On this episode of the show, I am interviewing Dr. Jennifer Ritchie who is a licensed psychologist and the founder of Gateway Behavioral Health Consultants in St. Louis, Missouri. She specializes in treating adults with anxiety and mood disorders as well as psychological evaluations. Dr. Ritchie creates a safe, nonjudgmental space in therapy to help clients open up about their challenges. Her goal is to help clients make sense of what is happening in their lives and stop doing things that don’t work! She works together with her clients to help them develop practical strategies to manage stress, improve relationships, and increase confidence. 

 

Email: jritchie@gbhconsultants.com

Website: www.gbhconsultants.com

Facebook: https://www.facebook.com/gbhconsultantsstl

Instagram: @gbhconsultantsstl

Transcript

Hello, and welcome to STL Active St. Louis’ premier health and wellness podcast. STL Active aims to give listeners in the St. Louis area the information they need to succeed and progress with their health and fitness. This podcast is brought to you by Stlouistpt.com and hosted by Doctor of Physical Therapy, Greg Judice.

Hey everyone, it’s Dr. Greg, owner and Physical Therapist here at Judice Sports & Rehab. On this episode of the show, I’m interviewing Dr. Jennifer Richie. Dr. Richie is a licensed psychologist and the founder of Gateway behavioral health consultants here in St. Louis. She specializes in treating adults with anxiety and mood disorders as well as psychological evaluations. Dr. Richie creates a safe, non judgmental space in therapy to help clients open up about their challenges. Her goal is to help clients make sense of what is happening in their lives and stop doing the things that don’t work. She works together with our clients to help them develop practical strategies to manage stress, improve relationships, and increase confidence outside of therapy. Dr. Richie enjoys spending time with her family reading, traveling, working out and being outdoors. Without further ado, let’s get into the interview with Dr. Richie.

Alright, welcome to the show. Today we’ve got Jen Richie from Gateway Behavioral Health Consultants. Welcome. Well, thank you very much for having me. I’m really looking forward to doing this. Absolutely. Well, I’m glad to have you here. Let’s just introduce you to the audience. I’ll have you tell us your background. Sure. So like I said, my name is Dr. Jennifer Richie. And I am a licensed psychologist and the founder of Gateway Behavioral Health Consultants. A little bit about kind of how I got started with my practice, I did a lot of work in community mental health prior to going to private practice. And I really just got burnt out there, there’s a lot of volume of clients, the needs are very different. And also the resources for those clients are different. So I really kind of wanted to take a step back and work more at kind of my own pace. So I started out doing private practice part time as I was working at my full time job. And I decided, after doing about four months of private practice that I was ready to go full time and leave my job. Super, super scary. For me, it was something that I kind of fretted over, but I am so glad that I took that chance in myself and did it because it’s been a great leap for me. And I really enjoyed working with the clients and the community. I went full time about three months before the pandemic hit. So testing timing,

had no obviously none of us had any idea. But I think that it made a huge difference in how quickly I was able to kind of go full time and feel pretty confident the need for mental health services in the past 18 months with COVID. And everything going on has skyrocketed. Sure, yeah. And so people are really just struggling. And for me, it’s really great to have clients who are coming in, and they’re really motivated to do the work, see the changes, which is different. In my experience working in community mental health, they don’t have the same level of investment and motivation to do those things. So that’s kind of how I got to my private practice just a little bit about the types of people that we see at the practice. We primarily work with adolescents and adults who are struggling with anxiety and mood disorders, we also see a lot of people who are struggling with a life transition. And what I mean by that is maybe they are grieving a loss of someone, maybe we have a kid who’s transitioning from high school to college, or, you know, college to first job, and they’re just trying to get a handle of how life is going to be different and what it means for them. So we see a lot of those things, too. We will see people who occasionally have some trauma in their background, but we aren’t going to specialize in processing and treating that trauma just because that’s not our area of expertise. So we’ll refer them out. So that’s just kind of a little bit about my practice. Starting with COVID, we went to telehealth and that’s the main way that we’re doing therapy right now. We’re not sure if we’re going to be able to switch over at some point. But that’s kind of what we’re doing to make sure that our clients stay safe and our clinician stay safe as well in the midst of everything going

on. Awesome, very good. Well, that’s exciting that you were able to grow into that full time position quickly, because I know that’s I can’t say that I’m even out of that phase yet with my businesses that you know, you’re building you’re building you’re building to that point where you can maybe hire someone or maybe get a little assistance or all of that and so the fact that you were able to get there quickly it’s got to be is a bit of a relief,

It was a relief because I honestly never thought I would go into private practice, the business side was very unknown for me, I didn’t. We don’t get training in that in graduate school, we don’t get training in our internships and postdocs for that kind of stuff. And so I had a couple of friends who actually at the same agency that I was at, did kind of their own thing. And they mentored me and helped me. And I think that just kind of gave me a little bit of confidence, like, okay, I can have the support, I can do this. And it’s really been a great experience. So I am hopeful that you will feel like you’re getting there sooner rather than later. Yeah, that’s a great feeling.

And it’s one of those things, I feel like this may be off base, but for a lot of different businesses. When they get a new client, they stick around for a while. Right? Not every business, of course, not every bit. I mean, but yeah, that’s kind of the goal. Like if you think of it like a personal trainer, right, you’re not just gonna go for two months, you didn’t need to go for, hopefully years right to, to achieve your goals. That’s just not how PT works, right? People come in, it might be two weeks, it might be six weeks might be 12 weeks, but 90% of the people that we see are gone. So we constantly need that new flow. It’s just a little bit different mindset. When it comes to building a business. I’m sure for you guys, you have attrition. But hopefully it’s a little bit slower than ours.

I feel like it really in the mental health field, it depends on the therapist, one thing I really hear from people is it, well, they went and saw somebody but they didn’t feel like it was a good fit. And so they stopped going. And so I really think how long clients stick around and how much work they’re really to do depends on that relationship that you have with the client. So, um, in my, in my work, in my private practice, I kind of keep track of this, because I think it’s a good business practice to know this. I have clients who stick around, I don’t have very many clients who drop out. But I, you know, I get that mindset of like, I need to keep people coming through the door regularly, because that’s how you sustain your business.

