Ep. 175- Complex Post Traumatic Stress Disorder (cPTSD): What is it and how does it compare to borderline personality disorder
This episode describes what complex Post Traumatic Stress disorder (cPTSD) is, how it's diagnosed, and how it's different to similar disorders like PTSD and borderline personality disorder. This episode was inspired by the angry comments on Dr. Kibby's latest reel on spotting emotion dysregulation in borderline personality disorder.
When someone has a history of childhood trauma and they struggle with intense emotions, self-esteem issues, and relationship problems- what disorder do they have? In this episode, Dr. Kibby delves into the criteria for complex PTSD, which is still not an official disorder in the DSM-V. Yet, so many people struggle with symptoms from long, painful histories of trauma that has shaped their entire lives and personalities.
Dr. Kibby also discusses the nuanced differences between Complex PTSD and Borderline Personality Disorder, revealing how trauma shapes self-esteem, relationships, and emotional regulation in surprising ways. If you've ever wondered why these disorders often overlap—and how understanding their distinctions can transform healing—you’ll want to hear this.
Dr. Kibby shares her own experiences with online criticism around trauma representation, sparking a deeper conversation about stigma and bias in mental health. She dives into the hidden intricacies of CPTSD, explaining why it’s often overlooked in the DSM-5 but recognized worldwide, and how prolonged trauma affects the brain’s ability to process memories, dissociate, and regulate emotions.
She also talks about how how trauma, whether overt or subtle, can lead to complex self-protection mechanisms that impact every aspect of life. Then she finishes with listing the best evidence-based treatments, from prolonged exposure to cognitive processing therapy and DBT, tailored for each disorder’s unique challenges.
She emphasizes the power of compassion and personalized treatment over stigma, advocating for a mental health field that treats all disorders with empathy and respect. Why diagnosis isn’t about labels- it's a pathway to personalized healing and recovery.
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Hi guys, welcome to A Little Help for Our Friends, a podcast for people with loved ones struggling with mental health.
Hey little helpers, Dr. Kibby here.
Before we dive into this episode, I wanted to tell you how I could help you navigate the mental health or addiction struggles of the people you love.
0:17
Cool of mine is the online coaching platform and community that I built to support you in the moment when you need it the most, like having hard conversations, asserting your needs or setting boundaries.
Even if you're just curious and want to chat about it, book a free call with me by going to the link in the show notes or going to kulamine.com KUL AM ind.com and click get started.
0:38
Thank you and enjoy the show.
Hey, little helpers.
Today one of my new friends is joining us to talk about the really cool ways innovating in the world of mental health.
So Mike Meany is the founder and CEO of One Small Step, which is an after hours mental health layer for Medicaid.
0:55
One Small Step is it's so cool.
He it connects people who are in a mental health crisis or struggling with substance use or addiction.
It connects those people to certified peers on nights and weekends, which is usually when people need the most help, but the only thing that's available is like the emergency room.
1:14
So it's a really it's, it's, it's addressing a really big need.
And so I think it's super cool.
And he's also scaling that support with Frontier AI that's optimized for a safety and really good clinical judgement.
He has a background in tech because he previously LED research teams at Meta and holds a PhD from Cambridge.
1:32
So he's a super smart guy, really, really nice.
And I invited him on this podcast to talk about one small step and what certified peers are because I think it's really important that we know all the different ways that people can get mental health treatment.
Most people think of psychiatrist, psychologist, and that's it.
1:50
But there are so many new ways now of people getting mental health support.
And I just love sharing that information with all of you.
But it was interesting, I thought, we're just going to talk about that.
But actually we ended up talking about his own personal journey from serious and it sounds like pretty dangerous alcoholism all the way to his long term recovery.
2:14
And the conversation went into a direction I didn't really expect.
It was so moving, he told a really honest, genuine story of redemption and how his loved ones and the 12 steps transformed his life.
So it's really worth a listen and I hope you enjoy.
2:31
Hi, welcome to A little Help for our friends.
How are you?
I'm good.
Hi Kibby, thanks for having me.
Yeah, Mike, we met at behavioral health tech, right?
And those strange little, like, dinner that I wasn't even thinking about going to.
2:52
Yeah, I was like, tired.
I was like, I don't, I don't know, want to do this.
But then I'm so happy that I came and sat down next to you.
Thank you.
No, me too.
So I guess shout out to Steve Duke at the Hemingway report.
Yeah, because that was his dinner, right?
3:08
Yeah, yeah.
I don't know anybody.
