Episode #148

How do we not just survive, but thrive in our work? How do we get to keep being our badass therapist selves and still enjoy what we do? Hint: I’m not going to just say self-care. There really are things we can do to help ourselves. 

Our workplaces, agencies or bosses aren’t going to take care of us the way we need. Some of them might, if you are lucky enough to be in a system that does that. But in general, the direction business is always pushing is hitting our field. More. More clients, more sessions. Just more. Trying to explain to a bean-counter what our job is like is like speaking a foreign language. People think we just sit and listen to people all day. Um, no. That’s not the whole of what we do. We know the truth. We know the toll it takes on us. It’s also going to be up to us to take care of ourselves the way we need to be cared for. We also deserve to be cared for as well. 

Today, I continue my conversation with Dr. Jenny Hughes about how we can help protect ourselves and even walk-back from burnout. We are joined by a friend and colleague, Sarah Sanders, LMFT who shares her experience as she has found the support she needed to help her continue to do this work by finding shelter from the storm in online spaces.


  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. This is episode 148. This is the last episode before we go to Braving the Course. That’s happening on Monday, September 18th at 6 p. m. central time to 8 p. m. central time. This live opportunity is where you can get CEUs for free. And today what we’re going to be talking about is an extension of what Jenny and I talked about last episode, where we discussed therapist burnout, secondary traumatic stress, and the things that lead up to a therapist feeling like they don’t have anything left to give and they need to leave the field. Then we talked about what it is that therapists do need. 

 I have Dr. Jenny Hughes, who we’ve talked with in the last episode and before, So we wanted to have a friend come join us today who has experience like us and also experience in this online therapist world that we are in. We have Sarah Sanders, who’s an MFT in California. Thank you so much, ladies, for joining me. Thanks for having me. So happy to be here again.

When I met Jenny and Sarah, it was part of an online therapist community that we were all working in that space. It wasn’t necessarily clinical in nature, but the common denominator was that we were all therapists. And as all of when therapists get together, we can’t help but talk about work.

What I found is that over the last many years of my career, I’ve been pretty isolated as a supervisor and a director. You can’t be friends with people when you have to be their boss. And so I was pretty used to not having friends around who were therapists, but this really changed everything. 

So today, what I want to talk about is I want to have Jenny and Sarah talk about some of their experiences in the field, where they came from, and what it was like to be in those organizations. Jenny, why don’t you talk with us about what your early career experiences were and how that impacted you as a therapist and what you needed. 


Yeah, I think that’s a great place to start. So for me, I was actually super lucky in that my early experiences in my training, both even like coming out of undergrad and before I went to grad school.

And then during my training there, I had overall, really positive experiences. Actually, when I was an undergrad and majoring in psychology, I was doing this kind of internship course where, they wanted us to get an experience, a clinical like experience as an undergrad and I ended up working at the Mental Health Center in Boulder, and it was one of the most amazing experiences.

We were doing home based work with people who were needing lots and lots of support and resources, but the team was run so well, and everyone knew that it was a safe space to be vulnerable. And so that was my very first experience in like agency or organization setting. So I just thought that’s what everything was like. And it’s not. And again, I was lucky in grad school and things like that to have overall positive experiences. 

But then once I was licensed. And out in the big wild west of this world I was still working in large organization spaces and started to encounter environments or climates within those spaces that were just not healthy. And some that were frankly, really toxic. And it was at that point that even though I had always been doing trauma work it was once I was in these spaces that were so unsupportive and left me feeling really unsafe and very alone. That I began to get in the fast lane towards burnout because I didn’t have spaces where I could be myself. Where I could show up and I could ask questions, whether I felt like they were dumb or not and explore and really reflect on what it’s like to do my work and support others in that reflection process too. 

And so that was really tough to have, like such a huge, stark contrast happened very suddenly in my practice, but it ultimately then ended up being I think a big motivator for the work that I do now within the Brave Trauma Therapist Collective. Because having seen both sides and experienced both sides, I didn’t want that for other people, and I wanted to figure out what I could do to create a space for therapists to come to where they can experience that safety, where they can be vulnerable, even if they can’t do that in their own workspace.

