What Happens Behind the Therapy Door

Dr. Leah Blain is a clinical psychologist and the Clinic Director for the Steven A. Cohen Military Family Clinic at the University of Pennsylvania. The Cohen Clinic is a mental health clinic available to any veteran or their family, regardless of discharge status or how long you wore the uniform. While Dr. Blain is located in Pennsylvania, the Cohen Clinic has locations throughout the country, so check to see if there is a location near you with the links below.

In this episode, we pull back the curtain to discover what it is like behind the therapy door. We walk through everything from the initial phone call, the first few meetings, and how to decide on a course of care.

We also dispel any myths about therapy to help ease the minds of those who are on the fence about seeking mental health treatment.

Links & Resources

• CohenVeteransNetwork.org
• Connect to a local clinic
• Cohen Clinic at the University of Pennsylvania
• Cohen Clinic at UPenn on Facebook
• Cohen Clinic at UPenn on Twitter
• Cohen Clinic at UPenn on Instagram

Transcript

Scott DeLuzio:    00:00:01    Thanks for tuning into the Drive On Podcast where we're focused on giving hope and strength to the entire military community, whether you're a veteran, active duty, guard, reserve, or a family member, this podcast will share inspirational stories and resources that are useful to you. I'm your host, Scott DeLuzio. And now let's get on with the show.  

Scott DeLuzio:    00:00:23    Hey everybody. Today, my guest is Dr. Leah Blaine. She is the clinic director for the Steven Cohen Military Family Clinic at the University of Pennsylvania. She's here today to talk to us about the Cohen Clinic and what happens behind the therapy door once you get inside the room. So welcome to the show. Why don't you tell us a little bit about yourself and your background?  

Leah Blain:    00:00:45    Awesome. Well, thanks so much for having me. This is such an important topic broadly and something that we really like to talk about as a team. So my background is, as you mentioned, I'm a licensed clinical psychologist. I currently head the Cohen Clinic at Penn, which we can talk more about what that is as we go, if that's helpful. My background is really from a tremor recovery model, all of my clinical work focuses on trauma recovery, started in the civilian space using what we call evidence-based practices. So, treatments that have been tested for the diagnoses that we're using them for. We know that we're giving folks the best chance to meet their goals and feel better as quickly as possible. That took me into working at the VA, worked at the VA in Baltimore for my internship and fellowship and really fell in love with serving service members, got to really know the population of it. There, opened a clinic down right outside of Fort Meade in the Columbia, Maryland area. I got to work even more with veterans and military family members there and then had the opportunity to come up here and open up the Cohen Clinic. So we provide evidence-based behavioral health care for no cost to veterans and military family members which is a pretty amazing opportunity. So yeah, that's a little short about me.  

Scott DeLuzio:    00:02:08    No, that's great. And I like the quick intro to what the clinic is all about. I do want to get more into that a little bit later on so anyone who's listening and interested in finding out more about that, definitely, stay tuned in this episode because I do want to get to that, but I wanted to have you on the show today to walk through what happens behind the door. When someone gets into mental health therapy, counseling, whatever you want to call it, I know it won't be a hundred percent the same for everyone, different people, different issues, different things that you might be going through with each individual. But if we could, I'd like to walk the listeners through what happens behind the door. Maybe let's start with the first meeting between a patient, and their psychologist. I'm sure some introduction period is going to happen there. So, maybe we can talk a little bit about that and see what that's all about.  

Leah Blain:    00:03:12    I love it. Yeah. And I think I might, even if it's all right, I would even start before that first session, because I think that's often such an intimidating factor for folks is like, how do I even find who to call, where do I go? How do I even launch into this journey? And so that I would say is probably one of the harder parts that we often end up navigating folks through fairly often, whether that's coming to us or going to other resources. And so a lot of folks will call their insurance provider. If they have one or for folks who are VA eligible, then we start there asking their primary care provider, if they have referrals, right. There's all these different on-ramps to care.  

Leah Blain:    00:03:53    We can send some of these resources. One of the ones that we really like is called psychology today. So if you're looking for a provider you can sort out their specialty area, their insurance, their geographic area. So just a really great, in your hands, easy access resource navigator for folks. So however you do call wherever you're calling, usually it's a call, sometimes an email. I do think it's helpful to also have a sense of what you're looking for. So some people are looking for a little bit more structure, some people are looking to just kind of talk and get some support, and sometimes people don't know and that's totally fine too. So, that’s where things then start to not look the same and different.  

Leah Blain:    00:04:39    So often it's, you make an initial call, somebody might schedule you straight away. Other times, like in our clinic, we'll actually do a little screen on the phone, it takes 15, 20 minutes, really to get a good picture of what's going on with that person. Are we the right services first and foremost, we usually are if they've reached us and then really within our clinic we have a lot of expertise. So making sure that that person is getting staffed to the clinician who has expertise with whatever it is that they're coming in to talk about. But also there's just that little bit of fit too, right? So our intake coordinators are fabulous. She'll stop somebody to say, Hey, they had more of a chill style. They might mesh well with this person versus like this person's a little tougher.  

Leah Blain:    00:05:21    Maybe we'll go over here. So hopefully that first fit is a really great fit and you go from there and you're all well and good. We do encourage people that if you've gone through 1, 2, 3 sessions and it's really just not feeling right, probably by that three session edge, if it's not feeling like the right fit, you can work with that organization to potentially get referred or try another provider doing therapy in a half-step kind of way where you're not all in because you don't really have full trust in the person and  this doesn't tend to work. Any therapist worth their salt knows they're not going to be the right fit for everyone. So we're not going to take offense. All of us really want that person coming in to get what they need from it.  