So you do peer support for is it just people with struggling with addiction or all kinds of tell us like a little bit about like what?
Who are you?
What do you do?
3:24
Yeah, sure.
Yeah.
Thank you.
So I run a platform for certified peer support.
We focus on nights and weekends, which is kind of like this very high risk, high acuity time where there's not a lot of support.
3:40
There's an over reliance on emergency care during that time, which is not always effective.
And we support patients that are struggling with substance abuse as well as serious mental illness and general mental health.
3:55
So we we kind of focus on the whole continuum and certified peer support is a treatment that has shown really positive outcomes for substance abuse, serious mental illness and general mental health.
4:11
And the whole premise is that a peer, a certified peer, is not a clinician.
They are some of like lived experience who has been through the challenges themselves.
And they have a little bit of training to help kind of structure how they support someone.
4:30
But they provide active listening and sort of empathic, yeah, journeying with the member of our platform.
That's awesome.
Yeah.
I'm such a fan of what you do because, I mean, it's it's just so hard for people to get the right care.
4:49
They only know that if something bad happens, they need a therapist and maybe a psychiatrist.
They're lucky.
And then send them to the ER if anything bad happens and you know, like people like us are trying to innovate and try to add new points of care and like, OK, you don't want to see a therapist doesn't really work for you.
5:09
ER is not really working for you.
What what then?
What do you do if you're like not doing well?
Yeah, yeah.
So I mean, it's interesting.
I, I, we view ourselves as as like a complement to the like clinical world, right?
5:29
So, so people have doctors, psychologists, psychiatrists, therapists, all that's incredibly important.
As you know, it's very supply constrained, right?
You have to wait three to six months to see someone.
But like mental health is, is, is something that is a daily, sometimes hourly, sometimes minute by minute struggle and people can't wait three to six months, right?
5:55
And there's this whole opportunity of certified peer support that can help plug these gaps.
It's like much more ready and on demand.
And it just sort of amplifies all of the clinical work that someone's doing.
So you as a psychologist, you can help with diagnosis and symptom management and also trauma processing and all the other amazing things that you do.
6:24
But like for me, so I was the first certified peer on our platform.
I'm recovering alcoholic, I have trauma, I have other like mental health challenges.
And I was, you know, I, I took the first 100 calls on our platform and I was just sort of there to like be with people as they describe their challenges.
6:49
When I had similar experiences, I talked about how I got through them and what I've learned and kind of help come up with a, a plan to just get through the day and then pick it back up the next day.
7:04
So that's yeah, yeah.
Does that make sense?
Totally, totally it.
It's, it's tricky because it does sound like a lot of what psychologists would do in those acute moments, like how do we get through the day?
But it's it's nice to know that that is something that is something that you have specialized in.
7:22
So that's really cool.
Yeah, Yeah.
So it is.
And like it's nice for like like patients too because it's, it's, it's, it's in some ways just like less threatening.
There's like less of a, like a hierarchy or like an asymmetry, right.
It's just like someone, but it also like taps in to this like ancient wisdom, right?
7:44
Of like, how do you solve any problem you like find someone who has solved it and asked them how they did it and asked them to teach you how, right.
And so you know, and, and like the origin of peer sport was in 12 step programs that are very high efficacy for the people who get there.
8:04
And I think like the peer support movement pioneered by Medicaid sort of looked at 12 steps and said, wow, this is really effective, but there's some barriers to entry.
People think that it's religious.
There's a lot of like misinformation about it.
8:20
How about we just bring that out into like insurance reimbursable clinical world contacts, certified peer support.
And the empirical literature on its impact is, is is really substantial and really significant.
8:35
That's super cool.
That's super cool.
I'm going to get into all of that and like what that peer support actually looks like.
But first, how did you you?
You have a whole story.
Yeah.
What's your What's your story getting to where you are now?
Yeah, so thanks for asking.
8:54
And, you know, like, like, gosh, yeah, I don't even know where to start.
So I never thought that I would end up like building a company or a technology platform in in recovery and mental health.
9:11
I'm a research scientist by training.
I've worked at technology companies.
I used to work at Facebook.
That's kind of my, like, background.
And like, I like building technologies that help people and then can have a big impact in the world.
And then there's like a concurrent part of my personal journey that ever since I was in high school, I struggled with drinking.
9:34
I, I blacked out the the third time that I drank, I was like 16 years old.
And I remember waking up that morning thinking how cliche and like, sad that I was just like another alcoholic in my family because I'm like Irish Catholic.
9:53
So like, you know, alcoholism is, is something that my family, like you, you, you know, it's in our DNA in some ways in our culture, ain't nothing but a family thing.
