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Cummins Values: Why Integrity Keeps Us Accountable to Our Consumers

Take a moment to think about what the word “integrity” means to you.

You might discover that integrity is one of those words you feel like you understand but find difficult to clearly explain. So let’s turn to the dictionary for help. Merriam-Webster defines integrity as firm adherence to a code of especially moral or artistic values”. We especially like the second definition given in this entry: “incorruptibility”. So, put simply, a person or institution that has integrity is incapable of being corrupted or led astray from its moral or ethical code.

If you know someone who you believe to have integrity, then you probably think very highly of this person. You probably trust that they will always do what’s right, even when it’s hard. You might even turn to them when you need advice about a difficult situation in life.

At Cummins, integrity is one of the core values that guides our organization and our employees. We strive for integrity in everything we do. All of our actions and decisions are characterized by honesty and adherence to our ethical standards. We are each personally vigilant in the effort to sustain the highest levels of principled behavior.

To explain what this means in practice, we spoke with four members of our staff who embody integrity in their work: Lee Power, Information Systems Database Analyst; Casey Ray and Christina Kerns, Outpatient Therapists, and Rebecca Bradford, Outpatient Team Lead for Marion County.

In this post, they explain what integrity means to them, why it matters in behavioral health care, and how they uphold Cummins’ commitment to integrity in their daily work.

Casey Ray, MS, LMHC (left); Christina Kerns, LSW, working toward CSAYC & LCAC (middle); and Rebecca Bradford, LCSW. Not pictured: Lee Power, MBA.

What Does Integrity Mean at Cummins?

As we discussed above, integrity is a word that can be tricky to define. We know that it has to do with upholding your moral and ethical standards, but what does that mean in the context of behavioral health care?

Everyone we spoke to agreed that a large part of integrity involves doing the right thing even when it’s difficult. Casey explains, “Having integrity means being internally motivated to do what is right simply because it is right. Maintaining integrity often means that you are doing the right thing despite it not being the easiest option.”

Sometimes the “right” choice can be determined without specific knowledge or training on a certain topic. But in the behavioral health field, this can also mean adhering to legal and ethical guidelines associated with providing treatment to others. For example, Christina mentions the National Association of Social Workers Code of Ethics as one thing that guides her practice at Cummins.

Lee makes the insightful observation that integrity doesn’t mean doing what’s right just some of the time, but every time. “For me, integrity means that I always need to have a consistent character, even when a compromising situation is available,” he says. This includes avoiding shortcuts that might compromise the ethical standards of our work even though they would lesson our personal burden.

Finally, integrity requires that we recognize when we’ve failed to do the right thing and take actions to correct our behavior in the future. “Integrity means living your values, being accountable to those values, and being honest with yourself and others when you are not living those values,” Rebecca explains.

Why Integrity Matters in Behavioral Health Care

Integrity is very important in behavioral health care because of the relationship between our organization and our consumers.

As recipients of care, our consumers place a great deal of trust in our organization when they come to us for services. We have a tremendous responsibility to help them the best that we can. Christina speaks to this responsibility when she says, “Integrity is important because it influences our daily decisions that impact our consumers, communities, and the profession.”

However, integrity is also important in other ways. For example, Christina believes that integrity aids in her ability to build authentic, trusting relationships with the individuals whom she serves. Casey agrees, adding, “Our clients count on us to be honest and consistent in our work. Without this, a good therapeutic relationship would be impossible.”

Lee also notes that integrity goes hand-in-hand with consistency and reliability. “I believe integrity is important in my position at Cummins because it allows me to be more reliable and easier to work with than those who don’t possess this important character trait,” he says. When we are committed to certain guiding principles, others can rely on us to consistently deliver high-quality of work, which naturally increases their trust in us.

Living with integrity means staying in alignment with our personal values, but it also means respecting the values of others. After all, most of us would agree that treating other people with respect and dignity—even when they are different from us—is always the right thing to do. Rebecca explains, “Integrity is important in my position because I not only need to be accountable to my values, but also acknowledge and respect the values of the consumer, provider, staff, etc., especially when they are different from my own.”

How Our Team Members Show Integrity in their Work

Our staff upholds Cummins’ commitment to integrity in many ways, both great and small, in their day-to-day work.

For example, Lee believes he displays integrity in his work by “telling the truth, not publicizing negativity, offering respect to every colleague, being forthcoming with important information, giving credit where it’s due, valuing diversity, collaborating, not competing, and being accountable.”

Rebecca once again emphasizes the importance of doing what’s right, not what’s easy, as a way of showing integrity in her work. “I believe I display integrity by doing what I believe to be right even when it is not easy or popular,” she says. “I am honest about my mistakes and missteps and try to make it right when I am able. I speak out when I see an injustice.”

In her work with consumers, Christina exercises integrity by building therapeutic relationships based on trust and respect. She explains, “I make sure to provide a supportive atmosphere where consumers are comfortable speaking honestly, knowing that they have a chance to be heard and their opinions honored. This is important because our consumers are highly vulnerable, and to earn their trust, a clinician must focus on their personal growth to encourage self-sufficiency.”

Although care providers must always respect their consumers’ beliefs and desires, they sometimes need to persuade consumers to do what’s right for their treatment even though it is difficult. This is yet another way they act with integrity in their work.

“My integrity has made a difference in instances where I followed ethical and procedural guidelines despite this being difficult and upsetting for clients in the moment,” Casey explains. “I have had clients come back to me later and thank me for following the ‘rules’ or doing what I said I would, as it helped hold them accountable and aided in their recovery—even if they didn’t recognize it right away.”

Integrity is an essential characteristic of any organization that provides behavioral health care to its community. Integrity demands that ethical standards are followed, consumers are treated with respect, and an emphasis is placed on doing what is right instead of what is easy. In essence, integrity is the moral compass that guides the organization, which is exactly why integrity is one of our core values at Cummins.

We would like to thank Lee Power, Casey Ray, Christina Kerns and Rebecca Bradford for explaining what integrity means and how they live it out each day. Your commitment to integrity sets a model for all of us to follow!

If you enjoyed this blog post about integrity at Cummins, then you might enjoy reading about our other organizational values below!

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Why Respect Is at the Core of Our Work
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How Our Providers Inspire the Hope of Recovery
cummins-values-continuous-learning
How We Practice Continuous Learning Every Day

Wellness for Care Providers: Surviving the Cycle of Caring

Caring professions, also called helping professions, are those where the role means directly caring for others physically, mentally, or emotionally. Some of the most common caring professions include nurses, teachers, social workers, and mental health therapists. 

When you work in a caring profession, there can sometimes be a disconnect between how you care for others and how you care for yourself. It’s easy to give too much and not refuel yourself when you need it, which can quickly lead to burnout.

To ensure a healthy balance and care for both yourself and others, it’s important to understand the cycle of caring and create a plan for managing your self-care. In this blog, we’ll explain the four stages of the cycle of caring and show you how to begin assessing the stressfulness of your job so you can best take care of yourself. 

Ciera Jackson, our Professional Development Specialist here at Cummins, shares her expert advice about the cycle of caring and creating a solid self-care plan for your own personal wellness.

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Ciera Jackson, MSW, LCSW, Professional Development Specialist at Cummins Behavioral Health

Explaining the Cycle of Caring

The cycle of caring is the process that happens when professionals, such as therapists, provide help to clients without receiving help in return. 

This process happens continuously in the helping professions because clients come and go. The therapist helps the client, the client puts the lessons into action, and then the therapist has to let go of that relationship because they’re no longer needed.

There are four stages of the caring cycle: empathetic attachment, active involvement, felt separation, and re-creation.

Empathetic Attachment

The first stage of the cycle is all about building rapport. During empathetic attachment, the practitioner must be open to what a client needs and be emotionally compassionate. Ciera explains, “This is the phase where you’re building rapport with a client, the client is emotionally vulnerable with you, and where you’re other-oriented.”

The empathetic attachment phase requires you, as someone serving another person, to be “on” and lend yourself to other people. It’s all about connection and trust.

Active Involvement

After empathetic attachment, the next stage is active involvement, which is where the professional invests time and energy to use their skills in helping the client. This is the phase most caring professionals spend the most time in. 

It’s the phase where professionals must figure out what the client needs, whether that’s assistance with anxiety, depression, social skills, or relationships. Ciera notes, “You have to reach for all these different tools in your tool bag.” 

Active involvement is also about making coping tools accessible to people who may not understand them or be overwhelmed by where to start. “It’s our job to help them simplify it. That’s what we have to do in the active involvement phase. We have to simplify things for them so it’s not so overwhelming,” Ciera says.

Felt Separation

During felt separation, the professional’s work is complete. The client applies what they’ve learned, and the practitioner detaches themself from the relationship. No matter what kind of role a professional fills, there are bonds created with the people they regularly serve, which means almost everyone in a caring field feels separation at some point. 

This separation isn’t always easy. Ciera says, “Sometimes it’s very uncomfortable, and sometimes it’s bittersweet because you have an attachment to them. It can be a great attachment, but you are not in their life permanently, and that’s a good thing. That’s a great thing.”

Re-Creation

As the caring cycle ends for one relationship and the separation is finalized, a caring professional should take time for re-creation. “Get some rest. Get away from work, hit the ‘off’ button. That’s what should happen in this cycle,” Ciera emphasizes. 

For many people, this can be a challenge because of the pressure to be constantly productive and on the go. Ciera tries to remind herself and her co-workers, “I need to shut it off. I need to shut it down. I need to prioritize myself, because you can’t pour from an empty cup. You can’t give what you don’t have and you can’t run on fumes.”

Ciera adds, “Sometimes people don’t give themselves permission to take the time to rest, because even when they’re resting, they feel like they should be doing something and making themselves busy. When you don’t rest, your body starts to give warning signs that say ‘Attention, I need you to stop.’ ”

Care and the Practitioner

Generally speaking, we know what happens for the client during these phases, but what’s happening for the practitioner? How are they responding and coping with the stresses and different stages of the caring cycle? 

Caring is a precondition for an effective helping relationship.

Ciera puts it plainly: “If you’re going to be effective in your work, you have to care.” For caring professionals, caring is quite literally part of the job, and that feeling must exist for them to do well and care for others in an effective way.  

Inability to care is the most dangerous signal of burnout, ineffectiveness, and incompetence. 

