Episode 142

Learn how to THRIVE while treating trauma & substance use! Tired of feeling limited in your practice? We’ve got you covered! Hi, we’re Betsy Byler and Jenny Hughes and between us, we have 30+ years of treating trauma and substance use under our belts! We know you love doing trauma work, and understand the connection between trauma and substance use, but don’t always know how you can help your clients at this intersection.

As we continue talking about the intersection of trauma and substance use work, in today’s episode  Jenny is going to be sharing an important skill with us that is designed to help us not just survive the work we do. It’s built to help us be resilient and to be able to do what we love without burning out. 

Don’t forget about  Braving the Course, a FREE online event that will leave you feeling empowered and ready to thrive while treating trauma and substance use!

Whether you join us LIVE or catch the replay, you will:

  •  Discover how to thrive while treating trauma and substance use
  •  Strengthen your skills in asking clients how they use substances to cope with trauma
  •  Walk away with tangible and actionable skills!

You don’t have to do this work alone. Join us in addressing substance use and trauma while energizing and inspiring yourself.


You’re listening to the All Things Substance podcast, the place for therapists to hear about substance use from a mental health perspective.  I’m your host, Betsy Byler and I’m a licensed therapist, clinical supervisor, and a substance abuse counselor.  It is my mission to help my fellow therapists gain the skills and competence needed to add substance use to their scope of practice.   So join me each week as we talk about All Things Substance.

Welcome back to the All Things Substance podcast, and this is the second week that I am joined by Dr. Jenny Hughes out Texas, who is a friend and colleague. Last summer, we put on Braving the Course in August and we’re getting ready to do it again. You can head over to betsy byler.com/braving-the-course and register. It’s a free event on that Monday night, August 28th, and we are here to talk about trauma and substance use.

So last week we talked about the intersection of it. Part of the reason it shows up together is that substance use is effective at managing pain and trauma. Of course it’s not permanently effective, but it is immediately effective and it’s hard to compete with that. So one of the things we talked about is that it can feel heavy for therapists to start talking about substance use and delving into it for a number of reasons.

One of the things that we are both keenly aware of as trauma therapists is that the work we do is already heavy. The stuff that we signed up to hear isn’t something that polite company always want to know about, and you find that when you have maybe a little dark humor or some other kind of way, you start to figure out like, oh, other people don’t talk about stuff like this all the time. And we do. 

One of the things that happens because of that though, is that people get burned out. They start experiencing some symptoms of their own because of this work. So I know that when I’m encouraging people to start adding substance use to their scope, I’m asking them to take on a lot, and I wanna tell you that it isn’t going to feel as heavy as it seems.

And that there are some really good ways to manage that and to manage the stress anyway, that I wanna ask Jenny about today because the work she does in the Brave Trauma Therapist Collective is a huge benefit to all the members of BRAVE and helping prevent secondary traumatic stress and minimize the risk of burnout. So I wanna ask Jenny to talk to you today about some of the things that she has found that work really well. And so I’m gonna turn it over to Jenny so she can tell you about a really specific skill that can really make a huge difference. 

Thank you. And before I dive into that, I want to first acknowledge that actually as I am talking about some of this I’m going to be contradicting some of the things that I said in our last episode about myself.

And I am acknowledging that upfront because I wanna be transparent. And being transparent is so important to me.  One of the things that comes up for me, like we talked about in our last episode is I intentionally don’t delve into doing that substance use work because I know I can’t be entirely objective and yet the things that we’re gonna talk about today that I’m going to be recommending may sound contradictory to some of the stuff that I talked about in the last episode. So I just wanted to acknowledge that upfront. And just so that our listeners know that I’m aware of that and it’s all on the table. 

A skill that we use a lot in the Brave Trauma Therapist Collective, it actually really comes out of Buddhist practices. But big thought leaders like Brene Brown talk about this. It is also an important part of different kind of evidence-informed interventions for things like secondary traumatic stress. It’s called soft front, strong back. 

Honestly, when I first start to introduce this to the members in the Brave Trauma Therapist Collective, they’re always like, what? The actual F we’re not doing this because soft front, strong back is a concept that encourages us to be open to all of the things in front of us. It encourages us to be vulnerable and to embrace that vulnerability. Knowing that we have done the work that we need to have that strong back. To be able to stand up, to stand strong, and to feel grounded.  Even just describing it conceptually can feel really confusing. Does it even make sense to you when I talk about it in that way? 

