"Our Family Shrink" with Aileen Van Wie Psy.D.

Aileen Van Wie is a  licensed psychologist in the state of Florida and is currently employed at an inpatient psychiatric hospital. Aileen graduated with a doctorate in clinical psychology (PsyD) in May 2021 and, after completing a year-long postdoctoral residency, she also became licensed in August 2022. She has worked at a community mental health center, addiction recovery center (inpatient, IOP, and recovery house program), and multiple psychiatric hospitals during her training. 

8/2016             PsyD, Clinical Psychology
9/2021             Loyola University of Maryland: Baltimore, MD
8/2016             MS, Clinical Psychology
1/2018           Loyola University of Maryland: Baltimore, MD
American Psychological Association accredited program

RESEARCH EXPERIENCE

9/2016 –          Loyola University of Maryland: Baltimore, MD

4/2021            Principal Investigator, Doctoral Dissertation

Dissertation Chair: Emalee Quickel, Ph.D.

• Finalizing a quantitative study assessing the efficacy of mindfulness-based stress reduction practices on adults receiving outpatient treatment for one or more substance use disorders. 
• Successfully defended 9/11/2020

9/2015 –          Temple University: Philadelphia, PA

5/2016              Principal Investigator, Undergraduate Thesis

      Advisor: Phillip Kendall, P

📢 **Announcement!** 📢. We want to introduce our new 24-hour, 7-days-a-week hotline for crisis or substance use treatment. Whether you are seeking help for the first time or are an alum in need of immediate assistance, our team is here for you around the clock. 📞 **Call 1-800-HELP-120 anytime, day or night.** #ScrantonRecovery #ScrantonRecovery #ScrantonRecovery Fellowship House
As a treatment center, Fellowship House offers both residential and outpatient treatment services to

allbetter.fm
Discussions on addiction and recovery. We interview clinicians/researchers, legislators, and individ

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.

Chapters

• 0:00 Intro to Dr. Aileen's background.
• 4:40 How did you become interested in psychology?
• 9:07 How research and clinical practice are intertwined.
• 15:36 The definition of addiction
• 21:41 How addiction changes the chemistry of the brain.
• 29:48 The importance of curiosity in a spiritual awakening.
• 33:47 What was the most transformative thing you learned from addiction?
• 38:13 How much have you learned from your patients?
• 42:33 What is addiction and how is it treated?
• 45:51 What does addiction look like in a hospital?
• 50:45 The false refuge of the Central Intelligence Agency
• 56:07 The human experience of safety and control.

Transcript

Joe Van Wie  0:02  
Hello, and thanks again for listening to another episode of all better. I'm your host, Joe van wie Today's guest is Dr. Aileen manway. She is my cousin. Aileen finished her undergrad studies at Temple University with a Bachelors of Arts in Psychology honors research track. He also finished with a dual degree in Spanish. She continued her studies, or she picked up a master's and clinical psychology at Loyola University of Maryland. Continue to finish her sidey in clinical psychology, also, Loyola University of Maryland, in Baltimore. Currently, she is the SAT staff psychologist at South Florida State Hospital, where she serves as the unit psychologist for the challenging behavior Unit. Today we discuss some of the distinctions and uniqueness of the condition she finds at the hospital. That becomes an interesting chat. We also talked about how she started her career in drug and alcohol treatment in Baltimore, Maryland. We've discussed the continuum of care and trend that has changed over the last decade. Specifically, on how you design a partial hospitalization program, over the next 90 days after inpatient treatment, we go into the weeds on that. And we also touch on some of her research experience. Loyola and her dissertation, finalizing quantitative study assessing the efficacy of Mindfulness Based Stress Reduction practices on adults receiving outpatient treatment for one or more conditions, especially substance use disorders. So we get into the idea of mindfulness where it's not spooky, and what practically is happening neurologically and how that affects behavior, and helps you achieve what some people would want to define as recovery. So let's meet Dr. Aileen family. Well, Happy New Year. Anyway.

Aileen Van Wie Psy.D.  2:25  
Happy New Year.

Joe Van Wie  2:26  
Dr. Van we Aileen Are you the first family, that's a doctor.

Aileen Van Wie Psy.D.  2:31  
According to my father, there has not been fact check, though.

Joe Van Wie  2:35  
I don't think it has to be thoroughly. So many families in the first that arrived here in the 1600s were pioneers and they weren't doctoring anything but themselves. Well, that's that's quite an achievement and families. And it's exciting. And I'm I'm really excited that you are in town, and we can have a podcast because we always have meaningful conversations. And I'm always picking your brain clinically. And I had such a career change in the last two, three years, you've been a great support of not only encouragement, but a resource to ask to bounce things off of you. And what is profound is that I've been an addict, or addiction, really, it's been a scenario in my life. And you just took this natural course, after graduate studies and getting your Psy D, you end up in drug and alcohol treatment. Yeah. And you're not in recovery yourself. Right. So before we get there, why don't we tell a slow story? What was the draw to psychology? And when did it start?

Aileen Van Wie Psy.D.  3:55  
Well, you know, that's an interesting question. And I think it's something that psychologists have been asked in countless interviews and, you know, by general people, families, friends, and I haven't met anyone who knows a true answer. We have stories that we've come up with, you know, to explain how we got into it. But I think for me, what feels the most natural as an answer is to say that when I was in high school, I really found myself being drawn to being that person to lean on when you're having a difficult time. And, you know, really take in all of the struggles that people are going through and having my eyes open to that and being a source of support. And also, you know, figuring myself out and not having a good handle on myself and my own emotions. And you know, there's the one route of going to therapy yourself and doing the work or getting a whole doctorate and a degree In helping other people and avoiding that we're both or both Exactly.

