Kim Howard  00:03

Welcome to the Let’s Talk EMDR Podcast brought to you by the EMDR International Association, or EMDRIA. I am your host, Kim Howard. In this episode, we are talking with EMDR therapist Lauren Rich about EMDR therapy for male veterans. Let’s get started. Today, we are speaking with EMDR therapist Lauren Rich to discuss EMDR therapy for male veterans. Thank you, Lauren, for being here today. We are so happy that you said yes.

 

Lauren Rich  00:28

Sure. Pleasure.

 

Kim Howard  00:29

Can you tell us how you became and EMDR therapist?

 

Lauren Rich  00:32

Absolutely. So, As a college kid, I did an internship with the FBI and met some really great psychologists, and then met my husband, who’s also a veteran, and went to Iraq and a couple other armpit holes, and just really have always loved military life and everything that came with it. So I ended up going to work for the VA [Veterans Administration] and I was there for almost seven years. And what got me into EMDR was the fact that, and this is kind of sad, but comical, and it turned out well, the fact that I was handing out a national PTSD brochure that offered prolonged exposure, cognitive processing therapy and EMDR, but no one at my facility offered EMDR, so it was literally printed in the brochure that I’m handing to a veteran, saying, here are your treatment options. Oh, but we don’t offer this one. So after being trained or certified in prolonged exposure, and informally in CPT, I started seeing a bunch of veterans. And probably the first year in prolonged exposure, I put, I would say, 28 or 30 veterans through it, and I thought I was doing a really great thing, until about 12 months later, when they all started coming back. And all but one came back, and all of them said, Doc, that one instance is fine, but all of the others are still a problem. And so at that point, I stopped using prolonged exposure unless the veteran was just absolutely insistent upon it, and I had been using EMDR ever since, and that was probably six years ago.

 

Kim Howard  01:56

Wow, okay, I didn’t realize you were also a veteran.

 

Lauren Rich  02:00

No, no, my husband is your husband is okay, husband and the rest of my family.

 

Kim Howard  02:03

yes, okay, yeah, okay. That’s like me, everybody in my whole family, including my husband and both of my father in laws and sister in law, we have every branch of the military covered, except for the Coast Guard. I don’t really know how that happened, but I knew at a young age I did not want to be in the military, because I did not want people telling me what to want people telling me what to do. So yeah, that is not for me. And so I never went into the branch, but my husband, who was in the Air Force, who also realized a week into basic training that he did not like being in the service, so he only lasted four years. And I’m like, I know that about you. The first couple of days I met you. You didn’t know that enough about yourself at 18 to figure that out.

 

Lauren Rich  02:43

Oh, poor 18 year old brain. Yeah, that’s how it works. That’s how good. So, so yeah, I ended up going and sought out EMDR training on my own dime, of course, on my own time, without the support of my employer, because I thought that it was ridiculous that we were putting veterans through this horrifically painful process. And if the listeners are not familiar with prolonged exposure or CPT (cognitive processing therapy), I’ll give you the quick and dirty version. You come in my office, you spill your guts in painful detail, and I ask you very personal questions about smells or taste or touch or how your body feels and how intense is the SUDS. (subjective units of distress scale) And then you go home and you listen to the recording every single night. Now I don’t know about you, but I don’t think that that is a very kind process to put people through. And I would not want to leave relive the worst day of my life over and over and over again and again. You know, the woman who supervised me in prolonged exposure was also a veteran, and she was PE, CPT, and EMDR trained. And when I went and got EMDR training, she said, Well, yeah, it’s great. You know, I use it at the end of PE and CPT don’t work. And I said, Why are you using it at the end? If it works in the beginning, why put the veteran through the misery of that with the other two? The important thing to realize is that, and I always encourage listeners to go do research beyond what I say. Don’t ever take anybody’s word for anything? When you look at the research numbers, and even in the body, keeps the score, I think old Van der Kolk quotes the dropout rate of prolonged exposure at something like 43% I mean, it is just crazy high. And then we end up labeling a veteran as non compliant because they can’t get through the treatment. Could it be that the treatment is the problem and not the veteran?

 

Kim Howard  04:21

Yeah, I wouldn’t want to do that.

 

Lauren Rich  04:25

No.

 

Kim Howard  04:27

I wouldn’t want to go back and listen to that over and over again. Here’s the worst day of my life, Doc, let me go back home and listen to it every day for the next day week until I see you again. I mean….

