Kim Howard  00:00

Kim, welcome to the let’s talk EMDR podcast brought to you by the EMDR International Association, or EMDR, I’m your host. Kim Howard, in this episode, we are talking with EMDR, certified therapist, trainer and consultant, Dr. Timothy Vermillion, about EMDR therapy for veterans and how to navigate the VA. Let’s get started. Today, we are speaking with EMDR, certified therapist, consultant and trainer, Dr. Timothy Vermillion, to discuss EMDR therapy for veterans and how to navigate the Veterans Administration. Thank you, Tim, for being here today. We are so happy that you said, Yes,

 

Tim Vermillion  00:36

I’m happy to be invited. Thank you for having me.

 

Kim Howard  00:38

Tim, can you tell us about your path to become an EMDR therapist?

 

Tim Vermillion  00:42

Sure. So, I was in Iraq in 2008-2009 had just finished my degree prior to being deployed, and so when I came back, I was looking for a job, and ended up at the the Vet Centers in 2010 and that’s where I got my start with doing therapy with veterans. And then within a year, I went and started to get my training in EMDR. That was in January of 2011 and I started in Virginia Beach [Virginia], my first training. And then it wasn’t until November of that same year that I started my my second basic training, and was able to get everything done within one year. It was awesome, and it really gave me some good material to work with. Since I it was still pretty new in terms of doing therapy period, since it was like a year out, so it was really helpful. And then I had Ted Olejnik, who was basically a mentor through my certification and also to become a consultant. And we’re still, we’re still, we still have a good relationship. We still have a good professional relationship. So I talked to him now, and then I just took over for him for the military SIG special interest group on the EMDR website. But yeah, so that basically how it all went through. You know, took me a year to get fully trained, and then was working with Ted for, I guess, a number of years in order to become certified, and then a consultant.

 

Kim Howard  01:58

So, when you went over to Iraq, you did not go over as a therapist, did you? You went over as some other position? Correct?

 

Tim Vermillion  02:07

Yeah. From 1998 till 2012 I was a medic. So while I was in Iraq, I was a medic. At that time, I didn’t get direct commission to become a behavioral health officer until 2012 in the military, mostly I do assessment, so I actually don’t do a lot of therapy within that context of the military.

 

Kim Howard  02:24

Got it. Tim, what’s your favorite part of working with EMDR therapy?

 

Tim Vermillion  02:28

I would say it’s the it’s the quick results. And that’s a generalization, because they’re not always that quick, but when you do see quick results and it surprises the client, I think that’s awesome. They’ve been through therapy before. They’ve been suffering for so long, and then they come meet you, and you’re doing EMDR with them. And then within a couple of sessions, I should say that issue that they’ve been dealing with for so long is now not bothering them. They don’t even trust it. They’re not even confident that this is going to last. And so, you know, they come back and they still tell you how great it’s been, you know, they haven’t been thinking about it, or they haven’t felt certain things. And then oftentimes they they also say that families are even noticing the improvement. And that’s probably the best part, is that those quick results and how shocked the clients are.

 

Kim Howard  03:11

Yeah, we’ve talked about this before on the podcast, what a sense of relief that clients must feel whenever they find whether it’s EMDR therapy or another form of therapy. I mean, we’re a little biased here, but what when they find a therapy that works for them and it helps them to heal, this immense weight is off their shoulders, this big, huge sense of relief that they must get from that is, it must be pretty rewarding to see that. So for the fact that you guys have to listen to everyone’s trauma and awful things that have happened to them over the years. At least, you get some benefit of of seeing that success happen and that sort of that watershed moment of, oh, this is what it’s like to be healthier than I was before. So that’s great.

 

Tim Vermillion  03:54

As a therapist, we have to be kind of humble, because, you know, therapy isn’t all that successful when we when we look at the whole venture, you know, it’s still more than half of the people that do improve, but I think EMDR is really a great tool that that gives me confidence, probably a lot of other EMDR therapists, confidence that we can make that impact. And even though we’re humble, we could have some confidence in doing some good things for our clients.

 

Kim Howard  03:54

Yeah, absolutely. Can you share with us any success stories or positive outcomes from using EMDR therapy with veterans?

 

Tim Vermillion  04:25

Sure. An, you know, trying to keep everything private and everything, because the DA is pretty big on that.