Absolutely, yeah. So while we’re on the topic of building relationships with patients, I will have more background questions for you. But while we’re already there, that was my next question. Okay. How do you develop those relationships with your patients? How do they feel like you’re the right person, if you’re hitting those higher numbers where people are sticking around for longer, you’re probably able to develop more of an impact with them. So how do you achieve that relationship status with them?

Great question. I mean, obviously, it’s different for every person, but I do have a really, like, solid few things that I try and do. So first off, when they’re coming in, or they’re calling to schedule even, I really try and talk with them about what’s going on, I explained to them, kind of how I approach treatment, and how things are what to expect. Because I don’t think a lot of people know what to expect when they’re coming to a therapist, we know what to what’s going to happen when we go to our primary care doctor or the emergency room. But that’s not something that we have a lot of experience with in general. So talking with them about the type of work I do, and also talking with them about what their goals are. Here’s where you are now. How did you get here? But then also, where do you want to be? And so it gives me some good background with people to be able to understand their process, get them to know me a little bit, because calling a therapist is one thing. Scheduling is one thing going in and actually seeing that person is a whole nother thing. So for me, yeah, yeah, I really want to make sure that when I am talking with someone that I It feels like a good fit from the start. And they understand what they’re getting into, they know what’s going to happen. That’s the kind of the first piece when they come in for that initial appointment. I just want them to tell me their story. I’m not going to necessarily go through and try and tick all the boxes of everything I absolutely have to know in that one session. That’s not what it’s about. It’s not like okay, how is this? Do you have this symptom? Or this symptom? Or no, just tell me your story.

So I feel like as a patient in that situation, I wouldn’t even know where to start. So how do you get them to tell their story? Is it just, they just kind of go and they you put it together later? Or are you asking some open ended questions just allowing them to feel comfortable saying the next 10 minutes of stuffs of their

story? Good question. So I typically start with like, tell me why you decided to come to therapy now what’s happening in your life now and how it’s impacting you. That typically gives people a pretty good place to start. And I A lot of times here it’s impacting work, it’s impacting my relationships, I can’t get stuff done. And then I can if, if they give me something I can usually Ask more questions about what they’re telling me. So if you’re telling me like, I can’t focus at work, I just feel so unmotivated. Well, is this only at work? Or is this at home, too? And I really just try and talk with them and understand what they’re going through a lot of just validating their emotions and saying, like, yeah, it makes sense that you feel this way. Like, if I had that much stress, or I had that going on, I would, most people would probably feel that way. And I think that makes it kind of reassures them that like, they’re not crazy, because that’s the thing that I hear frequently from people at the beginning of our sessions is like, why don’t want I don’t want you to think I’m weird, or I don’t want, I don’t want you to think I’m crazy. No, so just kind of giving them a sense that like they’re not alone, it makes sense that they’re feeling that way.

So that’s, that’s kind of the start that first appointment. And at the end of that first appointment, when we’re talking, I asked them about their goals, what they you know what they want, and kind of flesh that out a little bit. But I also really want to know how that session felt for them. Because knowing what their experiences like helps me, like kind of hone my approach with them. Because everyone’s different, what works for somebody might not work for somebody else. And I’m very clear with this about very clear about that. When I talk with them, I say like, I’m going to ask you for feedback, I’m going to ask you, you know, I’m going to make this suggestion, if you don’t like it, or you don’t want to talk about something, just tell me. And so I think allowing people that opportunity to say no, and respecting their boundaries, if they tell me, I don’t want to talk about this, or I don’t want to go there. That’s a huge relationship builder. And it gives them a sense of control. And just feeling like that. This is theirs. It’s not what I necessarily want to know all the time. It’s for them. Sure. And I think like you mentioned that reassuring point is got to be the biggest thing because yah probably workup a lot of courage just to even pick up the phone to make the first call. Absolutely. Yeah, when I was there’s still a stigma even though the Olympics have happened. And Simone Biles made it much more public. And, you know, it’s 2021 instead of 2010. And there’s less stigma in general with most things, right?

There’s still a stigma, there’s still

very unfortunate stigma. Yeah, there is. And so that’s something you know, I really talk with them about it’s, it’s brave, it’s, it’s, you know, very courageous to reach out for help. It’s not easy to do. So when we talk about those things and talk about that you’re sharing some things with me that you might not be sharing with everyone else, or anyone else in your life. And so it’s okay to have clients who cry quite regularly in session. And they always, not always, the majority of them will apologize. I’m sorry, I’m a blubbering mess. I don’t normally do this. That’s okay. Like, that’s what this space is for. Absolutely. And so I, I just kind of be with whatever my clients emotional experiences in that moment. Listen, allow them to feel those emotions. Sometimes, like, a lot of times as people we just complain. And it’s not because we want someone to offer us a solution all the time. Sometimes we just want to air, our thoughts, our feelings, our laundry. Sure, yeah. And so that’s something we talk about too, that like, you know, I might not always be giving you specific suggestions. It’s okay, if you just need to come here and talk about what’s going on. Those are some kind of just basic things I try and do with all of my clients. The other The one other thing I do is I really think I mentioned this, when I talked about the phone call is education, like helping them understand what’s going on, so that they can stop trying to give themselves an answer about what’s going on. Oh, okay, you’re having trouble sleeping, you’re not eating? Well, you’re losing weight, you just feel down and unmotivated all the time. Well, this is how depression looks. You’re constantly on edge, or you can’t focus you are worrying and having panic attacks. This is what anxiety is, because I think that’s also part of the process of normalizing that, okay, there’s a name for this, we can understand what this is. And when you understand something, you’re able to think about it a little bit differently than if you’re just trying to guessing blindly about what’s going on.

Right. And I think that’s any helping professional, you have to truly understand the full, full scope of the problem before you can. Whether it’s just listening and letting them you know, fix themselves to an extent or offering advice. Yeah, so I think that’s that’s crucial. So it was kind of underlying Adding a few keywords here. So it sounds like the process is educate set expectations set some goals and reassurance. Yep. When it boils down to it, those are kind of the hot points of when you’re getting someone in the in the door, how you’re able to build that relationship? Yes. Awesome. Now, how is that different for you in private practice, versus when you’re in the other setting.