 

Lauren Rich  04:36

Exactly. So I found over time the EMDR was a very kind way, much more kind than prolonged exposure. CPT, and not only is it more kind to the veteran, but it’s more kind to the clinician. And you know, going through that training process, they would say, well, it’s not your story to carry, you know, it’s not yours to absorb. It’s not yours. Blah, blah, blah, whatever the statement was in. Reality, if you are working with veterans, and they have grown to trust you, and they rely on you, and sometimes I have veterans that have gone through 14 or 15 therapists before they get to me, they become quite attached, and you are in it with them, so your trainer can say all he or she wants, that you don’t absorb this, and it’s not your story. But the reality is, is that it will impact you too. And that was what I found with prolonged exposure. The veterans were coming in, we were going through the treatment, they would leave, and then I would go cry, and I would clean myself up, and then I would do it all over again, five or six more times every single day. And so over time, it was a wear and tear issue.

 

Kim Howard  05:38

Yeah, absolutely, absolutely. And we’ve talked about this on the podcast before, and we’ve even written about it and Go With That Magazine about resilience and how and self-care and how therapists really need to take care of themselves and regulate themselves, because the clients that are coming to the door are using your your regulation to help them regulate themselves. And so it’s, it’s really crucial that you guys don’t do what you just said, cry after each session, you know, and and become that that way.

 

Lauren Rich  06:07

And so, yeah, the other piece was, there was no there was no clinician support. There wasn’t a time to meet with colleagues, you know, we had a standard lunch break, which they would later change, and it forced everybody into a different lunch hour. So you didn’t even get to see colleagues that you worked with in the same building. So it was really isolating in that regard, which meant that you’re going through this direct trauma basically every day, hearing great details, and then, you know, pushing them through like cattle. And part of the struggle that I always had with PE and CPT is that they are married to the idea that it should be done within 16 weeks. And the reality of trauma work, especially in the veteran world, is that they are concerned you’re not going to stick around, and rightfully so, because sometimes the good ones get pushed out, or they get promoted, or they just decide to leave. So one thing is that I personally think it takes about six or eight sessions even to get to know each other and to build trust. Well, if that’s the timeline for prolonged exposure, I’m already in the trauma by session three. You know, Session One is psycho Ed. Session two is breathing in a suds development. And session three, you’re you’re in the nitty gritty. So one thing is that the time frame allowed me to build better rapport with veterans. The other thing is, and I have thought this since the beginning, and I think emdria needs to do an article on it so bad, I think that EMDR is undersold to men as a whole. And I say that because men have been labeled as not wanting to come to therapy or being ashamed. The reality is they don’t want to talk about it. They’re not talkers like women. Therapy is made for women, not for men, in that regard, and we could be doing so much good with the male population if we would sell this as a therapy that is not talk therapy. You know, you could come in and what I tell them is, after we get to know each other and we take some history, we can get through the process, and you don’t even have to disclose the event to me if you don’t want to, which is what I do a lot of times, because they are classified events. And so I had one gentleman that was having nightly nightmares since about 1992 came in in 2020 so imagine how long that is. Yeah. And because it was still classified. All I knew is that we were in Africa. It was nighttime, and there was burning jet fuel, and with those three tiny details, we got through EMDR, and he went from having nightly nightmares to about one a quarter. Is spectacular, as far as I’m concerned.

 

Kim Howard  08:34

Yeah, absolutely. What’s your favorite part of working with EMDR therapy?

 

Lauren Rich  08:39

Oh goodness, it is so flexible. One of the great parts, I think, is the fact that I can start with present day symptoms, and we can work to calm the waters, because we all know that people cannot get anything done if their lives are in chaos. So if they come in and they’re having present day panic or anxiety attacks, I tackle that first we get them to a regulated, stable place, and then we can go to the past. And sometimes we start with the present day symptoms, and then we move to the future. You know, what? If you have one in the future, what do you want it to look like? How do you want to be able to handle it? For many of my people, they come to me and they are on a lot of medication, 12-14, medications, and their goal is to get off and so we’ll agree within, you know, the first 18 months of treatment, let’s make an agreement that you meet with your provider and we figure out how to get you off of that. That can only be done if you’re willing to learn a new skill set, put it to use. And that’s where the future templates and the present day work comes in, before the historical work. And I have found that to be a really great equation. And again, you just can’t do that in other types of therapy.

 

Kim Howard  09:42

Yeah, absolutely. So Lauren, you and I were talking and we were emailing back and forth, and you had mentioned that bipolar disorder often gets misdiagnosed. So can you talk a little bit about how bipolar disorder often gets misdiagnosed? How can this affect the approach to EMDR therapy?

