Dr Andrew Greenland: 0:00

Hello, and welcome to Voices in Health and Wellness. This is the show that brings forward the clinicians, thinkers, and changemakers, transforming how we understand health, healing, and human potential. I'm your host, Dr. Andrew Greenland, a young and London-based integrative medical doctor, exploring the edge where medicines meet meaning. Today I'm joined by Dr. Joanna Rosen, a clinical psychologist and trauma consultant based in Connecticut, whose work is firmly rooted in the belief that mental health outcomes can be radically improved, not just through treatment, but through prevention, early identification, and meeting people exactly where they are. So, Joanna, thank you very much for joining us today and welcome to the show.

Dr Joanna Rosen: 0:36

Thank you so much. I'm really happy to be here.

Dr Andrew Greenland: 0:39

So maybe you could just tell us a little bit about your journey and what you're doing now in your role.

Dr Joanna Rosen: 0:48

My journey probably dates back to when I was in college, to be honestly, and it really came together relatively seamlessly in an unpredictable yet not surprising way. I've always, from as early as I could remember, I've always just been curious why bad things happen to people. And I should say not so much why bad things happen, but what makes it so that some people can be okay afterwards and why some people really have a lot of challenges. So that really sort of was the road path that I followed. I did a lot of different volunteering things in college in settings where people really had horrible things happen, whether it was a juvenile detention center, I worked in a domestic violence shelter, did some work in children's hospitals as a clown, actually, on a cancer unit. So it really just, I my eyes just kept opening up, I should say, and my ears kept opening up. And ultimately when I went to graduate school, I really took on, I think it was a based on the research as well as the clinical direction, that there really are um there really are ways to try to figure out what makes some people more vulnerable than others. So in terms of my dissertation, that's what I studied. I studied what were some predictors of chronic PTSD and trauma survivors. I ended up focusing my internship work on prevention, early identification, really trying to help people and learn about how to help people who by know um nothing that they bring to the table, bad things just happen. And that really just it just continued in all of my work. So I've just focused on looking at the unique factors that research has told us to both guide what we do as clinicians and do my best to try to bring that out to the public so that people are as aware in the scope of mental health as we are in medical health, I would say. You know, prevention and early identification is so important to people with every organ except for the brain. And in part, that's I think it's rooted in how mental health has positioned itself and the stigma that has gone along with it. But I'm really hoping to bridge that gap and really let people know that in the same way we can adjust lifestyle for things like cardiac health to reduce issues related to cholesterol, related to risks for cancer, let's say. Can't take it away, but there are a lot of things we can do. And the same really is true when it comes to mental health, in particular with trauma. So that's sort of the web I've woven and sort of the space that I am in right now.

Dr Andrew Greenland: 4:12

Thank you. Really good to hear your sort of background origin story. I know your philosophy is move forward better. What does that mean in practical terms in your work?

Dr Joanna Rosen: 4:21

Um, you know, the the move forward better really came from many, many years working with people in my office who recognize that they really tragic things have happened. I mean, I whether it's high, high-profile events like 9-11, um, some really school shootings, other you know, bombings, loss of to people by suicide, homicide, accidents, I mean, so many horrible things. Everybody knows such and such happened, and it kept coming up. I just want to move forward. I just want to move forward better. And it really just resonated with me that that's really what the purpose is. It's of everything. If something comes our way, are we we just want to do better than we're doing. So that's really how I've structured and really seen my work is I'm here to be that catalyst, to be that bridge between what's what happened, what's happening, so that what happens next can be better in whatever way the individual wants it to be better. That's my job is to meet them where they are and help them get to that next step better.

Dr Andrew Greenland: 5:40

Thank you. And how does that, in practical terms, how does that translate into your clinical model and your trauma consultancy?