Leah Blain:    00:06:05    So don't worry about offending your provider on that front, please. We would much rather see you get your needs met. So once you're in that first session, what the heck does that look like? So normally session one, I'd probably say that 1, 2, 3, is that getting to know you phase? So the clinician is typically conducting an assessment, just really trying to get a sense of what's been going on for you recently. Where are the challenge points? What are your goals, right? Like how will we measure success? How will we know if we get there and usually some history as well, because that's going to inform typically the game plan. So, folks will need to know if you have had a history of other treatments or any problems learning as a kiddo, right.  

Leah Blain:    00:06:50    If you say, oh yeah, I got held back to the grades because I can never pay attention. Wow. Okay. We might need to update our game plan to make sure that we're making sure that you can keep up on your appointment reminders or whatever the case is. So just a lot of that pertinent info. So it's a lot of info gathering from there; once you go through that assessment, you figure out, Hey, as a team, we've decided these are the concerns that are really bothering you. So I'll give an example. Like if somebody comes in, I've been feeling down, I’m  able to get out of bed, I go to work, but I'm just not feeling like myself, right. We're going to dig in. Are there stressors that have just come up?  

Leah Blain:    00:07:28    Are there things that have changed in terms of a pandemic, maybe you can't get to the gym like you normally would. We're going to build out that conceptualization together to figure out, okay, what's going on? Where do we think it came from? But more importantly, what are we going to do about it? And I would say in our clinic and in clinical spaces, you're going to find that you'll have that conversation together. Here's what the game plan is going to look like. You know, here's what we would recommend. How's this sound? And then we're embarking on that journey together. Right? We have a lot of expertise in therapy and our clients are the experts on them. We put that together and we can get to our goals. Other spaces, I'll be honest, are a little bit more flexible or maybe a little less structured.  

Leah Blain:    00:08:11    So it might be more of that kind of supportive therapy. You're coming in chatting about the problems of the day or week. There may not be that kind of overarching heading towards that goal. You know, we're going to measure our time points, see how we made progress. We anticipate changing the game plan. So we're on the more structured end, I would say very much on the structured end. And there are lots of things that are on the less structured end as a clinic that is more structured. We're also having a conversation with, if people are like, I just want to come in and be able to have a space to talk. That's not us, but we're going to help you get to that place. So that's at least through session three or four.  

Scott DeLuzio:    00:08:55    So, my goal anyways, for this episode, and a lot of other episodes that we use to talk about mental health is to break through that barrier and reduce the stigma and the that fear of the unknown that people might have where they're like I don't even want to pick up the phone and call because I don't know what's going to happen. Am I going to get thrown into some institution or something like that and get locked away, or people just don't know necessarily. So, none of that's happening so far in this whole process. You've gone in for three or four sessions, you're getting to know the provider that you're talking with and everything seems like it's almost as if you're going to a dentist or a doctor's appointment; you're going in for maybe 45 minutes or an hour. And it really doesn't seem all that scary at this point. 

Leah Blain:    00:10:02    Well, you know, I am a very intimidating beast, so I don't know if you picked that up.  

Scott DeLuzio:    00:10:06    I picked that up.  

Leah Blain:    00:10:09   I get that. I think that there is that fear of the unknown and I like that parallel you drew, because I think we think about that a lot as kiddos, right. You know, by the time we're leaving our parents' house, it's our own decision. But typically folks have had an experience of going to the dentist, going to the doctors. There is no parallel for therapy, right? So even though we know mental and emotional wellness is critical for our overall functioning in every domain of our lives, we don't have that baked into the kind of how we bring people up, whether you want to call it like the medical or the wellness kind of mindset in our culture. And so that's okay, but it does create another barrier of, as you said, just the unknown.  

Leah Blain:    00:10:52    I think often when people are thinking about mental health, behavioral health whatever folks like to call it, they're essentially synonymous. It's like minor technical differences, but it's essentially the same thing; they think about that extreme end, right? They think about people having a “breakdown “or a suicidal crisis. And those are important. Certainly if somebody is at that place, we want them to call straight away and we want to give them all we can. But we really like to think about that continuum of care and continuum of wellness. So I want to work with somebody in crisis because I want to help them stabilize and get to a better place. I also want to work with somebody who has been in a funk for a bit, and we can get ahead of that becoming an even more chronic problem, right?  

Leah Blain:    00:11:41    Or an issue that's going to recur or worsen. I also want to work with people who are just having trouble, right? So you've transitioned out of a military setting and you're in a classroom full of kids that are 10 years younger than you, and they don't pay attention and respect the professor and it's driving you up a wall. All good, come in for that, because we have folks that we've worked with, who've literally dropped out of classes because they couldn't stand the culture clash. And that closed the door for them. Nobody else got hurt with them at that moment. So is that a huge major mental health problem? Is that going to be hospitalization? No, but gosh, did that impact your life? And wouldn't it have been cool if you had been able to keep that door open? So I would think again, we really like to look at whether it's a moment of crisis or you're just in that surviving, not thriving, or there's just a little tune up, a little something that you could use some support on. There's really never a wrong time to come in.  

Scott DeLuzio:    00:12:42    Yeah. And the way you described it, sounds almost like you would go in annually for a physical.  

Leah Blain:    00:12:53    I wish. They won't come in annually for mental health treatment though. 

