Ohio Counseling Conversations
Ohio Counseling Conversations
Conversation 30 - Beyond Physical Healing: The Impact of Medical Trauma
Dr. Michelle Flaum, LPCC-S, DCMHS, is a Professor in the Department of Counseling at Xavier University and a Clinical Mental Health Counseling Specialist in Trauma Counseling and Integrated Behavioral Health Care Counseling. Her groundbreaking book, Managing the Psychological Impact of Medical Trauma: A Guide for Mental Health and Health Care Professionals, is the first to conceptualize the psychological aspects of medical trauma and provide mental health professionals with models they can use to intervene when treatment becomes trauma. Drawing from her personal experience with a life-threatening postpartum hemorrhage, she recognized missed opportunities for psychological support in medical settings. Given the potential for traumatic stress responses to evolve into medical PTSD, she emphasizes the critical role of counselors in fostering trust in healthcare service, including opportunities for counselors to expand their roles in hospital and healthcare settings. Dr. Flaum proposes that discharge instructions extend beyond physical wound care to include mental health resources. Her assessment tools and protocols are used throughout the U.S. and globally. Michelle has been a featured expert on medical trauma throughout the media, including NPR's All Things Considered, Doctor Radio on SiriusXM, Healthcentral.com, and The Conversation. She is currently working on her second book Treating Medical Trauma which will be available in early 2026.
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Created by the OCA's Media, Public Relations, and Membership (MPRM) Committee & its Podcast Subcommittee
·Hosted by Marisa Cargill
·Pre-Production & Coordination by Kailey Bradley, Marisa Cargill, Victoria Frazier & Kendra Thornton
·Editing by Leah Wood
·Original music selections by Elijah Satoru Wood
·Closing song: Accretion Discotheque by Who AD
Welcome back to Ohio Counseling Conversations, the official podcast of the Ohio Counseling Association, bringing you conversations from around the state. On today's episode, we're joined by Dr Michelle Flom, professor at Xavier University, anda, leading voice in medical trauma-informed care, dr Flom shares how her groundbreaking work, including the first ever certificate program and book on medical trauma, is transforming how counselors and healthcare professionals respond to the psychological impact of medical treatment. Rooted in both professional expertise and personal experiences, her mission is to ensure the patients feel safe, seen and supported in every stage of their care. And I'm your host, dr Marissa Cargill. Let's dig in. Welcome back to Ohio Counseling Conversations. I am Dr Marissa Cargill and I am so excited to get into today's conversation. We are joined by Dr Michelle Flom. Michelle, we're so excited and eager to talk to you today, and there might be some listeners who don't know who you are, don't know what you're about. Can you tell us a little bit about yourself and what led you into the counseling profession?
Michelle Flaum:Absolutely, and thank you so much for having me today. So yeah, absolutely so. Um, I have been a proud counselor in Ohio and actually, um, uh, all my life at Ohio in and uh, and so I've been a counselor for almost 25 years now and educated here in Ohio, got my bachelor's at the Ohio State University, my master's about 26 years ago at the University of Dayton and then my doctorate at the University of Cincinnati. So I've been in private practice for almost 25 years and I've been a professor for almost 20 years. So the first five years at the University of Dayton and so then the last 15 years I've been a counselor educator at Xavier University.
Michelle Flaum:So really what brought me to the counseling profession was just a strong desire to help people. My initial calling was actually to be an attorney, and so I started my educational journey down in North Carolina. So I said I've been in Ohio in my whole life. I spent a couple of years down in North Carolina at the University of North Carolina and Duke University and spent actually just a couple of weeks in law school. Didn't take me long to realize that was not my journey and left there A few months later, found myself in a master's program in counseling and then never looked back. I knew that counseling was my calling, and I've been a clinical counselor ever since, and so I've just been passionate about the field and an advocate for our profession ever since.
Marisa Cargill:That's amazing, yeah, and I love to hear you know. Yes, a couple years in North Carolina, but Ohioans and Ohio counseling is such a rich field and it's in and of itself and we love having like people who've been here and kind of what's going on in this state. So, beyond counseling and a counselor education, I know that you are also an author and that you have written the groundbreaking book Managing the Psychological Impact of Medical Trauma. What inspired you to write this?
Michelle Flaum:Yeah, thanks for the question. So actually I can really, unlike some authors, maybe I can pinpoint the exact day that inspired me to write this book and, bittersweet, it was the day of my daughter's birth. So back in 2004, april 9th beautiful day in so many respects, the day of my daughter's birth, but actually was my own medical trauma. So I had a postpartum hemorrhage and a massive hemorrhage right after her birth and experienced a significant trauma her birth and experienced a significant trauma. It fought for my own life for many hours after her birth and almost lost my life as a result of that and had a week-long hospital stay in the ICU really fighting for my life. So spent the first week or so without really having even met my daughter, my newborn, and so, as you can imagine, just a massive trauma in a cascade of events.