Joe Van Wie  5:05  
Do it. So just just to pause there for a second, you find good therapist get therapy? Absolutely. Yeah, yeah, yeah. Okay. So the first year mark, you noticed in yourself, and I think anyone who knows you is an above average sense of empathy and an ability to use that empathy. Prior to training, or the draw to psychology, there was more of a humanistic virtue happening in your life, people can lean on you. And I think when people say that, it sounds general, that means you can listen to someone's pain prior to having training, did you sometimes yourself get affected by the depth of someone else's pain and not know where the boundary or autonomy was for

Aileen Van Wie Psy.D.  5:55  
yourself? Even after training? Absolutely. You know, that's something that's a constant conversation with peers, colleagues. But even more so before training, that hearing the depth of the difficulties that people have endured it it does affect you and you do learn how to deal with it more over time, but it's a constant conversation.

Joe Van Wie  6:20  
was the first way in dealing with it was becoming aware were you ever say in high school, college friends, or crisis arise with friends? They're leaning on you? They know you? Could they could trust you with something serious? This scenario, this can this rises up in you, their pains lingering with you, were you even able to articulate that that was what was affecting you? Or do you think it was your own life? Does it get muddy?

Aileen Van Wie Psy.D.  6:47  
It was definitely money. And I, I had some degree of awareness that it was affecting me. But I just didn't even really have good language for my own internal experience at that time. And grad school really helped me with that. And so being able to put words to what I was thinking about and fixating on and struggling with emotionally because of my own stuff, and other people's Yeah, I just didn't I didn't know what to do with all of that.

Joe Van Wie  7:18  
What was your concentration? Your major in undergraduate school was a psychology,

Aileen Van Wie Psy.D.  7:24  
psychology and Spanish. Yeah.

Joe Van Wie  7:26  
Did you pick it right away?

Aileen Van Wie Psy.D.  7:28  
I went into clear, so

Joe Van Wie  7:29  
you knew after high school? So what, say senior year? I'm just I want to I want to bore down here. What is it about the study of psychology that the science of it to be contained in method? Were you surprised by things that were unintended, unintended truths or consequences, say from an experiment? Or were you immediately drawn to the therapeutic measures of psychoanalytic? Like were you picking aside already right, I think and how would How would you? Yeah, how would you divide them professionally? How do you call like a PhD sidey? Okay. One is a, you know, the study of the mind, the other is this clinical training? How do you explain that to a layperson?

Aileen Van Wie Psy.D.  8:22  
Well, I think the first thing that's important is that even though in the field, we do distinguish them as separate entities, they are inherently intertwined. You can't have effective clinical practice without the research and without that foundational understanding of study that's more geared towards a PhD. And the same with the research giant, you know, you have to pay attention to what kind of research you're doing and who you're doing the research for, that has a clinical lens to it, that they need to coexist.

Joe Van Wie  8:53  
Yeah. So, what you're drawn to first seeing what psychoanalytic talk therapy can produce, and someone whose life has been put on pause or isn't always in a state of crisis from either a mood disorder and addiction, clinical depression, some spectrum, you're seeing, wow, this really works. This changes people's lives.

Aileen Van Wie Psy.D.  9:21  
Absolutely. And so I would enjoy reading about the research and the discoveries that we've made, but really, it was the the clinical therapeutic focus of okay, if somebody can go in and just talk to another human being. We have these specific methods, these strategies of how to have conversations of how to produce effective discussions that can in time affect change that really drew me in.

Joe Van Wie  9:49  
Well, I guess I'm trying to build a story from my own understanding of what you were drawn to personally how this is is going to evolve, and how it evolves because of circumstances you don't decide where your first clinical practice. And so you're on your way to graduate school, you finish undergrad, and you're going all the way. At that point, what would you say you understood about addiction as a condition or disorder? without, without a good answer, what did you personally see? Like, what lens? What was your bias on it?

Aileen Van Wie Psy.D.  10:30  
I think the bias on it was that it was something I knew nothing about. And that, you know, through the things that we talk about in society of you have to be in the program to get it. And if you're not in the program, separate and it's

Joe Van Wie  10:49  
guarded language. Yeah, that's just for program. People just sign them there, though.

Aileen Van Wie Psy.D.  10:53  
And I think that's something that continued throughout grad school as well, where it's like, okay, that's separate, you have to be in the know, to do that kind of work. And if you're not in the know, then no one wants to touch it. And let's,

Joe Van Wie  11:05  
let's pause on that. So that we're agreeing in the know can also would, would this be accurate peer to peer someone that's for people in recovery to help other because we're such a broody bunch, we only you have to be branded with your

Aileen Van Wie Psy.D.  11:21  
own addiction? Absolutely. And I didn't understand that. Going that I thought that going into grad school, I would be in the know, in that peer to peer I thought they would teach us skills to really be a clinical eight, because I thought that was happening more. Yeah. And that there were a lot of mental health providers actively involved in the treatment of addiction. And so my own lens looked a lot different than other individuals in the program and the professors that we had, because I kept asking like, Okay, how is this going to get tied into all the discussions, we're having all the things we're doing? And I kept kind of drawing blanks there. You know, and a lot of people were not really having that discussion and saying, like, well, I don't know much about that. You know, that's more of people who have master's degrees in addiction specific areas.

Joe Van Wie  12:21  
And so this is your experience in graduate school. And I've heard this, you know, famous clinicians, doctors, Gabor Ma Tei. Will, he had an hour of training that was 30 or 40 years ago in medical school, about alcoholism, which was probably just some garbage reach packaged idea that was incomplete. So you're in graduate, do you? This is systematic, though, this isn't just absolutely isolated to your experience?

Aileen Van Wie Psy.D.  12:53  
No. Because, you know, I went on to do a dissertation in addiction, and addiction research, and I couldn't even get good data for my literature. I didn't have a lot there, I couldn't even get a consistent definition of addiction or substance use disorders. And that was very jarring.