It was. A difficult thing at first when I first was learning about it and then I even listened to Brene’s podcast about it because it felt a little bit like I was walking into a conversation that was already happening. And that I had somehow missed a piece and I did catch up. But I think it can be really challenging. And I do think it’s really important as somebody for whom vulnerability is difficult is something I’ve learned to do. But it is definitely not a thing I ever thought I would want. 

But I do think it’s necessary.

I think that’s the missing piece of the conversation, and that’s the best way that I’ve ever heard anyone describe it. Betsy is like with strong, soft, front, strong back that it feels like they’re walking into the middle of a conversation. But that’s totally it. And I think that’s how so many people feel because when we just start talking about this concept, this skill, even.

We’re not acknowledging the fact that, or we’re just not talking about the fact that our natural inclination is to armor up, is to protect ourselves. And like in our last episode we were talking about that shell and that protective shell. There’s nothing inherently wrong with that. But as therapists, when we are too armored up, It means that one, it takes a lot of effort and energy to maintain that shell, and then that is just like fast tracked burnout.

It also means though, that we’re not only protecting ourselves from the things that are scary but we’re also protecting ourselves from the amazing things that happen in our work and the amazing things that we see from our clients, whether we’re doing trauma work, substance use work, whatever it might be.

And when I say amazing, I’m not talking about huge things or graduation from therapy. I’m talking about people showing up and saying they didn’t wanna fucking come today, but they came anyway. People telling you when they had a quote unquote setback. Also people telling you how they’ve overcome things big and small, and those are moments we talk about those in Brave as vicarious resilience, where there’s vicarious trauma, right?

Where this sponge soaking up stress and trauma from the work that we do. There’s also vicarious resilience. We can soak up this incredible work and the gifts that we receive all the time from our clients, but when we’re armored up, when we don’t have a soft front and we’re not trusting our back, our strong back, then we’re missing out on those things.

And this year in Braving the Course, that’s a huge goal of mine is to really even strengthen these skills even more with people that attend because I want them to be able to soak up all of that resilience. I want them to be open to those things and to feel confident in that, not that they have to just be splayed open and on display, but that they are prepared for that vulnerability.

And I think part of our work From the very beginning is finding the middle ground between absorbing everybody’s pain and stress and trauma and being approachable and warm. And I get that question a lot from supervisees I’ve had who are early in the field . As they hear in a staff meeting, people talk about atrocity after atrocity, and we’re all talking about it like we’re reading a paper.

Oh, it’s a high of 72 today, and we’re not being flippant. It’s just that was a normal Tuesday. Yeah. And oftentimes early in our career, we’re trying to figure out okay, our boundaries can’t be so diffused that everything’s coming through. So how does that work? And it is very hard to put into words, and I think that as a supervisor over the years, that was a struggle of it just happens or you can’t keep being a therapist, which isn’t a great answer. And I think having something  that does speak to that and teach us a bit on how to do that because, As I have looked into the practice and know more about it, it is what I’m doing. I just didn’t realize that’s what the secret was. Of finding a place of groundedness and for me a place of my neutrality where I feel really balanced and settled, and then that’s how I’m able to withstand what’s coming at me every day. 

Do you know how you’re doing that?

I think for myself, I’m very cautious about and I know it’s a buzzword about self care, about sleep, about connection with my people because I know that. If any of those things are not pretty close to a hundred percent, I’m not gonna be great. It’s not that it has to be perfect.  I can’t run ragged. So I know for myself, if I go more than three nights not getting enough sleep, I will get sick every single time. And so part of that is just arranging my life in such a way that there are certain things that have to be non-negotiable in order to feed into me. 

What does that strong foundation allow you to do in session in those moments when you are the sponge with your client? 

I think I’m not distracted by my life and what’s happening out there. Because all of that stuff has time to be managed, if something comes to me, I write it down. Make a note so I can get it away from me. And I can really focus, I can be really present with the person and I can manage my own emotions, especially ’cause there are times when, even though I’ve been doing this 20 years where I can still be moved to tears. Yeah. Because of something joyous and wonderful where I feel just love or I feel heartbroken because people are terrible.

Or whatever. And It allows me the energy to do that, and then when the hour is up,  I’m not great at time management, so I go session to session, and so by the time I’m at my eighth or ninth session in the day, I still can be totally present because I had enough sleep, I have this stuff managed. I’m eating.  I’m doing all these things that, for me, are making me feel grounded and centered. And in that place for me of neutrality and not being pulled in this direction or that direction or whatever. I don’t know if that is the case for how everyone is, but I know that’s what it has to be and how I’ve found to do this kind of work. ’cause it is a lot. 

