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Keith Bonnes, Psy.D. - Guest
Keith Bonnes, Psy.D. is a clinical psychologist and an Air Force (deployed Army) blue to green veteran of the Iraq war. Keith has worked extensively with veterans, as well as civilian individuals impacted by trauma and their families and now works at Growing Together Preventative Psychological Services in the San Francisco Bay Area East Bay https://growingtogetherpps.com, which provides a range of community based treatments including work with individuals, children, families, couples, and groups. He is also working to establish a training program and curriculum, and to take on more teaching and public speaking opportunities to help develop the clinical skills of early career clinical doctorate and master level trainees and provide an exceptional training experience as a training center. He works from a humanistic, client centered, trauma informed phenomenological approach, meeting the client where they are, and connecting with their experience, and then integrating modalities of treatment and interventions to fit for the clients perspective of the world. Keith uses insights from humanistic practitioners and the concept of hierarchy of needs, self actualization, and empathic attunement as a building principal along with cultural humility in his work with clients to ensure a holistic approach to the clients experience is considered. |
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W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D. (00:24):
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:32):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D. (02:20):
Today, I'll be speaking with Keith Bonds Psy.D., who is a clinical psychologist and an Air Force deployed army blue to green veteran of the Iraq War. Keith has worked extensively with veterans and their families, and now works at the Hume Center in the San Francisco Bay area in the East Bay. The Hume Center is a nonprofit that provides a range of community-based treatments, including full service partnership with homeless individuals, outpatient services, and partial hospitalization programs, and many other community-based services and programs. He is also a trainer with the human Center working to help develop the clinical skills of early career clinical trainees and to provide an excellent training experience as a behavioral training center. He works from a humanistic client-centered phenomenological approach, meeting the client where they are and connecting with their experience, and then integrating modalities of treatment and interventions to fit the client's perspective of the world. Keith uses Maslow's hierarchy of needs as a building principle along with cultural humility in his work with clients to ensure a holistic approach to the client's experience is considered. Let's listen to the interview.
Keith Sutton, Psy.D. (03:27):
Well, hi Keith. Thanks for joining us today.
Keith Bonnes, Psy.D. (03:30):
Oh, thank you for having me.
Keith Sutton, Psy.D. (03:31):
Always nice to meet another Keith.
Keith Bonnes, Psy.D. (03:35):
It's very rare, actually. In my experience, I don't meet a lot of Keith, so it's nice.
Keith Sutton, Psy.D. (03:39):
There's not too many of us out there. So I learned about your work from a colleague of mine Keith Fel, who had mentioned that you have experience working with families and working with veterans, and we've been talking about, you know, you doing a talk for our organization, the Association of Family Therapists of Northern California. And so I'd love to hear about you know--especially too with what's, you know, recently with the exit from Afghanistan and so on-- It's just been making me think about military families and people that are, are also going through that experience. And so yeah, would love to hear about your work and your thoughts on working with folks in the military and their families and systems. But first I'd love to hear about your background and kind of the evolution of your thinking, how you got to kind of thinking about the work that you're doing now. So yeah. Well, welcome.
Keith Bonnes, Psy.D. (04:34):
Thank you. Thank you again. Yeah, so I -- a little bit about my history -- I'm a veteran and I'm married to a veteran as well. I met her in the military, and we've spent a lot of our life together at this point. And we met each other very young, and we ended up deploying together as well. We did similar jobs in the military, and so in that experience we were in during kind of the height of the Iraq war, and there was a severe shortage of personnel available to carry out convoy security personnel and convoy duty in at that time the army was quite taxed, and so they reached into the Air Force, and my wife and I were both in the Air Force at the time, and they cross trained us.
Keith Bonnes, Psy.D. (05:35):
So this is what we commonly call "blue to green" and we got trained as gun truck operators and security personnel. We ended up deploying together. Some circumstances-- the Air Force doesn't generally like to deploy husband and wife but some circumstances came up that had us deploy together, which was a very unique situation in and of itself. So we spent around eight months deployed, all told, and it was a very violent time in the war. Oh, wow. And we experienced quite a bit of you know, mortar rounds and small arms fire, but we also experienced a lot of attacks off base. And me personally, I did not experience any of that. I experienced the mortars on base and a lot of that because my duty was mostly support around doing electrical work and setting up the base.
Keith Bonnes, Psy.D. (06:41):
My wife, on the other hand, did a lot of convoys up and down one of the most dangerous highways. And so during our time together around October, her truck was hit by a roadside bomb. And thankfully, the casualties was more superficial. It wasn't anything, no one died in that attack. But,it was an intense situation for me; I was on base listening to the radio chatter of her incident, and that they were taking casualties and they didn't know how bad it was. You can't just jump in a car and go drive to her, so you're kind of stuck listening to a very hectic scene, play out on the radio. And she was airlifted to a military base-- severe whiplash and concussion. And at the time, this is in 2005, traumatic brain injuries were not being heavily examined.
Keith Bonnes, Psy.D. (07:48):
And so we suspect[ed] she had some traumatic brain injury since the explosion happened right at her truck. And within a second or two sooner, it would have-- all of the ball bearings would have pierced the entire truck. Thankfully, it went right behind the cab.
Keith Sutton, Psy.D. (08:09):
Wow.
Keith Bonnes, Psy.D. (08:10):
--blew out all of the brakes and tires, and she was the driver. So she navigated heroically her team through kind of the-- what we would call, commonly call "the kill zone" as they would disable a vehicle and then use small arms fire to clean up. And so she drove on one tire, essentially, and laid it over outside on an embankment. And everybody landed on top of her. And so she took a lot of damage that way as well.
Keith Bonnes, Psy.D. (08:39):
So fast forward we come home stateside and even in 2005, PTSD was still more of an academic understanding. It really hadn't hit the mainstream of therapy, and so she was getting seen because she was having some kind of reverberations from that experience that were still bubbling up. She was put in a situation that-- he decided that--her therapist at the time, I think he was fairly new-- decided to try out exposure therapy and put her in a similar truck and set off some M80 explosives around her.
Keith Sutton, Psy.D. (09:22):
Oh, wow.
Keith Bonnes, Psy.D. (09:22):
Which, as you can imagine, understanding what we know now, completely destabilized her and brought the trauma home. And it made what we were experiencing at home much worse. But again, we didn't know what we didn't know back then and so we got out of the military and we went back to school. The stress of school seemed to be a major kind of impingement moment for her when it came to managing whatever she was dealing with underneath the surface.
Keith Bonnes, Psy.D. (09:53):
She went into a deep, long depression. At the time I was in marketing, trying to get my degree in marketing. And so we thought it was the school and the travel. So we got out of that school and we went to a different one; we went to a community college, much smaller stakes and closer to home. And at the time we were living in the South Bay Area. The first couple quarters, I don't know the newness of it all, it seemed to abate. And then the depression came back with ferocity, and she went into a really deep, deep dark depression. And during this time, I've never seen her like this. She's the person in my life that had always been my grounding force and my stabilizing force, so I didn't know what to do.
Keith Bonnes, Psy.D. (10:41):
And at the time, at this point, I had switched out of marketing because at community college, they don't have marketing per se, but I was in business. And because of her experiences on base those years prior, she was adamant that she would not go and be seen by a psychologist again. She just couldn't trust the process the same way. . And so I didn't really know if I had any other options, so I dropped out of business and switched my major to psychology, is what happened. And I started taking classes-- really, I don't know how often I --I'm privileged in many ways because of the fact that I went to the military. They were willing to pay for me, so I was taking classes not really with a career in mind, [but] I was taking it simply as a place to go and learn what was going on.
Keith Bonnes, Psy.D. (11:30):
Then I would come back and teach this stuff to her; I would just run home and I would teach her the day's lesson and I was taking, I took every psychology class that they offered at DeAnza Community College, a wonderful school. Through that process I was learning quite a bit. I mean, I was attaching everything to real world experience, and I was being at home. And at the same time, I had several friends that I had served with struggling, and so I was not only teaching her, but I was teaching my friends, and I was talking them through a lot of really tough transitions themselves. Ultimately that kind of started me on this path. I ended up helping my wife manage her PTSD. It does have a happy story in that she really got an understanding, a deep understanding of PTSD and taught me a lot about it.
Keith Bonnes, Psy.D. (12:27):
And through that kind of process, I felt like, "well, I have all this knowledge, I should probably just keep pursuing it"; even though it was a liberal arts degree, I could have toggled at some point, but I actually found that I liked it and I enjoyed it, and so that brought me to it. And so then I went into grad school and pursued it at a doctorate level. And again, I'm thankful that the VA was able to put me into a program that would help pay for that and give me enough money that I could focus solely on that. And so that's kind of how I got my start; I kind of backed into it, never really-- all along knowing that this was going to be what I was going to do. But when you see that there's something you know-- and since I'm speaking to an audience of clinicians and therapists-- there's something that's unspeakable, I can't put words to, about watching someone go through their own transformation and to be witness to that.
Keith Bonnes, Psy.D. (13:36):
My wife put the work in, I want to be very clear about that. She put in all the hard work. I got to witness it though. And yeah, that's a gift that makes the work and the challenges that this field presents worth it, in my view. Yeah.
Keith Sutton, Psy.D. (13:53):
Well, it sounds like it really, you, you went into this out of necessity and really getting the help and going through that process together to really kind of have that experience. So many of us go into this field because of our own experiences and trying to understand or gain tools or so on. Sometimes that might be after the effect of our kind of experiences or trying to help someone else. But that's so great that you were able to do that and to do that work, and she was able to do that work, together. I mean--and particularly too-- and being able to help her helping her, and I'm sure her helping you developing your abilities.
Keith Bonnes, Psy.D. (14:34):
Yeah. Yeah. Absolutely. And, you know, at the time, my own history with trauma and my experiences growing up and you know, I had brief moments of homelessness and things that have brought me to where I was into the military. So that wasn't really the foreground of what I was exploring, but through that process, I was learning a lot about myself and my own history and my own reactions. And it was a very auto-didacted therapy experience in many ways. And I had already had some therapy in my past, but it was never on this level. And because I was doing it for a class and then I was attaching-- every paper I wrote was very personal, and I really made, I tried to make it as much about my own growth and my wife's growth as much as possible to maximize my time with this.
