Polyvagal Theory for Mental Health Care: Applying the Work of Deb Dana in Therapy

“Safety is not the absence of threat, it is the presence of connection.” — Gabor Maté

For providers of behavioral health care, it’s very important that the people we serve feel safe around us.

The process of therapy requires vulnerability from those in care, and vulnerability is difficult or impossible unless a client feels safe opening up to their therapist. Without this sense of safety and trust, the therapist won’t be able to make the emotional connection needed to help the consumer succeed in therapy.

Therefore, one of the provider’s chief duties is to make the individual feel safe and comfortable to engage in treatment. But how can we do this? There are many strategies that may work, but at Cummins, we prefer a trauma-informed approach to care that incorporates the developing science of polyvagal theory.

In fact, we have recently begun training our providers on the work of Deb Dana, LCSW, who has pioneered work in applying Dr. Stephen W. Porges’ ground-breaking polyvagal theory to therapy practice with clients. Deb Dana has written several books describing clinical strategies and techniques that further apply this foundational understanding, including The Polyvagal Theory in Therapy: Engaging the Rhythm of Regulation.

We’re very excited to be incorporating Deb Dana’s techniques using polyvagal theory into our own clinical practices! In this blog post, we’ll provide a brief synopsis of polyvagal theory and preview how it can serve as a framework for mental health care.

Deb Dana, LCSW, author of The Polyvagal Theory in Practice

The Bodily Response to Danger

At some point in your life, you’ve probably had the experience of feeling unsafe.

If you think back to one of those instances, you’ll remember some interesting physiological symptoms. First, at the moment you detected danger in your environment, there’s a chance you might have frozen in place. Perhaps it was only for a second or two, or perhaps it was for longer than that. During those few moments, you made a rapid and instinctual assessment of the threat at hand without moving or speaking.

Then came the rush of adrenaline. Your body entered a state of high alert as your senses sharpened on the source of danger. Depending on the situation, you made a gut decision to either move away from the danger as quickly as possible, or, if you were threatened by a person or animal, to confront the aggressor in order to end the threat of danger. And then you did so, almost without conscious thought about it.

When you reflect back on the event today, you can probably understand it in its greater context. Using the logical part of your brain, you can surmise whether or not the perceived threat was a legitimate threat to your well-being, and you can judge whether you acted reasonably or unreasonably in the heat of the moment. You might even have some idea of how you wish you had reacted instead. But at the time of the incident, it would have been nearly impossible to have these kinds of thoughts.

Why is this so? Polyvagal theory offers an answer.

Polyvagal Theory: Linking Physiology and Cognition

As human beings, our cognition is closely linked to our physiology, and our physiology is closely linked to our perceptions of danger and safety. Polyvagal theory states that the presence or absence of a perceived threat activates different parts of our brain and autonomic nervous system (ANS), which produces different physiological states.

When we feel calm and safe, we are operating in what polyvagal theory calls the Engagement State. This state is associated with higher-level cognitive processes, social interaction, and emotions like joy, compassion, curiosity and mindfulness. When we’re in the Engagement State, the ventral vagus nerve and associated ventral vagal complex of the ANS are activated.

If we perceive a threat in our environment, our ANS may shift into the Mobilization State. In this state, our sympathetic nervous system is activated, which prepares the body to move in response to the threat. The Mobilization State may trigger “fight or flight” behaviors, and it is associated with emotions like anger, fear, anxiety and panic. Importantly, higher-level reasoning and social engagement are extremely difficult when in this state.

Finally, if the perceived threat is so great that we feel unable to counteract it, our dorsal vagus nerve and dorsal vagal complex may become activated, triggering the Collapse State. In this state, we might feel ashamed, hopeless, disassociated, depressed or even suicidal. At lower levels of dorsal vagal activation, we may also exhibit freezing behavior, which can occur when a sense of danger comes on very strongly and abruptly. While temporary, “defensive” freezing behavior can be useful for surviving dangerous situations, prolonged dorsal vagal activation is especially dangerous to our mental and emotional well-being.

The 3 Organizing Principles of Polyvagal Theory

In addition to the three physiological states described above, polyvagal theory proposes three key principles that explain how our bodies shift between them. They are:

1. Hierarchy

The three states of polyvagal theory are always activated in a specific order, without skipping any state. As our level of arousal and perceived danger increases, we move from the Engagement State (ventral vagal activation) to the Mobilization State (sympathetic nervous system activation), and then, if arousal continues, to the Collapse State (dorsal vagal activation). As arousal and perceived danger decrease, we move from the Collapse State to the Mobilization State, and if we are sufficiently calmed, then to the Engagement State.

