Join a unique conversation with Helen and Valerie as they discuss the therapeutic relationship with Valerie’s psychiatrist of 28 years, Dr. Trey Aoueille. Their teamwork led to her recovery, and this is the story of their successful journey. You’ll also hear the answers to many questions that you’ve always wanted to ask a therapist.
Learn more about your ad choices. Visit megaphone.fm/adchoices
Relationships Part Two: The Therapeutic Relationship—Valerie’s Journey
Episode 3
Helen Sneed: Welcome to Mental Health Hope and Recovery. I'm Helen Sneed.
Valerie Milburn: And I'm Valerie Milburn.
Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational stories of recovery. Our knowledge is up close and personal.
Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals. But we are experts. We are experts in our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.
Helen Sneed: We live in recovery.
Valerie Milburn: So can you this podcast does not provide medical advice. The information presented is not intended to be a substitute for or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers with any health related questions you may have.
Helen Sneed: Episode 4 the Therapeutic Relationship of all the relationships in the journey to recovery, we've chosen the therapeutic first. It's the bedrock of hope and recovery for so many just two people alone in a room. A place where real intimacy is a sacred experience. As John Donahue said it, When I think of my own therapy, there seem to be two wildly conflicting goals. To tell the truth about myself and to avoid the shame and pain of doing so. I needed the right professional to guide me through my doubts and despair and to fan my often flickering hope. DW Winnicott said it brilliantly. It is a joy to be hidden and a disaster to not be found. I needed to be found. I could no longer survive in hiding. So I searched for a therapist with the empathy and understanding to help me find myself. I've been in individual therapy for 40 years. It's way more than half my life. But today is a first, the first opportunity to talk with a psychiatrist and his patient of 28 years. This will be a special, intimate episode. So let's begin. Valerie, tell us about our guest today.
Valerie Milburn: With pleasure. Our episode today is just beyond special for me because our guest is someone who has been the driving force in my recovery, Dr. Trey Allye. He has been my psychiatrist since 1993. During our 28 years of working together, we have navigated therapy and medications through the buildup to my psychiatric breakdown, through my five year crisis. And now we've journeyed the 21 years of my recovery together. I would not have the life I have today without his consistent medical and therapeutic care, his extraordinary compassion, insight and support. In the darkest moments, I had the faith and the trust to follow his lead throughout it all. Because of his wonderful sense of humor, we've had the gift of laughter and now I'm going to give you his bio. Dr. Alye is a fellow alumni of the University of Texas Hook em Horns. He went to medical school at the renowned Baylor College of Medicine in Houston and did a psychiatric residency at the University of Denver Health Science Center. He started his practice, his private practice in Boulder, Colorado in 1983 and has been in private practice in Austin, Texas since 1986. Welcome Dr. Alye. Thank you for joining us. And I do want to let everyone know that we're going to call you Trey because I've known you for so long, that's what I call you. So again, thanks for being here.
Dr. Trey Allye: Thank you very much, Valerie, and thank you Helen as well. I'm very touched to have been invited to join Yalls podcast and Valerie has certainly shared this experience of the podcast as well as all the other efforts she's put forth in the interest of supporting proper care for patients with mental illness. And it's quite a special thing. So thank you Valerie.
Dr. Trey Allye: I'm happy to be here.
Valerie Milburn: Well, as we head into our discussion, I do have to admit that I'm a bit nervous because this is quite a different setting for the two of us. I am just so excited. I just kind of don't even know where to begin. But we do have a first area we want to talk about and that's so we want to talk first about if someone is looking for a psychiatrist or therapist for the first time. I know our listeners going to be very interested in this. If you're looking for a therapist or psychiatrist for the first time, how do you evaluate the relationship to find the right fit?
Dr. Trey Allye: Well, it's a great question and you know, there's more than one answer I think in our work together over the last 28 years, really remarkable. I mean we've kind of grown up together over the course of time that we've enjoyed the opportunity to have that kind of consistency because I feel so grateful and appreciative of the opportunity that I've had to take care of people like you, Valerie, and many other patients. As I think about it at this juncture, I've been practicing psychiatry for 38 years and I enjoy the privilege of taking care of many, many of my patients for between 20 and 30 years. And so that has allowed the development of these long term trusting relationships that are so special and where I believe that that's the basis of really significant lasting change and Healing comes from in terms of evaluating that initial fit. I think it's so important for a patient or client entering into a therapy relationship to feel empowered and to know that they are hiring me, I'm working for them, and that I want them. I emphasize that a lot with folks and that it maybe feels a little bit different than a doctor patient relationship in another setting where there's not quite a level playing field so much. But I think in part, what you're saying is that I want to empower a patient to be able to say, now you're not the right doctor for me, and to know that that is a decision that lies in their hands. And I guess there's a lot of subjectives to that about whether a person feels an initial sense of connection or trust. I don't know. Not quite sure how to speak to those particulars, if that's part of what you're asking.