 

Lauren Rich  09:58

Sure. So. In the veteran population, you have to remember that not everyone is a combat veteran. Only 11% of those deploy to a combat zone. Of that 11% only about 9% or less have an interaction or an engagement with the enemy. So the percentage is very, very small. So in my experience, when veterans have been seeking services at the at the governmental level, and people don’t know what they’re looking at. They either misdiagnosed them with bipolar disorder or some type of schizoaffective and in my experience, since my job was wholly with combat veterans, it was a lot of times complex trauma or PTSD with psychosis. And so then we’re giving people a bipolar medication when they don’t have bipolar disorder. On the flip side of that, we have people who are presenting and because they’re drinking so heavily, the provider suspects they have a personality disorder or something of that nature. We don’t know until they get sober and then turns out they have bipolar disorder, but because of the presentation of symptoms and the poor assessment on the part of the clinician or the prescriber, we don’t get enough information, which is why I always ask people one, one major question that I’ve painfully learned over the years in differentiating PTSD or bipolar disorder or personality disorders, is, at what age do You first remember being suicidal, and I say that because I learned the hard way when one of my guys presented, and he was a two time Deployer, medically retired, shot in the chest, and he presented that the PTSD was the problem, and I trusted that, because I didn’t know better at the time. So a number of months go by, and all of a sudden he makes a statement that he’s been suicidal since he was 12 years old, and it completely changed everything for me. We went and we did a pai assessment, we did a PDQ, just a screener, and it came back with borderline personality disorder. And I ever since then, have always asked people, at what age do you remember being suicidal? And I’ve had answers as young as seven, and so don’t assume that when a veteran comes in with PTSD, that it’s there’s not some sort of comorbidity that is being presented as PTSD, which is why assessing is so important.

 

Kim Howard  12:17

That’s a good reminder. Thank you. How can EMDR therapy be specifically beneficial for individuals who have bipolar disorder?

 

Lauren Rich  12:26

So one of the things that I have really worked on with my guys, and I think I have probably five or six that are have a bipolar diagnosis, one and first and foremost, is that we do a mapping, or what I refer to as a topo map, topographical right? So peaks and valleys and I want to know at what time of the year, do their symptoms get the worst? At what time of the year, do they manage things the best? When are the anniversary dates of their deployments? When are the anniversary dates of losses, divorces, death of children, whatever that may be for them, how often do they go through this cycle of not giving a damn about medicine? Because some of them will say, I care for about six months, and then I just stop caring. And so we insert that into the process. And you would be shocked by how many people don’t realize how irritable they get in the summer or in the winter. And I’ll say, well, What month is it? It’s September, where we What were you doing in September? Does it relate to a deployment? Yeah, I was about to discharge because I had been shot up, and I was in Germany in September of 2006 and so they will start to put that correlation together, so between the time frame that we create the symptoms and when they appear, and any other type of helpful information that we can come up with, like their employment schedule or other life events, we can really put together a pretty comprehensive picture for people that helps them manage the symptoms better. The other thing that I found really successful is when we take somebody with bipolar disorder and we use EMDR to work with the negative thoughts. And one gentleman came in. He was a two time deployer Air Force guy, and he had probably 10 years of failed treatment with the VA. They said it was personality disorder misdiagnosed. We finally got him. I got to him to a residential program. They got him diagnosed with bipolar. We got him on the right meds. It’s amazing, the turnaround. And he said, The the voices will come to me, and my my question was, well, what do you do with them when they show up? And he said, Generally, I just try to ignore them and or push them away. And I said, Well, what would happen if you did something different? He said, I don’t know. I’ve never been told to do anything different. He said, they always just, they always just tell me not to think about it. I said, Well, that isn’t working. So what would happen if you had a conversation with them. And so we have developed this tool or this protocol over time, where, when the voices do appear, or when the images appear, we have a conversation with them as if they are truly there, and we work to meet their needs. So one gentleman, actually it’s the same guy. He. Calls his Bob, and Bob is just a very degrading, negative voice in his mind. Don’t take the medication. It’s not going to help you, you know, it’s going to fail. And when we sat and did imagery on it and and we did some watching yourself on TV, you know, the removed objective viewpoints, I said, I just want you to sit next to Bob, and I want you to think about what he is needing from you. And he said he really just needs reassurance that it’s going to be okay. So instead of pushing the voices away and working to deny that they even exist, he has basically welcomed them, which has reduced the amount of stress and anxiety. So again, we all know that EMDR cannot make tinnitus physiologically better. It cannot make hallucinations go away because it’s neurological, but it can help people deal with the stress and the anxiety and, maybe more importantly, the distress that shows up in their body when those voices and hallucinations do make their appearance.

 

Kim Howard  15:55

He must have been so relieved to finally get the correct not only the correct diagnosis, but the correct treatment for the diagnosis.

 

Lauren Rich  16:04

Yes, and he had been self medicating with alcohol for a decade. He had ended up being obese. In fact, he just had bariatric surgery that did not go well, that we are, we were, you know, he was afraid of and so now we’re going to have more content to work with in that regard. But yes, it was a night and day shift for him, because it gave the veteran the power back. It gave the power back to choose. It gave the power back to respond. And instead of, I’m helpless because I can’t make this distress stop, it’s how do I want to respond to this right? Which is pretty amazing, when you think about it.

