#10: EMDR and The Meaning Of Life In One Word with Dr. April Minjarez

Dr. April Minjarez is the only therapist I know who is both experienced at healing infant trauma and an end of life doula.  She is also an expert in multiple trauma healing modalities including Eye Movement Desensitization and Reprocessing (EMDR) and an amazing mentor, teacher, and healer.

In this episode you will hear how a terrifying experience with gangs in middle school inspired April to become a therapist.  You will also learn how EMDR therapy stimulates healing by reprocessing components of traumatic memories, and how this modality can integrate ketamine journeys.  Also, you will learn April's compelling one word answer to my question about the meaning of life.

Theme music by The Thrashing Skumz

Produced by Dirk Winter and Violet Chernoff

Developing Meaning is NOT MEDICAL ADVICE and NOT AFFILIATED WITH ANY INSTITUTIONS

Timestamps
0:19 - Finding Meaning in Therapeutic Modalities
11:31 - Middle School Gang Story
19:20 - Evolution of Therapeutic Modalities
23:32 - EMDR Therapy for Trauma Processing
40:00 - Integrating EMDR and Ketamine
48:51 - Working with Grief and Loss
58:00 - The Meaning of Life According to April
1:02:02 - Being Mortal by Atul Gawande
1:06:00 - Wrap Up and Look Ahead

Transcript

Dirk: 0:19

So hello, welcome back to the 10th episode of Developing Meaning. I can't believe we've had 10 episodes and I am excited because at the end of this episode I am going to tell you what the meaning of life is in one word, and actually April Mungaris is going to tell you. So if I can figure out how to do these timestamps, you could just fast forward ahead, but then you would miss an amazing conversation with an amazing person. So April Mungaris has a really interesting story and we're going to hear about. So she's an expert in EMDR and she trained me in EMDR and supervised me with a bunch of cases and we're going to hear her story about how she was in a very dangerous situation with gangs in middle school and a middle school counselor really intervened in a way that changed her life and led her to become a therapist. And so there's a theme happening in, I would say, the last, in the last episode this episode and also in the next episode with Dr Richard Brown of really bad situations turning out into having positive impacts. So in the last episode you heard about how Richard Brockman survived his mother's suicide right which is the most horrible imaginable thing that I can imagine and I became an incredible healer and helped me, and we wouldn't be friends if that horrible where we might not be probably wouldn't be friends if that horrible thing hadn't happened. And then in this episode, you will hear about how a gang situation led April to become a therapist. And then in the next episode, you'll hear about Dr Richard Brown, who built this amazing breath, body, mind training program that's now treating trauma for thousands of people in Ukraine, sudan, rwanda, turkey, many, many places. So that's going to be the next episode. So, even after you know what the meaning of life is at the end of this episode, I think you'll want to stay tuned for the following episode, because that's a good one.

Dirk: 2:56

So, and just to stay with this theme of bad things turning out in good ways, I feel like since my ketamine training, I see these weird connections between things. I don't know if that's healthy, I think it is. So it reminds me of the old Chinese fable about the farmer who's had a horse and the horse ran away and all his neighbors said, oh, you must be so upset, you lost your horse. And he says who's to say? Who's what? What is good or bad fortune? And then the horse comes back and he brings back a mayor, or the mayor brings back a beautiful stallion, and now he has two horses and his neighbors say, oh, you must be so excited, you have two horses now. This is amazing, you must be so happy. He says, well, who's to say what's good or bad fortune? And then his son rides the horse and the horse, the new horse, and he gets thrown and breaks his leg and all his neighbors are like, well, you must be so upset, and who's to say what's good or bad fortune? And then war breaks out and there's a conscription and lots of people have to go off and fight, but his son doesn't have to, and so it just continues going on and on and like this. And so I'm playing around a little bit.

Dirk: 4:22

But there is tragedy in this world and there's, you know, it's just a part of it, and finding meaning in tragedy is a really important component of healing, and we do get get into meaning in this episode. So in this episode you will get to know an amazing clinician and her story. You'll get to hear about what is EMDR eye movement, desensitization, reprocessing which is a way of bringing up traumatic memories while moving eyes back and forth and changing components of the memory, so they become less distressing and don't interfere with our lives and our sleep and cause all kinds of you know our stress system to be overly active, and so it's an amazing treatment. It's a weird treatment and you will get to learn about it in this episode from an expert. And then you will hear her tell you about meaning and the meaning of life, and there's also a component where she talks about combining EMDR with ketamine, which I had never heard of before. So if you're interested in that, I think that that'll be interesting.

Dirk: 5:41

And then she brings in a tool, govande, who has a book called mortality which talks about end of life and finding meaning at the end of life. So there's and she's a. You know she started out working with babies and little kids and she's really one of the most wide ranging clinicians that I have come across. So you are really going to enjoy this interview. I am confident, and maybe you can guess the one word answer to meaning of life, but regardless, I think you're going to want to listen. Please stay tuned and enjoy this interview with my friend and supervisor, dr April Ninjars. So it's really nice to see you. First of all, I have not seen you in so long. I don't even remember the last time I saw you. It's been more than a year, right.

April: 6:38

It must happen. Yeah, it's been a while.

Dirk: 6:42

It's been a while, and so you and I are connected, because I kind of went through this midlife crisis, I guess I would say, of not really being satisfied with professionally what I was doing and wanting to get different skills. And somebody said, hey, learn EMDR. And so I did EMDR trainings and you were one of the instructors and then you were a personal mentor helping me get my basic EMDR certification. You also connected with me me with Bruce Hersey. So that's how you and I know each other, and now we haven't met in a long time, but it's nice to see you.

April: 7:24

It's nice to see you. It has been a journey. I do remember that training. It must have been at least two years ago.

Dirk: 7:30

Yes, yes.

April: 7:32

And I do remember us talking about how to integrate other modalities with EMDR, so I'm so glad to see you again.