Valerie Milburn: Well, you mentioned trust, and I think that's really one particular that leads to talking about how can someone participate fully in their therapy. And the thing about trust is what I think we should focus on, and I have a story about that that I think you'll remember about how important trust is. That'll. Well, it's just. You and I were about a year and a half into our work together when I hit a wall for the first time and started into my crisis. And we had decided you had. And I had agreed that I needed to go into the hospital, and you were helping me decide. And we had chosen a hospital that focused on substance use disorder. And there was an area of my life that I had yet to share with you because there was so much shame surrounding it and so much fear of opening the wounds. But somehow, instinctively, I knew that a hospital based on substance use treatment was not the right place for me. And because I had the trust at that point, I was able to let that area of my life tumble out. And you made the decision with me that I needed to go to a trauma hospital, and it was just a game changer. And that was based on trust. And so I think talking about how someone can participate fully and find the right fit, like you said, is based on trust.
Dr. Trey Allye: Right. Well, that's. You know, I do have a recall of that time, and I think that you speak to something that several things that are really important. And one of the things I've been thinking about anticipating
Dr. Trey Allye: our talk today is something that one of my supervisors said to me or said to us in our class in Denver when we were residents. He said, well, you will learn from us, and you will learn from literature, and you will learn from conferences and trainings, but you will learn the most from your patients. And that's something that I've always taken to heart. And I think it illustrates that what you're describing in that vignette is a good illustration of that, because you and I were really working together at that point to identify what you needed and that, you know, I made an assumption that substance abuse treatment, because maybe that was the leading edge of what you were wrestling with, was the direction to go. But through that really, hopefully respectful and humble dialogue that we had, you helped me see that we needed to shift in a different direction and by your courage and capacity to be honest. And I think it speaks to something you said earlier, Helen, about how difficult it is to be able to open up in a therapy relationship. It really was a game changer in terms of shifting in that direction. I would have to say, I guess that would have been, what, 95 or 1995 or thereabouts. And it's one of the things that value. You know, honestly, you really paved the way for my, you know, growing and continuing to grow, understanding of the impact of trauma. And, you know, some of those things that you talked about and that you shared with me way back then really opened my eyes to something that is so often kept in the dark and that. That, you know, that journey continues to this day in terms of more and more knowledge about trauma, how powerful it is, and the tools that we have now to, you know, be more effective in treating that.
Helen Sneed: I was quite taken with something that you said early on about that you want the patient to feel empowered, which is something that I think can be very difficult for someone who's going in to see a therapist or a doctor for the first time. First of all, for me, and I think for many people, there's so much shame attached. There's the. The biases of society that you're even having to go in and do this. And so I never felt empowered. I was so downtrodden by the illnesses that I felt lucky that anyone with your stature would even see me. So I'm the one that threw it out of balance. But I came across something that. I wondered if you thought this sounded logical for someone who is looking for a therapist or doctor and kind of doesn't know how to go in. I just love this. It says, potential clients don't care about the acronyms behind your name. They care about these three things. Do I like you? Can I trust you? Can you Help me. And I was wondering if those are the kind of things that you think a potential patient should keep in mind going in to meet someone like you for the first time.
Dr. Trey Allye: Absolutely. You know, that's. That's right on. On the mark, Helen. And yeah, I think those are really good guidepost. And again, it speaks to the, you know, the fact that we really need to be on a. On a level playing field a lot, versus, like you were saying, kind of being intimidated by this notion that the doctor is this all powerful person that has, you know, allowed you to see him or something along those lines, versus recognizing that here are two people that are sitting down together and trying to craft a plan that is something that empowers a patient not just in terms of that choice
Dr. Trey Allye: of therapist, but also, you know, to identify what needs to happen in their own lives in order for them to heal and feel better. I can't talk about this without talking about my own experience with my own psychiatrist and how he validated many, many of these kinds of things. And, you know, I think one time I was giving him some grief about why he didn't anticipate something that was a path that created. Was problematic without going into a lot of details, but he said, well, I try not to get out ahead of you. I try to stay right with you. And so that kind of speaks to this idea that it's not the job of the doctor to make presumptions or to be all knowing. I've learned that it's really the job of the doctor to be right alongside the patient as opposed to being out ahead of the patient and making assumptions about what they think the patient needs. I mean, in some situations it's more apparent than others, but to really maintain a humility and a recognition that for one, I think it takes a long time to really get to know somebody, to really get to know them, and that we don't want to make assumptions about things that we think we know, that we really. That are not really validated.