Keith Bonnes, Psy.D. (15:33):
I didn't really know what it would turn into, but yeah, certainly. I found myself-- I do connect with those that have come in searching for answers for themselves or loved ones. I also learned those hard lessons, right. That once I had the success with my wife-- I had lost some friends to suicide--I learned really hard lessons that you can't save everyone. And sometimes the therapeutic frame is not possible when you're too close to someone, and those are lessons also were part of my growth.
Keith Sutton, Psy.D. (16:10):
Definitely. Well, and I think too, as you're saying that the field was still kind of developing around PTSD and I remember years ago we had another Keith, actually, Keith Armstrong from the VA in San Francisco here, who wrote a book, 'Courage After Fire', was talking about how the VA was a bit ill-equipped and the therapist, because they had mostly been working with Vietnam veterans. So they were all these therapists, oftentimes in their thirties, forties or so on, working with folks that had been in a war decades before, sometimes before they were even born. And now all of a sudden they were working with veterans who had just come out of the war in Iraq and Afghanistan, and there was kind of a different situation that they needed to kind of adapt to and learn and understand how to help support those folks who hadn't been living with PTSD for 10-20 years.
Keith Bonnes, Psy.D. (17:10):
Yeah, certainly. I-- and Keith's book is fantastic. I could not recommend it more to help understand a little bit of this experience. And I think that that was one of my early benefits when I was working with veterans exclusively. I worked with combat trauma and military sexual trauma. And I worked with a lot of Vietnam veterans and I'm a little bit of an older-- I went into the military a little bit older. I went into this field a little bit older, so I've had some life experiences before I came in, but I think the main thing was I was willing to see war through different lenses. I was willing to set aside my understanding of war from Iraq. And even still, I won't dare say I understand what the Afghanistan war was like-- I wasn't there. And, and there's, there's different layers to even the Iraq experience.
Keith Bonnes, Psy.D. (18:09):
Then you go to Vietnam and there's so many different layers added to that, right? You have the draft involvement in that. You have the unbelievable amount of death and injury and loss. I mean Iraq and Afghanistan-- I don't know the most recent numbers-- but we're not talking much more than 3,000-4,000 deaths in 10+ years. And yet you know, Vietnam was 55,000 deaths and even more injuries. Our ability to battlefield triage was just completely different than back then, than it is now. Many lives were lost simply because they didn't have the resources. And so you're talking about a layer of understanding there and then you talk about the experience of coming home and the not being welcomed.
Keith Bonnes, Psy.D. (19:08):
I mean, when we came back, we were given first class seats and people stood and cheered for us while we were in uniform; the Vietnam veterans did not have that experience. Many of them that I spoke with really felt shame around their service and weren't able to hold that. When you do something for a country and sacrifice so much of your own morals and values to protect a country. To go through those experiences and to come home and not be well received, to be called a baby-killer, and many other things. It's a whole different level of trauma that you have to attune to, and you add in other intersectionalities of race. I mean, I worked with a lot of people of color that didn't join, weren't welcomed in the country before they joined, went and fought a war that they didn't want to be at, and came home to a country that didn't value their service. That's just a really, really, really tough, tough experience to live with. Many of these men are 70 years old and carried this without ever talking about it. You know, I met many people that their very first therapy experience was with me, and they're in their mid seventies .
Keith Sutton, Psy.D. (20:38):
Yeah, and I think you're going to talk about this-- the dual family system paradigm-- but my father actually was a Vietnam vet. He was a marine recon and got the purple heart. It wasn't until they did the welcome home parade in the eighties that they actually,-- he was in back, they put him in the battalions kind of walking together, and so many people had not realized the other was still alive because they just hadn't kept that connection. I think there was also not only just coming back and getting that reception, but a lot of message of being told to be shameful of being a soldier or so on. And that aspect and the [mumble] after giving so much love for your country and then having your country-- many people feeling like the country hated them.
Keith Bonnes, Psy.D. (21:28):
Yeah, yeah. You know your father's service is admirable. I know what marine recons, I've heard many stories. I've worked with several of them. And that is-- it's hard for, for anyone who is not initiated into the military culture to fathom what that experience is like, and even with some initiation and my own experiences, it's still hard to wrap my mind around sleeping inches from the enemy or enemy combatants and often being alone in these situations in a foreign country and not knowing if they're going to find you.
Keith Sutton, Psy.D. (22:17):
--behind enemy lines--
Keith Bonnes, Psy.D. (22:18):
--sides, It's just, yeah. And I do want to talk about the competing family systems. The military training experience is a programming in many ways that makes you an effective weapon for the United States government. And they teach you to channel indecision into aggression, and fear into aggression, and sadness into aggression. They teach you to make these adaptive-- and I'm not saying that that's wrong, those are very adaptive-- programming needed in order to survive in those conditions.
Keith Sutton, Psy.D. (22:55):
Survival; Yeah, exactly.
Keith Bonnes, Psy.D. (22:57):
And you do this with people from all over the country and small units or large units even. And you bond over these experiences that no one can quite understand what that experience is like to be-- whether that's very beginning basic training or whether that's training before you deploy. You go to war and you experience things that in many ways you hold shame over. I remember sitting with several gentlemen that would talk about the behaviors they did in the fog of war, and there's so much shame tied to that. And so you don't want to bring that to your family. And the only people who could understand what it's like to put an ear on a necklace or any of the other horrific things we've heard about come out in documentaries or stories since, are people who were there and know what that was like, and know what it's like to live in that level of aggression and to be drawn down to fight or flight at that level of survival.
Keith Bonnes, Psy.D. (24:08):
And so you build this really tight knit bond, and I'm going to borrow from Maslow a little bit when I say "peak experience", but, you know-- he talked about that often in a more, you know, positive light, but I mean-- "peak experiences" here as well, right? These are flashbulb memories that many of these individuals have that are linked to an experience unique to only a handful of people, and they come home whether that's Vietnam or Iraq and Afghanistan, and they're trying to reintegrate to a family system that didn't have that experience, and don't change while you're gone. In many ways, it's a blip in the radar of their life; They suffered. They feel like they deployed with you and they're right. Their emotional suffering should be validated as well.
Keith Bonnes, Psy.D. (24:57):
And yet there's something different about that individual, and they can't quite wrap their mind around it. And that individual knows there's something different about them too. I'm not even talking big T trauma in many ways. I mean, PTSD can be a part of this, but just the experiences you have change you, and you come home and you try to reintegrate, and it's not a natural process, and there is no government program that helps you reintegrate or deprogram you or helps you kind of learn to take that aggression now and channel it back into an emotionally focused sadness or fear.
Keith Sutton, Psy.D. (25:37):
Yeah. More of those vulnerable emotions, which were--
Keith Bonnes, Psy.D. (25:39):
Yeah, bring those back forward, right?
Keith Bonnes, Psy.D. (25:42):
There's just not a manual to do that again. I would say that has been a bulk of my work when I work with veterans is to rewire and reconnect the emotional-- the more vulnerable emotions in them. I'm sure you've heard it, we often use the metaphor that if you try to shut down that pervasive fear or looming dread of PTSD, you end up shutting down the whole warehouse lights; you shut off the good emotions and the bad, right? And the thing is that to be able to really feel that fear again, and to really attend to it, you have to wade through a lot of programming and a lot of conditioning. We all can kind of understand what social conditioning does to us, but we haven't had a very purposeful and well designed behavioral conditioning in the way that the military does.
Keith Bonnes, Psy.D. (26:34):
And so that care is part of it, and that family reintegration is part of it. But there's also another piece that's also part of it, which is you've been trained to be a collective, right? When one person messes up, everybody does pushups. When, when one person makes a mistake, we all suffer, and it could be life threatening. The level of threat of that is hard to understand for many individuals. You know families can say, "oh, it's not that serious that we're running late," but to a veteran that's been programmed, that being late means possible death or losing a teammate, it is that important. And that's on a very, you know, autonomic and nervous center system activation. So it's hard for them to even put words to what they're experiencing there.
Keith Sutton, Psy.D. (27:25):
Well, I imagine too, there's got to be a-- like you're saying with the family system-- and then they've got kind of that the military family system or that that kind of connection, that bond, that camaraderie, that kind of programming that, when you bring that in too--if you're taught that "we're a unit", "we're all together," that coming home and having relationships where we have differences and people aren't listening to other people or so on, or wanting to do their own thing-- I wonder if that also plays out to be feel like a rejection or like almost a kind of like a disconnection or so on at all.
Keith Bonnes, Psy.D. (28:01):
I just certainly imagine it would, and I can understand why. If we talk about the family system when it comes to diffusion of anxiety, if the whole family system is experienced, this, the diffusion of anxiety feels welcome in many ways because we're all moving that around. We all were there, we saw what happened, we're all kind of swimming in the same suit. But when that individual comes home, and what I often dealt with working with their families is, it's too intense for that family system. That family system cannot carry the load of that level of anxiety anymore. And the veteran is also trying to be protective of their family, so they're trying not to put too much of their stuff, so what are they, what have they been trained to do? Swallow it down, but where does that turn?
Keith Bonnes, Psy.D. (28:46):
It turns back to that same aggression that's not pro-social anymore, and it doesn't fit in a civilized society. And so, you're right, the rejection just becomes this hall of mirrors of rejection, right? It becomes, "I'm rejected in my family," "I'm rejected by society". And especially when you're talking about Vietnam veterans dealing with the rejection that they experienced now that they've had it in their face. I mean, at least for the Iraq and Afghanistan, for the most part their service is valued and respected and appreciated. And I've heard, "thank you for your service" a lot in my life, which is a little bit of also a challenging place to be. Because what, what does that mean? You know, are you thanking me for my sacrifice? Are you thanking me for being willing to do it? And that's a whole different layer to that as well. And so, yeah. I mean those are really vulnerable experiences to feel rejected by your own family and to feel like you don't fit. And then to have a service, but you don't fit there anymore. Especially if you have PTSD and you've been discharged from the service as a result. Now, you don't have anything to attach into. And it's a very destabilizing experience.
