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115. Are Therapists Causing Harm When it Comes to Sexuality? with Raquel Savage

Nicole: For the listener who has never met you, never heard of you, how would you introduce yourself?

Raquel: I would introduce myself as Raquel Savage. I use she and her pronouns, and I'm a therapist, educator, and sex worker. That's the short version of my introduction. Mm-hmm. Mm-hmm.

Nicole: I think there's a lot to talk about there.

Raquel: There is a lot to unpack.

Nicole: Yeah. Yeah. I'm curious, where are your passions at now? What is that thing that you're sharing with the world really like feeling in your heart right now?

Raquel: Definitely ecc, the Equitable Care Certification, um, which is a certification that my colleague Angie Gunn and I have been working on for a couple of years, and it's essentially a 24 hour, which is 12 courses, certification program for clinicians to learn how to work with sex workers as therapy clients.

I think that that's probably my. Passion project right now. Mm-hmm.

Nicole: And so I'll ask the question, well, why is this needed? Why do you think we need this?

Raquel: Yeah. I mean, so I think as both a sex worker and a therapist, I'm uniquely positioned to see the intersection of those two identities or those two experiences.

And as a client of therapy for my entire life, I recognize how many flaws and limitations and barriers there are to competent care generally. And then specifically as a sex worker when I was in my graduate program, of course we have like a multicultural class where we try to cover like all of the marginalized identities in one fucking course, which is ridiculous, right?

Whatever In that course, Which would be the only course that we would talk about sex workers in. We didn't talk about sex workers. And the only time that we ever mentioned sex workers in my graduate program was when we talked about, uh, victims of trafficking. Mm. And specifically the rhetoric around that one conversation.

And it was one conversation in one course one time. The rhetoric around that conversation was that sex workers bad foreign leads to trafficking, and all sex workers are trafficking victims. And it was a horrific conversation that was hard to sit through as a sex worker. Throughout my experience in grad school and sitting with my peers, I realized no one was gonna be graduating with the skills or knowledge or empathy to work with.

Sex workers and then more broadly with women or with people who are, have autonomy around their sexuality or have any understanding of capitalism and how labor shows up in our lives, and like just systems of oppression generally. Just like no one is gonna fucking know what to do with this. And so, yeah, I think that that personally prompted me to have an interest and, and that's what made me start a, after I graduated, I said, I'm not gonna work anywhere until I can work in my own place.

And then I started Zep Wellness, which is my own nonprofit, and we serve specifically sex worker communities. And it wasn't until later, until I met Angie and we started doing E C C, but I think just personally, that was my own experience. That was like, wow, I'm recognizing just the limitations in how clinicians are educated.

I am lucky enough to say that I have never had a personal. Bad experience with a therapist as a sex worker, because the therapist that I have who I've had for like six years is incredible and I love her and she's amazing. And I don't even think that she knows anything about sex work, but she's just not judgmental and she's more on a, like, relational aspect.

She just wants to be in the moment here with me rather than me. Like, wait, what is that? And it's an umbrella term. What? It doesn't get into that. So I'm really lucky to have not had bad experiences. However, I know that that's not the norm. Most people who do any kind of of sex work who go to therapy have shitty experiences where therapists at minimum show their bias through body language.

But typically, more often it's more explicit in that there's an assumption of trauma, there's an assumption of childhood trauma, there's an assumption of exploitation. There's an assumption that people want to, or need to get out or leave this industry. So yeah, that was pretty like lengthy. But, um, there are, there are a lot of reasons why sex workers specifically need.

Competent and unique care and how that knowledge can benefit all clients, including people who are not sex workers. Yes,

Nicole: it is lengthy and I love it. That's what I wanted. Right, because I think that's exactly what needs to be said in this space is that I would say there is harm being done from the lack of education around this.