Dirk: 7:41

Yeah, and you connected me with Bruce Hersey. I ended up doing some of his trainings and I have an episode with him that I recorded that's going to come out. But yeah, maybe just tell me about yourself and what you're doing. I'm curious what kind of a therapist are you? How would you describe yourself as a therapist and how did you get to be that kind of a therapist?

April: 8:07

Well, I've been thinking a lot about this question. I asked a couple of my colleagues how would you answer this question? What kind of a therapist are you? And how did you become that way? And a lot of them went straight to their therapeutic modality. What modality do they subscribe to? And how did they get there?

April: 8:27

And I think I was maybe overthinking it, but I was thinking about well, what kind of a therapist am I? You know, at the very core, and then, of course, what kind of a person am I, because that's where it starts so kind of spiritual being am I? And sometimes I go that deeply about things. So I was really thinking well, how do I actually summarize what kind of a therapist am I? And I immediately went to this memory and this memory was in graduate school and the professor I still remember her, beverly Peterson. She says to the group okay, I'm going to go around and I'm going to ask you what is your theoretical orientation? This was my first year in my master's program and when she got to me I said CBT, cognitive behavioral therapy. She looks at me very curiously and she goes I don't see that for you. And then she moves on. Yeah, she moves on to the next person and I'm stunned and I'm like, well, what does she mean by that? What does she see that I don't see?

April: 9:31

And I held on to that for quite a while and as I developed, you know, as I began developing and I believe I'm always developing, always growing I started to realize, well, while CBT definitely cognitive behavioral therapy has some really good, good things in it, I think that maybe I, I like maybe just a little bit more of body based approaches, right, more related to attachment theories, and really just looking at a person as a whole, like, okay, what, what experiences have shaped you to be who you are and where you are today.

April: 10:17

You know, as I think, about the people I deal, deal with or that I work with, it's like, okay, so what has informed their ability to be able to be an awesome, fully functioning therapist or a chemical engineer or parent or teacher, and and what is it that really drives, drives this person? And what, what are the good adaptive qualities and what are maybe some of the things that maybe are more challenging? And as I grew and grew and grew as a therapist, psychologist, I realized that it's not just one thing. If, if that professor were to ask me again what is your theoretical orientation?

April: 11:01

I would say I can't answer that because it's just so vast and it's limitless and it's also a co-creation. When I meet with a client, I do start off with a foundational piece, but it really is this co-creation between me and the client.

Dirk: 11:22

So it's really broad and maybe to back up, I'm curious can can you say your story about how you became a therapist? What was your background and what? What drew you into in that direction?

April: 11:37

Yes, so it was a middle school. I had a great school counselor, mrs Goodrich, and when was this?

Dirk: 11:47

Where were you in middle school?

April: 11:49

This was an Imperial Beach Marvista Middle School.

Dirk: 11:52

So California California. You're in the San Diego area now. Is that, yes, around the San Diego area.

April: 11:59

It's maybe 30 minutes south. Okay, right now I'm in Rancho Bernardo, more inland.

Dirk: 12:06

All right, so you so back to middle school? Yeah, continue.

April: 12:09

Back to middle school. She was just so kind and she was really there. I saw how she interacted with the students and then, when I was in need, she was very helpful. You know, she made time, she provided some insight, she provided maybe some alternatives you know, alternative ways of thinking and alternative ways of responding and just was just such a genuine person and I thought, oh, my goodness, like I want to maybe help people out like that. You know, maybe there is this silver lining, maybe there is a way out of, you know, things that seem impossible to escape. Maybe there is a way, and she was kind of that guiding light.

Dirk: 12:54

She showed you the way, and can you? We could cut this out, but can you say what your struggle in middle school was at the time that she was maybe helpful with?

April: 13:04

Middle school was rough. I am an Imperial beach. At the time this was in 1990, 1991. So back in that in those days gangs were very prevalent and there was two distinct subsets of gang members and I had made one of the people in one of the gangs very upset because I wouldn't give them my pencil or something, something really, really, you know, whatever, I didn't give them my pencil and I became a target and I didn't know what to do.

April: 13:46

I also didn't have a very supportive family at the time so I couldn't go and ask for help. So I went to. Actually, the counselor had found a note that was being passed around about you know what their plans were. You know what they were going to do to me after school and she intercepted that somehow and then called me in and then helped me out and, you know, really helped me. You know, figure out what to do.

Dirk: 14:14

What did she help you do? How did you handle the gang?

April: 14:18

Well, she called in my, my mother and my stepfather and kind of let them know what was going on, which was nice, because I wasn't able to really advocate for myself, I didn't know how to, and she was able to let them know that, hey, this is a serious thing, this isn't, you know, something that she's making up and it's not something that she caused. And then the people that were harassing me, they got expelled because the threats were pretty serious. And she asked me well, who? At this time I was thinking like well, nobody, nobody's here for me, nobody is going to help me.

April: 14:54

But there were this other group of individuals who were there and she asked me. She said, well, who is there who looks for you every day? Who asked how you're doing? And I remember it was this woman, her young girl named Angela. I said, well, angela, and she says let's call Angela in. So she calls Angela in and Angela was like what, am I in trouble? But no, she wasn't. She was just a safe space for me and Angela kind of just took me in and her friend group took me in and I just felt really safe and protected from that moment forward.

Dirk: 15:25

Wow, that's like a heartwarming story. Somebody who really saved you had a you know, maybe saved your life even, but just in middle school being in that situation and getting that kind of a practical help, that's a great story. And so that touched you and you said I'm going to be a therapist now.

April: 15:48

Yes, yes, I thought I was going to be a school counselor.

Dirk: 15:51

Okay, and that stayed with you, and then you did undergraduate, and then what was your undergraduate? And then how did you get into?

