Cartoons, EMDR Therapy, and Virtual Reality | Sandra Paulsen of Paulsen Integrative Psychology

You know, when you want to plant something in a garden, you have to turn the soil. You can't plant a seed in hard soil. And that's why you have to process the trauma at least part way. First having turned the soil, then when you plant the repair image. And I'm talking about, wouldn't it be great if you could do this through virtual reality? Then it can grow if it's vivid enough. That new experience. Now that brain has had the experience of getting what it needed on their terms. The loving parents, feeling welcomed, feeling wanted, feeling like they belong, I think that could be made vivid. Now if you just do it without doing the trauma work, I don't think it's necessarily going to stick.

Welcome to the Mental Health Entrepreneur Podcast. We are here to inspire creative ideas and connections for entrepreneurs and advocates working to address our mental health crisis. As you listen, I hope you will experience new ideas and motivation to innovate in your business, your community, and in your life. Welcome back, everyone, to the Mental Health Entrepreneur Podcast. I am your host, Rachel Harrison, and with me today is someone near and dear to me and my learning journey, Dr. Sandra Paulson. She has been an innovator in mental health throughout her career as an author, trainer, artist, and therapist. And I am just so excited to introduce you to Sandra. Welcome.

Thank you so much. I'm delighted to be here. Thanks for inviting me.

Of course. So let's dig into how this all started for you. How did you get involved with mental health? Originally?

I had been working as a technical writer in my early 20s at a large bank in San Francisco, and they had a social service leave program. And I got accepted. I went off for six months and worked at suicide prevention, helped them write a training manual. And when I came back to the bank at the end of six months, I said, I think I want to do this thing. I think it's called psychology. Which required me to go back to college because I had dropped out, finish up my bachelor's in psychology, which I did at Berkeley, and then on to the University of Hawaii Manoa, which had a cross cultural program. And I adore understanding cultures. Cross cultural psychology. And the way I put myself through graduate school was by consulting with the same organization that I'd been employed by over, I mean, it was many years. So I was doing writing and cartooning for executives, which was its own innovation, for sure. I mean, nobody was doing that.

Yeah, yeah. And I mean, I think that's a gift you've given to the mental health community too, is writing as well as doing Cartoons to help explain pretty complex concepts. So how did that start for you, adding the cartoons into your writing?

Well, it started when I was working in the corporate world and when I set the goal for myself to become a psychologist. My reason was I wanted to integrate my various gifts. So that meant writing, cartooning, speaking. So what I do is I just let pictures come to my mind. I have a new book that's going to be out in a couple weeks, the Beauty and Burden of Autism, about mild autism or what's called high functioning autism. And so you can see the pictures telegraph. The idea is this is an example of mind blindness, that the autistic person doesn't understand what's going on in the mind of their listener. Exactly. Supposedly that's what the word means. And they may not fill the listener in on all the things that are going on in their mind. That was just one example. But I've done it with dissociation, with the early trauma approach. When we're repairing attachment injuries, because attachment injuries aren't in explicit memory, like a fiery car crash, there's a picture and a narrative about what happened. But attachment injury, nobody remembers. So here's an example of a cartoon on the COVID of the book. A child that knows no one's coming. They just feel alone in the world, and they develop generalized anxiety as a result. So what's fun for me is the pictures just come to me. I just work here. I draw them.

So it's a very spontaneous process.

It sounds like it feels guided, but I don't know if it's guided or not. But I write out of the left hemisphere of my brain. I assume most of us do, but the pictures come out of the blue. And I think that's how the right hemisphere works. It just pops in. And I've learned to really trust those. And that's where all the cartoons come from. And I use them in my work with clients. The first time I did a cartoon in a corporation, there was a very senior executive who was trying to pitch to the board of directors of a very large bank that they needed to put all this money out for a backup data center in the event of an earthquake. And I drew the building, their head office, with flames coming out of the windows. And they funded it like that. And I was told it was because the. There was no denying the reality of what the risk was.

Ooh. Yeah. So by giving them a picture instead of just a bunch of words, it spoke to them differently.