It should be noted that arousal can happen very quickly, such as when someone who is calm jumps to freezing behavior in response to an abrupt threat. However, this is the one notable exception. In most cases, an individual does not move from a state of calmness and connection (Engagement State) to a state of numbness and hopelessness (Collapse State), or vice versa, without first passing through the state of frustration or anxiety (Mobilization State).

2. Neuroception

Neuroception is the premise that our nervous system can and does take in outside information and respond to that information. Importantly, this process happens without our conscious awareness.

Neuroception stands in contrast to perception, which is our capacity for consciously interpreting the world around us. While perception is moderated by conscious thought, neuroception is not. Neuroception explains how a person, object or environment that subconsciously reminds us of danger can create changes in our autonomic nervous system, even if we consciously know the person, place or thing does not pose a threat to us.

3. Co-Regulation

As our bodies and bodily systems mature throughout our lives, our autonomic nervous system develops the ability to self-regulate. For example, once it is sufficiently developed, our ANS can “learn” to transition out of heightened states of arousal on its own. However, this development process begins with co-regulation, which involves mirroring or mimicking the behaviors and arousal states of others.

Co-regulation can be seen commonly among young children, such as when an upset child is soothed by a parent or caregiver. Through neuroception, the child’s ANS responds to the calming cues given off by the parent and successfully de-escalates its own arousal level. Although co-regulation becomes less critical as self-regulation skills develop, it remains a useful principle to leverage in situations such as therapy and counseling.

Applying Polyvagal Theory to Clinical Practice

So, what exactly does all of this have to do with providing mental health care?

For individuals receiving care, seeking and receiving mental health services can be a challenging experience. For starters, a person who is seeking services may feel a variety of difficult emotions, such as uncertainty, anxiety, fear, or shame. What’s more, the therapeutic process may elicit upsetting thoughts and feelings as the consumer works through whatever issues they are seeking help for.

In some circumstances, these difficult emotions—perhaps coupled with traumatic memories or certain features of the treatment environment—may cause a person to feel unsafe, triggering an ANS response. If this happens, they will be temporarily “locked out” of the cognitive processes associated with the Engagement State, which are necessary for productive participation in treatment.

As care providers, we can use our understanding of polyvagal theory to help prevent this from happening. Although this is a nuanced process, Deb Dana’s framework poses three essential elements of practice:

1. Context

Some people seeking services may feel unsafe if they do not fully understand what is happening in treatment and why it is happening. For this reason, providers should demystify the process by consistently explaining what will be done, why it will be done, and how it will be done in the context of our brain and our nervous system. This will reduce the chance that the individual’s ANS will detect a perceived threat via neuroception.

2. Choice

Individuals may also be prone to feeling unsafe if they believe they don’t have any control over their treatment. This can create the feeling of being trapped within treatment, which may trigger ANS arousal. To prevent this, providers should ask their clients what they would prefer to do or offer multiple choices whenever possible. This will help the individual feel safe in the knowledge that they are in control.

3. Connection

As we mentioned above, the emotional tolls of treatment may cause some distress for the person receiving services. To prevent or counteract this, providers must constantly monitor their own emotional state and strive to remain in the Engagement State of the ANS. Doing so will assist the consumer in staying or becoming calm via the principle of co-regulation.

Robb Enlow, LCSW, Cummins’ Chief Clinical Officer, 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.“

At Cummins, we are always working to provide the most effective care possible for the people we serve. Part of this means training our providers in new and promising clinical practices. (In fact, continuous learning is one of our core organizational values!)

To this end, we’re thrilled to be incorporating polyvagal theory and the work of clinician Deb Dana into our standards of care. We believe it will further improve the knowledge base and therapeutic effectiveness of our care providers, which will in turn result in better outcomes for our consumers. And this, after all, is our most important goal.

If you are interested in advancing your career with a position at Cummins Behavioral Health, we encourage you to visit our employment page. We are always looking for talented and passionate people to join our team!

Wellness for Care Providers: Nurturing the Personal Self

Let’s face the facts: working in the caring professions—such as health care, education, emergency services, criminal justice, and social work—is often stressful. On top of attending to the people they serve, care providers must also make time to manage their own health and wellness.

In previous entries in our “Wellness for Care Providers” series, we’ve discussed:

We’re now ready to discuss the concept of the personal self and personal self-care. Whereas the professional self is the part of a person that identifies with and is nourished by their work, the personal self is the part of a person that’s concerned with everything outside of work. It is who we are on a day-to-day basis when we’re left to do as we please.