April: 16:04

It was more in pieces it was. I knew I wanted to be a counselor or a helper in some respect, but I didn't really see the whole picture yet. I had a lot of challenges. You know, like I said, I didn't have the most supportive family. I did have a wonderful grandfather, but as far as, like you know, mom, dad, stepdad at the time they are in case they ever listen to this they are lovely now. But when I was growing up, you know it was challenging.

April: 16:33

So, you know, there was a point where I moved permanently with my grandfather in high school and I was just trying to get through, get through the day, get through the years, and I thought about joining the military because I was an ROTC but I had asthma and I wasn't able to really do the physical parts. I'm like, oh, you know, maybe it would be great to be a therapist in the military, but it's okay if I can't. And I wasn't able to. So then I just did my associate's degree at a community college in psychology. And then I'm like, okay, I'm done with that. Now what do I do? Well, I guess I should get my bachelor's degree.

April: 17:12

And you know, then I got my bachelor's degree, also had my son at the time. And then I got I was with my bachelor's degree and then I'm like, well, I'm just going to chill out for a couple years, no-transcript. And I did, I just I just, you know, was with my son. He was very young at the time and then I decided, well, it's time to keep moving. I'm not a counselor yet, let's go and do my masters. And that's when I met Dr Peterson and she rocked my world with my, you know, with the theoretical orientation question, and I started working in the field in 1998. When I was working in my on my associates, I worked in a residential facility for children it's called Polinsky Children's Center here in Karnie Mesa in California and I was exposed pretty early on to the field and I've been in it ever since. What was the?

Dirk: 17:59

population there that you are working with. What kinds of what kinds of troubles were you helping people with?

April: 18:05

It was really any any child, one, you know, maybe one week old, two weeks old, depending on their age, to age 17. At the time they had different cottages, so they had, like an infant cottage, a pre-toddler, toddlers, latency age, junior age and then teens, and so this was a facility where let's say that something happened with the parents or something happened with whatever unit they were living in and they needed to be removed immediately. This is where the children would go, and so at the time, I was a residential care worker, so I was there to help with their everyday needs, you know, helping with bathing, helping with feeding, helping with changing, helping with behavior issues, getting them to school, and it was. It was a really difficult time for the children because they were, their world was just rocked in terms of you know what they were in an environment, and then they were moved suddenly and then from there they're placed in a more permanent or semi-permanent situation.

Dirk: 19:09

So, so, really needy kids. And how long did you stay there?

April: 19:17

I worked there for two years, from 1998 to 2000.

Dirk: 19:20

Okay, and our, our paths over overlapped with EMDR, I'm curious. So so you thought CBT, and then yeah, how did? How did your modalities and interests evolve?

April: 19:38

Well before I started my master's program, as I said, I worked at the Polinsky Children's Center and that was very behaviorally oriented, right when you did a shape and modified modified behavior because there was a lot of disruptive behavior happening, a lot of aggression, a lot of maybe suicidal thoughts and behaviors, homicidal thoughts and behaviors. So to be able to shape the behavior was super important. After that I became a therapeutic behavioral coach where I worked with children in their adoptive homes or their foster homes or in their schools at the time, to help modify, shape behaviors so that they wouldn't lose their placement, so that they can continue to thrive in whatever situation they were in. So by the time I entered the master's program I was pretty deep in behaviorism or like cognitive behaviorism. So that's where I thought I was going. And then when I finished, when I finished graduate school, I landed in residential facility, one here in San Diego, san Diego Center for Children. And then I also went to Arizona for a little bit and there was a residential facility called Inner Mountain Centers for Human Development. Both really great, awesome experiences.

April: 20:50

But I started to get fatigued. I said, oh, my goodness, this is the same story over and over and over again. You know these children. They go through these horrific experiences. They come into the system in one way or another. We help, we help them, we help with this cognitive behavioral therapy modality. We do family therapy, we do group therapy. We maybe attend IEPs, those individualized educational plans, and we help their teachers and their parents or foster parents, whomever really help help them understand where the child is coming from, so that everyone could have a successful time or a better time.

April: 21:32

But it seemed like it was. There was something still there. There was just some angst, there was the sadness, there was the conclusion about self. Well, because all these things happen to me, or because my parents didn't, didn't want me, or because I was neglected or abused in some way, then it was difficult to separate self, like who you are versus what happened. So who am I versus what happened to me? And it was just so, so, terribly sad. And I didn't know if I could continue in the field. I didn't know if, if what I was doing was even making a dent in in what was happening. And then I switched to work with veterans and active duty at that point Because I thought, oh my gosh, I just can't bear this anymore. It was, it was just so, so sad. And when I got to working more with adults, I'm like, well, it's the same thing, they're just they're suffering with the same issues. They're just older. What, what are we going to do? So then I learned other, other modalities. You know, I learned Go ahead.

Dirk: 22:40

Sorry to interrupt, but just to um, the thought I'm having is the CB. As you said, cbt is useful because you can change thought patterns, but it and this is sort of a realization that says I've come to also, or a feeling that that it works more cognitively, that it's sort of the top of the brain and that a lot of the problems are more in the the right way and so you are in the, the right brain and the base and the feeling and and deeper, and so you can't make those shifts using the cognitive and talk therapy approaches. As much Is that. Is that kind of what you're saying or what your experience is.

April: 23:32

Yes, that's exactly it. You know, at the time I couldn't articulate it, I just knew this wasn't working. Yeah, and I tried other things. I tried GPT dialectical behavior therapy. I tried CPT cognitive processing therapy. I tried narrative therapy. I, I, you name it. Whatever training was out there, I was there because I wanted to really make a difference. Then, in 2009, they say April, I was working at the veterans village, san Diego, and they said, april, do you want to go to this EMDR training? I'm like what is EDRM? And they're like no.