Michelle Flaum:Following that experience and having experienced that as a newly licensed clinician, while I was experiencing this as a new mother and as a patient, I was also experiencing this trauma through the eyes of a mental health professional and I was seeing all of the missed opportunities. I was seeing all of the ways that I could have been helped but wasn't. While in the hospital and in the days and months following my experience, I started to see myself really struggling and subsequently I became more and more affected by this trauma and developed post-traumatic stress disorder. And so I spent the next several months and even years really on a journey to heal myself. And while that was happening, I was really grappling with what had occurred and recognizing that it could have been very different and I really didn't want my wanted to do something about it, and I had always been a writer, I'd always been a creative writer and so I began writing. I began writing about my experience, I wrote a few articles and, through the early years of my daughter's life, I decided to go back and get my doctorate and I was writing at that time. And I wrote an article and decided to take a risk and and submit it to a nursing journal, because I thought, well, I'm writing this article about all the things that happened in my experience that could have been different and a lot of what I was writing was really to the nursing audience. And so I thought, well, let me submit this and see what happens. And it was accepted. And so, long story short, some researchers at Stanford University read this article and contacted me and asked me if I would partner with them, and so I began working with them on creating some protocols for what was called at the time is still the California Maternal Quality Care Collaborative, which is an organization that creates protocols not only for California but is a leader on the national stage in setting guidelines and standards for maternal care across the United States. And so I played a role in setting new protocols for mental health and maternal care stage with the National Obstetrics and Gynecology Association and some national nursing associations to create mental health standards for maternal care. And so my work with maternal mental health kind of expanded from there.
Michelle Flaum:And all the while I'm I'm beginning to think about medical trauma, and when I first started doing this work the term medical trauma really didn't exist, you know. And when I started to talk with physicians and and and really other providers about medical trauma, they would kind of look at me, you know, curiously and just kind of push back a little bit and say, well, medical trauma, that's really not a thing. I mean there's. You know there's no difference between medical trauma and other kinds of trauma, and I thought you know what there is.
Michelle Flaum:Medical trauma is very unique, it's a different kind of experience, and I'm glad I kept pushing back because it really kind of spurred me on in my work and really it's been a labor of love. And it's also been a lot of advocacy about our profession because all the while I've been I've really been advocating for counselors Because you know, as the quote unquote, kind of new kids on the block in the mental health sphere we sometimes can be overlooked, you know, and social workers and psychologists are often the first kind of named in the mental health sphere, within healthcare. And so I've, you know, I've been really kind of banging the drum for counselors within healthcare as part of my advocacy about medical trauma. So maybe long answer to your question, but that's kind of what sparked my work and kind of where that came from.
Marisa Cargill:I'm sorry that you had to experience that, but I, I think you know the message that that you created and the advocacy that you're doing is so meaningful, and so you know thank you.
Marisa Cargill:That inspiration is. I got like teary eyed at the beginning of you sharing, like your, your own personal story. Um, just because, like even though maybe not the same and maybe not to the same degree like I had like an outpatient surgery, but I'd never had surgery before and I remember after my mom left the room, being alone kind of waiting for them, and I was like so scared and vulnerable right.
Marisa Cargill:And that that feeling is maybe not unique to just one individual right, like it's a vulnerable position and, um, being in those spaces is, you know, often very unfamiliar for people, which makes it even scarier. Um, yes, yes. So yeah, I really appreciate you sharing your, your own experience. I think a lot of people can probably relate to just some of that vulnerability that they felt.
Michelle Flaum:Yeah, yeah, thank you for sharing that too, because I, you know, I talk about medical traumas being kind of a disenfranchised kind of trauma, especially for adults, because we were socialized to, you know, really submit to whatever needs to happen for us within the medical setting, you know, and we, because we, we understand that this is to treat us, to heal us. There's this expectation that that you know that we are almost that, that you know that, that we aren't allowed to be scared, or that you know that, that we were quiet about it. You know we don't, um, we don't necessarily talk about it and it is scary, it is vulnerable.
Marisa Cargill:And as a counselor, I was like thinking like, why aren't like no one's even saying like let's breathe for a minute? Or you know like and I know these things but it's just like I felt very alone in it and and so. I like was relating on a different level, but relating that like, yeah, probably this is happening more frequently than maybe other professions are aware of.
Michelle Flaum:Yes.
Marisa Cargill:Yeah, you conceptualize in the book the psychological aspects of medical trauma. Can you elaborate on that concept for our listeners?
Michelle Flaum:Sure, sure, absolutely. So really, I mean we can think about medical trauma as traumatic stress, a traumatic stress response to pain, to injury, to serious or chronic illness, to medical procedures, to being in the medical setting really anything to do with our bodies or being in the medical setting. So the threat, the traumatic threat, could be our own bodies, it could be the hospital or the medical setting, it could be staff or providers. That could be kind of a trigger for us, especially if we've had past traumas. You know medical traumas. It could be the procedures themselves, it could be pain, really any combination of those things. Yeah, and and and. So any of those kinds of traumas.
Michelle Flaum:They can lead to clinical disorders. I mean they can lead to what we call medical PTSD. They can lead to anxiety. They can lead to depression, grief. They can lead to substance use. You know substance use disorder. They can lead to, you know, subclinical kinds of issues or other kinds of crises. You know lots of different kinds of difficulty in people's lives.
