Carey 1

Livi Carey

Chawkat

Independent Research G/T

24 January 2018

Interview with Heather Bond-Pushman:

Heather Bond-Pushman: Hello this is Heather!

Livi Carey: Hi this is Livi!

Bond-Pushman: Hi Livi how are you?

Carey: Good how are you?

Bond-Pushman: I’m good, thanks.

Carey: I’m sorry, do I address you as doctor or…?

Bond-Pushman: Oh no, Heather is totally fine.

Carey: Okay! Thank you so much for taking the time out of your schedule to talk to me I really

Bond-Pushman: No problem, no problem at all, happy to help. Can I just ask how you Livi how

you found my information I was just curious about that.

Carey: Well I was just googling mental health professionals in the area, specifically those who

specialize in anxiety and trauma.

Bond-Pushman: Oh, okay!

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Carey: Oh, is it alright if I record this for my purposes?

Bond-Pushman: Sure!

Carey: And if I find any pertinent audio clips would it be alright if I used them in my

presentation?

Bond-Pushman: Yea, as long as your class is okay with it haha

Carey: Oh haha. So I expect my research question to kind of um, evolve over the course of the

year, probably even after this interview as I learn more. So I, well I had a therapist when I was

younger to treat an anxiety disorder and she used cognitive behavioral therapy techniques and

they were like drawing pictures and playing games so I was fascinated um curious as to how that

is used with adults or how otherwise it is treated. So when you are treating anxiety in those who

are suffering as a result of trauma are there any specific ways you change your treatment or go

about that?

Bond-Pushman: Well yea so I kind of wanted to ask you some clarifying questions about that too

because I wasn’t sure if you, because when you said about anxiety, are you talking more about

people that have like PTSD are you just talking about like generalized anxiety or kind of what

are you looking for here?

Carey: Yea I guess it’s kind of PTSD since I’m talking about those who experienced sexual

trauma when they were children.

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Bond-Pushman: Okay so is that kind of what your focus is? Sexual trauma specifically because

that is kind of different there is kind of more that goes into that as I’m sure you’re aware.

Carey: Right

Bond-Pushman: Okay so that’s why I”m asking it’s also not just a one-time trauma it would be

like sexual trauma growing up maybe for a more extended period of time that kind of thing?

Carey: Yea

Bond-Pushman: So not everybody presents the same way, when they come in, I mean some kids

are more resilient than others, and some kids have some anxiety around it and about it but they

don’t fit the criteria for PTSD and then other kids do. Are you also talking in your presentation

about uh the diagnosis and kind of who meets that?

Carey: Yea so how exactly does that present in either children or adults? I’m mostly focused on

adults who suffered as children.

Bond-Pushman: Well, if you go into the handy statistical manual, right, the DSM, there’s a

whole listing of how you know what the specific symptoms are to be PTSD but usually you

know when people come in and they have PTSD they’re um they have a certain set of criteria

where it just makes you wonder for example with most of the adults that I work with that were

victims when they were younger um not all but most of them have things like problems sleeping,

they might experience nightmares, they might be hyper-vigilant, a pretty good startle response,

so you know if something that’s startling happens they probably tend to react to it a little bit

more than other people and then you know one of the big criterias for PTSD that you don’t see in
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any of the other anxiety disorders is flashbacks. And so that is you know, the actual re

experiencing of the event um and it’s usually triggered by something they can be triggered by a

smell, or a sight, or just you know, it can be triggered by anything in the senses. And they

actually kind of in the moment feel like they’re reliving what happened. SO that’s you know

flashback. And that’s kind of a trademark thing more of a PTSD than some other things you

don’t really find that in a lot of other anxiety disorders. And so, just to kind of finish out the

question now, above and beyond that, my, and I wish I would have known it was sexual trauma

cuz I could have kind of dug around more.

Carey: Oh gosh sorry about that

Bond-Pushman: Oh no no don’t worry. But just as I’m trying to think about my own clients you

know the one of the really big things that comes up for most of these adults is shame and guilt

for sure um you know and that’s I don’t know if that’s something that’s coming up in your

research but that’s certainly something I deal a lot with in my practice is how to deal with um the

self blame the guilt you know depending on whether or not it’s still a secret or if it’s not still a

secret those kind of things seem to matter you know people want to be validated in adulthood

about what’s happened and sometimes it’s still a secret sometimes the secret comes out and it is

a relief but it doesn’t really turn out to be exactly what people are hoping for in terms of

apologies and those other kinds of things. So yea so just to finish the question out you can

experience all kinds of symptoms depression, anxiety, all kinds of things but you know the guilt

and shame or the big things that come up especially for my folks that are survivors of sexual

trauma. Does that make sense to you?