Joe Van Wie  13:19  
So two things, you can't get data. It's a hard population. It's so hard to track, especially people in what you would deem a late stage addiction can have no addresses, right, move off and do not want to even admit they have this condition, even in not late stage, very hard to get data. It's not like inpatient treatment centers are offering data outside of marketing purposes. So that's a problem. Second problem you just stated is there isn't a shared definition. I grew up where it was alcoholism or drug addiction, drug dependency, substance abuse. Now it's substance use disorder, opioid use disorder, which I think are better it's better language, substance use disorder. Samso as a different definition, the American Psychological Association American cycle. rehabs have their own independent condition. We think it's this kind of stance, it's a genetic geneticists have an idea that it's a genetic disorder. psychoanalysts say no, that's only activated when an emotional life. So I know you may not answer this, but I want to throw a Hail Mary. Does this get solved in the next 3040 years? Can we get a professional consensus that we're that addiction is a secondary problem.

Aileen Van Wie Psy.D.  14:47  
I would love for that to happen. I think I've seen some small changes moving forward for this to be better integrated, because to go back to what you're asking me earlier about, you know, as my individual experience in grad school consistent? Yes, our I have data that only 30% of American graduate degree programs that are doctoral level even offer a single class in addiction. And most of those are a single elective credit, where you're just getting like a very quick and dirty kind of overview of the different types of substances that are around and how it's related to mental health.

Joe Van Wie  15:33  
Yeah. And I think that that's, that can be a disservice, because it's just the way you described it, it can leave this after glow that, oh, addictions caused by this drug in this way this drug, does it? Yeah. And it's couldn't be more false, right? That addiction doesn't come from drugs. And the disorder isn't just limited to drugs, right? The disorder is this complex neurological response to pain. And it can be a behavior, an agent, an outside agent, that could create euphoria. So I like to bore Mati, as I've seen smarter language, but I guess, just to tie that off that little thing we were talking about one, one thing that would be tremendous would be can we all share a deaf, same definition of addiction? Hopefully, yeah. SAMSA has a good one.

Aileen Van Wie Psy.D.  16:31  
All right. Which one they have gone by,

Joe Van Wie  16:35  
I would have to read it, look it up. But I've read it. I always go to it to draw from it like a group of like, let me make sure I'm saying this, because it's gonna tell a lot of intelligence went into it. Sure.

Aileen Van Wie Psy.D.  16:48  
My favorite that I think is simplistic, but very meaningful, and I forget where it came from, but addiction as a false refuge. Yeah. And I really like the way that boils down because you can see that there are other factors and components like false refuge, what are you seeking that refuge from? And how are you doing? What does that refuge look like for you?

Joe Van Wie  17:13  
It's usually on my desk. It's refuge recovery, which I got active in online. It's a Buddhist approach the full path towards recovery, and that, you know, it's a false refuge. And addiction is also driving this, this this, this virtuous idea in your head. That's false. That the cure for your pain is pleasure. Yeah. Especially with opioids. But I have a book here, I could just cut it in later. But that bore Mateus is this short term behavior ingestion of something irregardless long term consequences for temporary relief? Absolutely. And you can't have rational thought about the consequences, you need the relief immediately from thought to action.

Aileen Van Wie Psy.D.  18:05  
And, to your question of like the common definition, I think that false refuge premise is where we could go with this because that is the root of all psychological distress, right? So that your something is in distress, there's something that you are seeking refuge from in the way that our body, our brain, whatever is going on with us is trying to seek out that refuge is where we ended up having problems.

Joe Van Wie  18:31  
It's a great approach that it really boils down to. If addicts drugs are the problem. Detox is the solution. And why doesn't that work? Exactly? Why exactly. The homeostasis rise up in your frontal lobe, your brains like oh, boy, well, I made a mistake. Don't do that. Again. Magic is because your, your body's telling you you're in pain, emotional, physical, or bondings. Off. Attunement, low dopamine, something's causing this. That's just it. That's where the story could get complex is your anatomy that's different. I'm not producing enough dopamine. So this causes certain cognitions we call negative thoughts, rumination, resentments. We were talking about it yesterday. I don't know what your ideas are. This rumination, a cause of resentment to refeel. We were describing them in a group, put it on the chart as ski slopes. And the slopes are neural net pathways. And you know, I'm sitting bored. Oh, I know what slopes I know how to ski down. This person got me. I'm never going to be good enough. I have to settle up here. I want this. So Fantasy Life rises up and it's a life that causes distress in my head, fantasy or anxiety about the future. But I don't know any other slopes exactly like the easy paths to take If I do that long enough, I'll drink for relief. And then people just see drinking as the problem. Why don't you just stop drinking? Well, because it's a nightmare when I'm not drinking.

Aileen Van Wie Psy.D.  20:10  
And then once you have used drinking as the way out one time, that changes the chemistry in your brain long term. And so the way that your brain is experiencing dopamine and serotonin, these things that we need to feel happy and fulfilled, that's going to be affected. And so using opioids for an example, if you start using heroin for a couple of years, and let's say you've been off it now, a year, two years down the road, clean, your brain is still not accepting dopamine and serotonin levels the way that you were pre addiction. Yeah. And so that threshold that you have to get to to feel joy and contentment even is so much higher.

Joe Van Wie  21:04  
And this goes beyond what someone could call will, or agents are beyond. And the bridge between this, how would you advocate this MA t make this period, say, the first year two years of the recovery from an opioid addiction, I don't want to shoot heroin. I don't want to die, man. It's I can't get three months. I'm in some fundamentalist group that says you can't do MIT. So we're so you know, you see that debates getting more logical. But how substantial is the difference of a really good, thoughtful, monitored MIT program? of someone has a goal of I don't want to be on ma T's in a year. Another one says, Well, no, this is just gonna be good enough for me. How do both of them proceed? And how are they different? Like if someone just wants to meet, do a maintenance, assisted treatment? With a Subutex? What's the other one Suboxone? Yeah. How does that give them quality life back? You have you have direct access to this?