Dr Joanna Rosen: 5:47

Um, you know, so I began off, I'm a longtime um, you know, clinician. I've been doing clinical work for the past 25 years, I would say. And then was during COVID that um, and I know that happened to a lot of people professionally, especially in health, it just a lot of shifts. I shouldn't say just in health, probably everywhere. And the murmur behind the scenes was there's going to be a mental health tsunami when this is all done. And that was really what everybody knew was expecting to happen. So I really started thinking about how do we get out of the one-on-one in my office space, which I love, but that it's not able to reach everybody for so many reasons. Whether it's because there aren't enough providers, and that is totally true, um, whether they're not enough hours in the day, whether people's lives are too busy, or insurance, that I wanted to create this framework to help people not just in my office space move forward, but in the non-clinical space. So I separated the two in essence. One of so I have two branches of what I do, which is I call it both the clinical and the non-clinical. For clinical, it really to me means staying up to date, being really informed. I attend a lot of trainings, I attend research conferences to really find out what's the next step, especially in terms of trauma and working with people who have experienced trauma. So my the bridge with that work, move forward better, is use what science is giving us, adapt it, and provide people with the options and the opportunities to best get to their goals using modalities, using approaches that work. And I'm you know, I confidently can say what I do helps people and it works because people really experience a major shift in the positive direction. When it comes to the consultant work that I do, my consultancy is really to it. Actually, it started some of the ideas were I was doing, you know, all this really great work. And then people would come back to me, you know, at the next session and there'd be a setback. And usually the setback came from an unintended statement approach, something by somebody in the community, whether an individual, whether, you know, oftentimes healthcare providers, service providers, by no means did they mean to say or do something that caused a setback, but nonetheless it did. So then I was like, okay, so the whole approach needs to involve everybody. So everybody knows or at least can understand and have awareness about how we really all can work together. We are dependent upon each other. Um, we all have become siloed, uh, more so during COVID, especially after COVID. And my hope is to really be um to let people know that they play such a critical role in somebody else's well-being, even if they don't know that other person is struggling.

Dr Andrew Greenland: 9:20

Thank you. So, talking a little bit more about your model, um, um let's start with prevention, because you talked about the importance of early identification and the role that plays in reducing the longer-term mental health challenges. But what does that look like in practice?

Dr Joanna Rosen: 9:34

Prevention, honestly, to me, is um really focused on raising awareness. I think that if we have awareness about, I'm gonna, you know, in terms of trauma, trauma by definition, the the concept of it has shifted in terms of how it's understood. Something happens to somebody, and that something is of such magnitude that it overwhelms their nervous system's ability at the time to process what happened the way they would an ordinary event. So, given that we can't predict when something terrible might happen to us, but it's life, right? Like we know in life terrible traumatic things happen. We know that as a result, if we can be best prepared for that, we're gonna be in the best position to manage what comes our way. And that's what prevention is all about. It's giving information, raising awareness, really putting ownership on others to get prepared the way we know. We know, meaning research information um tells us what we can do to set ourselves up the best way possible. It just doesn't become part of normal dialogue. So prevention can look like um letting people know the importance of building this thing called resilience. Like, what does that mean? Making sure that we get outside, exercise, right? In heart health, we know what that means. Healthy diet, um, exercise, don't smoke. Mental health prevention looks like maintaining social connections, being connected, taking care of yourself in terms of nourishing yourself, whether it's through exercise, through reading, keeping your mind sharp, whether it's job-wise, um, preparing yourself for meetings. But if you don't have the information, you can't prevent what might happen. So I have a whole big prevention push. Um and my uh I would say at this point right now, my my my um real passion right now is that adolescent risk period, which really is not spoken about how challenging it is to go from high school to college, from high school to a career moving out of the house. It is so overwhelming to the nervous system that prevention looks like talking about it and making our conversations just based on what could happen is likely to happen. So it's normalized. I think that that's probably the best, uh, most succinct answer is normalize the reality that it is tough out there, and we don't want to just wing it. We could wing it, but we also could set ourselves up for success in a way that we may not be aware of. So that's really what the prevention piece is about. Similar to the concept of a well visit that might take place in a doctor's office, an annual physical prevention is all about checking in on the areas that we know if they are um weaker, pose a risk for somebody, and then moving from there.

Dr Andrew Greenland: 13:21

Thank you. So you've worked you've worked across um vastly different trauma contexts from first responders to frontline health workers, and you just mentioned transitional stress in students. Are there any patterns or common themes in these vastly disparate kinds of trauma?