Michelle Flaum:So so you know, these kinds of traumas can have wide ranging effects for people and as counselors, we, you know we we might treat the clinical issues themselves. We might be helping people work through sometimes the invalidation that they might experience with, maybe, healthcare staff, maybe they experience some dehumanizing treatment, maybe they struggle with the vulnerability that they've experienced, maybe they've experienced some what's been termed medical gaslighting, and maybe they're struggling with medical avoidance, which is another really important consideration with medical trauma. And that makes sense, right, when we're working with trauma, experiential avoidance is a concern, and so when we're talking about medical trauma, it makes sense if someone has experienced a significant trauma within the medical setting, well, you know, it makes sense that someone would want to avoid that experience. Well, if they're avoiding healthcare, that has wide ranging implications for them, and so our part of our role as a counselor, then is to help them re-engage with healthcare. Um so, so, hopefully that gives kind of a sense of really the the broad focus of medical trauma, um, andanging kind of interventions and the way that we can conceptualize our work and many different factors that can contribute to medical trauma, where we might be focusing on the client.
Michelle Flaum:You know the client factors. I mean people come with many risk factors that can contribute to their experiencing medical trauma, maybe previous traumatic experiences or mental health concerns that make them more vulnerable to experiencing medical trauma. You know, maybe it's, you know they've, you know, had a very traumatic medical experience, such as maybe you know they've gone into cardiac arrest or you know they've had kind of a life-threatening medical incident. There's so many factors that contribute to, you know, to medical trauma. It's quite complex, you know when you really start to think about it.
Marisa Cargill:And multifaceted in that, like you mentioned before, it can be a combination of all of these things too, and that it extends past even like the healthcare system or like the setting too, because if your, your healthcare providers, are invalidating you, it's really easy for other people to kind of pile on, Like if the doctor doesn't think it's a problem, then your partner or your you know, your family members maybe like it's not that big of a deal.
Michelle Flaum:Right.
Marisa Cargill:Right yeah absolutely yes. Yes, while I think everything you've shared highlights the importance of raising awareness about this explicitly like why do you think it's important for us to make sure we're raising awareness about medical trauma and its impact?
Michelle Flaum:Yeah, I, you know, I think in part because, again, as counselors we we really value soulism and and kind of treating our clients, you know, mind, body, spirit and and, and you know, and treating the whole person and and valuing that when we're working with our clients and we're learning about their histories, you know these are important opportunities for us to, you know, really help our clients to when you know they are kind of exploring their stories.
Michelle Flaum:You know, number one, I think oftentimes we can miss aspects of their stories that could potentially contribute to their current difficulties and struggle, difficulties and struggle.
Michelle Flaum:You know, I've worked with so many clients who might be struggling currently and not realize that some of their struggle ties back to maybe previous, you know, medical struggles or previous, maybe chronic illness. Or you know, oftentimes there are so many dots that we can help them connect that if we don't kind of bring forth um, this, um, I guess this um additional kind of way to conceptualize our clients, um we're we're really missing out on an opportunity. I think also, you know, when we learn more about medical trauma, this gives us another I guess you know toolkit and opportunity to learn how to collaborate with other professionals, with healthcare professionals. It gives us another kind of language, I guess, to be able to collaborate with healthcare professionals. It gives us another kind of language, I guess, to be able to collaborate with healthcare professionals. We are such of value this you know and their history, and you know maybe the implications of their health history and chronic illness and those kinds of experiences.
Marisa Cargill:Yeah. Yeah, it might seem just like a little blip on an assessment question. Yes, Question or something, but that generally there's a much larger story. Even if, like someone's been, you know, relatively healthy, they may still have like experiences that have that tell the story about their relationship with health care.
Michelle Flaum:Absolutely, and you know, I'm glad that you said that, because oftentimes, you know, on our, on our intake forms, we have a section that is medical history and when I talk to clinicians sometimes they'll say things like well, I just kind of glance at that, or there may be there's a part where it might say past surgeries and I just quickly read over that because I kind of think, well, that's not my, that's not my purview.
Michelle Flaum:That's not my, you know right, that's, that's medical and you know. But when we stop and say like, even if we ask a simple follow-up question, how was that for you? I mean, what was that like for you? I can't tell you how many times clients have said, well, you know, actually, when I, when I went into, you know, to have my, you know, my, my daughter, I, I, I did, you know experience, you know X, y and Z, and it was really terrifying and no one's ever asked me about it before. I was just kind of told everything was fine, I was fine, my child was fine, so get on with it. You know, and there's so much that happens that's invalidating for us. You know there's that disenfranchisement that I was talking about earlier follow-up questions. It can really kind of, you know, bring forth so much more important conversation and exploration with our clients.
Marisa Cargill:Yeah, and you mentioned, like the integration of counselors into like other, you know, professional treatment teams. How do you feel like this can really enhance patient experience, improve the care that is given? I think this can really enhance patient experience, improve the care that is given.