 

Kim Howard  04:31

Oh, yeah, of course.

 

Tim Vermillion  04:32

Well, recently, I had somebody that’s been through prolonged exposure, prolonged exposure. It works. Let’s just put that out. You know, evidence shows that it works, however, it works for the people that stick around and prolong exposure is very difficult for a lot of people to sit through because really it is just sitting with your trauma and like letting it go over and over again in your mind. EMDR, doesn’t have to do that. We do start out with knowing what the memory is that we’re working on, and we. To just allow ourselves to go from there almost pre associate. Let the mind jump around, if it can. But there’s one client that I’m thinking about. They did amazing. We did a couple memories beforehand, as as often happens, you know, Touchstone and all that. But when we got to the the memory, they went through it pretty quickly, and they were amazed by how quickly they went through it and the results from it, they’re like, I don’t even know why this was bothering me, because now they had the ability to free associate and make these connections to adaptive material that they haven’t been able to do before, right? Because they’ve been locked in to thinking about the trauma over and over again. They hadn’t made any of these external connections to more adaptive material. And the the change was night and day. They were telling me how they can go and, you know, they go for a run that’s still on a military base, they can go for a run and go past places that remind them of the trauma that no longer remind them of the trauma. So this was fairly recently, and so it’s just a good example of things that can come from doing EMDR therapy with people also, in my early time, my early years of doing EMDR, when I wasn’t doing it that fantastic. You know, I was kind of just learning I had a Vietnam veteran. And really the Vietnam veterans, one has to realize that if they came to see you, they’ve been suffering for 30 to 40 years or something. And so this person came in and we were able to do what he called voodoo, which is the EMDR, and passing something in front of their face, and all of that. And the results were so astounding that they were also talking about how it impacted their family, which was huge, because a lot of Vietnam veterans, they’ll tell you, like, oh, you know, I’ve been divorced three times, and no, the last one is my angel, right? Because I stayed with them. And so the gift that they could give their significant other, of being better, of feeling better and having better communication with them, that really was the biggest thing for them. You know, EMDR, isn’t just about the person, their suffering and the relief off their back, but also their families, their communities and the people that they associate with.

 

Kim Howard  06:57

Yeah, absolutely. My dad was an Army lifer and served two tours in Vietnam. And when he came back from Vietnam, both tours, he had nightmares, you know, for months afterwards. And at the time, you know, in the late 60s, early 70s, PTSD wasn’t even a medical condition, yet. It wasn’t even, you know, on anybody’s radar that we know of, and at least in a public way. And I know that that particular group suffered for quite a long time, and for decades afterwards. You know whether they were, I think they were lifers. They had a little more insulation being within the military, but if they had volunteered, or they had gotten drafted, or they were reservist or guard, and they had to go over, they were treated pretty harshly when they came home, because of the political climate in our country, and so I’m glad that he was able to find some relief, even though it’s been decades later, that’s That’s wonderful.

 

Tim Vermillion  07:46

And it didn’t end there, right? The even getting into the VA at that time, the VA was populated with a lot of War Two veterans, the people that were working there, some of the interactions the Vietnam veterans were the people that lost their war, right? And so they were not treated appropriately by the people working at the at the VA at the time. So it was multiple, multiple hits, I guess you would say yes, in terms of being able to get care once, once they recognized it and were seeking care.

 

Kim Howard  08:14

Tim, what are some unique challenges or considerations on applying EMDR therapy with veterans?

 

