The Practice of Therapy

Gordon Brewer
Okay, let's try it again, if you want to do your little blurb at the beginning, and then we'll re reintroduce

Dr. Omar Reda
you. Hi, Gordon, it's my pleasure to be with you today on the practice of therapy podcast. My name is Omar reader. I am a psychiatrist calling from outside Denver, Colorado. And I would love to talk today about the wounded healer, how to take care of the caregiver.

Gordon Brewer
Great. Well, hello, everyone, and welcome again to the podcast. And I'm really happy for you to get to know today Dr. Omar Rida and glad you're with me, Omar.

Dr. Omar Reda
Thank you. Absolute pleasure to be with you, Gordon.

Gordon Brewer
Yes. And when Nemours team reached out to us, I was really, really intrigued by some of the work that he's been doing just around burnout and, you know, self care, particularly for for those of us that are in mental health and just other allied health professions. But Omar has of us as a start with everyone, why don't you tell folks a little bit more about yourself, and how you've landed where you've landed?

Dr. Omar Reda
Thank you. So yeah, I am a psychiatrist, by training, but humanitarian at heart. So I found myself to be doing lots of trauma work based on my own trauma story coming from a refugee background, and also having family members who died because of the Civil War, in my home country, Libya. But not only taking care of refugees, I have found that trauma can impact us as individuals, families and communities. And very, very recently, during the pandemic, I have noticed that, you know, trauma can also cause dysfunction in the homes of my co workers. Many of them are leaving the field of medicine or nursing. Many of them are using substance to numb their moral injury. And some of them unfortunately, have died by suicide. So I wrote the wounded healer to bear witness to their stories.

Gordon Brewer
Wow. Yeah. Thanks for sharing that story. Yeah, so what? So what have you learned about all of this so far? And tell us about kind of your process around writing your book? And then, yeah, just kind of some of the maybe some of the things that you've landed on about about all of this?

Dr. Omar Reda
Yeah, I mean, I have been writing for the psychiatric times for a number of years. And during the pandemic, I really wrote extensively about the amount of dysfunction that I have witnessed, and the healthcare industry. And it looks like the system has been really scandalous, system and very dysfunctional, even before the pandemic, but it has been heavily exposed, how toxic the healthcare industry during the pandemic. So, unfortunately, I have lost a number of my co workers for suicide. Others are, you know, coping with their trauma through substance use. Others have decided to leave nursing or medicine. So while erotically was approached by Upshur, Norton, who told me, I need to write a book, and I told them, I'm happy to write the book if they wanted a book with a soul, which means I'm going to write the stories of my co workers. And I was very lucky and privileged to do that. So the Wounded Healer, You are read many, many stories, and each story will bring a specific theme that I have noticed a theme that needs to be broken, because this, you know, pandemic is a silent killer is affecting many, many people and leading to severe dysfunction, not only on an individual level, but they have also seen families that are destroyed by trauma.

Gordon Brewer
Yes, so I'm curious to just to hear kind of you talk about the brokenness of the system, and just kind of how we, how we landed where we've landed, I think, yeah, I think you're exactly right. I think that probably the trauma of the COVID pandemic, just brought out a lot of the problems that were happening and, and as you've heard people's stories, what what are you seeing as kind of the things that have created this system that is dysfunctional?

Dr. Omar Reda
Yeah, I mean, I see a spectrum. I see some good news that you know, that is a blessing in disguise, that some people that actually you know, appreciating the value of self care and are asserting their boundaries and taking care of their loved ones. I have seen on the other side, that we are still holding very deeply to very dysfunctional beliefs that we have learned from, you know, medical school, nursing school, social work, school therapy school, that we are invincible, that we need to be everything for everybody all the time, that we should not show any emotions, that if we express our feelings, that's a sign of weakness. And even maybe if we talk to someone, and trust our supervisor, maybe our case is going to be reported to human resources, and we might lose our license. So all of these beliefs, make people continue to suffer in silence. That's why I hope that one did hear that as one added tool to break the silence and break the cycle.

Gordon Brewer
Right, right. Yeah. So would you mind sharing maybe some of the stories that you've heard and just kind of what was the what was kind of the the resolution for people? Or what how have they healed from these different things?