 

Kim Howard  16:40

It puts the control back in. And control can be a bad word sometimes, but it puts the control back in their hands and lets them manage it the best way they they can. So absolutely, that’s wonderful. I’m glad to hear that. So you’ve already mentioned that that success story. So do you have any other success stories or positive outcomes you’ve seen from using EMDR therapy with clients?

 

Lauren Rich  17:01

I have had a number of veterans who had gone through a prolonged exposure in CPT before they came to me for EMDR, and we have done wonderful things with all of those veterans who had not found success before, one of them in particular. And you know, it gets graphic when you work with veterans, so you can’t necessarily be soft about everything. So this guy had done prolonged exposure with me on an ambush back in 2004 on his first I can’t remember it was, I think it was his first deployment. So they’re going back to camp. Leatherneck, the convoy gets ambushed, and they are pinned down for 24 hours, and he has to run from one MRAP to another. And MRAPs have a loading deck that comes down in the back on hydraulics, and so you can actually run out and run to another one, which is what he ended up doing. And when he gets to the other one, one of his best buddies was shot in the eye, and he is bleeding everywhere. He’s bleeding out, and my guy is holding him in his arms and in his hands. And we had to go through that process of, you know, what do you feel? And I remember the moment I changed my opinion on prolonged exposure. It was when this guy said, I can feel his brain in my hands.

 

Kim Howard  18:15

Oh my God.

 

Lauren Rich  18:16

Yeah. And how awful that was. Oh my gosh. I cried with that. I did not hold back on that one. I cried with that man because it because it was, it was just so sad. Yeah, so that was in probably 20….mmmm…. that was in probably my first year of EMDR, we’d already done prolonged exposure, and he was one who came back and said that one is fine, but the others are not. And I have successfully only seen him off and on the last five years. Of the last five years, maybe a total of nine months, because we went back and we did the EMDR work, and we took care of multiple birds with one stone, and we were able to clean all of the others up. And so now he’s just on the, what I call the come and go plan. You’re free to do whatever you want. You just call me when you need me type deal.

 

Kim Howard  19:04

That’s great. That’s awesome.

 

Lauren Rich  19:07

So those veterans really make it worthwhile, and they have to know that there is an easier way than what they’re being offered. Again, I think that goes back to the sales pitch for men. I think it’s also important to realize in success stories like some of mine, that I use it in particular because of classified events. And I had a TS clearance for quite a while, a top secret clearance for about a decade, and it expired. I asked my employer if they’d be willing to go back and help me get it back so that I could work with veterans who had classified events, and they wouldn’t do it. So that left me with having to be very creative and figure out, how can we get these guys through this without violating the non disclosure agreement.

 

Kim Howard  19:47

I’m very glad that that they found you. So thank you for doing all that work with them. Yeah, I love them Absolutely. What are some unique challenges and considerations when applying EMDR therapy with male veterans? Yes, you’ve mentioned a few already, but there might be more.

 

Lauren Rich  20:02

So there are a few. One is the fact that they have to go through so many therapists, and so when a new veteran comes to you, don’t make the assumption that this is the first time they’ve been in therapy or tried and they may have only seen somebody two or three times and not felt like it was a good fit. I think the highest number I’ve ever had was I had a veteran, I think that had 14 therapists before me. Yeah, wow, yeah, pretty terrible. And goes back to that revolving door that we talked about, right? So one is they may already have some preconceived notions about therapy. A lot of it can be personality fit, you know, some of them, you have to remember, they are afraid of exposing you to violent things. Even my husband has made this statement before. You know, I don’t want you to hear what I went through. And they think that they are protecting you by not disclosing certain things, and sometimes they’re getting in their own way. So it’s okay for you to say, I’m a big girl. I’m a big boy. I can handle it. You know, you can share whatever you want, but you don’t have to overshare by any stretch. So that’s an important piece to remember. I think the other thing is the fact that we are asking people to make a pretty big commitment. You know, we’re asking for them to be here one time a week, in the very beginning, probably at least for six months, depending on how severe the PTSD is, and some of mine are exactly like that. It’s a weekly attendance for the first year. Some of them, depending on where they are in their lives, we schedule twice a week in the first six months, especially if they’re out of work or if they’re in a transition period. We take advantage of that free space, and we try to be as productive as possible. So the thing about it is, I’ve always told them, and I think they would agree that getting here is the hardest part. So part of my sales pitch is, you just worry about getting here. I will get you through the rest. So don’t be too hard on them in the beginning, if they’re not super excited about homework. If you’re a homework giver or, you know, you’re just kind of getting used to each other, just remember that for them showing up is success. And I think that could be true beyond the veteran population. I think that could be true for a lot of our clients.