Raquel: Absolutely. 100%. And, and again, to sex workers and to folks who are not sex workers as well. Because really the bigger issue is that clinicians, we don't learn about systems of oppression at all. Like we just, it's actually really ridiculous to think about what we do learn about. Yes. And what is actually useful in client, like in interactions with other humans and how we don't, like, we don't learn about trauma either.

It's like ridiculous to think about the, the barriers to, um, in mental health. So, Yeah.

Nicole: Yeah, I talk about that a lot cuz I'm still in school for my doctorate right now. And so I'm always talking about how the fact that trauma is not a required course. I know. Right, right,

Raquel: right. It's, it's really ridiculous.

And I think I'm lucky to be who I am, I guess. And, and I don't know to have my own like interests and my own agency because when it was time for me to do my practicum and internship, I was trying to decide where I wanted to do it. And I initially was gonna do it at like an L G B T center. And ultimately I took a class with my now supervisor, who's been my supervisor for many years, um, was also previously my professor, and I forget what the course was, but in one of the courses she mentioned trauma.

And we just like talked briefly about like the physiology, the neurology, the, the chemistry of trauma and how it impacts us. And I remember just being so. Fascinated and, and it was like a light bulb went off and I was like, why is this not more of our conversation? Cuz it sounds like something that almost everyone experiences.

So if we're a therapist, we should know this. And so I asked her for more information and I, and I ended up doing my practicum and internship at a trauma resolution center. Yeah. Um, where I learned techniques that were specific to processing trauma that were not talk therapy. And then that, that opened up a whole other thing about limitations around mental health, which is the therapists don't know about trauma and they're using fucking C B T, so nobody's getting better.

And it's horrific more broadly than just sex workers being my like part and my niche and my community and my people. I'm also really, all of my work is really grounded in trauma. Mm-hmm. And understanding trauma and using approaches that actually work to process trauma. Um, and not just asking people. To talk about their trauma and then tell them that they're having cognitive distortions because of the way that they think or you know, whatever else.

Nicole: Right, right. And then the collective trauma that we've all experienced. Right. Working under the systems of oppression. That's like a whole conversation that is not talked about in psychology enough, I would say, because the reality is that plays into a lot of these things at times. I'm frequently shocked that we're not all depressed given, you know, the world that we see the laws and the things going on.

I mean, I. That seems like a reasonable response to the social conditions that we are experiencing. Right. And I don't think that conversation of that nuanced nature of what's going on on a systems level is talked about enough. And especially when you bring that into something like sexuality. Right? Right.

That is a whole thing that we've experienced. So there's no classes on sex. And just like you said, like if everyone's experienced trauma, maybe we should have a class on it. If everyone has some sort of relationship to sexuality, even if you're asexual, you have in a relationship to sexuality in some form.

No class, no discussion, and yet that comes up in the therapy room. And how are clinicians trained for that?

Raquel: Yeah, and I, I think in my graduate program, we did have a human sexuality class, but it was really centered around like, I. It was really just hella vanilla, which like only, you would only like know that if you are not vanilla, if that makes sense.

Right? Like I think for the people who are just, I don't know. I don't know. But it was just very much, it was very, very centered around treating couples around intimacy. Not even so much sex and sexuality or the exploration of unpacking things around having a sex negative experience or trauma around sex.

I mean, those are the things that I think are most important. Right. Um, we don't get to the important bits that show up most frequently with clients, and this is why, which brings us to so much harm is being done because clinicians are ill-prepared to deal with these conversations once they're happening.

And I think particularly around sex. At least from what I understand. And the clients who come to see me, who know that I'm a sex worker and, and my clients are not always sex workers. They're either sex workers or people who know that I'm a sex worker and they're like, this is why I wanna see you. Cause I know I can come in and talk about sex and not feel embarrassed.

Right. Um, when they come to me, particularly those who are not sex workers, what I often hear is that they have other therapists and they're not talking about these things with them because they don't know how to broach the subject because they don't feel comfortable. And it's, um, and it's, and it's wild because I think that it is necessary or, or a good, I don't know, reflection of your competency, that you can at least engage in low level.