And that was when I was 16.
10:12
And I was afraid because I didn't know how to handle that.
And, and I was reasonably successful in like other parts of my life.
My, you know, I played sports, I got good grades.
So there's always this kind of parallel dual track of my life where I was getting good grades, I was playing sports, I was doing all the things I was supposed to do.
10:35
And then I was trying to like, party and have fun on the weekends like everybody else.
And like, I could do it two out of three times, but then like 1, every third time I would black out and I'd have some incident.
I would do something stupid, do something embarrassing, harmful to other people emotionally, you know, harmful to myself physically and emotionally.
10:57
And yeah.
And.
But I didn't think I was an alcoholic because I didn't drink every day.
And this is where, like, my peer support journey probably starts because, yeah, like, I, I thought an alcoholic was someone who drank every day and was under the bridge with a brown paper bag, Right.
11:16
Sort of like the media portrayal.
But I, my friends who are not in addiction, were worried about me in college because in college I was hospitalized five times, including falling down a flight of stairs and shattering my jaw, having my mouth wired shut.
11:39
Yeah.
But like, you know, I was drinking liquor through a straw like a week after that happened, and I was, like, 20 years old.
Yeah, it was.
I mean, really like things that I'm not proud of and, and that were were certainly difficult at the time, but but now that I'm, you know, I've, I've been in recovery for 12 years.
12:05
I view all of those as, like, features of my journey that were like a requirement to look at me where I am.
But my friends were worried about me.
And so one of them, I mean, I have this vivid memory of like, one of my best friends in college.
12:20
He's like 6 foot 6.
He's like a lot taller than me.
He put me under his arm.
He like, walked me to my first a, a meeting.
Yeah.
And it was like, really powerful.
And I, I didn't get sober then, but like I met people there that were blackout drinkers like me, which I was like, astonished by.
12:42
Like I thought I had this like uniquely like paralyzing difficulty, but it was Nope.
There was a lot of other people.
And, and they taught me that in the alcoholic isn't someone who drinks every day necessarily.
13:00
The only thing that matters is whether you can stop once you start.
So it doesn't matter if you drink once a year, once a week, once a month, can you stop once you start?
And like, that made sense to me because like, I struggled with that.
I would try to only have a few and I would wake up 12 hours later in a different part of town.
13:21
And so that's where I met other people that stopped drinking, and they just helped me understand what was actually happening to me.
And then when I finally sort of reached my own rock bottom, I didn't have anywhere to go, but I knew there were people in 12 step rooms that allegedly didn't drink and were allegedly happy.
13:48
And so I was like, I guess that's where I got to go so.
Yeah, wow.
What so many questions when you're 16 or even college drinking to the point of blackout and doing stupid stuff.
14:07
I mean, for argument's sake, that like, that could be normal, right?
That could just be like a dumb young man, right?
And experimenting.
How how did you know?
And you, you had a moment where you're like, oh, this is so cliche, but how did you know that this was not just like, teenage stuff?
14:27
Was it the extremity or what you would do or?
Yeah, it's a good question.
So I think I I can share it toward the end.
So I got sober right after I graduated college and everyone blacked out in college.
14:49
I mean, I don't like not everyone, but like I was not the only blackout person in, in my friend group, but like the frequency was, was was much higher.
And so I was, I blacked out a lot.
15:07
People didn't know I was blacked out half the time.
So like that's scary.
Like, you wake up, no recollection, worried about who I texted where I was, like, yeah, like waking up with your eyes still closed and being afraid to open them because I'd like, didn't know, like where I was.
15:29
And then just being like, oh, yeah.
Like, you were fine.
Like, you were like, cogent, like carrying on about, you know, you're like poli sci class and just like, whoa, like scary.
But then other times, like, you know, starting fights and other kind of unhelpful things to a lot of my friends having to like, carry me home a lot, you know, like, so it was always like sort of worse.
15:58
And then like, like being hospitalized and like when I fell down a flight of stairs and broke my jaw, my blood alcohol content was like .34, which is like very.
The the legal limit of drinking or something or like point isn't point I'm trying to remember .4 is death or something like. .4 is death, yeah, and, and typically .3 is like a coma.
16:26
And I was like sprightly hanging about just totally blacked out.
And they, and, but like, I, I mean, I'm smiling now because like, so the thing about recovery is that is the most liberating, joyful, freedom enhancing thing in my life now.
16:47
And my journey as an alcoholic was a requirement for me to find this peace and freedom.