Tim Vermillion  08:19

So within the VA itself, there’s often a time consideration, and the Vet Centers, there’s often less time. And the Vet Centers are still part of the VA. They’re just outside of the VA hospital system. They’re often found in like little Street Mall complexes or something like that. It’s like an away from the medical the medical field, so that they tend to have a little bit longer of a period of time where they can work with somebody and the VA hospital system and stuff, we are kind of set up to have a certain number of sessions, and they’re flexible, per se. You know, it’s not like strict but it’s strict enough to where it can become an issue. If you’re in a B hit Program, which is a behavior health interdisciplinary program like I am, we have to do treatment episodes. So you get a certain number of, certain amount of time to do these treatment episodes in and so, and this is because they want to do evidence based care. And so, evidence based care are 12 sessions, 15, you know, not, not that many sessions. We need to manualize care with the EMDR. It can be a little bit different sometimes, sometimes, you know, we will have enough, we’ll have a certain amount of memories to go through that allow us to do that within that 12 to 15 session time period. However, more often than not, people that are more complex. And so we have to understand that. We have to pick the priority right, what is the thing that is ailing the veteran most at the time? And then we also have to figure out how we’re going to maneuver through our memories, because we can’t just always start with a touchstone and work all the way through because we don’t have time to do all of that. So we oftentimes look for the memory that’s going to have the biggest bang for the buck. Sometimes that’s that index trauma, the one that they, you know, really come in for, that they’ve been nightmares about. But sometimes it’s a different memory, and we just have to kind of do a good assessment. Investment and make sure we get those memories so that we can have the best bang for our buck in the limited time that we have. One of the other things that I think is important to recognize is that working with veterans, this is outside of the VA too. Veterans come with fantastic, positive, adaptive material. They just don’t have access to it. We can help them get access to it by asking appropriate questions. So when what I’m talking about is the fact that they have things that they had to overcome, they have things that they had to adapt to, they had to demonstrate bravery. You know, what was it like joining the military? How did you make that decision? What does that say about you as a person, right? And then we also have them going through basic training, right? What is it, what is that quality that allowed you to push through that, the perseverance, the commitment that you must have needed, tell me about that, right? So we can continue to keep pulling on these things. Some people have gone not just to basic training, not just to boot camp, but to elite schools, their Rangers, they’re special ops, you know. So what was it like for them to do that? What does it say about them? And then you could also go into the specific skills. Were they marksmen? Were they snipers? You know? What does it say about them to be able to do that? What talents that they have? We really kind of just highlight and keep pulling on this adaptive material. And this is before we even go and talk about deployments. This is just about their training, their ability to get through it. Some people even needed to get high scores to be in the specific jobs that they have. Like a medic, you need a certain as that score ASVAB is the Armed Services Vocational Aptitude Battery. It’s basically the test that allows you, or the army, I guess, or the military, to tell you what jobs that you can and cannot have. And so if you’re low on that, you can only get a certain number of jobs, and you’re high on that, then you get other jobs. And so you can say, well, I’m intelligent, I’m smart, right? So what I’m trying to get into is that there’s a whole breadth of using the military to find the positive adaptive material to do your preparation phase. And I think the preparation phase is often not paid attention to as much as it should be in trainings anyway. And I think that we with the military, especially, we can really sit there and highlight these positive things. So before we even get into these trauma memories, these index memories, they have a good sense of who they actually are and what they actually bring to the therapy.

 

Kim Howard  12:18

That’s a good point. I come from a military family, my dad, all of my siblings, except for one sister, my husband, both of my father in laws and a sister in law. We’ve got everybody but the Coast Guard. We’ve covered all the all the military branches. And it takes a special kind of person to make that commitment. And when I just see glimpses of what boot camp is like, hats off to people who make it through that. I mean, I know basic training is, you know, it’s called basic training, but it’s anything but basic. And people who are drill sergeants and and are charged with taking people and making them a cohesive unit, but having to be on the the receiving end of a drill sergeant is probably not the most pleasant experience anyone’s ever had to have, but they make it through for whatever reason that they’re there, whatever motivation that they’ve brought them to the table. So that’s good, that you’re helping to remind them of who they are and how they got there, and how that matters in their their journey, whether it’s their their life journey or their mental health journey. So that’s, that’s great. That’s a great idea. Thank you.

 

Tim Vermillion  13:24

Yeah, there’s so many other things. Just add one more. The, you know, we’re talking about positive affect, you know, getting a positive material, adaptive material, we’re trying to get to. But also, they’re taught skills, right? So if you’re thinking about doing that other piece of the preparation phase, which is teaching people how to state shift, right? They’re taught skills. If you’re trying to do be a sniper, if you’re even just doing regular marksmanship, you have to control your breathing, right? So you can, if you don’t, your weapon is going to go up and down, and you’re not the target where you want to hit. So you have to control your breathing and operators the you know, overall term for all the people that do secret squirrel missions over there and the Navy Seals and everybody, they have to control their autonomic nervous system to an nth degree, because they have to go out there and do certain things, and have to do them quick, without being bogged down by anxiety about the different things that come up for them, so they might not have access to it. Now, when they’re sitting in front in front of you as a as a therapy client, so it’s just something that you can bring up and try to get them to remember to use and hopefully that state shift exercise will also be something that’s worthwhile in terms of that preparation phase.