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Carey: Yea thank you! So I also saw on your website that you also work with the abusers um I

didn’t know about that so what exactly do you do with that.

Bond-Pushman: Well with the abusers just to clarify I work with adolescent abusers.

Carey: Ohhh okay that makes sense.

Bond-Pushman: Yea so I don’t really know how that happened ha ha I got a job and I ended up

working with that population but it was good I got tons of training it’s important cuz I think that

subset of people they also need somebody to be helpful with them, because most of, not all, but

most of the adolescents I work with who are abusers have also been victims.

Carey: Oh yea I never really thought about that.

Bond-Pushman: Yea not all, but most, have something in their own trauma history that they’re

repeating that pattern and so they also need, you know, because now they’ve been labeled and

you know especially nowadays you hear something like sex offender and everybody’s eyes shoot

way open and we’re talking about teenagers here so it’s kind of a slippery slope to label

somebody who was also a victim as a sex offender I think we need to be careful. Most of these

kids not all are just really in need of treatment and some understanding and I worked with those

kids a lot in a residential treatment center and now I see kids on an outpatient basis more for step

down and they’ve already been through the residential piece and now I see them to make sure

there’s no relapse.
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Carey: So earlier you mentioned how not everyone ends up in a situation like that some people

are more resilient I know there are factors of resiliency where people might not suffer as much in

their adulthood do you know what affects whether someone deals with PTSD or not from it?

Bond-Pushman: Well I don’t have the statistics in front of me but from what I remember is um

things that really matter is if they if a victim tells somebody and somebody believes them that’s

very important and that can help lessen the effects. Most of the people that I’ve seen who were

not believed definitely blossom into PTSD and um also some other factors that will uh it depends

is things like how violent, how often, how you know a lot of my adult, especially women,

struggle with that they feel like they were consenting in some sort of way because there was a

bribe involved so they would feel like you know I really was willing because they said they’d

give me five dollars or you know whatever it was and it’s like right, but at that age you can’t

give consent because you don’t even know what sex is you’re saying you give consent but

legally you can’t even give consent at that age so.

Carey: Right, right. Yea

Bond-Pushman: So, not on you! But yea so factors like that you know just given like you know

if the abuse was something like it was my brother and we had a good relationship and I was a

more willing participant which again that gets into the guilt and shame you know but those

factors seem to kind of help and then you know some of it’s just kind of temperament and what

you’re born with and how resilient you are as a person like what kind of household you grew up

in what are you parents like are they supportive or are they negative all the time so i think all of

the kind of you know can help decide whether or not you’re going to end up on the “I had some
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anxiety but I went into treatment and I’m a pretty well-adjusted adult” or “I have PTSD my

whole life and still as an adult” and interestingly enough, just to show you, even what a trigger

can be, is I have one client who is an adult victim of sexual abuse and she is extremely triggered

by Donald Trump because of his views and what she feels he feels about women’s rights and as a

victim of sexual abuse she feels extremely triggered by that so that’s just an example of and her

kind of PTSD that she really struggles with that with just even having the president be who he is

and say some of the things he said and it’s just really really hard for her day in and day out. So

that’s not something I think most people think about, you know?

Carey: Mm hmm, yeah, wow.

Bond-Pushman: So that’s really interesting I think. But just to show you how the span of triggers

can be really far and wide in things that we might not even think about.

Carey: And I guess this goes with the believing or not, would I be correct in guessing that it

would be significantly more traumatic if it’s a parent, and the non-offending parent knows or

doesn’t know, have you found that to create any specific or significant issues?

Bond-Pushman: Are you asking if the non-offending parent knows about it and doesn’t

intervene?

Carey: Yea, yea

Bond-Pushman: Yea, again I don’t have statistics but again it’s about the child feeling some

support so if they know the non-offending parent knows about it but isn’t doing anything

anything that’s another betrayal right? I mean I’ve had lots of people say “I just don’t know if
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my mom knew, and she didn’t want to deal with it” or “How could she really not know!” you

know? It’s a tough one you know. So I think they do ask those questions but I think in

households where the child becomes vulnerable let’s say the parent is the father and you know

the child comes to the mother and says “Dad is doing abc” or “Your boyfriend is doing abc”

which seems to be more common and the mom doesn’t believe the child and still gives the

boyfriend or the father access to the child consistently that’s just another betrayal for the child,

like “not only was I not believed but it’s still happening”

Carey: I know this is a super general question, but how do you go about treating, well I guess not

anxiety, more PTSD, the only treatment I’ve really come across is the cognitive behavioral

therapy where you identify the problematic thoughts that lead the behaviors and try to change

those. I don’t know if there are other treatments or like what exactly you do.