So like there's very funny things about it and if you ever go to a NAA meeting, there's a lot of laughing because like we do crazy shit all the time as Alcoholics.
So like I go in to a NAA meeting and I say my BAC was .34 and people are like impressed.
17:08
They're like, holy shit, man.
Like that's deep.
Like how did you get there?
Right?
Like and so, but my friends, I didn't realize I did this.
And this is like the, the weird thing about alcoholism was I was in a blackout.
17:23
I didn't know I was doing this.
My friend said that they they they nicknamed a drink the meanie special because when I was drinking and I was shit faced I would make my own drinks and it would be like vodka like 3/4 of like the solo cup and then a splash of orange juice.
17:43
So people just thought that it was like a normal mixed drink, but it was like basically.
And I have 0 recollection of ever doing that.
Whoa.
Yeah.
Do you see like a different kind of like sometimes when people get drunk, they become like a totally different person?
18:00
Were you?
You said most of the time people didn't even notice, but like, did parts of your personality like, yeah, were you like, different?
Yeah.
So, yeah, I'd, so I, I think toward the end it was more clear because like basically other people were blacking out.
18:20
Then they graduated and sort of stopped, like they started to like work and they stopped like blacking out and like I was not.
And so it just became very, very clear kind of around that time earlier and in I'd say in high school as a teenager, I was much more emotionally like, I don't know.
18:47
I don't know if emotionally disturbed is too hard.
Probably like I was, I had way more shit that I was like trying to deal with as I was like a young teenager with like girls and like my family and like my own.
I grew up with a really bad speech impediment.
19:04
So I have this like stutter and this was like this big chip on my shoulder.
And then I would get drunk and it would sort of like lower all my inhibitions and I would just talk shit and I would be mean to people sometimes.
And most of the time I was fun and, but like, I, but like, I could get triggered, I could get set off.
19:26
And I think like retrospectively, I would say another signal was that I don't know that I pay attention a lot now.
Like if you have to lie a lot about something in your life, like, that's usually a pretty good signal that you should look at it really hard.
19:45
And like I, I, I had to lie a lot in high school because when I was drunk, I would do things or I would be with people or I'd be in situations that I like that we're not OK, that we're like conjured how I would want to treat my friends, my family, myself in a, in like a respectful, like loving way.
20:07
And so that created a bunch of emotional damage that then drinking helped me feel better about.
And so this is like where this like vicious cycle kind of.
Comes and you create all this like damage in your life and then there's only one thing that makes you feel OK and gives you that easy comfort, but it's the thing that creates more damage and it's very vicious cycle.
20:30
But yeah, so I mean, without going into like too many yeah, I would say like in high school it was off like drama fights, crying, kind of making an ass of myself.
But it was probably hard to, like, disentangle that as alcoholism, like, versus like just being a hormonal teenager.
20:56
Yeah.
Right.
It's tough.
It's interesting how it can cleave off like a different identity or different like way of being and then keep doing that because it it's a coping mechanism.
So it's like it would be you as you're forming your sense of self, right?
21:13
It's like who I am, this is what I care about.
But then these other times I'm doing these crazy things that are hurting people.
Like that's not me, but is it me?
Right.
Yeah, so that so thanks for sharing that and and and that it sparks something I think that is very profound and important.
21:34
Yeah.
Like so I went to college at Georgetown, which is a Jesuit university and they were founded by or the Jesuits were founded by Saint Ignatius of Loyola, who's this like Catholic St. and and has the, the spiritual exercises that centers discernment and, and sort of how you encounter the world.
21:56
And one of the challenges of Saint Ignatius and like a nation discernment and spirituality is to integrate like the pieces of yourself and to like pay attention to the parts of your life that are like cleaved off and, and like not integrated because that's actually somewhere where we should look.
22:16
And so the Georgetown Jesuits helped me start to unpack that because my whole life there were these two tracks.
It was like this like loving, kind, nice, successful leader, whatever.
And then this like person who was like, so like hurt and like in pain, but also like selfish in his behavior and actions and hurt people emotionally.
22:49
And I had to live with that cognitive dissonance between who I was, both those people.
And like, I think that for me is the greatest trauma of being an addict.
23:09
And like, the process of recovery for me was like a journey of integrating those parts of me and like recognizing the motivations of both of those dreams of my life and then like creating a new life where I got to like emphasize and lean on one versus the other, thankfully.
23:31
Wow, that's so, that's so interesting and powerful.
How?
How?
What did that look like to integrate?
Like.