I was reminded as you were talking about an in-home team that I was on, and that, It feels like in home, at least in some of the experiences I’ve heard of, does tend to be a little more supportive because it’s hard work when you’re in people’s houses. That’s a totally different atmosphere. I feel like new therapists should all do in-home, at least for a little while. You have to learn how to be in somebody’s home and be focused, but also gracious. If somebody is smoking the entire time you’re there and it’s a hundred degrees or there’s lots of animals or whatever the case may be,  to offer you a meal. Yeah. Oh, that too. I had a family who had ordered a special vegetarian meal for me because it would have been super rude in their culture for me to not eat. So I really feel like that was actually a more supportive experience.

Sarah, how about you? When you started in the field, why don’t you tell us what your experiences were like? Yeah, so my undergrad is in psychology. I pretty much always wanted to go into a helping profession and wanted to be some sort of therapist from a really young age. And so that was always on my heart. It was always a goal. I just didn’t know exactly how it would look. 

But after I got my bachelor’s in psychology, I wasn’t sure which area I wanted to study so I didn’t go straight into grad school and basically took three years where I just started working in the field. And one of my jobs was working as a support kind of behavioral role with families of kids with developmental disabilities, and I worked with licensed therapists and the licensed therapist would take a systems approach. And then us support staff would be in the homes in the day to day, like the nitty gritty with these families. 

And after doing that for like, 2, 2. 5 years, I got so burned out. I had compassion fatigue.  I was so traumatized by the intense work and the lack of support, but at the same time, it really solidified my desire to go back to school to become a therapist like these therapists I worked with and change people’s lives. And once I recovered a little bit from that burnout, I went to grad school and became a therapist. 

But the organizational structural systems types of issues Like, Jenny was talking about are very real and I worked at a community mental health place and there was no on site support and we had our once a week supervision, but there was nobody there. So there weren’t people calling back clients and this really high level of need. And so I started just running it where I was actually making sure there was therapists there to cover the phones. And I was returning phone calls and doing all this extra work because I was like.

We can’t do this to people like I live in a rural area of California. I don’t think about beaches and, So-Cal or the Bay Area or anything. It’s very rural. And so we need a lot of support with therapy and counseling. And so again, I was getting really burned out with this extra load. And then when I started working for a group, private practice, I loved the therapy world and the therapy work, but the organizational stuff again was really getting to me.  

I’d always wanted to open up my own practice, but my boss and owner at the time, the supervisor, basically let me go when I got licensed because he wanted me to work full time and work even more than full time hours so that more money could be brought in. And I had a little one at the time and didn’t feel like I could work full time or else I would burn out and needed to be home with him. And so he basically told me as soon as your license posts and you get licensed you don’t have a job unless you’re willing to go full time.

And so I panicked because I’m like, I don’t want to go full time, but I don’t feel like I’m ready to start private practice yet. And my husband said it doesn’t seem like you really have a choice. So let’s do all the research and basically open up my private practice overnight. And so I would say with private practice, with the flexibility of scheduling, how many clients you want to see in your own hours and setting your fee and everything, there’s not the burnout in that sense, but the isolation and the lack of community has been huge.

Since meeting you guys and the other therapists and, having been a part of Charting the Course and Brave both individually and at the same time. It’s just been life changing for me.

We all went into private practice for various reasons and have had success there.  I think each of us have figured out the business aspect of private practice. It’s not super complicated. It is at least to start, especially if you’re taking insurance, but over time  you get a handle on that. You figure out estimated taxes, all of the things that go along with being in business for yourself. But the work that we do clinically is really different and especially for those of us who are either in single private practice or in very small private practices.

We have the clients that we have, but we don’t really have a lot of space to get any kind of. consultation. I know that when I was early in my career needing supervision for my hours, I didn’t get great supervision. I didn’t have time that I really felt like was well used.