Scott DeLuzio:    00:12:56    No, exactly. You might feel like you're okay. You might feel like physically for a normal doctor's appointment that you might go to, you might feel okay, but then the doctor notices something that's wrong. And so then they help you and they get you the treatment that you need and you get better ideally, and you move on. And so you might feel okay, but there might be some warning signs. And so going in to just a checkup every so often would be a good place to start and then you can maintain that mental health. So, just because you're feeling fine right now doesn't mean that six months from now, you're not going to be heading down a path that's going to be sending you in the wrong direction.  

Scott DeLuzio:    00:13:49    I think that that's, that's a great way to think about it and to put it. After those initial few sessions, you determine the course of treatment that's appropriate for the patient at that point. So, can we go over maybe a few of the different treatment options that might be available and what some of those might entail? I looked on the Cohen clinic's website and saw a few treatment options that I was familiar with and some that I was not so familiar with. And so maybe some of the guests might not be familiar with these either. I'll just throw some out there and see if you can talk about a few of them like cognitive processing therapy, who's it designed to help, what's the process that a patient goes through, those sorts of things?  

Leah Blain:    00:14:45    Well, I don't know if you picked my favorite treatment, but you did. In fact, I am hook line and sinker total I'm hardcore believer in CPT, in fairness, I believe in all evidence-based practices. And I will believe in any practice that becomes evidence-based in the future, because I just think it's the right way to go. Cognitive processing therapy is a great example. So that's one of the two frontline evidence-based treatments that we offer here for post-traumatic stress disorder in particular. And we offer, as you mentioned, a whole range of treatments for a whole bunch of different things, right? So it could be from that, we talked about that adjustment, these kids are driving me up a wall kind of thing. It could be forced to reality. It could be for PTSD, depression, not getting along with your partner.  

Leah Blain:    00:15:30    So many different things that bring people in, sleep, anger. So again, I think there's no wrong place to start. If you're not feeling like you, if you're having trouble sleeping, if you're feeling irritable, whatever the case is, you don't have to know, Hey, I think it's PTSD. And I think I need CBT, just call if something feels off and your provider is going to help you. Because they have that expertise to say, Hey, based on what you're coming in with, it sounds like this might be going on and we're going to check and make sure. Does that sound right? Or am I missing something, right? I'm not going to say you have PTSD. Nope. This is the stuff you're telling me about. Sounds like it could be PTSD. Does that jive, usually that really does. We'll walk through [the process], we share videos, handouts.  

Leah Blain:    00:16:13    We really make sure that folks are informed about what that means, because that's your legal, medical record. We want to make sure it sounds right. and if we're in agreement that, “yeah, Hey, I thought I was just snapping at my partner and not able to sleep, but now that I'm thinking about it, I do spend a lot of time avoiding thinking about what happened when I was deployed. And I am waking up in volts, but sometimes, and I don't always remember my dreams, but when I do go, Ugh, that's what it was. And I don't feel like myself.” If we see all these things, start to hang together that on their own, maybe those weren't the things that were driving the anger, well, if we really feel like, oh gosh, okay, that was the tip of the iceberg.  

Leah Blain:    00:16:53    There's this other piece that's actually in some ways, great news. So if we say there's all these differences, sometimes the thing with PTSD is once we start addressing the trauma and tackling the PTSD, all those different symptoms also start to fall away together. So it's a package deal. So we don't have to address the sleep and the anger and the nightmares and the avoidance and the not feeling like yourself, or we can do that altogether. With cognitive processing therapy in particular, just as an example and we walk through the whole process we're going to give folks options. You know, these are the one or two treatments that we would recommend; how do these sound? Cognitive processing therapy is just a fabulous treatment that really helps with a trauma focus lens, but then also helps folks develop tools that they can use in their everyday life, which is why I really love it in particular.  

Leah Blain:    00:17:49    When I talk to my clients about this, we talk about the idea that we have to go back to go forward. There's something that got stuck within that trauma recovery. So you were deployed, you had that first combat experience, you came home. I'm thinking of folks that I've worked with over the past year who came back. Things were not feeling perfect, but you know, deployed again, came home, maybe transitioned out of the military and now, things are starting to unravel in the marriage, not feeling like yourself, you are down more often, things start to unravel at work, right? Like these kinds of pieces that start to string together so we have to go back and figure out what changed back then? What was so impacted that you started not feeling like you and have all this stuff going on.  

Leah Blain:    00:18:35    And typically there's some guilt, blame or shame around something that happened with respect to a trauma. And so we talk about shoulda woulda, coulda. That thread that runs through people's minds. And so we go back, we talk about what happened, but we talk about what happened in the service of unpacking. What are all those thoughts that you've been carrying around with you that are eating at you that are sinking the ship. Because nothing's heavier than guilt. Once we sort through, unpack some of that and nobody's gonna make it sunshine and roses. So for myself as a provider, I'm not going to tell somebody, “Hey, you saw something truly horrific, but it's okay.” That's not gonna work. That's not true.  

Leah Blain:    00:19:19    It's awful. And that happened. And we've got to figure out how to move forward with that knowledge. With that experience with us, how do we carry that? We can't take it away. We can't ignore that it happened because it doesn't work. So how do we move forward in our lives with that knowledge? And then that's really, the second part of the treatment is looking at the current state and looking forward, how does trauma tend to impact how we see the world? So I used to feel safe and I don't anymore. I used to trust people and I don't anymore. I used to feel okay about myself, right? So all those themes that can really get so impacted by just this huge event or series of events that really kind of unraveled somebody's world for a minute. So, that's where those kinds of skills prevent any challenge that somebody might run into.  