And so everyone’s foundation is going to look a bit different, right? And the goal of having that strong foundation, strong enough foundation, it’s not about perfection, like you said, is to allow us to be present. And that’s really what , soft front is the ability to be present and not only about, and with our client and what they’re saying and sharing with us, but as you said, with your own emotions and reactions and thoughts, even if they’re like random thoughts like, oh shit, I need to get milk.

Like I’m gonna write that down. But soft front, another term that we can think about is mindfulness. It is that practice of really being present and being mindful of whatever is happening in the work with our clients and when we’re working with trauma and substance use. Of course, our nervous system’s jerk reaction is to armor up.

There’s nothing against that. That is our brain’s natural response when we’re hearing all of this really painful stuff. And so especially for newer therapists, it is a learning process and it can be a steep learning curve to be able to be present while hearing that stuff. Because we have to teach our brain and body that we are actually safe, that the things that we’re hearing are not happening right now.

One skill that I like to teach therapists and Brave and just generally, To help us with this is it’s a visualization skill, but it can be done in a lot of different ways. But the goal of it is to give us a little bit more of a tangible way to watch our emotions and our physical sensations, both during sessions but also afterwards.

And The way that we practice this is we imagine that our thoughts, feelings, emotions, images that are coming up are like a fire that’s burning in front of us. You can take this however you want, whether you want to imagine yourself camping or you’re only focusing on the image of the fire.

Whatever works for your brain. But what we wanna do is we wanna watch the fire as it gets started, as it builds and as it comes back down. Now, we don’t wanna just douse it because then that is running away, that’s not being present. We don’t wanna add fuel to the fire and amp it up and turn it into a bonfire, and we don’t wanna turn our back on it and avoid it because then it could get totally out of control.

The water, the avoiding, the adding fuel, those are oftentimes natural responses again that our brain and body do. And so it is really this visualization of an EMDR, bringing up the image. What’s the image? Watch it burn in the fire as it goes from beginning, middle to end. And when we are able to do that, and again, this is easier said than done, but using something a little bit more tangible like that can allow us to just strengthen this skill of soft front so that we are open to the things that are coming up in session, good, bad, ugly and also so that we can have a skill to continue digesting this stuff, to continue processing it for ourselves afterwards and to continue embracing and enhancing the positive things.

I think that’s something that gets missed as well with the vicarious resilience, it’s easy for us to get. Stuck on that kind of hamster wheel of the vicarious trauma stuff. And then something cool happens in session and we don’t necessarily get to celebrate it or enhance it, and it can quickly leave.

And so using a skill like this, watch the fire burn, can help us to process the beginning, middle, and end of difficult things. And also to acknowledge the beginning, middle, and end of the beautiful small little things that happen every day. 

I was thinking while you were talking and saying that about how we can be listening to something really painful and then find the thing that is real and true about it. I’m not a negative person, but I’m not a super like rah, like positive kind of thing. But I do like to find something real in it. So hearing someone say when their child who is neurodivergent and they were accused of being cold because they weren’t responding to every outburst.

And so they were saying this and how that was really hard. And I just said, I hear that you weren’t reactive. It wasn’t a planned reframe. But as I’m right, as I’m listening to thinking like, clearly this person who made that comment can’t know how much you have to not be reactive to these outbursts, you would be just up and down, but just being able to point out Yeah, that sucks and that was painful that they said that and not, but, and you didn’t get hooked. Yeah. And you still chose calmness and care and concern for your child, even though they were super dysregulated in making a giant scene.

Yep. And again, that’s that soft front of stepping into that with your client, validating it and noticing another side of it and bringing in that reframe. And that’s the strong back piece for you. You have a lot of years under your belt to have figured this out, to have trudged through the mud and dealt with all the shit.

And I think also as we move through our careers, especially when we start to become supervisors, if that’s something that we choose I think that can be really reinforcing for us because we have to practice what we preach a little bit more. We can’t, we have to be more real with that, with ourselves.

But that is the strong back piece of,  that you have strong skills and that they’re gonna show up for you. And so you can have the soft front, you can lean into the pain, the struggle, whatever it might be, and then be able to bring in that other element for the client and for yourself.

The way I describe it for folks in the beginning of our career, It’s a little like learning to drive. I remember trying to teach my oldest daughter how to drive and realizing how much stuff I needed to tell her.  Because when you’re driving in the beginning, you’re paying attention to how fast you’re going and that you’re not gonna hit people and cars and whatever, but you’re not paying attention to the street signs or who’s behind you or what a car’s doing over here or the radio. And there’s just so many things, and I remember that about early therapy for a number of years about all the different things that we’re supposed to be paying attention to and feeling like there’s no fucking way I would ever figure that out enough to be aware of what I’m feeling and what I’m thinking and what my face is showing and all of that. And the thing is that it happens. 

