Guns & Mental Health: A Deep Dive with Jake Wiskerchen

Show Notes

In this episode of Faithfully Engaged Johnny and his guest, Jake Wiskerchen, dive deep into the important topics of mental health, gun ownership, and gender affirming care. Jake Wiskerchen is a Licensed Marriage and Family Therapist in Nevada. He is as well the champion of dad jokes!

Jake shares his valuable insights on various aspects, starting with the significance of understanding emotions and cultivating emotional intelligence. They explore the groundbreaking work of Walk The Talk America, an organization bridging the gap between firearms ownership and mental healthcare, and the positive impact it’s making.

Another critical subject of discussion revolves around gender affirming care, where our guests delve into the challenges faced in this field and the potential ethical implications that arise. As the conversation unfolds, the role of insurance in mental health care comes into the spotlight, along with the benefits of direct primary care.

Jake encourages listeners to check out the emotional functioning videos available on the Zephyr Wellness website, a resource that can provide valuable insights into emotional well-being. He also extends an invitation to mental health practitioners to register themselves in the 50 state directory, offering their support to individuals in the gun community who may be dealing with mental health issues.

And to add a touch of humor, the episode concludes with a delightful dad joke. So, if you’re interested in gaining a deeper understanding of the intricate connections between guns and mental health, along with gender affirming care, and the importance of emotional well-being, this podcast episode is a must-listen!

Don’t forget to support Walk The Talk America and explore the resources provided by Zephyr Wellness. Tune in now and join the conversation!

Jake Wiskerchen’s Links

Twitter: https://twitter.com/jakewisk

Emotional Functioning: https://www.zephyrwellness.org/media/2021/2/12/emotional-functioning

Walk the Talk America: https://walkthetalkamerica.org/

Noggin Notes: https://www.nogginnotes.com/

12 Rules for LIfe: https://amzn.to/3q3gNZe

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Transcript

Johnny Sanders (00:08):

Welcome back to another episode of Faithfully Engaged Today, and I’m going to do my best here. Jake, I have Jake Discursion. Did I get it? Nailed

Jake Wiskerchen (00:17):

It.

Johnny Sanders (00:17):

Yes, nailed it. All right, I got it. So got him on here For our guest today, I’m going to let Jake kind of introduce himself and we’ll jump into things. So Jake, tell the audience a little bit about yourself.

Jake Wiskerchen (00:29):

Thanks, Johnny it. So I’m a clinician and I’m a marriage and family therapist by trade licensed in Nevada and here in Northern Nevada. So in Nevada, we’re not just Las Vegas. So for those of you who are not geographically familiar with our state, we do have other parts that are not Las Vegas. And I’m in the Reno Sparks area, which is up north a little bit right next to Tahoe. So I own an operator, an outpatient counseling agency called Zephyr Wellness. We do talk therapy and we’re pretty well engaged in the community, and I wear a bunch of other hats and sit on a bunch of different boards and stuff, but usually people aren’t really interested in a verbal resume. So I’m just going to stop there and not bore everyone.

Johnny Sanders (01:12):

Well, speaking of not boring, everyone that, those of you that watched kind of my previous content under Truth and Grace Counseling podcast, know that I like to take things. We like to talk about serious things, but to take somewhat of a humorous bent, I think sometimes we can just be a little too serious at times. So I’ll kind of conversed with Jake on Twitter before, and I know that he’s the expert of dad jokes, so I was wondering if you had a good dad joke that you could share with the audience here.

Jake Wiskerchen (01:46):

Oh, man. Expert of dad jokes. I don’t think I’ve ever carried that mantle before, so I’m going to tell one that’s not cut for Twitter because it’s long. Okay. Okay. But it is my favorite and it is my children’s favorite. All right, so these three strings are sitting in a bar and over the bars, the sign says no strings allowed, and these three strings are wanting some drinks. And so the one string says to the other two, he says, I’m, I’m going to go get us some drinks. He go, walks up to the bartender and he says, Hey, bar, keep like a pitcher and three glasses. Please take that pale L over there. And he flips him a $10 bill and he says, that’s for you. I’ll pay as I go. The bartender looks at me, he goes, man, I’d love to, but you see our sign, no strings allowed.

(02:36)
Sorry, slides him the 10 bucks back, says, wish I could help, but you probably shouldn’t even be in here. So the string goes back, he’s all dejected. He sits down with his two friends and says, Hey, he wouldn’t go for it. Second string says, well, you just didn’t do it the right way. So he goes up there and flips him at 20 and says, Hey, bar, keep that for yourself. I’d like a pitcher and three glasses, please. And man, what a great place you have here. I, I’d love to come back here with more of my string friends, and I’ll bet if you treat us well, I can recruit some more business. Bartender looks at me, strokes his chin, and he says, man, I’d love to, but this is our policy. And you see it, it’s big. It’s hanging right over your head and says, I can’t pushes him to 20 bucks back. And string goes, sits back down. He is all, he’s all bummed. He says, man, I totally thought that would work. I offered him more business, gave him a big tip. Third string says, I got this. He goes in the bathroom, he ties himself up, he tussles his hair, walks back up, doesn’t hand the bartender anymore. He says, bar Barcade, you pitch him three glasses, please. Bartender looks at me. He goes, aren’t you one of those strings? He goes, no, I’m afraid not.

Johnny Sanders (03:48):

Oh man, you’re, you’re correct. I don’t think that could fly on Twitter. That’s just too long. But the characters, man, that is, that’s almost like a Norm McDonald type of thing where he would have those real long things and it would just be something so stupid. But he just has that ability to string you. Oh, string you in. There we go. That

Jake Wiskerchen (04:14):

Isn’t string you along. That’s great. My sound effects were working. I’d play the rim shot, but yeah, I’ll take that. Compliment. Norm’s. Norm was a norm was a legend. Yes. And I’ll accept that. I’ve been telling that joke since 1999 and it is now 2023. So

Johnny Sanders (04:33):

Hey, hey, it’s stood the test of time then, I guess at least for kiddos that, and they’re the ones that matter,

Jake Wiskerchen (04:41):

Clean jokes. Yes.

Johnny Sanders (04:42):

Yes. Hey, well, I know that I, I’ve ran across you, I don’t think I’ve told you this and in a couple different ways. One was initially just through, I had watched some of Stephanie Wynn’s podcasts as some kind of therapist, saw you on there and through that ended up through looking at Walk the Talk America of mentioned off camera, I’m in Oklahoma, so gun guns are a pretty big deal ar around this part of the country. And that was just such, it was very refreshing and something I hadn’t really seen in the mental health world l looking at some of those trainings. So just kind of talk a little bit about Walk The Talk America is and why that’s an important organization.

Jake Wiskerchen (05:37):

Yeah, it is, and it’s a really cool story and I will tell it. But first I want to give a hat tip to Stephanie Wynn. If you’re listening, audience doesn’t know about her, she You should, she is, yes, absolutely a dynamo. She’s an incredible human being and just amazing, amazing work that she’s doing up in Oregon, her podcast called You Must Be Some Kind of Therapist. And at first I thought it was like, you must be some kind of therapist, but it’s actually listening to her intro, you realize it’s like you must be some kind of therapist. She’s like, yes, I am as a therapist. And I think both of those work, it’s kind of cool. And yeah, she’s incredibly intelligent, very well read, super well spoken, fierce advocate for not only our profession and doing things right and ethically, but also for challenging some of this woke postmodern erosion of values that we’re seeing now.