Vulnerable, exploring, curious, open kind of conversations around sex and sexuality, even if that's not your strong suit. Sure. And that does not seem to be the case at all.

Nicole: Yes. Yeah. Yes. Yes. Just a basic openness to it. You don't have to be an expert and if it falls outside of your, your scope, if it is too triggering based on your own things, right, that's when you refer out.

But like just basically having that ability to hold that conversation for someone, I would say is a crucial part of what we should be trained in. Yeah. And I, it's great that you had that human sexuality course, but I didn't. Right. And that's not a requirement. So I'm curious like at that point then what we're doing is we're allowing clinicians to work from their own frame of reference, which is problematic because like you said earlier, that can be vanilla.

Frequently, a lot of people don't fall into that category, but if that's the frame of your therapist lens, then anything outside of that can become pathology real fast, real quick.

Raquel: And not only is it that we're not teaching clinicians about like systems of oppression more broadly, and so it means that they're leaning on their own perspective and framework.

The other piece is that we're also teaching clinicians to be objective. Mm. And I have such a fucking problem with that as a practice in terms throw out.

Nicole: Let's hear it.

Raquel: I was gonna say a lot of my, a lot of my beliefs I think generally are like pretty provocative and also they're right. Mostly I love it so much.

But, um, I think the, a lot of the things that we learned in our graduate program, as we know are like based around cis white male. Fucking from the 19, whatever the fuck, right? It's like not any kind of modern or inclusive knowledge. And that includes perspectives on a variety of things, including like suicidality.

We could talk about that as a whole other fucking conversation, but also this idea of objectivity. And I remember many times throughout my graduate program being told, leave your bias at the door. Leave your this at the door. Don't bring your bias into the thing. And it's like, that is such a white supremacist practice to be able to say, leave your A, B, C at the door.

Because the reality is, is that your, your capacity to leave something at the door is revolves around your proximity to privilege. Like your ability to just kind of separate. So on the flip side of that, like as a black queer, autistic sex working therapist, I can't leave those identities at the door. And, and so that's the first part is.

The whole idea of being objective is based in white supremacist ideology because it is framed around privilege and the capacity to like separate yourself from your identities. The second piece of that is the assumption that how your identities show up in therapeutic spaces are inherently bad. And I think the opposite of that.

And I think that what we miss there then is this piece about learning how to be discerning. Mm-hmm. So for me, for instance, all of my identities, my, my proximity to blackness, my, my womanhood, my sex worker identity, my autism, my whatever the fuck, my politic more broadly, very much so informs how I work with my clients because it means that if they say something, I might say, so for instance, if I have a client who, um, has a family member who uses drug and drugs, and they come in and they're like, well, my, my brother is a junkie and you know, they're an addict and da, da da da, da.

And they start talking about AA and they, they never do it successfully and they always relapse. I might say, depending on the, where we are in the therapy and like if it feels appropriate, right? This is a piece of discernment, that's a skill to recognize when it's the right time to say a thing. I might say, I'd love to invite you to learn, uh, learn about harm reduction.

I'd love to talk to you about how 12 step programs are almost never successful and they're very faith-based and they don't work for a lot of people. I'd love to talk to you about language and how people who use drugs perhaps is a more, um, empathetic term than addict or junkie. And I'd love to invite you to think about how the criminalization of drugs makes us, you know, it's like all of this, and that's Yes.

How my identities show up in a therapeutic space in a, in a useful and competent way. And again, to go back to the other piece is it's, it's about discernment. It's not about leaving everything at the door and pretending I have no other identities or ideologies. It's about figuring out how I can use those in ways that are gonna be beneficial for my client.

And I think the other piece of that comes in with disclosure too, is in the, in our graduate program, we always learn do they shouldn't know anything about you. It's blank slate and blah, blah, blah. And uh, that to me, again, going back to the like white supremacist CI had mail, all of that bullshit, it creates this barrier between you and your client that you are not a human or like that you, so it prohibits this like ability to have shared experiences which deepen intimacy.