Yeah. Yeah. It goes more than 50% of the way the reader Only has to do like 20% of the work.

I mean, I'm all about that, the

writing and the cartooning. I've done almost all the work.

Do you get that same feedback in your books that are geared toward therapists and mental health treatment?

Yes. The best compliment I ever got. I had just taught a workshop, probably on the dissociation topic. Yeah, my first book, it was about dissociation, and I.

That's one of my favorites. That's like regular use for me.

Thank you. And I was teaching the workshop for a weekend, and a fellow approached me in the cafeteria in the hotel and said, Dr. Post and I attended your workshop and I want you to know I didn't learn a thing. And I was horrified. And I apologized and said, oh, no. And he said, no, let me explain. I attended the same workshop five years ago. It changed my practice, many patients lives, and I thought I must have missed some of it. And I take it again to see what I missed. He says, I didn't miss a thing. I got it all the first time. Because of the cartoons.

Yeah. A compliment that didn't look that way at the beginning. I like that. So cartooning for you, that started a younger age?

Yes. Actually, I used to grow pumpkins when I was like 9 or 8 or 10. And every year I'd harvest them and carve faces in them, expressing different emotions. And then in high school, I took a drawing class. I wanted to figure out how to convey each and every emotion, what each emotion looked like. So it was right along Pink sepien kinds of thinking, you know, it's really wanting to understand the emotions on their own terms. Pinks up. Being the father of affective or emotional neuroscience, who I knew. He's gone now, but we briefly collaborated a bit. In fact, I still have one of the art products. I created this when I was 13. Most of the ones, the emotions I did were in chalk or acrylic or oil. But this was a piece of sculpture of shame. Oh, yeah.

If you're listening and can't see the visual, it's a person kind of crouched down, sort of covering their face. It's a sculpture. Yeah. Okay. So art has been part of you since the beginning.

Yes, except that I'm not formally trained, but I don't let that stop me. I'm not trying to be fine art. I'm trying to just capture the spirit of psychological concepts quickly.

Quickly and easily for people to understand, which I think is amazing. So on that topic, I'm really curious. You've been working in this field in so many different ways for a long time now. What do you think is most important for just the everyday person to know about mental health or our brains or how we're wired?

Oh my goodness. Sorry. Question. Well, I guess Jaak Pangse. I think of him every day. He's the one that proved experimentally, scientifically, not just a hunch, that we mammals are born with hardwired emotional circuits that are present from birth and require no learning. And on top of that we learn what to expect from others. And so what psychoanalysts called object relations learning, but more modern terms might be relationship templates or expectancies. What we expect from other people is established on top of those circuits. So the circuits go 120 miles an hour. And then in mom's loving arms we learn down regulation of emotions and that others will be there to help. And then everything else that we learn about emotions and relationships is neocortical on top of that. So those three pank sepian levels of emotional processing are there for all of us. A lot of clients think well there's negative emotions, they shouldn't feel angry and so forth. Well, it's there, it's hardwired for a reason. It's there to prepare us for injustice or prepare us to fight and so forth. Each of the emotions, I think of them as dashboard gauges. We need them to drive down the road of life. And so people who learned that their needs or feelings were shameful are going to be symptomatic because they had to jettison their true self.

Right. It's all of the things we do to complicate or hide that that tend to create issues and problems for us internally at least, maybe externally too.

A lot of the powerful therapies and EMDR is the most powerful therapy I know, but it's used adjunctively with other things too. But they're involved with integrating parts of self that had to be jettisoned. And then people reclaim their life, their body, their identity when they're no longer having to jettison that which they were taught was unacceptable or that which was overwhelming at the time.

Yeah. And so if we take that on the individual level and sort of zoom out to what is happening maybe more globally or culturally. And now I think, especially since COVID what is your perspective of how people have been impacted? I mean, we're seeing higher rates of people that need mental health care therapy. We're seeing therapists struggling to stay in the field, we're seeing doctors and nurses struggling to stay in the field. We're seeing people struggle with their executive function focus. I'm just really curious how your brain kind of conceptualizes where we are as a whole with our state of mental health.