 

Kim Howard  22:13

Yeah, we’ve talked about this on the podcast before that people who go to who decide that they need to go to therapy are pretty brave. I’m sure they don’t feel that way. I’m sure that they they feel defeated, and they feel like something’s wrong with them and they have to fix it, and they wonder why. But it’s pretty brave to go to somebody that you don’t even know and say, I have this problem that I can’t fix on my own. So anybody out there who’s been to therapy. Thank you. You guys are, you’re on heroes. I mean, that’s that’s pretty amazing that you’re doing that. So keep doing what you’re doing.

 

Lauren Rich  22:47

And, and for men, especially, and for veterans, you know, you have to remember they’re not coming to you unless they are absolutely miserable. And the average age of one of my veterans that walks in the door is probably about 42 they have to suffer for a good 15 to 20 years before they’re willing to walk in your door, and by that time, they’re either having legal problems, they’re losing a relationship, they’re getting a divorce, they are almost suicidal, or they have recently attempted suicide. And that’s the other thing I wanted to hit on just briefly, is the discussion of suicide with veterans. So the government has run this down like you would not believe. It is all they hear. It’s all veterans here. Are you suicidal? Do you feel like you’re going to kill yourself? Blah, blah, blah, blah, blah. At a certain point it just loses its oomph, if you know what I mean, right? So in talking to veterans about suicide, you need to understand that ambivalence toward life is a given for a lot of people in that population because of some of the trauma that they have gone through. So this is my explanation of it. On one end of the spectrum we have ambivalence toward life, which is, I’m okay if I die on the way home today, no big deal. I’m at peace with everything, perfectly fine. On the other end of the spectrum is planning or action five o’clock on Friday under my favorite shade tree with my favorite firearm with a note and my driver’s license on the dashboard. Okay, I’ll give you an example. I had a veteran who came to see me one year, and he made a really bad decision and ended up being charged with assault and battery with a deadly weapon because he was in his vehicle and he got into a road rage incident with a couple other folks in town. So he was a random assignment because he showed up at the clinic and I had a free slot. So lucky me, I got this guy, and he’s he is a peach. I still love to see him and visit with him. He’s just a good person. He just didn’t know how to deal with the symptoms. So he comes in one day and says, you know, I’ve just been thinking about killing myself. And I always say, Okay, well, if you’re to do it, how would you do it? You know, just very comfortably. And he said, I would probably just drive my car for bridge. Said, Okay, if that’s a 10, what is an eight. And he said, probably not wearing my seat belt anymore. So my veterans and I make the agreement that between zero and eight, we, collectively, the therapeutic alliance, can handle anything zero to eight. We can handle all of that ourselves. Anything beyond eight, we call in reinforcements of wives, friends, siblings, children, whatever that may be, that model has worked really well for them, because I don’t constantly screen them. Are you suicidal every single session, like some people do, because the bottom line is, questionnaires do not save lives. Relationships and rapport save lives, and since I have started functioning that way, I have knock on wood, I’ve never had a veteran commit suicide, but since I have started functioning that way, I have not put anybody in the psych unit. Now, there may have been one or two that went voluntarily, on their own, even without my knowledge, something happened over the weekend, some major stressor, and they would call and let me know, but we have the agreement that we handle things Monday through Friday, eight to five, and if they need to call me on the weekend, if they have an emergency, they can do that. But that is so rare, I think I maybe get one of those a year if that because we learn that suicidality is a part of trauma, and that just because we feel it doesn’t mean that we have to validate or engage with it, and so remembering that by the time they get to you, they are on that suicidal spectrum a lot of the time they’ve already attempted or they think about it continuously, and being confrontational with the thoughts and saying it’s okay to feel that way, but it doesn’t mean that you have to act on it. Those are really important discussions to have with the veteran population, because the numbers say their suicide rate is at 22 a day. I don’t know how much you read or research, but there was a program that did some data and statistics, and through time, I think 2012 to 2018 they discovered that the VA was falsifying data, and the real numbers are about 39 a day. So suicide is a big deal, and it’s it. I think it all goes back to how you approach it. And again, of course, the client’s autonomy, but realizing that they are well beyond the standard client when they walk in your door is important to know they’re not coming in because they’re mildly stressed out. Middle aged women about a work relationship or something that’s going on, you know, a change of life process. They’re coming in because they’re miserable and they are at the end of their rope.