(06:33)
And so I can’t speak highly enough of Stephanie’s work, so I’m glad you mentioned her. I’m really glad that you found me through her because that just makes me feel better. But also about Walk The Talk. So Walk the Talk America, or I’ll say W T T A for short because it Walk The Talk America’s a mouthful. It was founded in 2018 by president and founder Mike Sodini, who is a third generation firearms industry professional. He came into the field because his family ran an importing agency or business called Eagle Imports. So they would take guns from all over the world and bring ’em into America and sell them, brand them, market them, put them on store shelves and whatnot. So he had a hand in that. And for years I’d worked with, well, no, I even worked with, just talked with one of my best friends from college, his name’s Jordan Slotnick, and he manages Reno Guns and Range, which is a premiere range and retail store here in Reno about how we connect these two cultures of firearms ownership and mental health care because it’s necessary because gun owners are skittish and suspicious of what we do as clinicians because they think their rights are going to get taken by acknowledging that they need some help.

(07:45)
So one day Jordan texts me says, have you heard Walk Talk America? No. So I look up the organization and realize that they’re trying to bridge the gap between firearms ownership and mental healthcare. So at that time, and I still do have a podcast called Noggin Notes, and I, that’s a cool story too I can get into later. But I basically invite guests on from all different walks of life and we talk about mental health stuff. And so I reached out and said, Hey, would somebody from the organization like to come on the show? And Mike wrote back immediately unbeknownst to me, he’d been searching for clinicians to help the organization and they weren’t in great supply. So my email was a godsend. And so we chatted for a little bit, got on the show, ran for about an hour and a half, ended of the show, stayed on the phone, talked for another hour and a half or so, became instant Best Friends, and realized we had a lot of work to do.

(08:41)
And I had a role to play. What I’d forgotten until several months ago was that at that time when I had him on the show, I said, we can talk about your organization, but I don’t want to talk about how I’m a concealed carrier. And he was like, all right, cool, whatever. And I realized my self-censorship was the problem. And since then I’ve come out of the closet, as I like to say, as a gun hunting practitioner because I couldn’t straddle that. I couldn’t tiptoe into it if I was going to be of a help. I had to be honest and authentic with my role in both of these fields. So what we ended up doing was we created a curriculum which you have now taken for a course on firearms cultural competence for practitioners. And it’s not just mental health people, anybody who wants to take it.

(09:25)
But what we’ve done is we’ve gotten it validated for continuing ed credit in the state of Nevada and also with the National Board of Certified Counselors. And you can take this series of three courses. There are two that are available online on our website and get a certificate at the end for learning about firearms. And it’s really, really great. So in conjunction with a couple of the other board members, we’ve put together this series of courses. The flip side of that coin now is that we’re also reaching out to the gun community to demystify what counseling is so that we remove any sort of suspicion or apprehension about getting into care. And at our root, we’re a suicide prevention organization. And the story is that Mike lost the president of his company back in 20 0 8, 20 0 9 2 firearm suicide with one of their own guns. And it’s bothered him ever since.

(10:16)
He tells the story better than I do, but I’ve heard it so many times I’m comfortable telling it. But it was like they went to the funeral and everybody just kind of moved along. Nobody addressed this thing. And if you look at the statistics, the gun deaths overall pie chart, you look at that and it’s about 60%. So it depends on the year, but somewhere between 58 and 64% of firearm deaths are suicides. Another third are homicides, and then the remaining balance are negligent, unintentional law enforcement or whatever. So it’s the vast overwhelming majority of firearm deaths. So if you talk about gun violence, which is not a phrase I like because it attributes the act of violence to an inanimate object. I don’t like that kind of word comparison or compilation, I just say violence. But if you’re going to say gun violence, you want to stop gun deaths, especially the preventable ones, then we need to focus on suicides and not mass shootings.

(11:17)
Mass shootings get the clicks and the attention for media because they trigger the limbic system and make us pay attention and get scarce and all that. But the truth is that they’re about three tenths of a percent of all firearm deaths are mass shootings, and that include school shooting. Now, pew Research just came with some new studies because my information only went up to 2020. Well, since 2020, they’ve now captured 20 20, 20 21, and it looks like it’s a little higher than a third of a percent. It’s more like one and a third percent, but still statistically insignificant if we’re going to focus on mass shootings opposed to suicides. And suicides have increased since then also. So that’s what we do. We’re trying to bridge this gap and ways that we do this are by inviting people to take free and anonymous mental health screenings through the website.

(12:04)
I’m more on a wristband right now. It says wt.org/love. So it’s wta.org is the website slash love takes us straight to the free and anonymous mental health screening link. There’s 14 of ’em or something. A couple of ’em are in Spanish. And those are powered by Mental Health America, which is one of our partners. Mental Health America does the ranking of state’s report every year. That shows that Nevada, where I live is dead last every year in mental health care and provision and access. So both of us live in Nevada. Mike lives in Vegas, I live in Reno. And it’s imperative to us to get the clinical community hip to this so that when ailing firearms owners come in for care, we don’t offput them with clunky judgmental language or just plain ignorance about how to navigate unsecured firearms in the home and how to keep oneself safe when they’re in crisis or when their kids are dealing with something or what have you.

(12:57)
So that’s what we’re trying to do. We also have a podcast called Guns and Mental Health, and it’s available wherever podcasts are found. And I’ve got a little sticker here, it’s nice and shiny holographic. I love holographic stickers. Take one of these if I can mail you some if you want. And then we also have flyers that go into packaging that invite people to take the free and anonymous mental health screening. So we partner with gun companies and accessories manufacturers to put our literature in their boxes as well as ranges and retail stores to have it sit passively on the counter. I’m looking around here, and I don’t have a flyer, I usually do, but the on one side says, as gun owners, we often find it difficult to ask for help when we need it. Oh, there they’re, and just says mental health, it’s okay to talk about it.

(13:42)
And then on the flip side, there’s some white space for a local practice or agency to stamp their logo. So it sits passively on the counter while you’re making your purchase or whatever. You pick it up and you’re like, oh, that’s interesting, mental health talking to me on the counter next to the register in this gun store. And then they flip it over. It’s like, oh, there’s a practitioner that’s advertising this person or this place must be gun friendly. And it’s a nice non-threatening way to say these two things can coexist at the same time. They’re not mutually exclusive. So those are some of the ways that we’re inviting people to take care of themselves while also promoting education and training to demystify a lot of what goes on around it. So there’s my commercial. It was a little longer than an elevator speech.

Johnny Sanders (14:27):

So for Walk The Talk America, I think that is, again, such an important organization and not only important is, like I said, it’s just very unique. I, I’m a gun owner. I live in rural Oklahoma. I’m a mental health counselor, and I hadn’t put two and two together. I knew that it was an issue, but again, it was just so refreshing because it’s, when you’re given those statistics like that when we use gun violence, and that annoys me too, are we really getting at the issue? And I think unfortunately the answer is not. So this organization’s fantastic to play. I don’t know if we want to call it devil’s advocate or whatever, but let’s say I am a more left leaning clinician or just left leaning person that says, well, look, we see all these shootings in the news, all these bad things. Wouldn’t it be better if we just got rid of guns in general, just had gun control because we’re looking out for the kids, looking out for the better community. What’s your response to that? How do you respond to that type of argumentation?

Jake Wiskerchen (15:48):

So the, I’ll throw another statistic and then I’ll answer the question. Approximately half of Americans either live with a gun or own one themselves. So that’s roughly half of our clientele that could walk through the door. And we can’t afford to be willfully ignorant of the mechanisms and the dynamics that go into that. So depending on geography, that will go up or down. If you’re living in San Francisco, it’s probably a little lower. Maybe it’s one in five, something like that. But if you’re in rural Oklahoma or rural Nevada, it’s more like eight and 10. So we can’t afford to not know how to have a competent conversation now to the anti-gun people, we’ll just call ’em. Or the ones who are ignorant and don’t know the dynamics. I would say you got give or take 300 million guns in America, you can’t get rid of ’em.