Leah Blain:    00:20:10    It may not need to be trauma related, “Hey, there's this jerk at work and it's really errr!” And you want to have somebody have those tools to say like, “okay, I haven't told this to lean on any stressor that comes my way. So we start with the trauma, but we really try to give somebody a lasting toolkit. They can take with them into the future. So they don't have to be in therapy forever if they don't want to, they can have an additional skill set that they didn't have when they walked in.  

Scott DeLuzio:    00:20:35    That's great. And I think that's a good overview of how that will help, that particular form of therapy would help. Now what's the difference between cognitive processing therapy and cognitive behavior therapy?  

Leah Blain:    00:20:48    Excellent question. CBT, cognitive behavioral therapy is a big umbrella of different forms of therapy that fit under it. So the idea with cognitive behavioral therapy is kind of a big picture is pretty cool. It's the idea that when something happens, our thoughts and our emotions and our behaviors are all linked, right? So if somebody cuts me off in traffic and I think bleep, bleep, bleep bleep about that person. And then I'm pretty pissed. And then maybe I will start driving a little more aggressively. Well that was a series of cascading series of probably small things. I didn't even really notice. All linked together. But if road rage is a problem for you, and if you're getting in trouble or putting yourself in danger, then touching that first guy and checking in and saying, okay, yes, that guy is (insert bleeps here).  

Leah Blain:    00:21:53    And is it worth it for me to get so upset about it, that I put myself in danger or if you're a believer, legal repercussions, whatever the case is. So stopping that in that moment. So that's where that power CBT is. We can either address what we're doing. I am mad and I'm not going to follow that person, or I'm going to address the thoughts so that the rest of it loses its power. And you can see where CPT is just a really trauma focused version of CBT. We just focus on the trauma because we know that was a super impactful event that really shaped how we tend to see things.  

Scott DeLuzio:    00:22:35    Yeah. That makes sense. And controlling your emotions and your thoughts which ultimately influence the behaviors and all of that stuff. It is sort of cyclical where  all of those things kind of play into each other. And then when you think this bad thing about the jerk who cuts you off on the highway, that's your thought. And then your bet that gives you that negative emotion. And then that gives you the behavior of driving faster or more aggressively. That's just going to trigger even more different thoughts about the next person who seemingly did you wrong or whatever, right. 

Leah Blain:    00:23:17    Because you are already in a bad mood, you have that mind frame on, then you get to work and you perceive something neutral as a snub instead of just neutral. It is it's self perpetuating.  

Scott DeLuzio:    00:23:28    Yeah. It is. And then by the time you get home that night you're yelling at your kids or your wife or you know, whoever is at home for you. And is that really any way to keep going with things. So, it seems like that's a good way to divert the flow of the stream if you will. So it doesn't go down the waterfall and crash down and it just continues to the lake where it belongs, you know?  

Leah Blain:    00:23:58    I hope it's also inserting choice, right? So I think that's something that's really important. I'm not going to do therapy to someone. I'm not going to make them have different thoughts or emotions, but I think building in the skillset so that you have the opportunity to pause and say, is this what I want? Is this worth it? Is there something else I can do differently if I want to? And I think for a lot of the folks I work with very often, the answer is I do want to do something differently and I want them to feel really empowered if they're like, “Nope, this person deserves whatever's coming,” fine. That's your choice as an adult human, hopefully, you know how that's going to go. But I do think a lot of the folks that I work with when things have gotten to that point is not feeling in their control. It's not feeling how they want it to feel. And so it's getting that kind of ownership of their experience,  

Scott DeLuzio:    00:24:49    Right? And like you're saying, you do have the choice and there are certain circumstances where things should upset you. And that's probably a normal, healthy response to the situation. So, this is the goal, this is not obviously to shut off all emotions and make you numb emotionally and just not feel anything, it's to be able to have control over those emotions once you recognize that you're experiencing certain circumstances.  

Leah Blain:    00:25:20    Exactly. Right. Yeah. And just like you would if you broke your leg, it would hurt. And you would use that sensation to let you know, you probably need to do something differently. You know, we use emotions the same way in therapy, right. If I'm feeling angry all the time or scared all the time or down all the time, that's my emotions telling me something. If I'm feeling guilt we may or may not end up keeping that emotion, but it usually means something big happened. Then I need to wrap my head around in some way, shape or form. So that's how I think of emotions. They really are that guiding light. And that initial kind of, okay, pause, let's, let's check this out.  

Scott DeLuzio:    00:25:58    Now another treatment option that you guys have on your website, is prolonged exposure therapy. And I know a little bit about this. I had a guest on the show around this time last year, who talked about his experience as a patient, with this form of therapy, but from your perspective what is the process like, what is it that you do for this, who would be a good candidate for this type of treatment, I guess, and what's the ultimate goal for it?  

Leah Blain:    00:26:30    For sure. So, I do want to just kind of harken back to that continuum conversation. So we're jumping in with some of our heavy hitters, which is great. I think for folks where this course of treatment is needed, it's truly life changing. And I think often in a shockingly small amount of time I worked with a woman on the civilian side, she had experienced a gunshot wound in the community that impacted the rest of her life. So I was working with her for decades after her trauma. She had resolved not just the vast majority of her trauma symptoms, but didn't meet criteria for PTSD at all in under eight weeks. So, I mean, just sometimes it really does just happen that quickly. I feel like I have to insert one of those [disclaimers], “not indicative of all results”

Scott DeLuzio:  Right (chuckling).  