Michelle Flaum:I think it can enhance the patient experience tremendously. You know, right now, I mean, there are so many opportunities that really aren't being seized right now, especially within the hospital setting. Especially within the hospital setting, I think about this ideal world in which patients who are in the hospital setting from the time they enter the hospital to the time they're discharged, and I imagine, wow, if there were counselors at each step of the way, from um the time they enter, you know, from the the aspect of prevention, you know if we are, if we are, screening you know patients and um, even helping them with giving them some tools for um, for stress management or checking in with them. How are you feeling about this upcoming, you know, surgery? Or if patients you know are coming into the hospital for, you know, for emergencies, you know sitting with them, helping them kind of work through whatever kind of you know mental health kind of reactions they're having to this experience as they are kind of moving through their episode of care.
Michelle Flaum:You know, I often kind of thought about, when I was in ICU after having my daughter, if at any moment while I was in ICU, a mental health professional had walked into that room and taken a few moments to look at me. They would have known something was very wrong If I had been assessed at any moment and someone would have intervened. That could have made such a difference in my outcome. That could have meant a very different trajectory. Intervene early, you know, and able to be a bridge for patients, helping to connect them with mental health resources at discharge, because right now, when patients are discharged at the hospital, they often aren't told. Things like what you've just been through is potentially traumatic, and here are some resources for mental health. What they're given are instructions for caring for their wounds and here are your prescriptions. So people are leaving the hospital and, if anything, if they are recognizing that they're struggling with their mental health, they're either second-guessing that or it's not in their awareness, or, if they are struggling, maybe they're told look, get over it, you survived.
Marisa Cargill:Yeah, you should be grateful.
Michelle Flaum:You should be grateful, you know. And so that is really invalidating for people. And so we have so many people falling through the cracks and they're just getting on with their lives and maybe, and so then they might land in our offices months later, years later, when they're finally putting the pieces together, or maybe even not. They're just coming to see us and they're thinking I don't know what's going on with me, but I'm struggling, I'm stuck. And then if we have this lens of medical trauma as one of the many lenses that we use and we're asking those follow-up questions and we see in their medical history two years ago you had the surgery and we're asking follow-up questions, maybe the dots do connect back and they say you know what? This might be one of the factors for me. I had this surgery and I've been struggling ever since.
Marisa Cargill:Right, right, you know, and the lack of conversations around it, you know, indirectly, are stigmatizing right, like if we're not gonna talk about it, it means we're not supposed to.
Michelle Flaum:Exactly or something.
Marisa Cargill:And so, by getting this collaborative approach and working into these teams where we can be supportive and, like you said, intervene earlier, it normalizes like hey, there might be some mental health impact of what you've experienced.
Michelle Flaum:Yes, and that that I think what you said it's validating. And I think what you said is so important because I can't tell you how many clients have said to me you mean, I'm allowed to call this trauma, yeah. And and I'll tell you that something that there's been sometimes troubling to me, even in conversations that I've had with a few colleagues about medical trauma and and I think that there's been some confusion about this and I've had to kind of clarify, and sometimes there's been some confounding between medical trauma and PTSD. And so in some of these conversations sometimes the conversation has gone well, I've had these clients but they haven't met the criteria for PTSD, so they can't call it trauma. And I've come back and said no, no, no, no, no. We're talking about two different things Trauma, trauma.
Michelle Flaum:There's a subjectivity to trauma. There's a subjectivity to trauma If something was traumatic, if someone has experienced traumatic stress as a result of an experience, that's trauma Period, full stop. That is my philosophy and no one can talk me out of that. And so when I hear sometimes our mental health colleagues, you know, be kind of a little more rigid about that and say, no, you need to meet the criteria, that post-traumatic stress disorder, that is one effect of trauma, but that's one effect of trauma. That's a clinical diagnosis, but that's very different.
Michelle Flaum:Medical trauma can lead to many effects, one of which is a very, you know, severe I mean, this is a clinical disorder, medical PTSD. That's one effect of medical trauma, one of many effects of medical trauma. So it's, you know, and, as I said previously, it's amazing how many clients have said to me and I am just, by virtue of what you said just a moment ago, I'm guessing that you've had this experience too where it's so validating for clients when you know, when they hear us use this language, like you know, I can, I can say that this was traumatic for me, yes, this was trauma, and hearing their counselor say that, and yes, you can, you can, of course, you can say that that's what this was for you.
Marisa Cargill:Yeah, and that we're validating by, like, reflecting back what they're sharing, like this is your experience, like I'm project for you, your mission. You developed a certificate, the first ever certificate in medical trauma-informed care at Xavier. Can you tell us more about that?
Michelle Flaum:Sure, sure, yeah, so yeah, this is actually this is the first certificate worldwide, so it's been really exciting. So we've had international students yes, yes, yes, and Ohio, yes, so yeah, it's been really exciting. So this was back in 2022. So this is a it's a nine credit hour certificate and been kind of a labor of love and been kind of a labor of love, and so this is a postgraduate certificate that is open to not only mental health professionals. So it's been exciting to see it's an interprofessional certificate Counseling students or licensed professional counselors, social workers, psychologists, nurses, physicians, health care administrators so that's been really exciting to see, you know, such an interprofessional representation of students kind of moving through this certificate.