Bond-Pushman: Yea, there are some other treatments that you might want to look up just for

reference in your research for example there’s a specific kind of CBT that’s actually called

trauma-focused CBT so that’s one that I was well-trained in when I was at the residential

treatment center and you know that’s for more complex kind of anxiety-driven trauma and um

cuz trauma can be really complex for a lot of people you know not easily treatable and then for

you know PTSD, CBT yes but you probably want to interject some other things there are other

kinds of treatments to look at I guess to bring in you know sometimes people use exposure

therapy as part of the CBT process but it’s kind of a different thread and that’s just having the

person detail what’s happened and then eventually after the exposure you get to a restructuring

where you try and get they’re less and less aroused by that for example with a client who feels

guilt or shame you might have them say something like, as they’re reliving this trauma
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experience, “he was holding me down and then I allowed him” or whatever and then you say

well alright let’s look at that thought as something like “and I did the best I could, even if what

happened I didn’t want”...

Carey: Okay, like a trauma narrative. I was reading about that

Bond-Pushman: Yea, yea. So more like a trauma narrative but also you know, part of it not just

the narrative part of it is trying to restructure the thoughts that go in there. And for, I think it was

veterans- I don’t work in the veteran population- but there’s a lot of, especially with the

nightmares, people do a lot of work around detailing their nightmares and then writing different

endings for their stories, which I’ve dabbled in with clients with mixed success rates I feel like

that actually worked better with kids and adolescents but it’s a way of kind of giving them more

control over the outcome and I’ve done some stuff with art having them draw pictures of

different outcomes. Another thing to look into which is not always used for PTSD but there can

be some parts that you bring in just depending on what you’re trying to accomplish but there’s

something called DBT which is dialectical behavioral therapy and that’s usually used for access

to borderline folks but sometimes people can incorporate things into that because it’s about

restructuring cognition and that can be helpful to some folks. And then with my folks, as part of

the CBT we always hit hard relaxation and ways to bring down the hyperarousal because you

can’t really work on trauma til you have a really good sort of subset of tools where people feel

like they’re really in control of their emotions that they can step on the gas or step on the brakes

in their own mind so we work on a lot of doing different things with breathing and imagery and I

use mindfulness which is sort of a newer buzzword in the therapeutic world. But lots of people

use pulled from those sorts of things just to get people calm enough to be able to do that and for
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some folks they also turn to medications for those purposes so that they feel like they have a little

extra support while they’re trying to do the work.

Carey: So those choose who to use medication to supplement their treatment do you see any

significant improvement or do you change your treatment at all?

Bond-Pushman: I don’t change my treatment at all unless the person is just so completely off the

charts anxious they’re just really not able to do the work then we just have to sort of keep getting

the arousal down and work with that. Medication is a mixed bag I mean it’s really a tough one it

seems really good for some people, for some people it doesn’t seem to be very effective at all. I

think if you look in the literature it kind of says that especially PTSD cuz it’s like people take

antidepressants and other things but I’m not sure they’re overly helpful for my clients I always

recommend, uh you probably read this on my website, I tend to work more body and mind

together, I kind of feel like more of a holistic. So I’m less about medication but not

anti-medication. I’m more about things like making sure we’re on a sleep schedule, getting

enough sleep, make sure our diet includes the things we need and we just eat sugar and carbs all

the time and expect our brain to function well! So yea I talk to people a lot about nutrition and

you know how to fit that in there’s a lot of research that suggests that sugar and some of the other

things that we eat are just really not good for people that have a lot of anxiety.

Carey: So you mentioned how you use the nutrition and just general health and sleeping at home.

Are there any other techniques or treatments you assign for your patients at home to deal with

their anxiety when they can’t see you or they have a flashback or some kind of episode?
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Bond-Pushman: Well they always know that they can call 911 if they need to haha. But

otherwise it’s really about practicing these things and the other thing I tell people is you know

with anxiety and panic attacks and things like that is they don’t last forever. They feel really

scary and they feel like you’re gonna die but you have to just use your techniques and kind of

hang on until it passes through. I really encourage people to work at that and to see the difference

between a flashback that may or may not last longer or something they feel like “oh I kind of got

in there and did some work around it” and once they’ve had some success under their belt that

seems to be helpful but yes I mean often times I’m sending people home with little homework

assignments at home and we’re practicing breathing and we’re doing things in the office and I’m

saying practice that because it’s much easier to practice when you’re not in a hyper-aroused state

and then when it comes you’ll be ready but you have to practice it and then sometimes people

don’t practice it and they don’t end up getting better. But it happens and it’s part of you know I

don’t know if you’re majoring in social work or whatever it is or you’re thinking about that for

your future but it’s part of self-determination it’s really up to the client it’s not up to us we’re

sort of like the tour guide you know.

