Clinician Interview #1 Adam Hill LSW

A couple of weeks ago I had the opportunity to sit down and catch up with my old friend and wonderful therapist, Adam Hill, LSW. Adam and I were able to catch up outside of Kopi Café on the North Side of Chicago. The day was bright and warm but provided an excellent reminder of why I love Chicago. People were crowding the sidewalks and the city was awake. After some needed catching up, we ordered our coffees and got into our talk.

Throughout this conversation, we touched on everything from common anxieties to different approaches for helping people. We spoke for so long that we meandered to the different struggles that performers and athletes face apart from some more traditional career fields (though you’ll have to wait until 2 weeks to get that half of the interview).

The most important things that Adam and I talked about centered around the importance of having patience for oneself and the absolute necessity of recognizing our own limits.

Selfishly, I got to take away a key lesson for myself, in that I need to tap the brakes sometimes, as burnout can be an incredibly cruel wake-up call that I hope to avoid.

That said, if you were to ask most people in my life, I could be doing a better job, so for now it’s an aspiration.

If you are looking for some helpful advice on that key issue, look no further. Adam is one of the most insightful people that you can speak with about it. So, without further ado, enjoy my conversation with Adam:

In your practice, have there been any trends or common anxieties that people are facing?

“I would say that current events have been especially triggering lately. [Relating to everything from politics to current wars]. There is a lot of anxiety and stress regarding the unsettling changes in the world, especially at this time.

What I have seen over the course of the year is that this anxiety comes in waves. There seems to be heightened anxiety, followed by an acknowledgement of “Okay, this is what’s happening,” and then a new event occurs and the anxiety understandably spikes again.

I’d also say that the job market is super challenging; be it someone who is looking for a work position or someone who is unhappy with their current position and is searching for a new opportunity. It is very tough to feel like you are trapped in your work-life. Even if you are employed and receiving a consistent paycheck, it’s upsetting to be stuck in a position where you are unhappy and don’t feel like your natural core self is able to be expressed or your inherent traits, interests, or passions are being utilized. This in turn can lead to depression (mild–severe). Because of the competitive job market, overall, I’m observing a lot of anxiety and depression about being stuck professionally.

Relating to the common practice of psychoeducation (i.e. explaining when anxiety is useful vs not), how do you conceptualize education around this spike of anxiety? What about when the anxiety is appropriate for the situation your clients are in?

“Oftentimes the challenges are bigger than any one situation or person. There can be so many societal and familial pressures and expectations with stigma around the assumption that someone may not be working hard enough or putting enough care into their work. Oftentimes there is little-to-no consideration of what the person may be going through day-to-day, the resources available to them (or lack thereof) and what other factors may be contributing to that anxiety. No matter what someone’s circumstances are, it is important to validate, empathize, and acknowledge the situations clients find themselves in and the experiences they are having. For those with more limited resources, it may be even more important to be mindful of this as it can feel as though they are playing catch up or falling behind, by no fault of their own.

A lot of people seek out support because they are absorbing messaging that contributes to heightened anxiety and depression, whether it originates from society or family. Therefore, it’s really important to create a space where people are seen and heard; helping them understand that it isn’t a matter of not working hard enough or a character flaw, but rather a very difficult set of circumstances that are making an already challenging situation that much more difficult.

Now, there are times when anxiety keeps us motivated to strive for our goals. It can also be our nervous system or brain’s way of making sure we are focused on the task or moment at hand and ensuring that we stay alert for possible dangerous, life-threatening situations. A big part of my work with clients, though, is to support them in reaching a place where more often than not, the present anxiety is helpful versus out of proportion to the situation or circumstances. If it is out of proportion, it is likely due to negatively impactful or possibly traumatic events or experiences from one’s past getting triggered, resulting in an individual’s nervous system reacting as though it is a true life-threatening situation, when it may not be.