April: 24:10

EMDR yeah, what is that they're like, well, it's supposed to help with, like, ptsd trauma. That's how it was introduced to me and if you'd like because you're, I was volunteering there at the time. Since you're volunteering here, you can get trained. And I'm like, well, I was already soaking up as many trainings as I could. I was like, sign me up and I signed up and I saw those videos in the weekend one training and how the changes came about so quickly and that's what I was looking for. It's like, okay, here it is. It's that, it's that sense of of who you are versus what happened to you, like, yes, those things happened and I can have a meaningful adaptive conclusion about myself, so I don't have to be way down by the past anymore and I thought, oh, this is it. And then, ever since then, I just took off with it and I've and I dare I say I've been in love with, with EMDR yeah, so let's talk a bit about EMDR.

Dirk: 25:11

A lot of people I didn't really learn about it in my training. A lot of people I come across with are like this is this is. People don't know about it. So how do you tell people what EMDR is?

April: 25:26

At first it was a little challenging because 2009, 2010, when I, when I started to really use it, it it was less known then than it is now.

April: 25:36

And it's like what do you want to do with my child?

April: 25:39

Oh, by the way, I went back working with children at some point and so I needed children to work on and, you know, explaining it to parents was very difficult.

April: 25:47

So, basically, what I ended up saying is that, okay, there's this therapy and what it does is it helps to unstick those, those frozen memories that aren't helpful, and it gets them unstuck and unfrozen so that it no longer is bothering your child every day. So right now, whenever you ask your child to throw out the trash and they you say it in a certain tone, they're remembering when that thing happened two years ago and there might be a frayed that it's going to happen again. So if we can, if we can get that memory and we can do our EMDR process with it, we can unstick it so that now it won't be just sticking out at your child all the time. Now, when you ask your child to throw out the trash, they may be able to just throw out the trash without all the emotion involved in it, and so when I say it that way, they're like. Parents are like yes, yes, we want our child to throw out the trash or to be able to respond in an adaptive way.

Dirk: 26:52

And yeah, this was really exciting for me with EMDR also is the model of the brain and the mind and how memories are stored and that you know there's this sort of the normal, healthy style of processing memories and you know, I kind of, you know, remember what elementary school was like and what I was like in my teens or 20s, and you kind of have these general memories and there's this timeline and things sort of fit in, but it's not like crystal clear memories, but then traumatic memories, which are emotionally intense, are just sort of burned into our system in this way that it's separate from time. It's just this activating fear response that alerts our system and so we react in this very intense way. And then the idea of, oh, we can bring up those memories and all the different components, the ticies right. The EMDR talks about what is it? Thought, images, sensations, emotions, and you don't have to talk about it, you just bring it into your mind and then you start moving eyes back and forth or doing tapping or some other bilateral, and now that memory starts to get reworked. And another component is so you're going into the memory but then by moving eyes back and forth, you're triggering a relaxation response.

Dirk: 28:38

Yes, also. And there was that nature paper a couple of years ago where they showed that in mice you could prevent fear memories by moving a light horizontally back and forth, and a flashing light didn't. So there's some, there's really interesting ways that our brain stores information and we can, we can use that to reprocess memories. And then, and then there's the the you guys teach us, you know, the memory becomes like yesterday's news. It's like reading, reading a story and I actually I had. There's a patient I was working with today who I was using EMDR and she she had been assaulted and and had PTSD from it and and she's like, yeah, some I don't get it, like it doesn't trigger things anymore, and so that that's amazing.

April: 29:36

Yes, definitely it's. It's like these stuck frozen memories, and you know what some clinicians might call Trauma Time. They're here and they're informing your everyday experience and they don't have the chance to connect to what we call your adaptive memory network. So your adaptive memory network informs, like, who you are. Like my adaptive memory network said, okay, april, you can come on this podcast show and you can talk about this, even though I was a little nervous, right. So I have this adaptive memory network.

April: 30:09

But let's say that I had some, really some experiences that maybe weren't very favorable, and then they would cause me to maybe say thank you for the invitation, but I can't do this right now. Maybe those stuck frozen memories are just, they're not able to connect to that larger system and integrate with my adaptive memory network to inform who I am. Like, yeah, maybe those experiences were not very great and I can still do this. And so what EMDR would do is we would, in a very structured way, get the presenting issue maybe it's performance anxiety, right, maybe it's other types of public speaking anxiety, whatever it might be and through this process, find the memories that are related to this and once we get one of those memories that are isolated and frozen in time and not able to integrate with the specialized procedures that you talked about, the TICY strategy, getting the memory like the image, the negative beliefs we might have about ourselves.

April: 31:09

You know the emotions, you know where we feel it in our body, how disturbing it is. Then we bring up the memory as it's currently stored and then it's it's amenable to getting restored with the safety of today. So once you begin the eye movements, then it does produce that relaxation response and it's also difficult for the memory to be stored the way that it was, because now you're bringing it up with the safety in the present, with the relaxation response, and you're taxing your working memory so that you can't just attend to this memory and you're also looking at the clinician's fingers or the app on the screen or the light bar or the tapping. So when the memory is ready to be restored, it's restored with the relaxation, the safety of the present and maybe additional information that the therapist might provide like a reminder of you're safe, now it's over now.

Dirk: 32:09

Yeah, those are all really interesting elements of how it works, and I'm also thinking about the dual attention piece that you're you're mentioning and, I think, being in the memory. But then also there's sort of a different. Somebody was explaining with hypnosis you're back in the memory, you go fully into it, but EMDR, you're here with the therapist and then in the memory. And can you just say a little bit more about how your therapeutic session is? You sort of mentioned? Somebody comes in with a presenting problem and then what happens?

April: 32:56

Where do we go from there.

Dirk: 32:58

Where do you go from there?