Valerie Milburn: Yeah, we had. That's so interesting and so important, and we had a journey like that together. When I had said, I think I remember something like this happening, and you may have already known where I was going, and you let me discover that on my own time. And when I said that, you said, well, if you remember it, you'll remember it. And you didn't lead me down a path. You let me find my own journey down that path. And we did eventually get there, but you made no assumptions and you let me find it on my own time. And so what you're saying is exactly the path we took together. You said something a little while ago about talking about what needs to happen in a patient's life. And it makes me think about your approach to what needs to happen in your whole life, because you do look at the whole life like exercise, eating, sleeping, supplements, along with medication. And we're going to talk about medication in a minute. So let's talk about the importance of that, because I know a lot of people who see a psychiatrist on a regular basis. They don't have those discussions with their psychiatrist about the big picture of their life.
Dr. Trey Allye: Right, right, absolutely. And there's a couple of broader thoughts about that, as well as some specifics. You know, one of my colleagues who's just a wonderful clinician and teacher, her name is Sandra. Jan is the way she pronounced it. It's spelled as if. I mean, it's. It's spelled J, A, I, N, as if it would be pronounced Jane, but it's pronounced Jan. She's a psychologist here in town, and along with her husband Rakesh, who's a psychiatrist, are really very compassionate, brilliant thought leaders in our field. And several years ago, they developed this whole paradigm that I know, Valerie, you've heard me talk about a fair amount called Wild five. Sleep, exercise, nutrition, mindful meditation, and social connectedness. And so those are these elements that are key to our best efforts to take care of ourselves. And none of us are perfect in those regards, but those are things that are certainly kind of guideposts and goals that are worth striving for, particularly during the pandemic. One of the things that of many, many just awful elements of this and the psychological trauma of the pandemic, as well as just the actual impact of the virus
Dr. Trey Allye: that we've lost so much of the time, we've lost the usual structure that we have in our lives. And so I found, and I've talked with Sandra about this, and we talked early in the pandemic about how Wild five would be particularly useful as establishing for individuals establishing their own structure when so much of the rest of their usual daily structure has been removed as a result of the pandemic. So much of what we try to do, whether it be the therapy piece, medication, Wild five efforts, has to do with trying to establish and maintain as much resilience in our lives as possible.
Valerie Milburn: Mohelen and I definitely are resilient. Helen, you and I will say to each other every once in a while, we are survivors, so we understand the importance of resiliency. For sure.
Helen Sneed: I think now with the pandemic, it's been quite challenging to remain flexible enough, limber enough, I guess, to get through the restrictions of it when all these wild things that you're talking about, so.
Valerie Milburn: Many have been cut off, particularly whatever.
Helen Sneed: Yeah, the social media.
Dr. Trey Allye: One thing, right, A healthy relationship is defined by the capacity of the two to play in the space of the relationship. And so that. That's also something that I've held dear. And it's, you know, quite valuable because of, you know, the need to. To inject some playfulness and humor and lightness in the context of therapeutic relationships that can otherwise be so heavily burdened by such dark elements and painful elements in our lives.
Helen Sneed: Well, that was about my first question that I asked Valerie. I said, does he have a sense of humor?
Valerie Milburn: And that's why I mentioned that, that we've been blessed with the gift of laughter. We laugh often. I one time said, I've been doing so well, you know, I really think I could get off my medication. And Trey, you said to me, what, are you smoking crack? I mean, we've had some good laughs over the years over very serious things I've said, you know, so talking about laughter, we'll go to the other side of that and talk about something that is often very funny but is also very serious. And that's about medication. We wanted to talk about both the path to the right medication and the fact that medication is extremely difficult to manage and is not always the right answer. I know, Trey, you and I have talked about that. Actually, just this morning, we talked about that. I wanted to hear your thoughts on that and your comments. And Helen, of course, yours as well. You and I both have. Helen, you and I have a similar background with medication in that we've been. Been on a big mix and we've been stable for a long time. And that's not everybody's path. And so I really want to talk about that.