If you find yourself in a situation where you don’t or can’t muster a feeling of caring, “that likely means you’re burnt out, which means you’ll be ineffective and incompetent,” Ciera says.

Low points and burnout occur for everyone, regardless of what your role may be. However, as a caring professional, it’s essential to rejuvenate before you find yourself unable to care. Ciera encourages, “If you feel in your spirit that you don’t care, take a little break. Take a little leave of absence because that’s not how you should feel.”

She also points out that you should try to avoid reaching a point where your work and character are deemed questionable, or where people wonder whether you’re competent, because these doubts can follow you into the future.

Sustaining oneself, being vital, and being active in the caring professions means being fully present for the Other.

When you’re providing care to others, it’s important to be present and in the moment. “We to be fully present for the people we are working with,” notes Ciera. The clients are counting on you, and it’s your job to ensure you have the capacity to provide the care they need. That starts by taking care of yourself. 

Repeatedly, a practitioner must engage in a mini-cycle of closeness with the consumer and  grief over the end of the professional relationship.

“This is what we do. We get close and then we have to let go,” Ciera says. The cycle can be difficult for practitioners because some relationships and bonds are very strong. While this is great for facilitating helping, it can also make it more difficult to let the relationship end.

The Self-Care Action Plan

As a caring professional, you need to make sure to leave enough time for self-care. A Self-Care Action Plan can be an invaluable tool toward this end. At Cummins, we use a Self-Care Action Plan template inspired by the book The Resilient Practitioner: Burnout Prevention and Self-Care Strategies for Counselors, Therapists, Teachers, and Health Professionals by Thomas Skovholt and Michelle Trotter-Mathison.

In the remainder of this post, we’ll go over the first two steps of creating your Self-Care Action Plan: assessing your work stress and determining what kind of self-care/other-care balance you have in your life right now.

Step #1: Assess the Stress Level of Your Work

Work stress can be determined by assessing three factors: Demand, Control, and Social Support.

First, consider the following questions to assess the Demand of your work:

  • Do I have to work very hard for my job?
  • Am I asked to do an excessive amount of work?
  • Do I have enough time to get my work done?

Based on your answers to these questions, give yourself a rating from 1–5 for how demanding your work is, with 1 being low demand, 3 being moderate demand, and 5 being high demand.

Next, assess the Control you have in your work by considering:

  • Do I have to do a lot of repetitive work?
  • Do I have much freedom to decide how my work gets done?
  • Do I get to be creative in my work?
  • Do I get to learn new things for my work?

Use your answers to give yourself a rating on how much control you have over your work. Again, let a score of 1 indicate low control and a score of 5 indicate high control.

Finally, assess your level of Social Support by asking yourself:

  • Do I work with helpful people?
  • Do my co-workers take personal interest in me?
  • Is my supervisor helpful?
  • Is my supervisor concerned about my personal welfare?

As you did for Demand and Control, give yourself a rating from 1–5 indicating how much social support you receive in your work.

Once you’ve determined all three scores, you’ll have a better picture of exactly how stressful your work is. High demand, low control, and low support all tend to increase job stress. By contrast, the least stressful jobs combine high control and high social support with low demand.

Step #2: Give Yourself a Balance Score

Once you’ve determined how stressful your job is, consider how much you care for others versus yourself. Ask yourself: Do I tend to give more other-care and less self-care? Or do I tend to give more self-care and less other-care? Or am I about even?

Determine your current ratio of self-care to other-care. For example, if you are perfectly balanced, your score would be 50/50. If you are highly imbalanced, your score might be 90/10 (90% self-care to 10% other-care) or 10/90 (10% self-care to 90% other-care).

Once you’ve determined your balance, think carefully about any imbalances you see. If you find that you have a very unbalanced score, consider: What are some of my imbalances? Why am I out of balance?

These questions can be informative and enlightening  when it comes time to determine the wellness practices that will help you correct any self-care/other-care imbalances.

For caring professionals, caring about other people is part of the job description. This can result in work that is personally rewarding and deeply fulfilling. It can also create situations that are highly stressful and emotionally exhausting.

Fortunately, having a Self-Care Action Plan can help caring professionals balance the demands and responsibilities of their work. In future articles in our series on Wellness for Care Providers, we’ll explain how you can improve your self-care practices, focusing on areas like professional care, personal care, and physical care. Stay tuned!

Introducing TMS: A New Service Option for Treatment-Resistant Depression and OCD

Approximately 19.4 million adults in the U.S. have been diagnosed with major depressive disorder, also known as major depression. An additional 2–3 million adults live with obsessive-compulsive disorder. Together, that’s 9% of the total adult population whose daily lives are affected by these common disorders.

Many of these individuals can find relief from their symptoms with the use of psychotherapy, medication, or a combination of both. With a little help from medical professionals, most people can learn to manage their disorders and live full, enriching lives in spite of their mental health challenges.

However, about 33% of people with major depression and 40–50% of people with OCD do not see improvement in their condition even after undergoing the normal treatments. In these cases, their disorder is known as “treatment resistant.” Treatment-resistant disorders can severely impact a person’s daily functioning and destroy any hope that their condition will ever improve.

Finding new ways to manage treatment-resistant disorders is an ongoing challenge in the mental health field, but breakthroughs do happen. One notable development is transcranial magnetic stimulation, or TMS, which has been found effective at helping individuals with treatment-resistant depression and OCD. Although results vary from person to person, research has shown that 73% of participants with depression and 58% of participants with OCD see a noticeable reduction in their symptoms after a full course of TMS treatment.

Cummins has recently received a Federal grant that will allow us to provide TMS treatment for our consumers at our Avon office. We’re very excited for this opportunity to better serve our community, and we want to answer any questions you might have about this new treatment!

In this blog post, Cummins’ Medical Director Dr. Steven Fekete explains who will be eligible for this treatment, how it is different from other forms of treatment, and what you could expect if you were to begin a course of TMS treatment at Cummins.

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Steven Fekete, M.D., Medical Director at Cummins Behavioral Health

What Is TMS?

Transcranial magnetic stimulation is a form of treatment that uses electrical impulses and magnetic fields to affect the functioning of the brain. These impulses are created by a series of powerful magnets, which are placed around the patient’s head and controlled by a special machine.

Dr. Fekete explains, “The machine creates these little magnetic fields over different parts of the brain, and those magnetic fields then induce the brain cells to depolarize or become active, therefore regulating brain activity and helping that individual address the symptoms that they’re experiencing from their disorder.”

The electrical impulses are administered in waves over a period of several minutes, so this treatment is technically called repetitive transcranial magnetic stimulation (rTMS). The latest equipment is also capable of sending these impulses deeper into the brain than earlier machines could, which makes this specific form of rTMS deep repetitive transcranial magnetic stimulation (drTMS).

As we said above, drTMS is targeted toward individuals who suffer from treatment-resistant depression or OCD. “Treatment resistant means a person has used at least two antidepressants at maximally tolerated doses for six weeks, and received a course of evidence-based therapy, and they just did not get the response that they had hoped to,” Dr. Fekete explains. “Unfortunately, in the psychiatric field, the response rates of antidepressants are not where we’d like them to be. So there are a lot of individuals who experience this.”

At Cummins, we are especially interested in making drTMS available for individuals who get their health insurance through Medicaid, as this population has had poor access to TMS treatment in the past. “Treatment for depression is reimbursable through Medicaid, but there are a lot of individuals who we specifically want to target because Medicaid doesn’t pay for it. For example, we’re using the grant to help pay for individuals with OCD,” Dr. Fekete says.

How TMS Treatment Works

As we’ve mentioned, drTMS works entirely through the use of electromagnetism.

“An individual comes into the office, and they sit in a chair under this thing that kind of looks like an old hair dryer,” Dr. Fekete explains. “And they wear a cushioned helmet underneath this more rigid helmet.”

When the machine is turned on, the exterior helmet passes electric currents through a series of electromagnetic coils. The person wearing the apparatus can hear this as a repeated tapping or clicking sound. The coils inside the helmet create an electromagnetic field that reaches about 1 to 2 inches into the wearer’s brain, which stimulates neural activity in specific areas of their brain. For example, for patients suffering from depression, the apparatus is configured to stimulate the dorsolateral prefrontal cortex.

The magnetic field is similar in intensity to an MRI scan, and it is safe for the majority of people. However, side effects of drTMS treatment can include headaches, pain or discomfort at the treatment site, and jaw pain. No individual who has metal on or inside their head (which may include plates, medial devices, shrapnel, or metallic tattoos) is eligible for drTMS treatment, as the magnetic fields can be dangerous for these persons. Other possible contraindications include suicidal ideation, psychosis, substance use, and pregnancy or lactation.

Other pros and cons of drTMS include:

Pros

  • The treatment is non-invasive and is performed in an outpatient setting
  • Most patients can drive themselves to and from their appointments
  • No memory loss or cognitive impairments
  • Any medications may be continued during treatment

Cons

  • Risk of minor side effects (headaches, site pain, jaw pain, muscle twitches)
  • Very low risk of seizure, mania activation, and hearing loss
  • Large time commitment (20-minute sessions for 30–36 days over a span of 6–12 weeks)

Dr. Fekete sums up the pros and cons of drTMS: “To me, the biggest advantage is you can drive to the appointment and drive away. The biggest downside is it’s very time consuming. I think about people who work, or who have responsibilities for children, or maybe responsibilities for an older adult or somebody else in their life. That may be very difficult to get around. They may have to arrange for somebody to take care of things at home while they’re gone. But once they’re done, they’re not impaired from the treatment to do whatever they need to the rest of the day.”

Example of what the drTMS machine looks like when in use

A Typical TMS Treatment Session at Cummins

If you or a loved one are eligible for drTMS treatment and choose to receive it through Cummins, it begins with a conversation with our Central Access Office.

Dr. Fekete explains, “An individual would reach out to our Central Access saying they’re interested in getting TMS. We would also take a referral from a provider who might call us and say, ‘I have such and such, would they be eligible for getting TMS?’ “

Depending on the person’s eligibility and insurance coverage, the next step would be an initial consultation about drTMS services. “We would set up an appointment for that individual where we would come in and interview them,” Dr. Fekete says. “This psychiatric evaluation takes about an hour. We would go over the process with them and then determine if they are still interested in in it after reviewing the risks and benefits, side effects, etc. We would also take them over and show them the treatment room as long as there wasn’t anyone in there.”