Keith Sutton, Psy.D. (30:00):
They're kind of feeling disconnected from both worlds and not fitting in anywhere anymore.
Keith Bonnes, Psy.D. (30:06):
Certainly. And then you turn to something like the VA and they want to give you standardized manualized, CPT or something else-- care. And while I understand the perspective of why you would want to do that. You're again, not helping to deprogram the collective mind. You're not re-individualizing them, you're not helping them ground themselves back in an individual experience, but they don't have a collective experience to share anymore. And so these competing values against just kind of make you feel more hopeless, more lost, more on your own. And for the individuals that I've worked with, but also my friends and family that have experienced this, it's just another reminder that nobody wants to see you for you. And that is a very tough thing to feel, you know, I think many populations can actually attune to that feeling of pure rejection and invalidation.
Keith Sutton, Psy.D. (31:08):
Yeah. So kind of the individual treatment, you know, for the trauma ends up missing that piece of the disconnect of the kind of attachment with either the family or with other veterans or so on, is kind of what you're saying. Like that it kind of tries to section out that part, but kind of maybe leaves out those-- that other aspect.
Keith Bonnes, Psy.D. (31:31):
Yeah. I would say when in my experience the VA offers a lot of group therapies and a lot of manualized treatments, evidence-based, this is our new point phrase that we love to follow. But the challenge with that is when we talk about evidence, in order to have evidence, it has to be done the same way, or at least within the, you know, means of error so that it can be evidence-based. And so when you have standardized care, you're missing the individual many times. And interventions, in my view, are individualized. And when you look at a CPT manual, it's like 800 pages and it has a script of what you're supposed to read. And for an individual that's experiencing a loss of attachment to anything that's grounding and feeling on their own, and feeling unvalued to have somebody literally read a manual to you is pretty insulting.
Keith Bonnes, Psy.D. (32:33):
It feels even more de-identified. And I think that that is a real big challenge because we also have to recognize that the VA can only produce so many clinicians, and people have to want to go into this field and want to work with a really difficult population. I mean, again, and I would like to talk about homeless and later too, this is very similar. We're talking about some of the hardest trauma stories you're going to hear. I mean, the trauma stories I've heard I still stick with me, you know, and I hear that all day every day. You know, that's a big challenge.
Keith Sutton, Psy.D. (33:14):
What-- tell me about the approach that you use in your thinking, in your work with clients. Yeah. What approach do you use or any theoretical orientations that you're guided by?
Keith Bonnes, Psy.D. (33:25):
So I am definitely going to be the person that is using a little bit of all of the approaches for what fits the client. I know that's the integrationist or eclectic view is often looked at as some kind of a jack of all trade, master of none or an answer you give when you don't want to be asked about a particular theory or-- I actually mean it in this way. I try to-- my view of therapy and the people I train will probably roll their eyes if they listen to this. I say so often my view of therapy is therapy is a distillation of the most basic form of relationship. We provide a relationship to practice on in many ways by withholding a lot of our stuff. We don't compete with their challenges, with our challenges.
Keith Bonnes, Psy.D. (34:20):
We don't bring that into the relationship. We try to keep the focus on them. And as a result of that, my job and my view is to calibrate my understanding of how your metaphors and your analogies and the language you use, the ways in which you orient yourself to the world. And once I've understood that, if you're more of an intellectualized person, I might pull out a CBT intervention or a CBT perspective. If you're really attuned to your childhood or something that's happened in your life, I might go into that more psychodynamic depth work just to follow you wherever you want to be. If I hear you talking about your life in a very narrative form, I'm going to pull out narrative and we're going to talk about the hero's journey, right? It is-- I'm trying to make sure I'm speaking their language and not making them have to come the distance to speak mine as much as possible.
Keith Bonnes, Psy.D. (35:11):
And in that process, I'm calibrating what interventions make sense. I'm not looking at a book and reading this intervention, you should journal. I'm looking at what ways are they coping or what are their defenses that are maladaptive, but what's the intent behind that? Where did that go wrong for them? That obviously is something they're using. So maybe I should kind of work backwards from that instead of trying to wholesale teach them techniques that are brand new to them. Now, some people want that, but for the most part, people want to stick with what they're comfortable with.
Keith Sutton, Psy.D. (35:48):
Or, so trying to kind of connect with the client and get a sense of them and what might be kind of most fitting for them or what they might engage with most or what might fit with their worldview and being kind of flexible and integrative to kind of match that.
Keith Bonnes, Psy.D. (36:03):
Certainly, I mean, I think theories are wonderful. I often, when I do train, I often talk about common factors and the ways in which there's many components to this that you can attend to. And me personally, I'm humanistic. I'm very drawn to Maslow's hierarchy of needs and how that affects people. And where that can take therapy if you attend to certain levels. I'm also very big into Husserl’s phenomenological view of people. And so I'm willing to believe your reality, which isn't always easy. And as I often say, the hardest intervention in my view is Carl Rogers’ unconditional positive regard. It is so challenging To stay in that zone and to live in that experience through therapy. And it's not just within that session, right?
Keith Bonnes, Psy.D. (37:02):
It’s-- I could have a session where somebody's complaining about their grades and getting a bad grade, which I have to give that the full weight of what their emotional experience is. But then I go from that into a trauma story, the very next session, and I have to also equally give that the same weight, and then I can go to the next session and it could be something completely different. And each of those experiences need me to have unconditional positive regard, need me to have full empathic attunement. That's the challenge of that particular modality.
Keith Sutton, Psy.D. (37:34):
Being the client and the client's experience and them feeling seen by you?
Keith Bonnes, Psy.D. (37:38):
Mmhmm.
Keith Sutton, Psy.D. (37:40):
Yeah. Now, tell me a little bit about you know, you were talking about Maslow's hierarchy of needs, and I know when we were talking earlier, you were talking about the work that you do in community mental health and clients who are struggling with homelessness and also the intersectionality with veterans.
Keith Bonnes, Psy.D. (37:56):
Yeah. Thank you. Yeah. I do-- I've been working for the past three years with the Hume Center and a nonprofit that does amazing work in the community to working with people with severe mental illness and chronic homelessness programs. And the intersectionality was really apparent to me for one severe mental illness work is a lot of trauma work, and it's a lot of relational work. And many times that's the skill is just to build a relationship and try to hold it for any sustained period of time. And going through the ups and downs of their own experience of life and to be there. But I also see in the same way, kind of these systemic barriers to kind of cresting that hill. And It's not that I say that in a place that I don't understand.
Keith Bonnes, Psy.D. (38:55):
I get why that exists. But for chronic homelessness and the veteran community those individuals may not be able to qualify for VA because of various behavioral issues or before PTSD was truly understood, they may have, have acted out in a way that got them discharged and other than honorable or dishonorable, and now they're not able to get the housing support they need. And they kind of go back into the community mental health particular pipeline for support. And the barriers are pretty apparent when you start to sit with the idea of “why do some people still want to live on the streets when we have options?” You know, we’ve had many initiatives in the last few years that have really tried to target getting PE as many people off the streets as possible and indoors and housed.
Keith Bonnes, Psy.D. (39:52):
And yet in my program we still have many individuals that are opting to stay on the streets. And that's many different factors, but one of the bigger ones is we're not looking at the holistic view of the person. Again, we're losing sight of the individual for the larger standard view of, “What can we apply from a top down model to support these individuals?” And the idea is, “Let's get them all houses, or let's get them hotel rooms and they'll want it.” But many of them have pets. And to tell them, get rid of your only support, or the only person, or the only the--
Keith Sutton, Psy.D. (40:32):
The only attachment you have.
Keith Bonnes, Psy.D. (40:33):
Yeah. Attachment in your life, you know, family member that loves you and that hasn't rejected you, get rid of that. So you can stay in a ho-- a motel six room under our rules and under our guidance. It doesn't, that's not a welcoming experience. And I've heard that too many times. I'm not giving up my dog to go sleep in a shelter. Well, and so many, but there's also--
Keith Sutton, Psy.D. (40:57):
Yeah. Experience trauma, you know, animals are innocent, you know, and that they provide that unconditional positive regard and humans are not safe. They're-- and they're scary and they're dangerous and so on. And so sometimes that is the relation to connection to another.
Keith Bonnes, Psy.D. (41:18):
Absolutely. Well said. I mean, that's exactly right. So again, we're not looking at the trauma response. We're looking at the symptom. The symptom is homelessness. The trauma response or the symptom is addiction. Again, addiction is not welcomed into many board and cares or room and boards. And so those are new barriers. And again, these are symptoms that were just kind of passing off as behavioral issues that are things that we would have to put our arms all the way around, in my view. And then there's the nature of funding of this. And I know there's many different ways to come about this. And I know we do spend quite a bit of money. But again, a program like mine is a nonprofit that's going to have some of the hardest clients that are in the county system to work with.
Keith Bonnes, Psy.D. (42:12):
And many times the county is in, you know, in not so many ways using nonprofits as a cheaper way of delivering these services that they would be otherwise doing, but it costs too much from their perspective. And so we have less wages to deal with. And what does that mean? That means a lot of turnover. That means less qualified people coming in because the most qualified are going to go take a better paying job with an easier population, it’s human nature. I mean, we all want to have vacations and lives, and we don't want to be on 24/7 call. Well, that's not-- and we're already dealing with a license shortage, right? We don't have enough licensed clinicians. And so how do we draw in the best people if we're giving-- these are some of the lowest wage positions out there.
Keith Bonnes, Psy.D. (43:02):
You have to almost be altruistic to want to do that. And there are so many people that I work with that have dedicated their lives to this, that could be making considerably more money and doing work that would allow them to be around their children more. But they do this because they really want to make an impact. But that only has so far to go because we're all human and there's burnout is very real. And so, that particular barrier creates a trickle down effect directly to the clients if they don't have someone that's there for multiple years. You know, these programs are often subsisting on trainees coming in through grad school. And they may do it for their first year somewhere, but they get that taste and they're like, “Never again.” And they shut the door to that completely.