 

Kim Howard  14:34

Great advice for any EMDR therapist out there working with veterans or active duty. Thank you. Since you work at the Veterans Administration, what suggestions do you have for veterans navigating their mental health journey through the VA?

 

Tim Vermillion  14:47

The VA is not coming after you, right? They’re not coming to give you therapy. It’s something that, unfortunately, you have to go get so it’s something that you have to do, so be patient in the whole process. There’s different faith. Phases. If you go and say to your primary care physician, I’m not feeling well, you know, I want to talk to a therapist. One of the first things they might do is to get you to talk to the therapist that’s right there, right? They have a primary care mental health integration so they have somebody that’s working within the primary care that can work with you for about four to six sessions. And they usually do like half hour sessions, short term therapy, and hopefully that’ll be all you need, right? It might be just one of those things where you have a little bit of an issue, you come in, you get it taken care of, and you’re good to go in that level of care. You can also get medication prescribed to you by your primary care physician. And sometimes there’s even a psychiatrist that will consult with your primary care physician in order to make sure that any mental health medication is working for you after that, you know, somebody might say immediately, like, Yeah, this is not something we can take care of here, right? You need a higher level of care. So where I work is a behavioral health interdisciplinary program we just call BHIP. And what we do there is treatment episodes. So we take your issue, we try to really figure out what that issue is through a good, good assessment. And then we figure out what evidence based therapy would be good for you. So we kind of do evidence based care as much as possible. So again, those might be 12 to 15 sessions, sometimes up to 20. And then after that, you know, you you’re brought back down to primary care. Something comes up. You can talk to your primary care therapist for the short term things if you’re not okay by the end of our treatment episode in B hip, then we try to figure out something else that might work for you. So it’s kind of going from one treatment episode to another. We also have groups and various groups, and the groups will be different depending on where you go. We have groups for depression, anxiety, even anger, different things that come up for you. And then finally, we have specialty programs, which is, like the highest level of care if you need it. So PTSD has its own program. You have the PTSD program, which is, that’s all they do. What’s interesting about that is, if you have an alcohol issue or something like that, you can’t go to the PTSD program yet. You have to go through the alcohol program and just have really the PTSD to concentrate on when you get there. So again, they’re very specific. They also have an alcohol program. So they have different programs depending on which VA you go to, like a star program, something like that. So be patient and go through the process. And one other thing that I think would be worthwhile is to learn about whole health. So whole health has been around for a couple of years, like 10, maybe you know it’s been around for a while. However, that kind of looks at you, the veteran as a whole person, and tries to figure out how to get you the best carrier. You end up the center of your own care, and they’re coaching you. They’re trying to help you through the whole process, trying to get you physically and mentally in a space where you feel comfortable. So they have different programs attached to that, like acupuncture, chiropractic stuff. Also, hypnotherapy is something that they might have for you. So, yeah, get get involved in whole health as well. I think that would be great.

 

Kim Howard  17:53

That’s great advice for anybody listening. Thank you. Are there any myths that you would like to bust about veterans working with EMDR therapy through the VA?

 

Tim Vermillion  18:02

A lot of the right now. There’s a lot of therapies out there that have been rolled out by the VA. The VA has sponsored training. Cognitive Processing Therapy is one of them, prolonged exposure is another. And these are for PTSD. There’s other ones as well that are not for PTSD, but those are the ones for PTSD. EMDR is in the practice guidelines for the VA and the DoD far as something to be used for PTSD. And so you would think that they would roll it out, but they haven’t yet. And some of it makes sense. So one of the reasons that I’ve heard is, you know, they already spent so much money on these other two and they work. So why would I spend something, you know, more money on things even though it works. But you know the other things work too, is why spending the instrument? One of the myths is that it’s not accepted. And so that’s what I want us to kind of get into, is that it is accepted. And right now it’s even more accepted because the office of mental health and suicide prevention, which is the overlying office for VA mental health, they’ve grabbed up what was a grassroots organization within the VA that was working on getting EMDR support. They’ve grabbed that and started to make it their own. And so they’re really in the process right now of getting acclimated to what EMDR is. So use the support there is. There’s EMDR support out there, even in that National Center for PTSD, which has a PTSD consultation program for people working in the VA. They have somebody there that provides EMDR consultation. So the support is there. The training is hit or miss, because some VAs will pay for the training. Some won’t, right? There hasn’t been a roll out yet. So the training is hit or miss, but the support is out there. So if you get the training, the support within the VA and please go get the training, because the veterans really, really benefit from EMDR.