When I was doing community mental health, I did a lot of trauma work where clients were involved with the court system in some fashion or another, they were in foster care, they were going through the process of guardianship or adoption. And so they would have to come to me to go on to the next step of their process, or, you know, to continue receiving services, they would have to come. And I, I did a lot of those same things. When I was meeting with clients in the community mental health field. To me, there’s a different level of engagement, that it goes both ways, if they’re not as engaged, and they’re not wanting to kind of do the things or come and talk about this stuff. There’s only so much that I can do. And so that got really frustrating for me. And so that’s one thing about private practice that I’ve absolutely loved. Is that that people who come to see me want to be there. Absolutely. They want to be there, they want to make the difference. They’re choosing to be there rather than being told, okay, you need to go see this person at this time and participate for this long. Sure. So that that’s

the thing that enough, that’s enough, right? The fact that people actually care to be there, right? So there’s a there’s a fun stat that PTS like to throw around. Do you know what the most common length of a care plan is in physical therapy? I have no idea. One session,

I was thinking it might be like,

do we do one session? They come? They don’t understand why they’re there? Because the surgeon said, Oh, well, you got to do this before you can get the MRI, or you got to do this before surgery, because that’s exactly check the box. I don’t actually want you to do this. I want to do the surgery. But this is what you have to do. That’s what the here Yep. Instead of this can be a great option that can help you avoid surgery, or this can be a great option that can save you money so that you don’t have to get an MRI. Yeah, it’s totally on a mindset saying things. So when they come in the door, they don’t even want to be there. So I can’t tell you how many times it’s like you’re doing this, this whole big evaluation, which takes a ton of time. And you got to be super thorough. And at the end, they’re like, Alright, see you never see it again. Yeah, exactly. I

do diligence. I came in and did this. Yeah. And

they can, you know, check the box and say they did PT and they didn’t. But they did check a box. Yes. Yeah, we don’t have to deal with that.

Yeah, that’s, that’s Yeah, I think that’s such a difference that I think as a clinician, for me, that makes a difference in how I feel about my job, which in turn makes a difference in how engaged I’m able to be with my clients. And if I’m in a better space, personally, professionally, I’m able to give more than if I’m just exhausted, because no one’s making progress, and nobody really wants to be there. Right.

And if you’re burnt out, how good is your therapy mind is going to be

burnout is real. I mean, that’s kind of why I left community mental health is because I was burned out, I couldn’t do that anymore. I didn’t want to I don’t want to do that. I don’t, I don’t want to live in that space. And I don’t want to feel like I’m not serving clients.

Right. And I’m not saying that you’re not the best therapist on the planet. And I’m not saying I’m not the best therapist on the planet, but it’s highly unlikely that we are, but we still get excellent results, because we’re not burnt out in our current situations. So the results speak for themselves. Typically, in my experience, clinicians that are in private practice, they care more, and the clients care more, and they participate more. And because they do the work, they get better.

Yes, it’s amazing. It’s amazing if you come and because I always talk about it as like, Okay, you’re learning a language if you’re gonna come to therapy for 50 minutes a week or maybe even twice a week. It’s gonna take you a long time to be able to speak that language kind of fluidly. And I kind of remote refer to it. It’s like that emotional intelligence that coping skills. That’s the language we’re trying to speak. But if you come to therapy, and then throughout the week, you’re trying to use some of these skills, at home at work with family or friends. They build a lot quicker. And so I’m sure you know that like as a physical therapist, like you can’t just come in and do some rehab exercises when you’re here,

right. People come once a week if they’re doing one hour at 168 It’s not gonna work.

Nope, nope, nope, nope. You’re not going to go for that hour for a couple of weeks and then go off to Spain or Italy and write, communicate,

right doesn’t work like no, it does not. So I’m generalizing generalizing here. But do you? I would assume there’s some heaviness in what you do, right? People have crazy stories, some significant traumas and past and everything. How do you not get affected by that yourself? Because I would feel like, right, we’re empathetic people. That’s why we’re into the therapy world. How do you not just get pushed into that darkness yourself?

or do you? It can go both ways. It’s not an easy answer to that. But I am very cautious of the type of people that I have on my caseload at one time, if I have several clients who are struggling with suicide, or have had some really recent traumas,

setting boundaries at work, setting boundaries in my personal life. That’s one thing but also then just like taking care of my own mental and physical health, I am an avid runner, I’ve run five half marathons and a full marathon multiple5ks 10ks, see you’ve got the shelf full of metals, right? We do we have them hanging from our dress.

And so that’s something I do. But I also participate in my own therapy, which I have found in valuable. And it is also just like a preventative thing. It’s not that like I’m struggling so much. But for me, I know having a place to go and talk about my stuff, and have someone listen and kind of support me through that is really huge, because I hear a lot of stuff. I, you know, talk with people who are struggling and in crisis, and that that’s really intense. So for me, I just, it’s a process. It’s not a process that has a start and end point. It’s a continuous process. And that’s also, you know, part of my professional growth is being able to go through this and walk with my clients and say, Yeah, I get it, it’s hard to make time for yourself. It’s hard to say, No, you can’t go to this thing, because you have too much going on. Because you’re living it. I get it. I get it. And so I think that’s another huge thing of building that relationship is being able to say like, yeah, it’s I’m not saying what you’re doing is easy. And we have that conversation in therapy a lot that like, this is not easy. What I’m asking you to do is not going to be easy. But long term, let’s talk about the benefits of being able to do this. And so I always have to use that mind frame for myself to like, Okay, I recently had to say no to something because we are scaling back with a pandemic. And we’re not going places,

right? Going out to eat not traveling. Nope, nope, nope. Nope. Might have been two months ago until we peaked again.

Yes. And so I’m having to say to people, like I don’t like having to tell you no, I don’t like having to say we’re gonna sit at home. My husband and I recently had the conversation about like, wow, I’m really just feeling disconnected from certain people and places in our lives. And so having those conversations and doing that myself is how I kind of manage all of that heavy stuff that comes up. And I think it gives me a better way to relate to clients as they’re going through that as well.