I'm not sure I have a great. I don't know that I have my finger on that pulse. I am out here in the forest, on an island, surrounded by trees and animals. So I'm the last one to ask. However, I do see some things coming in the future that I'm pretty excited about. I'm collaborating with a retired lieutenant. Kenneth Gardner, was head of the Detroit Homicide Task Force for many years. He's now retired and he's an EMDR clinician. And we're excited about a vision of the future in which EMDR is provided to incarcerated people either directly. Which is a thorny path because prison administrators probably don't trust clinicians unless they're well known to them. But now we have telehealth. And so prison administrators don't have to worry so much about what fool thing is this naive therapist gonna do if we let them into the unit? And also, it solves the problem that some clinicians have had in prison settings of having to do their clinical work, sitting on a vacuum in a broom closet. Cause they don't have facilities and so forth. So with telehealth, think how we could intervene in the intergenerational transmission of trauma by providing EMDR to the incarcerated, those who are going to get out. I mean, serial killers are never going to get out. But a lot of people, 80% or more of prisoners, are going to get out eventually. And then are they going to reoffend or not? Well, they're less likely to reoffend if they've had their trauma tidied up.

Absolutely.

And so that's one thing I see for the future. Another thing I wish could happen is that there's a variation of EMDR that was developed initially by Katie o'. Shea. And then she and I collaborated on it and I wrote this book about it. When you're working in implicit memory and there's no picture, no narrative of what happened in the first three years of life, I find that some of that practice, the early trauma modifications of emdr, seems like it could be done in part by virtual reality to make like when we repair using imagination, we first process the negative experience as it appears by what's present in the body for a particular time period, a particular developmental milestone, and we go through them all. Then once we've processed the negative, we go install what the person would have needed back then. And it's always the same thing. Loving parents who are caring and nurturing and guiding guide the child and all that well motivated. A lot of those lines of what good parents would say could be not only systematized, but I think if delivered through virtual reality, the vividness of it would really, really enhance the repair. So in the picture I'm seeing now is when you want to plant something in a garden, you have to turn the soil. You can't plant a seed in hard. So and that's why you have to process the trauma at least part way. First having turned the soil, then when you plant the repair image. And I'm talking about, wouldn't it be great if you could do this through virtual reality? Then it can grow if it's vivid enough. That new experience now that brain has had the experience of getting what it needed on their terms. The loving parents feeling welcomed, feeling wanted, feeling like they belong. I think that could be made vivid. Now if you just do it without doing the trauma work, I don't think it's necessarily going to stick. It'll be a pleasant experience, but it won't stick. You have to turn the soil first.

Now, do you think the VR versus imagination would maybe resonate less, though, potentially? I don't know if I'm thinking about the person that I picture giving me that loving acceptance might be very different than the person that you. Well, that's true in our minds.

I don't know how that would work. I mean, maybe you would just see the back of the ideal mom's head in a natural environment. I don't know how it would work. I don't know very much about virtual reality, but it just seems to me that somewhere in there is a way to deliver some of these repairs to the masses.

Right, right. I'm thinking, like, if we could make it. You know how like sometimes you can buy something online, like a T shirt or whatever, or a Christmas ornament, and you choose the skin tone and the hair color.

Yeah, yeah, yeah, yeah.

Right, right. I mean, if we could choose that,

if part of it was visual and then the voiceover was to invite them to imagine those details. But what I'm saying is I've been doing nothing but the early trauma repair for 15 years. And when I do that, I can hear the amount of repetition in it. If it can be repeated, that means it can be systematized.

Right. That's interesting. And I like that process because the whole system of individual therapy, while I think very effective, I don't Think we have enough people to be able to meet the demand.

Exactly.

So there are other things that we need. There are ways that we need to try to open that up to more accessibility.