Dr. Trey Allye: Absolutely. So, you know, Valerie, I can't speak to that without thinking about your video that you recorded, Valerie's story where you talk about that diagnosis, your. How you came, or how we came to the diagnosis of bipolar disorder, which is often something that takes quite some time to get to and something that we have to kind of tease out in order to get to that accurate conclusion. And so that was certainly a process. And when I think back and look at the regimen of meds that have worked well for you, Barry, it was a kind of a, you know, as an empirical trial and error kind of process. In terms of finding the right meds that, you know, had an effectiveness that significantly outweighed side effects or, you know, tolerability issues. And that's always something that is critical. Sometimes patients will be prescribed meds by psychiatrists or other doctors and they'll take the medicines and put up with really unacceptable side effects because that's what the doctor told them to do. I think in our case, Valerie, by virtue of the fact that we had an ongoing rapport and dialogue, we could really partner together and you could share with me this one
Dr. Trey Allye: is not a workable one for us and we need to shift gears or modify or change doses and such. It also reminds me of another book. It was from a long, long time ago, again in my residency. And back then, in the late 70s, early 80s, the array of psychiatric meds that we had then versus now were just paltry. You know, they were just really just about a dozen or so, period. And, and so. But what holds hold true then still holds true now. This book was called the Art of Prescribing Psychiatric Medication. And so, you know, it's not the same as prescribing an antibiotic. It really is a very different kind of process. And so there's certainly the science, and we want to rely on the science as much as possible, but it also is an R as well that's crafted together with the therapy, with the, you know, therapeutic relationship, if that makes sense.
Valerie Milburn: It does. And. And you are an artist with it.
Dr. Trey Allye: I had some good teachers and I, you know, continue to, to try to learn as much as possible. But, you know, when you and I spoke briefly earlier, Valerie, we also talked about sometimes it's almost impossible to find the right medicine or a medicine that's well tolerated. We've got to recognize that, be humbled by that, not give up, but also really respect that. We have to leave no stone unturned in terms of a variety of therapeutic interventions. Medicine, non medicine, and it kind of circles back around to wild five some. But I think it also speaks to an area that we want to touch on and particularly as we're treating bipolar disorder. The two non pharmacologic cornerstones of treatment of bipolar disorder are sleep and sobriety without sleep. And it's true for other psychiatric disorders, but particularly for bipolar disorder without sleep and without sobriety. You can try a plethora of different medications, but you're just going to be swimming upstream the whole time if you can't nail those two things down.
Valerie Milburn: Right? And the importance of sobriety is so paramount that at One point. Well, you were the first one to send me to substance abuse treatment, and it was the beginning of the turnaround. It took me five years to get sober. But you stuck with me, and I stuck with it. And when I tell my story, I always say that. I always say, my psychiatrist says sleep and sobriety are the cornerstones of recovery from bipolar disorder, to live in recovery with bipolar disorder, and that. That you were the one who sent me to treatment for recovery, to get into recovery. I also tell the story about it being so important that at one point you pulled out a prescription pad and wrote 8 hours of sleep on a prescription pad. It's that important.
Helen Sneed: I have a question. We know that there are other treatment methods. We know. I mean, the efficacy of medication for me has been a life changer and a lifesaver, I would say. But there have been some other methods that have helped me almost as much. And I'm wondering, do you use or do you recommend other therapies or treatments such as EMDR and DBT and intensive outpatient programs, that kind of thing, in conjunction with talk therapy and medication?
Dr. Trey Allye: Absolutely. It's great question. Helen and Valerie and I actually touched on that before we started the podcast today. Absolutely. And that DBT Dialectic Behavioral therapy is a very accessible kind of therapy. And you're referring to iops, intensive outpatient programs. It's often used as a standard and effective, reliable, reproducible treatment modality in those settings, both for psychiatric illness, mood disorder, as well as substance abuse disorder. EMDR is a whole nother world. And that EMDR
Dr. Trey Allye: is really remarkable. I have a number of friends and family, fellow clinicians, that are really masters at using emdr. And the more I see that and more I learn about it, Valerie, you and I talked about that, and I referred you at one point to one of our colleagues, Sonja, who I've sent many, many patients to for emdr. And it's truly remarkable. And I was going back and reading a bit about that, the EMDR stuff and the origins of that, and that that came about kind of along, you know, some of the same time, the late 80s. This one does a PhD actually. She's a PhD in English literature. Francine Shapiro was the one who kind of serendipitously discovered that eye movement had a healing effect on her dealing with her own trauma. And from that stem this whole science of emdr. It's really impressive. So, great question. And absolutely, absolutely, yes, EMDR was the.