Michelle Flaum:And so really it is a kind of training in trauma informed care, kind of fundamental kind of concepts. And then the most exciting part of the certificate for me is in the last course there's a capstone experience, what I call a project of impact, and so every student creates this project that really just connects back to whatever they're passionate about, be it research or clinical work or education, training, consultation, and it really just moves the work forward in some significant way. They've done presentations, international presentations, and write articles and do trainings at their organizations, do social media campaigns, and so it's been just amazing to see the work and to see people so passionate about medical trauma in so many other disciplines and to move this work forward, has been it just it's just incredible to see.
Marisa Cargill:Yeah, just because I know like the question occurred in my mind and so if it's occurring for someone listening. The practical part of this program is it virtual? What's the length of the nine credits? Tell us more about that too, just in case people are interested in like a certificate.
Michelle Flaum:Yeah, so it is. It's over the course of well, it's over the course of two semesters. It begins every May. It is fully online because we have international students and it's asynchronous because we have international students and it's asynchronous it needs to be because of the international students. So, yeah, so fully online, nine credit hours, and so students take the first two courses over the summer. So from May to August they take two courses back to back and they take their final course over the fall semester and they end in December, over the fall semester and they end in December. So it's a May to December program. And then that leads to the certificate from Xavier University and medical trauma informed care, and so, yeah, so we've. This is going to be our fourth, yes, our fourth cohort, which is really exciting. That's incredible.
Michelle Flaum:Yeah.
Marisa Cargill:I love that. It's a labor of love and that it's like actually expanding beyond counseling, like you said, like there are other people taking it, because it's important that they kind of have a seat at the table so that we can understand their perspective, but that they understand, like from you know, how we can advocate for clients as counselors too.
Michelle Flaum:Yes, yes, it really is. And and something exciting that's come out of of this certificate is I have now three graduates of the certificate, all social workers who decided to go on. They were master's level social workers who decided to go on. They were master's level social workers who decided to go on to doctoral programs. And all three are studying and focusing on medical trauma and doing dissertations in medical trauma in social work. So that's been amazing. And two of them I'm on their dissertation committee. Yeah, so it's been really rewarding. And again, that interprofessional collaboration is so important yeah, definitely.
Marisa Cargill:Now you know, switching to sort of the patients and the clients that are experiencing the medical trauma. What are some of the common challenges that you see them facing?
Michelle Flaum:That's a great question. So you know, I would say we see, you know a lot of complex medical and mental health issues. For one, I mean that you know certainly is a challenge. One of the things I mentioned previously is medical avoidance. I would say that's a really common challenge that I see with medical trauma and something that certainly I have kind of on my radar when I first began working with anyone who's experienced trauma. We have to be really careful with that because oftentimes people who first begin in therapy, they're often not ready to reenter the medical setting and that takes time. But at the same time we're very aware that you know, to be disconnected from all healthcare has, you know, some really significant implications, you know, in terms of overall health and well-being, and so that's certainly a challenge, you know. I would say you know. Another challenge that you know that I see with us is, or you know with our clients is certainly a need for advocacy. Often, working with medical trauma and working with clients, we do quite a bit of advocacy as counselors, advocacy in terms of speaking on behalf of our clients, or I would say more empowerment, speaking with our clients, helping our clients build the skills to be able to advocate for ourselves in terms of creating new protocols within the healthcare space.
Michelle Flaum:So, just to give a really quick clinical example, I have a client who has significant medical trauma and she recently turned 50 and had to schedule her first colonoscopy. And so the protocols at this digestive center were that her husband could only kind of go back with her to kind of one part of the facility but could not go back to another part of the facility. And so I, you know, and my client, was very nervous about the whole kind of procedure and she wanted to meet the doctor ahead of time and there were some other things that she, you know, she wanted to kind of put in place. She also really struggles with IVs. She struggles, you know, with different aspects of the kind of the procedure, of um, of the kind of the procedure so, um, so I helped her with writing, you know, a letter and um with kind of changing the protocols, and so she, I mean she's just such an amazing, um, amazing kind of person, um anyway, and she's just come so far in in our work together, and she, she's done so much to advocate for herself, but she, in the process of this work, she ended up advocating for herself changing so much of the protocol for how they do things at this particular clinic that they ended up changing the protocols for everyone. That they ended up changing the protocols for everyone because of her advocacy. They kind of realized that the way they were doing things that really wasn't great for everybody and so by kind of her challenging them to look at how they were kind of going about just their procedures, that you know how they were kind of going about you know just their procedures.
Michelle Flaum:You know that I mean that really benefited all at healthcare organizations to help kind of better meet the needs of people with medical trauma. But then also helping kind of clients with brainstorming to how to help with pain management, how to help with the vulnerability, know, with the vulnerability in being in the healthcare setting. I've written several meditation scripts and recorded some meditations for clients that you know that they use to, you know, to kind of help them kind of move through the healthcare experience. And so you know, there we we have a lot of challenges in working with medical trauma, but but I would say that you know the challenges that the clients face really are kind of engaging in the healthcare system, because this is something that as, as people we're, we're always facing, as people we're, we're always facing, I mean we're always going to be going to the doctor. We're always going to be you know kind of facing illness and injury and and needing you know this, you know wellness checks and and preventative care.