Um, which I think are so, and that's the relational aspect of therapy, which I think is so important in building rapport. And again, though, the piece is not. Gossip to your client or tell them everything about your life. The point is use disclosure in ways that amplify and strengthen the therapeutic relationship.

So I think even when I talk about me being a sex worker and a therapist, people who are like super vanilla, not sex workers, don't understand. They think I'm going into session and being like, I saw Dick for $500 this weekend and I was doing this and I was shaking my ass. And, and thinking that I'm like taking up space in session in that way when really it's like a sex worker client comes to session and they're like, I had a bombass week at the club.

I made blah, blah, blah amount of money. And I'm like, I love that for you. I know how it feels to make your bag. Like I, I I see you. And they're like, yeah, right. So like that's how it actually looks in real time. So that disclosure piece, I think go, goes back to this objectivity thing, which is just to me generally a bullshit kind of white supremacist perspective.

Nicole: Yes, a hundred percent. A hundred percent. Because one existentially, we're never gonna be able to leave that bias at the door. Right? That is just a reality of the world that we're living in, and the fact that I am restricted to my lens of what I see the world, and that is for each person regardless. Okay?

There is never this completely unbiased perspective. I don't think liberation psychology would even ascribe to that idea because that's just like, Not possible. And on top of that, like you said, it, it's the framework then of like these normal white, cis, he identities. So yeah, I can leave it at the door because that's what everyone has, right?

Everyone's in that framework. It's like that's not the framework that I'm living in. And so I do see the world through a different lens that is gonna be inevitable. And I love that nuance that you said of it's not so much that you are taking up space with your identities there, but you are able to hold them in a way that you're able to be in relationship with the other person.

That they can be seen because that client that you have could come to someone else who is so uncomfortable about sex that they would never bring that up in the room. Yeah. And then what does that create? That creates shame around it? Because I don't feel like I can bring this part to myself, to my therapist, so I'm gonna be in shame about it.

Yeah. Which is what we know creates all of the psychological distress, is feeling like I can't be accepted for this part of myself.

Raquel: Yes. Quite literally. I would say the root of. Much of our trauma is the deep, like, somatic, visceral, whatever word we wanna use. Felt sense of not feeling seen. Yes. It's really not like the traumas that we experience it is the aftermath of that which is not being seen, not being witnessed.

Not being held, not being, and I don't even mean held physically Sometimes. Physically, yes. But also mean like, I don't know if you've ever seen the movie Midsummer. That's one of my favorite movies. When they have that moment. Yeah. There's a scene where they're like crying, but there's another scene where, and I forget his name now that I'm talking about it, but he says to Danny like, do you feel held by him?

Mm-hmm. And it's not held in the sense of like, does he hug you? It's held as in does your, your identity, does your, your, your soul. Does your, do you feel seen by him? And that is in a greater sense in that movie is so funny and I love that movie so much. But that's the core of it is being seen is, is exactly so.

Yeah, that's, and I think that that piece is missing and we don't talk about that in graduate school either. And I think that that's mostly because we all generally have such a hard time with our feelings, uh, including therapists. Yeah. And I think be bigger, more important than all of the skills that we learn or have or whatever the fuck is in our toolbox, is like, are you secure?

I don't know if that's even the word I wanna use, but are you secure enough in your own body? And do you feel safe enough in your own body? Which means you have worked through at least, or you, you have begun to work through some of your stuff and identify your own shit. Are you secure enough, safe enough in your own body, and the icky kind of feelings that you potentially could feel to model experiencing that with your client?

Who's struggling with that and like just how that co kind of like regulation works as humans. Like that's the core of. What we're all missing, which is this being seen piece.

Nicole: Yes. That's why I've always loved relational cultural theory, because that's what it talks about, is that need to have that relationship.