Dr. Omar Reda
Yeah, I mean, as you will notice, I mean, the wounded healer is divided into four chapters. The first one is about our relationship with our clients. So that will bring lots of pain, but also lots of joy, hopefully, of, you know, the value of what we do, if we work on our burn out of we value, the contribution that we, you know, provide the system. So sometimes we tolerate behaviors that are really should not be tolerated, like violence against staph, maybe harassment, all of these things happen to us as a therapist as people who are healers. And we continue to carry that wound, and we don't acknowledge it, we don't notice it. And we just stuff one more skeleton into our closet. And that will end up unfortunately, biting us in the back. And so that's when it comes to the relationship with our clients. The second chapter is our relation with our families. And I have noticed that burnout can lead to a trauma that can break our family unit. So many of us, we take care of our patients, and we ignore our families, I spend all of my energy outside home, and I come to my loved ones very depleted, and I don't even have the energy to play with my children or respect my spouse, maybe I will take my anger on them my frustration with the family unit. And I have noticed many, many of our loved ones are walking on eggshells around us because we are either lashing out or shutting down in front of them. So that's the second chapter. The third one is the relationship that we have with the systems that can either crush or revive our souls. So for example, our female co workers, they go through lots of trauma, because of sexual harassment, some of people of color, they might go through racial trauma. And there is lots of trauma that is embedded in the system, and some systems that just need to be rehabilitated, but other systems, they deserve to be dismantled. And the last step that is a relationship with ourselves. And this is maybe the most difficult thing to do is to sit down and acknowledge our own needs and take care of our old wounds. So that gets re opened with the new trauma.

Gordon Brewer
Right, right. Yeah, that's, I'm looking forward to, to jumping into the book. But as you've as you've worked with people as they work through these, these, that to some degree, maybe, I don't know if it's fair to say this, some of this is kind of secondary trauma to the trauma that they deal with with patients. And I would I would imagine that that just kind of compounds things for people. But as you've worked with people as they work through this, these things, what's what's kind of the starting place, do you think for people?

Dr. Omar Reda
Yeah, thank you. And for acknowledging this is usually cumulative, or, you know, compounded trauma. It's not only one, you know, event that will lead somebody to leave the industry. And it's really something that they have tolerated for a long time. It's a toxicity, it's a burn out that's causing dysfunction, and their professional and their personal life. So what I do usually is just a to use a comprehensive approach to wellness and healing. So yes, many of us we only take care of our biological needs, we focus on our body. We practice sleep hygiene, we eat healthy with exercise, all of these are wonderful. At the same time we should not forget a garden that we are not only made of a body, we are made of, you know, a psyche or a mind. So you need to take care of my psychological needs. We are made of our heart so you need to take care of my soul. Your needs, and we are made of, you know, a soul. So I need to take care of my spiritual needs. So the wounded healer encourages, you know, the wounded healers to take care of themselves in a, in a very comprehensive way. And also to practice self care in a community. So I don't do it in isolation, but also my co workers will lean on me and I will lean on them, they give me feedback, I will notice them. And together, we practice what I call deep kindness. So we really care about one another, and we notice the subtle changes in each other, and we receive and give feedback, I think that will be a better, you know, quality of care a bit, to actually work and

Gordon Brewer
yeah, I just have, you know, it's funny, what kind of coincidental I had my took my wife to a doctor's appointment, I've shared on the podcast before that, my wife is disabled, and she has, you know, several medical concerns and that kind of thing. But also, I had a follow up appointment for myself. And one of the things I noticed when I was going to these appointments is that a lot of the people in the in the doctor's offices, including, including the doctors, just there was a sense of being rushed, and a sense of, of urgency to everything. And I realized and, you know, in some medical situations, there is an urgency, but these were just follow up visits. But and and just feeling and kind of tied to the the processes behind the scenes seem to be more important than the people around them. And that was just an observation I had today.

Dr. Omar Reda
Yeah, I mean, thank you for noticing that. That's really one of the most important and the most common things that my coworkers use, or share with me when we talk about reasons that they are burned out. Many times it's their moral injury. That's their ethical dilemma, when I spend more time documenting more time talking to the electronic chart, more than the patient, really, you know, the, unfortunately, because the insurance pressures and other issues within the system, that we treat people as checkboxes, and the faster I see someone, the faster I make money. And I refuse to do that. I mean, I am a psychiatrist, but I don't only dispense medications, I try also to prescribe hope and listen to the trauma story and spend time with my patients. Even if I miss the bonus at the end of the month. That's worth it for

Gordon Brewer
me. Yes, yes. It's yeah. And that's a, you know, I think that's the thing that I think has to be really acknowledged is that we've particularly as as healthcare has gotten, really kind of, for lack of a better term kind of corporatized. I guess I'm making up a word word here. But to some degree where you're right, I think sometimes the profits become more important than, than the care that is given.