(16:37)
No. And I say this in the training. This is a problem where we have to meet the problem where it is not where we think it could be someday or where it is in some other country. It’s just not feasible, not even realistic. Now, if you could wave a magic wand and make all firearms go away, and everybody would be whatever your definition of safe is, okay, maybe that’s fine. Go repeal the second amendment. There’s a process for doing that. Good luck getting 75% of state legislatures to agree to it, I guess. But let’s say that that actually happens. We still have a problem with people being mentally ill and wanting to take their own lives. We still have a problem with people being unstable and wanting to take other people’s lives. So we swap out one tool for another tool. I don’t know that that hits the root cause.

(17:22)
And we’re we’re big fans of root cause mitigation, which is why we push education over restriction rights. Restriction is not something that appeals to me, especially when you’re talking about fundamental civil rights. The right to self-defense, projectile weapons is just one of those ways that we defend ourselves. So I’m not interested in restricting that. And neither are places like the liberal gun club or liberal gun owners who are very active in this space. And you can’t see the back of my computer, but I’ve got a sticker, two stickers from the liberal gun club. One says, unicorns do exist. It says the liberal gun club. And it’s a picture of a unicorn with a rainbow coming out of it. And the other’s, the traditional rainbow that says every civil for every single person. And what they’re talking about is the civil right of self-defense. So pol politics aside, I don’t think firearms ownership should be political, just not.

(18:13)
And if we’re going to split hairs on the political spectra, I think that when you’re talking about left-leaning people, they’re more you. And I know this vocabulary and sort of the rest of the clinical community, they’re more about external locus of control. It’s like reach out and control the thing rather than the internal locus of control, which is self mastery. And then if you’re on the right end of things, you tend to be more toward liberty and autonomy. And you say, well, it’s up to you to control yourself. It’s not up to me to control your environment for you. And we have general application for that across all presentations. So to that, I would say it’s not feasible. The numbers don’t work, the efforts don’t work, and then you got to deal with enforcement and collection and all sorts of things. It’s just too heavy of a lift where we can go the other direction.

(19:00)
Much lower cost is to educate people on this. And if we hadn’t lost trust in our public health authorities over the last three years, but I think public health broadly could be very instrumental in that space in saying things like store responsibly, that’s one of the language things that we’re trying to all alter with within the gun community. Instead of saying safe, which is mercurial and subjective and also been watered down since the pandemic hit. And it’s like, what does safe mean? You ask a random gun owner say, Hey, store safely. They’re like, I, of course I’m safe. I got guns staged everywhere, loaded chambered in case iis kicks in my window at 3:00 AM. It’s like, well, yeah, but is that responsible? So we’re defining responsible storage to mean preventing unauthorized access. And then the unauthorized access could be somebody who obviously smashes your window and comes in and wants to steal your stuff.

(19:50)
Or it could be the angsty teenager, or it could be the neighbor’s kids, or it could be you in that time of crisis. We need to be able to figure out how to prevent access in the time of crisis to people who aren’t authorized in that moment to handle firearms. So again, we’re shifting away from the external locus control to the internal teaching firearms owners to be more responsible about how they store their firearms. And let’s face it, if everybody took that approach, then no irresponsible people would be doing irresponsible things. That would be the shop owner. That would be the owners themselves. That would be everybody who conducts a purchase. They would be making sure that whoever handles the gun is responsible for handling it and is authorized Right now, that’s a little pie in the sky, I’m sure. But along the way, we have to be able to be honest with ourselves about when we’re in a time of crisis, when the darkness overshadows the light, and we have to address mindfully and with good competence without taking people’s property.

(20:52)
That’s not something that’s up for debate in our realm. So that’s why when we get into red flag laws and talking about, well, it’s a nice intermediary between send somebody to jail and institutionalizing ’em. Just take the instrument. Right? Well, okay, but do we need.gov involved or can we just rely on our friends and neighbors? And the answer would be yes. In an ideal world, that would be great. But most of these states with red flag laws, mine included, also have something called a background check law. So in order for me to hand you my guns, if I’m in the time of crisis, you have to undergo a background check. And that’s an obstacle to care. It’s an obstacle to doing the right thing. Sometimes you can read these laws and they’ll say, well, in exigent circumstances, you can receive somebody’s guns without going through the background check.

(21:39)
But then they add language that says something to the effect of only so long as it’s necessary. It’s like, well, how long is that? We don’t know. It’s up to the judge. Or it’s up to the person who assesses it later on down the road. Is it 72 hours? Is it three months? Is it a year? I don’t know. How long does it take you to get? So we want to attack that and say, let’s not make this about policies and legislation that don’t do anything to move the needle, and let’s tackle root cause mitigation. How do we mitigate the root cause of what got somebody to the point where they believe that it was a reasonable option to take one’s own life or to take the lives of other people? And now we’re talking about things like family structure, time with your children, getting off your devices, stop in taking negativity through the endless doom scrolling of Twitter, anything that alters your psyche to the point that you fall into depression or anxiety. So it’s not feasible, it’s not reasonable, it’s just not even on the table for discussion as far as I’m concerned. Not as long as we’re living in the United States of America with our Constitution written the way that it is to protect those rights.

Johnny Sanders (22:50):

And sadly, we get into these nuanced type of debates on things that, quite frankly, this is a situation that’s really not that nuanced. It’s fairly clear. Are there real world ramifications? Sure. But yeah, it is what it is. And I love the internal locus of control that is, I think that not only is that a freedom loving thing, but that it’s liberating for the individual even that’s going through a crisis. Let’s throw gun stuff out of the way. I’ve got a family member that just died, or I’m going through a divorce or there’s a tornado that hit something catastrophic. If everything is external, my whole wellbeing in life is by these outside forces. That’s a pretty helpless type of life. And if things don’t go my way, if the election doesn’t go my way, I am in emergency mode. And that’s not a way to live life. So on that side of things, and this could be gun related or really just for general mental health, what are some just basic internal locus of control, things that everyday Americans can use to just improve their mental wellbeing?

Jake Wiskerchen (24:11):

Well, your emotions, you can master them. And unfortunately, emotional functioning is not in anybody’s curricula. And so I’ve got a video series, it’s available for free on the Zephyr website. You can go to our YouTube channel too and watch me standing in front of a whiteboard talking about your 10 core emotions. This is all based on the work and research of Carol Isard. And what I want to do is I want to train people to know properly how their brain works in response to environments so that you can navigate these emotional upheavals that you experience without handing your power over to the external. So he made me mad. I allowed myself to feel anger when I should have just felt the disappointment in the failure to deliver on expectations. So disappointment or sadness is one of our 10 core motions. As dudes, we are particularly disadvantaged in feeling feelings, but also the most vulnerable ones like disappointment, sadness, shame, guilt, anguish, despair.

(25:12)
So knowing that we can tolerate these things and life goes on, is critical to navigating when life presents these things to us. If all we do is reach for something that doesn’t accurately attend to that anger or contempt, not only have we improperly addressed the emotion, but we are left with a residue that doesn’t get addressed either. So the limbic system keeps running whether or not we want it to, and we keep feeling feelings knowing how to accurately identify those as paramount if we’re going to engage well with each other. So emotional functioning is one of those things. And you have 10 emotions. We all have 10. They’ve been around for the last 40,000 years that we’ve been walking the earth. And if you know how to do that, you can improve your communication, you can improve your distress tolerance, you can teach your children how to do it.

(26:03)
Schools are getting a little better at teaching this stuff, but in the form of social emotional learning. But really 80, 90% of social emotional learning curricula is poor at best, nefarious at worst, and the remaining 10 to 15% or whatever is pretty good. But the bottom line is the adults don’t know how to do it to the kids anyway. We need to know ourselves what we’re doing so we can teach the next generation and also to regulate our own responses. So that’s one practical thing. And I know it’s a kind of non-answer to a question cause I’m referring you to a video series, but that’s required. If we’re going to own this internal locus of control, we have to make some efforts and we’re going to get good at whatever we practice. If we practiced avoidance for a really long time, we’re probably pretty good at it.

