Dr Andrew Greenland: 0:00

So, welcome back to Voices in Health and Wellness. This is where we explore the real conversation shaping modern care beyond the buzzwords. I'm your host, Dr. Andrew Greenland, and today I'm delighted to be joined by Ladonna Carey, a licensed psychotherapist and betrayal trauma specialist, trauma specialist based in Kingsport, Tennessee. Ladonna is the founder of the Betrayal Recovery Centre, where she helps individuals and couples rebuild trust, process emotional wounds, and reclaim safety after experiences of betrayal. Her work goes far beyond communication strategies. It's deeply rooted in trauma-informed therapy, attachment repair, and whole person healing. So with that being said, Ladonna, welcome to the show. Thank you very much for joining us this afternoon.

Ladonna Carey: 0:40

Oh, I'm very happy to be here. It um it's always nice to chat about betrayal trauma first thing in the morning here.

Dr Andrew Greenland: 0:48

Absolutely. Well, we'll diving into that in a second, but maybe we could start at the beginning. What first drew you to the work of therapy and how did betrayal trauma become such a strong focus for you?

Ladonna Carey: 0:59

Oh, that's interesting. I my undergraduate's actually in criminal justice corrections. And so I wound up taking a lot of um criminal law classes, forensics, um, and I paired that up with a lot of thinking I may go to law school. I paired that up with a lot of political science classes, and psychology got sprinkled in there. Um, after I graduated with undergrad, I got a job offer that was not really a very attractive job offer. Um, it would have been working with parolees, and I decided maybe that wasn't the path I needed to take. So I sat down with my mom and said, What do you think I should do? And she said, Well, Ladonna, people have come to talk to you all through your life. What about psychology? How did you like that? So actually, my mom kind of directed me that way. Um, I went on to grad school and my first work um after grad school was at a domestic violence shelter. So I've got a lot of education very quickly about the realities of interpersonal violence, domestic violence, safe houses, the struggles that we go through in abusive relationships. And that really created the foundation of all the work I've done since then.

Dr Andrew Greenland: 2:27

Thank you. And um, during our pre-call, you mentioned that not all couples' counseling is created equal, especially when betrayal is involved. Could you expand a little bit on that?

Ladonna Carey: 2:37

Yes. Um sometimes I when I'm hearing other therapists or seeing other therapists discussing couples work um online in therapist groups and things, sometimes people are going into it without any formal training in couples therapy. Um one that actually was um was paramount to me starting my training program that I have for therapists is that a therapist was saying, I'm I've got um a couples counseling session in the morning, I've never done it before. Can somebody tell me where to start? And I thought we want everybody to know where to start with this because couples counseling is very different than individual work. Um, you have to be able to look at the dynamics between the couple, you have to understand both of their histories coming into it, and also in the majority of cases that I see in couples work, there's a degree of gaslighting, emotional abuse, verbal abuse, and what I've consistently see growing more and more and more are issues with infidelity and betrayal. Um, and betrayal and infidelity doesn't have to just be sexual, it can be financial infidelity, it can be addiction and the deception that goes along with that. So anything that's really rooted in deception. And if you're not trained to be able to pick up on those things when you go into the couple's work, many people have told me that they actually felt like they were betrayed by the therapist because they didn't really hold the room and they didn't provide therapy that was trauma-informed couple's work.

Dr Andrew Greenland: 4:42

Thank you. So there's a real specialization here. I mean, was there anybody doing this kind of work as a thing on its own at the time that you were getting interested? Or did you have to self-learn research? I mean, how did you kind of get into this and kind of upskill yourself from probably more generic um therapy training?