 

Kim Howard  27:32

Yeah, absolutely, that’s that’s good advice for people to remember, especially in the clinicians who might be listening to to the podcast, our son lost a good friend in junior high school to suicide, and so for a number of years, we used to participate in the Out of the Darkness Walks. I know that’s a it’s a difficult subject for people to discuss, but I am glad that you have given us some perspective on on that issue with veterans, because, yeah, the statistics are always put out there about about veterans and the numbers, and, God, that’s depressing as hell. So…

 

Lauren Rich  28:09

Yes, and, you know, there’s something odd for me. It always has been odd for me, it’s a very comfortable topic. I don’t know if it’s just because of the language or the audience I’m so used to dealing and working with them, or, you know, being married to a veteran family. I don’t know what it is, but I don’t have any qualms. I have no fear about discussing suicidality, because I know I’m not planting a seed. They are already well ahead of me on this thought process and this plan, but so many of them are afraid to say something, because they’re afraid they’re afraid they’re going to be locked up. And I don’t blame them, because a lot of times that is exactly what happens. So in generally, the first or second session, I outline my spectrum for them, and we make an agreement. And this is how the process works. And I don’t like to go to the psych unit. I don’t want you in the psych unit. There is nothing that you and I cannot handle, that is not fixable on an everyday basis. And I think over time, I have figured out that most of those folks are making split second decisions when they’re under the influence of something that they normally would not make that decision otherwise.

 

Kim Howard  29:19

Correct. Lauren, how do you manage and adapt indirect therapy for clients experiencing mood swings or instability?  Oh boy, that is an excellent question, because irritability is a huge piece of PTSD. So we can take the irritability and we can make that a target, which I do quite often, you know. So again, let’s say you have some irritability issues in dealing with your child. Let’s say you have a screamer of a kid who just is learning to hear their own voice, and they’re little, they don’t realize what they’re doing, and it is just grating on your nerves, and you have to take a break frequently to go mow the lawn, even if it’s been mowed three times before. So one thing is. Remembering to, you know, find the target of irritability. Where is it at in your body? How do we work to soothe that or calm it down? And then is it possible that it’s relating to something else, like a deeper belief of, I’m a failure as a parent, or I’m not a good person, or I can’t meet my kids needs, whatever that may be. But again, that goes back to those future templates of, okay, well, next time when she starts to scream and holler and you feel that irritability, how do you want to handle it? What do you want it to look like? And I can tell you just from personal living experience, my husband has a few months that are a struggle, and he had a best friend who died april 25 and so that month of April is a struggle, and he’ll have some mood swings and some grief and things that he’s not even aware of, but then he’ll say something. I’ll say, Well, yeah, it’s April. And then it finally clicks. So sometimes you have to step back and again for certain deployments, if it’s Iraq and it’s been 130 over there, and you come back and you live in South Carolina or Oklahoma and it’s crazy hot that can make you irritable in itself. Sometimes there’s the mood swings because they’re not sleeping. Well, that’s the other piece of it that I think is important. Research has shown as recently as 2015 that of those who deploy even if they do not engage with the enemy, of those who deploy 69.2% are more likely to have some sort of obstructive sleep apnea. And so with that being said, if they’re not sleeping well, it may not be due to PTSD symptoms, it may be due to sleep apnea. So always and forever, send them to get a sleep apnea test and see how it comes back. And I say that because that, in my opinion, is is a miracle fix. And I tell them, this is the shortest way from point A to point B in fixing your mood. And no, it’s not a pill. All it is is oxygen. And once they hear that, they’re more open to it. And I can tell you of the dozens that I have submitted over the years, I can count on one hand how many did not have sleep apnea, but three of them had some sort of ENT problem, and one of them actually had a spinal cord injury that he didn’t know about that was causing a limb movement in the middle of the night. Every three seconds one of his limbs would move, involuntarily, It wasn’t apnea, it was, it was an injury. So please assess for sleep apnea and PTSD, because there’s such a high correlation. And remember that they may not meet. Need a medication for sleep, or it may be making an apnea worse. There are some that do make the apneas better. Trazodone is one of those. But go have them assessed. It never hurts to have them assessed. I will say, for any parents out there, I feel like all of us feel like we’re not doing a good job as a parent. I mean, I I’ve never met anybody who says, Yeah, I’m the best parent out there. My kids are great and I’m doing a bang up job. You’re always, always second guessing what you’re doing as a parent. You know, you’re like, Did I do the right thing? Did I make the right decision? You know….

 

Lauren Rich  33:01

And, with major trauma of distorted perceived failures, and then you’re just a failure at everything.

 

Kim Howard  33:08

Yeah, and I also will say my my husband, has sleep apnea. He was diagnosed in 2014 and he was waking up 38 times a night the sleep study now, he was not a combat veteran, but he just had sleep apnea, and let me tell you, his life changed the once he got used to the CPAP machine. It did take a few days, but we won’t travel anywhere without that. Yeah, it’s really made a difference.