Next would come the first drTMS appointment, which involves taking neurological measurements of the patient’s brain. “We map their activity in their motor cortex, and a percentage of that is utilized to adjust the magnetic impulses that will be used in their treatment,” Dr. Fekete explains. “It takes about an hour. Either myself or the other physician would be there the majority of the time, because we’re doing that mapping with the assistance of a technician.”

After this mapping session, the patient can begin attending treatment sessions based on the schedule determined with their provider. “It’s usually 30 treatments that are 20 minutes each,” Dr. Fekete says. “After the first appointment, you would not necessarily interface with the prescriber, you would interface with the person who is going to be setting up the machine. You would come in for your 20 minutes, and then you would leave. And that’s it.”

As you progressed through treatment, you would also continue your normal therapy or psychiatry appointments, if you were receiving these services. Dr. Fekete explains, “The TMS is freestanding, yet part of a larger approach to managing some of these more significant treatment-resistant illnesses that we face. The nice thing is that the TMS is one item in an armamentarium we can use to help people manage their illness. So it fits in with medication, it fits in with therapy, skills training, self-help groups, mutual help groups, and meditation.”

According to Dr. Fekete, the most important aspect of drTMS treatment at Cummins is that we are able to bring a new standard of care to people who did not previously have access to it. He says, “I only know of one other place in Indiana that currently provides TMS for the Medicaid-based population. This has been around for 13 years, it’s FDA approved, it’s Medicaid payable, but it’s not being offering to these people. This gives people access to care that they should have had since 2008.”

If you are interested in exploring the possibility of drTMS treatment for yourself or someone under your care, we encourage you to speak with your psychiatrist, therapist, or care provider. If you would like, you can also call us at (888) 714-1927 to speak with someone about drTMS services.

Suffering from a treatment-resistant mental illness can be extraordinarily difficult and discouraging, but with the help of new treatment technologies like drTMS, recovery is possible!

Wellness for Care Providers: Identifying and Managing Burnout

Anyone who works in a stressful, emotionally taxing line of work may be familiar with burnout.

Merriam-Webster dictionary defines burnout as “fatigue, frustration, or apathy resulting from prolonged stress, overwork, or intense activity.” However, this description doesn’t quite do justice to the experience. Burnout is a state of debilitating emotional exhaustion that can lead to a lack of motivation, a reduced sense of accomplishment, and even a diminished sense of personal identity.

The health care industry and other “helping professions” are notorious for high rates of burnout, which can be seriously damaging to the health and wellness of workers. In the worst cases, burnout can lead to employees missing extended periods of work or even quitting their jobs to pursue careers in different fields.

At Cummins Behavioral Health, we care about the wellness of our team members and of all mental health care providers. If care providers struggle to maintain their own health and wellness, then the quality of care they can offer their clients will also suffer. That’s why we’re committed to helping mental health professionals avoid work-related wellness issues like burnout.

Although burnout is a danger for care providers, it can be managed if we know the warning signs and what to do about them. In this blog post, we’ll identify some common signs that you may be approaching burnout and explain how you can correct course before it’s too late. We’ll also include examples and insights from Ciera Jackson, Professional Development Specialist at Cummins, who leads our internal wellness trainings and initiatives.

We hope you find these tips useful in your own work!

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Ciera Jackson, MSW, LCSW, Professional Development Specialist at Cummins Behavioral Health

Warning Signs of Burnout

Sometimes it can seem as though burnout happens all at once, like a tornado or hurricane that strikes unexpectedly and upends our lives. In reality, just as with a storm, there are almost always warning signs that precede it.

Below is a list of common signs a person may be approaching burnout. The more of these signs that are present for an individual, the greater are the chances that they may be headed for burnout.

Exhaustion

Physical, mental, and/or emotional exhaustion is a common precursor to burnout. As Ciera points out, exhaustion is a more oppressive version of the tiredness or lethargy you may sometimes feel on bad days. “This is more of that perpetual, chronic, ‘I am tired. I’m done. I’m kind of just over it,’ “ she says.

Lack of motivation

Waning motivation is also a significant sign that burnout could be near. “Your job doesn’t excite you like it used to,” Ciera explains. “You feel like you can’t muster up the energy to do it another day. You feel like it’s something that the weekend or a vacation won’t necessarily solve.”

Lack of resilience

“Normally, when people are resilient, they have an ability to bounce back fairly quickly,” Ciera says. When someone is approaching burnout, this ability becomes diminished. Frustrations and setbacks in their work may trigger feelings of resignation and hopelessness.

Bad interactions with others

Negative feelings about work may manifest as rude or inconsiderate behavior toward co-workers and clients. Ciera says, “We all have bad days, but sometimes when you’re burned out, it’s more than a bad day. It becomes a part of your character. People have a bad taste in their mouths about who you are as a person, because they may not have had favorable interactions with you.”

Inability to make decisions

“Sometimes, if burnout becomes chronic, it can feel paralyzing,” Ciera says. Work-related decisions you once made without difficulty may seem strangely unsolvable now. “Maybe there’s some counter-transference with consumers going on, maybe there’s some blending of boundaries going on, and things are becoming a little more personal or a little more close to home,” Ciera adds.

Increased work stress

Work stress often comes in the form of additional tasks that must be completed. “You just keep getting more piled on, and so it becomes a struggle to manage what you have,” Ciera explains. However, increased stress can also come from longer hours or greater responsibilities.

Being cynical

An individual who is approaching burnout may develop a negative attitude about nearly everything related to their work. This could manifest as snide or sarcastic comments to colleagues or even clients. The person may develop a reputation for negativity among their peers.

Reduced performance

As stress and exhaustion develop into burnout, an individual may find themselves unable to perform their work to their normal standards. “Maybe you used to be a high performer, and now you’re not performing so well or producing as much,” Ciera suggests.

Lack of satisfaction from achievements

Even when someone performs well in their work, they may cease feeling any sense of personal accomplishment. “People could praise you and reward you for what you do at work, and you could feel apathetic. And so you could start to feel numb and disconnected from what’s going on,” Ciera explains.

Using vices to cope (food, alcohol, cigarettes, etc.)

When everyday life becomes too stressful, some people may start to rely on something to numb that stress. These vices can come in many forms, but they always serve to cover up negative emotions. “People use vices to try to just get by and focus, just because they’re trying to feel something, or just because they feel like it helps them function,” Ciera says.

A change in sleep habits

Altered or unusual sleeping habits can be an early sign that stress is becoming unmanageable. “Some people wake up in the middle of the night because they are dreading going to work the next day,” Ciera says. Alternatively, they might also find themselves chronically oversleeping due to a lack of energy.

Lack of creativity

When a person is overburdened by long work hours or extraordinary stress, their ability to be creative is one of the first skills they lose access to. “For some people, they may have been artists in various forms, and that creative piece has dwindled,” Ciera says. “When your brain has experienced some trauma, creativity is hindered.”

Physiological issues (headaches, upset stomach, gastrointestinal issues)

Stress can commonly manifest as physical symptoms, which can be a clue that it’s becoming a chronic problem. Ciera explains, “Some people carry stress in different ways, and you have to figure out, ‘What is producing this?’ “ It’s possible that physical symptoms may be indicative of burnout.

A feeling of dread when you think about work

This is one of the most clear and obvious signs that a person’s work situation is leading them to burnout. “For some people, Sunday night is the worst time of the week,” Ciera says. “They may cry, they may have a pit in their stomach, because they think, ‘Monday is tomorrow, and that is the work week, and that’s when it starts.’ “

Burnout Creation vs. Burnout Prevention

We’ve discussed many common signs for detecting burnout, but what can we do to prevent it or recover from it once it has occurred?

The conditions and situations that lead to burnout are not always easy to change, and there is no one-size-fits-all solution for preventing burnout. However, burnout is often caused by several common sources. Therefore, it can be helpful to understand the sources of burnout creation vs. burnout prevention.

Your best option for counteracting burnout is to do whatever you can to tip the scales toward burnout prevention in your specific circumstances.

Work overload vs. sustainable workload

A workload that is chronically too heavy is almost guaranteed to create burnout over a long enough time frame. While short periods of heavier workload can be managed, unending overwork usually leads to exhaustion.

“In social services, I think we know when we’re going into it that there’s not always going to be sunny days, rainbows and gumdrops,” Ciera says. “And I think we also know that there are going to be seasons that are heavier than others. With that being said, I think it’s fair to say that you’re going to have sometimes where your caseload may be a little heavier than others. However, if that is the norm, that is a problem, and that is where there needs to be balance. Because if there is always work overload, or that is normally the case, that’s what starts to create burnout.”

The best way to achieve a sustainable workload is to let your superiors know when you have too much work to handle. This may feel uncomfortable sometimes, but if your management is truly supportive, then they’ll do what they can to help you get your workload to a sustainable level.

“It’s OK to say no. You should normalize saying no. There’s nothing wrong with that. There’s nothing wrong with work-life balance at all,” Ciera adds.

Lack of control vs. feelings of choice and control

If the current state of your work is unsatisfactory and you also believe that you have no control over it, feelings of burnout are likely to increase.

“In reality, there are things we don’t have control over,” Ciera explains. “There are certain policies we don’t have control over, there are certain things regarding billing we don’t have control over. But there are other things that are within our control, and that we can speak up and say something about.”

Again, the best way to regain feelings of control is to make sure your team and superiors know what you need from your work. “I want to encourage people to use their voice,” Ciera says. “It’s OK to speak up and say something. It’s OK to assert yourself. The things you do have control over, assert yourself, use your voice, and make sure your needs are known.”

However, it’s important to remember that asserting yourself doesn’t mean acting rude or being selfish. Ciera explains, “That doesn’t mean you don’t act like a team player. There’s give and take. Sometimes you cover things for people because there may be a time where somebody has to cover something for you. It’s not like you can always say no.”

Insufficient rewards vs. recognition and reward

A little bit of recognition and reward can sometimes go a long way toward making difficult work more tolerable.