When you got sober, because I imagine it's interesting to think about that because like personality disorders and all these different people are like, no, this is not me.
23:48
This is not me.
And then you have to be like, no, that is part of me.
But then with alcohol or any kind of drug, you'd be like, well, it's not my fault drinking, right?
But then when the drinking is gone, that barrier is down.
Like what did that?
24:03
What was that like to have to integrate?
Yeah.
I mean, and like, yeah, it's such a good question.
I mean what?
Happened to that guy.
What happened to the selfish mean guy?
Well, so you know, like I do want to yeah.
24:23
And I don't, I don't know what causes like full mental breaks and like, I don't know, like I've, I've never been diagnosed with like any sort of like personality disorder or anything like that.
But like there was a world where the way that I was living my life, trying to maintain both of those lives at once and like not out of desire, I didn't ever want to be like a selfish asshole, but like I wanted to drink.
24:56
Like I definitely wanted to drink right.
And and then, but like that was like an outcome often.
And but like I like that can cause like full mental break.
Like like you're trying to integrate these two different parts of your life that like do not integrate right.
25:14
And I don't know, like personality disorders and all that stuff, but like, I know that sometimes like the coping skills that people acquire to like deal with these like divergent parts of their life, oftentimes not in like oftentimes externally imposed, right?
25:34
Like when they're children, like they just like become someone else and then trying to integrate them causes this like break.
And in some ways, I, I think my point where my sobriety journey started after many, many other high quality moments where it should have started like was where like I, like, I couldn't handle the disintegration anymore.
26:04
Like it was like, this is going to kill me.
Like and, and, and it scared the shit out of me And, and like it should have long before, but like my first day of sobriety, I like remember for the first time feeling like in the depth of my soul, like, Oh my God, I'm going to die because of this.
26:23
And that like scare the shit out of me.
And like, but where did he go?
I mean, so the steps is how I got sober.
And the steps are like a systematic process of like taking those two parts of who you are and forcing yourself to see them as the same person and giving you tools to both accept the reality of who that person was and give you tools to realize that moving forward, that person no longer has to have active agency in your life.
27:00
And and so it's just like you, you, you, you know, I don't know who said it.
I don't maybe Dostoyevsky or Solzhenitsyn.
But like the line between good and evil, like runs down each of us, runs down the center of each of us.
27:17
And like a A and the 12 steps just, they gave me a tool kit to like accept what had happened and like not let the shame of that cause me to like cause more damage.
27:34
And then tools to like lean into like the good parts of me.
And, and I'll just share one more thing on that because it is scary.
I mean, the scariest thing in sobriety is when you notice yourself doing shit that you did when you were drunk, but you're no longer drunk anymore.
27:57
And yeah, like, and I mean, I guess, sure, fuck it, why not?
I mean, so there's like the relationship inventory part of like your 12 steps where like you detail, you know, all of your past relationships traumas.
28:16
I know you guys.
Did that.
That's cool.
Oh, yeah, yeah, yeah.
So that's a big part of it because they're like, that's honestly like the source of trauma for a lot of people.
Sex inventory, like relationship inventory, it's all sort of like, like bundled up together.
28:37
And when I got sober, I was like, wow, I was like a really bad, like, person in romance and, like relationships while I was drunk.
Like, wow, like that guy.
That's pretty messy.
Yeah.
28:53
And then in sobriety, I mean, it's nothing like it was, but like, in my 20s, right?
I was like still young and like, you know, dating and trying to like figure out my romantic life.
29:11
And there were still some selfish behaviors that were like, not really aligned with who I was or not with who I wanted to be that were still cropping up.
And it was like, Dang, like it wasn't just the alcohol, it what like I need to go deeper to like unravel.
29:30
Like I realized and over the course of sobriety, I've realized multiple times, there are layers that are still cleavaged off in my like internal life that I have to like consistently be rigorously thorough and evaluating and like reintegrating into my life because like I have to do that in order to stay sober.
29:56
Because like, if that, like the moments in sobriety where I had to confront that there was some part of me that was like not integrated with who I aspired to be were the only times were like, I've never wanted to drink in sobriety, thankfully.
30:15
But the emotional terror that used to guarantee that I was going to have a drink happen in sobriety, when I realized there are these nooks of my identity that I've not integrated into who I aspire to because it's, it's like, it's very scary.
30:35
That's so, so interesting and insightful that thinking about people who have active addiction to kind of cope and deal with things that they can't deal with, right?
Like, I, I want to avoid reality, I want to escape, whatever.
But also, escaping parts of yourself is a big motivator that people aren't aware of.
