

but you can't learn skills from somebody you don't trust, you're

Katie McCoog:

not really going to learn it, you're not going to absorb it,

Katie McCoog:

you may not even listen to it. So why would you want to work

Katie McCoog:

with somebody become vulnerable, and start really digging through

Katie McCoog:

all of this stuff, if you don't trust the person in front of

Katie McCoog:

you. So it really is relationship based? And we get

Katie McCoog:

to use all these other tools as well.

Rob Gent:

It really value that. Yeah, thank you. Thank you.

Rob Gent:

Well, let's talk a little bit. We talked about ways to mitigate

Rob Gent:

it, I would just like to touch on a few things. When we talked

Rob Gent:

about being a therapist, I always like to ask the question.

Rob Gent:

As a therapist, one of the greatest ways to prevent this

Rob Gent:

burnout or this sense of resentment is what's filling

Rob Gent:

your well, or what's what's rewarding to you. I don't know

Rob Gent:

how you approach that with with your team. But I always like to

Rob Gent:

maybe your thoughts on that. Katie is D, how do you know your

Rob Gent:

clinicians? Or what's rewarding for them?

Katie McCoog:

Well, knowing your what, or your why, you know,

Katie McCoog:

depending on what theory you're coming from, but like what, what

Katie McCoog:

brought you into this field in the first place? And how are you

Katie McCoog:

working towards this goal, I think is really important. So

Katie McCoog:

knowing if it's fulfilling or not any progress at all, that's

Katie McCoog:

going towards your what I think brings them back. So knowing

Katie McCoog:

your what is really important, knowing

Rob Gent:

your what knowing your why I have found maybe you too

Rob Gent:

is that somehow people get into this field thinking this this

Rob Gent:

altruistic life that I'm going to leave of just giving, giving

Rob Gent:

give where I noticed those are the people who usually have

Rob Gent:

nothing left to give very quickly, right? Like the well,

Rob Gent:

the well becomes empty pretty quick. And I'm always like, no,

Rob Gent:

let's change the framework, it actually this is you need to be

Rob Gent:

simultaneously growing and experiencing that growth, like

Rob Gent:

you mentioned before, and progress, as well as your

Rob Gent:

clients. And so I don't know, I always like to bring up this

Rob Gent:

term, I'm not sure how familiar you are with flow state, if

Rob Gent:

familiar with flow state. So flow state has been a long time

Rob Gent:

studied, it's this, I'll give you the three criteria. But flow

Rob Gent:

state is something that when you're doing it, there's three

Rob Gent:

criteria, that time transfer, there's a time transformation,

Rob Gent:

you kind of forget about time, time disappears when you're

Rob Gent:

doing a certain activity. The next one is that you're

Rob Gent:

appropriately challenged, your skill set is appropriately

Rob Gent:

challenged, where you're not overly challenged, or you're not

Rob Gent:

under challenged. And then the final one is called unambiguous

Rob Gent:

feedback. So I always like to bring up for anybody say chi,

Rob Gent:

what's an activity that you do that gets you into that flow

Rob Gent:

state? Can you think of one for you, Katie, I know I've talked

Rob Gent:

to a lot of people that like my son's a rock climber. He's like,

Rob Gent:

Dad, I love rock climbing. And we talked about it actually gets

Rob Gent:

him into the flow state time disappears. He gets immediate

Rob Gent:

feedback doesn't mean like you make a wrong hold. You

Rob Gent:

immediately get the feedback, which is great. And he's

Rob Gent:

appropriately challenged. He actually doesn't do the climbing

Rob Gent:

that's exceeds his ability or else he would get frustrated

Rob Gent:

with the activity. So I don't know if there's something for

Rob Gent:

you, that gets you into that flow state.

Katie McCoog:

Well, I really hope you believe me when I say

Katie McCoog:

I'm residential, being here. Yeah. My, my kids, you know, my

Katie McCoog:

kids, the clients hear sorry, but when they come, it's family.

Katie McCoog:

Time, time does kind of disappear, you get really sucked

Katie McCoog:

into the environment and what you're doing and why you're

Katie McCoog:

doing it. And I told them that I haven't worked a day in my life.

Katie McCoog:

So my flow state is being here.