As Ciera explains, this reward can look different from person to person. “It could be making sure your pay matches your duties. It could be simple verbal recognition. Like, ‘Hey, you did a really great job on that case. I know that you were on the phone for hours with that one client, and you did a good job getting them in the hospital.’ It could be a team reward. People have different reward systems, and people are motivated by different things,” she says.

It can be helpful to let your superiors know what kind of rewards and recognition you find most personally meaningful. You might also need to discuss whether the rewards you are receiving match the level of effort you put into your work.

Breakdown of community vs. a sense of community

For some people, a sense of teamwork and camaraderie among their co-workers is an important part of fulfilling work. This sort of community can often act as a protective factor against burnout.

Ciera gives an example of what this might look like: “Let’s say I’m out for a day, and one of my consumers comes in. They weren’t scheduled, but you’ve seen me with them before, and maybe they’re a little bit agitated. Are you going to de-escalate this person and take care of them the way I would take care of them?”

A sense of community can be enriched by superiors who lead by example and not by giving orders. “If you’re asking me to do something, are you going to be willing to do what you’re asking me to do? For some people, it is hard to be in a place where they’re moreso with bosses than with leaders. They want servant leadership instead of dictatorship,” Ciera says.

Unfairness vs. fairness, respect, and justice

Fairness and unfairness are subjective measures, but they are nonetheless very important for job satisfaction.

If we feel that our job is unfair, this might go back to the issues of work overload or insufficient reward that we discussed above. Ciera explains, “Some people may feel like, ‘I’m working, working, working, working, and I’m not being recognized. I feel like I’m spinning my wheels in mud. I’m giving all I can to this company, and it’s not fair because I’m not being recognized.’ “

Feelings of unfairness could also stem from the perception that other employees are being treated more favorably than you are. Whatever the case, unfairness can easily contribute to burnout if it is not addressed. “For some people, that leads to burnout, because it’s like, ‘Why am I doing this? Yes, I have or had a love for the population or the field, but now I’m at a point where I’m wondering if this place a match for me,’ “ Ciera says.

Significant value conflicts vs. meaningful, valued work

Every organization has a set of values that guides it. In the best cases, these values are compatible with the personal values of each employee at the organization. But sometimes there can be significant mismatch.

Ciera says, “The best example I can give is that I once had to leave a place I worked at because there was a high focus on money and a low focus on patients. And my belief was that we couldn’t be after their money and not treat the person with dignity and respect. There was a mismatch there, so I had to exit.”

If the values of your organization are at odds with your personal values, you will run the risk of becoming disillusioned and burned out. Therefore, you may need to assess whether the organization is a good fit for you.

“Sometimes you have to ask yourself: do my values match the company values, and do their values match my values? Ciera adds.

Lack of fit between the person and job vs. high job-person fit

We all have the ability to improve at a task or get better at our jobs, but it can sometimes be the case that a particular job is just not right for a particular person. This job-person mismatch can lead to burnout if it is not addressed.

“Sometimes people are not the best at something, but can they be coached to be better? And if not, maybe they just need a different position within the company,” Ciera explains. “Maybe they need to be moved to something else, because maybe they really are good in terms of certain value sets, or certain sets of job skills, but maybe just not at the position they applied for.”

Good managers may be able to recognize when their employees would do better in different positions. However, if you suspect you may be a poor match for your job, you shouldn’t wait for a superior to say something about it. “Maybe we ourselves say, ‘I applied for this job, but maybe I should move to this position. What do you think?’ “ Ciera says. We can’t always wait for someone else to tell us that. We have to be in tune with ourselves to tell ourselves that, or be honest enough to say that.”

The Bottom Line on Burnout

We’ve covered many ways of understanding, detecting, and measuring burnout. In fact, it might seem a bit overwhelming just to keep all of this information in mind at once. We’d like to close by briefly summarizing how you can assess whether or not you’re becoming burned out in your work.

When you think about your work, ask yourself if you are:

  • Energetic or exhausted. Does your work excite and inspire you, or does it drain your energy and enthusiasm?
  • Involved or cynical. Do you feel engaged and invested in your work, or do you feel detached and defeated?
  • Effective or ineffective. Do you believe you can make positive changes within your organization, or do you believe that any effort you make amounts to nothing?

“This is what you need to ask yourself when you’re weighing if you’re burned out,” Ciera says. “Where am I on this burnout scale? If you feel like, ‘I’m still engaged, I’m still OK,’ then you also have to start to ask yourself, ‘What am I going to do to remain engaged?’ Because you’re going to need to be intentional on taking breaks, giving that self-care, and doing things that are intentional to pour into yourself. You cannot pour from an empty cup.

In future posts in our “Wellness for Care Providers” series, we’ll go into greater detail about self-care strategies for preventing burnout. For now, we’ll end with these important words from Ciera Jackson:

“You cannot give and give and give and give to your work, because then what’s left for you? And if you have a family at home, whether it’s a significant other, whether it’s kids, whether it’s pets, what do you have left for them? You’re going to stop working one day. You’re going to retire one day. And the people that you’re left with are your family, or your friends, or your pets. Your job doesn’t last forever, so you have to maintain those relationships, because that’s what lasts. Not your work. Granted, it can be fulfilling. But be sure you’re intentional about the relationships in your life, and preserving yourself. That’s what’s important. Because you can’t give out what you don’t have, period.”

If you found this article on burnout useful, we encourage you to share it with someone else who might appreciate it! Our goal at Cummins is to be an advocate for all providers of physical and mental health care. The work you do every day changes people’s lives for the better!

Haven Homes Opens Its Doors to Survivors of Domestic Violence in Plainfield

Approximately 40% of women and 27% of men in Indiana will experience intimate partner violence sometime in their lives. That’s a total of 2.2 million individuals whose lives are altered by intimate partner violence.

The harmful effects of intimate partner violence or domestic violence continue long after an incident occurs. In addition to physical and psychological injuries, survivors may find themselves lacking the basic resources they need to rebuild their lives after an abusive relationship. In the worst cases, this can lead to sporadic or chronic homelessness.

In order to provide housing assistance to survivors of domestic violence, RealAmerica LLC has built Haven Homes, an affordable housing apartment complex in Plainfield, IN. Haven Homes is catered specifically toward individuals and families who are escaping domestic violence, offering amenities such as built-in kitchen appliances, in-unit clothes washers and dryers, and free in-unit internet service.

Cummins Behavioral Health and domestic abuse shelter Sheltering Wings have partnered with RealAmerica to provide support services to Haven Homes’ residents, as well. At the on-site clubhouse and community resource center, residents can speak with social workers and mental health professionals, receive counseling, and attend life skills classes either in-person or via teleconferencing. These services can further help residents recover from domestic violence and return to independent living after escaping abuse.

Haven Homes held its Grand Opening last Friday, December 17th, and we were thrilled to be in attendance! Below are some photos showing off the complex and the people who made Haven Homes possible.

The Haven Homes Grounds

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The two-story apartment building

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The three-story apartment building

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The clubhouse and community resource center

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Children’s playground behind the community resource center (lawn under construction!)

The Clubhouse / Community Resource Center

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Clubhouse room

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Clubhouse room—second angle

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Gym/fitness room

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Children’s playroom/activity room

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Classroom/meeting room

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Computer room

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Telehealth room (equipment not set up yet)

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Entrances to children’s activity room and private consultation offices

Grand Opening Ceremony

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Melanie Reusze, COO of RealAmerica LLC, opened the ceremony and introduced the speakers.

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Jacob Sipe, Executive Director of the Indiana Housing & Community Development Authority (IHCDA), which provided Rental Housing Tax Credits for the Haven Homes project

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“When we have a project like this, we’re really, really excited, because it truly does help fill our housing needs in Plainfield.” — Bill Kirchoff, Vice President of Plainfield Town Council

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“I couldn’t be happier to see this project completed, and I’m optimistic that it will help with the housing vacuum that’s been created.” — Brad DuBois, President/CEO of Plainfield Chamber of Commerce

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Brian Shelbourne, Vice President of Originations at Merchants Capital, which provided financing for Haven Homes

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“We’ve been talking for years about how we need to have better and more affordable safe housing in our communities, and Haven Homes is an answer to that need.” — Cassie Mecklenburg, Executive Director of Sheltering Wings

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“We look forward to serving the residents of Haven Homes in building safe and independent lives.” — Amy Mace, CEO of Cummins Behavioral Health Systems

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Ronda Shrewsbury, President and Owner of RealAmerica LLC, expressed her gratitude to everyone who helped make Haven Homes a reality.

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The ceremony closed with a ribbon cutting led by Melanie Reusze (click to view video)

We would like to thank all the organizations and dedicated individuals who had a hand in bringing Haven Homes to fruition. This is an important project for a vulnerable population in our community, and we are very excited to assist in their recovery and growth.

In the future, we hope to share more information about the services we are providing to residents at Haven Homes. Keep an eye on our blog in 2022 for that story and many more!

Cummins Values: How We Practice Continuous Learning Every Day

It would be hard to deny that learning is a big part of being a human.

When we are born, we come into this world without any knowledge or understanding of it. Everything that we know now, we had to learn.

This learning happened in many ways and came from a variety of sources. When we are very young, our parents bare most of the responsibility for teaching us about life. Later, schools and educators take the lead in filling our minds with knowledge, which can last more than a decade or two depending on the amount of formal education a person receives. And all throughout this time, we also learn lessons from personal experiences and the experiences of other people who are close to us.

After all this learning is done—not to mention the learning we must do when we start a new job or advance further in our career—we might feel that we’ve learned enough. After all, learning is often challenging, and it’s comforting to believe that we know enough. However, we believe in lifelong learning at Cummins Behavioral Health, not least because it helps us provide the best possible care for our consumers.

Continuous learning is one of our core organizational values, and it influences everything from our team’s professional development to how they work with consumers. To learn more about continuous learning at Cummins, we spoke with two of our staff members who embody this value in their work: Joel Sanders, a School-Based Therapist in Hendricks County, and Jennifer Knight, one of our Onboarding Specialists.

In this post, they explain why continuous learning matters and how they embrace it in their work.

Joel Sanders: Learning More to Improve Consumer Care

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Joel Sanders, LMHCA, School-Based Therapist

One reason we believe in continuous learning at Cummins is because it improves the quality of care we can provide to our consumers. When our care providers have up-to-date knowledge about mental health disorders and the best methods for treating them, they can help their clients achieve better outcomes.