30:55
Yeah, I mean, yeah, that, I mean, yeah.
I mean, I'd say for me at least, that was like, it was, it was one of the principal reasons, you know, and, and then I can also just take is this, I think is somewhat related to what you know, and, and what you, you're helping pioneer, which is there were people in my life who were not Alcoholics, who were like, not addicts, like my friends and family and like my now wife, who when I had to confront in sobriety that there were still these like parts of me that were, you know, varnished and had some chips in them.
31:47
The scariest thing is like confronting it, acknowledging it, talking to people who love you about it because you're afraid that they're not going to love you anymore.
And then like the healing is that like they do still love you and that like you can integrate these parts of who you are without shame, without embarrassment, without having to use.
32:09
I like encountering that love, like in the real world is like, yeah, I mean, it's, it's it's like the the most beautiful blessing that I've ever had.
Can you give us an example of that?
Like I wanted to ask about what is, you know, talking about peer support?
32:26
What did your friends and family do?
But like, that must be so scary to be like, here's the the ugly side that I'm afraid of.
Well, you still love me.
And some people might not right?
Like some people might feel like, you know?
32:43
Yeah, Yeah, that's, that's a good question.
And I, I think I'll probably speak probably more general about this than like with specifics.
33:05
So like part of it was like the amends making process.
So like in, in the 12 steps where you sort of do this like systematic inventory of like what has caused you harm and then what like the harm that you've caused others and then actually like taking ownership of those harms to the person themselves.
33:33
It's really scary.
And there were people that like didn't text or call me back.
Like there are people who like I couldn't make amends to because they like we're like, no, I'm good.
Like I don't need to speak with you ever again.
And I have to sort of make like a living amends for the rest of my life for all of that.
33:55
That's kind of how I think about it.
And that's what, sorry, that's not what I mean.
That's what my sponsor was like.
This is how you think.
It's not like I have this novel insight, but making amends to people that, like, cry with you and are just, like, so happy that, like, you're just like, safe and OK and like, yeah, like, just from, like, from being drunk and, like, sleeping in and missing, like, nice engagements and moments that, like, this Jesuit priest at Georgetown, like, invited me to attend something and I like, blacked out the night before and I like, missed it.
34:44
And you know, like, in the grand scheme of things, like not like the biggest deal, but just like, that's a really shitty thing to do to someone that you love and who loves you, you know, And like, I like made amends for that.
35:00
And it was like this really powerful moment, right?
Or like, like in my previous romantic relationships, like sitting down, having coffee with honestly, the people that probably bore the brunt of my my alcoholism, aside from my family.
35:21
And like, take full accountability for like my actions and make a commitment to do like whatever's needed to, like, make it right with them.
Yeah.
And for them to just kind of be like, like, yeah, I can.
35:42
I mean, I'm like getting a little like emotional.
But it's like in one of those instances, this person, you know, she, she just looked at me and was like, I'm so proud of you that like you're not drinking anymore.
35:59
And it's just like they never thought that that was probably possible.
And yeah, I mean, so it's like things like that where it shows you like what like forgiveness and healing can actually look like and, and that you don't have to like chase it away with with substances.
36:21
Yeah, that's so beautiful.
And so that that taps into what she must have been afraid of is like, I'm just going to have to watch this person die.
Yeah, right.
Yeah.
And like my mom, my dad, like my aunt and uncle, like just, you know, and like also much situations like the priest at Georgetown that like invited me to an event that I like blew off like shit that I'm not proud of in the grand scheme of things.
36:56
Isn't like I'd like, you know, I didn't break any laws or I mean, I did in other instances, but not these instances, right?
But like this, like accumulation of all of these like moments in your life where like you just you fed your addiction instead of like lived up to like the love that others are giving you in the world.
37:18
It's a really harsh thing to have to like confront, but then confronting it with others, with family, with support, it's deeply transformational.
What I'm I'm putting myself in, in the perspective of the people around you.
37:40
And you know, like I remember with my own family having to deal with like, you know, my watching my mom and other people like kind of spiral out of control.
And you feel so helpless and scared, also pissed, but also like it's sympathetic.
What what is like the what should people do?
37:58
Because actually, like that story that you just told about your friend, like bringing you to a a, that is something that we all fantasize about, like just grabbing that person and taking them to get help.
But then that usually backfires, right?
38:15
Because it's like the person doesn't, you can't make someone want to change.
So what?
What can people do around that?
Yeah, I mean, it's, it's so sensitive and, and hard and like, I give my friends a lot of credit.