Dr Joanna Rosen: 13:38

Um, yeah, I mean the the the theme is um unexpected, um, unexpected things happen and it oh it's overwhelming. And I know that that's like that is the theme. And the theme is I didn't want this to happen. I thought I thought I was doing everything possible, but yet it still happens. And everybody, people want to do right by themselves, and we're really good as humans to sort of separate ourselves and just like push aside how different events actually impact us as a human, right? So, in terms of as a professional, whether you are, let's say, an attorney, let's say you are prof um a healthcare worker, first responder, an educator, it doesn't matter. We put on our professional hat when we go to work, and we really want to do best by those we serve. And our brain is really good at letting us do that. The problem is when we re-enter our families, when we re-enter the world without our professional hat on, we kind of forget that we're human and that we just may have experienced something that was somebody's worst day in their life, let's say. And that impacts us as humans, and we forget that because our brain does a really good job to carve it out. So by bringing it together and letting people know they are human is really, I would say, the common theme that as hard as somebody might want or try to not let life impact them, it does. And um, that's really what we have to accept. In addition to, I would say, what, death and taxes, we can predict adversity impacting us, and we could do something about it.

Dr Andrew Greenland: 15:40

Amazing. And I know you've um designed your model to reduce acute distress more efficiently. How is it different from what is going on in other conventional forms of therapy at the moment?

Dr Joanna Rosen: 15:53

I think that um, you know, I guess that the difference and part of why I shifted my model, I did, you know, what's called standard conventional therapy. This is when I'm talking about my clinical practice here. The conventional therapy that is this sort of designed and organized by insurance, I have to say that it's these single sessions, we have a time limit, and you know, once a week if you're lucky. And although that could be really helpful for support, what I found is that when it comes to working with trauma, we're dealing with what is called a bottom-up uh you know approach, meaning what makes trauma overwhelming is that it overwhelms, what makes an event overwhelming is that it overwhelms the nervous system. And the nervous system is not as easily accessed safely, like where people get activated in 45-50 minutes. And I found that people were in therapy longer, you know, it just stretched on too long, or people who had short um time off from work. So I created a model that went just like it went right in there, um really looking at helping people feel really comfortable, let's say, in this space, and using the treatments that we know work, helping their nervous system really get to the present. Everybody knows, for example, that something is over, but the brain doesn't necessarily know that. Because when something terrible happens during childhood at any point, if it overwhelms the nervous system, the brain doesn't store it, so it continues to um react to it as if it's happening now, and the shift and where it can happen so rapidly is as soon as people can really um understand that the symptoms come from a physical place in their brain, that's the immediate buy-in. And then we basically work to get the brain back on board in the present. I realize this is not a really good um explanation um to your question, but I work with people in a really short period of time, maybe you know, a couple of weeks to two months, and the amount of stress reduction has been unbelievable. That for me, there's no turning back. I that's you know, a terrible answer to uh that's very helpful.

Dr Andrew Greenland: 19:00

I'm trying to understand your model, uh, how it might compare with more conventional things, what the differences are. So thank thank you for that. Really helpful. So what have you noticed? You've been doing this work for a while. What are you noticing in terms of client expectations, in terms of the way people show up to access care from you? Um, do you have any observations about millennials, Gen Z people, or any other observations about client expectations and how they've changed since you started working in this in this realm?

Dr Joanna Rosen: 19:28

Um, I would say not necessarily. Um, I have a I really created this niche, this concept of doing intensive trauma therapy as opposed to conventional means that I really spend a lot of time up front with people to make sure it's the right approach. So somebody will reach out to me initially, we'll have a conversation. I want to make sure that they understand what I do and what the goals of this kind of work are compared to this idea of conventional. We then meet in person and I, you know, explain it a little bit more. So by the time somebody decides to work with me, they have a full understanding of what we're after because we've spoken about it, we've identified why this approach is a good fit for them. So everybody wants to feel better as soon as they can. Everybody wants to not be interrupted by distress. That is the common theme. And whether or not somebody works with me really becomes up to them, right? And there are some reasons I wouldn't want to work with people based on whether I'm the right clinical fit. But expectations are if you meet with me, you're gonna do a number of baseline um sort of questionnaires so we can get real numbers on distress in a whole lot of different areas, and we redo them and I show them to everybody, and the expectation is these numbers will come down, and that is the goal. So it becomes very collaborative. I think that that's important. Um, if somebody is the right fit for my practice, it's because they're motivated, they're collaborative, and they've they've already bought in because we've spent so much time before we actually get started. So that's sort of um something that I can do uniquely just because of how I've structured my work and I work for myself.