That’s awesome. So changing gears here a little bit. I want to talk you mentioned at the very, very beginning, that adolescents folks with mood disorders, how would someone recognize that they need help? Other than just like, I feel depressed?

Yeah. Yeah. And so I’m gonna give an answer for this kind of for teenagers, and then one for adults, because typically, it looks a little bit different in teenagers than it does adults. So there’s a couple things that I always whether you’re a teenager or an adult, if you are thinking about death, or wanting to harm yourself. That is one of those first indicators like call someone, pick up the phone, reach out, it can even be like your primary care doctor or some other doctor that you’re affiliated with. But call that person, don’t do it alone. There’s tons of crisis lines. And that’s the number one thing that I always want to make sure that people know. For teens, it looks a little bit different. So when kids are depressed, you might think like they’re just gonna be moping around, you know, sad, but that’s not typically how it presents. It presents more of that like irritability, anger, like, out of nowhere, you’ll say something or do something. And then your kid just like, melts down. And it’s like, wow, that was a pretty strong reaction for the situation. Another couple things we see with teens is like, their grades are dropping, they don’t want to go places and do things with their friends. They’re spending a lot of time alone in their room. And I hear parents tell me a lot like Oh, my kids on social media like they’re talking with that’s, that’s a different thing than going out and seeing their friends going to a school event. Whatever the case may be, if they’re spending a lot of time in their room, that’s not a good sign. You also might notice a change in their eating habits. So kids who typically had a pretty good attitude, appetite, maybe not eating much at all losing weight. The opposite can also be true that if your kid is stress eating, you see them going for that bag of Doritos and going through an entire bag of Doritos. Hmm, that’s, that’s on normal. So check into those things. Also, just like the focus issue, and I see this a lot, people think, Oh, I can’t focus, I have ADHD. Not necessarily. If your kids saying like, I can’t focus, I can’t do my work, I’m getting distracted in school, that also might be a sign that they’re having trouble. They’re not getting their homework done, they’re falling behind. Those are all kind of signs for teenagers that something is a little bit off. And I always encourage parents to be open and talk with their kids about this. I think sometimes we try and protect kids a little too much. And we’re not as real with them as we should be. So if you notice some of these things in your teenager, talk with them like, Hey, is something going on? Can you know? Are you feeling okay? Is there something we can do to help, here’s the things that we can do. And just being open and being there for your kids, I think is a a great way for parents to kind of help out if they’re not sure what to do. Adults, it looks a little bit different. For adults, you’ll see more of that you’ll see the irritability and anger, but you’re more likely to see the sadness than you are in kids. You have adults who say my moods are just all over the place. I don’t want to do anything. Like, one thing I hear is like, Oh, I used to enjoy doing this, but not anymore. Okay, why what’s going on. And typically, I hear people say a couple of things, that either they’re too tired, or they don’t have the energy to do some of those things that they enjoy. Or that they’re just not as fun anymore, they just kind of feel like they’re going through the motions. And it doesn’t bring them the same level of enjoyment. It just more feels like a chore. So that’s something that we see with adults a lot of times, and some of the other things we see is just a lot of guilt about I’m, I have a one year old daughter. And so I hear the mom guilt thing a lot. I also hear with guys, oh, I’m not providing for my family, or I’m not keeping up and helping my wife the way I should or spending time with my kids. Just feeling that guiltiness because you’re don’t have that energy, you don’t feel like doing anything. Same thing with adults is like spending a lot of time in their room or not wanting to go to events. Another thing I really hear pretty commonly is like I’m struggling at work, I can’t keep up at work, I just am going through the motions. Those are some of the things that really kind of stick out. To me when people are struggling with depression. I don’t know if we want to talk about anxiety, because there are some similarities and differences with anxiety. So kind of you

up to you. I mean, if I know that’s what you deal with. Mostly, I do want to get to some chronic pain stuff later. But we can certainly get there and I’m sure there’s some overlap.

There’s Oh, oh my gosh, there’s so much overlap with that. So maybe

let’s Yeah, let’s do the anxiety, depression, but with a mindset of we’re going to move into some pain like physical pain. Sure.

So with anxiety, and this can the worry with anxiety, or I’m sorry, the worry in adults and adolescents with anxiety is pretty similar. just worrying about everyday stuff, school, work, finances, your to do list, that stuff happens. Panic attacks is also a big one. And that’s when you know, your kid has a meltdown. They’re crying, they’re having a hard time calming themselves down. And that’s what parents typically see with adolescents for adults. Panic attacks always feel like I’m getting overwhelmed.

So and I think when I a little bit like chronic pain, when it comes to anxiety and depression, stress is a huge thing for making someone more susceptible to suffering from anxiety and depression. If you’re in pain all day, every day, you’re not only dealing with the stress of like work, kids, finances, you know, all that good stuff. You’re dealing with this constant ache, severe pain, whatever the case may be in your body. And that’s I like to think about stressors as things that kind of compound, it’s not just one stressor over here, they are like layers of a cake. And the more layers you have, the harder it is to kind of walk through your day, and do the things that you need to do. And so if you’re constantly struggling to do something, you’re constantly having a hard time doing the simplest things, you’re not going to be very motivated, sure to keep going and keep doing those things. Right. And I’ve heard it described whether it’s anxiety, depression, whatever, when you’re having those feelings of I just, I can’t do anything, nothing sounds good. I would rather sit on the couch, I’d rather watch TV then do whatever the fun thing is, right? Right.

Just the act of going and doing it will probably make you feel better. Right? Action action before desire to do the action can produce that desire. Yeah, right. But when you hurt, as well, it adds another layer of, well, crap, even if I do do this activity. I’m gonna feel bad because I’m hurting. Right? Like actual physically, yeah,

not just like that emotional pain. But like, if I want to go, you know, to the store, or go out with my friends to something outdoors, I’m going to walk go for whatever it is, your body’s gonna hurt. And another thing I see is that, like, if I do this, I’m going to pay for it later. I hear that a lot. Yeah, I’m going to pay for it later. And so that’s another like, if I’m going to do something, and for four days, or five days, or however long, I’m gonna be miserable. It might not be worth it. And so it becomes this like, like you said, added layer of like, something you have to think about when you’re trying to make yourself get up and do something, even if you know, you don’t want to even if you know it’s gonna be hard.