Keith Bonnes, Psy.D. (43:53):
And so they-- many of my clients have seen 5, 6, 7 clinicians since they've been in these programs. And you have different levels of skill, different life experience. And so it's really hard to keep and maintain buy-in. It's really hard to see progress when you're constantly changing. And so these are very real challenges. And the human center does all that they can to try to train and prepare and, and welcome people. And they create an environment of teamwork and support. But that can only take you as far as the people wanting to walk in and do this work. And so veterans run into this same thing, especially the veterans that are no longer in the VA pipeline, but the VA pipeline has their same limitations and they're seeing a lot of turnover in a lot of different clinicians because, carrying someone's trauma--
Keith Bonnes, Psy.D. (44:47):
-- one of the things that I want to digress for a split second, and one of the things that I think is often on a meta level misunderstood about our field is that because we have evidence-based and because we have practices and theories that we are just fo we are just following steps until we get to some conclusion. And this work is so taxing to carry someone else's trauma . And to live in that experience, to try to embrace that feeling so that you can, from that experience, use yourself as a tool to tell them what it-- what that's like is really, really, really hard. And I don't know if, if people who don't do this work can truly understand that level day in, day out. You know, five, seven clients a day, five days a week, if you can't-- haven't experienced that emotional load, it's quite taxing.
Keith Bonnes, Psy.D. (45:45):
And I think if we could value that part of our field a little bit more, we could understand why we need to pay better and increase that kind of incentive to want to be in this field. Because it's just so hard. And I see so many good people doing such hard work, you know, people doing housing, you know, slightly above minimum wage or whatever it is. And they're just constantly carrying the weight of wanting to keep people housed and the options are limited. So, you know, those are the things that I think really cross between both worlds and we're talking about many different types of people and populations. Because both military, you have a cross section of the United States in many ways, but in other countries, because they come here to serve for us. And yet in our homeless streets, you see the exact same cross prop population occur.
Keith Sutton, Psy.D. (46:42):
Definitely. Yeah. And I think that that aspect that you're talking about, and I think you were mentioning that you had listened to the interview I did with Jane Ariel around privilege. And we were talking about, you know, empathy. I always kind of go back to that. There's a little video Brené Brown's one with the little bear goes down the whole, and it talks about how, you know, to truly empathize with another person, you have to connect with that part of yourself that has felt that same feeling. And so that can be really dysregulating for the person listening, or particularly in this case, like you're saying, the therapist, especially going into the person's trauma, their suffering, the intensity, the helplessness, and being and really going to that place and sitting in that place with them and being with them through that process as you're doing whatever the different types of therapy that you're doing.
Keith Sutton, Psy.D. (47:35):
And I think, like you're saying that this population particularly, you know, that especially the homeless population, right? That, you know, they might be come-- they're coming in potentially for complex PTSD, but if they're only working with somebody for a year or something like this is not going to be your 10, 12 session kind of research-based intervention, you know? This is going to be something that's going to be ongoing. And oftentimes even just working towards some stability to even begin doing the trauma work and dealing with the substance abuse or the housing or so on. And it makes sense too why you have to focus so much on being able to connect with the client and really see them and and really hold them to engage them to be able to continue even a therapeutic relationship when you don't have all those other aspects of structure and somebody getting off work at five o'clock and then coming to therapy, you know, at six o'clock or or so on and all those aspects to hold the therapy even in mind.
Keith Sutton, Psy.D. (48:36):
And that being important when there's so many other aspects of survival that are kind of higher priorities at that moment. To be able to even then do some evidence-based kind of approaches or even even using some of the common factors of PTSD work that needing that basis of that relationship and, you know, finding people that can go through that training and stay there long term and learn how to sit with all of that pain rather than saying, “Just trying to rely on a protocol,” and saying, “Well, we're supposed to be doing this right now.” Like, let's not focus on that and losing the client because they're misattuning and not not being with the client and kind of walking alongside them through this process instead maybe trying to pull them along. Yeah, yeah.
Keith Bonnes, Psy.D. (49:26):
Well summarized. You know, and that, and I think that that's why there was that rash of veterans committing suicide in the parking lots of VAs for some years . You know, in many ways that's a “Do you see me now?” statement and “Do you see that this isn't working?” And that refrain is very common. And again, one of the wonderful things about my experience at the Oakland Vet Center and in the VA was we really, really focused on how to connect with these clients. And many of them had been there for 10 years. And if, and what I saw there is what gives me hope that we can do this, if we could replicate that understanding that if we create a place that encourages people to stay there, many of the employees had been there for 10 plus years and had gone through ups and downs with these clients through their lives, we could create that experience for even community mental health where we can pay them.
Keith Bonnes, Psy.D. (50:24):
Well, we can ex-- understand that someone with schizo-- severe schizophrenia is not going to get better. They're-- what we're trying to do is give them a quality of life, support them in what life that they're living, instead of trying to push them to become an employee at Burger King and out of the system, which is just setting them up for those failure that life has been knocking them down anyways. And so in that vet center experience, I really saw the value that a group that's been together for five years, and these men were able to talk on levels that I've never seen replicated in any of the other groups I've done. And yet they were still wanting to show up. They would-- we were still doing things. I ran a PTSD 101 group to explain, and many of these men had, and women had been there for 10 years, and they came to that because they wanted to be around each other.
Keith Bonnes, Psy.D. (51:15):
And so we're creating that sense of family system, community, again, in an environment that's healing and, and you know, if you ever have me back on or if we ever get a chance to talk again, I'd love to talk about ways that we could create that, you know, using old or other things that we could create cities, small towns within our towns that holistically understand the challenges and barriers, people with mental illness or severe mental illness face. And we can give back dignity and quality of life in ways that simply throwing money at the problem doesn't solve.
Keith Sutton, Psy.D. (51:54):
Yeah, definitely. And I love you know, kind of what you're talking about with the, those ongoing groups and so on. It's, you know, because I was talking, I was thinking like engagement of the therapists, engaging with the client, but in that sense, the clients were engaged with the community of clients. It sounds like, and so then if therapists are coming in and out, there's something that's all drawing them together, is that community and then maybe in those engaging in the services or so on. But, you know yeah, because I think that's so important. You know, kind of like you're saying, kind of using even that larger system of that community to even be able to help clients to get services. Especially when there's the barriers to maybe having an ongoing therapist that can work with them for a couple years, where the organization around it that again, that that connection is much more stronger in that community and to the other folks to keep them engaged and to keep them, you know, participating and getting treatment and so on. And just the healing this of the relationships between themselves.
Keith Bonnes, Psy.D. (52:57):
Right. Certainly. And, again, this goes back to kind of my Maslow, my Maslow's love of the hierarchy of needs, right? We created the vet center being run in the way it was with the perspective. And not all of them are the same, by the way. And so that's another issue in and of itself. But this particular Oakland Vet Center really had long time employees and the trainees that would come in would come in for their year. But the vet center was where the love and belonging existed, and the trainees were adding to that. And they were able to bring in their ideas and their perspectives. But there was also long-term, well-compensated employees that loved their work and that loved being around. And they knew it was hard, but yet they balanced that with a connection to individuals and to celebrate a new grandson and to put out a newsletter.
Keith Bonnes, Psy.D. (53:48):
And they had wonderful connections to-- PGA was helping them. They'd go out and golf and learn to golf together and learn to play the guitar. And these are the ways in which I think if we think on a community level, we take that idea of community on that small of a scale, and we take that into our communities. We can actually give people with schizophrenia that same experience and that same connection, because love and belonging is important. And many of the people I work with don't have that. Sadly, there is no one to go home to. There is no family to call.
Keith Sutton, Psy.D. (54:22):
Sure. Yeah.
Keith Bonnes, Psy.D. (54:23):
And so yeah. I see that
Keith Sutton, Psy.D. (54:26):
So important. Yeah. I had-- I was volunteering building houses after Katrina and they were saying, “What can we do to help some of these folks?” And I said, “Throw a party, have people come together.” Because really, you know, like beyond just a therapist doing a session here or there, connect them and everybody has been through this shared trauma and you know, people love to eat, people love to have food, and really kind of even just starting on those base levels of that connection. Thank you so much for taking your time today. I really appreciate it. This is so great to hear about your work and about your story and about your passion. And you know, I thank you for your service both in as a soldier and also your service in the work that you're doing with the homeless population. And I think that, you know, that I can really see that you're really driven by your values and living those values and connecting with others. And it's just, it's wonderful. And we'll definitely put some links to that Oakland Vet Center and also the Hume center on the website with the bios and so on for folks to learn more. So yeah. Thank you so much. I appreciate it. Thanks for coming today.
Keith Bonnes, Psy.D. (55:39):
Thank you so much for having me. And I appreciated this conversation very much.
Keith Sutton, Psy.D. (55:44):
Great. Take care. Bye-Bye.
Keith Bonnes, Psy.D. (55:45):
Thank you.