Rob Gent:

Yeah, and so on. Now, I like to put a label to it. And

Rob Gent:

I love that you're saying it's actually being in this

Rob Gent:

therapeutic environment is that flow state for you, that

Rob Gent:

actually, you don't leave and say, Gosh, I work too many hours

Rob Gent:

today, like I'm just resentful that I, I worked so many hours,

Rob Gent:

it's not about that the time actually disappears. And you're

Rob Gent:

appropriately challenged, right.

Katie McCoog:

But more than others serve

Rob Gent:

some some days more than others, certainly, but, and

Rob Gent:

then you're constantly getting feedback from the clients, yes.

Rob Gent:

And the therapist, and it's unambiguous. It is so clear. So

Rob Gent:

I like to bring that up. So now we have a construct, especially

Rob Gent:

for those people listening or might be Clinical Directors, or

Rob Gent:

therapists or professionals, to be able to recognize that I

Rob Gent:

always like to say, to bring it up in supervision that a

Rob Gent:

therapist should be doing therapy that they actually enter

Rob Gent:

into this flow state. Because flow state, as you know, as we

Rob Gent:

defined it, you're saying, I don't really count it as work, I

Rob Gent:

counted as a integrated part of myself. Yes. And you're not

Rob Gent:

dividing it out. And that's ideally what we would want for

Rob Gent:

our therapist, to be able to recognize and identify Well, I'm

Rob Gent:

actually in this flow state, where it's rewarding for me. And

Rob Gent:

I have appropriate challenges, I meet the criteria. And that's,

Rob Gent:

I'm grateful for it, rather than resentful for.

Katie McCoog:

Absolutely. Once you start becoming resentful

Katie McCoog:

than I think we're starting to walk down that path of we're

Katie McCoog:

very overtired. And using the burnout term, yeah.

Rob Gent:

And not that you're gonna be in flow all the time.

Rob Gent:

That doesn't happen. It's not flow all the time, but a little

Rob Gent:

bit of flow, because I'm amazed at how many people even from

Rob Gent:

clinicians, you ask them about flow, and there is no flow. They

Rob Gent:

can't identify. And then you know, the reason I wanted to

Rob Gent:

bring up that's a huge red flag, right? If there's no recognition

Rob Gent:

or awareness of entering in a meeting this criteria flow

Rob Gent:

state, I can guarantee you how long are they going to last?

Rob Gent:

Right? They aren't going to last. So thanks for letting me

Rob Gent:

bring that up. I really appreciate it. I think that's

Rob Gent:

one of those things that I want to make sure that we give some

Rob Gent:

resources to therapist and Clinical Directors to recognize,

Rob Gent:

gosh, am I getting burnout? What should it feel like? How should

Rob Gent:

it be rewarding? I think I think that's important. Well, Katie

Rob Gent:

thinks about that. So let's shift gears just a little bit.

Rob Gent:

Now that we understand we're talking about flow state, and

Rob Gent:

you've done so well to articulate Hey, some things to

Rob Gent:

be aware of and all that. Let's dive into vicarious trauma,

Rob Gent:

because this is one that as in the helping profession,

Rob Gent:

especially one like ours. We knew it going into it, didn't

Rob Gent:

we? Yes. It wasn't like some surprise that, like, I'm gonna

Rob Gent:

listen to people's troubles and their trauma, and all of this.

Rob Gent:

So maybe a little talk a little bit about Katie, how you like to

Rob Gent:

conceptualize vicarious trauma, and how that shows up with your

Rob Gent:

clinicians and with your practice,

Katie McCoog:

I think, um, I mean, sometimes it's completely

Katie McCoog:

evident to a person and they really feel it. They take it

Katie McCoog:

home with them, it's an thoughts. It's you're trying to

Katie McCoog:

cook dinner, and you're already thinking about maybe the things

Katie McCoog:

that you've heard today, and it's really affecting you, and

Katie McCoog:

you're not functioning as you used to. And sometimes I think

Katie McCoog:

that it's not, I think that vicarious trauma can be

Katie McCoog:

something that happens over time that you don't actually

Katie McCoog:

recognize that you're experiencing until you have

Katie McCoog:

someone from the outside say, are you okay? Because you don't

Katie McCoog:

seen yourself lately or whatever that looks like for you. And so

Katie McCoog:

I think it's important for people to recognize that I mean,

Katie McCoog:

to me I of course, I broken into like two things very simply. But

Katie McCoog:

sometimes you really feel it and it's in your face and you can

Katie McCoog:

avoid and you're, oh my gosh, I don't know if I can work with

Katie McCoog:

this case, because I'm having countertransference and

Katie McCoog:

sometimes it's I've been working with maybe a specific population

Katie McCoog:

for so long that I not recognizing that I'm now

Katie McCoog:

becoming reactive to my clients instead of responding to them.

Katie McCoog:

treating everybody as though this is the population, whether

Katie McCoog:

it's colleagues, it's clients, it's outside people, you're at

Katie McCoog:

the grocery store. So vicarious trauma to me is, it can be

Katie McCoog:

sneaky. It's really important to have a relationship with

Katie McCoog:

somebody that you work with that can kind of help you make sure

Katie McCoog:

that like, you're regulating it, and you're really monitoring it

Katie McCoog:

because especially in trauma therapy, you hear so much, or

Katie McCoog:

you see so much, but recognizing what do you need for yourself to

Katie McCoog:

just say emotionally protective?

Rob Gent:

Yeah, create definition. To add on to what

Rob Gent:

you're saying is that vicarious trauma, I like to add this piece

Rob Gent:

for most people is that it's a, it's a result of cumulative

Rob Gent:

exposure from somebody else's traumatic experience that I like

Rob Gent:

to say, it's sort of like you said, sneaky, I'll use an old

Rob Gent:

school analogy of the frog and the frog in the boiling water.

Rob Gent:

We as therapists, you know, the frog, you put them in some

Rob Gent:

lukewarm water, you turn up the heat, it boils, and the frog

Rob Gent:

doesn't know to jump out. And before it knows that it will

Rob Gent:

actually be in the boiling water to its own detriment. I think as

Rob Gent:

therapists you're saying kind of the same thing. We're the same

Rob Gent:

way. We're just we're hearing it, we're taking it in, we think

Rob Gent:

that we're dealing with it. But all of a sudden, like trauma

Rob Gent:

does, it starts to show itself and all kinds of peripherial

Rob Gent:

auxilary ways. Maybe even somatically, I'm feeling

Rob Gent:

tension, or I'm not like to say maybe I'm not eating right, or

Rob Gent:

my movement is or I'm getting headaches, or whatever it is. So

Rob Gent:

there's all this trauma that can be experienced. And we as

Rob Gent:

therapists have to know that it's actually part of our job.

Rob Gent:

Yeah. Like we are primed, susceptible. I mean, it's like

Rob Gent:

being firemen, but we have to go into the fire every single day.

Rob Gent:

Right? Yeah. So something to be aware of, in that. It's amazing

Rob Gent:

how much of that exists, maybe you're saying this to that

Rob Gent:

exists sometimes underneath the surface in a pre conscious way

Rob Gent:

for a therapist. And then sometimes it manifests in way,

Rob Gent:

like I'm getting irritated or I'm burnout. When they don't

Rob Gent:

even recognize, gosh, it's actually a build up of all of

Rob Gent:

this vicarious trauma and vicarious stress that I've that

Rob Gent:

I've endured. Yeah. So I really appreciate talking about it.

Rob Gent:

Because I think it's important that it's oftentimes burnout is

Rob Gent:

a cumulative effect of a bunch of different things.

Katie McCoog:

Absolutely. And I don't, I'm sorry, I'm just gonna

Katie McCoog:

say I don't feel like anybody is truly immune to it either. So I

Katie McCoog:

gotta say, like, when I was, you know, entering this field about

Katie McCoog:

17 years ago, I definitely went in with like, Nope, I'm fine.

Katie McCoog:

Like, it's not going to affect me. And yeah, no, it really

Katie McCoog:

does. So, don't think that anyone is immune to it, there's

Katie McCoog:

no special thing to stay, you're, you're going to be

Katie McCoog:

affected, especially when you put your heart into something.

Katie McCoog:

And you're in your flow state, you're going to get affected by

Katie McCoog:

it. And it's okay, but like, how do you take care of yourself?