Carey: Right, I definitely see that, and have been guilty of that haha.

Bond-Pushman: Hahaha yea. And you know I might have a client say to me “i want you to give

me more homework” and then they don’t do it! And it’s like people get busy especially adults

get busy and kids have a lot of homework now it’s not like it used to be but yea I really

encourage people to practice everything when they’re not in I think that for a lot of people yoga

is a really good activity to get into and I also encourage everybody that has anxiety depression

whatever to get out there and exercise you know whatever you like to do it doesn’t have to be
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you go to the gym you know five times a week but take a walk, call a friend, go for walk, you

know whatever floats your boat just whatever you like to do to get your body moving.

Carey: So I know we’re running out of time here just one last thing. I was wondering if there are

any- so I know you spent a lot of time in school and working in that residential treatment center-

are there any methods that you have chosen not to use or you’ve discovered on your own- I know

you said you had mixed results with the one thing- is there anything else that you have been

using in your treatments that might different from what you were taught or is especially helpful?

Bond-Pushman: Are you asking about theory or anything?

Carey: Oh anything

Bond-Pushman: One thing I think is important for people to know entering the field is that the

techniques and the theory is important, but relationship is also equally important and so um you

really can’t do any of this work if you don’t have a relationship with somebody. You can be the

best therapist in the universe and if your PTSD comes in and doesn’t connect with you or click

with you or trust you then you’re not going to be able to do the work. No matter how good you

are cuz you’re not going to build a good relationship with them. I just think that’s important to

know too and I actually do supervision on the side as a side business where I supervise people

who are trying to get their next higher level of licensure and I like to spend time talking with

people about that cuz that’s really important,​ that the relationship is a really important agent of

change​, and you can’t discount that. So that’s kind of another thing to think about. Have I found

anything particularly unhelpful that I learned? That’s a hard question and I’m like way past

school now hahaha cuz I graduated college in ‘98 and so I graduated high school in ‘94 so I
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don’t remember and probably a lot of it has even changed by now cuz I try to keep up with

things that are coming out. But there’s nothing that particularly comes up for me or stands out

like oh that didn’t work it’s the worst thing I ever learned. I actually feel like for me doing the

internships and things, getting the hands on experience was really important. Because there’s

only so much you can read about. So are you interested in this for a career or are you just kind of

doing this for a paper…?

Carey: Well I’m not sure. This class is a self-paced research study and it’s an elective for the

whole year in whatever topic you want so I did have to apply and do an interview to be able to

do this. I’m not quite sure what I want to do with my life, I’m kind of all over the place, but this

is a very important topic to me and the more I get into my research the more interested I am in

continuing it.

Bond-Pushman: Yea well you’re young you have time to figure it out. Are you a senior?

Carey: I’m in tenth grade actually.

Bond-Pushman: Oh you’re in tenth grade so you have a while to decide about college. Yea the

first two years of college are usually very general so you have some time.

Carey: Yea haha. Well I think that’s actually everything I wanted to cover. Thank you so much I

am so grateful!

Bond-Pushman: Oh no problem, I am happy to help. I hope it goes well, shoot me a text let me

know how your presentation goes.

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Carey: Alright! Thank you so much

Bond-Pushman: Alright take care bye-bye.

Reflection

I was really nervous for this interview, but I’m very happy with how it turned out. I have

a habit of talking extremely fast and unclear but I was able to slow down and be easy to

understand. I was happy with the extensive amount of information she provided me, and they led

perfectly into my other questions. She was very sweet and helpful and I am excited about

continuing a relationship and dialogue with her. I believe I prepared the best I could for this

interview, but reading over the transcript I see follow-up questions to her answers I wanted to

ask but couldn’t process in the moment, so I will write those down for my next interview. The

hardest part of the interview preparation process for me was coming up with intelligent questions

since because I am very limited in the information I can find because it is medical and

confidential, I didn’t have a good enough grasp on the subject to ask college-level questions.

Now that I have learned about other terms and treatments, I feel much better prepared for the

next interview. During the interview, however, it felt easy to build off of what she said and ask

pertinent questions.