Aileen Van Wie Psy.D.  22:19  
Yeah. So the first place that I worked, that was an addiction treatment center, did a lot of a mentee. And we would have Subutex and Vivitrol. And, you know, a lot of the individuals who were curious about getting on those medications had a lot of the same questions that you were just asking, you know, what does that path look like? How long term is it? Will I be accepted? Going into these recovery groups? And, personally, I've seen people feel a lot more confident in day to day recovery, when they have that as an option, either short term or long term. Okay. And, you know, I think it's the same with everything, we're everyone's got their own path for it. You know, it depends on how much you've been using, how long you've been using, what your brain chemistry is looking like as far as how much assistance, you're going to need to be able to combine with your willpower to keep moving forward and recovery.

Joe Van Wie  23:24  
So one story is measuring the person's withdrawal, short length of use, dosage, and how long this has been going on. Right. And it usually coincides with the deepness of their trauma be Oh, it's emotional neglect, violence. You see a correlation that late stage addiction usually comes from a well have deeper traumas that are

Aileen Van Wie Psy.D.  23:54  
early stage two is Yeah, trauma is a very, very prominent theme across the board. Yeah.

Joe Van Wie  24:03  
And would you describe trauma like? How do you tell like a patient? I don't know what trauma is. I thought trauma is a car accident. I've been violently attacked. Yeah. How would you tell them there's there's a word and a definition in between those two words word?

Aileen Van Wie Psy.D.  24:21  
Well, I don't always tell them because sometimes you know that word has become so popular. Now. Everything is trauma informed, or that's trauma, this episode of exactly. And some people really connect with that and are looking for a word to describe their experience that has a community built into it. Yeah, trauma is something that I've heard about, and if that's what I'm experiencing, other people have gone through that too. I've got books, resources, podcasts, whatever it is, that can help with that. But other people just really struggle hearing that word and labeling The experiences they've had as trauma.

Joe Van Wie  25:02  
Would you put? Can you describe people? I'm not saying it's research, but like, is there a grouping you can make? Is it an age up that trauma like say, 40 up traumas? They don't have this new pop culture definition that's traumas. Broader? Right? Like, are we seeing people? Like it's same word? It's like you see God used? What will we all have? There's 40 people in the room, they have 40 different definitions.

Aileen Van Wie Psy.D.  25:30  
Yeah, I would say that age is a factor, it is more common for younger generations to kind of use that label of trauma. Culture is also a huge factor, you know, depending on your lived experiences, your cultural background, the kind of conversations that were had in your family, in your community about what trauma is, and who has it. Yeah, that can really affect how you see that word as well, because it's, it started as a very white middle class kind of term being used. And so groups that do not fit into that category often describe their pain and experiences in another way.

Joe Van Wie  26:12  
Yeah. Yeah, that's interesting. I mean, as you're talking, I'm thinking I'm just taking a stroll through my memories. The first time I think of would relate the word was probably to mash. Like, er, yeah, man has trauma has this blood squirting out of his shoulder. Like that's, that was the limit of it until the last five or six years, I reentered recovery in a new way. And, you know, I needed to hear new language, on top of some old ideas, and I've used a lot of different resources in different recovery communities. But that word, it resounded with me. And I was like, what does that mean? And I just thought, Okay, here's some forms of trauma I never considered I didn't know, it was a broad idea, PTSD, prolonged abnormal grief, then I was starting to relate it, I'm not a clinician, but it cannot be the cause of ADHD, in some sense, some sense of detachment bonding. And I saw a whole new story being told of why a person like me could be anxious or fight or flight price prediction, in a day addiction, Sue that. And they seem to just have a rubber stamp, and they're saying that this is a realm of trauma, this aroma, trauma, and then resound it with a but I could see that it doesn't want other people. And that's where you are professionalism could come in that sometimes is lacking in peer to peer communities, that you would take the time to understand someone's culture, social background, that you can't just say, No, this is how you're doing it. This is how you join this group. Do you do you see? How does someone get that training? How long did it take for you to see that? That's where you would be distinctly different than a paraprofessional or a peer to peer when someone has real trauma or a different culture.

Aileen Van Wie Psy.D.  28:17  
You know, I think, obviously, throughout grad school, my program was five years that I learned a lot about how to expand my own thought to not just what my own lived experiences were, but to think about how someone else's might have been different. And with that in mind, how do I approach another human being. But those conversations don't stop with grad school, you know, programs are getting better, just like trauma is being discussed more in the general community. We're still just kind of doing it in grad school, too. It's not like we're lightyears ahead of the general population. And so continuing to interact with other people and read books and attend lectures throughout time is important to develop that.

Joe Van Wie  29:10  
Well. That was what I always said, the first symptom that you're having a spiritual awakening is that you have unbridled pure curiosity. Yeah, yeah. And this is a spiritual quest, as any seen is in that sense, but the curiosity, I think real good, graduate, specialized education is produced people who will profoundly be curious in their life,

Aileen Van Wie Psy.D.  29:34  
right? Because it's like, I went into grad school hoping that by the end of grad school, I will have achieved this arbitrary level of confidence and knowledge. It's like, okay, I will have checked the box, I will know the things and I will be ready for life. And then you get to the other end of that line, and it's like, Oh, I've learned enough to know that I know nothing, and that there's so much more out in the world to continue learning and to continue being cured. guess about that I can only hope to be more knowledgeable about in the future.

Joe Van Wie  30:06  
So your first, what was the position? And where were you working with addicts distinctly.