For example, Joel views continuous learning as a way of getting better at his craft. “I always want to learn more about mental health because it means I’m providing the best care and support for the kids I see,” he says.

In fact, Joel believes that improving in his work is more than a just nice bonus for his consumers. He views it as an obligation. The kids I see deserve it. They deserve my very best,” he says. “I’m also super passionate about it, so I’m constantly wanting to learn everything I can. It helps me to better serve my kids.”

The main way Joel practices continuous learning is by attending optional trainings and workshops that teach new therapeutic skills. “I am always interested in going to trainings and workshops,” he says. “The information you get there is invaluable, and the resources and networking are incredibly helpful.”

Joel mentions that one of his favorite topics to learn about is trauma and trauma-informed care. “I swear that I could be a full-time trauma workshop attendee,” he jokes.

On top of his desire to serve his clients, Joel also says that his colleagues help to inspire his passion for continuous learning. He explains,

“I think my co-workers inspire me to learn more and always try to improve myself. One of them in particular shares my drive and passion for continuous learning. It’s almost like we push one another. I am constantly sharing workshops and training opportunities with this co-worker. We are always talking about trauma and how we can learn more about it so we can best serve our kids. I love talking about trauma, so it’s pretty easy and natural to engage in continuous learning about it.”

Jennifer Knight: Empowering Staff to be Continuous Learners

Jennifer Knight, Onboarding Specialist

Another reason we believe so strongly in continuous learning is because it tends to go hand-in-hand with growth mindsets.

To put it briefly, a growth mindset is the belief that we can improve and develop our talents with practice and hard work. The alternative to a growth mindset is a fixed mindset, which is the belief that our abilities are determined at birth and cannot be improved or developed.

A growth mindset is just as important for our staff as it is for the individuals we serve. As one of our onboarding specialists, Jennifer works hard to encourage a growth mindset among each new person who joins our team.

“For me, continuous learning is having a growth mindset and accepting that growth is not always linear,” she says. “Sometimes, we grow and learn more through the setbacks and failures we experience rather than via successes.”

As Jennifer points out, some amount of failure is inevitable whenever we are trying to do something that’s difficult. She believes that a continuous learning mindset can help us stay motivated in spite of setbacks. “Continuous learning is important because it not only conditions us to be able to handle challenges and struggles, but also to feel gratitude in areas where we may not have previously,” she says.

Like Joel, Jennifer views continuous learning as a team effort. For example, she believes that she learns from her co-workers just the same as she helps them learn new concepts. She explains,

“I live out my passion for learning and growth at Cummins by valuing the relationships that I have with my colleagues and teammates when sharing our experiences in the field and learning from one another. I think I inspire my co-workers to continue learning and growing by trying to always stay positive and encouraging, as well as by highlighting the many positive qualities and strengths they have but may not always see in themselves.”

At Cummins, we believe that we are never finished learning. When we work with our consumers, we ask that they learn about their mental health and wellness, learn new life skills and coping strategies, and sometimes even learn new habits and routines. Our providers also commit themselves to continuous growth in order to serve our consumers the very best way we know how.

We would like to thank Joel Sanders and Jennifer Knight for sharing their thoughts and for acting as models of continuous learning among our staff. Your commitment to our consumers is what makes our organization remarkable!

If you enjoyed this blog post about continuous learning at Cummins, then you might enjoy reading about our other organizational values below!

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Why Respect Is at the Core of Our Work
hope-of-recovery
How Our Providers Inspire the Hope of Recovery
cummins-values-integrity
Why Integrity Keeps Us Accountable to Our Consumers

HOPE for Youth Who Engage in Harmful Sexual Behavior: Explaining the Treatment

The onset of sexual development is a major milestone in the life of any child. Not only does the child’s body begin to change, but they also develop an interest in the bodies of others, and they begin discovering ways to express their newfound sexuality.

Unfortunately, not all of the ways they may choose to express this sexuality are healthy or constructive. In a previous blog post, we explained how children and teens can sometimes learn sexual behaviors that are harmful to themselves or others. Once an individual has learned these behaviors, they may repeat them without much conscious thought and without realizing they are unhealthy.

However, youth can learn to identify and change these harmful behaviors with help from caring adults. This is exactly what our new service program, called “Healing for Optimal living through Protective factors and Education” (or HOPE), is designed to do. Through a combination of individual therapy, family therapy, skills training, sexual education, and other services, our HOPE program can help youth express their needs and desires in constructive, age-appropriate ways.

These interventions not only protect a young person from potential legal problems and relationship issues, but they can also help set them on a path toward healthy, safe living.

For Part Two of our series on our new HOPE program, we once again spoke with Ashlee Prewitt, our Director of Specialty Programs. In this post, Ashlee explains what the treatment entails and what you could expect if you were to enter your child into services.

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Ashlee Prewitt, LMHC, CSAYC, Director of Specialty Programs at Cummins Behavioral Health

Getting Started in Services

All services at Cummins Behavioral Health begin with a simple assessment called an “intake assessment.” This occurs during an initial appointment with an Intake Specialist, and it is designed to determine what kinds of services your child may require.

Ashlee explains, “We’ll do an initial intake where we are assessing for mental health and behavioral health, including sexual maladaptive behaviors and trauma, and from that we’re going to get service recommendations. We’ll communicate with the family whether we are aware of any sexual maladaptive needs based on that initial appointment.”

For some consumers, an additional psychosexual assessment may also be conducted at this time. “We’ll get a complete psychosexual history and dive into more detailed questions regarding sexual behavior, sexual attitudes, values and beliefs around sex, and those kind of topics,” Ashlee says. “The benefit of this psychosexual assessment is really getting that deep history.”

If these assessments indicate that treatment for harmful sexual behaviors might be appropriate, then the family will be referred to a specialist in their county for further consultation. This specially-trained provider will work with the family to determine if treatment is truly needed.

If it is, then the youth and their family can begin attending therapy and counseling sessions. These sessions will seek to address any and all emotional, behavioral and developmental issues that are contributing to the youth’s harmful sexual behavior. Ashlee explains,

“We will usually start with weekly or biweekly therapy sessions, depending on their risk level, protective factors, and past treatment. We’ll provide case management and skill development to wrap around the family, so not only is the youth learning new skills and treatments to help with building relationships, healthy impulse control and urge management, but we’ll also incorporate that with the whole family. How can the family help? How can the family demonstrate impulse control, set healthy boundaries, promote safe sex practices, and things like that?”

How Treatment Changes Harmful Behaviors

Maladaptive, reactive, or otherwise harmful sexual behaviors are often only symptoms of underlying struggles a youth may be facing. As we have said, the goal of treatment is to discover these route problems and address them.

“We’re going to identify different decisions or skill deficits that have led to this behavior, whether it is a trauma response, poor impulse control, communication difficulties, or anger management issues,” Ashlee says. She continues,

“For example, if impulse control is a problem, then we’re going to help the child be mindful of what they’re feeling, be mindful of what they’re desiring, do some sort of pro/con list or stop-think-go techniques to help them be able to think through decisions and take in all of the different factors that are at play when they’re making this decision. On the other hand, sometimes these behaviors are manifested because the child doesn’t have words to communicate what they’re feeling. We’re going to teach them: how can you communicate that you’re sexually aroused? How can you communicate that you’re feeling unsafe? How can you communicate you have a need that needs met, and how can you meet that need in a healthy way?”

Consider the specific problem behavior of sending sexually explicit photos to peers over the phone or social media. Because this behavior has become somewhat normalized among adults, a child or teen might believe this is an acceptable way to express their sexuality. How might treatment go about correcting this behavior?

In this particular example, one of the first things the treatment team would do is educate the consumer about the legality of this behavior. Child pornography laws often prohibit the sending or receiving of sexually explicit images of a minor, even if they are sent and received consensually. “It’s something that kids and parents can get in legal trouble for, and not many people actually realize that,” Ashlee says.

Next, the providers will work with the youth to determine why they are engaging in this behavior. “What needs are they trying to meet, or what is the goal there? And what are the healthy ways that they can now meet those needs or have that desired outcome?” Ashlee explains. “If it’s because they want to be in a relationship with someone, then we’ll talk about how we can build a healthy relationship. If their motivation for doing this is to be funny, or for shock value, then we’ll discuss how we can do this in a way that’s not going to run the risk of getting them into legal trouble.”

Once the providers understand what need the behavior is meant to fulfill, they will work with the youth to help them meet that need in a more constructive manner. Ashlee explains,

“If we’re working on, for example, building healthier relationships, that’s going to take time. We’re going to dive into: what examples of relationships have they seen that are good, or positive and healthy? What have they seen that’s not positive and healthy? What did they like about each? Then we’ll move forward and start to apply. We’re going to practice how we build those relationships. We’re going to roleplay communication. We’re going to roleplay interacting in ways that are appropriate and healthy. And we’re going to help them achieve that desired outcome in a healthy, prosocial manner.”

Working with the Whole Family

Although our HOPE services are focused on youth-facing interventions, that doesn’t mean the rest of the family is left out of the process. On the contrary, as a child or teen progresses through treatment, their parents or caregivers will be involved at every step along the way.

Ashlee explains, “We have family therapy sessions with the whole family together, and parents or caregivers also have their own sessions with the therapist who’s providing services. That way the parents have a place that is safe where they can walk through and process what’s going on, and they can work with the therapist so that the treatment team truly is aligned with everyone.”

It can be difficult for parents to watch their child struggle with a behavioral health issue, so we also try to provide emotional support for parents as needed. “It is very tough, and there are not a lot of resources and support for parents who go through this with their children. That is one of the big reasons why we set up our treatment pathway the way we have,” Ashlee says.

Additionally, different families may hold different beliefs regarding what constitutes “appropriate” expression of sexuality. The treatment team will work with parents or guardians to ensure that everything they communicate with the youth is in alignment with family beliefs about sex. Ashlee explains,

“We are absolutely going to be culturally sensitive and take into account the family’s beliefs, whether they are religious or personal. We are always going to partner with parents and make sure they are on the same page with us so that we are never in contradiction of their beliefs. That is how we’re going to meet them where they are and communicate those beliefs that are healthy and appropriate.”

Meet Our Treatment Team!