38:37
I think there's like, yeah, and this is maybe hard and like not helpful advice.
And I don't know, maybe as a psychologist you, you'd have different perspective.
But for me, and I think for a lot of people that I've spoken to who struggle with this, there's like fear of like abandoned, like there's like this fundamental fear that you like, you're not lovable.
39:06
Like that's like the like the like, if people knew what I was really like and who I really was, they wouldn't want to have anything to fucking do with me.
And I had a group of friends and I still have them.
39:21
They're still my friends.
They were at my wedding.
They were in my wedding.
Like these are and they were pissed at me.
They would, I mean, many of them have punched me in the face, like just, I mean, like I've punched them like this is like they, they're angry at me.
39:40
Like they were like, you need to get your fucking shit together because like you're like, you're kind of die and now I'm going to be pissed, you know, like you're just being an asshole.
But they were fiercely loyal and they like never, ever, like threatened to like not be my friend or anything like that.
40:05
And so like, I don't know, like I do think it's like, I mean, and obviously like, I don't recommend punching people in the face.
This was not like their tactic.
That was after things escalated when we were drunk often.
But they were fiercely loyal.
40:21
And then I think the other important thing is.
In non escalated moments, it's like the person probably knows and they're probably deeply ashamed and it probably makes sense less to emphasize like hey, like you have a problem and you need to get help because they probably know that.
40:41
It's more like saying like, Hey, do you want to talk about how this is for you?
And like what is like, what does healthy look like for you?
Like what, what do you want out of this?
41:01
And just like kind of like lower the stakes and like lower the barriers because most of the time people have to like be very defensive.
And I think that's a result because you know, like, well meaning people don't know how to help.
And it's like, hey, you have a problem.
41:16
You you should go get help.
But it's kind of just like, hey, this happened.
Like, how are you feeling about it?
Like, like, where are you at on this journey?
Yeah, I think is.
And you know, if they're like, oh, I'm fine.
41:33
Like it's not a problem.
Like I, I think it's actually just like if you have their trust and you are loyal, you can just keep asking them.
Like, how are you really?
How are you really?
Because like, at some point it's just all kind of calm crashing down.
41:49
And my friend who brought me to the meeting that night, will reminded me of this years later.
He said, like, you called me that day and said like, you were finally ready.
Oh, wow.
And I totally forgot that.
42:05
Like I in my life, he just like ripped me out of my bed and like brought me to this meeting.
And he's like, you know, like.
So they had all pushed and prodded and probed to help me like, you know, like they like got me a big book.
42:22
They, they told the priest at Georgetown like, hey, he has a problem.
And so they they did things to like kind of nudge it along.
And then at some point I but like ultimately the person has confronted for themselves.
Right.
That's I mean, that's amazing that's it's so lucky to have people like that in your life.
42:43
I mean, probably live because of them.
And I could see why then this LED you to this work of peer support because it's so it was so instrumental to your journey.
What do you, what do you do as a peer supporter when you're talking to people who are in your position, were in your position a few years ago?
43:01
Yeah.
What do you say to them?
What do you do?
Like how do you help them?
Yeah.
Well, thank you.
Yeah, I mean, it's, I'm really excited and, and, and proud of like what we're doing.
Often times when people call in, it's like I just say like, hey, I'm here.
43:22
Like I'm here to listen without judgment.
I'm here to listen and like share my own stories to, to like make you not feel alone, like share similar things that I've gone through.
43:43
And then if they're open, it's like, this is how I got out of that situation.
Like are you open to talking through like potentially like, like coping skills and like strategies and tactics to actually like help you through the situation?
44:00
Or do you just want to listen and like have someone listen?
So it's like a lot of listening.
It's a lot of like strategic disclosure of like my own story and then just very practical coping skills.
Pull up a meditation.
44:16
We'll both do it.
We have an app that has a bunch of coping skills.
And then just helping people kind of like find greater like regulation.
Yeah, that's like, that's most of it.
That's awesome.
44:32
That's really awesome.
What how, how do they know, how does someone going through something like that know to look for peer support versus like, I got to, I should go to the emergency room because I'm thinking about that too.
You know, I'm going to think about like my patients, people I work with, I'm like, OK, when do I send them to peer support or something else versus like they got to go to the hospital now.
44:55
Yeah.
So it's a great question and it's one I spend a lot of time thinking about.
So it's basically like we're there for nights that aren't emergencies yet.
So a big part of the the broader challenge is people on nights and weekends are alone.