Ladonna Carey: 5:01

Well, I had always done a lot of couples therapy continuing education, and with that criminal justice background, you know, I was drawn more to what's the pathology in it. My master's is in clinical psychology. So always looking at what's going on internally. Um, so what I found is that there number one are not a lot of couples counselors because it's hard work. And typically you get reimbursed about the same thing for couples' therapy as you do individual therapy. So therapists are like, why would I do that? And some therapists just hate couples work. You know, it's really just like any other specialty that we go into, it has to be something that comes from inside that this is important. And I got into betrayal trauma from going through my own betrayal in a long-term relationship and finding out I'd had a partner that had had a hidden life for a very long time. I quit looking at one point because I knew all I needed to know in moving forward. And I could not find anyone that understood the impact that that had on me. Um, I talked to a couple of therapists, and there was a lack of understanding of the depth of the trauma from that. So I actually wound up working with a life coach who was trained in internal family system and the Enneagram, and he was extremely helpful to me. What that clicked in my mind is that we have more and more people who are dealing with being betrayed, and we don't have the appropriate resources for that. So I started looking for betrayal trauma programs, and I went through a couple of a couple of those pretty in-depth programs, and then I started doing a lot of work, just what's the research that's out there, what's the best resources that we can pull together that we're going to be able to do crisis work, which it is a crisis initially. Um, and also through the years, I've been doing this a long time, so I've done a bunch of things, but I've done a lot of work in critical incident management. So I've been trained in the emergency first aid, psychological first aid. And so certainly I incorporated that into the work that I do. And what are the different stages that go along with the healing process with betrayal trauma? Part of what the research says is that it's not uncommon for the effects to be there for a minimum of three to five years. And in couples' work, a lot of times what I see is that we just want to move through this. You know, the person who has done the betraying, we just got to move past this, you've got to put this behind you, you've got to forgive me. And if you don't forgive me, you're the problem now, rather than the betrayal being the problem now. So I created, you know, an intensive package and a therapeutic package that incorporates the knowledge that therapists need to have about what betrayal trauma is, about what's going on with the betrayed partner, what's going on with the person who's doing the betraying. And because we don't necessarily want to villainize that person, we want to understand what are those dynamics that are at play there. And now how do we do the art of therapy and working with the couple together? Another thing that I look at is being able to not predict but assess is the person who did the betraying ready to do the work to repair the rupture. And I firmly believe if they're not ready, if their mindset's not ready, then we don't go into couples counseling because that can further betray and hurt the betrayed partner.

Dr Andrew Greenland: 9:48

Got it. So you kind of built your own curriculum to really learn and get into this, and now you've developed a curriculum to help and train other people. Is that is that fair to say? Yes.

Ladonna Carey: 9:59

Yes. That's a very good summary of my long answer there.

Dr Andrew Greenland: 10:02

No, no, I'm just trying to um kind of understand because this is interesting for me learning something new. So do you find that um clients often come in expecting one kind of support and actually they then realize they need something deeper?

Ladonna Carey: 10:15

No, actually, on the flip side of that, what I see is that clients come in many times in a desperate crisis situation. And when I talk to them about here's what, excuse me, here's what we're gonna do, here's where we're going to start. So many times I hear people say, you get it. It was such a relief. I could feel it when I knew that you understood what I needed.

Dr Andrew Greenland: 10:45

So, what does the journey look like for a couple who are coming to you for you know for assistance? What does it how does it kind of map out? What's the general trajectory for them?