Valerie Milburn: Beginning of the real healing from my trauma. And your referral was. Was just One of the most powerful things to help me get into recovery with my trauma. I can't believe that it is time to wrap up today's episode. I feel like we could go on for another hour about, you know, through this rich conversation. But, you know, Trey, just thank you so much for being with us today. I know our listeners have gotten a lot out of this. I know Helen and I have. And it's just like icing on the cake for the time that we have spent together over the years to have had this time with you and for you to share your time with the two of us today. So thank you so much.
Dr. Trey Allye: Oh, it's been my pleasure. And, Ellen, it's a pleasure to have met you for the first time. And, well, like you say, Valerie, we could talk for a long time about a lot of these things, and everything we talk about kind of triggers another thought or possible direction. I'll just have to close by saying, you know, when Valerie asked me if I was interested in doing this, you know, this, the podcast or presenting is not my forte, so. So initially, I expressed a little reluctance. But as has been true in other situations with Valerie, when Valerie tells me I really need to do something, it's usually the right thing to do.
Helen Sneed: See, he must be obeyed.
Dr. Trey Allye: I can think of a few other situations about referrals and such when I may have expressed some reluctance in the beginning, but it just speaks to Valerie, you know, when you. When you tell me something, I need to trust my gut and listen to what you tell me. So that's paid off today as well as it has at other times in the past. So thank you all very much. Well, thank you. And, yeah, good luck with what you're doing. I'm so happy you guys are doing this, and I'd be happy to be helpful in any other way I might be in the future.
Valerie Milburn: Well, thank you. And we're going to circle back to one of the Wild five, the importance of mindfulness, as we end each episode with the mindfulness practice. And what is mindfulness? Well, it's an ancient practice used by many cultures. And basically, mindfulness is a mental state achieved by focusing one's awareness on the present moment while calmly acknowledging and accepting one's feelings, thoughts, and bodily sensations. Today we're going to practice mindful driving, driving calmly. So if you are driving, you can practice this with me. And if you're not driving, you can take in the exercise so that you can practice it the next time you're behind the wheel. There's nothing like heavy traffic and impatient drivers to make stress levels soar. And the worse the traffic, the worse the stress. Austin, where we all live, has some hellacious traffic resulting in some unserine drivers. But it doesn't have to be like that. In fact, sitting in traffic in a traffic jam can be an excellent opportunity to build your mindfulness muscle, increase your sense of connection to others. And I'm going to explain that. And
Valerie Milburn: to maintain your serenity, we're going to go through the steps to a simple behind the wheel practice. And this is adapted from Mindful magazine. So here we go. First, take a deep breath. That's simple, yet profound. Because the moment it takes to breathe deeply allows us time for a change in perspective and a different choice. So take that deep breath now. Ask yourself what you need. It may be that in this moment you need to feel safe, at ease, or you just need some relief. Understanding what you need will bring balance. Ask yourself what you need. Give yourself what you need. If ease is what you need, you can scan your body for any tension and soften any tension or adjust your body as needed. Speak self compassion, such as, may I be at ease, May I feel safe, may I be happy? Now look around and recognize that all the other drivers are just like you. Everyone on the road wants the same thing you do. To feel safe, have a sense of ease, and to be happy. You'll probably see a few fellow drivers who look a bit agitated. But you know what? You might also catch that driver who is singing or actually smiling. And this is going to lessen your own stress immediately. You can apply to all the drivers what you just offered to yourself, saying, may you be at ease, may you feel safe, may you be happy. Take another deep breath. In 15 seconds or less, you can turn around your mood by applying these simple tips. When you feel frustration of traffic rising, choose what you need to work on and offer that condition to others. If you need to feel safe, say, may I be safe, may you be safe, may we all be safe. Breathe in, breathe out. Spread happiness.
Helen Sneed: Oh, thank you, Valerie. I think that I now have the capacity to improve my mood as a driver. But I have no skills, so I'm still in the same boat. I am so reluctant to bring this episode to a close and yet I must. It's been a revelation. I've learned things I've never known before and many things I think that will help me become more productive in my own therapy. So thank you, Trey, for giving us your time and incredible knowledge. And Valerie, your courage and candor, your willingness to discuss. Your process with all of us is a rare and precious gift. You've also laid the groundwork for our upcoming episode five, family Relationships. Please join us as we explore the complexities of family ties and family history, the almost inestimable impact of family on mental health and on the struggle and achievement of recovery.
Valerie Milburn: Thank you to our listeners. As always, it's an honor that you have spent your time with us.
Helen Sneed: And now I will leave you with our favorite word, onward.