Our HOPE services are now available in Marion, Hendricks, Putnam and Montgomery counties. We hope to extend services to Boone County in the future, but for now, consumers in Boone county may be connected with a provider in Marion County or Montgomery County.

Depending on the county you receive services in, one of the providers below will act as your primary clinician.

Stacey Bostian-Miller, MS, LMHC, NCC, CSA (Hendricks County)

Stacey has had the enjoyment of being in the helping field for almost 25 years. While most of her work in the helping field thus far has been in the dental field working with people of all ages, she switched careers in 2017 and went into the mental health field. She earned a Bachelor of Arts degree in Psychology with a concentration in childhood and adolescent development and a Master of Science degree in Mental Health Counseling and has been employed with Cummins Behavioral Health Systems Inc. since October of 2017, where her role is a school-based therapist for kindergarten through 4th grade. She has also had the opportunity of working with adolescents, teens, families, couples, adults, and domestic violence survivors. Prior to her time as a mental health counselor, she volunteered as a CASA in Boone County and volunteered with Mental Health America of Hendricks County, where she went to elementary schools and presented puppet shows focusing on mental health and social topics. She is always excited to engage in trainings to further her knowledge, improve her skills, and keep up with the latest evidence-based interventions. She truly enjoys trauma work and play therapy techniques and is working toward a Certificate in Trauma Studies as well as focusing on becoming a Registered Play Therapist. Her most recent venture is beginning to work with adolescents who have engaged in sexually harmful and/or reactive behaviors.

Jeremy Haire, LMHC (Montgomery County)

Jeremy started his career working with youth and families in 2005 after volunteering in an after-school program. He has served in several roles as a volunteer, case manager, community-based therapist, home-based therapist, school-based therapist, group therapist and a supervisor. He loves having the opportunity to make an impact in the lives of children and their families. It is important to him that youth feel respected and they learn there is hope in recovery. During his career, he has been given the opportunity to receive training to strengthen and improve his clinical skills. Some examples are: Motivational Interviewing, Cognitive Behavioral Therapy, Family therapy techniques, Play Therapy techniques, Theraplay techniques, and Trauma Focused-CBT. He has used these skills to provide a variety of services that include intake evaluations, risk assessments, individual and family therapy, group therapy, skills training, and case management.

Christina Kerns, Outpatient Therapist and MHIOT Group Facilitator at Cummins Behavioral Health
Christina Kerns, MSW, LSW (Montgomery County)

Social work has always been the right profession for Christina because of the overwhelming passion she has for helping individuals meet their mental, physical, social, and spiritual needs. She strives to understand all difficulties by encouraging individuals to challenge themselves to make a change in their own lives. Over the past nine years, she has developed a strong clinical skill set through the combination of education and practical experience. She provides therapeutic services for children, families, and individuals by utilizing an integrated approach tailored to their unique needs. She has also worked with a variety of diverse populations within the community. She understands the benefits of both professional and personal development throughout a lifespan and would consider herself a lifelong learner. She cultivates new opportunities by learning additional skills and techniques to assist all individuals. In addition, she has gained extensive experience in policy and public health research under the guidance of a research team and a fellowship. She encompasses advocacy and prevention surrounding the mental health of Putnam County’s residents, as seen through her work as Co-President for Mental Health America of Putnam County (MHAoPC). She works hard to establish financial stability and sustain community partnerships.

Erica Bostic (Putnam County)

Erica has been a provider supporting children and families since 2020. Her aspiration to help this underserved community has been her passion since she can remember. She started this career path in 2015 at Indiana State University by choosing to study social work. She served as an intern at a nursing home and the Salvation Army, but instantly learned that her passion was working with youth. In 2019, she started her master’s program at IUPUI and chose the school track in hopes of becoming a School Social Worker. She interned at Northwood Elementary school and was amazed at all the opportunities to help children within the community. When COVID-19 hit that school year, it opened her eyes to how desperately the field and community needed the extra supports and services that she could potentially provide. Through her education, she has been given the opportunity to improve her clinical framework by utilizing Cognitive Behavioral Therapy, play therapy, Trauma Focused-CBT, Mindfulness, and Dialectical Behavioral Therapy. Through these techniques and her current position as a School Based Therapist with Cummins Behavioral Health Systems, she can offer a wide range of services and supports to children and families in the community by providing skills training, individual therapy, and family therapy.

Kendra Solana, LSW (Putnam County)

Kendra is from a small rural town that suffers from mental health stigma, and it has been her goal to continue challenging that mental health stigma on the micro, mezzo, and macro levels. She graduated from Indiana State University with her Bachelor's in Social Work in 2020, and with her Master's in Social Work in 2021. She has interned with community mental health centers for the last 2.5 years, two being with Cummins, with a focus on working with the addiction population, i.e. IOT, life skills training, and case management. She was then offered a permanent position with Cummins prior to graduating with her masters. She was privileged enough to continue her professional development with those who supported her academic success, as well as found the inspiration through the Cummins team to take on the position she now fulfills. The position includes completion of intake assessments, collaboration with juvenile probation/DCS and their youth/families, focus on the high-risk youth population, and she facilitates the adolescent relapse prevention group. Thank you to our youth, families, affiliates, and team for allowing me to be a part of their processes! Recovery is possible.

Allen Graham, MMFT (Marion County)

Allen is enthusiastic about helping others to heal and to grow. He started working in mental health in 2014 as a life skills specialist at an inpatient setting. He worked primarily with adolescents and children, helping them to build Dialectical Behavior therapy skills. Since completing his Master’s in Marriage, Couples, and Family Therapy, he has worked with a diverse population with a variety of challenges. This has allowed him to further develop his clinical framework, building his understanding in Dialectical Behavior Therapy, Cognitive Behavioral Therapy (CBT), Trauma Focused CBT, Feedback-Informed Treatment, Structural Family Therapy, and Internal Family Systems.

Laura Braun, LMHCA (Marion County)

Laura has enjoyed being a mental health therapist since 2018. Professionally, she has served this field as a community-based therapist and an individual therapist for children, adolescents, and adults. She has been given the opportunity to strengthen her clinical framework by providing Cognitive Behavior Therapy, Play Therapy techniques, Trauma Focused-CBT, Certified Individual Trauma Informed Therapy, and best practice treatment for adolescents that have engaged in sexually harmful and/or reactive behaviors. She has utilized her framework to provide services and support to children and their families including but not limited to individual therapy and family therapy.

Our services for youth who engage in harmful sexual behaviors are available now! If you believe your child or teen might need treatment and you would like to speak with someone, please call us at (888) 714-1927. With the proper help and support, your child and your family can recover from these challenges!

All About OCD: What It Is, Who It Affects, and How It Can Be Treated

Have you ever felt that something in your environment was not quite right?

Maybe you’ve been lying in bed at night and started to wonder if you locked the front door after coming home or turned off the oven after cooking dinner. Perhaps you’ve felt a bit dirty after engaging in a physical activity and decided to wash your hands or take a shower. Or maybe you’ve noticed that your home has become disordered and spent a few hours tidying up.

If you’ve ever experienced a situation like one of these, then you know that they generally produce a mild amount of anxiety. This anxiety usually isn’t too troubling. It draws our attention to some situation that might be unsafe for us, and it motivates us to fix the unsafe situation. Then, having served its purpose, the anxiety subsides.

However, sometimes a person can have a very strong, exaggerated anxiety response to everyday situations like the ones we’ve described. This is precisely what people who have obsessive-compulsive disorder, also known as OCD, experience on a daily basis.

OCD is an anxiety disorder characterized by intrusive thoughts that cause anxiety and repetitive behaviors that a person performs to reduce this anxiety. It’s estimated that 1 in 100 adults and 1 in 200 children live with OCD in the United States. However, the ongoing COVID-19 pandemic has worsened the symptoms of many people living with OCD, which makes this disorder especially important to discuss right now.

In this blog post, we’ll explain the basics of obsessive-compulsive disorder, including how it works, who is susceptible to it, and how it can be treated. We’ll also include some thoughts and insights about OCD from our Chief Clinical Officer, Robb Enlow. We hope this information will help you know what you can do if you or someone you know is suffering from obsessive-compulsive disorder.

What Is OCD?

As we explained above, OCD is a disorder characterized by intrusive anxiety and behaviors that help to manage that anxiety. However, we can deepen our understanding of OCD by breaking down its name.

Robb explains, “Obsessive-compulsive disorder is a condition that involves a pattern of unwanted, unhelpful thinking that is driven by anxiety, called an obsession. For many, that obsession also involves a burdensome behavior that attempts to reduce the anxiety in repeated and time-consuming ways, called a compulsion.”

Most people have troubling thoughts and feelings of anxiety from time to time. However, people who have OCD tend to feel anxious much more frequently and for reasons that seem unnecessary or excessive to others. Both obsessions and obsessive-compulsive patterns become very difficult to stop and interfere with the person’s ability to function and feel internally safe,” Robb adds.

Many people who have OCD first experience symptoms in childhood, with most being diagnosed by age 19. The disorder tends to be equally prevalent among women and men and across different races and ethnicities. Although the causes of OCD are still unknown, it does appear to have a genetic component, as individuals with a parent or sibling who has OCD are more likely of developing OCD themselves.

What Does OCD Look Like?

OCD can be easier to understand if we also look at some of the ways it commonly presents itself. Specific obsessions and compulsions vary from person to person, but they do tend to fall into some commonly identifiable categories.

For example, some common obsessions among people with OCD include:

  • Fear of germs, dirt, illness, or contamination
  • A desire for items to be arranged in a specific way, such as symmetrically or at right angles
  • A desire for actions to be performed in a certain predetermined order
  • Fear of lacking a certain item when it is needed
  • Aggressive thoughts or urges to harm oneself or others
  • Unwanted and unpleasant sexual thoughts and urges

Some common compulsive behaviors in response to these obsessions include:

  • Excessive cleaning, bathing, or handwashing
  • Arranging and ordering items in a very precise way
  • Repeatedly “checking” things, such as checking to see that the door is locked or the oven is turned off
  • Counting and re-counting objects or actions
  • Hoarding items
  • “Mental checking” for intrusive, unwanted thoughts

As we mentioned above, the COVID-19 pandemic has only worsened obsessions and compulsions for some people with OCD, especially those whose anxiety revolves around sickness and contamination. Robb explains,

“At its core, OCD is about anxiety and one’s sense of safety, wellbeing, and balance, as problematic thought and behavior patterns organize safety for the individual in a world that is perceived as having dangers. COVID presents the world with legitimate dangers that make it imperative for us all to stay safe and healthy. For example, an individual with OCD who is concerned about germs and contamination repeatedly washes their hands; to them, COVID now gives something ‘legitimate’ to obsess about, and they increase handwashing behavior to attempt to relieve the distress. We all have been told to hand wash more frequently, but the individual with OCD perceives the impact with amplified distress, as there is no doubt to the dangers of COVID contamination. And for many, increased safety behaviors and rituals actually maintain that distressing anxiety instead of quenching it.”