Ladonna Carey: 10:56

Well, typically the assessment of, you know, like the betrayed partner, like I was saying, are they ready to look at accountability, transparency, doing the repair work of I'm not a trustworthy partner to you. I was comfortable being deceptive to you. And here's the work that I'm gonna do to understand how I could live that hidden life, how I could live that double life, and be okay presenting as though that wasn't going on. Yeah, one of the things, um, Omar Minwala is a person I really respect his work in this field, and he says that a lot of times, you know, this hidden life is really like having the hidden basement, that you don't know that you got a basement in your home, and all this stuff is going on underneath it, and there's the feel of it coming through your house, but you don't know you have a basement, so you don't know what it is that's happening there. So, a part of the assessment of the betrayer is are you ready to open up the basement and find out what's going on and what the deep, dark secrets are that are there? Kind of shadow work, really, if you think about the analogy of a basement that's hidden there. So, are they ready and are they able to do that type of work? What I see most often is a reluctance to do that, because if a person has the ability to have a hidden life, they've learned very clearly how to avoid emotional dregulation. You know, they avoid things that are upsetting to them, they go in a different direction to soothe themselves, and so it can be difficult work for the betrayer to get to a comfort level that I can address these issues that are going on with me. So that's really first step in doing an assessment. Are we going to do couples' work or are we going to move on to individual work? Some couples do not want to do individual work, they want to move on with the couples' work, even if I say I don't think you all are ready for that. So that's a discussion that you have to have with couples of you know what are the pros and cons in addressing this. So I've got an assessment form that I use of how ready do I feel like that they are. And then if they're ready, the first part of it is moving into trust building and what does that look like? Um, there's a thing that we call trickle truth in this work. Uh, many times when a person has betrayed, they like to kind of trickle out the truth of what's happened. And a lot of times it's how much do I think you know? What's the least amount that I can get by with saying to you? But what we see in research, and what I've certainly seen in my practice, is that if you have a person who's dropping out those trickle truths, then you've got a therapy room where continued trauma is happening. What does that do to the betrayed partner with their sense of safety in a therapeutic environment? So I educate the couple about here's the dangers of trickle truths, and we need to really have what we call a full disclosure. You need to be able to say, I'm open to answer whatever questions that you have. And then you coach the betrayed partner on what are the questions that you want to have answered. I always caution them too that you once you hear something, you can't unhear something. So let's think about what you really want to know and why you want to know that, and what's the best way that we can ask those questions so that you can get the information you need with the least amount of additional trauma with that. So that's a lot of work that we start off with. And if people hang on through that, then if we feel that trust is there, if the betrayed partner's nervous system has been able to settle, if they're starting to feel some more safety and security in the relationship again, then we move more into what was going on with you guys as a couple. So, what was going on if there was a blindness to that betrayal? And how did the betraying partner take advantage of that betrayal blindness? So that's an important stage of therapy as well. So, in every stage, we're working to build more openness, more transparency, more safety, and move into a secure attachment with each other as partners.

Dr Andrew Greenland: 16:36

Thank you. So, are you seeing any particular trends right now in the trauma recovery space, either sort of clinically or culturally?

Ladonna Carey: 16:46

I think across the board, what we're seeing is more and more hidden life through the internet, you know, with porn, with camgirls, you know, all everything that's accessible at your fingertips. It's very easy. And a lot of people want to say, well, that's not really cheating, because I wasn't in a relationship with them. I wasn't meeting up with them. I it was just over the computer. That's not really cheating. Well, anytime you're lying about something and hiding something, that's cheating. That's the definition of it right there. But I see that that's really in epidemic form. Um, another trend that I see is, and what the stats show, there's more and more growth in divorces of what we call gray divorces, people 50, 55, and over who have been in long-term relationships, and that is growing while the other divorce rates have kind of leveled out in the United States anyway. Um we've seen gray divorces be like four times the rate of divorce. And I actually read some research just the other day that was saying there's an issue that when women are diagnosed with some sort of medical concern, and the husband becomes more of the caregiver, that there's a spike in divorce at that point. That's not true when men are diagnosed with medical concerns. Women are not divorcing, they're staying to caregive. So that's another trend that we're seeing more and more of.

Dr Andrew Greenland: 18:37

So you mentioned on our call before about your sons working in physical therapy and the value of um holistic treatment approaches. Has that shaped your own perspective on how you approach your work with clients?

Ladonna Carey: 18:50

Yes, yeah, and I talked about we have to feel safe and secure, and a lot of that is nervous system regulation. So we have to work on emotional regulation. We have to think about what are you eating, what sort of exercise are you doing. Um, part of being able to customize treatment for people is recognizing what's my personality style and what do I need. Some people, when they've been hurt and traumatized and they're grieving, they need to go to kickboxing class. They need to go hit things. Other people need yoga and they need journaling and they need time in nature to be able to reground themselves. So being able to look at the whole person of how are you taking care of yourself? Crisis work is always how are you getting the nutrients that you need? Are you sleeping? What do we need to do to get those things going for you? So you've got physical energy to be able to survive this. So, yes, it it's very important. Important to me that we're looking at what's happening with you medically, what's happening with you spiritually. A lot of people have a crisis of faith, if they're faith-based people, of how did this happen to me? And I was doing all the right things. And I thought if I did the right things and I followed my faith, that good things would happen to me. So we have to look at that aspect of how it impacts them. And then what sort of work are they doing, somatic work, to be able to settle their internal system?