Aileen Van Wie Psy.D.  30:14  
So this was in Baltimore, if you've ever seen the show the wire, like right around that neighborhood, I memorized it. So it was in that general area, and it was an inpatient recovery treatment center that had also some IOP, intensive outpatient. And they had just established two recovery houses in the community, one for men under 27, one for women under 27. So I came in at a really unique time. And I was there part time as a student clinician with a friend of mine. And we were able to design this treatment program for the individuals in the recovery houses. So I did inpatient groups, and then really developed my own structure for how we can continue helping people once they moved on to the houses.

Joe Van Wie  31:07  
And so would this be 28 days or not three months? In Baltimore? out of the house, it

Aileen Van Wie Psy.D.  31:15  
was mostly 28 days, depending on the insurance, you know, depending Sure,

Joe Van Wie  31:20  
and yeah, I've kind of found that strange. Oh, 20 sevens is arbitrary. But is that the number in Maryland that you'd find on someone else's? Because it's

Aileen Van Wie Psy.D.  31:29  
the number that insurance has decided, good enough for you to be walking out the door?

Joe Van Wie  31:35  
So in that 20 days, this is your first and you're designing this clinical program? How did this responsibility fall on your your lap?

Aileen Van Wie Psy.D.  31:45  
Well, it kind of came down to I was limited in some senses, because I was not a licensed drug and alcohol counselor. So even though I was a third year doctoral student, I did not have the necessary classes, LPN or some some sort of you have to in I looked into it to try to get the certification, and I needed several more addiction classes, which makes sense, I had only gotten one, you know, so that's logical. Not true.

Joe Van Wie  32:16  
You lived in Scranton, I'm your cousin. I'm the weirdest fucking guy in this neighborhood and town use, you had experience what weird, weird addictions.

Aileen Van Wie Psy.D.  32:26  
You know, I submitted an essay on that. And shockingly, they didn't accept it as life experience to be able to get certified. But effort was there. So that because again, you know, everything comes back to insurance and the systems that we have to work within, I wasn't allowed to do any individual therapy with any of the inpatient individuals. And so I could run groups. And so I did that. And I found myself with way too much free time. And I don't like sitting by idly neither did my friend. And so we said, hey, like, we're, we're working with all these people, when they're inpatient, we're seeing them go to the recovery houses, let us do something with them. Like, we're just kind of sending them out into the world after one month, and they're still struggling, and there's

Joe Van Wie  33:12  
no continuum of care. That is a system, right? You get to decide. That's, I'm so excited, because that's why your family I sit around go design and make something happen. Yeah. Yeah. Man. So you design a continuum of care that will now be there as a structure and a support past 28 days that will bring them into a recovery house. And, I mean, this is this isn't emergence. It's only been happening last, you know, seven, eight years, where people are saying no, recovery needs a year, it different levels of care. And you got to design that program. I was so excited when I remember when you were doing that, yeah, talking about it. I might have been drinking them. But I was still cheerleading.

Aileen Van Wie Psy.D.  33:59  
You can be both. It's not mutually exclusive.

Joe Van Wie  34:03  
I always need drunks in my life, I'm sober or drunk, I need my peers. We stick together on a sinking ship. Always. So from there, what what was so what would you say was the most transformative thing if it was an idea or something you learn from an addict, and a person themselves that was profound to you that like, holy shit, it gives me a new insight of what addiction is and what its recovery could mean, in that window of design in that.

Aileen Van Wie Psy.D.  34:40  
Yeah, I think what's coming to mind and what I didn't feel prepared for that first day walking in was truly what the impact of the trauma is because like we were saying before, you know, we use that word so commonly now, but actually sitting there and I was He assigned to do this pretty structured group. So we've got the worksheets, we've got everything handed out, it's like, okay, here are the skills I'm here to teach you skills for this hour. And I would just have these side comments come up from participants and examples like, okay, name a time that you were angry, and what's something we can do to cope? That's supposed to be very flowery, and you know, very general. And I would hear these deeply raw experiences of immense trauma, just casually thrown out there. But you see that look in there? I have, I don't know how to actually express this, like I have all of this built up inside me. And where's my space? To let it out? Yeah. Because here's a roomful of people who are nodding alone, when I say something horrific and graphic that I have endured. And then I have to just move on to the next item on the list, man. And that's just so hard. And it's not, you know, there is a give and take there, where there's space where you have to teach skills, but

Joe Van Wie  36:11  
to interrupt is this, some of these things that make you move on are some of them coupled with mandates that have to be brought through through these groups and say, Maryland or

Aileen Van Wie Psy.D.  36:21  
sometimes, but other times, it is also down to the clinical judgment in the room, like, if I have a group of 20 people, and someone has said something like that, I can't turn the entire session around to focus on them, because that's not appropriate for the whole group. Because that can be very traumatizing to other people. And it's also a lot for that one person,

Joe Van Wie  36:42  
there may not be enough staff, right to to say, hey, let's, you know, have a processing group for this guy, let's get them right into an individual. Not every place has the resources to do this. And was this a Medicaid population, the census, and that rips my guts out, because this is where the needs, you know, if two or three clinicians, you're running the group, I mean, that would have been great. All right, bird dog that won't go in this room, they're there, they're ready to talk, right? See what we can get on in 20. Holy shit. And that's where, you know, like,

Aileen Van Wie Psy.D.  37:17  
we do have things in place, you know, no, psychologist is gonna just sit on that

Joe Van Wie  37:24  
was gonna get some sandwiches.

Aileen Van Wie Psy.D.  37:25  
Thank you, that was a great example to share. So we're gonna move on anyone less traumatizing thing to say. So you do follow up at the end, like, hey, I really appreciate you sharing, like, if there's something you need to check in with. But I wanted people to have a better space where they can just process what's going on. And I'm known for always going back to let's just get a group of people together and learn from each other about what we've dealt with, and kind of get it all out on the table now.