There are actually many different dimensions to the personal self, such as the emotional self, the playful self, and the solitary self, to name just a few. Good personal self-care is about properly nurturing each dimension of the personal self; if any one dimension receives insufficient care, we may begin to feel unhappy, stressed, aimless, or otherwise unwell.

In this post, we’ll break down the various dimensions of the personal self and provide some instruction for nurturing each one. We’ll once again be guided by insights and advice from Ciera Jackson, our Professional Development Specialist here at Cummins.

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

10 Dimensions of the Personal Self

Here at Cummins, we use a model of the personal self 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. This model divides the personal self into a dozen different sub-selves.

Today, we will discuss 10 of them in detail:

1. The Emotional Self

Humans are emotional beings at our core. The emotional self is the part of us that needs to feel and express our emotions in order to be at peace. If we keep emotions bottled up for too long, our emotional self will suffer.

The emotional self can be nurtured in a variety of ways. “Some people might journal. Some people might have a good cry everyday,” Ciera suggests. Others might use art as a way of expressing their emotions. One of the easiest things you can do is simply speak with friends or family members about emotions that may be troubling you.

Attending therapy is also a great way to nurture the emotional self—even for people who are therapists themselves. In fact, studies show that 86% of psychologists who prescribed therapy to their clients found therapy to be helpful for themselves, as well.

“How many people who are in the field ‘take their own medicine’?” Ciera asks. “A lot of people wonder, ‘If I admit I’m a clinician who goes to therapy, does that make me lesser? Does that mean something negative for me?’ And no, it doesn’t. I tell people that I go to therapy. I do it because I need check-ins, I need accountability, I need perspective.”

2. The Financial Self

Whether we like it or not, we have to admit that money is an important part of life. If you have poor money skills, are financially unassertive, and tend to have a consuming nature, then you will eventually experience financial stress. For practitioners, this will make it harder to form empathetic connections with clients and remain focused on meeting their needs.

“My grandma always used to say, ‘Have some money for a rainy day,’ “ Ciera says. “Rainy days come. It’s bound to happen, whether it’s unexpected car expenses, house expenses, health concerns, or whatever it is. And if you don’t have anything in savings, that tends to be stressful.”

For these reasons, it’s crucial to develop your financial literacy, and preferably to live a little below your means. “It’s important to have that financial self-care, even if it’s just, ‘For each paycheck, I’m going to send a certain amount to a savings account, so that if I don’t see it, I don’t touch it,’ “ Ciera adds.

3. The Humorous Self

Just about everyone likes to laugh. In fact, laughter has been proven to carry surprising health benefits, such as improving immune system functioning and helping to prevent heart disease. In a study of psychologists regarding coping strategies, maintaining a sense of humor was also the #3 career-sustaining behavior. It’s important to laugh, have fun, and be playful regularly in your life and even in your work.

Ciera shares an example from her own life: “When I first started in the field, I was working with families involved in DCS. I don’t know if I really knew what I was getting myself into. But I would go home every day for six months straight and watch The Nutty Professor and laugh like I had never seen the movie in my life. That was my thing.”

If possible, it can be helpful to use humor at your place of work, as well. Joking around with your co-workers (in appropriate moments) can be a great way to bond, form friendships, and relieve stress in a communal way.

4. The Loving Self

Affection is a powerful source of professional vitality. The loving self is the part of us that needs to express affection and receive affection from other people.

“If all you have is work, then that’s not a flourishing reality for you,” Ciera explains. “That’s not something that is going to be long-lasting, because eventually you’ll burn out. I know some people tend to be ‘workaholics’, but you have to look forward to something other than work.”

We all need to have people or things that we care about outside of our work. These might be family, friends, pets, a mentor or mentee, and so on. These relationships can nourish the loving self by providing it with the affection it needs.

Of course, maintaining relationships outside of work also requires us to make them a priority whenever possible. “How good are you at spending time with the people outside of work? Do you make them a priority?” Ciera asks. “You have to ask yourself, ‘Do the people who are closest to me always deserve my leftovers?’ And work on getting better at not giving them your leftovers, but giving them some of the best parts of you.”

5. The Nutritious Self

It has been said that “Happiness is a steady rhythm of blood glucose.” While this might not be an absolute truth, it is nevertheless true that our bodies and minds need fuel to be healthy. This is where the nutritious self comes in.