Keith Sutton, Psy.D. (55:47):
Thank you for joining us today. If you'd like to receive continuing education credits for the podcast you just listened to, please go to therapyonthecuttingedge.com and click on the link for CE. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, where we provide trainings for therapists in evidence-based models through live and online workshops, on-demand workshops, consultation groups, and online one-way mirror trainings. To learn more about our trainings and treatment for children, adolescents, families, couples, and individual adults, with our licensed experienced therapists in-person in the Bay Area, or throughout California online, and our employment opportunities, go to sfiap.com. To learn more about our associateships and psych assistantships and low fee treatment through our nonprofit Bay Area Community Counseling and Family Institute of Berkeley, go to sf-bacc.org and familyinstituteofberkeley.com. If you'd like to support therapy for those in financial need and training and evidence-based treatments, you can donate by going to BACC’s website at sfbacc.org. BACC is a 501(c)(3) nonprofit so all donations are tax deductible. Also, we really appreciate your feedback. If you have something you're interested in, something that's on the cutting edge of the field of psychotherapy, and you think therapists out there should know about it, send us an email. We're always looking for advancements in the field of psychotherapy to create lasting change for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advances in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area, and the Director of the Institute for the Advancement of Psychotherapy. At the Institute for the Advancement of Psychotherapy, we provide training in evidence-based models, including Family Systems, Cognitive Behavioral Therapy, Emotionally Focused Couples Therapy, Eye Movement Desensitization and Reprocessing, Motivational Interviewing, and other approaches through live in-person and online trainings, on demand trainings, consultation groups, and one-way mirror trainings. We also have therapists throughout the Bay Area and California providing treatment through our six specialty centers, each grounded in an evidence-based approach, with our Lifespan Centers, Center for Children and Center for Adolescents, where all the therapists are working systemically; our Center for Couples, where all the therapists are using Emotionally Focused Couples Therapy; and our specialty issue centers, our Center for Anxiety, where all the therapists are using CBT and EMDR for trauma; and our center for ADHD and Oppositional & Conduct Disorder clinic, where we're integrating those four approaches.
Keith Sutton, Psy.D. (01:32):
In the institute, we have our licensed, experienced therapists, and for those in financial need, we have an associated nonprofit, Bay Area Community Counseling, where clients can work with associates, psych assistants, and licensed clinicians who are developing their abilities and expertise. Additionally, as part of our nonprofit, we also have the Family Institute of Berkeley, where we provide treatment, training, and one-way mirror trainings in family systems. To learn more about trainings, treatment, and employment opportunities, please go to sfiap.com and to support our nonprofit, you can go to sf-bacc.org to donate today to support access to therapy for those in financial need, as well as training in evidence-based treatment. BACC is a 501(c)(3) nonprofit, so all donations are tax deductible.
Keith Sutton, Psy.D. (02:20):
Today, I'll be speaking with Keith Bonds Psy.D., who is a clinical psychologist and an Air Force deployed army blue to green veteran of the Iraq War. Keith has worked extensively with veterans and their families, and now works at the Hume Center in the San Francisco Bay area in the East Bay. The Hume Center is a nonprofit that provides a range of community-based treatments, including full service partnership with homeless individuals, outpatient services, and partial hospitalization programs, and many other community-based services and programs. He is also a trainer with the human Center working to help develop the clinical skills of early career clinical trainees and to provide an excellent training experience as a behavioral training center. He works from a humanistic client-centered phenomenological approach, meeting the client where they are and connecting with their experience, and then integrating modalities of treatment and interventions to fit the client's perspective of the world. Keith uses Maslow's hierarchy of needs as a building principle along with cultural humility in his work with clients to ensure a holistic approach to the client's experience is considered. Let's listen to the interview.
Keith Sutton, Psy.D. (03:27):
Well, hi Keith. Thanks for joining us today.
Keith Bonnes, Psy.D. (03:30):
Oh, thank you for having me.
Keith Sutton, Psy.D. (03:31):
Always nice to meet another Keith.
Keith Bonnes, Psy.D. (03:35):
It's very rare, actually. In my experience, I don't meet a lot of Keith, so it's nice.
Keith Sutton, Psy.D. (03:39):
There's not too many of us out there. So I learned about your work from a colleague of mine Keith Fel, who had mentioned that you have experience working with families and working with veterans, and we've been talking about, you know, you doing a talk for our organization, the Association of Family Therapists of Northern California. And so I'd love to hear about you know--especially too with what's, you know, recently with the exit from Afghanistan and so on-- It's just been making me think about military families and people that are, are also going through that experience. And so yeah, would love to hear about your work and your thoughts on working with folks in the military and their families and systems. But first I'd love to hear about your background and kind of the evolution of your thinking, how you got to kind of thinking about the work that you're doing now. So yeah. Well, welcome.
Keith Bonnes, Psy.D. (04:34):
Thank you. Thank you again. Yeah, so I -- a little bit about my history -- I'm a veteran and I'm married to a veteran as well. I met her in the military, and we've spent a lot of our life together at this point. And we met each other very young, and we ended up deploying together as well. We did similar jobs in the military, and so in that experience we were in during kind of the height of the Iraq war, and there was a severe shortage of personnel available to carry out convoy security personnel and convoy duty in at that time the army was quite taxed, and so they reached into the Air Force, and my wife and I were both in the Air Force at the time, and they cross trained us.
Keith Bonnes, Psy.D. (05:35):
So this is what we commonly call "blue to green" and we got trained as gun truck operators and security personnel. We ended up deploying together. Some circumstances-- the Air Force doesn't generally like to deploy husband and wife but some circumstances came up that had us deploy together, which was a very unique situation in and of itself. So we spent around eight months deployed, all told, and it was a very violent time in the war. Oh, wow. And we experienced quite a bit of you know, mortar rounds and small arms fire, but we also experienced a lot of attacks off base. And me personally, I did not experience any of that. I experienced the mortars on base and a lot of that because my duty was mostly support around doing electrical work and setting up the base.
Keith Bonnes, Psy.D. (06:41):
My wife, on the other hand, did a lot of convoys up and down one of the most dangerous highways. And so during our time together around October, her truck was hit by a roadside bomb. And thankfully, the casualties was more superficial. It wasn't anything, no one died in that attack. But,it was an intense situation for me; I was on base listening to the radio chatter of her incident, and that they were taking casualties and they didn't know how bad it was. You can't just jump in a car and go drive to her, so you're kind of stuck listening to a very hectic scene, play out on the radio. And she was airlifted to a military base-- severe whiplash and concussion. And at the time, this is in 2005, traumatic brain injuries were not being heavily examined.
Keith Bonnes, Psy.D. (07:48):
And so we suspect[ed] she had some traumatic brain injury since the explosion happened right at her truck. And within a second or two sooner, it would have-- all of the ball bearings would have pierced the entire truck. Thankfully, it went right behind the cab.
Keith Sutton, Psy.D. (08:09):
Wow.
Keith Bonnes, Psy.D. (08:10):
--blew out all of the brakes and tires, and she was the driver. So she navigated heroically her team through kind of the-- what we would call, commonly call "the kill zone" as they would disable a vehicle and then use small arms fire to clean up. And so she drove on one tire, essentially, and laid it over outside on an embankment. And everybody landed on top of her. And so she took a lot of damage that way as well.
Keith Bonnes, Psy.D. (08:39):
So fast forward we come home stateside and even in 2005, PTSD was still more of an academic understanding. It really hadn't hit the mainstream of therapy, and so she was getting seen because she was having some kind of reverberations from that experience that were still bubbling up. She was put in a situation that-- he decided that--her therapist at the time, I think he was fairly new-- decided to try out exposure therapy and put her in a similar truck and set off some M80 explosives around her.
Keith Sutton, Psy.D. (09:22):
Oh, wow.
Keith Bonnes, Psy.D. (09:22):
Which, as you can imagine, understanding what we know now, completely destabilized her and brought the trauma home. And it made what we were experiencing at home much worse. But again, we didn't know what we didn't know back then and so we got out of the military and we went back to school. The stress of school seemed to be a major kind of impingement moment for her when it came to managing whatever she was dealing with underneath the surface.
Keith Bonnes, Psy.D. (09:53):
She went into a deep, long depression. At the time I was in marketing, trying to get my degree in marketing. And so we thought it was the school and the travel. So we got out of that school and we went to a different one; we went to a community college, much smaller stakes and closer to home. And at the time we were living in the South Bay Area. The first couple quarters, I don't know the newness of it all, it seemed to abate. And then the depression came back with ferocity, and she went into a really deep, deep dark depression. And during this time, I've never seen her like this. She's the person in my life that had always been my grounding force and my stabilizing force, so I didn't know what to do.
Keith Bonnes, Psy.D. (10:41):
And at the time, at this point, I had switched out of marketing because at community college, they don't have marketing per se, but I was in business. And because of her experiences on base those years prior, she was adamant that she would not go and be seen by a psychologist again. She just couldn't trust the process the same way. . And so I didn't really know if I had any other options, so I dropped out of business and switched my major to psychology, is what happened. And I started taking classes-- really, I don't know how often I --I'm privileged in many ways because of the fact that I went to the military. They were willing to pay for me, so I was taking classes not really with a career in mind, [but] I was taking it simply as a place to go and learn what was going on.
Keith Bonnes, Psy.D. (11:30):
Then I would come back and teach this stuff to her; I would just run home and I would teach her the day's lesson and I was taking, I took every psychology class that they offered at DeAnza Community College, a wonderful school. Through that process I was learning quite a bit. I mean, I was attaching everything to real world experience, and I was being at home. And at the same time, I had several friends that I had served with struggling, and so I was not only teaching her, but I was teaching my friends, and I was talking them through a lot of really tough transitions themselves. Ultimately that kind of started me on this path. I ended up helping my wife manage her PTSD. It does have a happy story in that she really got an understanding, a deep understanding of PTSD and taught me a lot about it.
Keith Bonnes, Psy.D. (12:27):
And through that kind of process, I felt like, "well, I have all this knowledge, I should probably just keep pursuing it"; even though it was a liberal arts degree, I could have toggled at some point, but I actually found that I liked it and I enjoyed it, and so that brought me to it. And so then I went into grad school and pursued it at a doctorate level. And again, I'm thankful that the VA was able to put me into a program that would help pay for that and give me enough money that I could focus solely on that. And so that's kind of how I got my start; I kind of backed into it, never really-- all along knowing that this was going to be what I was going to do. But when you see that there's something you know-- and since I'm speaking to an audience of clinicians and therapists-- there's something that's unspeakable, I can't put words to, about watching someone go through their own transformation and to be witness to that.
Keith Bonnes, Psy.D. (13:36):
My wife put the work in, I want to be very clear about that. She put in all the hard work. I got to witness it though. And yeah, that's a gift that makes the work and the challenges that this field presents worth it, in my view. Yeah.