Joe Van Wie  37:59  
As a psychologist, and not being in recovery, did it take a little effort to watch peers help each other in your presence? When you're facilitating a group? How do you use your judgment? Now, you you have training, you went to school, but you see, you see someone with 28 days about to leave the program who was really helpful to someone in their second week. And you do let that happen? For sure. And when did that judgment arise, and you just six was a true rock experience of working in this treatment center that you're like, I'm not going to interrupt it.

Aileen Van Wie Psy.D.  38:35  
Yeah. And I think that's something that I had to figure out on my own, because there's no class that you can take to prepare you for that. But I think it comes down to the recognition that we serve different roles, like there are things that I'm going to be able to help you with that I can provide explanations for, that you haven't had the opportunity to learn on your own. Yeah. But if you also have an opportunity to sit next to someone who has lived an experience similar to your own, who you're able to take advice from, by all means, why not add to the support?

Joe Van Wie  39:07  
How much have you learned from your patients their

Aileen Van Wie Psy.D.  39:09  
tremendous amounts?

Joe Van Wie  39:12  
And would you say you learn more about recovery from them

Aileen Van Wie Psy.D.  39:16  
than anything? Absolutely. Hands down.

Joe Van Wie  39:19  
It's a human story. It really is. And it's experiential. And so sometimes, like, you can see why it's hard to have research and data of just your experiences of making. But man, we need it. There's got to be a good way to do this. You ever get interested, maybe being a part of collecting that data or finding a way that's not intrusive, not exploitative, but can produce better systems and modalities

Aileen Van Wie Psy.D.  39:47  
ever get drawn to that? Sometimes,

Joe Van Wie  39:50  
I always ask every clinician, are they ever gonna get a research bug and disappeared?

Aileen Van Wie Psy.D.  39:56  
You know, I think I was really discouraged. Just by my own research in grad school, and just how hard it was with all of the drop out that you see. And, you know, really the research that you see out there in psychology is what we call evidence based practices, right? And that's all of the manualized stuff. It's the stuff that has the worksheets and the homework. And there's a specific thing to say in a specific schedule to adhere to, because that's what is easy to research, right? You know, it's a lot harder to get data on something and generalize it when the individual sessions are going to be so different. So when you have modalities like motivational interviewing, which is where you have the states of change for addiction, right, like the pre contemplation, contemplation, that stuff, that gives the therapist a lot more leeway, and gives the client a lot more leeway to in terms of what your day to day sessions are going to look like. Which is great. That's the kind of stuff that really gets me going. But how do you quantify that? How do you research that on a larger scale?

Joe Van Wie  41:02  
Yeah, and I think there's a huge temptation to have research, just focus on chemical biology, anatomy, trauma, head trauma, physical trauma, nutrition, is leaves, it leaves away the agency, the idea of consciousness, sure, at least, I don't want to get spooky, but I'm getting settled with my consciousness has been buried by the reality of this world. That's kind of the shortcut I found for my addiction, and made my therapy far more meaningful. How does this end? Where did you did you proceed anywhere else and another level of care after Baltimore, that was focusing on addiction and drug and alcohol treatment?

Aileen Van Wie Psy.D.  41:52  
So it hasn't been like, if you looked up the definition of the sites that I've been at, would you see addiction there? No. But any site, you're going to, you're gonna see addiction come up, right.

Joe Van Wie  42:04  
And you get an hour of training, you get one class to prepare yourself, that's something that's hemorrhaging in every mental health, er, medical, dental, people are going to dentists to fulfill their addiction, absolutely. ers, police stations, magistrates, home to universities, and, and this has been taught that it's a neurological problem, or genetic problem, or it's from the drugs, how potent the drugs will cause. Do you see this changing soon?

Aileen Van Wie Psy.D.  42:37  
A little bit. And so the American Psychological Association, recently, and recently, I mean, last year, started coming out with this curriculum for graduate students have six modules, that should be taught like six hour long kind of PowerPoints, that should be taught too, that people are better prepared to understand addiction and to treat it. And there is good information, I gave one of those presentations to my school that I had gotten to after I graduated last year, and there's a lot of valuable information in it, but six hours isn't going to

Joe Van Wie  43:19  
in six hours change the game here, this is more of a presentation to identify that the person before you may have an addiction. It's it's not in depth training of what addiction is it get into what it does it have a shared definition of how addiction rises in the means of Rick pathways to recovery, or is it just identifying addiction?

Aileen Van Wie Psy.D.  43:43  
It was a mix of all of that. So it's like Module One is what is addiction? And then Module two is how does mental health and addiction go together? How might those two be related? We've never discussed this before. I wonder if possibly there's a link here. Yeah. And then the third is if you think maybe that link is there. What about this idea of trauma. So let's talk about how trauma is involved in this. And then kind of general overview of modalities that are commonly used in therapy to address addiction. And then, like a nice takeaway message. So now you're you're effectively trained right

Joe Van Wie  44:25  
now. We're What are you doing now, where you're seeing addiction, you know, bump into this level of care.

Aileen Van Wie Psy.D.  44:36  
So I work at an inpatient psychiatric hospital. So I mostly see individuals with primary diagnosis of schizophrenia or other psychotic disorders, ality disorders, mood disorders, yeah, all of that. And that's very commonly comorbid with addiction.

Joe Van Wie  44:54  
So wow, this is I want to talk about this because anyone who's dabbled in Psych 1101, abnormal psych, you know, it's just these are weird, weird concepts and problems, psychiatric problems from schizophrenia. Now that the DSM five, has changed a lot of these mood and personality disorders has put most of them on a spectrum. Right? So even schizophrenia

Aileen Van Wie Psy.D.  45:24  
Yeah, so it's, I wouldn't use the term spectrum loosely. What what?