But you know what's much easier, I know what's so much easier is to say, I'm gonna come into this room and we're gonna do C B T and I'm gonna have a thought log and we're gonna push on these intrusive thoughts and that's all we're gonna do for today actually. And I, I hear that that's so much easier.

Right. It is so much easier to look at the work in that frame of like, A plus B equals this. Right. But. That's not the reality of what people are needing, right? The traumas occur and you need to be able to sit with someone who does not give you that flat affect, who does not give you that tabular rasa who can be with you in a way that is grounded and secure right, where you've processed through your own stuff so that it does not be become, uh, the client care taking for you in the room, but that you're able to go there with them when they're talking about that horrible atrocity and crying and sobbing in that you don't have a blank face in that you don't look at them with that blank face.

I would say that causes even more harm because it's having a relationship where you're going somewhere and you're not being seen by the other person.

Raquel: Yep. I would say that the reason that I've been with my current therapist as long as I have is not only because we do e Em, d r, and I'm at emdr r. Stand and it has changed my life.

But, but also because she is like the most fucking regulated person I've ever met in my life. I don't know what the fuck I need to ask her. I've been talking about this with other people more recently. Yeah. Um, just as I continue to try to do to model that in my therapy sessions. Totally. But like, I don't know if she just like, hasn't had a hard life, so it's like not hard to be in her body or, or what, but she literally is like, I could be saying the most horrific and have said the most horrific shit.

And like you said, she's not giving me blank. What she mostly is doing is breathing. Mm. Like she's doing that and she's just, and just taking a breath and which makes me take a breath, right? Mm-hmm. Which is the whole fucking point. And so just like co-regulating with her while I'm having a fucking meltdown is just like, Incredible.

And, and she's also, and I think that this came up like throughout school too, when I have gone to really dark places, she has emoted with me. Like she, and, and she's cried sometimes, but not in ways where it's like, she's like, oh, and it's like, you know, whatever. She's deeply feeling what I'm feeling, which is what allows me to feel it with her.

Yes. Cause just like you said, she's going there with me. And so it's not just me like having an experience and her being like, wow, how does that feel? Right? She's like, I feel it already. I'm crying with you. How, oh my God, that's painful. And like it's, and it's quite literally. But that her capacity to do that is informed by that.

She probably has worked through her shit because otherwise she wouldn't be able to be there with me. She'd be her own. Like, and again, I'm, these are things that I'm still practicing too. Like when people come to me about specific things and they. Trigger activate me in certain ways. That means I'm no longer able to hold space for that person.

Mm-hmm. Cause I'm, I'm thinking about, well, when I was 10 and my dad said this, and when my da da da and my own sexual assault experience, you know, whatever that takes you out of the, I'm here with you. So, yeah. It's, it's, it's so, it's so much. And I think that there is something about graduate school that doesn't require therapists to get therapy enough.

I know. Isn't it? While I talking about this, I'm like, every therapist in graduate school should be doing EMDR or somatic experiencing or something like that because you can't be with And therapists. Yeah. It's easier to do like CBT because that means a therapist doesn't have to go there. Yes.

Nicole: Yes, and I mean we know C B T is helpful in certain stages of where people are at.

Everyone's at different, you know, parts of the journey and like when you're severely dysregulated, C B T is super helpful to like come back to the reality and come back to the present. But that's not the whole healing continuum. And I think that the healing continuum happens in these relational dynamics.

And I know that. What you're talking about with your therapist has been what has been therapeutic for me. I remember talking about my sexual assault and my therapist being brought to tears as I was sobbing, again, in a controlled way. But what it made me feel was seen right in that moment in my pain that someone else understood and was looking at me and validated the deep pain that was there.

And so I always carried that before I went into the school of knowing that that's how I wanted to show up in the room with my clients controlled, able to go there with them and help them regulate in that. And so when I've talked about my work of doing that sort of, um, connection with my clients, some of my other colleagues in class have been worried to go there because of the potential professionalism.