So, beyond this anxiety being warranted, then you take your role as someone that is here to hold space, as opposed to trying to always reduce their anxiety?

"Yes, I often think about things from a nervous system perspective or a trauma perspective. In that approach, invalidating someone’s feelings or lived experience is counterproductive to helping someone relieve the anxiety or distress they are experiencing.

For example, telling someone to “just feel less anxious” rarely works and often just amplifies the anxiety. This, in turn, further spikes the anxiety or negative beliefs about ourselves that we are working to relieve. We want an individual to know that their anxiety is heard, as a way of releasing the emotional charge or energy that is associated with it. As an example, if someone’s internal voice is saying  “I’m not good enough” or “I’m a screw up”, then those thoughts or beliefs get echoed, and that voice is validated and receives further data saying “SEE IT IS TRUE, IT IS MY FAULT, I’M NOT GOOD ENOUGH.” This is ultimately the opposite of what we want - shame doesn’t need any assistance in holding us back, and it certainly is not helpful in the therapeutic space.

In large part, I get the sense that this has gotten a lot better in the last 10 years or so. Repressed or suppressed anxiety is likely to only further exacerbate these negative beliefs and keep us immobilized or stuck versus allowing us to grow and move forward. This is another area where past impactful negative or traumatic experiences can be triggered. For our brains and nervous systems, the anxiety and negative beliefs are intended to help keep us safe and protect us, but these protective responses are very short-term versus long-term. Holding space and supporting clients in expressing and processing their anxiety and any negative beliefs, events, or experiences go a long way in cultivating long-term relief from the anxiety.   

Do you think that being in a city as urban as Chicago, that it can be easy to get caught up in a sort of autopilot?

“Yes, it can be very easy to find yourself on a cyclical hamster wheel, going into the next thing, and the next thing, and the next thing, and so on. Sometimes there are moments—be it days, weeks, or months—where that happens.

With that, I think that it’s important to intentionally embrace the moment, reflect on it, and get off the treadmill before you get burnt out. If you don’t, eventually, your body will shut down.

Does having a harder job market exacerbate these problems? Maybe it’s harder to take a break or make a change?

“Yes, it is that much harder. It’s one of those things where there is a sort of “paradox of choice.” For example, one may have various goals or tasks that they want to accomplish, but if they are invested in looking for a new job, then inevitably, they are taking investment away from something else that may also be very important to them. It’s a balancing act.

There is a concept that I often discuss with clients known as “energy management”— the idea being that ideally, we start the day with an energy tank of 100%, however realistically it’s more like 80% based on how we slept, other things that may be happening in our life, etc - and with that, it can be really helpful to map out how we want to spend our energy in advance- throughout the day, week, month, etc. [Insert Graphic Here].

It’s important to give yourself permission to map it out, because, for example, many company cultures expect you to put 100% of your energy in the day to work. That is not realistic, however, as we all have responsibilities and other areas of our lives that require our attention, not to mention ensuring we have energy available for the fun and fulfilling things we both want and need to do.

Our bodies are incredibly adaptive to different situations, and they will find reserves to call upon when we exert more energy than we have in store. This can work for a time, but eventually, they will shut down or find a way to force us to slow down. Therefore, making sure that you are working or operating at a sustainable pace is one of the only ways to avoid burnout. Some people will literally lose consciousness when they get too burnt out; other people will slide into depression and/or will start to lose interest in things that historically have been of interest to them. 

That makes me wonder, in your caseload, how many people would you consider more traditional clinical cases versus “coping with life” cases?

“I would say that it’s about a half-and-half split. Some clients fit very clinically—those clients would often fall into the treatment of complex trauma. Other clients are coping with life in the sense that they are making it through, but are wanting to work on navigating life in healthier ways.

Some clients and I work together on making adjustments through building insight and cultivating both emotional and cognitive regulation, while also focusing on interpersonal relationships. With others, we work on fine-tuning, tinkering, and making smaller changes, because what they have been doing has been working well. Making small adjustments can make a real impact both in the short and long-term, but may not relate to larger or deeper background experiences in an individual’s life.