Joe Van Wie  45:35  
How would you describe like, can someone have different severity of how schizophrenia is interrupting their lives from like, can you have schizophrenia without auditory hallucinations? Yes. So, how do you describe, like when you would make a diagnosis of someone 18 year old male, paranoid idea. Say he's meeting all the markers in your DSM five, but he's not having auditory or visual hallucinations. How was that annotated that had schizophrenia and versus schizophrenia with now I'm seeing shed and hearing shit,

Aileen Van Wie Psy.D.  46:14  
right? That's substantially different than mine. It is substantially different. And there there isn't. It is not annotated anywhere. Yeah. And especially when you're in a hospital system, a lot of times people just get this blanket, schizophrenia diagnosis, every hospital I've been at has a different blanket diagnosis was, everyone's diagnosed with schizophrenia until proven otherwise, basically, or Schizoaffective Disorder until proven, effective. schizoaffective means schizophrenia plus some kind of mood component. Okay. And so that because that's, that's a catch all, you know. So,

Joe Van Wie  46:49  
schizophrenia, borderline personality disorder, any antisocial disassociation kind of disorders, really, where you're kind of all of them have this earmark, you are removed from a shared reality, that's and can make it dangerous. You can make your life really horrifying. And is there moments where a person has agency knows they're suffering something substantially different than the pale or they have a memory that maybe there was a life prior to this that say they're suffering this from yours is how do you fuck it? Watch that, like someone? Yeah. Wake up and look how palpable and then they're gone. Like you

Aileen Van Wie Psy.D.  47:33  
said, like psychosis really can look very different. Like there are people who are, for most intents and purposes, well functioning in general society, but they have one delusion, one non reality based belief that they are latched onto. And delusions are the one thing that we at this time do not know how to treat well with medication is the most treatment resistant symptom of psychosis. That there is give you an example

Joe Van Wie  48:00  
of a delusion versus maybe something that's like, I don't know a pet affection that I have, but it's not a delusion, what makes something a delusion.

Aileen Van Wie Psy.D.  48:12  
So a delusion in its most base. Explanation isn't any non reality, any persistent, non reality based belief. So if I persistently believe that I was in the CIA, that's a common one. Okay. Yeah. That yeah, they're always in the CIA. And especially when I was working close to DC that was for people who

Unknown Speaker  48:33  
were tortured by the CIA to

Aileen Van Wie Psy.D.  48:37  
do all you wonder they're sometimes it's, it's true that they were formally in the government, you never know. Yeah. And so you know, if I have this belief that I was in the CIA, everything else that I'm believing that I'm experiencing in my day to day is consistent with everything everyone else around me. But I, to my core believe that I was in the CIA. I don't want to listen to any evidence that is contradicting that, any Yeah, anyone that's challenging me, I have explanations that tend to make less and less sense as you go on. But I'm locked into that belief.

Joe Van Wie  49:14  
And that's a such a, like, Herculean belief that your entire identity is going through the lens that okay, I am a product of being in the CIA. Everything up to this point, my relationship view is through a lens that I was a Yeah, age, holy

Aileen Van Wie Psy.D.  49:33  
shit. And that's, that goes back to the idea of the false refuge like why the hell would I want to change that belief? Because disconfirming that belief means acknowledging that I am, however, your old adult that has been locked in this mental health system for a substantial portion of my adulthood, that I did not have this thriving career in a government agency that is well known I've been here and if that's not true, why would I want to have some believe that have you

Joe Van Wie  50:06  
seen breakthroughs from things you learned in school and I've learned are pathologies that are seemed terminal? And I don't want to say that you're the clinician if you correct me. So terminal by meaning a psychopathy. sociopathic narcissism like really high stakes with schizophrenia. A paranoid schizo. So disorders applied to someone. Are you seeing better stories or breakthroughs not only pharmaceutically. But with talk therapies that you can now this person could leave the CIA in this fantasy. Because that's got to be devastating their entire power structure, meaning fundamental meaning of their life is tied in this narrative. So they don't have to. Because it sounds like reality is horrifying. And significant. It's, it's, it's a group at power.

Aileen Van Wie Psy.D.  51:05  
And people that have no family involvement will have this belief that their families, they're there waiting for them. And that is soul crushing to hear you don't want to go up to someone and say, No, you you, you were never married. We don't have children. That's not true. Or even if you do that, they're they're not involved in your life anymore. But But to your question of, you know, how common is that that kind of idea of this is this? Is it long term? That's not so common anymore? Oh,

Joe Van Wie  51:35  
wow. Yeah. I've read a book recently a psych book. I don't know It's over here. But I couldn't believe what I've read it because I picked up one in a while. And it was saying, there's borderline personality disorder schizoaffective, paranoid, delusional. They're seeing long term effects people reintroduced into work and stuff. I was like, when I was a kid, if you were that man, you're fucked. Yeah, you let go too much

Aileen Van Wie Psy.D.  52:03  
that that was the mentality. And then they came up with a little bit after that this rule of thirds. Like if you're diagnosed with psychosis, something related to schizophrenia, a third, we'll have one break, then, you know, go back into their everyday life, no problem at all. A third, we'll have a couple hospitalizations here and there, but overall be able to maintain no third. That's it. And so we don't have that anymore. It's so much better than that. And I think that older mentality of what schizophrenia looks like long term, is the biggest barrier to people accepting their diagnosis, because they're scared of what that means for their life.