So I wasn’t really well versed in how you use consultation or supervision. Not until much later when I began being a supervisor. Certainly at our stage, all of us are fully licensed and have been for many years. I feel like sometimes there’s this idea that we shouldn’t need to consult, that we know these things. I wonder how you guys have felt about that.

I think that your experience, Betsy, of not having the greatest supervision is not uncommon for therapists. One thing that I hear a lot is that in their supervision experiences, they were oftentimes told either directly or indirectly that they’re not allowed to be affected by things that they need to do their own work, if they’re having some kind of a reaction about a client, things like that. Instead of having experiences where they can be open and reflective about things like countertransference and whatever might be coming up.

Those kinds of experiences are going to leave you incredibly closed off to asking for help, whether you’re licensed or not. There also are so many messages that I think we get, again, directly or indirectly, that we’re supposed to have all our shit together, that we’re therapists, and so we should know all the things and do everything right.

And especially once we’re licensed, we should be and need to be operating independently, and need to have the answers for all the things. And… Frankly, that’s not true, nor is it a healthy message to be continuing forward. And, for me, I again was really lucky to have that strong foundation of being in spaces where I was taught how powerful and how helpful consultation and supervision is, but that is not a common occurrence for a lot of therapists, unfortunately. And out of fear, out of self preservation, out of lack of resources, or just not knowing that it is an option, they end up, I think, functioning by themselves, and feeling really alone, and unfortunately feeling sometimes really ineffective when they encounter something new, or they’re not quite sure what to do.But don’t have the resources to be able to ask other colleagues.

Yeah, I would agree with that, Jenny. And I think the pressure to feel like you have it together, your license, like, Oh, I did all my hours. I’m good is how I felt, and there was recently a case that I was consulting with Betsy on and Betsy said, no, you’re not bothering me. These are great questions. And she’s like, I don’t know if you’ve ever had great supervision or consultation, but these are the types of things you ask. And I was like, if this is great supervision or consultation, then no, I’ve never had it. I’ve never had a great version of this because I feel so supported. 

I feel so just honestly loved as a therapist and as a human that this is really hard stuff to go through and to experience and to know how to support the client in such a difficult thing. This is like everything, like this is so important and because we can’t separate out that. We’re not robots who do therapy.

We’re humans that do therapy. And like you said, Jenny, with the countertransference and all of that is , that’s going to come up and there’s going to be vicarious trauma and all of that. So we need to have a safe place to fully show up as humans and people who do therapy. , I think that’s the biggest thing for me is to feel supported as a therapist and supported as a human as I do therapy is everything.

Yeah. And Sarah, that’s something that we talk about together in Brave too, is that a lot of times we think that we’re supposed to be able to separate our personal and our professional lives. And I have been a hundred percent guilty of that too, because that’s what we’re taught. We’re taught like, Oh what skills do you have to leave that at work?

That’s a phrase that we hear all the time, but we’re the same person. We’re the same human, no matter where we’re sitting or what we’re doing. And yeah. It just means so much to hear you say that you, to hear you say what it feels like to be treated like a human in these spaces. Thank you for sharing that.

And what’s nice is knowing that support is there whenever I need it. Like how often can you just reach highly specialized therapists, supervisors and professionals to get the support you need when you need it in a moment’s notice. Like, how often is that? We have doctors that if we have some kind of illness, we have to wait to get in. And if we need a specialist, we have to wait to get in. There’s so many barriers. To be cared for in general, but especially as therapists and as a member of Brave and with Betsy with Charting the Course I don’t have to wait. And that makes all the difference in the world. Just knowing that I have that care when I need it. And then knowing that it’s. It’s incredible when I do speak up and need the help. 

I think that the timeliness thing has got to be a huge deal because so often with clients you need what you need and you need it now. Maybe not right this second, if it’s what, Sarah’s in California and I live in the Midwest and our hours are a little bit different, but it’s going to be within a day and before she sees the client the next time. Because I think that we move on if I have to wait a week in order to get a question answered. That’s not always going to be helpful. Now, if it’s something that can wait, that’s fine and maybe it’ll be in a group consultation call and maybe we  talk either texting  or voice messaging or whatever about something. 