Leah Blain:    00:27:21    I think the fact that it can, is amazing to me and actually really what, as a provider, that's what keeps me moving, is wanting to get those awesome outcomes for people. So PTSD, again, we talked about there's really in the field, there's three leading treatments: cognitive processing therapy. We just talked about prolonged exposure therapy is kind of like Seminole, like the very versed evidence-based treatment for PTSD. And then EMDR, which is eye movement, desensitization and reprocessing. I always want to mix those letters around, which we don't do. We don't do it in our clinic for a variety of reasons, which say nothing about the evidence, it works. And so if  it feels good and you can get your hands on it, go for it. but so prolonged exposure is just another side of the equation of one of the treatments that we could use for PTSD that we have pretty good confidence that

Leah Blain:    00:28:14    it's going to really work for folks because it's been tested up one side and down the other in a whole range of populations, right? So just like CBT, it's been tested in active duty, it's been tested with active duty, it's been tested with veterans, right. It's been tested up and down the age groups. People who've had one trauma, which is actually exceedingly rare to see in treatment versus many, many traumas over many, many, many years. So both of these treatments are super robust really, really helpful for folks. And so prolonged exposure, I think it sounds even like for some people, I feel like it sounds a little more intimidating, like exposure, right. It sounds like it's, “oh, there's this spook factor there and so I think it really is, whereas cognitive processing therapy is kind of taking that top down.  

Leah Blain:    00:29:00    How did the trauma impact the way you see things? And we're really gonna break that down for prolonged exposure therapies work from the bottom up, right? It's like you went through this and you've been working really hard to avoid thinking about it, because normally when we're working with trauma, folks have really tried to put stuff away, bury it and lock it up. I mean, as far deep down as they can get it. The problem is for the folks that we're seeing that typically doesn't work and causes a lot of other problems. So with PE you know, we just cut to the quick and just say, okay, guess what we're going to do. We're going to talk about it. We're actually going to talk about what happened on repeat. And in addition to talking about what happened every session for several, we're also going to have you get back out in the community and reclaim some of that territory that PTSD took.  

Leah Blain:    00:29:46    Right. So you know, just to think about it, I'll pick a non-trauma exposure just to kind of give a similar breakdown, but if I had a fear of elevators, say I was stuck on an elevator for like an hour, I know that's not PTSD, but just go with a lighter example. I don't want to be a trigger for anybody, so say if you had been stuck on an elevator for an hour and so you were really scared of elevators, couldn't take them. So in treatment, what we would do is talk about what happened that day that you were in the elevator so scared and what were the worst points and how did that go and move to talk about it? Talk about it and talk, we say like wearing out the tape for people who are pre-digital era, we just wear out the tape.  

Leah Blain:    00:30:30    We just talk it through until the emotion that's connected with that memory can resolve. And it gives the opportunity to make some new sense of things that might've happened; so often people will say it's my fault because I left late because of this or that. And in terms of talking it through, it gives that opportunity to really look at it given all of the things that were happening that day, is that really right? So it kind of makes that space. And in the meantime, we're also working people up, say you work at the Comcast building and now you really need to be able to hit the elevator, right. Because you literally can't get to work otherwise. Well, we want you to be able to reclaim that territory. So let's think through what would be the steps to get you to take an elevator to the 50th floor of a building?  

Leah Blain:    00:31:18    Well, we're not going to start by taking an elevator to the 54th floor of a  building on a workday that's super crowded. We're going to start by, I might have you stand in a closet, right? The goal is not for you to be able to stand in a closet. The goal is for you to mimic that same stimulus, right? Have a part of that experience. Then I might have you go up in a tower or whatever really relates to that fear, to be able to reclaim that. And you can imagine, depending on the type of trauma, somebody went through those might be a number of different things, right. It might be being around people that you've been avoiding from certain groups. It might be smelling certain smells or hearing certain sounds that you can no longer tolerate or feel really anxious when they occur.  

Leah Blain:    00:31:59    And that takes a lot of space from people, right? Like if you're constantly worried when you're out with your family, if you're gonna run into somebody who looks like somebody that was there the day the trauma happened or hear a song that happened when the trauma was playing or that was playing when the trauma happened, right. You gotta be on guard all the time. And it's just so exhausting for people. So I think any little bit of bandwidth that we can help folks get back and we can usually help them get back a lot is just such a gift for themselves and their loved ones. You know what I mean? It's really, I think people come in like my partner was so psyched. I sat with my back to a door in a restaurant and really, that's a huge victory.  

Leah Blain:    00:32:42    We're going to celebrate that. And you didn't wind up late. You were actually relaxed, you were focused and present and didn't have your guard up the whole time you were at that dinner for your kiddo. How cool was that? So that's always got to have that. What is that light at the end of the tunnel? When I work with my clients, I want to have a picture. I wouldn't be like, you want to be able to do what you like, take your kid to a Phillies game. Let's do it. Like, that's the goal, right. Enjoy the Phillies game. It's heavy work. I think you really got to remember what you're doing it for. And again, it's possible to get there. I think it is often a lot faster than people think.  

Scott DeLuzio:    00:33:17    Yeah. And the guests that I had on, that I mentioned earlier, his thing was he didn't even realize at the time that he had any kind of post-traumatic stress or anything like that from his deployment, but he was at a party and there was a balloon there and it popped and it just triggered him. And that caused him to, if I'm remembering the entire story correctly, he just went off into a corner and he was in tears and he was just inconsolable at that point. But they went through this kind of therapy and like you said, the sounds or smells or things like that. And it's like the name implies, you get exposed to those things over time. You're not necessarily exposing the person to gunshots all the time but maybe popping a balloon and making that loud noise to get comfortable with that.  