(26:50)
If we practice vulnerability, we’re going to get good at that too. And then from vulnerability comes intimacy and through intimacy is how we build human relationships. I don’t want people wandering the earth with proxy relationships or feeling proxy emotions because that is a form of avoidance. And avoidance in my view is what’s splintering a lot of society. It’s the blame shifting onto the other. It’s the externalizing. Congress is doing the wrong thing as opposed to I’m responsible for capturing my own sanity and happiness in life. So the more we push it off onto others, the more power we’re handing over to those people, things, entities, agencies, businesses that they A, don’t deserve, B, probably don’t know that they have. And C deprive us of the ability to navigate our own life. And there’s always going to be something that’s going to pop up that I can blame for my own circumstances at the end of the day, who’s in the center of it?

(27:51)
Me. So we have to get out of this mindset that it’s somebody else’s fault that I’m feeling the way that I am. Well, that may be true, may may be true that it’s your parents’ fault for raising you poorly and neglecting you or abusing you or introducing you to violence or whatever. But at the end of the day, it’s your responsibility. It doesn’t matter whose fault it is. You are responsible for dealing with it now, and I tell that to a lot of my patients in the office, and it’s amazing how well they respond to that kind of thing. I go, yeah, you know what? I like how you frame that. It isn’t my fault. The fault doesn’t matter. What matters that we fix it. Yeah. So yeah, practically look at yourself, look in your own mirror. However, if over many, many years you’ve been conditioned to believe that it’s, it’s very hard to look at yourself because it’s scary, because you might have to question everything that you thought you knew about the way the world works, then that’s a challenge. And that comes down to how do you tolerate the fear of looking at yourself and seeing all of your potential.

Johnny Sanders (28:46):

Yeah. Well, and again, I think we have to do, as clinicians do a good job of balancing the fact of, yeah, there are some challenges there. I tell people often if they’re going towards alcohol or food or whatever that replacement behavior is, if we take that away, then yeah, you’re going to be uncomfortable. It’s like you, you’re going to face some anxiety if you’re going to dig into this. But one, we need to build up some of those healthy coping skills to help you handle these emotions. And two, you can do it. I think we spend so much time, even in the mental health profession of this is bad. That’s bad. This is bad. That we’re almost priming our clients to say, yeah, this is awful. I can’t do it without you. And almost a dependence on the counselor to make, take ’em through whatever the problem is, instead of empowering that individual that, no, you can do that. What are your thoughts on what I said there? And how do you navigate communicating that to your clients?

Jake Wiskerchen (29:58):

We don’t want to become yet another external control locus for these people. I don’t want to create a dependence. I tell my students, my interns, my employees all the time, that our job is to help make them better, not to help them feel better. I want to get you, well, not feel better. Feelings are temporary. So we don’t want to create that dependence, and we don’t want to become another thing to which they can point upon which they rely. That’s something other than self. So we want to have an eyeball toward the termination of treatment, not just Tuesday at 4:00 PM and per perpetuity, even though it fattens my wallet and keeps you on the calendar, it also is highly unethical to do that. I want to tap into your inner potential so that you stop coming through my door. This is why we do podcasts and YouTube videos and that kind of thing.

(30:44)
So people can arm themselves with the information to solve their own problems in their own kitchens instead of having to come in all the time. There’s always going to be professional psychotherapy available. But I mean, to your point about not taking it too seriously, we want to take the work quite seriously, but not ourselves. Yes, if I’m taking myself seriously, it puts me at the center of their healing and not them all I am is a guide and I should be temporary after the symptoms abate and they’ve replaced some behaviors with some healthier ones, I’m done. And really, if we retreat to the medical model, you got symptom presentation amounting to criteria that results in a diagnosis. Once those symptoms go away, you no longer have a diagnosis. Now you’re not treating anybody that becomes coaching, which there’s nothing wrong with coaching. I have no problem with coaching.

(31:30)
But friends can coach, parents can coach, mentors, can your bartender and your barber can coach. You don’t need me. And I don’t want to be that person, even though I’m, it’s nice to take your money and give you some insight and advice. That’s not my role. If I’m adhering to the medical model, I want to make sure that I’m targeting the problem area and achieving problem resolution. And once we’re done, we’re done. So right behind you is somebody else coming in. I should not be insecure about that. I need to have faith that if I work myself out of a job and the entire community in which I live is now healthy and healed, then I’ll be happy to pay my bills doing literally any other work because everybody around me will be happy. Yeah,

Johnny Sanders (32:09):

Great. Great. When we’re talking about internal external locus of control, two major things that certainly get all sorts of people in trouble for talking about, but that’s why we do these podcasts, to talk about these things, came to my mind. One is what you referenced before, public health pandemic, all of that mental health is at the center of all of that, which unfortunately going to take us decades, I believe, to really unravel. And then the other one that’s massive in our field right now is gender affirming care. So let’s go for just on the pandemic, the public health side of things. Me real personally, I’ve shared some of this on my podcast before. I was working in the hospital setting back pre pandemic and then through 2021, and I’d like to be careful on my language here because I was not technically fired, but it was one of those where, hey, if you don’t get the vaccine, you don’t get the shot, then you will be.

(33:22)
And I had the opportunity, and honestly, I could have gotten the religious exemption, but that wasn’t my primary reason for not getting it. And mind you too, I’ve not had issues. I have coworkers, friends, families that got the shot and they feel great about and that’s great, but I had my other reasons. All that being said, public health kind of took a job away from me, which I don’t think is the role of public health. And that’s not mention in all the other missteps that were taken well before even shots were introduced. So as a mental health professional, what was your first kind of reaction here of uhoh? The public health people may not have the public health best interest in mind. And now that we’re mostly out of the severe restrictions mostly anyways, where do we go from here? Particularly as a profession, we can’t take these things back. How do we gain some of that trust back? So I know it threw a lot at you, but kind of do with that what you will.

Jake Wiskerchen (34:34):

I have a different experience. I was leaned on pretty heavily by some public health people and some state people to lead the charge. And if I demonstrate everybody that my shot was safe, then we could reopen to in-person counseling. That was the apocryphal story that we were all fed, which is that it stops transmission and all this stuff. And I was deeply skeptical about that. And eventually I got to a place where I said, all right, I, I’ve got my own internal reasons. I was in my early forties. I’ve got a history of asthma. This is an upper respiratory virus if it helps me to stay out of the hospital. Then. So I ended up getting my first series of shots in late 2020 as one of the leaders, and I posted on Twitter, and I wasn’t a hundred percent in, but I thought on the whole, if this helps people, then great.

(35:33)
Sure. Later we get new information and then find out that we were lied to and we were coerced with donuts and free beer and all sorts of stuff that you shouldn’t have to rely on if the product is good. If you’re brand new restaurant opening and you want to give a 20% discount for people to get in the door, eventually you stop off from the 20% discount because the food stands on its own and people just recruit themselves into your restaurant. And that didn’t happen with these shots and certainly not with the masking. The masking was absurd on its face from the beginning. And I fought that pretty openly and pretty publicly, and I still do. And I did it on the premise of emotional development through facial recognition, which you can see in the videos. And I did. I wasn’t interested in stunting children’s development, which we did.

(36:19)
And now we have evidence of that. And I hate saying that I was right, but I was right. And it bothers me deeply that we went all in on this of absurd face covering thing that absolutely impacted children’s ability to develop, not to mention the school closures, which now Randy Weingarten is denying she ever even had a hand in. Yes. So it’s very disturbing and distressing that so few public health professionals have stepped forward and said, you know what? We probably miscalculated this. There’s a guy on Twitter, I follow his name’s, Kevin Bass. He has done an about face, and he got skewered by the people who were doubling down because they got so locked into their own egos that they couldn’t let go of the narrative that they’d built because they didn’t have an authentic sense of self to withstand the ego change. And I’m saying ego and self, I’m talking Carl Jung, analytics psychology left lens and frame of reference.