Good nutrition can be complicated and may look different from person to person. However, there are many rules of thumb that can be helpful for most people. For starters, it’s generally a good idea to eat plenty of fruits and vegetables and limit your consumption of fats, sugars, and processed foods. Drinking plenty of water is also essential, so you should drink whenever you feel thirsty, and limit dehydrating beverages like coffee, tea, soda, and alcohol. Breakfast is also an important meal not to skip, as it jumpstarts your metabolism and provides fuel for your body to begin the day.

Above all else, it’s important to develop a long-term perspective with regard to eating habits. “Do what is sustainable for you,” Ciera suggests. “If you’re going to change eating habits, make sure they’re sustainable eating habits for you. That way you’re doing something that is not just going to get you quick results, but long-lasting results.”

6. The Playful Self

Even the most serious people—and those who perform the most serious work—need to have fun from time to time. After all, the world of play helps make the world of work possible. The playful self is the part of us that needs to be silly and light-hearted sometimes.

“I think sometimes when we get to be adults, and especially in this field, we can become so serious, or so focused on what it is that we’re doing, or drained, that we’re just like, ‘I don’t have time for anything else except my work,’ “ Ciera says. Playfulness, like humor, is an important counterbalance to stress and anxiety.

Once again, there are many different ways someone can nurture their playful self, and the best methods for you will be those that align with your interests. Many people enjoy games of various types, whether they are card games, board games, video games, or games based in physical activity. Another common example is attending festivals or partaking in amusement park rides.

“You don’t have to spend money to have fun,” Ciera adds. “You can just get creative. Channel your inner child.”

7. The Priority-Setting Self

Most of us feel like we always have too many things on our “to do” list. When we don’t have enough time to finish everything, we are liable to feel overwhelmed and over-extended.

Ciera says, “Sometimes we start so many things at once that, for some people, they don’t get anything done, and for other people, they feel like they have to get everything done. That stresses them out, and then if they’re stressed, they can become snappy, and that can stress out other people around them, or make other people around them uncomfortable. And it just makes the whole atmosphere unpleasant.”

To satisfy the priority-setting self, we need to learn to do the most important things first and leave the rest for later. Ask yourself: What has deadlines? What’s more time sensitive? What’s more urgent? Put a star or asterisk next to those tasks, and put aside the rest until you have time for them.

8. The Relaxation/Stress-Reduction Self

As care providers, our work can be stressful and hectic. This is to be somewhat expected, but it can’t be sustained forever. Our relaxation and stress-reduction self demands that we also make time for peace and serenity.

“You have to practice de-stressing, period,” Ciera says. “You can’t carry the weight of the world on your shoulders. Everything is not within your control. You can do what you can do, and after that, it’s up to your client, it’s up to your family, it’s up to your boss, or whoever. Do what you can do, and then let it go.”

Everyone has their own methods of relaxing and de-stressing, but activities like meditation, mindfulness, yoga, and relaxation training work for many people and have been proven to reduce instances of high blood pressure, heart disease, depression, cancer, arthritis, and gastrointestinal disorders.

It’s worth mentioning that stress-reduction activities are not always easy to maintain. “Sometimes it takes practice, and I’m not saying it will be a day of practice. Sometimes it takes weeks, months, or even years to get to that point of giving yourself permission to just be,” Ciera says.

9. The Solitary Self

People are social animals. We all enjoy talking to and spending time with other people (especially if we like those people). But we each also have a solitary self that needs to be alone every once in a while.

Solitude means removing yourself from the known channels of life. It means unplugging from the electronics and being at one with yourself. It means getting away from the noise in order to refill yourself.

Although we all require solitude sometimes, it comes easier for some than for others. “A lot of people struggle with this because it means being alone,” Ciera explains. “Some people really enjoy being by themselves and have no problem with this at all. For other people, it’s like the worst thing ever.”

If you’re someone who hates to be alone, know that it’s alright to embrace solitude in baby steps. Ciera says, “It’s OK to start small if you do struggle with this. It can be 5 minutes of just saying, ‘I’m going to unplug for 5 minutes and just do nothing.’ “

10. The Spiritual or Religious Self

The spiritual or religious self is the part of us that seeks connection to something larger than ourselves. An active spiritual or religious life is important for many people because it gives meaning to the “big questions” of life. Are people basically good or evil? Is there an afterlife? What moral rules should govern your life?

Nurturing the spiritual or religious self can also help practitioners find meaning and purpose in their work. When the things we do every day are in service of a greater purpose—whatever that purpose may be for us—then we are more likely to find our work personally relevant and important. We’re also more likely to believe that we’re living a fulfilling life.