Katie McCoog:

That's a really important question to constantly evaluate.

Katie McCoog:

So

Rob Gent:

maybe we can give as we close, Katie, this has been

Rob Gent:

so helpful to talk about maybe we can give some specific

Rob Gent:

things. I always like to tell even Clinical Directors or

Rob Gent:

anybody in the field. Boy, mentorship is really key.

Rob Gent:

mentorship, absolutely is a primary thing, what are some

Rob Gent:

other things you would say are real, specific things to do? In

Rob Gent:

the field.

Katie McCoog:

I feel like I've said this a couple of times. And

Katie McCoog:

I'll just keep saying it because it's part of my practice of who

Katie McCoog:

I am as a social worker. But relationships are incredibly

Katie McCoog:

important to me. So having a great supervision, very

Katie McCoog:

intentional about it, having strong relationships with people

Katie McCoog:

that you have someone to go and talk to, and and be able to

Katie McCoog:

share that with therapists. I am a big believer that therapists

Katie McCoog:

should have therapists, because who else can you say all of this

Katie McCoog:

to and really lay it all out on the line and feel that

Katie McCoog:

protection and that comfort and the openness and the space to do

Katie McCoog:

it, having boundaries, knowing them and trying to feel minimal

Katie McCoog:

guilt when you implement your boundaries? And we at least I

Katie McCoog:

speak for myself, sometimes I feel guilty when I say no, I

Katie McCoog:

can't do this right now because it's a boundary for me that I

Katie McCoog:

need a break. But understanding that it's important for me to

Katie McCoog:

take it or I won't be able to show up the best way that I can

Katie McCoog:

show up usually.

Rob Gent:

And I can't support you enough to say structure and

Rob Gent:

boundaries is necessary to actually have accurate empathy.

Rob Gent:

This isn't a process. Therapy is so much integrated on empathy in

Rob Gent:

with burnout, with having vicarious trauma. Those are

Rob Gent:

things that erode our empathy. And then we tend to, we can get

Rob Gent:

in meshed and start to feel so I love the kid, you're saying, no,

Rob Gent:

no, you got to have structure, you've got to have some

Rob Gent:

boundaries, and get some relationships that support that,

Rob Gent:

right? And I'm saying, Get into a mentorship or a supervisory

Rob Gent:

relationship, or get with a therapist, if you know that to

Rob Gent:

help monitor it. Because if you don't monitor it, it often grows

Rob Gent:

like a weed. And then before you know it, you don't want to be in

Rob Gent:

the profession, or else you're trying to figure out how to get

Rob Gent:

a better work life balance, and then it kind of spins out in the

Rob Gent:

burnout just never goes away. And then your eyes how many

Rob Gent:

times I've seen therapists take vacations. And this is going to

Rob Gent:

heal my burnout. And actually, they come back and about three

Rob Gent:

days later, right back, right back to it and the vacation

Rob Gent:

magically didn't do anything. Rather than here. Do all these

Rob Gent:

other things.

Katie McCoog:

It's a constant process. Yeah.

Rob Gent:

Katie, this been so incredible. Thank you so much.

Rob Gent:

Any final words to in regards to this clinical resilience thing

Rob Gent:

we've been talking about? It's been so helpful today.

Katie McCoog:

It's okay to not be okay. As long as you go help

Katie McCoog:

for it.

Rob Gent:

Really well said. Appreciate that. Katie,

Rob Gent:

everybody, thank you. Thank you so much for your time. This is

Rob Gent:

such an important topic, especially with all that's going

Rob Gent:

on in the world with levels of anxiety and depression. And we

Rob Gent:

know that there's conflict happening everywhere. I mean,

Rob Gent:

who's who's not feeling a little bit overwhelmed and can

Rob Gent:

certainly feel some burnout. So those have been super incredibly

Rob Gent:

helpful tips. I appreciate so much your time, Katie, and thank

Rob Gent:

you for all the listeners. Thank you for listening to Sessions.

Rob Gent:

And doing that. Please access these podcasts wherever you

Rob Gent:

access podcasts are great. So look forward to seeing everybody

Rob Gent:

next time. Bye bye

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