A Touch of Therapy

SUMMER 2023 Newsletter

View PDF / Quito Focus / Robotics Innovation / A Touch of Therapy / Robert’s Legacy / The Road Ahead / Endowment Endeavor

Before leaving for Ecuador, I had a sense that I was about to do something challenging that would push me to new limits as a psychotherapist. I didn’t know what this experience would entail, but I wanted to keep an open mind and have no expectations. I knew I was going to give it my best and learn as I go. I had never given therapy abroad and I was excited to use my native language to offer support to people who might otherwise never see a psychotherapist. What I didn’t anticipate was how deeply my soul would be moved by being witness to the resilience, strength and gratitude in the hearts of the Ecuadorian people that came to our mission.

        My first patient was a man with no arms and no legs who had lost them in an electrocution accident 8 months prior. He was wheeled into my tent by his wife while they waited to be seen by the prosthetics team. They had very high hopes he would be receiving prosthetic limbs that would help them bring some sense of normalcy back into their lives. As I sat in front of them, I was at a loss for words. Words seemed so flimsy in the face of such a permanent loss. All I could do was trust my instinct to connect with them and accompany them in their experience. Empathic listening skills, genuine curiosity, and reflecting back the language of resilience I was hearing from them was where I started. The truth is I had been training my whole life for this moment. As they began to open up, I started to guide the conversation with specific questions designed to lead them towards a clear, tangible, and rich description of the future they desired for themselves.

During my dissertation studies in 2019, I conducted research on the Spanish speaking immigrant population with mixed legal status in Northern Texas. In working with them I gained a profound appreciation for how a collectivist cultural context can differ greatly from the western individualist perspective we are accustomed to working from in the United States. It seemed that the participants’ resilience came from social connections and a broadened concept of family.

         I was so touched to see this same phenomenon happening with the patients in Quito. Patients who had experienced unimaginable life traumas, such as the loss of limbs, faced their future with a sense of hope and resilience. “How could this be?” I would ask them. Their answers left me humbled. They spoke about simple things, such as getting to finally brush their teeth on their own after having learned new adaptations. One patient who had lost both arms shared he was surprised to see himself not falling into depression, despite being so afraid he would become suicidal. Over time he coached himself into looking ahead with a positive mindset and he was happy to report he had never fallen into depression after all.

         Many of my patients were not referred from the prosthetics team. Some came to me from internal medicine, others from pediatrics and gynecology. When patients showed signs of psychological distress from experiences such as domestic violence, sexual assault, or general anxiety or depression the doctors on the mission knew there was a place for them to go to talk over their issues and receive intervention, education, and a plan for the days to come. Some doctors wondered, “How can you help someone with one visit when they’ve been living in these circumstances for all of their lives?”

“A Solution Focused Method with a Multicultural Lens” was part of what I developed throughout the year-long research project I conducted when receiving my Ph.D in Marriage and Family Therapy at Texas Wesleyan University. This approach takes a model of psychotherapy that is already geared towards helping people in situations of crisis, and fine tunes it to have a deeper appreciation for Spanish-speaking populations. The focus of this approach is to ask questions that orient the patient towards what they truly want for their future, and it amplifies the resources and strengths the client already has within. For example, the question, “What are your best hopes from our talking today?” is followed by, “Let’s suppose your best hopes are obtained, what difference will it make in your life to have this? How will you know it is happening? Please describe what I might see you doing and hear you saying.” Lastly, “Can you think of a time when you had a little bit of this in your life already? What was different then? How did you do it?”

         Contrary to a traditional approach to psychotherapy, rather than further focusing the client on what is not going right in their life, this model emphasizes the realistic possibilities for the clients’ future and helps them define what they can do in the present to get to the life they want. Most importantly, this approach highlights the ways in which clients already carry within them the tools necessary to create it. For crisis situations this approach is exceptionally useful as it creates sessions that stand alone and equip the client with a clearly defined future and a clearly felt sense for the resources they carry within them to achieve it.

         In addition to talk therapy, the high volume of trauma cases called for a somatic approach to healing as well. This included progressive muscle relaxation exercises, guided meditation, and breathwork in session. The youth especially took to psychoeducation interventions that explained how the nervous system works, how trauma can cause dysregulation and the ways we can intervene to bring about our own healing after trauma. They were amazed to see how using breathing could bring them to a much more peaceful and calm place. Making good decisions from this place becomes possible, as well as learning and memory.

Clients reported having felt a new sense of hope after the sessions. I witnessed traumatized clients go from a completely dysregulated state to having experienced bringing themselves back down to a regulated state for the first time ever on their own. As nervous system dysregulation is a major basis for all addictions, intervening at this level can completely change the trajectory of a traumatized person’s life. By being informed about how our nervous system is most affected and is at the root of most all other symptoms of post-traumatic stress disorder, clients discovered their own agency in their healing.

As the sole psychotherapist on the mission for the first three days, my endurance was really put to the test. As the days continued, I was happily surprised by a team of three psychotherapists from a local university who were prepared to help me treat clients. By day four we had expanded our office tent space into three very small offices and started taking in a higher volume of patients. As I felt my way through the process, I realized I needed a way to funnel clients and the triage team was happy to incorporate questions regarding domestic violence, anxiety, and depression into their patient screening procedures. These small adaptations will be implemented in next year’s mission. Volunteer local therapists will be recruited from whatever destination is decided upon, and a liaison between our mission and local mental health resources in the community will be scouted.  There will be plans for virtual follow up visits, and pamphlet literature talking about mental health and nutrition will be available to hand out to patients in the waiting room.

         The therapeutic conversations and interventions that we provided during our mission to Quito might be the only time these patients gain access to psychological care. Just one conversation can create the vision, direction and insight needed to take the next right action for one’s own healing. I see a butterfly effect in the psychological care we provide patients on the IMAHelps mission in Quito. I see generations changed because one person decided to open their heart to a volunteer psychotherapist who truly cared.