April: 32:59

Yeah, Well, it depends on the client. Emdr is client centered, therapist led. So if if there is a client is looking for EMDR, or if it's obvious you know, maybe sometimes it is, maybe sometimes it isn't that the past is present, then we'll, you know, we'll do our normal and take in all that good stuff and then explain EMDR and if that's something they want to do, then we'll start with our state change strategy. So what you need to do is is there that adaptive memory network to connect to? Yes, ideal, you know there probably is, but sometimes the connection to it is is very weak. So we want to do some exercises so that the client can connect with their adaptive memory network. So we do things like you know, can they be? Can they go into a calm, safe state? Can they maybe do a containment exercise, maybe some guided imagery? Are they able to connect to their adaptive memory network so that they can change states? And that's what you need to know for EMDR. Can you change states? Can you go from being calm to annoyed to being calm again?

Dirk: 34:05

And by by adaptive memory network you mean being grounded, being present, being in like a relaxed, calm, good functioning place.

April: 34:16

Yes, yes, yes. And if they've got that then we're good to go, and if not, then we just have to work from the ground up and develop it. But once someone is ready, you know, usually clients don't come in with one issue. You know they don't say, oh, this is the one issue, right? Sometimes there's a lot of different issues. So we work with the client to figure out which one would be best to start off with. And once we identify that, then we do a structured way of finding those memories, what we call the target identification worksheet, and we, we get those memories and then we decide together which one we're going to start with. And once we've decided which one we're going to start with, then we, we activate. The memories are the component of the component of those memories and we begin our desensitization with our eye movements or tapping ideally it's eye movements.

Dirk: 35:14

And eye movements. You're moving fingers back and can you explain how the eye movements work and how the tapping works?

April: 35:24

Yeah, so ideally you want your client to be able to do eye movements where they move their eyes all the way left and then all the way right and, like you mentioned that nature study, in that study you had those, those lights going, going back and forth, and that helps with that relaxation response and it also helps to extinguish that fear response.

April: 35:45

So when we bring up the memory as it's currently stored, we want that, we want the eyes to move left and right quickly and that helps with the reconciliation of memory, helps with the relaxation, helps with the dual attention, so that the client can then get that memory stored in a, in an adaptive form, in a, in a, in a way where I can link to that adaptive memory network. If eye movements aren't possible, there are other ways to do that dual attention, that bilateral stimulation. You could do butterfly hugs where you would tap left and right, you can tap on your knees left and right. There's also auditory apps and stuff where you would hear tones or sounds left and right. So it doesn't necessarily have to be eye movements, although eye movements are the most, they're the best, they're the best thing to use because they're one, they're more, most researched and they tax your working memory the most.

Dirk: 36:46

Well, so much of our brain is eyes and vision and there's four of our cranial nerves, our eye muscles and then the optic nerve and then all the brain space of the vision. So you're really doing a lot with the brain while doing the memory too. So you're promoting integrate it. To me it makes sense. I think there's in, it works in the room. Sometimes it seems like there's sort of a I don't know if controversy is the right word but people, I think sometimes from from more traditional backgrounds, there's sort of a skepticism towards EMDR. I don't know what that's about, but I don't know if you have any thoughts about that, or yes, unfortunately, or fortunately, I've experienced this, especially when I worked on a military installation.

April: 37:37

It's like we had, it's like we had a two sides. We had one side of the base who really loved EMDR and was all for it. We had the other side. That's like no way. That doesn't work. We're going to do, you know, cbt or prolonged exposure, and actually they all work. If you look at the research they're, they're all pretty on par with one another. They just have a different way of going about things and of getting the you know the good, the good results. So what I like to do is when, when there's other clinicians or or clients who are skeptical, I just encourage them to go, learn it to, to experience it. Maybe sit on. If they're a therapist, you know, maybe they sit in with an EMDR therapist, with permission of the client, to see how a session goes. You know, just just keeping an open mind about how the, how the approach could possibly work for some of their clients.

Dirk: 38:29

Yeah, I mean, for me I feel like experiencing it yourself. That's an important element and I think the neuroscience is interesting. And then what I've looked at, like the Cochrane reviews on efficacy it's certainly as effective as other treatments for trauma. And then some people will say, oh, but it just it uses some common factors and it's, you know it. It to me that does. That doesn't make sense, like, oh it, it doesn't really just do the same thing as CBT, which is another evidence-based treatment. It's so different.

Dirk: 39:09

I think, doing it at first they showed this weird feeling of like oh, this is so weird.

April: 39:18

It's very weird because your therapist is asking you questions and then they're saying, okay, go with that. And you're like, well, what am I supposed to go with? And the therapist is whatever's coming up, just notice, right? You do the set of eye movements and then they stop and the therapist says, well, what do you notice now? And the client, especially if they're used to other forms of therapy, they're going to be like, well, what do you mean? And so it really does take some time to retrain.

Dirk: 39:42

Let me talk about it for a long time. We discuss everything that's coming up and you're saying, no, just give me what are you getting. And then keyword and go with that and continue, and this sort of chain of memory beads on a string that you're following.

April: 40:04

Yeah, I was listening to the other podcasts you have on your channel and you had one about psychedelics and I was thinking about that because part of EMDR you can do, like ketamine integration, you can do other psychedelic integration. So let's say somebody has a psychedelic experience, right, and then they go to do the integration piece. You can actually use EMDR to do the integration piece and deepen the experience even more. And also with the psychedelics, like with ketamine for example, you take that medicine and you go into this. For some people you get this deep experience, this expansive sense of self and it almost seems like EMDR, but times 25,000. Like you just get there so quickly. But with the help of EMDR it can really help to integrate it into your everyday life, like integrate that experience and integrate meaning into your everyday life. So I really like that EMDR is very integrative, that you can, someone can do psychedelics and you can use EMDR. Somebody can do do dbt and also EMDR.

Dirk: 41:16

So this is the first I've heard of about ketamine combined with EMDR, and I'm very interested in ketamine so I did a ketamine training and by the time this comes out, I'm going to. The next podcast I'm going to release is an audio diary of my ketamine training experience. Okay, and I'm not a psychedelic person Historically like I didn't play around with that but I felt like this is something I need to learn about and I did a training in it and it's an experiential training where we ourselves took oral and then I am ketamine and then helped each other and since then I've been using it some in my practice. So I'm curious about your story with learning about ketamine. I saw that that's, that's an interest that you've developed.