How Can OCD Be Treated?

Obsessive-compulsive disorder can greatly impact an individual’s quality of life, and there is currently no cure for the condition. However, there are several forms of treatment that can help a person manage their troubling thoughts and behaviors.

“OCD can be treated with behavioral, cognitive, and sometimes medication-based treatments,” Robb explains. “Successful treatments allow individuals the ability to examine their thoughts and behaviors in a safe environment.”

For example, cognitive behavior therapy (or CBT) is one of the most common forms of treatment for OCD. This type of therapy helps a person learn to recognize their obsessive thoughts and resolve their anxiety without engaging in a compulsive behavior. A specialized type of CBT called Exposure and Response Prevention may also be used, which involves controlled exposure to situations that trigger compulsions in order to help a person become desensitized to these triggers.

“Learning cognitive-behavioral strategies, such as thought-stopping techniques and grounding techniques, helps many people gain control of patterns that seem to run against their will,” Robb adds. “Other treatments, such as Internal Family Systems, involve exploring how the mind and body seek safety by developing patterns of functioning intended to safeguard their self from underlying exiled feelings.”

If cognitive and behavioral therapies are not effective at reducing symptoms, a person might also be prescribed medication. Certain medications known as serotonin reuptake inhibitors (SRIs) and selective serotonin reuptake inhibitors (SSRIs) can help reduce the intensity of obsessive thoughts and compulsive urges. In very specific cases, antipsychotic medications have also been shown to help certain people.

Finally, in cases where traditional therapies and medications do not achieve the desired results, several “add-on” treatments may be considered. One of these is transcranial magnetic stimulation (or TMS), which uses magnetic fields to stimulate specific nerve cells in the brain.

Although it is less common than other mental health disorders like depression and generalized anxiety, obsessive-compulsive disorder still affects the lives of 3–4 million people in the United States alone. Although this disorder is long-lasting and can greatly impact a person’s quality of life, it is also treatable through therapy and medication. With the appropriate treatment, and individual with OCD can learn to live a full and rewarding life despite their challenges with obsessive thoughts and compulsive behaviors.

If you would like to speak to a mental health professional about receiving treatment for OCD, we invite you to call us at (888) 714-1927. With the right help, you or your loved one can recover from OCD and take back control of your life.

HOPE for Youth Who Engage in Harmful Sexual Behavior: Understanding the Problem

Children tend to hold a special place in our hearts and minds.

In an objective sense, children are simply young human beings, but they are also so much more than that. Often, children represent the best parts of humanity. They are curious and creative. They are honest and welcoming toward others. And in the eyes of many, they seem innocent and pure. They remind us how good people can be before they are corrupted by harmful emotions, desires, and outside influences.

It is perhaps for these reasons that sexuality and sexual development are carefully scrutinized among children and teens. Society tends to have strong opinions regarding which expressions of sexuality are acceptable at which ages, and youth who engage in sexual behavior “too soon” are often heavily stigmatized.

These social pressures can be useful for guiding youth through their developing sexuality, which comes with risks they may be too young to understand. However, severe stigma can be detrimental if it prevents youth from receiving help for sexual development issues.

In particular, some children and teens suffer from a tendency to engage in harmful sexual behaviors. These behaviors may be subconsciously learned from a variety of sources, and they can be highly damaging to the youth, their peers, and their loved ones. However, these behaviors can be corrected, and youth can learn to express their sexuality in healthy, age-appropriate ways if they receive help from behavioral health care professionals.

Cummins Behavioral Health will soon begin offering a program designed specifically for youth who engage in harmful sexual behavior. The program, called “Healing for Optimal living through Protective factors and Education” (or HOPE), will help youth understand what constitutes healthy sexual behavior and change their actions accordingly. This sort of intervention can drastically change the course of an individual’s life, leading them away from destructive behaviors and toward healthier, safer ways of living.

Ashlee Prewitt, our Director of Specialty Programs, is the driving force behind our new HOPE program. In this blog post, she explains more about harmful sexual behaviors among youth, including what drives them, how they get started, and why stigma is dangerous to a youth’s treatment and recovery.

Ashlee Prewitt
Ashlee Prewitt, LMHC, CSAYC, Director of Specialty Programs at Cummins Behavioral Health

Defining Harmful Sexual Behavior and “Reactive” Sexual Behavior

The first step in understanding and correcting harmful sexual behavior is knowing what this behavior looks like.

First, we should clarify what makes this behavior harmful. In the simplest sense, harmful behavior is behavior that has negative ramifications for the person performing the behavior, another person or persons who become involved in the behavior, or both. The negative ramifications could include physical harm, emotional or psychological harm, or even legal consequences. Even if the negative effects are relatively mild, a behavior can still be harmful if it impedes a person’s daily functioning in some way.

“These behaviors are sexual in nature, and what it comes down to is: there is an inadequate adjustment or inappropriate response to the environment or stimuli that manifests sexually,” Ashlee explains. “This could be sending naked pictures of themselves to peers. This could be excessive pornography viewing. And it can go all the way up to hands-on offenses like sexual molestation and assault.”

It’s important to note that some of these harmful behaviors may be what are called “reactive behaviors.” This means that the behavior occurs in response to an event or stimulus without much conscious thought. For example, think about the decision you make to take a drink of water when you feel thirsty, or your decision to say “excuse me” after sneezing.

Reactive behaviors are behaviors that are learned, one way or another, as the normal response to certain environmental triggers. Many harmful sexual behaviors can be reactive in nature, meaning that the youth may not even realize they’re doing something wrong. Ashlee explains,

“If something is an immediate trigger, it is going to change a person’s thought patterns. Both intrigue and emotionality are going to be escalated, and so now, because of that escalation, something is going to happen. It’s kind of a cause and effect situation. In this case, triggers could be being sexually aroused, either because of puberty or through an external stimuli, such as seeing other people engaged in public displays of affection. That can absolutely trigger an increased sexual urge, which makes the youth want to do something to satisfy that sexual urge. That may be sending nude pictures. That may be excessive porn watching. That may be touching a peer or a younger sibling in a sexual way.”

How Harmful Sexual Behaviors Get Started

As we’ve said, most youth who engage in these harmful behaviors don’t realize they are harmful at all. On the contrary, their experience has led them to believe that these behaviors are normal. How is it that this happens?

In some cases, a history of trauma or abuse may be to blame. “Sexual abuse, neglect, and physical abuse are risk factors to starting the pathway to engage in some of these behaviors,” Ashlee says. “Youth may see these maladaptive patterns within their abuser, and if they’re not taught how to handle emotions, or sexual urges, or the trauma that they’ve experienced, they may be one decision away from engaging in these unhealthy behaviors.”

If a child has been the victim of sexual abuse in particular, they might develop a skewed perception of love, intimacy and sexuality. “That is the groundwork, that is the example, whether it’s, ‘I have been sexually abused, and now, in my brain, this is how I show love,’ or, ‘In my brain, this is how I have power and control,’ “ Ashlee explains.

However, past trauma is not the only factor that can lead youth to engage in harmful sexual behavior. For example, Ashlee notes that there can also be a variety of societal influences. “I would love to say that society doesn’t play a part in it, but it does,” she says. “Sex and sexual behaviors are often reinforced, so youth get the idea that this is normal, everybody else is doing it. So until there is that moment of, ‘Oh, no, I can’t actually do this, this is not OK,’ there are times where they operate under that impression.”

Ashlee also points out that these behaviors, although inappropriate and ultimately harmful, are usually undertaken in an attempt to fulfill the youth’s basic needs. Although we condemn the behavior, we must also recognize that the youth is simply misguided, not malicious. Ashlee explains,

“We do a lot of education around the five basic needs and how behavior is a response to try to meet the five basic needs that every human has. The five basic needs come from a psychiatrist named William Glasser, and they are love and belonging, power and control, fun, freedom, and survival. And the idea is that all behavior comes from a desire to meet those needs. So with these individuals, they’re seeking to meet those needs through that sexual component. Let’s take love and belonging for example. They want to feel that connection to other people, so they engage in behaviors that society, or porn viewing, or whatever it may be has shown them, ‘This is how we connect with people.’ So they seek it out in a way that is not beneficial or healthy.”

How Stigma Prevents Youth from Getting Help

Earlier, we mentioned that stigma can be a problem for youth who engage in harmful sexual behaviors.

On the one hand, this stigma is somewhat understandable. After all, behavior that is harmful toward other people is never acceptable, and it’s difficult to reconcile the innocence of youth with harmful sexual behavior. “People don’t want to go there, because I’m looking at a child, and how can I handle this child hurting another child and still see them the same way?” Ashlee says.

Parents or guardians of youth may also seek to minimize these behaviors so as not to feel guilty or at fault for bad parenting. “There’s the stigma of, ‘My kid engaged in sexually harmful reactive behaviors. I’m a horrible parent. Let me just ignore it so that I don’t have to deal with it.’ Or, you know, the ‘boys will be boys’ mentality, or, ‘Oh, they’re just kids, they don’t know what they’re doing,’ “ Ashlee explains.

However, seeking to ignore these problem behaviors always causes more harm than good, because youth are unlikely to change their behavior by themselves. Therefore, they will likely continue to cause harm to themselves and others for far longer than is necessary. “When we minimize it, we hurt the population, and we hurt the people who need help,” Ashlee says.

The good news is that these behaviors can be corrected with treatment from mental health professionals. “When treatment is followed, these kids have about a 4% recidivism rate, meaning they don’t re-engage in these behaviors after they go through treatment,” Ashlee says.