Sure. And I think that’s, that’s the biggest thing, the apprehension to doing things at all physically. Even if you’re not feeling the actual depression mood, right, then you’re just not doing anything. And it leads to that spiral of, okay, you you’re doing less, because you hurt more, you’re going to get weaker. And because you’re weaker, it’s harder to be more active. And because you’re it’s harder to be more active, it’s more likely that you’re going to be depressed. That’s a cycle, right? Yeah. And it’s, I’m not a psychologist, but we always have the chronic pain discussion, when I’ve got someone that’s been hurting for, I’ll say more than three months just to kind of give a generic number on that. And we always have that discussion. Here’s the cycle, this is where you are. If we can pluck you out of the cycle, then we’ve done our job, right? If if all it takes is just being more active, because you don’t hurt or decreasing the pain, which allows you to be more active, either one, it doesn’t really matter which we do from the physical therapy side. We’ve pulled you out of the cycle, right? And it’s easier said than done. Of course it is. The point is focusing on the fact that it is a cycle. And it doesn’t have to be this way, just because you’re here now doesn’t mean that’s how it always has to be.

Right. It’s part of that like education piece. Yes. One of the things I see pretty frequently in my work is that people think if something’s uncomfortable, or they’re getting a little bit anxious or sad about it, that something’s wrong, they need to change. And I mean, that’s kind of what our brain does is uses our emotions, historically to inform us of danger and kind of lead us to a different direction or lead us to make take some type of action. But in our society today, we don’t have the same threats that we did, you know, 2000 years ago and further back than that, and so helping people understand that like, okay, yeah, this might be a little bit anxiety provoking, you might be a little uncomfortable. That’s part of the site Call. And that’s part of like the growth process is being able to recognize that as it’s happening, and say, okay, like, it’s okay, this is the voice that I’m hearing or what I’m saying to myself, and just being able to kind of, like, evaluate some of those things. And if it’s, if it’s, I don’t say true, because for whoever it is, it’s, that’s their truth. Yeah,

all pain that is experienced is true pain. Yeah, cuz it’s, it’s how it’s processed in the brain, not what’s physiologically happening to the ankle, or the knee or the back, or whatever it is. It’s how the brain processes that’s what pain is. And yes, it’s all true. But is it? Nor is it common or normal pain? Is it a helpful man, that’s a great way to put it,

I use the word helpful, is this a helpful thing to think about? Does it get you to where you want to be? Does it help you get through your day? If it’s not helping you, then let’s, let’s try something different. And so that’s something we talk about a lot, because I don’t, I, I’m huge, I’m not invalidating my clients, I don’t want them to feel like I’m judging them or not listening to them. And so I never want to say like, this isn’t true. Because to them, it very absolutely is true, right. But helping them think about things in a different way is a huge part of doing therapy. And I’m sure for you as you’re treating people, helping them think about things understand things, and how it relates to their pain. And just kind of the overlap of like, how our how what we tell ourselves impacts how we feel physically, as well as mentally.

Absolutely. So let me ask you a question. So when it comes to someone, like breaking an addiction, or changing eating habits, or changing any habits, right, how long does it take to form a new habit?

Depends on how long it takes to form that old habit.

That’s true. But in general, what’s kind of the

end, I think it, it’s gonna vary. I tell people that it’s a journey, one step at a time, like, we’re going to do this. And it depends on how much you’re willing to put into your journey. But like, when I’m working with people, if they can kind of consistently do something, three, four weeks, it starts to become more of a habit. And there’s a lot of science behind that. Like, if you can do something for 30 days, your it just becomes more normal for you. And it might not be that like you keep that same level of consistency up for the rest of your life.

But it took a while it took a lot of effort early to form start the good habit. Yeah, but it takes less early as it becomes a habit,

it becomes part of your lifestyle, rather than

but on the other side of that there is the pain. And so what I how I kind of describe it to people is, well, if you hurt for three months, and every day you wake up and your back hurts, you come to expect it. Yes, you’ve learned to hurt. And that’s a weird way to think about it. It’s like, why would I learn to hurt, but your brain has become accustomed to hurting. And so while your back may not still have an injury three months later, maybe you have some weakness? Sure. Maybe you have some mechanical issues. Sure. But are you actually injured three months later, probably not. Most physiological processes of healing are done are really close to done around that three month mark. But if you’ve heard everyday for that three months, you’ve learned to hurt. So we have to teach you to not hurt. Yeah, and a lot of that can be done with the physical therapy side of things getting stronger, moving better, moving more, right, those are different, but moving, right? And educating them on their pain. So you can learn not to hurt. And so I would love to hear from your perspective how the PT and the counseling can go hand in hand.

Yeah, so we’ve all heard that like, Oh, our mind in our brain or connect, or I’m sorry, our mind and our body are connected, like they go together. But when you go see a typical doctor, your primary care a surgeon, somebody, they don’t really put those pieces together for you. They don’t really help you understand. And that’s one of the things I love about kind of your approach to working with patients is because you’re trying to bridge that gap. And I also try and bridge that gap with my clients of like, okay, if you’re physically hurting, if you’re not sleeping well, if you’re not eating well, if you’re not exercising it they all go together, that depression and that physical health play into each other. And so I think when you are working with a client, you have to be able to think about it as a whole picture. And I love collaborating with other professionals in the community. Dieticians pediatricians, teachers, whoever, because my client does not happen in the context of a vacuum. And so let’s let’s understand their pain, let’s understand some of the physical things that are going on whatever the case may be, so that I can kind of understand what their experiences like better. And let’s talk about the way that you think about your pain or the way that you think about this problem, how you’ve learned to manage it, or kind of learn to deal with it. Sometimes we have good coping skills, sometimes we have bad coping skills, but putting putting those pieces together and help them make sense of rather like a whole picture, rather than one or two pieces, and then leaving them to kind of fend for themselves to paint a picture.