In essence, spirituality and religion provide codes for us to live by and give greater context to our actions. “For a lot of people, spirituality or religion is important to them because it just helps govern their day-to-day,” Ciera says.

Self-Care Action Plan Step #4: Assessing Your Personal Self-Care

Now that we’ve reviewed the various dimensions of the self, let’s discuss how to assess your personal self-care for your Self-Care Action Plan.

You can begin by considering: How well am I nurturing each part of myself? What am I specifically doing to nurture each part of myself?

Next, make a list of the 10 dimensions of the self we discussed above. Next to each dimension, write down specific activities you are currently doing to nurture that part of yourself. If you can’t think of any, leave that space blank. Then, give yourself a rating from 0–6 for how well you are currently nurturing each dimension of the self, with 0 being not at all and 6 being very well.

Once you’ve done this for all 10 dimensions, write down your three strongest and three weakest areas of personal self-care. This will give you a better understanding about which parts of yourself are most nurtured and which parts you most need to focus on in the future.

Every one of us is a complex, multifaceted individual. Our individual identities, or “who we are” as people, are layered in several important ways. At a high level, we all possess a professional self and a personal self, but even the personal self can be subdivided into multiple smaller selves that make up our identity. In order to be fully well, all of these sub-selves must be regularly nourished and maintained. Only then can we feel content, fulfilled, and inspired to do our best work as practitioners.

We hope this article helped you discover some dimensions of yourself you might have never thought about before—and gave you some ideas for how to better sustain them. In Part 5 of our series on Wellness for Care Providers, we’ll dive into one final dimension of the self that we skipped today: the physical self. Until next time!

MHA Bell Seal for Workplace Mental Health: What It Means for Cummins, Now and Moving Forward

At Cummins, we place the highest value on people’s mental health and well-being.

This shouldn’t come as a surprise—after all, we are a provider of behavioral health services. However, our concern doesn’t stop with the individuals and communities we serve. We’re also invested in the health and well-being of our own team members.

Cummins has recently been awarded the 2022 Platinum Bell Seal for Workplace Mental Health from Mental Health America. The Bell Seal is a national employer certification program to recognize companies that prioritize employee mental health and well-being. Our award at the Platinum level—the highest level available—signifies our commitment to creating mentally healthy work environments for our staff.

We know that providers of behavioral health services have difficult jobs. In their daily work, they must support and empathize with individuals who are experiencing extremely challenging life situations. We believe service providers deserve the same amount of support and empathy they give to their consumers, which is why we are so committed to the wellness of our team members. We believe our receipt of the Platinum Bell Seal award stands as validation of our commitment.

Keep reading to learn more about this award and what it means for Cummins Behavioral Health moving forward.

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How Cummins Received the Bell Seal

Mental Health America (MHA) is the nation’s leading community-based nonprofit dedicated to addressing the needs of those living with mental illness and to promoting the overall mental health of all. MHA’s efforts are guided by its Before Stage 4 (B4Stage4) philosophy, which holds that mental health conditions should be treated long before reaching the most critical points in the disease process.

MHA has spent decades researching mental health in the workplace, and in 2019, MHA introduced the Bell Seal for Workplace Mental Health to recognize organizations that support employee mental health and well-being. The Bell Seal recognizes employer advances in workplace mental health by awarding Bronze, Silver, Gold, and Platinum recognition levels. The purpose is to help employees identify mentally healthy workplaces as well as guide employers who are committed to creating them.

Cummins is heavily committed to the wellness of all our team members. In order to provide the best quality care to consumers, our staff need to be mentally healthy themselves and have tools for self-care. Therefore, we do our very best to care for the whole employee, both their mental and physical health. With this in mind, we hoped to receive a Bell Seal certification from MHA to demonstrate this commitment to the communities we serve.

As part of the application process, MHA conducted a rigorous evaluation of Cummins’ policies and practices related to employee wellness. Areas of focus included workplace culture, employee growth opportunities, benefits packages, compliance practices, and staff wellness programs.

We believe our receipt of the Bell Seal at the Platinum level is a testament to the wellness-first workplace we have cultivated at Cummins. In particular, we have a strong wellness program in place for our staff, and we acknowledge that there is always room for further improvement for staff wellness. Our vision is to be the provider and employer of choice for mental health services in Indiana, and the Bell Seal award confirms that we’re well on the way toward our goal of cultivating a mentally healthy workplace.