Dr Andrew Greenland: 20:40

I don't know if you're finding that clients themselves are becoming more holistic in their expectations, but how do you see the role of a therapist having to evolve to become more holistic for their clients?

Ladonna Carey: 20:52

I see there are a lot of workshops, there are a lot of training programs that are focused in that direction. And the more that we learn about trauma work and the more sophisticated we become with it, the more we recognize that is an essential part of the work that we do. And if we're not providing that and not knowledgeable in that, that's certainly a spot in our work that we need to be able to up our game, essentially, because clients benefit from those things. Our research shows it is very beneficial for clients to, when they've had their world fall apart, if they feel like, you know, what I can do is control my breathing. I can control what I'm eating, I can learn to regulate my emotions and to recognize my emotions, to recognize what messages my emotions are sending me of what I need. And that's how I care for myself. So that's a way betrayed partners learn to trust themselves again. And the somatic work is absolutely essential in that. So therapists are becoming more sophisticated in there's a need for that, and absolutely our clients are more sophisticated in just all the information that's out there, you know, they read those things, they're looking for answers themselves. So we want to be able to provide every aspect of their healing that we can, and that's certainly a big part of it.

Dr Andrew Greenland: 22:35

Thank you. So thinking of your work and your practice as a business, because we're a business and you're trying always having wanting clients to come through. What's working particularly well from a practice point of view right now in your work?

Ladonna Carey: 22:48

I have started doing over the last couple of years, I've started doing intensive sessions. And those sessions can be anywhere from three hours to six hours, or they can be a couple of days. And that sometimes is a great starting point for couples because if we do kind of the traditional couples work in an outpatient setting, you come in for an intake and then you reschedule in a week or two weeks, and then you come in for your session. And what I found in 45 to 50 minute sessions is that a couple is just getting to some of the core things that they need to talk about, and then it's time to say, well, okay, hold that thought. Let's move on, and we'll start that again in a week. That's not therapeutic. So I the minimum amount of time that I meet with a couple is two hours now, and I offer the intensives early on with attachment style assessments. Um, there's a Gottman assessment that talks about a lot of different areas in a relationship. So I I use all of those assessment tools to be able to kind of jumpstart in that first session of treatment planning and direction that we go in. Um, so that's working very well. Another thing that I do, um, I've got a program right now that I'm running that's called Healing Through the Holidays, that is an eight-video program about eight different very important topics of betrayal trauma and healing from that. How do you take care of yourself when all the challenges of Norman Rockwell holidays are there and that's not the reality that you're living? And then um on Friday evening, I'm doing a webinar that brings together past, present, and future and how do we move forward. So I offer a variety of programs for Betrayed Partners in that way. And another thing that I do is train therapists. I've got a program that I do a free monthly training with therapists that's called SOS, sharpening our skills. And I also am planning a conference that's going to come up later in 2026 that's bringing in some folks I really respect in the field to help train therapists there.

Dr Andrew Greenland: 25:36

Amazing. And are there any particular challenges that you find in doing the work that you do, or you know, the the whole business of running a practice that you have had to overcome or that you're having to work through at the moment?

Ladonna Carey: 25:49

Um I have a lot more request for therapy than I have time for therapy. And that bothers me, you know, and it also inspires me. I need and want more and more therapists trained so that I can have a referral source for these people who are finding me. Um, a big challenge, of course, is self-care because you're listening to some really tough things, and you're watching people experience those really tough things. And there's the you know, the vicarious trauma aspect that goes along with this work. So that's a reason I have to watch the number of hours that I work every week. I have to be very mindful. Do I need to go to kickboxing or do I need to go walk, or what do I need to do to release all of this that I've kind of absorbed through the day? And another thing that I do is at the end of the day or at the end of a tough session, I think about what was my job here, and do I feel that I did my job? Even if we didn't resolve an issue, was I doing the work that this couple needed with that? What were the things that I accomplished? Was I able to join with them in the experience that they were having with that time and act as a guide through that? So, really some self-reflection, professional reflection, and just the value of having other therapists, you know, a cohort of folks that I trust that we take care of each other, and we can just go bounce off, you know. Here's some things I need to release here.