And, you know, in the field, many people will say it's all about the therapeutic relationship. And those of us that have done EMDR for 34 years, like myself, know that. Well, not exactly. I can have somebody walk in here that I have no relationship with. Not everybody. But some people, I can do EMDR and get them past their PTSD pretty darn quickly. Not everybody because there's mistrust as part of their story, then that has to be dealt with, or secret keeping or all that. But I just think we haven't fully explored what can be done to augment some of this. Because when I do the early trauma repair, they are in the intensive format. I work with people for three days. I only did an intake before they fly in. I work with them for three days, all day, and they fly home. And when I do that, the people that fly in have no relationship with me. But their lives are transformed after three days. Now I think that they are comfortable with me or we'd be dead in the water. But the point being, it's not the relationship that's curing them, it's the procedures that we're doing and the relationship with these mythic imaginary parents that is so

interesting because you're right. In our field, it's always talking about how that relationship, that one on one relationship is primary of therapist to client.

Yeah. And I'm just not so sure it's true. I mean, for some people it is. I get for highly dissociative people who never found anyone trustworthy. And the people who should have been the ones to love and care for them were the ones that betrayed them chronically and exploited them in the worst imaginable ways. So those people, it's not so easy. And therapeutic relationship is very much important. But not everybody's like that.

Right.

And what can we do for first responders? That's another thing. Innovation.

Well, and even the innovation of I tell people all the time I can cure ptsd. You just said it too. And that to some people is like, what are you even talking about? What, there's a cure for ptsd? It's like, yes. And it's been around for many, many, many years.

Right.

This is not new.

I get really upset when there are people that are sitting with their symptoms 30 years later. Some of them are on disability, but they could have been contributing in society if Their PTSD were cured. It may be more complicated than ptsd, but most of that, if it's trauma caused, we can cure it. It's so infuriating that there are people out there that don't know that in our field, let alone the general public.

I was going to say. And there are clients going to their therapist diligently every week, and they don't know that either.

Right. Wondering how many more years.

And then that question comes to me again, like, how do we make this more accessible? I'm almost hearing you're talking about some people could do it this way. So that means then there almost needs to be some sort of triage, like who needs an actual individual session and who maybe needs, I don't know, some guided VR sessions that have been set up by a therapist or all kinds of things.

Who would do best in the regular conventional weekly therapy format and who would be best served working in the intensive format? I don't treat did people in the intensive format because it would be destabilizing for them. It would remind them of the three days they were locked in the basement, spending three days here in an office with a therapist. But there are many of the people I work with, executives or lawyers or software engineers can really do well in the intensive format because they don't have to commute to a darn therapist's office every week for, you know, however many years to get things out of the way. So I think there's a trend towards the intensive format in our field. But there are risks with the intensive format as well.

What are some of the risks that you see?

I'm concerned about this tendency to talk about, elevate your practice. And they're marketing to really novice clinicians that have just come out of their EMDR training and they're two years out of graduate school. And I think if you're working in the intensive format, I mean, maybe a half a day is lower risk, but doing what I do several days in a row, I have to know EMDR backwards and forwards. I have to know ego state therapy in case they turn out to be more dissociative than they let on. And they fooled not only me, but themselves. And we uncover that in the work, the therapist needs to be able to work somatically to help people who are somatically cut off from their body to drop into the subjective felt sense. A lot of this work requires that.

Yes, it does.

And then also the early trauma protocol. So if somebody goes into an intensive treatment format with an eager young clinician, well motivated, but with insufficiently developed skills. They could be really squandering the person's time and money and potentially doing harm. If they, for example, uncover an undiagnosed, highly dissociative multiple personality. It used to be called, now it's did dissociative identity disorder. On day one, if they burst somebody wide open and then keep going, keep doing mdr, that would be like doing three days of surgery with a dull knife. And who knows what kind of condition the person's going to be in at the end? It could be very harmful. So there is triage. That's why I put forward a approach to therapy that integrates all those therapeutic methods that I described. But it starts out with, you could call it a triage. It's an intake with a decision tree. Is this person statically dissociative or not? Because what do you have to do differently? If they are, what kind of preparation is necessary? What if they're structurally dissociative? What do you do differently? What kind of preparation? Or are they just simple PTSD and then you go straight to EMDR1 and done kind of a thing? I'm still waiting for my first simple case of ptsd.