Dirk: 42:07

So you work with ketamine and how did that add into your storyline of therapies that you learned.

April: 42:18

I work with a lot of veterans and a lot of them are, you know.

April: 42:22

talk about going and doing some ayahuasca you know, in Mexico or talk about psilocybin, and I couldn't speak to that.

April: 42:30

I didn't understand, like what that meant, what it was like, how I can use that to inform our treatment plan, how, how we can really use this so that, so that they can feel maybe more empowered or maybe add to their, their goals. So I did a ketamine training and as part of that training it was also an experiential piece where you go and you do what I am and you have this beautiful experience. And when I did that I thought, oh, my goodness, that's when I realized this is like EMTR times 20,000, like it gets you right there, it doesn't give you any time, you're just boom there, I am at the core and and I realized how important it was to have the integration experience later, you know, otherwise it goes away, it fades. So to be able to whatever conclusion one might come to because of their journey and as they integrated into their everyday life, this is the perfect time to use EMTR to help integrate that, especially taking advantage of the neuroplastic effects post ketamine and using that time to really get some other meaningful changes done.

Dirk: 43:43

So yeah, psychedelics and ketamine create this neuroplastic state and people are very interested in using that therapeutically. And so you, how do you do it? What practically? So, you have clients who have a trauma or some kind of problem and then they're doing ketamine. Do they do the ketamine in your office or do they do that someplace else? And then you integrate afterwards. How does that work?

April: 44:14

They do it someplace else, ideally, you know, with a psychiatrist or or maybe they've got some sublingual ketamine that they have and they usually do it at home or with with their provider, and then the next day will will meet for EMTR. They do have the option. If they wanted me to sit with them if you know they wanted to do it at home and they wanted to meet me, to be like online with them or if they wanted to come in and they have that sublingual prescription, you know then then they could do it here. But mostly they do it either in their provider's office or at home and then we capitalize on the neuroplastic effects the next day.

Dirk: 44:55

Very cool, so you're not moving eyes while people are on the ketamine.

April: 44:58

No, that would not work.

Dirk: 45:02

Yeah, that seems like not a good idea. So then they have this experience and they're thinking, wow, this stuff has come up. And then they bring it to you and you use the, the EMTR approach to to work with it and and you do that the day after usually.

April: 45:24

Ideally yes, because usually there's not always. But there, if there's this expansive experience of unity and connection and maybe, you know, disease is usually like disconnection, right? So they're oftentimes suffering from some sort of disconnection, and then to have this expansive connective experience, it's like, ooh, we're gonna capitalize on that and let's go ahead and resource that. So let's go ahead and get that experience, get some image, emotions and physical sensations and do some slow, bilateral so we can enhance the connection to that experience and that ability to be connected. It's like serving as the antidote to the issue, right?

Dirk: 46:07

Can you say what you mean by resource? That I think you kind of explained it before. But just to be clear for people, yeah.

April: 46:15

So they come in and they say I had this, really, this awesome experience. I felt so connected to myself in the universe. Let's just say, oh, what was that like for you? Oh, it was just amazing. What image comes up, what emotions come up. Where do you feel that in your body?

April: 46:31

And so I'm getting the components of memory related to that experience. And then when we do slow eye movements with that, then that strength strengthens their connection to that experience. And then we give it a Q word. Okay. So what would you like to call that? Oh, I want to call it connection, notice connection in those feelings and do some other, some more slow eye movements. And now they have that as an additional resource so, as they're moving forward in their life, if they're feeling disconnected or they're feeling not so good or they're having an especially difficult time, then they can remind themselves. Or I can remind them hey, remember your Q word, resource or connection, Remember what you were experiencing. Just bring that up. So it really helps to remind them that they have this experience and that they can be connected, and it could help with the overall treatment planning process and their goals.

Dirk: 47:25

Cool. So that's a sort of this beautiful brain state where they're feeling connected and meaning and images that, and so they have that and they can just use your Q word and go into it whenever they want to, whenever they need to. So I think I want to shift towards towards meaning. I'm also curious about you've sort of said the populations that you work with, the kinds of. Do you want to say so you work with military population? What are all the the main types of people or troubles that come to you?

April: 48:01

I work with adolescents, young adults. I work with active duty and veterans. I work with people who are older and maybe are coming at the end of their life. So I work with like, like any type of PTSD or any other type of like, anxiety, attachment issues, developmental traumas, combat experience, first responders. And then I work with end of life issues. So I will work with grief and loss, but then also I'm also an end of life doula. So if someone is nearing the end of their life and they'd like the support of a doula, I'm there for that too.

Dirk: 48:40

Oh, wow, so you're, you're, you cover the whole lifespan.

April: 48:45

I don't do the littles anymore though.

Dirk: 48:51

So how come you think you're such a wide ranging therapist in terms of the people you serve and when I ask people? So my question about what kind of a therapist are you and how did you get to be that kind of? I'm curious, because there's so many different types of therapy is out there and I'm learning about them and a lot of them are interested in and very few of us do sort of evidence you know, pick the therapy. That's the evidence base. For the thing is somehow there's something about our personality, I feel like as therapists, that sort of draws us to working a certain way and we we end up using a set of tools that fits with with our personality a lot. So I'm curious about people's story and and how they come to to their own particular niche. I feel like you. Your story is sort of like well, you just wanted to be helpful and so you tried all these different things and this is just kind of the thing that works the best.

April: 49:59

It was really an increments. You know, at first it was like, oh, I want to be like Mrs Goodrich, right, I want to help young kids. You know that struggled like I did and that's why I started off with children, right. And then, and then, you know, the military is a population I always had affection for. So when I was a little burnt out with working with in residential, that's when I moved to active duty and veterans. And then I saw, oh, there was a lot of combat PTSD, so I need to learn how to do that.