Marisa Cargill:Yeah, yeah, and, and I think it's so powerful that, like in letter writing and having the conversations within session, we are empowering clients to be, able to self-advocate as well, but like it sometimes does start with us modeling. What does that look like? How do we say and stand up for what is maybe necessary if it's a protocol change or things like that, that we can also sort of help lead the way in a lot of those capacities?
Michelle Flaum:Yes.
Marisa Cargill:Yeah, I'm thinking of like so many different examples. Like I have a client who recently, you know, told a new doctor hey, I don't like when people say this and actually, you know, I think the physician understood but also said something like later in the appointment where they were like you know what, I'm going to find someone else. I just didn't like that they said that yes, and that they have, like you know, choice and I was, like you know, happy that she felt empowered to do that, because in the past maybe she would have just been like this is what physicians do. They just say it's weight yes.
Michelle Flaum:Yes, yes, and that's such a great example that I mean that that's such a perfect example, I think you know. And what I think is really cool about our work and you know, with medical trauma, is seeing those kind of changes over time that clients, you know, when they become more empowered and they learn that they do have choices and they can, you know, they can decide. You know what? I don't necessarily like the way that the communication is going with this particular provider, and I consider it a win when I'm working with a client and they come back to me and say you know what I felt really invalidated, I didn't like the way that this particular, you know, physician talked to me and so I've decided I'm going to look for a different provider and and so you know, that kind of really speaks to that sense of empowerment which I think is is fantastic sense of empowerment, which I think is fantastic.
Marisa Cargill:What advice would you give to counseling professionals at any stop in the journey, because this is maybe a concept that they haven't familiarized themselves with. What would you share with them to help them better identify or support clients who are, or have experienced medical trauma?
Michelle Flaum:who are or have experienced medical trauma. I would say I mean, first, you know, educate yourself more about medical trauma. I mean conceptually. I think you know there are a lot of articles out there at this point, which is fantastic. There are several trainings out there now, which is really great too, you know, certainly. You know you don't have to do like a full certificate, you know, unless it's something you're passionate about. But I mean there's certainly some really good trainings, you know, out there.
Michelle Flaum:At this point, I mean even you know Pessy has some great trainings, my co author of this second book that I'm working on now, sasha McBain. She does some fantastic trainings through PESI, live trainings, which I think are great. So I would say, definitely familiarize yourself, get some training there in terms of training there, in terms of, you know, conceptually, and I would say too, even you know, in a very kind of you know simple way to get started and I mentioned this earlier paying attention to your client's medical history. You know, paying attention to the in a really simple way. You know, paying attention to the in a much as this is part of my client's history and this could really be a source for, you know, distress. This could be, you know, one of the, the kind of the first dominoes you know to fall in in my client's life and could be really significant, definitely.
Marisa Cargill:I am curious if there are any assessments or protocols like you would suggest, like in tandem with kind of getting more familiar.
Michelle Flaum:Absolutely so. One I would say is that I think is really helpful is called the Brief Experiential Avoidance Questionnaire. That can be helpful when you're suspecting maybe that there's some medical avoidance going on and so you can have some conversation with your clients around kind of medical care. So that would be one that you could use with your clients. Certainly some some you know PTSD assessments, you know and you know whatever assessments that you're using to look at some of the potential clinical kind of you know implications of medical trauma. You know the PCL-5 or you know the CAPS-5.
Michelle Flaum:Some others that you know and I've shared and will share some of the assessment tools that I created with Stanford and then rolled out internationally, like the Experience of Medical Trauma Scale, which I first developed for the hospital setting, which really looks at all of the different factors in the hospital setting that could contribute to distress in clients. One of the ways that I use this tool within our practice as counselors is when I ask these really simple follow-up questions about clients' medical history. So let's say clients did have a surgery or they had a hospital stay and you ask that really simple follow-up question how was that for you, or was anything distressing about that experience and if your clients say like, yeah, I mean it was really difficult or it was a scary experience, then you could use that experience of medical trauma scale, even sitting down with your client and looking at a lot of the factors environmental factors, communication factors, relational factors with their providers, and as you're looking at those kind of different factors, some of those might really connect or resonate with your clients. They may look at that scale and say you know what, now that I'm thinking about it, it was really distressful for me that I was pretty much kind of tied to my bed for three days. I couldn't leave my bed and I felt really trapped and that really triggered something within me, I mean.
Michelle Flaum:So, so you know there are certain aspects of the hospital environment or you know things like that that you know having a, a, a screening tool like that in front of you can can help to really kind of elicit some of that conversation. Yeah, and so I, you know, certainly can can provide that resource and yeah, so because there's several assessment tools that are, you know that that I at a lot of secondary crises that clients can experience as a result of medical trauma, really looking at kind of the wellness dimensions and kind of where clients may struggle after medical trauma. So maybe struggling in their relationships, struggling occupationally struggling, you know, psychologically, physically, maybe even in with respect to even leisure their ability to engage in activities that they once really loved they can't do anymore. Yeah, the whole person you know.