Dr Andrew Greenland: 21:43

Thank you. So, what's working really well for you at the moment, whether it's from the clinical side or more of the business side of running um a practice such as yours, what are you particularly proud of?

Dr Joanna Rosen: 21:53

I think what's working really well, um, I mean, I definitely would say my relationships with um with my clients, um, that absolutely, that there is a comfort level. And certainly having done this for so many years and working with such a variety of um not only people, but I really don't think anyone will ever say anything to me about what they've experienced that comes as a surprise. So I think that I I I've been told, and I I do think I bring in authenticity to our work together so that people feel really good and comfortable in this space. So my answer is that's working really well. Um, I definitely feel really good about these the quote unquote treatment, what I offer people. It's very transparent and it's been incredibly successful, I would say, in terms of getting people where they want to go in a short period of time. So that's working really well.

Dr Andrew Greenland: 23:03

Brilliant. And on the other side, what are the challenges in doing this kind of work? And there are any particular challenges that you've recently had to overcome to do what you do.

Dr Joanna Rosen: 23:12

The challenges, I would say, absolutely really um have to do with my consultancy side of it, not my clinical side. There, for better or for worse, there is never a lack of individuals seeking mental health services, and there is no shortage of people who have experienced trauma. So it's not, I don't have challenges with my clinical side. Um, it's just me. I don't really do marketing for myself. A lot of it is um, I try to, that answers your question. What's what's challenging, which is finding time to really go out and spread this awareness to you know, to high schools, to um medical facilities, that we can do so much to reduce burden on healthcare, uh, fatigue, toxic stress, all that if we just shift a little bit in terms of our approach and really bring in this concept of prevention as being so critical and raising awareness, but it's a challenge to do that. Um I'm not a TikTok or Instagram or I've been told, oh, you should start doing that. I just I I uh I don't do that. It's it's just not my thing. So the challenge is to let people know that we really can prevent problems. Um because anyone who I speak to directly is so excited, they're like, absolutely, yeah, that makes sense. It just it's not mainstream, so it makes it a little hard to really um get it out there and have that be normal conversation.

Dr Andrew Greenland: 25:10

Thank you. And in terms of the larger mental health infrastructure, what's the hardest shift to what's the hardest thing to shift at the moment?

Dr Joanna Rosen: 25:17

Might be just in terms of the system in general, I think it's time and overload that I really do believe I've spoken to a lot of people, providers, who want to be able to give more to their patients, but they can't. They have quotas. You go to offices and they have people, many people. Mental health is lucky with that. We can't book more than one person at the same time, it's impossible. So I think that this shift is this concept called of burnout, of fatigue, of balancing life outside of work with work, that people genuinely don't or believe and experience not having space in their day to add in anything more because time is money in the areas of healthcare that are dependent upon, for example, billing. They have to have certain numbers of people, and it's just it's really unsustainable out there. Um and I think people really have to consciously step outside of it and make a decision, weigh the benefits and risks of stepping outside of a system that is not designed at this point to really serve the populations that we see.

Dr Andrew Greenland: 26:44

And if you had a magic wand and you could change one thing, whether it would be clinically, structurally, or culturally, what would that be?

Dr Joanna Rosen: 26:51

Ooh, culturally, structurally. I I mean, I know that this sounds pretty repetitive, but um if I had a magic wand, oof, I would want to easily have access to and not um try to join somebody's email deluge of um really letting people know that um we could reduce um honestly like we could reduce the problems that happen. It's factual that we know that medical diagnoses cause mental health challenges and those challenges impact how well people do with their um medical treatment, for example. We know that when you leave high school and you go to college, we know first year, first semester students struggle silently until they make a headline. Like we know this. And I would love to have a wand where everybody's like, oh, of course, of course, we have to include um information about trauma in medical school education, in graduate school and mental health, in education, of course, as part of our curriculum in high school, we have to prepare kids not just to apply to college, not just to get into college, but to succeed and thrive when they are out of college so they can stay in college and not come home and see me, for example, because something that could have been prevented wasn't. My magic wand is that um the whole culture shift and really focus on let's prevent problems when we can. We can't prevent everything, but there's a lot we can do and not just put out fires.