Leah Blain:    00:34:11    Or listening to a recording online of a gunshot. Anybody who's ever heard gunfire will tell you, it's not exactly the same, but it's like it. So then if your car does backfire or fireworks and you just get closer and closer and closer to the things you want to reclaim, and you're right. We're never exposing somebody to a legitimate trauma. I work a lot with all survivors. We're not going to talk to the perpetrator. That's not on the list. No, they can eat it. And if you see them, you should definitely not go near them. Right. That's safe. Good, good. And do you want to be able to go near men? I think those are the pieces of territory that we try to reclaim. This is whatever instincts they have lost. It's pretty remarkable.  

Scott DeLuzio:    00:34:51    It sounds remarkable from what I heard from you here and then other people that I've talked to, it just seems like it's a great way to, like you said, reclaim that space in your life, and be able to live life without being in fear, constantly over whatever the trauma happened to be. So now is there ever a point in the process where you might say this isn't working, maybe this person needs some sort of maybe a medication or something like that to help them get over this hurdle so that these treatments can be more effective for them, or do you recommend that for patients or is it just in certain circumstances? Like what does that look like?  

Leah Blain:    00:35:40    Sure. So I think that's one, that's been very, really widely based on who you see the context they're in. So I can certainly answer for myself in our clinic. We're very lucky to have just an amazing psychiatrist on our team. So we have medication management as an option for any of our clients who are interested. But I think the way that we practice is again using not really evidence-based models. So for something we've been talking a lot today about PTSD. There actually, if you look at the clinical practice guidelines for post-traumatic stress disorder, actually psychotherapy talk therapy is the gold standard. Medication can really help to manage certain elements of the symptoms. So for example, there's a medication Prazosin, which is incredibly helpful for a little over half the people who take it with nightmares, right.  

Leah Blain:    00:36:37    And has a pretty low side effect profile. So heck yeah. If you're having that problem, that's losing sleep, you're angry with the kiddos, all those things we talked about, and that's something you're interested in, there's no reason not to get that on board, get you some sleep back, even while we're going through the the CPT or the PE. And then maybe once you wrap up with your psychotherapy, maybe if you might decide, “Hey, I want to actually step that back or see how it's going without that.” So that's always an option there. I think it's really important to think through how medication and psychotherapy can be used together, but always in our setting. And I hope in any setting our client’s driving that decision making model, so we'll have some recommendations.  

Leah Blain:    00:37:22    To say, “Hey, you know sometimes, and it really is based on, I think a little bit more where that person's at in terms of how severe their symptoms are right. If they really are having trouble functioning, like every day is a struggle. We might be a little bit more to say would you be up for trying a medication and a psychotherapy, get them the help to take the edge off some of the symptoms. So the treatment tools that we're using in psychotherapy can have more traction faster, and then you want to kind of taper down. We can help you with that too. It really just depends on the client and what they feel is right for them, we'll make those recommendations. Of course, if we see that, but it's always going to be evidence-based.  

Leah Blain:    00:38:03    So for something like bipolar disorder there's a really clear body of literature that says that medications can be super helpful, not the only option, but really an important one. We consider it more highly, and then if somebody is coming in, because you know, they can't sleep actually. That's one of the last things that we would do, because if you can manage your sleep problems with behavior changes, actually they're really, really long lasting. And then you don't have to take something, especially not something that could be habit forming. So it should always be a collaborative conversation. But you know, we're thinking about the two, how they're going to interplay together. What I hate to happen is that clients do a lot of great work in therapy and then chalk it up to, “oh, it was that med,” like, dang it. Maybe we shouldn't have started that at the same time. Because you did great work and we don't know if you would have had the same gains without it. So it is worth being thoughtful in both directions.  

Scott DeLuzio:    00:38:57    Yeah. So, I mean, it's not always necessarily the thing that you start off with right off the bat and I like how you said it helps you get some traction, maybe if you're having trouble getting going with the treatment options that you've started it, the way when you said that it kind of put the image in my mind of maybe putting chains on tires in the winter,  

Scott DeLuzio:    00:39:26    If you're just spinning there and on the ice or the snow or whatever, and you're not getting anywhere, then you might need to put those chains on the tires to help you get a little bit movement down the road and then the chains can always come off too.  

Leah Blain:    00:39:41    Yeah, that's a perfect analogy. I'm going to steal that.  

Scott DeLuzio:    00:39:44    Perfect. I hope that helps. That makes sense, you know, medication isn't necessarily something to be afraid of, it can help take the edge off, get the traction, and allow some of these treatment options to work if they seem like they're just not working for you. I think that that's another thing that people might be worried about is are they gonna just throw some medicine that I'm going to end up getting hooked on these things? And that's ultimately not the goal. Like you said, you don't want people getting addicted to these things either. It's really just a way to alleviate some of the symptoms so that they can keep going with them.  

Leah Blain:    00:40:33    And I would say and first of all, I mean, the vast majority of behavioral health medication is actually not prescribed by psychiatrists or behavioral health providers at all. It's prescribed by OB GYN and primary care providers. So we know that most people are coming to their primary doctor with these kinds of things whether it's a low grade depressive concern or anxiety, worry and that folks would typically start on something like an SSRI or an SNRI. So like a common depression or anxiety med which I should just pull this thing are not habit forming in any way, shape or form and can be super helpful in just getting through a rough patch, or as you said potentially in being a starter pack that you can then put the chains on and then do some of the heavier lifting as you're able, and then see if we can take the chains off.  