Dr. Omar Reda
Yeah, I mean, many of my colleagues, they say, really, the challenges that they face are not clinical, it's very easy to work with the patient. The challenges are usually bureaucratic, or working with the system. And as you mentioned, with your wife, Amy, we are not only caregivers, when we work with our clients, we are caregivers in many, many other capacities. And unless I take care of myself, and I have some gas left in my tank, to spend on my loved ones, I might actually see taking care of them as dreading and resentful thing. I don't want to resent my loved ones. That's why I need to really take care of me and I don't see as selfish actually is as a selfless act. I think it's not a luxury to practice self care. It's a responsibility towards my clients towards my co workers and mainly towards my loved ones.

Gordon Brewer
Yes, yes. Yeah. I love that. And I think I think you're right, right on the mark with that. So Omar, tell again, well, what are what are some of the, I guess, kind of maybe stories of hope that you've been able to encounter or seen and you're in both your research and just in your own life experience where you've seen things change and become better for for people in health care and those of us that are caregivers.

Dr. Omar Reda
I have seen lots of progress, especially in the last two years since the beginning of the global pandemic that many systems are waking up on, they are prioritizing the wellness of their staff. They are creating positions for, you know, Chief wellness officer. They're building programs that focus on emotion expression, and Subong staff, especially frontline staff. So I'm very encouraged with that. And I'm especially encouraged when I see that on an individual level, when staff actually value their own worth, when they prioritize their own self care. When they verbalize their needs. I have seen lots of the at the same time because we are playing catch up. Unfortunately, we are seeing many people still leaving the field. So that's why I'm a big fan of not only intervention programs, not only, you know, reactive programs, but big fan of proactive programs that focus on prevention. So not only addressing the back door, but mainly addressing the front door. Why do people go through burnout? To start with? Yeah,

Gordon Brewer
yeah. Well, I'm curious other than people learning to treat each other with more, I guess, as I like to say kindness and compassion. What are the other things that I guess we can do in these in the various places that we work in the the interactions? What, what else do you feel like is helpful?

Dr. Omar Reda
Yeah, I mean, starting with myself, and I want to acknowledge Gordon here, um, I'm a psychiatrist. So I have extra privilege of easily speaking up, if I get fired from a position, I can easily find the job. I know that I'm at a position of privilege. And everybody can do that some of my co workers are stuck in very toxic systems, they have families to feed and they need to take care of the, you know, materialistic needs of their loved ones. At the same time, what I have found to be very helpful for me, at least, as a speaking up, if I see a dysfunction, if I see injustice, if I see anything that will take away from the beauty of the encounters that I have with my co workers, or my clients or my loved ones, I can easily speak up, I can challenge a policy or a procedure. And mainly I express my emotions and assert my boundaries. And I encourage everybody to do that as well. So when I see a co worker, and they have done that on multiple occasions, when, for example, one of my co workers who is not a physician, her best friend died and the best friend died in another state and left behind very young children. So my coworker wanted to take time to go and grieve her best friend, and she was told by administration, that she cannot do that, because the best friend was not a family member. And you cannot secure time off to grieve, you know, a friend. So I went to leadership and actually challenged that procedure, and that policy, and together, we were able to give her a weekend to fly and spend time with the loved ones of her best friend. And she told me that was the best thing that happened to her. The best thing for her emotional needs at the time is to have somebody at a position of power or privilege who can speak on her behalf.

Gordon Brewer
Right. Right. Yeah, that's a that's a great, great story. Just about I think, yeah. And I think, you know, what's, what's interesting. I know here in some previous episodes, I talked with some Ginny police, it was Ginny, he, I don't want to, I don't want to get her last name wrong without looking at it. But her name was Jenny. And she's done some work around vicarious trauma. And I think one of the things that we have to recognize is that with, particularly working in, in the mental health setting, and also just just a whole different other kind of trauma for people working in hospital settings, and that kind of thing, when we're faced with our own grief or in our own, you know, losses and that sort of thing, that vicarious trauma of the other people that we've been helping, just kind of comes up and it just creates kind of this complicated grief, if you will, for people and I think being able to acknowledge that is something that's important for people.