Keith Sutton, Psy.D. (13:53):
Well, it sounds like it really, you, you went into this out of necessity and really getting the help and going through that process together to really kind of have that experience. So many of us go into this field because of our own experiences and trying to understand or gain tools or so on. Sometimes that might be after the effect of our kind of experiences or trying to help someone else. But that's so great that you were able to do that and to do that work, and she was able to do that work, together. I mean--and particularly too-- and being able to help her helping her, and I'm sure her helping you developing your abilities.
Keith Bonnes, Psy.D. (14:34):
Yeah. Yeah. Absolutely. And, you know, at the time, my own history with trauma and my experiences growing up and you know, I had brief moments of homelessness and things that have brought me to where I was into the military. So that wasn't really the foreground of what I was exploring, but through that process, I was learning a lot about myself and my own history and my own reactions. And it was a very auto-didacted therapy experience in many ways. And I had already had some therapy in my past, but it was never on this level. And because I was doing it for a class and then I was attaching-- every paper I wrote was very personal, and I really made, I tried to make it as much about my own growth and my wife's growth as much as possible to maximize my time with this.
Keith Bonnes, Psy.D. (15:33):
I didn't really know what it would turn into, but yeah, certainly. I found myself-- I do connect with those that have come in searching for answers for themselves or loved ones. I also learned those hard lessons, right. That once I had the success with my wife-- I had lost some friends to suicide--I learned really hard lessons that you can't save everyone. And sometimes the therapeutic frame is not possible when you're too close to someone, and those are lessons also were part of my growth.
Keith Sutton, Psy.D. (16:10):
Definitely. Well, and I think too, as you're saying that the field was still kind of developing around PTSD and I remember years ago we had another Keith, actually, Keith Armstrong from the VA in San Francisco here, who wrote a book, 'Courage After Fire', was talking about how the VA was a bit ill-equipped and the therapist, because they had mostly been working with Vietnam veterans. So they were all these therapists, oftentimes in their thirties, forties or so on, working with folks that had been in a war decades before, sometimes before they were even born. And now all of a sudden they were working with veterans who had just come out of the war in Iraq and Afghanistan, and there was kind of a different situation that they needed to kind of adapt to and learn and understand how to help support those folks who hadn't been living with PTSD for 10-20 years.
Keith Bonnes, Psy.D. (17:10):
Yeah, certainly. I-- and Keith's book is fantastic. I could not recommend it more to help understand a little bit of this experience. And I think that that was one of my early benefits when I was working with veterans exclusively. I worked with combat trauma and military sexual trauma. And I worked with a lot of Vietnam veterans and I'm a little bit of an older-- I went into the military a little bit older. I went into this field a little bit older, so I've had some life experiences before I came in, but I think the main thing was I was willing to see war through different lenses. I was willing to set aside my understanding of war from Iraq. And even still, I won't dare say I understand what the Afghanistan war was like-- I wasn't there. And, and there's, there's different layers to even the Iraq experience.
Keith Bonnes, Psy.D. (18:09):
Then you go to Vietnam and there's so many different layers added to that, right? You have the draft involvement in that. You have the unbelievable amount of death and injury and loss. I mean Iraq and Afghanistan-- I don't know the most recent numbers-- but we're not talking much more than 3,000-4,000 deaths in 10+ years. And yet you know, Vietnam was 55,000 deaths and even more injuries. Our ability to battlefield triage was just completely different than back then, than it is now. Many lives were lost simply because they didn't have the resources. And so you're talking about a layer of understanding there and then you talk about the experience of coming home and the not being welcomed.
Keith Bonnes, Psy.D. (19:08):
I mean, when we came back, we were given first class seats and people stood and cheered for us while we were in uniform; the Vietnam veterans did not have that experience. Many of them that I spoke with really felt shame around their service and weren't able to hold that. When you do something for a country and sacrifice so much of your own morals and values to protect a country. To go through those experiences and to come home and not be well received, to be called a baby-killer, and many other things. It's a whole different level of trauma that you have to attune to, and you add in other intersectionalities of race. I mean, I worked with a lot of people of color that didn't join, weren't welcomed in the country before they joined, went and fought a war that they didn't want to be at, and came home to a country that didn't value their service. That's just a really, really, really tough, tough experience to live with. Many of these men are 70 years old and carried this without ever talking about it. You know, I met many people that their very first therapy experience was with me, and they're in their mid seventies .
Keith Sutton, Psy.D. (20:38):
Yeah, and I think you're going to talk about this-- the dual family system paradigm-- but my father actually was a Vietnam vet. He was a marine recon and got the purple heart. It wasn't until they did the welcome home parade in the eighties that they actually,-- he was in back, they put him in the battalions kind of walking together, and so many people had not realized the other was still alive because they just hadn't kept that connection. I think there was also not only just coming back and getting that reception, but a lot of message of being told to be shameful of being a soldier or so on. And that aspect and the [mumble] after giving so much love for your country and then having your country-- many people feeling like the country hated them.
Keith Bonnes, Psy.D. (21:28):
Yeah, yeah. You know your father's service is admirable. I know what marine recons, I've heard many stories. I've worked with several of them. And that is-- it's hard for, for anyone who is not initiated into the military culture to fathom what that experience is like, and even with some initiation and my own experiences, it's still hard to wrap my mind around sleeping inches from the enemy or enemy combatants and often being alone in these situations in a foreign country and not knowing if they're going to find you.
Keith Sutton, Psy.D. (22:17):
--behind enemy lines--
Keith Bonnes, Psy.D. (22:18):
--sides, It's just, yeah. And I do want to talk about the competing family systems. The military training experience is a programming in many ways that makes you an effective weapon for the United States government. And they teach you to channel indecision into aggression, and fear into aggression, and sadness into aggression. They teach you to make these adaptive-- and I'm not saying that that's wrong, those are very adaptive-- programming needed in order to survive in those conditions.
Keith Sutton, Psy.D. (22:55):
Survival; Yeah, exactly.
Keith Bonnes, Psy.D. (22:57):
And you do this with people from all over the country and small units or large units even. And you bond over these experiences that no one can quite understand what that experience is like to be-- whether that's very beginning basic training or whether that's training before you deploy. You go to war and you experience things that in many ways you hold shame over. I remember sitting with several gentlemen that would talk about the behaviors they did in the fog of war, and there's so much shame tied to that. And so you don't want to bring that to your family. And the only people who could understand what it's like to put an ear on a necklace or any of the other horrific things we've heard about come out in documentaries or stories since, are people who were there and know what that was like, and know what it's like to live in that level of aggression and to be drawn down to fight or flight at that level of survival.
Keith Bonnes, Psy.D. (24:08):
And so you build this really tight knit bond, and I'm going to borrow from Maslow a little bit when I say "peak experience", but, you know-- he talked about that often in a more, you know, positive light, but I mean-- "peak experiences" here as well, right? These are flashbulb memories that many of these individuals have that are linked to an experience unique to only a handful of people, and they come home whether that's Vietnam or Iraq and Afghanistan, and they're trying to reintegrate to a family system that didn't have that experience, and don't change while you're gone. In many ways, it's a blip in the radar of their life; They suffered. They feel like they deployed with you and they're right. Their emotional suffering should be validated as well.
Keith Bonnes, Psy.D. (24:57):
And yet there's something different about that individual, and they can't quite wrap their mind around it. And that individual knows there's something different about them too. I'm not even talking big T trauma in many ways. I mean, PTSD can be a part of this, but just the experiences you have change you, and you come home and you try to reintegrate, and it's not a natural process, and there is no government program that helps you reintegrate or deprogram you or helps you kind of learn to take that aggression now and channel it back into an emotionally focused sadness or fear.
Keith Sutton, Psy.D. (25:37):
Yeah. More of those vulnerable emotions, which were--
Keith Bonnes, Psy.D. (25:39):
Yeah, bring those back forward, right?
Keith Bonnes, Psy.D. (25:42):
There's just not a manual to do that again. I would say that has been a bulk of my work when I work with veterans is to rewire and reconnect the emotional-- the more vulnerable emotions in them. I'm sure you've heard it, we often use the metaphor that if you try to shut down that pervasive fear or looming dread of PTSD, you end up shutting down the whole warehouse lights; you shut off the good emotions and the bad, right? And the thing is that to be able to really feel that fear again, and to really attend to it, you have to wade through a lot of programming and a lot of conditioning. We all can kind of understand what social conditioning does to us, but we haven't had a very purposeful and well designed behavioral conditioning in the way that the military does.
Keith Bonnes, Psy.D. (26:34):
And so that care is part of it, and that family reintegration is part of it. But there's also another piece that's also part of it, which is you've been trained to be a collective, right? When one person messes up, everybody does pushups. When, when one person makes a mistake, we all suffer, and it could be life threatening. The level of threat of that is hard to understand for many individuals. You know families can say, "oh, it's not that serious that we're running late," but to a veteran that's been programmed, that being late means possible death or losing a teammate, it is that important. And that's on a very, you know, autonomic and nervous center system activation. So it's hard for them to even put words to what they're experiencing there.
Keith Sutton, Psy.D. (27:25):
Well, I imagine too, there's got to be a-- like you're saying with the family system-- and then they've got kind of that the military family system or that that kind of connection, that bond, that camaraderie, that kind of programming that, when you bring that in too--if you're taught that "we're a unit", "we're all together," that coming home and having relationships where we have differences and people aren't listening to other people or so on, or wanting to do their own thing-- I wonder if that also plays out to be feel like a rejection or like almost a kind of like a disconnection or so on at all.
Keith Bonnes, Psy.D. (28:01):
I just certainly imagine it would, and I can understand why. If we talk about the family system when it comes to diffusion of anxiety, if the whole family system is experienced, this, the diffusion of anxiety feels welcome in many ways because we're all moving that around. We all were there, we saw what happened, we're all kind of swimming in the same suit. But when that individual comes home, and what I often dealt with working with their families is, it's too intense for that family system. That family system cannot carry the load of that level of anxiety anymore. And the veteran is also trying to be protective of their family, so they're trying not to put too much of their stuff, so what are they, what have they been trained to do? Swallow it down, but where does that turn?