For a lot of folks who identify as being really empathic and they’re soft in their hearts, that the work that we do can be really difficult. I think all of us can help. each other, giving each other support of holding something when we’ve had a really fucked up day or heard something really messed up or feeling something really deeply because each of us have things that hit us really hard.

I know for myself, I’ve been doing this 20 years and I still, there are times when I have to fight tears. Of course I’ll let them show if I think it’s appropriate, et cetera, et cetera. But there are times when I work with a lot of really abandoned teenagers, and it is heartbreaking to me. And as a mom and  just a human experiencing this feeling of  if this kid had something decent and had an adult who gave a fuck, their life would change and how unfair it is that isn’t the case and that I can only be their therapist. And knowing that there are other people who are in my sphere that are in my Voxer app that I can text and  just say that to and they’ll be like, yeah, they’ve been there. They know that feeling of this is so unfair that this person doesn’t have what they need. And it’s so simple. And yet we can’t do it. 

And I think knowing that you have that support in addition to a clinical support, what the absolute fuck do I do with this client? How do I help them? And having someone else say, okay,  here’s what I think. Here’s some things I would try. It’s so hard to calculate what that’s like. And so I know that hearing what you’re saying, Sarah, and that Jenny and I have heard from other folks in our programs that. It’s made a really big difference.

It has made a huge difference. And I would say that for me, I was, I’m one of the founding members with Brave and I haven’t been able to make all the consultation calls and all the content calls, and I’ve told Jenny this, that. I don’t see it as something that I have to go to, but that it’s always there like I mentioned before for the support. And it can fit into my life the way that I need it to. And so I think for some people I think when we invest our time and energy and money, we think it has to be a certain way, or it has to be full, bore that. It’s got to be the gold, the gold standard of attendance.

We have busy lives. And so that’s been huge for me is that these. The support and these programs and groups are accessible. However, you need them to be and how you need them to be. And if your life gets busy, I, I might not be there showing my face or typing in the chat, but I’m still there and I still know the support’s there when I need it.

Was that hard for you, Sarah? Because you seem like a… You’re a fairly rule-following person in my experience. I know as a mom and a businesswoman and all of that, you’ve had to let, as moms, , as we raise kids and have jobs we all have had to figure out how to let things go because there’s no way to do it any other way.

But I wonder, when you join a thing, especially joining a thing with friends I wonder if it was hard for you to… Not be at certain calls, or if you already had reached a point where you felt like it was easy to just let that go. 

Yeah, definitely. Neurotic and perfectionistic is my vent. I like the gentle way you said it, Betsy. So yeah it was this, oh, I’m joining this and this is how it’s going to look and this is how it’s going to be. And these are my expectations for myself in the group. And when it started to not go that way, I was like, okay, what do I do with this? How do I. Okay. How do I still get out of it what I need without it looking the extreme ideal way that I thought it would look and yeah it took me a little bit of time to let the sand kind of filter through and look the way it needed to look. 

And I think it’s a great point that you made with, especially being mothers, we do constantly have to shift and adapt and, just for life to be how it’s going to look, and it’s not going to be perfect or ideal. And yeah, it did take me a little bit of time. But I have to take that pressure off of myself, of how I want it to look and  take from it what I need when I need it. 

And I know Jenny and I had a conversation early on with me being in Brave. Cause I was like, I can’t make the consultation calls. It’s when I have clients and I’m feeling like this pressure that I should go, I need to go, but I can’t. And so really figuring it out, she’s like, okay we have this secure signal app and, there’s always the Facebook group, to share things in. And so I. Had to get some guidance from her of whether it’s okay for it to look different and I have to be okay with that.