Dr Andrew Greenland: 27:48

So it's very interesting to hear about your self-care because I'm always very aware of burnout in this space, and it's interesting to hear what your personal kind of approach is for that. Is there um anything that for you in the work that you do is a particular time drain? Perhaps things that you don't particularly enjoy doing, but a part and parcel of your work?

Ladonna Carey: 28:06

Oh gosh, the paperwork, you know, that just the paperwork with it. If I could just do therapy all day and talk all day, you know, I I'd be skipping out of the hall more so at the end of the day. But um, yeah, I've worked to be able to streamline that as much as I can just because I feel like that's self-care for me, and what are the best strategies in getting the things that I need there, um, but making sure that I'm not overdoing what needs to be done. So being really very mindful of what are the goals with paperwork. Yes, it is a chore, but it's a necessary chore, and that allows me to do more of this other work that I'm doing. Um, I've got a person who does my billing for me, and she is a lifeline for me because I would never get billing done. I never get paid if I didn't have her doing this work for me. So being able to know what is my skill set, where do I need other people coming in to be able to help me with this, and finding the best people that I can to do that.

Dr Andrew Greenland: 29:24

Brilliant. And if you had a magic wand and you could fix one thing in the business or the wider therapy space, what would that be?

Ladonna Carey: 29:34

I believe it would be more accessibility through insurance for people. Um, because there are a lot of very good clinicians that do not take insurance anymore because of clawbacks, because of low reimbursement rates, um, disrespectful behavior to providers in many ways. And if I had a magic wand, I would make therapy accessible for everybody who needs it, and therapists be able to, you know, we've got masters and PhDs, we should be making some money, but there are therapists who are not making it, who are struggling financially, who say I have to leave this field because I can't make enough money. I make more money waiting tables somewhere. If people are in community mental health, they're not doing well financially. And clients who come to community mental health need to have clinicians who are reimbursed at the level they need to be so that they're not burnt out. There's a lot of turnover in community mental health as a result of that. That's not good for our clients. So I think you know the financial picture for therapists, if that could be fixed, there could be much better access to mental health.

Dr Andrew Greenland: 31:13

Got it. And do you have any um plans for the next year or so? Anything on the cards that you're working on or excited about going forward?

Ladonna Carey: 31:21

Yes, actually, I have a book that's going to be coming out. It's called Surviving Betrayal, and it's a book that has all different impacts of betrayal. And here's what's going on with your body in this area. There's some neuropsych things in there. Here's what's going on in your brain, here's what's going on in your body, and then worksheets that go along with each chapter of that. And in conjunction with that, I've created a therapist workbook that here's how you, as a therapist, can use this workbook in therapy sessions, in group therapy sessions. So they essentially have a manual of here are best practices in treating betrayal trauma. So those are rolling out. Um, and then I've got the conference. Most likely it's going to be in October at um in the Smoky Mountains here. There's a theme park that we have that Dolly Parton has. Uh, it's called Dolly Wood, and she's got some beautiful resorts there. So I'm working with them to get it all set up to be able to host as many therapists who are interested in coming to come to the Smoky Mountains and learn about betrayal trauma and trauma treatment.

Dr Andrew Greenland: 32:49

Very exciting. Well, we'll be very happy to um put you the mention of your book on the bio page for the podcast to try and give it a little bit of promotion and uh obviously let us know when it comes out so that we can um you know put some relevant details on the on the bio page for you.

Ladonna Carey: 33:03

Um I just said great, thank you. It's always good to get resources out there.

Dr Andrew Greenland: 33:13

Definitely. Look, I'm very, very grateful to you today, Loronna, for spending your time talking about your work. It's been such a deep and insightful conversation. Thank you for sharing everything, your learnings, your experience, and your journey through all this. Um just very grateful and thanks for your time. Really appreciate the conversation.

Ladonna Carey: 33:30

Thank you for the opportunity. I appreciate it.