(37:19)
So for the uninitiated, the ego, as I’m saying, it is not a bad thing or a good thing, it’s just a thing. It’s your comfort zone, it’s your place of being. And sometimes it grows into how you see yourself and your own identity. And that’s very dangerous because if your ego, which is fleeting and temporary and often crafted by the world is conflated with your identity, meaning your sense of self capital s, you’ll, you’ll have a really tough time letting go of that. So a brief analogy might be somebody who’s got a pattern of addictive behavior, say to a substance, and through that substance use, they see themselves in the world, letting go of that is going to be very challenging because they don’t know who they are if they let go of the substance use. And we do this with jobs and relationships and all sorts of things, clothes that we wear, hobbies that we do.

(38:06)
So how do we combat that? Well, I’m glad you asked. So what we want to do is develop a very strong sense of self capital s. And the way we do that is we have to find some anchoring principles, some matrix or rubric through which we evaluate the world and make decisions based on a series of evaluated stances that we take, that we know, that we know, that know are bigger than us and that are likely not to change. So a lot of people reach straight for spirituality and religion because it’s bigger than them. It’s usually anchored in scripture or doctrine of some kind, and it’s usually not going to change. If you believe something very well and you’ve examined your beliefs, you can stand on them when challenged, which it sounds like you did, you didn’t give into the coercion and the messaging and the advertising, you said no behind that.

(39:00)
You knew it wasn’t really about the religion, which I applaud you for, and that’s very commendable because you could have punched out with the escape clause there, but you didn’t. Instead you said, no, it’s bigger than that. I’m not going to use this cheap excuse. I’m going to stand on principle. So congratulations to you. Parents can do this with their children when they teach values and say, these are our values, we do not deviate from them. Now, that’s not to say that you just rigidly adhere to them. Values can change. You can change your mind, you can change your beliefs, but you want to know why. So my favorite orden really in counseling, but also in my life, is intentionality. And it’s something I picked up from my good friend and mentor, Christian Conti, who has a really wonderful way of dealing with people. He calls it yield theory, and he’s written a book about it.

(39:47)
It’s called Walking Through Anger. You can get up for about 18 bucks on Amazon. Anybody can read this book. It’s great. But intentionality is the spirit of knowing why you do what you do. And if you don’t have anchored principles, you don’t know why you do what you do, you’ve handed yourself over to limbic reaction, belief response, whatever lens you view the world through, and you are not in control. Now, your beliefs are, and most people’s beliefs are given to them by some external source, parents, clergy, teachers, neighbors, media, movies. So we don’t just abandon our beliefs. What we do is we examine them very, very well, so that when they’re challenged, we can know why. We can explain with intentionality, why we do what we do, why we believe what we believe, and then move forward. And if you’re not anchored in that, you don’t have a sense of self, and you do become subject to the louder voices, the more intimidating people, the policies that maybe you don’t agree with, but you comply anyway.

(40:42)
So the challenge is evaluate yourself. Stand on something that’s bigger than you are that you could point to. Now, for us, we can take it out of the realm of spirituality and make it very agnostic and say, what’s the counseling profession? Ethical code based on basically five ethical principles, justice, autonomy, fidelity, non-male beneficence. Through those we give rise to our entire ethical codes, and now we know why we do what we do. And those can be negotiated, they can be flexed, they can have friction, but at least we’re mindfully examining them so that when we have to make a call to cps and we’re balancing the difference between breaching confidentiality and protecting confidentiality, we can at least articulate our position with some reasonable rational understanding of the why. And that way when the patient comes back, say, they’re all angry, why’d you call CCPs? Or why’d you call for a welfare check?

(41:38)
When I was suicidal, I say, well, because of this and such, and here’s my rationale, and I’m more comfortable dealing with an angry person who breached, who’s confidentiality. I breached to call the authorities to make sure you’re safe than a dead patient whose family is suing me for protecting confidentiality. I’m more comfortable standing on one ledge than the other, but you’re standing on a ledge. And as long as you know why, you’re in a pretty good spot. But the only way you get there is constant self-evaluation. And if we go back to the union version of this, the self, the psyche, if you will, the human spirit is infinite in its capacity because it’s a divine creation. It’s bigger than we are. And you can’t ever achieve an arrival point of saying, I know who I am. I am fully individuated, I am fully differentiated.

(42:29)
Because if you do, you have become tantamount to God, and you don’t want to become God of your own world because then you’re the one making the decisions and driving everything instead of mindfully reflecting out of deference to what you’re supposed to be doing and what you could possibly do someday. So these are all deep, really deep fun things that I enjoy exploring. The infinite capacity of self also comes along with the negative side, the dark. It’s like, yeah, you got the capacity to be pretty dark. Whether or not you give yourself over to it is up to you. And that’s a matter of decision and choice. So that’s how we do it. We find out who we are so that when the storms of life blow, we know that we’re anchored in something and we’re not just going to blow away with ’em. Which probably leads into your thing about the trans ideology, right? Yeah,

Johnny Sanders (43:15):

Yeah, I was going to say that exact same thing. I think that is exactly it and why this has been, I think that’s part of what makes this so interesting as a mental health provider, because we’ve known about transsexual development and everything for a long time. This is not a new issue. What’s new is how we are coming about it, and just the massive spread of this ideology and it, it’s so incongruent with my value system that I couldn’t sit there as a counselor or just as a citizen and say, no, this is okay, what we’re doing. Tell me kind of your process with gender affirmation care. Where did you see this start, kind of going off the rails, so to speak a little bit, when did this start becoming an issue and how do you make sense of this as a clinician?

Jake Wiskerchen (44:26):

First of all, your audio is doing that thing again, but I’m going to let go because if you’re not noticing it in your headphones, it’s quite possible that it’s recording accurately and I’m only receiving it. Ok. So we’ll just go with it. Ok. But it’s not unintelligible, so we’ll just go, okay. All right. This is a tough one because like you said, we’ve had it in our realm forever. Only recently has it become pretty obvious that there’s an agenda being pushed. And what alarms me is the requirements you’re required to affirm, you’re required to use pronouns, you’re required to do all these things, and it never seems to come from the individuals it’s coming from. And they can be the professional associations, it can be the activists online with their anonymous accounts that all seem to have cartoon avatars. By the way, never from an individual sitting in front of me saying, hi, I’m Jake.

(45:24)
I go by them pronouns, and I would prefer that you asked me, you know, refer to me as this. And that’s very weird anyway, because they would only know that if I was referring to ’em in third person, in which case they probably wouldn’t be in the room. So that’s bizarre on its face. But for me, I, again, going back to yield theory, if I’m meeting people where they are and I have this experience, education and training behind me in my tens of thousands of hours of clinical contact, then what I’m going to do is I’m going to ask holistically what’s going on with you? And we’re going to find out what your distress is. So let’s go back to the medical model. If you’re not a clinician, or even if you are and you’re just new this field, maybe you don’t know this, something like this happens, you come into my office and say, hi, Johnny, I’m Jake.

(46:11)
How are you? What brings you in today? It’s like my favorite question because it gets, everything’s kickstarted and Johnny says, well, blah, blah, blah, and whatever, blah, blah, blah, is ostensibly your problem. And then from there, from that problem area, we might discuss some things. And I go, well, okay, that may be a problem. Maybe there’s something deeper, but we’ll put it on the board at the top. And right below that we’ll have a goal, your goal for counseling Johnny. And you’ll say, well fix the problem, right? Something resembling that. And I say, all right, cool. And then we’ll develop some steps called objectives to that goal so that we know that we’re on track. And then we develop intervention strategies. And I think what we’ve done is we’ve leapfrogged the goal and gone straight to interventions. We did this with covid. So covid was the problem, new virus. It’s attacking people, making ’em sick. And we weren’t straight to intervention strategies. Nobody asked what the goal was. Was the goal to stop covid? Was the goal to keep grandma and grandpa alive because they’re in the most vulnerable demographic?