Dr Andrew Greenland: 28:58

If you experienced um a sudden surge of demand, say double the number of clients turning up next week, um, what would break first? And hopefully not you.

Dr Joanna Rosen: 29:07

What would break first? Um I guess my printer actually, my printer probably. Um, I am not a um, I don't do things electronically. Um I'm not paranoid, but I don't, I I just we're not there yet. Servers have not caught up with protecting people's privacy. So aside from my printer and needing to um probably get a lot more ink, um that that would be an amazing problem to have. I probably would shift and really very excitingly move into this whole idea of prevention and early identification because I think that people can do a lot for themselves. They don't need to come to my office or the office of a mental health provider if they can catch things early. And they don't get to this peak level of distress. So I probably would just, I would have workshops, I would have um, I would gather groups together and just educate, probably, is what I would do if there were a deluge of people. Um, because not everybody is at a level, they feel like they're at a level, but uh there's a lot we can do if we just normalize it. Um I honestly, I think that I get so many calls, even now. I have three kids. One is graduated college, one is a junior in college, and one is a first year, a freshman in college. And I know I've been there myself, and I've been amongst their peers, and I've worked with young adolescents, for example. I know what's gonna happen for the majority of these kids. So I when I speak to parents a lot of times who are concerned rightfully so, like, oh my gosh, yes. And then the kids are like, you know that this is supposed to be really hard, right? Like, you know that it's not all this excitement being a first-year student, it is difficult. And the responses are, I didn't know that. That makes me feel so much better. I was like, yeah, like absolutely, it's hard. We get it. So um that's my uh that's my deluge. That's what I uh that's what I would do.

Dr Andrew Greenland: 31:38

Thank you. Um, and if you were starting this work all over again, obviously you've been on a long journey to get where you are, what would you do differently, if anything?

Dr Joanna Rosen: 31:46

What would I do differently? Um you know, the path that I found came very organically. I think that what I would do differently in the beginning is probably have more confidence. Um using the platforms that have been in existence to reach the people I would love to reach. I think that um, like listen, everybody feels like an imposter at the beginning of their career. And I think it takes a while to get to a point where you can be confident, unfortunately. Um, you know, I got there, I'm like, oh my gosh, like I'm like well towards that when I stop working, I have a lot of time to catch up. So I think it would be um, I think it would be trying some way to have a little bit more confidence a little earlier and just encourage other people to step outside. This could rub some rustle some feathers. It's not about being a healer, which is a term that's used so often. It's about using what we know about the brain, what science gives us, because that's how people identify with understanding what's happening to them. So I think that I don't think I could have done anything differently. Life has happened in ways that pulled me back to trauma and I didn't expect it to. So it's a it's a blessing that it did, and it's awful that it did as well. So I don't think I could have changed that path.

Dr Andrew Greenland: 33:34

I hear you. And finally, what's um what's next for you over the next six to 12 months? Do you have any plans afoot in your work?

Dr Joanna Rosen: 33:41

Yes, and I'm really trying to hold myself accountable. So perhaps this will do that. I created um a program, I've named it from lockers to lecture halls. And it's a playbook that I've created and a workshop that goes along with it or separately. I'm trying to get my playbook into a publishing form so that we can take away all the pages in all of these self-help books and just really get down to the nitty-gritty, how to have conversations with your kid before they, whether it's before they choose the school, make sure it's the right school for them. I've submitted a number of proposals to different conferences, PTA conference, like a national PTA conference, conference for educational consultants, who are people who oftentimes help with applications for high school counselors, medical professionals to try to get the word out and use this from lockers to lecture halls platform, whether it's on LinkedIn for social media, and just do it. I've been sort of not hesitant, but I have to carve out more time so that I can actually get that out there and then just kind of see how it's received. That's my hope in the next couple of months, less than six months.

Dr Andrew Greenland: 35:12

Amazing. Well, all the best with that. And um, if you ever want us to put it on the bio page of the podcast to promote what you do, that's absolutely fine. Um, sure people will be interested. Look, Jonas, it's been such an interesting and valuable conversation, not just because of the clinical insight, but because of the humanity you bring to the idea of trauma prevention. Um, the message that people can move forward better, even when life is messy, is such a hopeful one. So thank you so much.

Dr Joanna Rosen: 35:34

Thank you so much for having me. I really, really am glad I was here with you.