Keith Bonnes, Psy.D. (28:46):
It turns back to that same aggression that's not pro-social anymore, and it doesn't fit in a civilized society. And so, you're right, the rejection just becomes this hall of mirrors of rejection, right? It becomes, "I'm rejected in my family," "I'm rejected by society". And especially when you're talking about Vietnam veterans dealing with the rejection that they experienced now that they've had it in their face. I mean, at least for the Iraq and Afghanistan, for the most part their service is valued and respected and appreciated. And I've heard, "thank you for your service" a lot in my life, which is a little bit of also a challenging place to be. Because what, what does that mean? You know, are you thanking me for my sacrifice? Are you thanking me for being willing to do it? And that's a whole different layer to that as well. And so, yeah. I mean those are really vulnerable experiences to feel rejected by your own family and to feel like you don't fit. And then to have a service, but you don't fit there anymore. Especially if you have PTSD and you've been discharged from the service as a result. Now, you don't have anything to attach into. And it's a very destabilizing experience.
Keith Sutton, Psy.D. (30:00):
They're kind of feeling disconnected from both worlds and not fitting in anywhere anymore.
Keith Bonnes, Psy.D. (30:06):
Certainly. And then you turn to something like the VA and they want to give you standardized manualized, CPT or something else-- care. And while I understand the perspective of why you would want to do that. You're again, not helping to deprogram the collective mind. You're not re-individualizing them, you're not helping them ground themselves back in an individual experience, but they don't have a collective experience to share anymore. And so these competing values against just kind of make you feel more hopeless, more lost, more on your own. And for the individuals that I've worked with, but also my friends and family that have experienced this, it's just another reminder that nobody wants to see you for you. And that is a very tough thing to feel, you know, I think many populations can actually attune to that feeling of pure rejection and invalidation.
Keith Sutton, Psy.D. (31:08):
Yeah. So kind of the individual treatment, you know, for the trauma ends up missing that piece of the disconnect of the kind of attachment with either the family or with other veterans or so on, is kind of what you're saying. Like that it kind of tries to section out that part, but kind of maybe leaves out those-- that other aspect.
Keith Bonnes, Psy.D. (31:31):
Yeah. I would say when in my experience the VA offers a lot of group therapies and a lot of manualized treatments, evidence-based, this is our new point phrase that we love to follow. But the challenge with that is when we talk about evidence, in order to have evidence, it has to be done the same way, or at least within the, you know, means of error so that it can be evidence-based. And so when you have standardized care, you're missing the individual many times. And interventions, in my view, are individualized. And when you look at a CPT manual, it's like 800 pages and it has a script of what you're supposed to read. And for an individual that's experiencing a loss of attachment to anything that's grounding and feeling on their own, and feeling unvalued to have somebody literally read a manual to you is pretty insulting.
Keith Bonnes, Psy.D. (32:33):
It feels even more de-identified. And I think that that is a real big challenge because we also have to recognize that the VA can only produce so many clinicians, and people have to want to go into this field and want to work with a really difficult population. I mean, again, and I would like to talk about homeless and later too, this is very similar. We're talking about some of the hardest trauma stories you're going to hear. I mean, the trauma stories I've heard I still stick with me, you know, and I hear that all day every day. You know, that's a big challenge.
Keith Sutton, Psy.D. (33:14):
What-- tell me about the approach that you use in your thinking, in your work with clients. Yeah. What approach do you use or any theoretical orientations that you're guided by?
Keith Bonnes, Psy.D. (33:25):
So I am definitely going to be the person that is using a little bit of all of the approaches for what fits the client. I know that's the integrationist or eclectic view is often looked at as some kind of a jack of all trade, master of none or an answer you give when you don't want to be asked about a particular theory or-- I actually mean it in this way. I try to-- my view of therapy and the people I train will probably roll their eyes if they listen to this. I say so often my view of therapy is therapy is a distillation of the most basic form of relationship. We provide a relationship to practice on in many ways by withholding a lot of our stuff. We don't compete with their challenges, with our challenges.
Keith Bonnes, Psy.D. (34:20):
We don't bring that into the relationship. We try to keep the focus on them. And as a result of that, my job and my view is to calibrate my understanding of how your metaphors and your analogies and the language you use, the ways in which you orient yourself to the world. And once I've understood that, if you're more of an intellectualized person, I might pull out a CBT intervention or a CBT perspective. If you're really attuned to your childhood or something that's happened in your life, I might go into that more psychodynamic depth work just to follow you wherever you want to be. If I hear you talking about your life in a very narrative form, I'm going to pull out narrative and we're going to talk about the hero's journey, right? It is-- I'm trying to make sure I'm speaking their language and not making them have to come the distance to speak mine as much as possible.
Keith Bonnes, Psy.D. (35:11):
And in that process, I'm calibrating what interventions make sense. I'm not looking at a book and reading this intervention, you should journal. I'm looking at what ways are they coping or what are their defenses that are maladaptive, but what's the intent behind that? Where did that go wrong for them? That obviously is something they're using. So maybe I should kind of work backwards from that instead of trying to wholesale teach them techniques that are brand new to them. Now, some people want that, but for the most part, people want to stick with what they're comfortable with.
Keith Sutton, Psy.D. (35:48):
Or, so trying to kind of connect with the client and get a sense of them and what might be kind of most fitting for them or what they might engage with most or what might fit with their worldview and being kind of flexible and integrative to kind of match that.
Keith Bonnes, Psy.D. (36:03):
Certainly, I mean, I think theories are wonderful. I often, when I do train, I often talk about common factors and the ways in which there's many components to this that you can attend to. And me personally, I'm humanistic. I'm very drawn to Maslow's hierarchy of needs and how that affects people. And where that can take therapy if you attend to certain levels. I'm also very big into Husserl’s phenomenological view of people. And so I'm willing to believe your reality, which isn't always easy. And as I often say, the hardest intervention in my view is Carl Rogers’ unconditional positive regard. It is so challenging To stay in that zone and to live in that experience through therapy. And it's not just within that session, right?
Keith Bonnes, Psy.D. (37:02):
It’s-- I could have a session where somebody's complaining about their grades and getting a bad grade, which I have to give that the full weight of what their emotional experience is. But then I go from that into a trauma story, the very next session, and I have to also equally give that the same weight, and then I can go to the next session and it could be something completely different. And each of those experiences need me to have unconditional positive regard, need me to have full empathic attunement. That's the challenge of that particular modality.
Keith Sutton, Psy.D. (37:34):
Being the client and the client's experience and them feeling seen by you?
Keith Bonnes, Psy.D. (37:38):
Mmhmm.
Keith Sutton, Psy.D. (37:40):
Yeah. Now, tell me a little bit about you know, you were talking about Maslow's hierarchy of needs, and I know when we were talking earlier, you were talking about the work that you do in community mental health and clients who are struggling with homelessness and also the intersectionality with veterans.
Keith Bonnes, Psy.D. (37:56):
Yeah. Thank you. Yeah. I do-- I've been working for the past three years with the Hume Center and a nonprofit that does amazing work in the community to working with people with severe mental illness and chronic homelessness programs. And the intersectionality was really apparent to me for one severe mental illness work is a lot of trauma work, and it's a lot of relational work. And many times that's the skill is just to build a relationship and try to hold it for any sustained period of time. And going through the ups and downs of their own experience of life and to be there. But I also see in the same way, kind of these systemic barriers to kind of cresting that hill. And It's not that I say that in a place that I don't understand.
Keith Bonnes, Psy.D. (38:55):
I get why that exists. But for chronic homelessness and the veteran community those individuals may not be able to qualify for VA because of various behavioral issues or before PTSD was truly understood, they may have, have acted out in a way that got them discharged and other than honorable or dishonorable, and now they're not able to get the housing support they need. And they kind of go back into the community mental health particular pipeline for support. And the barriers are pretty apparent when you start to sit with the idea of “why do some people still want to live on the streets when we have options?” You know, we’ve had many initiatives in the last few years that have really tried to target getting PE as many people off the streets as possible and indoors and housed.
Keith Bonnes, Psy.D. (39:52):
And yet in my program we still have many individuals that are opting to stay on the streets. And that's many different factors, but one of the bigger ones is we're not looking at the holistic view of the person. Again, we're losing sight of the individual for the larger standard view of, “What can we apply from a top down model to support these individuals?” And the idea is, “Let's get them all houses, or let's get them hotel rooms and they'll want it.” But many of them have pets. And to tell them, get rid of your only support, or the only person, or the only the--
Keith Sutton, Psy.D. (40:32):
The only attachment you have.
Keith Bonnes, Psy.D. (40:33):
Yeah. Attachment in your life, you know, family member that loves you and that hasn't rejected you, get rid of that. So you can stay in a ho-- a motel six room under our rules and under our guidance. It doesn't, that's not a welcoming experience. And I've heard that too many times. I'm not giving up my dog to go sleep in a shelter. Well, and so many, but there's also--
Keith Sutton, Psy.D. (40:57):
Yeah. Experience trauma, you know, animals are innocent, you know, and that they provide that unconditional positive regard and humans are not safe. They're-- and they're scary and they're dangerous and so on. And so sometimes that is the relation to connection to another.
Keith Bonnes, Psy.D. (41:18):
Absolutely. Well said. I mean, that's exactly right. So again, we're not looking at the trauma response. We're looking at the symptom. The symptom is homelessness. The trauma response or the symptom is addiction. Again, addiction is not welcomed into many board and cares or room and boards. And so those are new barriers. And again, these are symptoms that were just kind of passing off as behavioral issues that are things that we would have to put our arms all the way around, in my view. And then there's the nature of funding of this. And I know there's many different ways to come about this. And I know we do spend quite a bit of money. But again, a program like mine is a nonprofit that's going to have some of the hardest clients that are in the county system to work with.