45:20
And what might start as a, you know, moderate emotional dysregulation can escalate and escalate to either self harm or drinking and using or something that then leads them to the hospital or the ER.
45:37
And we want to build a platform and create a system like with our partners in in the healthcare world, where people recognize that they need a little help and that they have a tool that allows them to find that help when they need it.
45:59
And like, the big thing here is that like nights and weekends, like I never relapsed during the day, you know, and that's not to say that that wouldn't have been part of my story at some point.
I know a lot, but that was just not, I never relapsed during the day, but on nights and weekends, VR is the only option.
46:20
And and so it's like, I mean, we we, we, we also have like a formal assessment, right?
So if someone's like thinking about self harm, like ideation itself is actually not necessarily A cause for escalation to an emergency.
46:37
Ideation itself can be a great use case for peer support because peers have had that experience.
They struggle with that.
We struggle with that ourselves.
ID 8.
But then if it ever goes to plans, intent or means, like that's when things like should be escalated.
46:56
And so that might not be like a perfect answer, but I think that's kind of like a good heuristic.
Like if people are not actively acting on harmful behaviors, doing drugs or self harm or something, and it's more the emotional like displacement and dysregulation that might prompt those behaviors.
47:20
If we can catch people in that moment where like before they start using, before they start self harming, but they're just like emotionally laden with these negative thoughts and they like they need help from a peer or a friend or a family member.
47:41
That's the and like everyone who ends up in the ER because of a mental health crisis started somewhere that was not a crisis.
Yeah, makes sense.
What kind of training or how does 1 become a peer support?
48:01
Like when people think about like, oh, OK, this is what peer supporters do.
This is what therapists do and the ER like what?
What did you guys get trained in?
Yeah.
So every state has their own process.
You have to like go through a formal state certification.
48:17
There's a lot of healthcare agencies that like train people as certified peers.
So we have like an application process.
We've had over 500 peers apply to be on our platform.
So like that's out of our market has like a lot of people interested in it.
48:38
They have to submit their certification, all their continuous like educational requirements.
We interview and then then we have like bi weekly like supervision with an independently licensed professional counselor that helps us up level and like helps us deal with like challenging cases and things like that.
49:01
Yeah.
And then we are building.
So like just to give people like a little bit of a better sense, we're building a platform that sort of like matches people that are in need of mental health support on nights and weekends with a certified peer.
And like we're, we're using AI.
49:18
Is that like we can create synthetic patients or like synthetic members to like both help filter for quality of peers but also help peers get better?
Oh nice.
Yeah.
So yeah, that's that's.
49:34
What we support, it supports like the peer supporters who are trained, who are providing it.
That's awesome.
That's really cool.
Yeah.
Because onboarding and training new, you know, providers is always like the hard part, right?
You're going to make sure that they're doing a good job.
And, you know, they know what they they have support around them.
49:52
So that's cool.
Yeah.
Where can people find you?
If people listening and they're like, Oh my God, I want I want to reach out.
Yeah, yeah.
Thank you.
So, I mean, we could do a whole nother episode on the challenges of the mental health care system.
50:09
So we are not sort of like broadly available yet.
We hope to be there one day.
Right now we are working with like strategic partners that have large behavioral outpatient clinics and that's kind of who we are working with right now.
50:27
But we do have a bunch of asynchronous free resources on our app and on our website where one small step dot IO, one small step app in the Android and iOS store.
Yeah.
And that's where you can learn more about us.
50:44
And yeah, show us to your behavioral health provider so that we can build partnerships to help help grow.
That's awesome.
Yeah.
And then we'll put the link in the show notes.
So anyone who's curious, you could check it out in the description.
50:59
But Mike, this was such an amazing conversation.
Thank you so much for your honesty and vulnerability because you know, we, we always hear addiction and recover, You know, there's all these big words, but knowing what that looks like on just like in a real person's life and what that could look like and people who might not even realize that they are struggling with this or, or their loved ones struggling with this.
51:23
And I always love these stories of hope, like yours is like, you know, like having someone in your life with addiction is terrifying.
And to know that it can get better so.
Well, thank you for having me.
51:38
I like, I'm like, didn't expect to get so emotional, but I, I hope that it mattered to her hoping.
And and yeah, it was, it was great.
And like, I'm, I'm happy that I got to share a little bit of my story.
51:56
It's like an honor to have been your guest.
Thanks for having me.
Thanks for coming and I'm going to talk about healthcare another another episode.
But thank you so much, Mike.
And for anyone listening, you could One small step, right is the name of your company One Small step.
52:13
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52:37
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53:15
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53:34
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