Dr. Omar Reda
Yeah, I mean, thank you for mentioning vicarious trauma just means that we get affected by listening to the trauma stories of others. And that is not a sign of weakness or reason for judgment just means that we are you know, genuine that we are compassionate, that we care about others, and this is the price that we pay for being a caregiver, the wounds that we carry Hurry with us, especially the soul ache that will eventually lead to burn out. That's why it's very, very important, as you say that we really pause and reflect and spend some time to nurse our own wounds while nursing the wounds of others.

Gordon Brewer
Right. Right. And we have to give Pete people space to heal. You know, I'm reminded when you're, when I heard the title of your book, The wounded healer, one of the things that I was reminded of is a metaphor that I use a lot with people in my own work as a, as a therapist, and that is of a, you know, a physical wound. In that when we when we receive a physical wound, we can do things on the surface to help facilitate healing, but ultimately, the healing of our the knitting together of a wound has to come from within. And but we've got to allow people the room to do that. And, in many ways kind of permission to, to heal from within, but at the same time, being aware of not poking at the wounds, so to speak, and, and reopening the wounds inside. Yeah.

Dr. Omar Reda
And what's very unfortunate, when it comes to emotional wounds, at least when you are, you know, wounded physically, people will actually point that out, and they will rush you to the emergency room and make sure that you are taken care of. But when somebody is emotionally bleeding in front of us, we will actually neglect their wound or them that they should not talk about it and as a reason for stigma and for silence. And that's something that we need to, you know, really change.

Gordon Brewer
Yeah, yeah. Well, one thing that I've mentioned before on this podcast, and I really feel like maybe one of the silver linings of the COVID pandemic was that it gave people the, what they needed to be able to speak up about mental illness and emotional, emotional trauma, because we were all affected by it in different ways at different levels. And so I think, at least I'm hopeful that we were able to have more open conversations around mental health and emotional health, without the stigma as much.

Dr. Omar Reda
Yeah, and I hope that systems will catch up to, because individually, we can have these conversations. But if you work in a system that will discourage you from talking about this, or punishes, you afford it, then many people will remain silent. And this is a cycle that we need to break together.

Gordon Brewer
Right. Right. Yeah. So. So Omar, I want to be respectful of your time. And I'm so glad we had this conversation. What are some cat maybe some closing thoughts that you have around this topic of the wounded healer?

Dr. Omar Reda
I think they have to do with four chapters. The first one, yes, I mean, our relationship with our clients can lead us to listen to trauma story that can cause burn out and soul ache. But please, when we listen to the trauma of others, we need to also listen for resilience for beauty and make sure that we give them meaning of what happened to them. And together, we work towards closure and healing. When it comes to the relationship with our loved ones, I don't want any of my co workers to lose the American Dream chasing it. Yes, we work long hours to try to take care of the materialistic needs of our children, our spouses, but we should not neglect their emotional needs. When it comes to systems. There are systems that are toxic, that are not healthy for your well being a few can rehabilitate a system that's wonderful. Otherwise, maybe you need to just find a better environment for you. Sometimes leaving is better than half staying. And eventually, Chapter Four talks about really paying attention to our soul ache, not ignoring the deep voice that we hear. That's the voice of our soul aching. So expressing emotions, taking care of our deep wounds is something that we really owe it not only to our clients but also to our loved ones. Yes.

Gordon Brewer
I love that. Yes. So Omar, tell folks how if they want to get in touch with you and also get access to the book, what's the best way for them to do that?

Dr. Omar Reda
Thank you, Gordon. So the book is available everywhere on Amazon, all other bookstores. My website is Dr. Omar reader.com. So that's the art Oh, Ma, R Ed a.com.

Gordon Brewer
All right, and we'll be sure to have links in the show summary in the show notes for this. Well, Omar, I'm so glad you joined me on the podcast.

Dr. Omar Reda
Thank you. Thank you. So it's really an honor and pleasure and I appreciate you giving me the platform.

Gordon Brewer
Yes, yes. And hopefully we can maybe have another conversation here soon. Take care. Wonderful.

Dr. Omar Reda
Thank you.