(47:12)
What’s the goal? We don’t know. But put a mask on, get your shots, separate distance, lock down. Don’t go to school, don’t go to work except for the special people who are essential, right? We didn’t know what the goal was. Two weeks to flatten the curve turns into two a half years. So when somebody comes in the office, I go, well, what’s the goal? If you’re in distress, it’s to alleviate the distress. Now, at some point, you signed some paperwork that handed some of your autonomy over to me to give you guidance. Now I’m going to respect that, and I’m not going to tell you how to live your life. I’m going to ask you what you think the pathway is to peace and tranquility through your distress.

(47:55)
Affirming care doesn’t allow for that affirming care, and it starts with trans-affirming care, but it ripples into other types of presentations. Affirming care says you’re not allowed to give feedback. You’re not allowed to give direction, you’re not allowed to give perspective. You’re only allowed to agree. And that presumes that the person coming in knows what the goal is and the interventions. Well, okay, then what are you doing in my office then? If you already know the answers, I don’t need to exist. So where I see this becoming very dangerous is not just with, and children are completely, we’re talking about adults, children. That’s a different argument, and I’ll get into that if you want. But adult comes in says, I’m really struggling. I don’t know who I am inside. I’ll go, you have an identity issue, and I’ll go back to the concept of the true self divinely inspired living within you.

(48:44)
Well, who do you think you are? Who do you want to be? And we start exploring much more holistically than just whatever gender presentation it is, gender may be the most available thing that we can pluck and point to. So I just feel like I’m a woman. I go, well, you said the word feeling. You only got 10 feelings unless it’s a physiological feeling like hot or cold or fatigue or hunger. So don’t feel like I’m the right. Gender is not a feeling. It’s not one of our 10. So what is it? It’s a belief. Now, beliefs can be changed. We already went through that. That comes from the frontal lobe. What is it that leads you to believe that you’re not aligned with your true self? Gee, I don’t know. Now we have a whole different conversation about where this came into being, and we can explore that mindfully.

(49:32)
Somebody’s just coming in looking for agreeance. So I go, yeah, all right. You feel like a woman, but you’re, you present as a man. Well, what do you want me to do about that? Just agree with you. Yeah, you’re a woman. Now what you’re, you’re fixed. You, you’re healed. And never is that the case, right? It’s always a trauma history. It’s always an failure to integrate socially. Everybody points to autism these days, says there’s a lot of autistic kids who don’t know who they are on the inside. It’s like, well, yeah, that’s because they lack social skills to be able to navigate their environments, and they don’t know where the guardrails are on how to interact with other kids, right? Bullying can do that. So it’s not just the traditional presentation of abuse and violence and neglect in the home. It could be bullying on the playground.

(50:15)
I don’t know who I am because I second guess myself every time I step on the playground, because one kid says that I suck at basketball. The other kid says, I suck at baseball. I go try chess. And they don’t like me either. I try playing the trumpet. Not very good that now I quote, don’t know who I am because of the external environment, the trumpet, the baseball, the basketball, the chess. Those are all external. Those aren’t who I am. Those are things I do. And now we’re talking to another sense of self. We get midlife crises all the time from, I was reached for Bob, the accountant. I don’t know why the accountant’s name is Bob, but I, he’s Bob the accountant. And I said, Bob, the accountant is approaching his retirement. And for his whole life, he said, I’m Bob. I’m the neighborhood accountant.

(50:56)
I’m Bob the accountant. Bob the accountant. Well, now he’s approaching retirement and he doesn’t know unquote who he is without his accountancy practice. Like, well, gee, Bob, you’re you’re husband. You’re part-time home brewer. You have children, you have grandchildren, you’re lots of things that aren’t just your job. So when we identify self with activity or self with presentation or self with external environment, now we’ve conflated what we think, what we believe with who we are at a much, much deeper level. And we’ve carved out opportunities for us to be anything but what we’ve repeatedly told ourselves or people have told us that we are. And I don’t want to limit people’s potential. That’s not for me to say. But I also fundamentally think that if people are infinite in their capacity to do and be all things, then why would I allow that in my practice?

(51:46)
I’m not just going to agree to agree, but here’s the real danger. You got parents, this is already happening. Before affirming care guidelines come into place, parents come in and say, here’s my kid. He has a D H D fix him. And at Zephyr, we have a policy on our intake form that says, we don’t do fix my kid. It doesn’t read like that, but it basically says he was the executives of your home as go, you so go your children, so you’re going to be involved. This isn’t jujitsu. Yes. You don’t drop ’em off for an hour and come back. So I’m not going to fix your kid. You’re going to help fix your kid. And I might see that a D H D presentation as lack of parental involvement and say, look, you just got to shore up your parenting parenting structure. Add some dynamics in the home that integrate more family time, be fully present.

(52:30)
Don’t be on your device. And oh, by the way, what’s your parenting philosophy? And usually people give me the trout face. Look, when I ask that, what’s parenting philosophy? And so the lens through which you conduct your parenting. So we start with that, but here’s what affirming care does. Affirming care says, I’m not allowed to do that. I’m allowed to just agree with the parent and affirm that the kid has a D H D. Like, all right, cool. I don’t prescribe medicine, but maybe Vyvanse. And then again, why am I in your life if all I’m doing is agreeing with your problem presentation? We’re trying to reach solutions here. We’re trying to achieve a goal. If the goal is distraction avoidance and diminish the hyperactivity, which again comes back to personal responsibility and sense of self, then I can coach you in that. I can help you with that.

(53:11)
But if my job now, because of affirming care, is just to agree that your kid has whatever you said they did because you watched a TikTok video, I’m rendered irrelevant, and we probably won’t help your kid except maybe get him addicted to pharmaceuticals. And then what do we cease to exist as a profession? Because all we can do is agree with whatever they came in after they searched WebMD. That doesn’t, doesn’t really jive with our ethics, which flies in the face or seemingly flies in the face of do no harm. The non-maleficence component of our ethical precepts says, person comes in complaining of whatever distress. And my job is to simply agree with that distress and do nothing to fix it that is causing harm. I’m being unethical by agreeing to go along with the continued distress presentation. So I’m just not on board with that.

(54:01)
It’s wholly unethical at its root, and it’s already happening. I’ve had people leave and go seek care elsewhere because I say, no, I think it’s actually a parenting thing. How dare you say, you know, see that my kid is doing whatever he is doing. I’m like, he’s six. He’s supposed to be distractable. And so that’s where I fear that this is going, and it’s not a good outcome, especially when litigation might be involved or licensing threats. Because right now the A mft, for example, has 26 pages of LGBTQIA plus affirming care guidelines And for those of you who don’t know, the entire ethical code from the A ammft is only 11 pages. So we got 26 pages of affirming care guidelines. We’re one step away from being, we’re from having those integrated into our ethics as it is. And once that happens, ethics are often embedded into law or adopted by reference into law, and then it becomes illegal not to affirm. And at that point I’ll probably just loudly renounce my licensure and become a coach because I’m not interested in being unethical with my patients.