So now when I drive. Having grown up in Chicago, I learned how to put on makeup, eat, smoke, drive, do all sorts of stuff while navigating Chicago traffic because when you drive long enough, you just do that stuff automatically and therapy’s very much the same way for me is that it is boiled down to I’m just being with people. I’m just gonna be with someone today. I’m gonna present for them. But as you practice and you just keep moving, I think it does get easier when it comes to having a strong foundation, strong back. I think of it as what is holding me up. If it’s lined up enough that I feel strong, then I really can be present ’cause I’m not worried about holding myself up while I’m doing this. I find that is really effective.

That’s one of our primary goals with Braving the Course, is to be able to start putting those things into alignment, to give the skills and to also provide the support and the container that is going to help people who attend, Braving the Course and work with us beyond be able to really put those pieces together in ways that work for them, because everyone’s alignment is going to be a little bit different, but it’s going to give a really good and strong jumpstart, not, it’s not just gonna be like, we’re gonna get you started and let you go. We’re gonna give you a strong jumpstart and then a long runway to really be able to try things out, to test them, and to figure out what works for any of the therapists that are coming to Braving the Course and continuing this work.

I think that is what I like most about how your work and my work intersects is the support because we know that we can teach a skill and we can give people the tools, but that when you’re back in your office, in your day to day, it’s so easy for all your good intentions and all your plans to get eaten up in a day.

At least that’s how it’s been for me. I remember doing that. And the first time I had consultation calls was when I was training for TF-CBT and every month, or every other week or whatever it was, I got a chance to recenter and come back to what I was doing and what the advice was or what the concern was. And it was so great to be able to have that because it meant that. I didn’t have all of this stuff that I just couldn’t use ’cause it was out of touch. And so I love with BRAVEthat people have as much contact or not as they wish. They can interact in the group, they can come to the calls, they can do the asynchronous consultation and then.

With people that work with me being able to have that intensive six weeks that we do our course, but then having six months of an opportunity to do group consultation and to talk to me privately in Voxer so that when clients surprise us because they do, we can plan. I’ll do this, or this, and then they pick like rutabaga. And that’s not one of the five options that I planned for. , that’s part of the thing I think is helpful is  knowing that there’s gonna be some follow up and some and that you really will get to use the skills rather than Will I really do this when it’s over? I think that’s one of the ways I love that our work intersects and overlaps. 

I think all of those elements too are invitations. And so just like you said in Brave, people get to use what they need, when they need it. Similar for Charting the Course. There are gonna be times when people are really needing that consultation call and other times when they get to sit back and absorb and receive in less active ways.

Yeah, it’s been really cool. And during this round of Charting the Course, have a little bit of discussion before we get to our class for that night about what happened last week during our clients, and did anyone have anything pop up or. This week we talked about mushrooms and microdosing and DUIs and stuff that people were like, I didn’t realize that things were gonna be popping up. so touching base and getting to normalize and feeling supported and getting recentered, I think is super helpful. 

And so I’m excited for the course and to talk about it. How people can move forward in doing the work that they do, feeling supported and being able to figure out how to talk about substance use with clients in a way that fits in line with what kind of work they wanna do and with what’s in front of them.  I’m excited that we’re doing it again this year. 

I am too. I can’t wait. And the rest of this podcast series is kick ass too, and I’m just really excited for the listeners to be able to hear everything else that we’ll be sharing and as we get ready and we’re really gearing up for Braving the Course.

We will be back next week with another episode together. Again, make sure you go and register. It’s betsy byler.com/braving the dash course. You can register for free. You’ll get an email saying that you’re in, and don’t worry, we’re not gonna spam inundate your email. We’re just looking forward to seeing you on that evening of August 28th.

We’ll see you next week. 

This podcast is designed to provide accurate and authoritative information in regards to the subject matter covered. It is given with the understanding that neither the host, the publisher or the guests are rendering legal, clinical or any other professional information.

Helpful Links

Braving the Course Registration betsybyler.com/braving-the-course

Home of the Brave Trauma Therapist Collective braveproviders.com

Charting the Course betsybyler.com/course

Brené Brown on Strong Backs, Soft Fronts, and Wild Hearts https://brenebrown.com/podcast/brene-on-strong-backs-soft-fronts-and-wild-hearts/