 

Lauren Rich  33:31

Yeah, they, they are amazing, even non combat veterans. So my brother-in-law is a was a naval navigator, which means that they’re the second guy in the plane. They’re not the pilot, they’re the navigator, and he and all his navigator buddies, you can go into any of their houses and walk into their bedroom, they’re all going to be very fit people. They all have sleep apnea, yeah, because of a job and so sometimes, and I still think that, let’s take the research and use logic if this applies to veterans who have deployed and not even engaged with the enemy just because of the heightened work that they do and being over there all the time and the constant arousal, would it not apply to police officers, paramedics, other populations, or even those that just work nights consistently, you know at a certain point when it works for one you would think that that same logic should be and can be applied to other populations.

 

Kim Howard  34:24

Yeah, and I can tell you, as a menopausal woman, not having good sleep makes me go from zero to completely out of my mind within, like, 0.1 seconds. I mean, it just that is like the goal every night is to try to try to get a good night’s sleep. And if you’re not, and you don’t know that you have sleep apnea, or you’re having some kind of Restless Leg Syndrome or something that’s physically happening to you, it’s, it’s, of course, you can’t function. So I’m glad you brought that up.

 

Lauren Rich  34:52

I would assess you for Pete, or I would assess you for sleep apnea, and then we would do a target and a future template on, okay, what happens when you wake up tired? And you’re frustrated, you know? How do you want to handle that? What do you want it to look like and giving people those tools to get through? What will show up? You know, it kind of goes back to you will have nights where you don’t sleep. You will have days where you hear voices. You will have days where you’re suicidal. Stop thinking that these things will go away, and learn to have a relationship with them.

 

Kim Howard  35:22

Absolutely. Thank you. Are there any myths that you would like to bust about working with EMDR therapy and male veterans? You’ve already alluded to some of them, but there may be more.

 

Lauren Rich  35:29

So really, just the fact that they don’t know about it, it’s not offered very much. And even on the National Center for PTSD website, it, in my opinion, is my humble yet accurate opinion, is very downplayed about the greatness that it is, and that is because the other two got a foot in the door ahead of them, and they are contracted. And you know, the world is about making money. Therapy is no different modality is you’re about making money. And so you will find that a lot of times you’ll sit with a veteran and you’ll say, Have you heard of EMDR? And they had, I have no idea what you’re talking about. Yeah, I’ve never heard of that.

 

Kim Howard  36:03

All right, well, we’re doing our best to get the word out there.

 

Lauren Rich  36:06

So, absolutely, converting one clinician at a time.

 

Kim Howard  36:09

Tha’ts right. Lauren, what would you like people outside of the EMDR community to know about EMDR therapy with this population?

 

Lauren Rich  36:16

Oh, it’s amazing. Again. There’s hardly any talking. You don’t have to disclose anything you don’t want. We can kill multiple birds with one stone. We don’t violate your top secret security clearance. There’s really no reason for you not to go take care of your business, because this is a very kind and gentle way to take care of it. And I will self disclose and say that my husband is a veteran who has struggled, and he recently started seeing a neighboring EMDR therapist up the road, and he came back from therapy a number of sessions, and he said, I just thought you’re full of crap. I thought you were just full of BS. He said, I don’t know what it is, but it works, and….

 

Kim Howard  36:58

…That’s because you’re the wife and you gave him the advice, that’s why. Yes. And she is such a great clinician, well trained, EMDR, she went to KU just like I did. But I think she, I think he was her first veteran, and he was probably a really intense case for her as where he’s everybody I see. So it wasn’t anything new. But he comes back and he said, Man, that stuff is amazing. You know, whatever she does, and, you know, I feel better and I’m not as anxious. And you know, we actually go out to we actually went out to dinner once in the in the recent past, which is not a norm for us. And so you can actually see the benefits of those things. But yeah, even my husband said I thought you were full of BS.  So you’re not full of BS.

 

Lauren Rich  37:39

Well not with that anyway.

 

Kim Howard  37:43

Lauren, how do you practice cultural humility as an EMDR therapist?

 

Lauren Rich  37:47

Oh tha’ts easy. So I grew up in Indian country, and one still work with Indians. And again, one of the perks with EMDR is there’s very little talking. And you’ll know if you’ve met a lot of cultural Indians that eye contact is horrible, horrible in the white mind, and the Talking is horrible in the white mind, you’re not going to get very much out of them. And that could be true even in African cultures or various tribes, whatever it may be. So I’ve had people who one fella drove almost two hours to come see me and walked in with a bag of medication, and I had to break his heart and say, I don’t write prescriptions. So the hour we spent, I called and facilitated for a new prescriber. That was part of it. The remaining 45 minutes, we worked on the distress of not getting what he needed fixed, and we did that with the light bar, and we actually ended up with the color orange because it reminded him of fire. And we got him down a ways before he got back in the car. And while that man said very little, and I have never seen him again. At the end of the session, he said, I’m glad we did that, because I would have been upset driving home. I think EMDR is great. Cross culturally, I have other people that I see that are, you know, Cherokee specialists or linguists or whatever. They have different preferences and different approaches. It’s just not a talkative culture, and don’t take it as non compliance or unwillingness to cooperate. There. We’re just not talkative people. And so using EMDR in that realm also totally undersold. I think it could be sold much more to people in the tribal world than it is. Yeah. Currently,