 

Kim Howard  19:44

Yeah, absolutely. And I, I’ve interviewed a couple of people on the podcast previously. Lauren Rich was most recently in my mind, who works with veterans and and I think we also should talk about dispelling the myth thatevery veteran has PTSD. Or every combat veteran has PTSD, because that’s not necessarily true. Not everybody who puts on a uniform has that. But you know, EMDR can also be used to treat things other than PTSD. It just happened to start out treating PTSD in the beginning. So if you’ve been assaulted, if you have anxiety, if you have depression, you know, you can, you can still use the EMDR for a My read of mental health issues. So,

 

Tim Vermillion  20:27

Yeah, definitely in the VA, they’re pretty specific. And, I mean, you could use it for other things. They’re specific about PTSD in terms of the practice guidelines. So, you know, practice guidelines have stuff for depression. They don’t have EMDR listed under there for depression at the moment, but maybe in the future.

 

Kim Howard  20:48

What would you like people outside of the EMDR community to know about EMDR therapy with this population?

 

Tim Vermillion  20:53

It’s very effective, so that’s the biggest piece. But one of the interesting things about EMDR is that it can be done blind, and a lot of veterans will come in, even though this might not be completely true, because there’s been some allowances for people that are working with therapists to talk about their secrets world missions and stuff like that. Some people come in and they’re very uncomfortable still about saying things that they were told were very secret, right? So I can’t tell you about this mission, because it was a secret mission, etc. We don’t need any of the details when we do EMDR blind, and there is a blind protocol that we can do. So this helps with working with those types of veterans that feel like, why am I even coming? Because I can’t even tell you anything. But EMDR works for them, also for people that have sexual trauma. And this could be for females, but males, a lot of males, have more of a stigma. They don’t even want to talk about sexual trauma. So for females and males that don’t want to talk about the details of their sexual trauma, EMDR can be done blind, and you can actually get through the whole process and have a lot of good success without them ever telling you the therapist the details they know, the details you know, they’re still working through them. However, I don’t need need to know the details to make EMDR work for them.

 

Kim Howard  22:03

Good reminders. Thank you, Tim, how do you practice cultural humility as an EMDR therapist?

 

22:09

There’s so many like levels or layers in terms of working with culture within the VA in our assessments, we specifically ask questions about both the positive end the negative things that come through culture. There are some people out there that already, when they come to see you, they’re already going against their culture, because their cultures don’t allow for therapy, and so when they go home, there’s no support for them. So these are some of the things that to recognize and realize, is that there’s different layers of culture and things that come up, and I do like the way that we call it cultural humility now instead of cultural competence, because in cultural competence to it, we can’t be competent in other people’s culture. We can learn a lot about it, but competence is not something that we really should be striving for, but humility and understanding is and to recognize that it’s not just the culture aspect of things, the bias and whatnot, that comes up, because those will come up, but also, you know, LGBT, for example, you know, is a huge component of culture in there. There’s huge history of things that bias and everything that went along with the military. At one point you couldn’t be LGBT in the military. At another point, they had, don’t ask, don’t tell. And that’s, that’s what I was in, you know, I was in the Don’t Ask, Don’t Tell, period. And I remember when, because I really can’t ask or tell, right? So when you go through in processing, they sit you in a room with a tape recorder, and they hit play, and they leave, right? And then you hear the policy of, don’t ask, don’t tell. And then they, you know, once it’s over, they come in and turn it off, and you move and you move on to the next room. So it’s very dehumanizing on some level in order to go through that. And then some people, you know, they get deployed, and then, you know, they’re alone in terms of being with their team, but they can’t say certain things and be who they are. So there’s a lot of different things that’ll go along with culture in general, but even some of the things like LGBT and right now with the transgender population, the back and forth of you know, you’re accepted. You’re not accepted, depending on, like, who’s in office and what’s going on just adds to again, another layer of just ongoing stress that they have to deal with while they’re also doing their mission. Yeah,

 

Kim Howard  24:18

absolutely. Thank you for bringing that up. Tim, do you have a favorite free EMDR related resource you would suggest, either for the public or other EMDR therapists?