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What the Bell Seal Means for Cummins’ Future

Cummins Behavioral Health recognizes that our industry is currently going through challenging times. Put simply, the need for mental health services in America is greater than what can be provided. Last year, government data showed that an estimated 37% of the national population lived in areas experiencing a shortage of mental health professionals.

The situation was undeniably made worse by the COVID-19 pandemic, and federal, state and local governments have increased funding for mental health services in response. But training and developing new service providers takes time, and meanwhile, many current providers are overworked and struggling with high levels of work-related stress.

Cummins believes that one crucial way we can alleviate this problem is by prioritizing the health and wellness of all mental health service providers. This is one of our primary goals both now and for the future, and we believe the MHA Bell Seal certification will help us to achieve it.

To begin with, we hope this award will demonstrate our commitment to provider wellness to employees and our community at large. In addition, the certification must be renewed every year, which will help us maintain focus on our goal of employee wellness. The annual application process will keep us aware of our strengths and bring to light areas for potential improvement in our wellness programs and initatives.

As we mentioned above, our vision for the future is that community and healthcare partners view Cummins as the provider and employer of choice in central Indiana. The MHA Bell Seal for Workplace Mental Health will be an essential asset for realizing that vision for years to come.

“Cummins’ vision is to be both employer of choice and provider of choice. These are complimentary goals, and one cannot be achieved without achieving the other.” — Amy Mace, CEO of Cummins Behavioral Health Systems, Inc.

You can learn more about MHA and the Bell Seal for Workplace Mental Health by visiting


Wellness for Care Providers: Sustaining the Professional Self

There are certain jobs that carry inherent health risks for the person doing the job. Police officers, fire fighters, construction workers, and military service members are a few jobs that come to mind. But these aren’t the only individuals whose line of work puts them in harm’s way.

Caring professionals like nurses, teachers, social workers and mental health therapists also suffer risks to their well-being because of their work. For caring professionals (also called helping professionals), investing in the physical and emotional health of other people is part of the job description. This is fine when care providers are able to adequately prioritize their own self-care, but that doesn’t always happen in practice.

In previous posts, we’ve explained how insufficient self-care can lead to burnout and why the cycle of caring can make self-care difficult for caring professionals. In this post, we’d like to talk about the professional self—the part of a person that identifies with and is nourished by their work—and how you can sustain your professional self for increased wellness in your work.

We’ll be guided by insights and advice from Ciera Jackson, our Professional Development Specialist here at Cummins.

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

The Hazards of Professional Practice

The first topic to consider when discussing professional self-care for care providers are the inherent hazards of practice.

“If you’re a first responder, for instance, you probably expect that there is some kind of risk that you are taking when you sign up for that job,” Ciera explains. “You might not consider that if you’re signing up for social services of some kind. You may consider that it’s an emotional job, but you don’t necessarily consider the word ‘hazard’ associated with social services.”

Nevertheless, there are certain risks to professional wellness that a person implicitly accepts when choosing to work in social services. Ciera identifies the following 8 hazards as some of the most significant:

1. The consumer wants a quick solution, but we can only offer slow success

“They want it now,” Ciera explains. “‘I don’t want to be depressed anymore. I don’t want this anxiety anymore. I want my kids back right now.’ They want it now, and we tell them, ‘You have to put in the work.’ A lot of times, that’s not sufficient for them, especially if they’re in the mode of crisis. They just want it to be fixed because they’re hurting. So sometimes, if you’re not careful, you can end up working harder than them, and that’s something that can’t happen.”

2. Sometimes we aren’t the right person for a particular consumer

“Yes, you may have whatever title you hold, but sometimes you’re not the person for them,” Ciera says. An example might be if a consumer has experienced past trauma and is not comfortable working with a male therapist. In situations like these, you shouldn’t insist that a consumer work with you if you know you aren’t a good fit for them. “If you can get them the help they need with a different person, because maybe in some way you’re a trigger to them, then do that,” Ciera advises.

3. The consumer might not be ready for change

Sometimes a consumer might say they’re ready to change in a moment of crisis, only to lose their interest in doing the work later on. Ciera illustrates, “You’re still trying to offer solutions, and they reject the solutions. So you’re spinning your wheels in mud trying to help them, and they don’t want the help anymore. They’re no longer in action phase; they’re back to pre-contemplation. And you’re working harder than them, and that is something that you should not be doing.”

4. Negative feelings are projected onto us

“Sometimes people will say things to you that are not necessarily about you. They may seem like they’re about you, but they’re not about you. Don’t take it personally,” Ciera says.