 

Kim Howard  39:17

yeah, we’ve had Shelly Speah Chief on she’s a EMDR member, EMDRIA member in Canada through EMDR Canada. And we talked about EMDR therapy with Native American cultures, populations. And one thing that she had mentioned, and I’d never thought about this until she said it on the podcast, and she talked about the light bar and and how, you know, you have to kind of know there are certain colors that people may not want to use, right? And one of them is red and blue, because those are usually police colors. And people, if they’ve had any kind of negative experience with law enforcement, or they’ve had some kind of tragedy happen, you know, even with emergency personnel, they don’t want to see those colors, because they can bring up a negative connotation.

 

Lauren Rich  39:57

I have a couple guys who did work on a submarine. They decline red immediately.

 

Kim Howard  40:02

Yeah, yeah, I never thought about that. So you kind of got to know your audience. So that’s, that’s good advice. Thank you.

 

Lauren Rich  40:08

it’s, it’s a great tool for them. I use it for a lot of people. Again, the future template piece, and, oh, you have to realize that with the cultural piece of EMDR, when we’re talking about imagery, you know, and we always know not to be suggestive, but understanding. For example, in Oklahoma, at least owls are inviting death. So it doesn’t matter if you’re Cherokee or Osage, I wouldn’t have an owl in your office. I don’t have any in my office. And I remember growing up with a girl from school who her mom would not let her take the science textbook home because it had an owl on the cover. So there you go. Could you keep those things in mind? And it’s okay to ask, because my tribe is not your tribe, and everybody did it differently. So it’s okay to say, I know it’s this way in Cherokee, but is it this way in the Choctaws? Unless I know it’s not, or I don’t know, or, you know, whatever.

 

Kim Howard  40:57

Good advice. Thank you. Do you have a favorite free EMDR related resource, you would suggest, either for the public or other EMDR therapists?

 

Lauren Rich  41:05

A free one? Oh man, I’ve paid for so much. I always think that the the [EMDRIA] brochures are helpful. I keep those in my lobby, the one for the military with the myths on it. I keep that one in my lobby, and I keep a couple others that are just very brief, but I always, or almost always, send the injury a video where they explain where it has Carol from Dallas and Marisol in it. Those clinicians, yeah, we either watch that together in the very early sessions, and I answer questions and we actually pause in the middle of the video. And so I will highlight the brain and say, This is what’s going on. This is your smoke detector. It just doesn’t understand if you’ve burned the toast or the house is on fire. This is what is happening in your brain. And that video, I feel like, helps tremendously. Like I said, I show it, if not every single time, almost every single time, or I send it home with them and they are I asked them to watch it before the third or fourth session.

 

Kim Howard  42:04

Yeah that’s great. I will put those resources in our podcast description so people can take a look at them. Lauren, if you weren’t an EMDR therapist, what would you be?

 

Lauren Rich  42:13

That’s such a great question. I honestly don’t know. Some days I think I pick a job without people….

 

Kim Howard  42:18

I know. When you find that, let me know.

 

Lauren Rich  42:24

But my husband and I also farm, and so we do wheat, corn and soybeans, but we also have an orchard, and so I really love that, and I think I would just probably do that full time, and maybe, maybe someday I will, and I’ll have a reduced practice, and I’ll get to go do that. But I always told people when I was a kid, I was a kid, I just said, I want to be a professional volunteer. I just didn’t realize that there was a license for that.

 

Kim Howard  42:47

Here we are. I like it. I like it. Is there anything else you want to add?

 

Lauren Rich  42:50

Nope, it’s just amazing. And you know, if anybody has any questions, they’re always welcome to email me at office@laurenrich.net, or message me internally on the directory system. You got to give it a chance, but you know, you have to understand where the client is coming from, and there’s going to be some hesitation. And you know, again, they may have been through therapy before in the past that didn’t work, so they’re going to be skeptical. So don’t take it personal. Just work to earn their trust, and then the rest will fall into place. Oh, and assess. Assess. Assess.

 

Kim Howard  43:19

That’s a great way to end the podcast. Thank you, Lauren.

 

Lauren Rich  43:21

Thank you so much for having me. It’s been a pleasure.

 

Kim Howard  43:23

This has been Let’s Talk EMDR Podcast with our guest, Lauren Rich. Visit www.emdria.org for more information about EMDR therapy, or to use our find an EMDR therapist directory with more than 16,000 therapists available. If you like what you here, please subscribe to the free podcast wherever you listen, thanks for being here today.