And it’s amazing to have it be there when I need it, know that it’s there and to be able to show up when I can, when a client cancels, I’m like, Oh yay, I get to make the brave call. And, having the support With, , your consultation calls, Betsy, and your Voxer support is huge. Like you said, you can get a hold of somebody within a day and get an answer within a day. And, it just removes so many barriers.

Jenny, can you tell us about the features of Brave that Sarah’s referring to? Yeah, definitely. So she talked about some of the calls. We actually have three different kinds of calls each month. We have a content call at the beginning of the month where we go through the content that we’re focusing on, where I get to do teaching around things like vicarious trauma, vicarious resilience, community.

We also have two consultation calls a month and we have a guest expert training, at least one. I’m starting to actually add more on the fly as I’m finding more and more amazing people to present and work with us. But in general, there are four opportunities for live calls per month. 

Then Sarah also mentioned the Signal app, and that is where we have asynchronous consultations, so Signal is like the super secure app, and we use it so that we can have those touch points when we need them, because it’s like we’ve been talking about, two consultation calls a month is actually pretty good, it’s more than a lot of people get in general, but weird things happen in between those calls, and it’s nice to have a space Where, you can reach out and get that support anytime.

And then we have a private community where actually everything is housed. It’s on the Heartbeat app and it has all of our content, our community, all of our events. It’s all in one place. So no one has to figure out like where is this thing and where is that thing? There’s one place to go to get all the things and it just makes it easy and keep all of us together in a community.

So I know that. I have been resistant to apps at different times in my life, but I got to say that the ones that I know that we use, either you use for your program or I use for my stuff, they’re really super helpful. And so if you’re hearing this and you’re  heartbeat signal, what, Jenny will walk you through it.

I promise.  It is easy for us to get on a Zoom call and share screen and help somebody get to know how to use these things because they’re not super complicated. But at times when we’re feeling really burnt out and like we don’t have a lot of energy, doing anything that takes more than one step can feel like a big deal. Making a Hot Pocket, no biggie, but mac and cheese, too complicated. And if that’s what you’re looking at, I promise we can help you.

Quick go over the parts of Charting the Course so that it makes sense what the bundle is that Jenny and I are offering right now. Charting the Course is my six week intensive course. Intensive, because it’s two hours a week, and there’s stuff that we’re covering each time.  Even in our last round, there was only one person who was able to make every call and instead, they ended up watching the video afterwards and doing it on their own time. And that seemed to work really well.

And I know that it can feel hard to not attend something. If there’s only six,  then they have to be there for all of them, but life happens. Kids get sick, the internet goes down or maybe it’s a night where you just can’t do it. So we have our six weeks and that starts on October 3rd. It’s a Tuesday night, 6 PM central time. Then it goes until eight. I usually stick around for up to a half hour afterwards for questions for folks who might have something they want to go through and talk about. Then there is a resource vault that has access to pretty much everything I have done that’s on the site.

So the recovery planning tool, the treatment planning tool, different trainings that I’ve done, and then all of the stuff from the course is also there. There are replays by the next day that pop up as well so you can always go back in the future. And anytime I update the course too, it’ll be there as well.

When the program’s over, it would be over right before Thanksgiving. And for six months after that, we have consultation calls once a month, they’re group consultations. And here’s the piece I want to say. It’s Jenny’s and my responsibility to show up every time. It’s your responsibility to show up when you need to and to take care of yourself.

We don’t have any expectation that everybody has to be there every time. What I’ve told my folks is that when we do our consultation calls, I don’t care if you’re eating, I don’t care if you’re walking your dog, I don’t care what you’re doing. You can have your camera on or off, it doesn’t matter. If you want to just listen to us, that’s great too. Whatever you need that to be or if you need that space in your schedule to not do anything, that’s what I want for you as well. 

In addition,  I use an app called Voxer. And it’s not secure in the way that Signal is, because Signal is I believe it’s HIPAA compliant. So in Voxer we might do some back and forth or general questions like, Hey, what would you do about an adolescent who’s doing this? Or what would you do about this adult who’s doing that? So we use that as well as doing the online course and that’s of course through Zoom and it’s all really easily accessible.