Sure. And I think that’s, that’s exactly kind of what I’m doing on my end, as well as like, yeah, we’re going to work on your strength, we’re going to work on how you move, we’re going to work on your joints, stiffnesses and all the physical stuff that we can do. We’re going to do it, and we’re gonna have the conversation.

But typically, I’m giving them resources, right, some people, some people, they listen to the podcast that I recommend all the time. From the Z Dawg MD show, which I’m sure you  saw that Yeah.

And it’s life changing. They buy into it, they feel heard, because their story is told in that podcast. That’s all it takes mindset mindset, completely shifted mindset. And they make huge progress mentally, overnight, seemingly, right, from my perspective is huge. There’s another resource that I’ll recommend called Explain pain. It’s a book by some Australian physical therapists, and it’s got some funky pictures, but it’s so short story, my wife had some chronic pain for quite a while. And when I let her read that book, she had never heard of it. She said, did they write this for me? Right? It was like connected with her. Right? Yes, she absolutely connected with it. So there are so many people dealing with chronic pain and think that they’re alone in that pain, that they can connect with some of these stories. And so sometimes just feeling that that connection or you know, feeling heard, or what was the word you used early, they feel reassured, right? You

listen to their story, and you just kind of be there with right to hear it. And

sometimes, that alone, along with the PT makes a huge difference. But there are some folks where we’re doing everything we can physically, maybe they’re feeling some better, but they’re just not quite getting over the hump when it comes to getting all the way better with their chronic pain. Just last week, I referred someone to you because we’d already had this conversation, not recorded. But, you know, it’s it’s someone that I think needs a bit of a boost, right? There’s some things I just I can’t have that conversation, right, I shouldn’t have that conversation, even if I could. And I think that’s where we can help each other. Right. As as clinicians, and I think that needs to be, I think, in general, the healthcare system needs a more collaborative approach 100% rather than the guy on the top making all the decisions for everybody that doesn’t know anything about the other professions, which is what currently happens. But that’s, you know, neither here nor there, but the point is, yes, exactly. But the point is, like, there are situations where your pain, you need a counselor, your pain, you need a PT, or you need both.

Yeah, yeah, there’s no I mean, I totally 100% agree with you that, whether it be just medicine in general, or physical health and mental health, we don’t collaborate in a way that is most beneficial for our patients. I don’t know everything, and I’m not going to pretend to know everything. And so if, if you need to go see a PT, if you need to go see, you know, a dietician or someone else, let me get you connected with that person, because there’s, there’s a limit to my expertise. Sure. And I realized that I’m just part of the picture.

Sure. And, you know, I would say, and I’m sure you do the same thing. It’s often that I’ll have someone come in and it’s like, yes, you have some physical stuff. From my perspective. Sure. You have some physical stuff. Let’s work on that. And if you’re not feeling any different, then you need to see someone else. Right. It seems like a lot of what you’re dealing with, could be mental. It could be a combination could be physical, but it’s hard to know, day one. Right. But I think that’s part of the clinical decision making that we have to do is therapists is okay, we thought we had this down two weeks ago. We need to make a shift. Right? It has to if they’re not making progress, then working with

aloan is not the answer. Yeah. So I have clients ask me all the time about medication, should I do medication? Should I not do medication? And I’m sure like when it comes to treating pain, that’s, you know, something that comes up quite frequently, too. And so I think talking with them about like, what are their options? If you want to try that route first, that’s your prerogative.

Here are some of the things I can try and we can reevaluate. It’s not like, if I don’t do it right, this second, I can’t do it at all right. But let’s, let’s try some of these things first, and let’s see, because there’s so much of our environment and the way that we think about things that can be changed without medicine. And is medicine appropriate for some people? Absolutely. 100%. Not everyone. And I think some of us are, I’m sure this comes across in PTT, like, some people want a quick fix. So they want to take that pill and they want to be done. Sure. There’s a limit to that, too. So

and I think that’s why we’ve gotten into the opioid epidemic a bit. But yeah, yeah, we’ll stop there. Because I’ve had that conversation on the show before and it it gets

long when I’m, I can imagine it gets very long winded.

But the premise is, if we can treat the pain without the things that can be dangerous, we should

yeah, if we can, just because there’s tons of medical side effects from psychotropic medicines as well, if we can teach you how to handle your stress, because stress isn’t going to go away. For chronic pain, you’re probably going to have some pain, you know, at certain times in your life, it’s not a completely avoidable, let’s teach you how to manage that. Let’s teach you how to do this on your own. So you’re not so that.

Exactly, yep. All right. I love it. That’s that’s the conversation I wanted to have. Perfect. Yay. Now let’s learn more about Jim. Okay, what do you want to know? All right. When we were talking before this You had mentioned, I asked the question, what is the biggest thing you learned this year? And you answered 80% is perfect. Yeah. So I would love to hear this contradictory statement explained,

okay, so I am admittedly a perfectionist, I am my own worst enemy. I, if I, my dad always has the saying, and he still uses it today. But growing up, I constantly heard this and it was ingrained in my head. Perfect, is

is never good enough. And so I got this mindset that, okay, if I accomplish this, I can do better, I can keep going to the next step. And when you think about like anxiety, and depression, and things not being motivating, if you’re never doing good enough, you Why do I keep putting in this effort? And so I actually started this coaching program, because I think that I think I mentioned this before that, like, I’m not the business savvy person, and they talk about this that like, how perfectionism is the enemy of productivity. And so to me, 80% is perfect means if I put in 80% of my effort, if I do this, and it gets done.

That’s perfect.

That’s funny that you said it came from a business coach, because that’s exactly I have a, I wrote down. Done is better than perfect. That’s what my business coach says. So we have the same concept. Exactly. And and that is absolutely something I deal with on a regular basis to, you know, trying to get the website out. Right? I mean, that process, right, me for her to launch my website, because it had to be perfect, right? It’s crap, it doesn’t have to be perfect. It just has to be good enough. It has to be you have to reach your clients. That’s what you have to exactly. That’s what it has to do. And so like, but that applies to everything. It applies to everything. When people are doing work stuff. When you’re trying to get your house ready for a party, when kids are doing schoolwork. I see so many times that people get paralyzed by wanting to do perfect, and then they don’t end up getting much done.