Marisa Cargill:Looking at the whole person. Yeah, to anymore. Yeah, yeah, the whole person, you know. Looking at the whole person. Yeah, um, you know, when we were doing our show prep, we also learned that live the pain is an organization, an international organization, um, that you're a part of, and it's professionals who are working to create um and develop solutions for pain management. Can you tell us more about your role within the group and how counseling professionals might benefit from their work? Sure sure.
Michelle Flaum:So, uh, yeah, so I originally connected with, uh, the founder of the organization, aura Kalfa, uh, many years ago. So she, she read my book and so live the pain really came out of a lot of conversations that we had early on, a lot of brainstorming. So Ora is in Jerusalem now, in Tel Aviv. So exciting about Live the Pain is she took a lot of my book, which is mostly conceptual, and she created an organization out of a lot of these concepts. I mean, she made it happen in Israel and so this is an organization that focuses on chronic pain and living with chronic pain. So she's created therapy groups. So therapists across Israel have therapy groups with clients. But they also do education, research, and they raise so much funding for research, train other therapists, and so, between research and development and education and training and psychoeducation for clients and families, it's a pretty phenomenal organization.
Michelle Flaum:So I'm, I'm on their board of directors, I'm a consultant for them now and um, and so they do have a couple of um clinicians in New York and so really it, the organization in Israel, is really a model and they want to kind of bring that to the states. But it's, you know, it's a, it's a process and, of course, um, I was supposed to travel there, um, right before, of course, the you know the. The. The war broke out and and began in Israel, so that's on hold right now, um, but you know, hopefully at some point we'll be able to continue that work.
Marisa Cargill:Yeah, it sounds like it's an amazing work and, like the surgery that I mentioned earlier, I was having chronic pain issues, so like I have lived that experience and can certainly recognize you know, even as an individual, how beneficial those kinds of um supports are. Yes, yes, so valuable, incredibly Um, because while my physical health was not great at enduring chronic pain, my mental health was not great either, as, as part of that, where it is like holy cow, like what is happening and, as you mentioned, like with kind of these other areas of life that get affected, right that just the ripple effects of the physical pain were incredible.
Marisa Cargill:Um yeah, so I, I resonate with everything and then the work that they do, know how meaningful it can be. So you know, whether with the organization or really just in this focus area of medical trauma, what are some developments or directions you see like for the future of this work?
Michelle Flaum:this work. Yeah, I see, in terms of developments, I certainly see More in expanded roles for counselors. I would, I would I guess I should say I would I would love to see more expanded roles for counselors in, in, in more kind of diverse types of healthcare settings. Types of healthcare settings. Certainly, I see us kind of moving into kind of specialty care, things like oncology centers, cancer support, which I love to see. You know, heart hospitals and you know cardiovascular centers, which I love to see, you know we are certainly present in. You know hospice and palliative care. I, you know I see us moving into the women's health space and you know, primary care space. I, you know, I would, I would love to see counselors moving into the hospital space and expanding our roles there. I think there's so much opportunity there, certainly, and so I think that's a really important development for us.
Michelle Flaum:I think too, you know, in Ohio especially and I hear this, I've heard this so much and I continue to hear it this idea of of, from a health care perspective, ohio being kind of quote unquote a social work state, meaning, you know, within the hospital setting and mental health, social workers and psychologists, kind of they are in the hospital, you know and we are, we're behind in terms of and obviously you know we've talked about this with the fight with you know Medicare and reimbursement and all of that. There's so many opportunities for us and so we, I think we need to continue to advocate for counselors. We are so uniquely qualified and educated and suited for this work and and so that the the opportunities are, opportunities are endless. We have, you know, okay, so I'm biased towards counselors. I'll just, if that isn't obvious, already it's a counseling podcast.
Michelle Flaum:You're allowed to be, I'm allowed to be.
Michelle Flaum:This is a safe space, right to be biased, but we are just so uniquely suited to this work, you know, I mean for this holistic work and, and I would, I would, you know, I would just love to see more counselors in this space working in the hospitals, you know, working in interprofessional teams, not only for patients, but also to support staff. Not only for patients, but also to support staff. I mean vicarious trauma, secondary trauma, compassion, fatigue. This is huge, and this affects the quality of care for patients as well, because our staff, our physicians and nurses, are struggling and they could use our help too, and so this is a systems issue. I could go on and on about this, and, and we are so uniquely suited for this work, and um, and so I, you know, I see, I see so many opportunities here.
Marisa Cargill:Yeah, yeah, and I appreciate you saying that too, because I have, you know, a fair share of healthcare providers different um, you know a fair share of healthcare providers different um roles that they've worked with, and you know it often comes up. You know the stress of work, but, like if we unpack, that it's not always just the stress of work, it's the trauma of the things that they they witness and experience on a day in, day out basis Absolutely, absolutely. Day in, day out basis, absolutely, absolutely. You have another book coming out you mentioned coming out next year.