Johnny Sanders (55:10):

That your last piece there, that is pretty much 100% of why there’s this rebrand of my podcast and it’s essentially an insurance that here’s this other entity that I can form into coaching or something different just in case. Now Oklahoma has passed some laws here recently that thankfully, I think we may be one of the last ones to kind of go that route of getting those ethics into law. But if you are a clinician that whether you’re right, left wing, whatever, that you have any apprehension to gender affirming care. I don’t say this to be alarmist, but just for best practice, you need to be prepared of what if the law is going to dictate. I have to affirm what are you going to do about it? And again, just prepare. Don’t, don’t be scared, don’t freak out about it. Hopefully things get better. We have more and more voices and organizations talking against it, but Jake lined very well.

(56:24)
Some of these legitimate concerns that are heavily influenced the top of the top of organizations, American Counseling Association is similar of some of the things that they’re saying you will be affected. So be prepared now. Be prepared to fight out and if your value system kind of going back into that importance of looking at yourself and your values, if it goes against this, it’s better for you to keep your values than to keep your job and keep your license. It’s not worth it at that degree. I hope it doesn’t come to that point, but again, you would be foolish at this point to not prepare. Is there anything on that end of spectrum as far as licensing and the ethics that you wanted to hit a little bit more?

Jake Wiskerchen (57:16):

Yeah, the concept of having a license only is relevant if you want to bill insurance, how it works. So insurance companies want to have the guarantee of minimum confidence, competence as stamped by the state. So the state guarantees minimum competence. They don’t guarantee maximum competence with your license. And we all know clinicians who are not good at their jobs, but yet retain their license because they renew every year, they go through their continuing ed courses and that’s all that’s required to be maximally competent requires much more effort and a lot more digestion of information and consumption of research and analysis and whatnot. So if you don’t care about billing insurance and you think that you’re going to stand on your own as a practitioner without that crutch, then that’s an option. The insurance companies aren’t really, this is a little cynical, but they’re not really interested in a healthy populace.

(58:10)
They’re interested in membership retention in their organizations. So you continue paying your policy premiums, which is why they’re incentivized to keep the networks artificially small by denying enrollment onto their panels and so forth. So in Nevada, we’ve run into that in a few cases where they say, sorry, we have enough of your kind in our network, we’re not adding any more marriage and family therapists or clinical professional counselors or psychologists or whatever. And you go, really? The last I checked Nevada was dead last in behavioral healthcare and provision. So we’ve cured mental illness in Nevada is what you’re saying. We have an adequate network to address the continued year over year statistical analysis that says that we suck at things we don’t want to suck at. Really interesting. So what do we do? We go to our legislators and we say, let’s adopt any willing provider law.

(59:02)
You don’t have to pay. We’re not asking you to authorize all claims. We’re not asking you to authorize payment and perpetuity. We’re just saying add people to the network who want to join. If they’re minimally competent and they’re licensed, add ’em to the network. Nope, insurance comes right over the top with their lobbyists and says, don’t do, because why? More people would access care more money goes out the door and their shareholders profits diminish. So it’s a money thing and that we see that with claim denials. I mean, I got one the other day speaking of A D H D, an adult we’ve been treating for some time, finally got a claim denial that says D H D cannot be possible in adults. I’m like, okay, so now you’re just overriding the DSM altogether and that’s what they do. And they throw up as many roadblocks as barriers as they can to retain profits.

(59:50)
And when it becomes so taxing to the provider that they don’t want to do that anymore, they just say, screw it. I don’t want to bill Anthem or whatever. And then Anthem wins because Anthem’s not interested in healing people. They’re interested in enrolling people and throwing up reasons to deny care. And I’m in touch with enough medical providers up and down the ladder from primary care to pediatrics to cardiology to emergency care. They’re all dealing with it. I can’t get an MRI ordered unless you go through six months of physical therapy first, and then if you still have pain, then we’ll get the mri. It’s like MRIs are peanuts. Once you pay for the machine, all you do is pay for the electricity to run it in the tech to read it. Right. It’s absurd, but it’s yet another nickel and dime strategy to keep people away from care.

(01:00:35)
So back to the what’s the solution? I don’t want to complain Without a solution. The solution is we get better at our jobs and we teach people that the answers are within maybe physical therapy is the more appropriate level of intrusiveness. I’m a big fan of that state of Nevada Medicaid requires least level of intrusive intrusiveness to address a problem before leveling up to the next level of intrusiveness. So low level of intrusiveness to me is talk therapy. Next level might be medicine and we can debate that it doesn’t matter. But the next level after that is multiple contacts per week of therapy. So in the form of an intensive outpatient program, I O P or the next level up might be partial hospitalization and then all the way up to hospitalization. We don’t want to jump right to hospitalization if talk therapy will work once a week.

(01:01:21)
And I’m a big believer in that. I absolutely think that that’s the most right thing to do for the patient who wants just their symptoms alleviated. Well, what does gender affirming care do, especially with the medicalization? It says validate that this person is accurate in their assessment, that they need to change their external parts to fit their internal sense of self and medicalize it. Well, that’s not the least intrusive method to achieving the distress relief. Hideously expensive, but people profit off of it. So now it’s seemingly that there’s forces at play who are interested in generating revenue off of chopping off healthy body parts of children and sterilizing them with Lupron when all that might be required is me sitting down with the kid saying, Hey, look man, you’ve been bullied for a little while. Of course you don’t know who you are, but let’s, let’s shore up yourself efficacy and give you something to reach for that doesn’t involve irreversible damage to your body that you may regret later in life.

(01:02:22)
Affirming care says I’m not allowed to do that. So we want to make sure that we’re doing the least intrusive methods possible first and then failing those look to the next step, not just leap to the most extreme. That’s absurd. So yeah, I do see it all over the place and if as long as we ourselves have a strong sense of self, we have a good sense of our author authority as given to us by law, then we can push back and say, no, no, no, no, no. I’m not going to sign that letter that sends you to the surgeon. I’m going to work with you on dealing with the internal stuff first, being able to push back on the bullies on the playground, maybe work with your parents to be more present in your life, ditch the substance abuse, whatever it is.

(01:03:07)
And if they don’t like that, then that’s the beauty of a free and open market you can choose somebody else to go to. Yeah, I’m just not going to be a part of it. I don’t have to be compelled into that. But when they take away my right to assess things as I see fit as deemed minimally competent by the state, that’s when I have a problem with it because now you’re you legislator who is non-clinical are inserting yourself into this clinical realm as though you have the same competence. And to me that sounds like practicing out of scope.

Johnny Sanders (01:03:37):

Yeah, well, something that I know we talked on Twitter just real briefly about how I’m making my own practice not centered around insurance just due to the natures of my value system and how I’m portraying to clients. It just doesn’t seem to be in my best interest, my client’s best interest, and I’m going to take this outside of my own practice for a second. I’m actually a part of a direct primary care and I’ve been beat in this drum very, very hard. Direct primary cares. They work outside of insurance. Insurance is not exchanged in any part. So I can see this as a consumer and see the benefit that when my medicine is out, we have a tech system or I can give a call, bam, we can get that taken care of if I have a quick little cough and normally I wouldn’t go and see the doctor because I have to pay a $50 copay and wait in the office for two hours.

(01:04:37)
I can call up my doctor and Hey, I can fit you in tomorrow at this time, or Do you have time for me to swing by real quick? He’s even done some home visits and bam, we get that. The level of care you’ve talked about, it’s through the roof. I have not experienced anything like this in a medical type of way. Always just felt like cattle being herded in and out. And when insurance is out of the question, just the creativity is opened up and I actually kind of get excited to talk to the doctor because I feel like I get my whole concerns lined out. I know I feel assured that if my daughter gashes her head open that we won’t have to pay $2,000. My doctor can just stitch it up. It really is worthwhile. So as a clinician, if you’re worried about the price tag and things like that, I know it’s a different world than insurance, but as a consumer there is a massive benefit. And if you’re doing your job well, having that maximum competence like Jake is mentioning, your clients are going to be able to tell that difference.