And that’s the opposite of what like perfectionism is is like people who are perfectionist, they always want to be doing better, they always want to be doing more and they have a hard time being satisfied with doing something. Right. So they end up doing nothing. Sure. And so I we use this phrase a lot. Oh, if you can do 80% If you can do 90% Like, perfect, right? And sometimes I have to start out with like, if you can do 99% Right,

right. And that’s, that’s funny that you say that. I mean, I have some patients that come in like, Well, I only did my exercises five days this week. It’s like, how are you doing last week? That is like 10 times better than most

people don’t give themselves credit sometimes because if you’re not doing it perfect, then you know, that’s more

than I would have expected. Get them to do it. Right. Like they’re thinking I wanted them to do it seven. It’s like, yeah, I tell you to do it seven so that you do it five. Perfect. Great. So that’s, that’s fantastic. And I think that applies to a lot of stuff. And like you were saying there can be a negative to being that perfectionist, whether it’s, it’s never good enough or even when I did the thing, it wasn’t enough, right. And I see that in myself like, the the excitement is why I do woodworking on the side just for fun, not not for selling stuff, but just for fun. The pursuit of designing a project of cutting the materials of measuring super fun. Yep, when it’s done, I see every imperfection. At least I feel that

but it’s never ever perfect. That’s just not how hand tools and you know, contractor grade stuff works. It’s never going to be the perfect thing. I’m not Norm Abrams, I can’t build chairs, like Nick Offerman, like I am not those people. Why would I expect to be perfect. But all I see is the negative. So which is so frustrating. Yeah. So to me, it’s like, alright, finished a project, forget about it. Get ready for the next one seems to work, okay. So that I’m not thinking about all the negatives from the previous one.

i

 For me, I really have to and I, I keep track of this stuff. Because it’s helpful for me, I write down things that I’ve accomplished and things that I feel good about and kind of like as they happen, because I’m wanting to quickly say like, I haven’t done anything like I’m

what have I been doing with my life these past six, four weeks, whatever. And actually, last night I journal quite frequently. It’s one of my self care things as well. And I was looking back at like, oh, how much have I accomplished in these past eight weeks? Like, kind of a lot, give myself a break? Give yourself a break? It doesn’t have to be perfect.

Right? That’s awesome. All right, let’s move on. Another question that I asked you was, what do you do to better yourself? Right? And we and basically, you answered with, I read a lot. And I like to try new things and challenge myself. Yes. So I would love to get a book recommended recommendation for the listeners.

Oh, I have. So so so many. There’s one that I recently read by Dan Harris. He’s actually I think, an NBC News correspondent. And it’s his real life journey through learning mindfulness and meditation. And just kind of understanding the process of change of doing things of being able to enjoy yourself. And I think so much that we think that we have to be happy all the time. And he just talks about, okay, like, if I do something, and it makes me 10% happier than what I am today,

right? Expecting a 10 out of 10 happiness all the time is ridiculous. If you could get like five and a half all the time. That’s pretty good.

Yeah. And if you can do something that you can say, Oh, this is gonna make my life 10% better, right? Would you be willing to do that, like if it’s consistent. Another one I really love is called the happiness trap. Okay, and this is based on a type of therapy called Acceptance and Commitment Therapy. And it kind of walks you through that, like the happiness trap is basically thinking that we need to be happy all the time. And it’s not okay to, you know, be sad or anxious or be in pain, whatever. And so it gives you some very practical techniques to figure out how to be okay, when things don’t necessarily go the way that you want to. It’s very practical, very easy read. Love that those are more kind of like therapy oriented. But I’m also a huge fan of just kind of like

 Brene Brown is a amazing researcher. I love anything by her dare to lead the Gifts of Imperfection. Oh my gosh, I could literally go on all day if you get me on this.

Side note my house is a library. Well, our living room has the theme of books. And one of the our coffee table has just a bunch of books that my husband and I love to read and you can just see through the glass and that’s the coffee table and it’s cool. It’s really cool. But yeah, I’m really a big book nerd and so that is my thing. So there’s a couple for that. Be happy to kind of like put a list together because I have Yeah, we

can do that show notes share it because typically like for myself, I can’t do like business personal development only kind of books right. So I have to have like the fun fiction book somewhere in there. So the most recent when I Read was the blanking on the name project. Hail Mary. Oh yeah, heard of that one. Do you know the guy that wrote The Martian? Yes. This is his follow up to that. It’s not like a sequel or anything. But like his, his next his next book. Exactly. So it’s fantastic. If you liked the Martian, or if you like the movie, The Martian. The book is amazing.

Are you one of those people who will read the book before you watch the movie or the show?

I don’t have to. Okay. I’m not someone that gets like, messed up with spoilers. Like, how does it end? Right? I’ll ask How does it end? Oh, that sounds good. I’ll read. It doesn’t matter that like, Oh, Harry dies? Oh, no, no, that didn’t happen. But like, it didn’t matter to me that Dumbledore died to be able to read the book. He knew exactly.

That was okay. So that’s fine. It’s interesting to me to talk to people and how they feel about that,

and never bothers me. Like, I can hear the end of the game score and still watch the game. Oh, that one’s a little tougher. But I still want to see what happened.

If I couldn’t watch a game, I would get off of social media until I was able to watch the game because it was inevitably going to come across my feed. Sure. I can’t do that, I guess.

Alright, and then we also talked about, you’d like to challenge yourself. So what is something that you’re doing right now to challenge yourself.

So one of the things I mentioned my coaching program earlier, and that’s something professionally, I’m really doing to challenge myself. When I went into this, when I went into private practice, I had no idea what I was getting myself into. And so I feel like, I’m a decent clinician, like, I feel like I have a lot of good training in those clinical skills and being able to relate to people where I feel like I fall short is knowing the business stuff. And so it is totally outside my comfort zone, to contact people and just kind of put myself out there. And that’s actually how we got connected exactly how we got a cold call. And so doing that kind of stuff, being able to have confidence in my ability to say like, No, I’m not going to take insurance anymore, because of the constraints of managed care. And know that I have something to offer people is something I’m really doing to challenge myself in a process. But I I really firmly believe that like, as humans, I don’t want to be stagnant. I don’t want to stay in the same place. And so I’m constantly trying to better myself as a clinician, as a person, whatever. And so I just recently hired a contractor and also thank you am being able to navigate that and lose this

your first hire. I have an assistant. Okay, so your first clinical hire. Yeah, okay. Yeah.