April: 50:28

And there was a couple of areas in my practice that I could not work with, and that was grief and loss and end of life. It was just something I didn't want to look at, but I was forced to look at it. What's 2022? I was forced to look at this and I had to deal with it myself personally and, instead of referring people out whenever they had like grief or loss or end of life stuff, I decided I was going to just handle it head on and do my own grief work and then learn how to do the work, and then now I'm able to provide it wholeheartedly.

Dirk: 51:02

So you had a loss of somebody in your family or you had clients who are losing people, or it all happened at the same time, I believe.

April: 51:11

When we were meeting I ended up having to take a leave of absence. That was because I had a really intense medical condition where I could no longer swallow and at the same time my grandfather was passing away, and my grandfather was the one who was like you know, my mom and my dad, my everything. So he was passing away at the same time that I was not doing well. So I was really out of my practice for about seven months, recovering and then also recovering from the loss. So at the same time, when I was coming back, a couple of my clients who stuck with me were also experiencing their own losses and I couldn't do it. I was like I'm just going to cry here at the session, I'm not going to be helpful, and so I had to just face it. I had to face it. I had to do my own work, my own therapy, so that I can manage it and then move on and help others.

Dirk: 52:09

What is helpful in learning how to deal with grief, or what have you learned about grief? And how to survive and thrive after grief and loss.

April: 52:21

I think it's learning to love without attachment. You know, like the Buddhists say, learning to love without. I guess the me in there that's difficult every single day, but I think it's something that we can practice I also. The ketamine was also very, very helpful because, you know, going into that experience and seeing, you know, my grandfather, and seeing all the people that had passed before them, and then saying we're still here, like really recognizing that the energy is never gone, it's here, it lives within us and around us, and then really learning to have a different relationship with those energies. And then, you know, doing some other grief work, like being able to close the loop on, maybe, relationships that are not complete. It's just, I think it just takes a lot of different things. I don't think that there's one answer to any of this and I think that's why I also like to do all these different things, because not everything's going to work for everybody.

Dirk: 53:21

That's really nice.

Dirk: 53:24

So connecting with those same people and with their energy in a different way that bringing the me out of it, but finding a bigger connection and yeah, I mean this sort of gets us to meaning right.

Dirk: 53:39

And I feel like I went into therapy to sort of fix my own existential questions and am sort of playing with this idea of well, what if we just get rid of all the DSM and get rid of the whole idea of mental health disorders and just sort of adopt Victor Frankel's idea that you know, the main, our main human drive is for meaning and purpose, and whenever we have symptoms, maybe we could just look at that as information that like somehow there's something blocking our path towards meaning. And if I'm anxious or depressed, that means I need to sort of listen to my body, listen to my system and see how I am connected to my environment, and so I'm like, is that a? Does that seem like a crazy idea to you? Or I mean, obviously we have to. You know we have to use conventional diagnosis and there's a lot of benefit from that. But I also think sort of shifting that perspective. I'm curious about what you think about that idea of.

April: 54:54

I think it's a great idea. I would, you know, maybe it won't happen in practice. You know, like maybe the DSM won't just automatically disappear, but maybe the way that individual providers talk with their clients and conceptualize their clients, you know, this could really make some meaningful changes in terms of outlook. And I think about the example of schizophrenia, for example. You know, I'm thinking like before we had the MRI machines, before you can detect actual organic differences.

April: 55:27

My understanding is that it was people said that schizophrenia was a result of stress, right, or like some trauma. And then we get all smart and fancy with our machines and we say, oh no, there's some really brain based differences here. So this is, there's a disease model here. There's nothing that can be done with it. But now we're coming back around and it's. It's like actually there are some forms of schizophrenia that can be held with therapies like EMDR and we can reduce some of the visual, audio, auditory hallucinations, you know, because maybe stress and trauma contributed to that.

April: 56:08

So I do hope that we can get back to that with many of these issues. For example, I have a client who really, really is holding on to the diagnosis of being borderline personality disorder. A provider gave that to her and she's holding on to it like a badge. Okay, you know well what does that really mean? It means there was, you know, there was probably some attachment disruptions and chaotic, chaotic childhood, right, and so does that necessarily need to be a disorder, or maybe it's just things we need to pay attention to and work on?

Dirk: 56:43

Yeah, I think the schizophrenia is interesting and there is work. There's that Irish psychiatrist who developed the whole EMDR for I read his book. It was amazing.

Dirk: 56:55

I wanted to do his training but I haven't been able to. But but that, yeah, there's the big World Health Organization study that finds that outcomes for schizophrenia are better in developing countries than in first world countries and that a lot of it is just sort of connectedness and in that we hear sort of shuttle people off and isolate people and that then leads to bad outcomes, Whereas if you can sort of keep people connected in connection is a big component of me, I feel like meaning is like. For me it's it's connectedness and then being able to have some kind of a positive impact, and then also maybe connection to something, something bigger, something spiritual even. I've, like I personally moved in a much more spiritual direction, I feel like every day, but I think the catamine was a piece of it. But yeah, I'm curious where. What is your perspective on meaning? How do you think about meaning in your own life and what, what are the main components of, of meaning for you?

April: 58:09

Meaning wow, that's, that's a big one too. What are we? What are we doing here? You know what's? What's the point of this all? Sometimes I wonder, and I think, initially, when I was becoming a therapist, it was kind of like my life and everything that had happened kind of pushed me in this direction and so, because I had this issue, this is what I was going to be a therapist. But then I think at some point it's no longer the push, it's it's now okay, now that I'm here, I get to choose. Am I going to choose to be a therapist? And and I've, I've passed that point, thank goodness. And now it's a choice for me, a real, real choice.