Keith Bonnes, Psy.D. (42:12):
And many times the county is in, you know, in not so many ways using nonprofits as a cheaper way of delivering these services that they would be otherwise doing, but it costs too much from their perspective. And so we have less wages to deal with. And what does that mean? That means a lot of turnover. That means less qualified people coming in because the most qualified are going to go take a better paying job with an easier population, it’s human nature. I mean, we all want to have vacations and lives, and we don't want to be on 24/7 call. Well, that's not-- and we're already dealing with a license shortage, right? We don't have enough licensed clinicians. And so how do we draw in the best people if we're giving-- these are some of the lowest wage positions out there.
Keith Bonnes, Psy.D. (43:02):
You have to almost be altruistic to want to do that. And there are so many people that I work with that have dedicated their lives to this, that could be making considerably more money and doing work that would allow them to be around their children more. But they do this because they really want to make an impact. But that only has so far to go because we're all human and there's burnout is very real. And so, that particular barrier creates a trickle down effect directly to the clients if they don't have someone that's there for multiple years. You know, these programs are often subsisting on trainees coming in through grad school. And they may do it for their first year somewhere, but they get that taste and they're like, “Never again.” And they shut the door to that completely.
Keith Bonnes, Psy.D. (43:53):
And so they-- many of my clients have seen 5, 6, 7 clinicians since they've been in these programs. And you have different levels of skill, different life experience. And so it's really hard to keep and maintain buy-in. It's really hard to see progress when you're constantly changing. And so these are very real challenges. And the human center does all that they can to try to train and prepare and, and welcome people. And they create an environment of teamwork and support. But that can only take you as far as the people wanting to walk in and do this work. And so veterans run into this same thing, especially the veterans that are no longer in the VA pipeline, but the VA pipeline has their same limitations and they're seeing a lot of turnover in a lot of different clinicians because, carrying someone's trauma--
Keith Bonnes, Psy.D. (44:47):
-- one of the things that I want to digress for a split second, and one of the things that I think is often on a meta level misunderstood about our field is that because we have evidence-based and because we have practices and theories that we are just fo we are just following steps until we get to some conclusion. And this work is so taxing to carry someone else's trauma . And to live in that experience, to try to embrace that feeling so that you can, from that experience, use yourself as a tool to tell them what it-- what that's like is really, really, really hard. And I don't know if, if people who don't do this work can truly understand that level day in, day out. You know, five, seven clients a day, five days a week, if you can't-- haven't experienced that emotional load, it's quite taxing.
Keith Bonnes, Psy.D. (45:45):
And I think if we could value that part of our field a little bit more, we could understand why we need to pay better and increase that kind of incentive to want to be in this field. Because it's just so hard. And I see so many good people doing such hard work, you know, people doing housing, you know, slightly above minimum wage or whatever it is. And they're just constantly carrying the weight of wanting to keep people housed and the options are limited. So, you know, those are the things that I think really cross between both worlds and we're talking about many different types of people and populations. Because both military, you have a cross section of the United States in many ways, but in other countries, because they come here to serve for us. And yet in our homeless streets, you see the exact same cross prop population occur.
Keith Sutton, Psy.D. (46:42):
Definitely. Yeah. And I think that that aspect that you're talking about, and I think you were mentioning that you had listened to the interview I did with Jane Ariel around privilege. And we were talking about, you know, empathy. I always kind of go back to that. There's a little video Brené Brown's one with the little bear goes down the whole, and it talks about how, you know, to truly empathize with another person, you have to connect with that part of yourself that has felt that same feeling. And so that can be really dysregulating for the person listening, or particularly in this case, like you're saying, the therapist, especially going into the person's trauma, their suffering, the intensity, the helplessness, and being and really going to that place and sitting in that place with them and being with them through that process as you're doing whatever the different types of therapy that you're doing.
Keith Sutton, Psy.D. (47:35):
And I think, like you're saying that this population particularly, you know, that especially the homeless population, right? That, you know, they might be come-- they're coming in potentially for complex PTSD, but if they're only working with somebody for a year or something like this is not going to be your 10, 12 session kind of research-based intervention, you know? This is going to be something that's going to be ongoing. And oftentimes even just working towards some stability to even begin doing the trauma work and dealing with the substance abuse or the housing or so on. And it makes sense too why you have to focus so much on being able to connect with the client and really see them and and really hold them to engage them to be able to continue even a therapeutic relationship when you don't have all those other aspects of structure and somebody getting off work at five o'clock and then coming to therapy, you know, at six o'clock or or so on and all those aspects to hold the therapy even in mind.
Keith Sutton, Psy.D. (48:36):
And that being important when there's so many other aspects of survival that are kind of higher priorities at that moment. To be able to even then do some evidence-based kind of approaches or even even using some of the common factors of PTSD work that needing that basis of that relationship and, you know, finding people that can go through that training and stay there long term and learn how to sit with all of that pain rather than saying, “Just trying to rely on a protocol,” and saying, “Well, we're supposed to be doing this right now.” Like, let's not focus on that and losing the client because they're misattuning and not not being with the client and kind of walking alongside them through this process instead maybe trying to pull them along. Yeah, yeah.
Keith Bonnes, Psy.D. (49:26):
Well summarized. You know, and that, and I think that that's why there was that rash of veterans committing suicide in the parking lots of VAs for some years . You know, in many ways that's a “Do you see me now?” statement and “Do you see that this isn't working?” And that refrain is very common. And again, one of the wonderful things about my experience at the Oakland Vet Center and in the VA was we really, really focused on how to connect with these clients. And many of them had been there for 10 years. And if, and what I saw there is what gives me hope that we can do this, if we could replicate that understanding that if we create a place that encourages people to stay there, many of the employees had been there for 10 plus years and had gone through ups and downs with these clients through their lives, we could create that experience for even community mental health where we can pay them.
Keith Bonnes, Psy.D. (50:24):
Well, we can ex-- understand that someone with schizo-- severe schizophrenia is not going to get better. They're-- what we're trying to do is give them a quality of life, support them in what life that they're living, instead of trying to push them to become an employee at Burger King and out of the system, which is just setting them up for those failure that life has been knocking them down anyways. And so in that vet center experience, I really saw the value that a group that's been together for five years, and these men were able to talk on levels that I've never seen replicated in any of the other groups I've done. And yet they were still wanting to show up. They would-- we were still doing things. I ran a PTSD 101 group to explain, and many of these men had, and women had been there for 10 years, and they came to that because they wanted to be around each other.
Keith Bonnes, Psy.D. (51:15):
And so we're creating that sense of family system, community, again, in an environment that's healing and, and you know, if you ever have me back on or if we ever get a chance to talk again, I'd love to talk about ways that we could create that, you know, using old or other things that we could create cities, small towns within our towns that holistically understand the challenges and barriers, people with mental illness or severe mental illness face. And we can give back dignity and quality of life in ways that simply throwing money at the problem doesn't solve.
Keith Sutton, Psy.D. (51:54):
Yeah, definitely. And I love you know, kind of what you're talking about with the, those ongoing groups and so on. It's, you know, because I was talking, I was thinking like engagement of the therapists, engaging with the client, but in that sense, the clients were engaged with the community of clients. It sounds like, and so then if therapists are coming in and out, there's something that's all drawing them together, is that community and then maybe in those engaging in the services or so on. But, you know yeah, because I think that's so important. You know, kind of like you're saying, kind of using even that larger system of that community to even be able to help clients to get services. Especially when there's the barriers to maybe having an ongoing therapist that can work with them for a couple years, where the organization around it that again, that that connection is much more stronger in that community and to the other folks to keep them engaged and to keep them, you know, participating and getting treatment and so on. And just the healing this of the relationships between themselves.
Keith Bonnes, Psy.D. (52:57):
Right. Certainly. And, again, this goes back to kind of my Maslow, my Maslow's love of the hierarchy of needs, right? We created the vet center being run in the way it was with the perspective. And not all of them are the same, by the way. And so that's another issue in and of itself. But this particular Oakland Vet Center really had long time employees and the trainees that would come in would come in for their year. But the vet center was where the love and belonging existed, and the trainees were adding to that. And they were able to bring in their ideas and their perspectives. But there was also long-term, well-compensated employees that loved their work and that loved being around. And they knew it was hard, but yet they balanced that with a connection to individuals and to celebrate a new grandson and to put out a newsletter.
Keith Bonnes, Psy.D. (53:48):
And they had wonderful connections to-- PGA was helping them. They'd go out and golf and learn to golf together and learn to play the guitar. And these are the ways in which I think if we think on a community level, we take that idea of community on that small of a scale, and we take that into our communities. We can actually give people with schizophrenia that same experience and that same connection, because love and belonging is important. And many of the people I work with don't have that. Sadly, there is no one to go home to. There is no family to call.
Keith Sutton, Psy.D. (54:22):
Sure. Yeah.
Keith Bonnes, Psy.D. (54:23):
And so yeah. I see that
Keith Sutton, Psy.D. (54:26):
So important. Yeah. I had-- I was volunteering building houses after Katrina and they were saying, “What can we do to help some of these folks?” And I said, “Throw a party, have people come together.” Because really, you know, like beyond just a therapist doing a session here or there, connect them and everybody has been through this shared trauma and you know, people love to eat, people love to have food, and really kind of even just starting on those base levels of that connection. Thank you so much for taking your time today. I really appreciate it. This is so great to hear about your work and about your story and about your passion. And you know, I thank you for your service both in as a soldier and also your service in the work that you're doing with the homeless population. And I think that, you know, that I can really see that you're really driven by your values and living those values and connecting with others. And it's just, it's wonderful. And we'll definitely put some links to that Oakland Vet Center and also the Hume center on the website with the bios and so on for folks to learn more. So yeah. Thank you so much. I appreciate it. Thanks for coming today.
Keith Bonnes, Psy.D. (55:39):
Thank you so much for having me. And I appreciated this conversation very much.
Keith Sutton, Psy.D. (55:44):
Great. Take care. Bye-Bye.
Keith Bonnes, Psy.D. (55:45):
Thank you.
Keith Sutton, Psy.D. (55:47):
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