 

Tim Vermillion  24:28

All right, so I’m kind of biased, but emdr.org

 

Kim Howard  24:33

is my favorite. That’s why we love you, Tim.

 

Tim Vermillion  24:37

So I think that’s the biggest one that I would put out there. I I’m big with standards, and sometimes when you move away, I call EMDR the flagpole, because that’s kind of where the standards are. So if you move as you move further away, you know, there’s some ideas and thoughts that come up that are just colored by other people’s opinions. And I would say, go to emdr.org if you want something that is just kind of more. More clear and standard EMDR also, and you know, kind of a self a self promotion here, I just started my own podcast, and all it is is about veterans. And so the last, the first and last one I did was last Wednesday, and it was on EMDR, what somebody might expect through EMDR. So as far as working with veterans, it’s going to have a lot of EMDR stuff in there because some EMDR therapist, but it’s going to be mostly about what to expect with veterans. We’re going to talk about survivors guilt, moral injury, all of that. So that’s another resource that I’d like to plug myself.

 

Kim Howard  25:31

We’ll put a link to your podcast in the description so people can check it out. And then also, you mentioned the Veterans Administration, but you also mentioned the National Center for PTSD. We’ll link all of that in the description of the podcast so people can go and and find the resources that they need.

 

Tim Vermillion  25:48

So, yeah, and now that you mentioned it, you know, just as far as the resource goes, the National Center for PTSD, like, if you Google National Center for PTSD space, EMDR, they have a whole page on EMDR and what to expect and everything else. You can also Google whiteboard and EMDR, and then the VA has created some of those, like cartoonish type videos that kind of explain EMDR. So you can use these things for your clients as

 

Kim Howard  26:11

Well. Great. Tim, if you weren’t an EMDR therapist, what would you be?

 

Tim Vermillion  26:16

Well, if you’re talking about therapists, probably CBT, cognitive behavioral therapy, because I just been trained in a lot of different versions of that, from cognitive processing therapy, which is one of the VAs accepted PTSD treatments, but also CBTI cognitive behavioral therapy for insomnia and then for depression. If it’s not about therapy, I would like to be a millionaire.

 

Kim Howard  26:37

Or a billionaire. I like it, yeah.

 

Tim Vermillion  26:40

Elon Musk is about to become a trillionaire, I think up to a billionaire, there you go.

 

Kim Howard  26:45

I like that. Nobody else on the podcast has ever said they wanted to be a millionaire, right? You’re my people. Is there anything else you’d like to add?

 

Tim Vermillion  26:56

Just going back to veterans having a lot of complexity, you know, they’re still human. First of all, you know, there’s a reason why a lot of them went for the military, and it’s not just because my family was was there, you know, in the military, and I wanted to follow in their footsteps. But some of them are escaping things. Some of them are trying to find different areas of life, different walks of life, from what they’re coming from, because they didn’t feel comfortable there, and they recognized that they needed an out. So they have the normal life situations and stressors that everybody has. But then they also have, again, that moral injury, the survivor guilt. Some of them end up going and getting exposed to toxic substances or getting involved in TBI. And then they a lot of them, when they deploy, will have family separation issues. And then we also have the bias, you know, the race bias, the LGBT bias, and all of that stuff that they got to play into while in the military, because that doesn’t escape once you’re in the military. So you know that doesn’t go anywhere. That bias still exists, unfortunately. So all of those things are things that are areas that we kind of need to pay attention to when we’re working with veterans.

 

Kim Howard  27:57

Great way to end the podcast. Thank you, Tim.

 

Tim Vermillion  27:59

You’re welcome.

 

Kim Howard  28:00

This has been Let’s Talk EMDR Podcast with our guest, Tim Vermillion. Visit www.EMDRIA.org for more information about EMDR therapy, or to use our find an EMDR therapist directory with more than 16,000 therapists available. If you like what you hear, please subscribe to this free podcast wherever you listen. Thanks for being here today.