Leah Blain:    00:41:24    I think there's that lack of control piece. And I think often for folks that are coming in, aren't feeling great, aren't feeling like things are in their control. And so I think the last thing I can certainly attest to is our clinic and I hope most places, we don't want to make anybody feel like anything's coming out of their control. So I think we have lots of issues like outright people think they're just going to get thrown on that. Nobody can throw you on meds, don't take them, right. If you don't like the first opinion, get a second one. That's if the first thing they did was throw meds at you, I mean, I know that happens and I'm sorry where it does.  

Leah Blain:    00:42:02    If that's not what you're looking for, ask for a transfer, find a different provider you know, it takes work, but once you find the right fit, it can be a lifelong change and I think some of those other issues we were talking about those kinds of barriers, those mental kind of assumptions. And I think sometimes that people don't even realize they have that, just got in there culturally, “oh, they're gonna lock me up,” or they're right. Or they're going to like take my firearms or they're going to throw me on meds. There's all of these pieces that I think here and there in our culture and don't necessarily take time to stop and digest. I would say I don't know any provider who is looking to have a client come in and just restrict their liberties.  

Leah Blain:    00:42:50   I don't think that's ever what anyone's disposition is. So obviously with respect to the hospital, it's a big concern. And so I would say what I talk to my clients about is if you need to ask me a hypothetical question, please do, right. So, if you don't know, if you can say something to me, without me having a certain reaction, hopefully I've done a good job with full informed consent. Hopefully I've made that clear what those limitations are, right? If you are going to hurt yourself or someone else, and we can't make a plan to keep people safe, then that could become a situation where we might need to get other people involved. But that's a really high bar. I can honestly say, oh my gosh, I'm going to have to knock on wood because I'm moderately superstitious.  

Leah Blain:    00:43:39    We've been up and running five years. And I don't think that we have had a single involuntary hospitalization, probably something like 1700 clients. I mean, It just doesn't happen. So how we help people get to the hospital when they feel like they couldn't keep themselves safe, you bet. If they say, “Hey, I'm going to go home and I don't know that it's going to go great. Let's make a plan. Is there somebody that can come stay with you? Do you have a supportive person in your life who can ask them to hold weapons, if that's needed, like whatever the case is, we want to make that plan, keep people safe, but we want to do that within people's control, absolutely, to the fullest extent possible.  

Leah Blain:    00:44:22    And if it's not, then, I've got to say just exceedingly rare. I think when folks come in and say, yeah, sometimes I have thoughts that I'd rather not be here. Okay. You, and about half of the people that talk to me on it on a daily basis, right? Most people in their lifetime will have some thoughts around death, right? We're mortal beings. That's not normal. but if it's a persistent problem, if you think you might do something that's going to be a different conversation. And normally it's a conversation to say, Hey, what are you going to do the next time? Those thoughts come up, how are we going to keep you safe? You know, keeping me from making a long-term solution to a short term problem and we can do that. We have lots of ways for that. So I think it's worth checking on some of those preconceived notions because it makes all the sense in the world that people end up with those ideas. And that's just not how behavioral health practice works. We actually have a pretty high bar that we have to reach to be able to send somebody to the hospital because we're beyond not violating folks' liberties.  

Scott DeLuzio:    00:45:22    I mean, I think that's a good piece of mind for people too, who might be like, you know what,if I go seek out this treatment all of a sudden they're going to come and take all my guns or they're going to lock me away, or whatever the case may be, whatever they're thinking of is as those worst case scenario type things. that's not reality. That's not really gonna happen. If you're at a point where you're feeling like you're going to hurt yourself, getting to the hospital is really what you want to do anyway. So ultimately this is all having your best interest in mind. You're not probably the wrong term to use here, but, shooting yourself in the foot or anything over, anything that you might be experiencing in the treatment. So you know, I think that that's a great way to put it and I think hopefully we'll put some minds at ease, if they're worried about those types of things.  

Leah Blain:    00:46:26    Always remember you have the right to ask hypothetical questions. You can say, “Hey, what would happen if I told you this?” That's okay. You don't know and providers know that most people who are walking in don't know the real answer.

Scott DeLuzio:    00:46:40   Right. Let's switch gears for a little bit. I know, I promised at the top of the episode that we'd talk about the clinic and what it's all about; what veterans are eligible to go to this clinic? You said it was free. So that obviously probably perks some ears, at the top of the episode. So what's it all about? And who can go, who's eligible and all that. 

Leah Blain:    00:47:05    So it's such an amazing thing. We call it our uniforms, still five years in, and I can't believe that this is a real opportunity. But it is, there's no catch that I found yet five years later. So as I mentioned, our clinic is free. I should mention that we are actually part of a network of clinics across the country. So if folks haven't heard of a Cohen clinic in your area, if you go to Cohenveteransnetwork.org; that's the network level and there is a clinic locator. So you can see if there's one near you or even if there's not one near you, and maybe there's one in a neighboring state, all the Cohen clinics also provide tele-health often to multiple states.  

Leah Blain:    00:47:48    So for example, we're here in Philly and we provide tele-health all the way across VA, all the way through Delaware and in south Jersey, sometimes we reach up to north Jersey but there is a Cohen clinic up at NYU as well. So really broad access, I would say, even if somebody is not right in your backyard, you can still reach out. So that's really a core tenant of the Cohen clinic mission. So our clinic, just to be super clear, our clinic is free of charge for all of our clients. Most Cohen clinics across the country have started billing, but I want to be clear because I think this is one of the coolest parts of the mission that no one is turned away from services. So regardless of your ability through insurance or ability to pay, they will make it work.  