5. The inability to say ‘no’

As caring professionals, we might feel obligated to grant every request our consumers or co-workers ask of us. But it’s vital for our own wellness that we turn down unreasonable requests that might damage our well-being. Ciera’s succinct advice is, “Set boundaries.”

6. Regulation, oversight and control by external, often unknown others

Ciera explains, “Sometimes there are higher-ups, things that are outside of our control, administration…Things happen that affect us, that affect our consumers, and we don’t necessarily like it, but we have to go with the flow. And sometimes we have to save face even if we don’t like it. That’s just how it is.”

7. Normative failure

None of us enjoy failure, especially when that failure negatively affects the people we’re trying to help. But because we can’t control every factor in our work, some amount of failure will be inevitable. “Some things are going to hit us hard some days, and other days we’re going to have great days,” Ciera says. Our work requires that we find ways to weather the hard days.

8. Practitioner trauma (emotional and physical)

“If there are times when you feel emotionally or physically unsafe with co-workers or with your consumers, say something,” Ciera urges. “Be sure to always be aware of your surroundings, and be sure to always keep documentation updated so supervisors may know where you are or what consumers you are dealing with.”

The Professional Self: Factors that Sustain vs. Factors that Deplete

When we talk about self-care, it’s common to use the metaphor of a full or empty glass. For caring professionals, the job requires us to “pour out of” our own glasses to fill the glasses of our consumers. If our glass ever becomes empty, then we’ll be unable to continue helping our clients, so we need to find people, places and things that “pour into” our glasses as well.

There are some factors that sustain or “fill up” our professional selves, and others that deplete or “empty” our professional selves. According to Ciera, the following factors are among the most impactful:

1. Finely tuned professional boundaries vs. boundaries that allow for excessive other-care and insufficient self-care

Ciera is quick to stress the importance of professional boundaries for caring professionals. “I cannot say this enough: boundaries, boundaries, boundaries. Professional boundaries are huge. You have to know when to turn it off. You have got to know when to check it at the door.”

Ciera likes to illustrate this point by telling a story of what poor professional boundaries look like:

“My sister is in the same field that we are in, and she used to work at a particular company. She had an on-call phone, and she was always supposed to be available to her clients. I will never forget one particular client. He called, and called, and called, and called, and called. We would be at dinner and that phone would go off; we could have Thanksgiving or Christmas, and that phone would go off. That phone would go off at 3 in the morning. It was the company’s stance that she was supposed to be available to him regardless. She needed to drop what she was doing, answer the phone, and see what he needed. And 9 times out of 10, there was never an emergency. Her position with the company was, ‘We need to teach our clients to be self-sufficient. We need to teach our clients to problem-solve in the case of an emergency.’ And their stance was, ‘We hear you, but you still need to see what he wants.’ So essentially, she had to prioritize him versus prioritizing herself, and ultimately she left because it was not feasible. That depleted her.”

2. Good supervisor support vs. Poor supervisor support

A supportive supervisor or manager can make a big difference when work becomes especially stressful. “It’s helpful when you feel like you can trust your supervisor, and when they can give you sound advice,” Ciera says.

By contrast, poor support can make a stressful situation even worse. Ciera says, “When you don’t have that support, then you feel like you’re out there by yourself. You might wonder: if you make a bad call, are they going to turn their backs on you? Are you going to be the one who ‘takes the fall’ for it?”

3. Humor and playfulness vs. Excessive seriousness

Just because our work is serious doesn’t mean there is no room for humor and playfulness. In fact, a little bit of lightheartedness (when appropriate) can help to counterbalance the often traumatic stories and experiences we witness. “When you enjoy going to work, that can keep you there,” Ciera says.

As Ciera explains, an atmosphere of excessive seriousness sometimes comes from the top down. “When you have a manager, a boss, a leader who’s too rigid, when there’s no wiggle room, when it’s their way or the highway, when they can’t hear anybody except themselves, sometimes that drains you.”