Jake Wiskerchen (01:05:47):

We have a plug for the most recent Naga notes podcast that came out most recent as of this recording anyway with Molly Ruth Ruthford. She’s a doctor in Kentucky. She’s big in the primary care, direct primary care stuff, and she lit a fire in my soul once I talked to her about that and she introduced me to this thing called DPC Frontier direct primary care frontier dpc frontier.com. And they just recently had a conference, actually it’s happening right now over this weekend and it’s in Kansas City and it was started by an anesthesiologist actually. So there’s more and more people who are getting on board with that. Now, I’ll tell you, as an employer, that sounds great to me because I don’t like the idea of spending $90,000 a year on my employees health insurance, which by the way is only half of that because they pick up the other half when we could save all that.

(01:06:39)
I had two emergency room visits last year, $1,300 a piece. The entire bill for the visit was like 2,600. So it was like I was paying half of that out of pocket. And how much of that really is the cost versus the inflated cost because they have to recover what they need from insurance. So if we can get around the insurance by doing this, it’s great. Everybody wins. But you’re flying in the face of the cultural intro Jack, which is another Carl Jung term, which is the unquestioned belief for assumption that this is just how it is and people can’t wrap their heads around the idea of not submitting claims or having that. I think it’s a sense of security, it’s a safety blanket. It’s like, well, what if I get in a horrible auto collision and I have to end up in the ed?

(01:07:21)
Like, well, there’s a way around that too, and if you really must have insurance for catastrophic stuff, it’s way cheaper than what we’re paying for our HMOs and our PPOs. So that is something to be explored. And behavioral health has, I think a moral obligation to get involved in that as much as they can. I don’t know how it works with drop-in visits and stuff like that because our current, I won’t say that this is the way it is, but it’s the way it’s been is the orthodoxy is continual care until the problem is resolved. Very much like physical therapy. And I don’t know that that’s necessarily the method. I think if you get in deeper faster, you don’t have to drag people out in perpetuity weeks on end. I think you can have some very, very powerful conversations at a much less frequent occurrence so that they can take this stuff home and integrate it and practice it and also load ’em up with, I think we can do that.

(01:08:16)
I think don’t think weekly sessions or twice weekly sessions is necessary. I think maybe for functioning people who are otherwise living normal lives and just have some distress, we can make great strides in their healing seeing ’em once a month on that model. Now I will say though, not everybody has access. So if you’re compelled into insurance by the state because you’re in the indigent population or you live in a rural area and Medicaid is your thing, I think we have a moral obligation to deal with that too. So sure, if you can’t afford insurance and the state has covered your insurance and is essentially free to you even though it’s not free, then we as direct primary care providers, I’ll just lump myself into that category. If I’m there one day, which I hope to be, then we have to manage to navigate those who traditionally wouldn’t have the financial means to pay the subscription fee, which is nominal by the way.

(01:09:17)
And it’s way less. Way less. So if it’s 20 bucks a month and all you want is behavioral healthcare, I think most people can probably afford that. If you’re extremely indigent, then maybe the state figures out a way to fund the direct primary care people instead of the insurance companies that will always stick middlemen in the way with their managed care organizations who are pilfering at every step. So it is possible it can be done. It requires a rethinking, and again, we go back to self self-examination. We have to question some of those interjects question some of those beliefs so that we can have mindful control over why we do what we do. I don’t think we need to have a Medicaid system if we can rethink it. I mean, I have solutions to this stuff. It takes a little more political will, right, than most people are willing to commit.

(01:10:05)
It also takes looking down the field 20 years instead of two and root cause mitigation to the point about guns, mental health root cause mitigation is not politically expedient. No politician is going to solicit donations by saying, stick with me for the next generation. We can solve this. Right? They’re more interested in flashy pizz, limbically triggering campaign statements and promises to ban guns or in improve mental health care with billions of dollars. Yeah, well, where are the billions going? Most of it goes to the managed care organization. They don’t go into my pocket. So it can be done and we just have to be more, I guess more connected in this form. More podcasts would be good. Everybody needs more podcasts. But also we have to have the courage to stand up against the system, say, I’m not doing it anymore. Yeah, I’m going to take the chance based on evaluated data and think that the market will sustain my practice and my living not playing the game and being part of the problem.

(01:11:11)
And then the more we grow in that capacity, the more courage that we have to step away from the orthodox system. I think the more people get healed too, because ultimately if you’re doing outcome-based treatment, you’re going to be successful because people get well and then they tell their friends. And that’s really how the market works anyway right now in our profession because the pendulum has swung so far from nobody talks about mental illness to everybody needs a therapist that it’s really easy for grifting opportunists who are very bad at their jobs to stay in business because the market can’t differentiate among good, fair, poor, elite. And we all just look the same. And it’s not until you receive care from a really highly trained elite professional that you go, man, what was I doing? Spending all my time with those other people who were just making me feel better instead of actually getting me better.

Johnny Sanders (01:12:04):

Absolutely. And it is encouraging. And again, that’s kind of the basis of this podcast of we’re not going to always figure everything out and have it all lined out perfectly, but can we get you in the right direction? And I think this for our field as best as we can. And I’ll be honest too, in my own practice, while I am getting it going, it’s not my only source of income right now. I I’m having to do some of the more traditional things contract-wise in the background. So it’s not an overnight thing, but be looking that way, especially if you have issues with the bigger entities in the mental health profession, it’s definitely worth it to get in that independence. Well, Jay, Jake, I think we have talked about some fantastic things. Are there any other things that you would like to plug and where are some places that the audience can find you?

Jake Wiskerchen (01:13:01):

Certainly on Twitter, I’m at Jake Whisk. It’s J A K E W S K. You can follow me there for whatever that’s worth. I invite everybody to watch the emotional functioning videos because I think if you’re in charge of your emotions in response to an environment, you can stay out of my clinic. I want to work myself out of a job. I’m not, this is not my identity. This is something I do. I’m very happy to do it. I’m comfortable doing it. I’m very good at it, but I don’t need to do it forever if I don’t have to. And I would love nothing more than to stop bullying on the playground and watch my kids made fun of and watching couples arguing in the line at the grocery store. If that stopped, I would happily go back to food service or driving forklift or putting pay on walls to pay my bills.

(01:13:43)
I’m not threatened at all by the disappearance of my profession if it’s disappearing for the right reasons. So watch the emotional functioning videos. Those are available at the Zephyr Wellness website. It’s zephyr wellness.org. Just type in on our search thing, the emotional functioning, the video series pops right up. And then walk the talk America w tta.org. If you want to support us, we’re five one c three. Certainly we can welcome your financial contributions, but also just share it around. Know that if you’re a practitioner, stop hiding in the shadows. Come forward, register yourself as part of our 50 state directory. We get solicitations all the time from people who are in the gun community who are suffering and don’t know where they can turn because they don’t want to be judged or have their rights taken away. So having a 50 state provider director of people who are out of the closet putting their names on our website and saying, you can come to me and trust me that my first lever to pull isn’t going to be the authorities to take your property.

(01:14:41)
That they know that they can enter with confidence. And it’d be nice to have somebody in every state who can do that. And then if we can grow from there, that’d be great too. So those are the three things I would offer people. And in the meantime, I really appreciate you having me on and probably close with another dad joke. So this mushroom is in a bar and he wants a drink and he walks up and bartender’s like, I’m sorry, we don’t serve your kind here. And the mushroom looks at me. He goes, why not? I’m a fun guy,

Johnny Sanders (01:15:09):

Perfect as all. He doesn’t take it. But I’m telling you, the king, king of dad jokes, especially if you follow him on Twitter, it’s relentless over there. So I’ll include all the jokes, information down there below is absolutely great having you on the show today. And yeah, those of you listening, I hope that you learned and that you’ll continue to engage in your life and not just sit there and be angry. So until the next episode, I’ll catch you next time.