Leah Blain:    00:48:36    So there are scholarship programs, right there; there are all sorts of ways for folks to engage. So, the Cohen veterans network is committed to no or low cost care which I think is just fabulous. In terms of who's eligible and can engage, again made it really easy if you wore the uniform for one day or are a family member of a veteran or military service member. So it's really really easy. So, in the past year we've had a really full development, we were always able to serve guard and reserves, and now we're able to serve active duty as well. So we actually can serve the entire military and military connected community which is just so cool. I think a lot of people think of, like, for example, with that sentence, it's like, well, you had to serve in combat; we don't have any of that.  

Leah Blain:    00:49:33    So it's regardless of role, regardless of combat experience. So if you wore the uniform, you said, I'm gonna raise my hand. I'm going to sign on the dotted line. We thank you. And we're here for you. And we thank your parents, and we thank your kiddos, and we thank your partner, whether you're married or not. And if your niece lives with you, we thank her. So we really want to wrap around the family because we know that if our veterans are doing well, our families are doing better, if the families are doing better than our veterans are well and our service members. And so we need to take care of the community. So that's how eligibility works. We try to make it as broad as we can. Another piece on that, there's all these AMs that I'm thinking of, all the questions that I get  

Leah Blain:    00:50:18    regardless of the character of somebody who's discharged status. So for veterans, because it's a big one, I think people often end up in a pinch. So other than honorable dishonorable discharges are all fully eligible within CBN as well. and then we talked a lot about individual psychotherapy, which is probably biased because that's what I do.  I mentioned we can serve the whole family. So we provide couples therapy, we can do child therapy, family therapy. So there's really a range of services. If somebody is looking to come in just for themselves, that's great, but if we're also looking for marital distress, whatever the case is, and I would say the other part is that if we're not it, so say we often get like a parent is looking for a kid who is having problems in school.  

Leah Blain:    00:51:10    And I think it could be a learning disability or an issue along those lines. If it's like a specialized evaluation service that we don't offer, we're still happy to help you get to wherever the right place is. So I think again we don't want clients to feel the burden of having to figure out if we do what they're looking for. We'd love you to just call, we'd love to help you sort it out. And if we're not, if we also really love the opportunity to help you get to the right place because we know just how complicated it is to navigate the behavioral health landscape sometimes.  

Scott DeLuzio:    00:51:41    Absolutely. Well, I think that's a great overview and you know, as far as eligibility goes, sometimes, you may or may not be eligible like you said, for the vet center or the VA for care through there. But it seems like you've streamlined everything, made it super simple to figure out if you're eligible or not. If you've worn a uniform at any point in time, you and your family are eligible. And I mean, it doesn't get too much more simple than that. 

Leah Blain:    00:52:09    We have Mr. Cohen to thank for that. I think he's been laser focused on making sure there's access and really making sure that it's easy. Because we know that the harder it is, the less likely it's beneficial for folks. So we'll do things via tele-health, we'll pay for your parking passes, If you need it, we'll get you the train fare if you need it, whatever, but a lot of the Cohen clinics actually have childcare on site, some limitations with COVID, but really breaking down barriers has been a huge focus.  

Scott DeLuzio:    00:52:42    That's great and I think that all is just geared towards the success of the treatment for these veterans and their families, ultimately too. So you know, a really great overview and great information, today. I really do appreciate it. So, it's been a pleasure speaking with you, finding out all of this information about the clinics, where can people go to get in touch to either, make an appointment to see if this is a good fit for them or to just learn more about the clinic in general?  

Leah Blain:    00:53:17    Sure. And so as I said at the national level, it's the Cohen veterans network locally, we are www.Pennmedicine.org\veterans. I can send you that if you can pop that up somewhere for our clinic, folks can call our number of the (844) 573-3146 calls to the main line, our fabulous care coordination team can help to tell you a little bit about what we do and if you're ready to get going, and we can get you over to that intake screen we talked about at the top of the hour. Typically we're able to schedule, again kind of in that, making it easy being, we're usually able to schedule folks if not the same week within typically two is our outside window. I will say, jus, a PSA is that almost every week actually every behavioral health provider I know has a bit of a delay.  

Leah Blain:    00:54:15    We've had a lot of need emerge after the pandemic, that's not the right language during this phase of the pandemic. I think just being aware that please reach out, please, even if there's a list in your local area, get your name on the list. They move quicker than you think sometimes. But there can be a bit of a lag, but you know, time flies. So even if they say it's going to be a month, just put your name down, just have them call you, just try anyway because it turns out in a month, whatever you're dealing with, likely won’t pass and if it did okay, tell them you don’t need it.  

Scott DeLuzio:    00:54:49    Exactly. It's a good problem to have. Okay, well, that's great. And I will have links to all of that stuff in the show notes. So anyone who is looking to check out this clinic and find out information about them, make an appointment or anything like that, check out the show notes. We'll have all that information there. Thank you again. Really it's been a pleasure and I really do appreciate you taking the time to talk to us today.  

Leah Blain:    00:55:20    Thanks for what you do.  

Scott DeLuzio:    00:55:22    Thanks for listening to the Drive On Podcast. If you want to check out more episodes or learn more about the show, you can visit our website DriveOnPodcasts.com. We're also on Instagram, Facebook, Twitter, LinkedIn, and YouTube at Drive On Podcast.