April: 58:50

And when I think about meaning, I think about the impact that all of us have on the world, you know, starting with ourselves and our family and each other and to see people struggle with an issue for months, years and even decade after decade, to see the relief on their faces, to see the tension melt from their shoulders and then to see them interact with their families differently. That's what it's about. Okay, now we're really we're making some real good change here. And and when I go home and I reflect, it's like okay, you know, maybe today was was not the best day, or maybe the next day is a great day and and maybe we've changed some people's lives today, maybe their perspectives, maybe, maybe the impact on their children or their animals or the world in small little bits of, in small little bits of pieces, you know just just that every day, every day, you know being present and and being with someone who is hurting and who can then heal from that hurt.

Dirk: 1:00:01

Nice. So I'm going to ask you some some sort of rapid fire sentence completion question. You you sort of already answered this, but but sort to start with, according to me, april Minjaris meaning of life is Connection. Nice, and the most meaningful thing that I did yesterday was Hug my dog. And if, if I or somebody else comes to you with a sort of a crisis of meaning and say I don't feel like my life has meaning, what is there a way that you would approach my coming to you?

April: 1:00:44

I would say tell me more about that. Tell me how, what's, what's happened and what. What has led you to the point of you know, you know feeling that way?

Dirk: 1:00:57

Just have a conversation and and and connect about that and after, after I'm I'm gone, is there a way that you know what would you most like people to remember you for?

April: 1:01:17

Well, if they remember me, I'd like, I'd like them to remember me as you know, someone who is optimistic and maybe helpful and maybe helped, you know, shine a little bit of light in their their journey on this plane, in this life.

Dirk: 1:01:36

Nice and in the last week or so. Is there a most meaningful TV show or book or music or artwork that you have come across?

April: 1:01:51

There is this great book called Bean Mortal. Have you heard of it?

Dirk: 1:01:55

No, what is it oh?

April: 1:01:57

it is. I'm afraid I'm going to say the name wrong, so I apologize. The author is Atul Gwande I believe.

Dirk: 1:02:05

Okay, yeah, I know him a little. I know I've read something of his, but yeah.

April: 1:02:10

His book Bean Mortal was absolutely life changing.

Dirk: 1:02:15

It is. What about it? Yeah, Struck you Well it's.

April: 1:02:19

It shines a light on our broken system as it relates to aging and dying and nursing homes and hospice homes, and it also talks about alternatives and what matters in the end right, and what matters in the end is exactly what we've been talking about this whole time connection and being making life meaningful even when it's ending that when a life is ending, it doesn't make it less meaningful, it doesn't make connections less important, it actually makes it more important and that there are ways that there are things you can do in ways that you can show up for people in those last moments of life. That will impact them, and I'm also very spiritual and I believe that it'll help them transition into the next phase of their energetic journey.

Dirk: 1:03:17

That's so important. I really like that you brought that up. Can you say a little bit more about your spiritual perspective at this point? If you don't want to, that's fine too, but I think it's super important.

April: 1:03:33

It guides me every single day. I grew up Christian. I'm more in line with what the Buddhists believe. I'm more in line with okay, there is a creator out there I'm just not sure what it is or what it looks like. That there is a higher purpose here, that we can help each other here in this plane and that there's going to be another one where maybe we learn right, we learn from this life and that we can continue to improve or work on in the next life.

April: 1:04:08

I think what we do here matters and that we all are connected, even though, especially here in the West, it's so individualized. It's a lot of me, me, me and boundaries and all this good stuff, and what I like to say is that boundaries are good as long as they don't hurt me or hurt anyone else. But we're also wired for connection as spiritual beings and as flesh beings, and I think a lot of the individualistic stuff hinders that connection. So I really want to just find like I like to like find like-minded beings, someone who I can be around, that is like just a person, right? Let's just be people and let's connect in that way. Oh, and it does guide me in my practice I do a little bit of a prayer before the sessions. At the end of the sessions I say another prayer just to wrap up the energetic circle and just keep moving forward.

Dirk: 1:05:15

Well, I've really enjoyed working with you and learning from you and I definitely sense this sort of warm, spiritual, kind energy from you in all of our interactions and just really appreciate that and really enjoyed talking with you. Now, is there anything more that we didn't cover or something?

April: 1:05:43

else that-. Yeah, I just wanted to say thank you so much for having me here on your podcast and I'm really thankful that we met and we connected and I'm so glad that you thought of me for this, even though I was super nervous to do it. Thank you so much, I appreciate you.

Dirk: 1:06:05

I really appreciate you. Thank you for taking the time.

April: 1:06:09

Thank you.

Dirk: 1:06:12

So there you have it we have figured out the meaning of life. Connection this comes from a wonderful healer and the only person that I know who works with both infants and is an end of life doula. What a thoughtful and kind person. I really enjoyed this conversation. I hope you did too. So connection what are we connected to? What is our impact on each other, on nature, and how are we impacted by the natural world and by others around us? Mission accomplished we have figured out the meaning of life, and yet our sense of meaning changes from moment to moment and person to person and requires continuous updating. So for now, I will continue, and I have a great person and very exciting episode coming up next with Dr Richard Brown creator of the Breath Body Mind Program for Healing Trauma, which is an international organization and method for healing trauma using breath, visualization and movement.

Dirk: 1:07:30

It's really pretty great. And then also with Deb Dana and Polly Vagle Theory. So we have a lot of exciting stuff coming up. There's more to come, more to learn.

Dirk: 1:07:40

I am so happy to be connected with you and have you along on this journey, and so until next time, I hope you have a meaningful and meaning filled month. And if you figure out the meaning of life, don't let me know, because April already figured it out in this episode. Just kidding, but not really. And yeah, see you next time. Peace, it's one of our times. In Paragraphics, dance the way across to the energy of the chest. Possible pumpkins to kill the needles, but life.

April: 1:08:39

no change to desire. And what she thinks, she says as she turns on campus, no particular tone of voice.

Dirk: 1:08:50

So on and on. In our baseball, no particular tone. Here's to Thank you.