It can be difficult to admit when a child or teen under our care has a behavioral problem, especially when it’s in an area as stigmatized as harmful sexual behavior. However, ignoring the issue only causes more harm. Youth deserve help overcoming these behavioral challenges, and with the proper treatment, they can learn to express their sexuality in ways that are healthy for both themselves and their peers.

In part two of our blog series on our new “HOPE” program, we dive deeper into the treatment itself, explaining what it entails and how it works. Click here to read more!

Shame-Informed Therapy: Debunking the Lies That Shame Tells Us

“If you put shame in a petri dish, it needs three ingredients to grow exponentially: secrecy, silence, and judgment. If you put the same amount of shame in the petri dish and douse it with empathy, it can’t survive.” — Brené Brown

At some point in our lives, most of us have had an experience where we felt we were not good enough in some way. As a result, just about all of us know what it’s like to feel shame.

Shame is a complicated emotion. We are first able to experience shame around the age of three, and it can feel somewhat different from person to person. However, shame is always about hiding some part of ourselves from other people. When we feel ashamed about something, we are desperate to keep it hidden from others, because we fear that they will judge us negatively for it. In fact, the word “shame” is believed to come from an old Indo-European word meaning “to cover.”

Not only is shame upsetting to experience, but deep-seated shame can create a variety of challenges in a person’s life. Shame can make relationships with other people difficult, and it can also complicate mental health conditions like depression, anxiety and PTSD. Shame is also deceptive by nature: shame tells us lies about ourselves, and if we believe these lies, they can cloud our judgment, interactions with others, and belief in ourselves.

Shame-informed therapy is a model of care that we are currently integrating into our services here at Cummins. This model is informed by modern neuroscience, which shows how activity in our brains and nervous systems can directly affect our thoughts and emotions. Most importantly, shame-informed therapy offers a pathway for overcoming shame and accepting ourselves for who we are.

Robb Enlow, our Chief Clinical Officer, is currently leading trainings to teach shame-informed therapy to our service providers. In this blog post, he explains how this approach to treatment can provide hope for those who struggle with shame and other related challenges.

robb_enlow
Robb Enlow, LCSW, Chief Clinical Officer at Cummins BHS

Explaining Polyvagal Theory, the Foundation of Shame-Informed Therapy

Before we can talk specifically about shame and shame-informed therapy, we need to explain a concept known as polyvagal theory.

You’ve probably heard of a phenomenon called the “fight or flight” response. When a human being encounters a threatening person, creature or object, it’s crucial that they determine how to stay safe from this aggressor. In some situations, fighting the aggressor may seem like the best option for maintaining safety, while in others cases, fleeing from the aggressor might seem more practical. This decision often happens quickly, without much conscious thought, and is controlled by the sympathetic nervous system.

However, there is a third response to danger that a person might also choose, which is to stay very still, or “freeze.” Freezing behavior is sometimes an attempt to avoid being seen by an aggressor, which could be the best option if fighting or fleeing doesn’t seem possible, or it may result from an extreme stress response that temporarily “overloads” the nervous system. Freezing behavior can often be observed in children (as well as in animals), and according to polyvagal theory, this reaction is controlled by the dorsal vagus nerve and related dorsal vagal complex.

Fight, flight and freeze are all responses to danger that can increase our chances of survival. However, these responses also limit our ability to perform higher-level thinking and reasoning. When we are fighting, fleeing or freezing in response to a threat, we aren’t wondering if we can appease the threat or considering whether or not it truly is a threat to us. We are simply thinking about survival. In essence, we are physiologically “locked out” of higher-level cognitive processes.

According to polyvagal theory, these higher-level processes are only possible when the ventral vagus nerve and ventral vagal complex are activated. Importantly, this nerve is also associated with social engagement and emotions like joy, compassion, curiosity and mindfulness.

Shame in the Context of Polyvagal Theory

What does polyvagal theory have to do with shame? As it turns out, polyvagal theory does a good job of explaining what happens when someone experiences shame.

“From a neurological standpoint, shame functions like trauma in a lot of ways,” Robb explains. “Trauma and extreme periods of shame, particularly between the ages of three and eight, kind of captivate or capture people into this frozen state.”

As we mentioned above, freezing behavior is common among children who are experiencing emotional distress. Due to their youth and limited life experience, young children are easily overwhelmed by negative feelings and emotions. As Robb explains, frequent activation of the dorsal vagal complex—which triggers the freezing behavior—can lead to trauma and shame that gets carries into adulthood:

“Research shows that between the ages of three and eight, the nervous system is developing at a very quick rate within the child. The nervous system is beginning to make connections in the brain about, ‘This is how I feel when this thing happens.’ It could be as simple as, I look at something disgusting, and I think, ‘Ew, that’s gross!’ while I feel unwell in my body. That feeling relays through my nervous system back to the brain, which I then make meaning of when I say, ‘Oh, that’s gross. Don’t touch that.’ That process continues as people begin to make meaning of the world.

Now, I’m going to make up a story. A three-year-old girl starts to play with older brother’s boys’ toys. Mom says to the three-year-old girl, ‘Little girls don’t play with that. That’s not yours. You play with dolls.’ Or maybe the three-year-old girl says, ‘I don’t want to wear a dress, I want to wear pants.’ And mom says, ‘No, bad! Girls wear dresses, not pants.’ These are just single instances, but think of all the times when people get told ‘no, bad.’ What happens is, when they’re told that, they go into that frozen state. They go into that place where there’s that painful feeling, and it forces people to do one of two things. They either become engulfed by it, or they hide from it, they avoid it.”

The Self-Lies of Shame

When young children are subjected to this kind of criticism, they can easily internalize it. Over time, they might come to believe that they are “bad” or “not good enough.” In many cases, these negative self-beliefs are carried into adulthood, resulting in shame.

Because shame is such an unpleasant emotion, most people develop strategies for avoiding it. Robb explains, “This is how we develop what’s called the ‘masks of shame.’ These essentially become parts of ourselves that get easily triggered by other things that remind us of that past pain. Deep down, we know we don’t want to feel that pain, so we exile that part of ourselves. We try not to go into that frozen state, and instead, we develop cover-ups.”

These masks and cover-ups are related to a fourth kind of response to danger known as “fawning,” or hiding our true self in order to feel safe. Some common masks of shame include self-beliefs like “I’m a bad person,” “I’m not good enough,” “I’m a failure,” “I’m a fraud,” and “I’m unlovable.” These masks may be covered up by behavior like shyness, secret-keeping, lying, co-dependence on others, substance use and addiction, and controlling behavior. But over time, these covering behaviors can actually reinforce the negative self-beliefs they were meant to hide.

All of these masks and corresponding behaviors can be highly destructive to the self and others. However, shame is almost always based on false beliefs. Put more accurately, shame results from false self-beliefs and misunderstandings about the origins of our behavior—behavior that was intended to help us feel safe and avoid our shame.

Robb explains in greater detail:

“I always like to tell people that shame is a lie, because it’s a cover. It’s always about not feeling what, for whatever reason, the body is trying to feel. And so shame will always have the ability to lie to people. It’ll always have the ability to tell people they’re not good enough, and they will even argue it as though it were the truth. It’s not until they recognize the origin of that shame, and how that origin played into their ability to maintain safety, that they realize, ‘OK, that had a reason. That had a purpose. And I can maintain my purpose and my safety without maintaining that behavior, that pattern.”

How Shame-Informed Therapy Helps Us Reprocess Shame

If we understand the root of shame, then we can understand how to eliminate shame. This is precisely what shame-informed therapy is designed to do.

“If I had to summarize it, you help people connect six things,” Robb says: “Feelings, body sensations, early memories of those feelings and body sensations, what core beliefs have developed in response to those memories, how are you really authentic today, and how can you create a new story to align all those pieces? That’s the process. You help people connect the dots with those things by gently talking about it in a safe environment.”

As we’ve discussed, revisiting or re-living feelings of shame is often an upsetting experience. This can emotionally and physiologically “trigger” someone, sending them into a defensive posture of freezing, fighting, or fleeing. In shame-informed therapy, every effort is taken to keep the ventral vagal complex activated so the individual can cognitively reprocess their shame. Robb explains,

“Part of what any therapist, nurse, teacher, or communicator has to do with other people is co-regulate. If you’re in an ugly frozen state, and the person you’re communicating with is in an ugly frozen state, that’s not a pretty conversation. In fact, sometimes we see that clinically. The parents are frustrated and triggered, the child is screaming and triggered, and neither one of them are communicating effectively with each other. They’re both frozen or very ‘fight or flight,’ and it’s just not working for them. The idea is we get them regulated to the ventral vagal state, or the social engagement state. When people are truly in the social engagement state, that’s when your brain is able to do miraculous things. When you calm down those cover ups, those protective, defensive parts, the rest of your brain is able to access creative, curious things that you’re just not able to access when you’re not in that state.

According to Robb, the ultimate goal of shame-informed therapy is to help people re-frame the beliefs and behaviors they feel shameful about. This process can help someone see that the behaviors they are ashamed of were always intended to help them feel safe:

“The good part about treatment is you can actually rewrite the way that the brain interprets information. The person who’s always believed, ‘I’m a bad person, I can do nothing right,’ maybe now has a new belief that, ‘OK, maybe I was never bad, maybe that’s what I had to do to get through the horrible trauma that I endured.’ In shame-informed therapy, this is what we call respecting and honoring the survival nature of what people have had to do to feel safe. That’s the key element there. If someone says, ‘Oh, I did that because that must be something I did that’s wrong,’ I’ll challenge that with, ‘No, you did that because that, at the time, is what you had to do to feel safe. And if you didn’t do that, I don’t know if you would be here today.’ And that’s hard for people to come to terms with, that, ‘OK, this very thing that causes me agony is also what’s helped me to establish who I am and feel safe.’ “

Shame is among the most difficult emotions that we can experience in our lives. Shame makes us believe that we are inferior or flawed, and to avoid feeling this way, we may develop behavioral patterns that harm ourselves or others. If we hope to overcome shame, it’s essential that we examine its origin, understand how it has influenced our behavior, and recognize the lies it has made us believe about ourselves.

If you are struggling with shame and would like to talk to a professional therapist or counselor, we have care providers who can help you. We invite you to give us a call at (888) 714-1927 if you would like to learn more or discuss treatment options. You are capable of living a life free from shame!