Building off of that a little bit, when you’re dealing with MDD, GAD, Bipolar Disorder, etc., we’ve gotten very segmented with healthcare in the last 30 or so years. How does collaboration work here in your experience?

It can really depend on the client and what we are working on. Personally, I have only had very positive experiences collaborating with other providers or care team members for a client. One really unique thing about a Social Work or a Therapeutic Role is that you’re seeing a client once every week or two. With that consistency, you have more opportunities to track things on a much more regular basis versus a psychiatrist or a PCP who may only see a client sparingly throughout the year, depending on a client’s support needs.

All of that to say, it is of great value to see clients more frequently to then share that information with other care team members. 

On average, I see about 23-26 clients per week, with a total caseload of roughly 36 clients, whereas a psychiatrist might see about 30+ clients per week with a caseload of 200–300+ clients. (I may even be low on the psychiatrist numbers.) On its own, there is more information for a psychiatrist to be working through in supporting a caseload of that size. If we then add in communication with additional care team members for these clients, the amount of additional information to collect, analyze, and parse through as a psychiatrist it can all add up very quickly. Therapists and psychiatrists who work in a clinical outpatient setting can have some similar experiences, but at times, the day-to-day or week-to-week experiences may also be very different.

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Before I leave you for this post, Adam and I got onto the topic of books that really shaped his practice and that were meaningful. Adam, in his thoughtfulness, took the time to organize and email these to me. Please enjoy this trove of a reading list:

Brené Brown’s ‘Trilogy’ on Shame, Vulnerability, Courage, and Resilience

• The Gifts of Imperfection
• Daring Greatly
• Rising Strong

Trauma & Healing

• What My Bones Know: A Memoir of Healing from Complex Trauma — Stephanie Foo
• Transcending Trauma: Healing Complex PTSD with Internal Family Systems — Frank G. Anderson
• Running on Empty: Overcome Your Childhood Emotional Neglect — Jonice Webb & Christine Musello
• I Hate You – Don’t Leave Me — Jerold J. Kreisman & Hal Straus
• Secure Relating: Holding Your Own in an Insecure World — Sue Marriott & Ann Kelley
• Our Polyvagal World: How Safety and Trauma Change Us — Stephen Porges & Seth Porges
• Anchored: How to Befriend Your Nervous System Using Polyvagal Theory — Deb Dana
• Polyvagal Exercises for Safety and Connection — Deb Dana
• No Bad Parts: Healing Trauma and Restoring Wholeness with the Internal Family Systems Model — Richard Schwartz
• The Wild Edge of Sorrow: Rituals of Renewal and the Sacred Work of Grief — Francis Weller

Therapeutic Approaches & Communication

• Maps of Narrative Practice — Michael White
• Nonviolent Communication: A Language of Life — Marshall Rosenberg
• The Worry Cure: Seven Steps to Stop Worry from Stopping You — Robert Leahy
• The DOSE Effect — TJ Power

Parenting, Life, & Perspective

• The Conscious Parent: Transforming Ourselves, Empowering Our Children — Shefali Tsabary
• Four Thousand Weeks: Time Management for Mortals — Oliver Burkeman

For Couples Support

• Us: Getting Past You & Me to Build a More Loving Relationship — Terrence Real
• The Seven Principles for Making Marriage Work — John M. Gottman & Nan Silver
• You Are the One You’ve Been Waiting For: Applying Internal Family Systems to Intimate Relationships — Richard Schwartz
• Hold Me Tight — Sue Johnson

That’s where I will leave things to start. I’ll have part 2 of my interview with Adam published in two weeks! Stay tuned!!!

If you or someone that you know might benefit from scheduling with Adam, you can see his practice information below:

• CFC Therapy: Adam Hill 
• Adam Hill, Psychology Today