And so that’s it’s been a process this past I’d say, I literally

had them first interview yesterday. Oh, it’s so

exciting. Yeah. So it’s, that’s kind of one of the things the past six months to a year, I would say I’ve been doing to kind of grow and push myself and get outside my comfort zone. Personally, I’m trying to think personally, where I’ve been, oh, I can, as I mentioned, I’m on a new mom. And being able to accept help is something I’m working on. Or even ask for help. If my parents are like, Oh, well come over and watch her. Okay, like, that’s okay. If they want to do that. It’s okay. It’s okay to say to somebody, like, I need a break. I need, you know, I

need a day.

I need time for myself. Yeah. So I recently scheduled a self care day and I’m planning to send my daughter to a sitter that day it go and just be by myself. And that’s something I haven’t done in a while. Yeah, I did pretty regularly. But since becoming a mom, it’s a lot harder to make that happen.

Understood, we’re very good. One thing that you said kind of drives you is your passion to help people. So how did you? How did you know that? Right? Because I feel like some people are okay, working the desk job and just kind of being behind the scenes and not really interacting with people. But like, you and I were therapists, we’re interacting with them intimately. Yeah. How did you come to that realization? Long story,

so I’m going to try and make it kind of short, but um, when I was 11, I was diagnosed with epilepsy, not a very severe form. They’re called absent seizures. So I would lose consciousness for like five to seven seconds, but I wouldn’t have the grand mal seizures.

But it was It looks more of like you zoned out.

Like I said out like I stared off into space and like, hey, come back. And so I got diagnosed when I was 11. And teenage girls are awful. And so I got made fun of a lot and I really struggled with like, something’s wrong with me, this is not like, why am I why is this happening to me? And I really struggled, I got really depressed. Kind of got into some behavior issues as a teenager and really struggled through this all through middle school, high school. out of college, my mom sideout is a special education teacher, or was she’s retired now. And I needed a job for college that would fit with my school schedule. And so she’s like, Well, why don’t you come and kind of do subbing in some of the special education classrooms just help out, it’s just kind of like having an extra pair of hands. They call you that day. And if you’re free, great, and if you’re not great, and so I saw some of these kids who were had such severe, whether it be physical disabilities, mental, you know, mental disorders, whether it be anxiety, or like intellectual disabilities, whatever. And some of them were so happy just to be at school and to be learning just to be around other kids. And it really, really, by helping them and just being there, for them pretty regularly, it kind of was like, helpful for me of like, oh, you know, like, I enjoy this, it’s fun for me, it helps me think about myself differently. So that’s kind of how it got started, I went into college thinking I was going to be a teacher, because my mom was a teacher. That’s, you know, that’s what I thought I was supposed to do. And I took my first psychology class at the same time that I took my first teaching class and hated my teaching class. But my psychology class was fun. And I enjoyed it. And I learning about how people work and what drives them. It got me really excited, like, that’s my nerd coming out. And so I really love working with people and seeing them evolve and seeing them out love seeing them struggle, I love seeing the other side of the struggle of how things change how they’re able to get to a better version of themselves. And I think it started with that experience with the kids in special education, being just kind of that hands on person to help them. And throughout college. I had some of those other experiences, I worked with kids on the autism spectrum. And just saw the, how impactful it was for the families as well as the kids that I worked with, to have somebody be there. Throughout kind of my own journey with my epilepsy, I had a couple people who were really instrumental and just kind of helping me through them. And I made that connection of like, oh, that’s what people need somebody to be there for them and help them through tough times. And I could do that I enjoy being around people I enjoy working I’m good at kind of meeting them where they’re at. And so that’s how it kind of came to be is like just a series of different experiences. And then finding like, this could be my job, like, I could do this. And it to me, it doesn’t feel like work all the time I enjoy going to work, I enjoy seeing the people. And I enjoy helping them through that struggle.

Very cool. Sure, it’s not the easiest story to tell. But I appreciate you sharing,

I have to kind of model some of the things that I want my clients to do show a little self disclosure, I don’t feel like is always a bad thing.

There you go. So we’re wrapping up here. I would love to.

I asked you before we get started if you had anything to offer the listeners, and you said you did, so I’ll let you take it from there. Yeah, so we have a new client special that we offer to first time clients. And it is a package typically four sessions for $500. It is about a 20% discount on what is like our typical rate. But for people who are listening to this podcast, if they mentioned the podcast, we will give them 10% off of that package and kind of just help them get started and save a little bit of money and awesome become a better version of themselves. So if they want to contact me, whether it be email phone, they can just mention Hey, listen to this podcast and perfect you drop this. So no keyword or anything like that. Just just mention it when we’re talking and I will be sure to get them hooked up with a discount. Very good, and then how would they get in touch with you? So there’s a couple of ways to get in touch with me. You can call the office and the number for that is 314-325-2685. And they can also email me at ritchie@gbhconsultants.com. And that’s a great way to kind of get in contact with me and we do free consultations. So talking with people I mentioned this the very beginning

A podcast talking with them getting to know their struggles. So if you just email me or call me and say, hey, I want to talk with you and see if you’re a good fit, I’d love to connect with the listeners and just be able to, if I’m not the right person, fine. Let’s get them connected with somebody who is a good fit for them. That’s the most important thing to me. And just since no one can see this, jritchie@gbhconsultants.com. Yes, perfect. All right. Anything else? No, I, this was so fun. I really enjoy doing it. And I hope our listeners found something that they could kind of resonate with or was helpful. I know I did. I’m excited to share this episode with my clients because we did have that discussion of here are the different things to keep in mind when it comes to pain. So I appreciate you having that conversation with yeah, thanks so much. I appreciate it being here. Absolutely. This has been STL Active. Thank you for listening to the STL Active podcast from stlouispt.com. If you enjoyed the show, please spread the word. Thanks again and see you next time.