I was gonna say, does that exist as a unicorn? For sure. So if someone is listening and thinking, what is all this talk about dissociation and what's the complication? Like, how do I know whether that's something I could go and do in intensive or not? How do you help people sort of understand in themselves, or do they need to understand in themselves? Do they just call the right person and hope to get some information that way?

Well, it's sad, but true. That did people, that is multiple personality people are the most severely traumatized people around, and they're the ones most likely to be re injured if they stumble into a poorly trained therapist who then uses a power tool like emdr. So what's the person supposed to do? I don't know. One of the reasons I wrote the first book about dissociation was because, well, I wrote it for both therapists and clients. And there are lots of times that clients bring the book to therapists and say, could this be me? But what happens, let's say, in childhood, a child's trying to navigate this or that developmental milestone, but instead of having help, the person who should be helping them is betraying them and, let's say, molesting them. Not only molesting them, but chronically molesting them. That child has no choice but to get with the program I call it. You sign on the dotted line because attachment is the prime directive. And if your primary attachment figure is harming you, you have to make the best of the situation. You have to both keep whatever croutons of love you can find in that harmful relationship, but you have to be whoever you have to be to perform on demand for whatever hideous thing is demanded of that child. And so those two things have to be sequestered. So let's pick a case of incest. It might sound like in the kid's head, the brain is organized around, oh, yeah, Daddy still loves me, but Daddy hurts me not to pick on dads. It could be mom, it could be anybody. So the way that that's done is like through self hypnosis. Dissociation is the use of self hypnosis to put over there in a separate closet that which. It would be overwhelming if the part of the child that needs to feel loved knew what's happening at night behind closed doors knew what's happening to herself. Then it'd be devastating. She can't know it, so she has to keep those separate. There's an amnesia barrier between them. And that's how dissociation. Well, dissociation is that use of self hypnosis to numb out with the body's own opioids to not feel the pain. It also involves the creation of amnesia barriers. And those act like walls to keep these two realities separate. That way the child can get up, go to school the next day, and pretend everything's fine and not even know what happened to her last night.

Yeah. And just for anyone listening, if any of that resonates with you, find a great EMDR therapist that's well trained with a lot of experience to be able to help with that, because that's definitely an important thing to get help with. So we are just about out of time, Sandra, which makes me sad because I have so many more questions for you. But I would love to hear if you could dream big if there weren't barriers in the way, what would you want to be able to offer? Either you yourself, or the therapeutic community to offer entrepreneurs to offer. What would you like to see in this world? It's a big question. I know.

Well, it's funny because that's kind of the question I asked myself when I started my career, which was a long time ago. And I don't know how to dream for the world exactly. Beyond the couple of things I've mentioned so far. I know that my vision was to use my gifts of being able to Write and cartoon and teach to help people understand how much of mental health really is about trauma and trauma resolution. Not everything is trauma, but even the things that aren't trauma are traumatic. There's trauma everywhere. And so the trauma business is going to just keep booming and booming. So I want the field to be not believing. The way the DSM is organized now and even the way psychology is organized now, eventually it'll all be reorganized, with most of it about trauma and then a few things that aren't trauma. So the sooner we can all use our gifts to get up to speed with what EMDR therapists know and get the rest of the field and the rest of the world to understand that a lot of this is treatable. And I wish it could be affordable. But the trouble is nobody wants to hear these hideous, awful, terrible stories for free. So the reward, you know, you have to get paid for it. But also the other reward is seeing miracles. I don't mean we do miracles. We're seeing miracles. The natural healing tendency of the brain is real and true. It only needs us to get out of the way. Or what did Francine Shapiro say, the originator of MDR said with emdr, just let the train go down the track and therapists stay off the track.

I always say it's the hardest thing for therapists learning to do EMDR is you got to get out of the way. Get out of the way. Well, thank you so much for joining me. It has been an honor. I have enjoyed our conversation and I know that our listeners will as well.

My pleasure. Thank you so much for having me.