Michelle Flaum:What can we expect from this resource? Yeah, so I'm really excited about this. This is a book that's written specifically for clinicians and clients. So, while the first book was really just to establish medical trauma in the space, and it's more, you know, the first book is more academic and systems kind of focused. This book is specifically a treatment book, and so this is for clinicians and patients. So this is treating medical trauma and it's um, it's, it's a resource and a workbook. So many activities, um, so there will also be digital downloads. So the um, the I'm a lot of my training is in mindfulness-based interventions. So those, um, those scripts that I talked about and those mindfulness meditations. So I'm going to be recording those and those will be part of the resource. And so I'm working with my, my coauthor, Sasha McBain, who is a health psychologist. So nice interprofessional collaboration there, and so, yeah, so we'll be. We'll be wrapping up the manuscript towards the end of this year and it'll be available in the spring of 2026.
Marisa Cargill:Wonderful. We might have to have you back so that we can talk more about that, but I, you know, I find that that is such a helpful. Kind of like you know, sequel follow up. Kind of like you know, sequel follow up.
Michelle Flaum:Sure.
Marisa Cargill:Because I know a lot of people, both counselors and clients, can really like wrap their head around concepts Right, and that awareness and insight is so incredibly meaningful, but that then the practical strategies sometimes are like well, now what Right? And this book sounds like it's answering that question.
Michelle Flaum:Exactly, exactly.
Marisa Cargill:Yeah, so this is a question we ask on every every episode. The name of our podcast is Ohio Counseling Conversations, and we just like to hear from our guests what important conversations do you think counseling professionals should be having with each other and or their clients here in our state and or their clients here in our state?
Michelle Flaum:Yeah, yeah, you know, I would say in this really kind of piggybacks off of what I was kind of just saying. I mean, how can we create more opportunities for counselors in healthcare, in the healthcare space? You know? I mean, as I said, we are a social work state when it comes to hospitals. How can we? Because we're, we are, I think, if we don't, we're missing a big opportunity for our profession to serve clients in this setting.
Marisa Cargill:Yeah, yeah, and I think it's important. I, I, one of our previous guests and pretty well known, I think, now throughout the country, throughout the world. But Dr Vicki Kress, who is our upcoming president elect for ACA, you know, talked about using the word counseling and counselors and making sure that we're creating language so that we can continue advocating in even like that smallest way like language is so important and and recognizing the role that counselors play. And so, even when I'm speaking to clients, I try to avoid therapy as a word which is tough.
Marisa Cargill:Yes, but I think it is meaningful to establish like counselors roles, right? Yes, yes.
Marisa Cargill:May seem small but like that ripple effect too, of making sure like our profession is known and distinguished from maybe other professions, is so incredibly important. And I believe your point is well taken because I have the counseling bias as well but we are holistic and that that means so much in that space where you know, I know that maybe this was also part of your counselor ed training when you were in your master's program. But like the medical model was like ew, avoid, avoid, but also recognizing that like we are shifting back that in collaborative treatment we can become part of the medical model.
Marisa Cargill:Yes, that we can shift the medical model by like using our voices.
Michelle Flaum:Yes, yes, absolutely. And that's why you know, with, like with the certificate that I designed, I mean it's really you know, helping to educate us. I mean you're exactly right, like, oh, medical model. But then it's like, okay, so how can we learn the language to be able to collaborate in that space and to work interprofessionally?
Michelle Flaum:Speak the language, but bring our unique identity, our stamp on it, like we are uniquely counselors, we are holistic, we are, we are bringing our um, our identity, and our lens, our lens, which is so valuable, um, but we need to be able to operate within the space. So we need to know the language, we need to know how to speak it and we need to know how to operate within the space. So we need to know the language, we need to know how to speak it and we need to know how to operate within this space. So, you know, we learn this team-based model to do that, so that we can operate within this space, but using our unique talents and our skill set, which is so valuable and it's needed. We just need to get in there.
Marisa Cargill:Yes, this is incredible, so informative. I've been a counselor for a little over a decade and I feel like I'm like, oh, I'm going to take this way, I'm going to take this way. And even though a lot of it makes sense, it's like, oh, am I doing that? Or am I doing that to the best of my ability? Can I assess more with my clients to say, you know like, hey, I know you have children. What was your, you know like, childbirth experience, like, or things of that nature that maybe don't get talked about, and leaning more into some of those things to just make sure we understand the whole person even further.
Michelle Flaum:So I know I'll be taking away.
Marisa Cargill:I am certain that our listeners will be taking so much away from this conversation, michelle. Thank you so much. Is there anything else you want to plug or add before we wrap for today?
Michelle Flaum:You know I can't think of anything. I just I'm so thankful for the opportunity just to connect with counselors. It's been wonderful.
Marisa Cargill:Yes, and we will be linking a bunch of these resources in the show notes for you listener, michelle. This is incredible. Again, I can't emphasize how great and informative, educational this conversation has been, and I'm excited for people to listen because this is valuable information for them to take back too.
Michelle Flaum:Yeah, well, thank you. Thank you so much.
Marisa Cargill:Yeah, no problem and thank you, listener. We will see you next time on Ohio Counting Conversations.