Joe Van Wie  52:45  
And how did you diagnose me? Let's, let's throw some darts on a wall. I'm not going to do anything. amuse me, entertain me in the sense if you had to pick a reoccurring theme if say, we could just talk in the caveat of emotional life bonding in the environment, what's your race? Genetics, let's mute it for a second turn the sound down on schizophrenia, severe reality distortion kind of disorders, diseases concept. Take away genetics and the anatomy structure if they didn't have a head concussion or do you see a common narrative of extreme neglect, abuse? And in any form in any of these stories of people getting better? Is the Genesis or is it coupled with other for muting that Is it severe abuse?

Aileen Van Wie Psy.D.  53:56  
What could I've seen no what what

Joe Van Wie  53:59  
what makes sense of it? What can maybe it's my bias of needing a universal story to all of this maybe it's but the symptoms are so distinct and plot it CIA but you you start reading case studies of schizophrenics all these paranoid there's there's common right simple, simple analogy like right and like what is that called? Thought broadcast? I hear your thoughts your broadcasts and to me right. What the fuck man? Why are the producing the same symptoms? Why are they coming from the same thing? What would cause that?

Aileen Van Wie Psy.D.  54:36  
Well, I think it boils down to the human experience of safety and control. Right? Yeah. of you know the paranoia of our people out to get me Are they trying to hurt me? Someone's after me. We all just want to feel safe and secure. And then are my thoughts secure within my head is Do I have control over my thoughts, my actions my itself,

Joe Van Wie  55:00  
I've tripped my face. And I've lost my grip for a couple hours. It's terrifying.

Aileen Van Wie Psy.D.  55:05  
And so I think that's where I see the themes boiling down to but the way people get there looks very different across the board. It could be anyone.

Joe Van Wie  55:15  
So if it was a mechanism, if it was fight or flight kind of just gone, fucking haywire, we're living in a world that it's just not needed for daily an average life of 30 running around killing other mammals to eat, right? Like I don't have to assess all these complex threats forest or more raw nature. I'm doing this through a meritocracy, social structure, competition, gossip, rumor stature. I'm now applying fight or flight this this, you know, Bronze Age leftover even or earlier, to social things. Education, competition, socio economics. Do you see some people that this anxiety of social achievement or fitting into our culture could cause mental illness? Do you think our culture is causing mental illness?

Aileen Van Wie Psy.D.  56:12  
I think our culture is creating mental illness great,

Joe Van Wie  56:16  
what what it's defining the defining because

Aileen Van Wie Psy.D.  56:18  
we're we, as a society are the ones that sit down and decide what is normal and what is not. Yeah, the sky is blue, because we have all gotten together and said it's blue. So when someone says it's not, that is mental illness. And that's why the cultural loading is so important to consider for what we're pathologizing and what we're not because not every culture is following the same script. And so, you know, some religious beliefs, talk about hearing the voices of your ancestors, you tell someone in this country, you're hearing the voices of your ancestors, and you're probably going to end up talking to a psychiatrist.

Joe Van Wie  56:59  
I think it's, I grew up with friends that have had serious conditions. And but they also talk poetically. Oh, absolutely. See if people almost exists, aggravate the diagnosis or, or the, the labeling of what was wrong with them. And they were just talking like a poet. Yeah. And that's how they interpreted things. And so talking to my ancestors means intuitions motivating me, let's say if you were Latino, or specifically from Mexico City would talk to this idea of you're more, or Shaman. Yeah, language, it's it's a conundrum. It's good that diversity and understanding of that being trained more, I don't think it was in the 50s 60s in any universal way, right?

Aileen Van Wie Psy.D.  57:53  
No, and we can still do a much better job. There's more regulation over ensuring that it's included in programs. But you know, it comes down to each individual to take it from this kind of face value or factual level, to really understanding and implementing it in your work.

Joe Van Wie  58:17  
Well, will you be available to be an advisor? At my PHP, we're going to need your help. Aileen, some guidance and consulting?

Aileen Van Wie Psy.D.  58:28  
Absolutely.

Joe Van Wie  58:31  
It's coming up to the hour. And do you have any final thoughts or ideas? If you could just shoot your well wishes out to training and seeing a curve? Where would you like to see a first and schools for training clinicians? When it comes to addiction and sharing the definition of it?

Aileen Van Wie Psy.D.  58:54  
Yes, I would say just being more involved. And taking that leap and jumping into the pool and actually being open to doing work to address addiction, and how it's impacting mental health and trauma and how all of that goes together economy. And so I think just yeah, just just diving into that conversation, and being willing to be a part of the treatment process and the treatment team that's helping someone through recovery.

Joe Van Wie  59:31  
And for the final 40 minutes of the show, I want to let's address your dad.

Aileen Van Wie Psy.D.  59:38  
Absolutely.

Joe Van Wie  59:39  
What is his problem?

Aileen Van Wie Psy.D.  59:40  
I mean, would you like that list alphabetically. I don't know what order you'd like us to go in. We

Joe Van Wie  59:45  
have to give him praise before he Jimmy, you're you're my favorite uncle that listens to my podcast.

Aileen Van Wie Psy.D.  59:53  
Yeah, he certainly wouldn't drive me home if I didn't say something nice about him. So

Joe Van Wie  59:58  
all right, a family man. We To be validated hourly, hourly.

Aileen Van Wie Psy.D.  1:00:02  
That's its own diagnosis. See it in the DSM six. Yeah.

Joe Van Wie  1:00:09  
I hope these concepts get better and broader. We need more language. Yes, we do. Aileen. Thanks for coming on, and all the help. I'd like to thank you for listening to another episode of all better. Find us on all better.fm or listen to us on Apple podcasts, Spotify, Google podcasts, Stitcher, I Heart Radio, and Alexa. Special thanks to our producer John Edwards, and engineering company 570. Drone. Please like or subscribe to us on YouTube, Facebook, Instagram or Twitter. And if you're not on social media, you're awesome. Looking forward to seeing you again. And remember, just because you're sober doesn't mean you're right.

Transcribed by https://otter.ai