So over the next six months,  if you join the Bundle, then there’s access to Brave for six months and all of the content there and all the back catalog content as well. And there’s access to Charting the Course, you’d get your 12 CEUs, as well as the support from me for the next six months.

What Sarah has gotten to experience in the last several weeks and months is that she has been able to have therapists around to consult on difficult cases. She’s had me to consult on cases that involve substance use, which trauma and substance use are almost always connected in some way. As well as support and specific knowledge and information that she needed for working with substance use. 

Cause Sarah is your very typical therapist and that her MFT program was what it was. It wasn’t necessarily focused on substance use. Sarah noticed substance use in her clients, even though she works with folks who are decently highly functional.

And still there’s trauma and substance use. And she has been able to walk away feeling more confident and competent that she can do this because she can. She’s an excellent clinician.  As a person in single private practice she’s been able to have that support. Which is why Jenny and I wanted to bring the bundle to you and wanted to offer it this way.

We really feel like our programs overlap super well. Our personalities match really well. You’ve heard us talk and we want to be able to support you because we need you in the field. We all know that there’s not enough of us running around and  we need more people. What I know to be true is that over the years in the field new clinicians are getting less and less support. They have less and less quality supervision, they have less training opportunities, and they’re having to see more and more clients. That as productivity concerns rise and the cost of everything is rising, that is going to just get worse. What we know to be true is that it’s going to lead to secondary traumatic stress and burnout, compassion fatigue, etc. 

Jenny and I both really feel strongly that if you feel called to this work, if this is where your heart is and you love it, let’s protect you so you don’t have to leave. And if you’ve already gotten to the place where you’re super close we want to help you scale it back so you feel better, whatever that looks like. And if you do need to leave our field. we are 100 percent behind you for those who aren’t ready or don’t want to, we want to be there and be supportive. 

So on Monday night, we’re going to be doing Braving the Course. That is a combination of Jenny’s Brave and my Charting the Course. We’re going to be talking about vicarious trauma and its effect on therapists, as well as the concept of vicarious resilience and its protective nature, protective of us. And I’m going to be sharing my top three screening questions for you to give you a place to start when talking about substance use.

This is the second presentation of this training an encore, if you will, and we’re doing it live Monday, September 18th at 6 p. m. Central time. And for those who are able to attend live, there’s 2 CEUs. Let me tell you, I would love to be able to offer CEUs to everyone who even watches the replay.

However, most boards require that we get pre approval and that is a long process and so I’m not able to do it for folks who only are able to see it on a replay. We encourage you to watch the replay because we think that the information is totally worth it. The only way for me to do these CEUs is to make sure that I can verify attendance at the training. The only way to do that is live. 

So we really want to invite you to join us. Please go register at betsybyler.com/braving-the-course and that’s again betsybyler.com/braving-the-course. I am so thankful for all of you, for you listening. I’m thankful for Jenny and Sarah. And let me tell you that for me as a therapist, who’s been the director and the supervisor and the one that all my staff came to, I got used to that. 

But what I have found in the last year and a half of knowing these women and we have  other women that could have been on here today with us. That I have reached a place where I see that I also needed their support. That I needed to have therapist friends that knew what it was like to be a therapist that are on the same organizational level as me and their peers, instead of somebody I have to manage or be in charge of, and it has been like a breath of fresh air for me and has invigorated my own work.

And so I want to encourage you that if you feel like you don’t have time for this, I promise you it is worth it to make time. Jenny and I want to invite you Monday and we are so excited to do this. And if you have any questions, you can please feel free to email me always. It’s betsy@betsybyler.com. And we hope to see you Monday night. And until then, have a great 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

Traumatic Events and Substance Use Disorders in Adolescents – PMC

Substance Abuse and Trauma. – Abstract – Europe PMC

The adverse childhood experiences questionnaire: Two decades of research on childhood trauma as a primary cause of adult mental illness, addiction, and medical diseases –