4. Constant focus on professional development vs. Little attention to long-term professional development

Few things are worse for the professional self than the feeling that our career has hit a dead end. It’s important that we frequently think about our next career steps and find ways to continue developing as professionals. Ciera illustrates this point with another story from her own life:

“I remember when I first finished undergrad, and I had an interview at a particular office. It was a great interview, or so I thought. The lady told me right then and there, ‘This is great, but I’m not going to hire you.’ I thought, ‘OK, did I not interview well?’ And she said, ‘I’m not going to hire you because this is not what you really want to do.’ She said, ‘I see you going way beyond here. You would be a great asset here, but you’re not going to really be happy here.’ And I can appreciate her saying that. She said, ‘My goal is to develop people, and if I were to develop you…I’m not even going to start you here. I’m not going to waste your time.’ So when you are a leader, or when you are sitting with your boss or team lead, it is important for you to be listening, or for them to be asking things like, ‘What’s next for you?’ They don’t have to do this every session, but you should have periodic check-ins. You also have to begin to ask yourself, ‘What do I want? Where do I want to go?’ “

5. Tolerance of some ambiguous endings and normative failure vs. Inability to accept any ambiguous endings or normative failure

“A lot of people, no matter what job they’re in, don’t get in it to fail,” Ciera says. “But you’re going to have failures. You’re going to have cases you don’t win. You’re going to have consumers who regress, who end up back in the system. Normalize the failures.”

An ability to accept some failures goes hand-in-hand with the idea of being realistic about your work. “In an ideal world, I’m sure we would have lots of things, but what’s realistic in our here and now? What’s realistic for this client? What is baseline for this client? If you’re expecting people to be perfect and make no mistakes, then that is not realistic,” Ciera explains.

6. Attempting positive closure at the time of professional separation vs. Neglecting the importance of positive closure at the time of professional separation

As we discussed in our previous blog, it’s important for the well-being of both providers and consumers that there’s an appropriate sense of closure at the end of a therapeutic relationship. “If you can have a good closure experience, that is something that will definitely help you throughout your professional career,” Ciera explains.

Ciera also provides an example of how lack of closure can be damaging:

“I had an experience where I was leaving a company, and my supervisor was not happy about it. I was trying to give proper notice, but he said, ‘You can just leave today.’ And instead of letting me end with my clients appropriately, he just shut it down. My clients had my phone number, and they were calling me saying, ‘I’m not working with any other provider.’ Because for them, they didn’t get proper closure. So when you can have a good transition, that is something that sustains the client and you as a professional.”

Self-Care Action Plan Step #3: Assessing Your Professional Self-Care

Last time, we introduced the concept of the Self-Care Action Plan and explained how you can get started creating your own plan. Today we’ll continue by explaining how to assess your level of professional self-care.

To begin, ask yourself: How well am I sustaining my professional self? What specifically am I doing to sustain my professional self?

After a little brainstorming, assess your professional self-care by considering:

  • Is my work meaningful to me?
  • Do I feel a high degree of professional success?
  • Am I able to appreciate the small victories of my work?
  • Am I thinking long-term about my career?
  • Do I have a professional environment where growth is encouraged?
  • Do I receive enough support from my peers and guidance from my supervisors?
  • Am I able to have fun at work in appropriate moments?
  • Do I find ways to keep my work exciting instead of boring?
  • Am I setting appropriate boundaries with my clients and co-workers?
  • Am I able to accept professional failures when they occur?

Based on your answers to these questions, give yourself a rating from 0–6 for how well you are sustaining your professional self, with 0 being not at all and 6 being very well. If you’d like, you can give yourself a rating for each of these questions, then find your average score.

Once you’ve done this, write down your three strongest and three weakest areas of professional self-care. This will give you an idea of which practices you can count on in difficult times, as well as which practices you can work to improve in the future.

Those of us who choose to work in social services do not choose easy careers. In fact, we assume a number of occupational risks when we take on the work. In order to protect ourselves from these risks, it’s important that we find ways to nurture and sustain our professional selves—and minimize our exposure to factors that will “empty our glasses.”

We hope you found this article helpful for your own professional self-care! In the next entry in our series, we’ll cover personal self-care as a caring professional. See you then!

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!

Why Respect Is at the Core of Our Work
How Our Providers Inspire the Hope of Recovery
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.

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.”


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.

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:


  • 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


  • 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!

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.


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


The two-story apartment building


The three-story apartment building


The clubhouse and community resource center


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

The Clubhouse / Community Resource Center


Clubhouse room


Clubhouse room—second angle


Gym/fitness room


Children’s playroom/activity room


Classroom/meeting room


Computer room


Telehealth room (equipment not set up yet)


Entrances to children’s activity room and private consultation offices

Grand Opening Ceremony


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


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


“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


“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


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


“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


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


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


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

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!

Why Respect Is at the Core of Our Work
How Our Providers Inspire the Hope of Recovery
Why Integrity Keeps Us Accountable to Our Consumers