I don't wanna cry. I know exactly, but I think that's why this is an important conversation to have because they'd be like, oh, well I don't know if that's professional. I don't wanna like have that moment in the room and like, yeah. What would you say to that? I'm curious, what would you say to that person who worries about it being unprofessional?

Raquel: To me even it, it's hard for me to even embody that concept long enough to like respond Yeah. If, to have a rebuttal or have a response. Um, because I'm just so not interested in being professional, like in, in any way. But I think mostly beyond needing to unpack your, your white supremacy, which is what the idea of professionalism stems from, separate from that.

I really think it does go back to everything we've been talking about, which is us practicing our own capacity to feel our feelings. Because when you say, oh, I don't want to go there, I don't wanna be unprofessional. Again, separate from the like, respectability politics, shit, it's, it sounds like fear. It sounds like if I go there, then I might, I might fucking spiral or I'm scared to go there.

And so I think it, yeah, it is, it is a, it is a moment to. Practice doing what we ask our clients to do, which is feel their feelings. And this is why I love doing E M D R with people because I did like four, I've been doing EMDR R for many years, but I did like three or four years before I started doing it with clients.

Um, so I know what it's fucking like and I know that it's horrific and, uh, but deeply rewarding obviously. But, and it is just interesting to think about and I don't think I've ever really thought about it this in depth until this moment, but it is interesting to think about all of the many clinicians in the world and throughout history, whatever, who are, are supposed to be creating space for people to be deeply vulnerable but have never gone there themselves.

Yeah. And that just fundamentally, the math doesn't math

Nicole: totally. Immediately in my head I was thinking about the psychedelic assisted, the therapy, and there's been conversations of whether it's ethical to be a clinician in that space that has never done it. Right. Can you really walk someone through a psychedelic experience if you've never done it yourself?

Raquel: No. And no. How could you, I mean, right. Yeah. I don't, I don't think that because coming to therapy, coming to a therapeutic space with a lot of shit and having never felt seen is horrifying. It's scary and it's, it's a total practice to be able to even let yourself go there minimally with a therapist. So to have deeper processing experiences like somatic work or like any drugs, requires just like so much.

Safety that, yeah. If a, if a clinician just has like not done anything like that, I don't know how they would be able to empathize or co-regulate. Yeah. Like, I don't know, I think, I think about even me as a, as a client of therapy with my therapist who I love, like mm-hmm. And how I ask my clients like to acknowledge what's going on in their body as it's happening and how much of a struggle that's been for me throughout my like therapy, my adult therapy journey, and that it looks so different from what we are taught therapy spaces look like, because at least from my experience, we're taught that therapy is like talking and it's like, I feel this and what's going on and what do you think about this?

When in reality it's like, when I'm mid processing, I might need to get up and scream and I mean like, Scream. Mm-hmm. Not like a bullshit. Mm-hmm. I'm mad. I mean like, yeah. Blood curling scream. I might need to rip paper up. I might need to just do some weird shit with my fucking body. Doing that is like deeply impactful for the healing process because you're doing what your body needs in the moment that it didn't get to do.

You're listening to your body as, as things are happening, so you're allowing the process to process and not doing those things does the opposite. It means you're doing more of ignoring your body, but it's scary and it's like embarrassing. And so it's only if you have a therapist who's, who's encouraging you to do that or, or who models it for you.

Yeah. So it's just, it's just, or effective therapy in my opinion, doesn't look anything like what we're taught in school.

Nicole: Yes, because it all comes back to this idea that it's all up here in the brain, which I would say is like a white colonial, patriarchal idea that has disconnected us from the body so much.

So that says it's, it's all up here. It's all up here. But the reality is what do animals do when they go through a trauma? They shake. Yeah, they shake. And we have just completely forgot the reality that we are still embodied souls, right? It is not all cognitive. There is a whole half of this experience.

Maybe more than half, who knows? But at least a whole half. I would say that is body. And this is why I scream on this podcast about the fact that I haven't had any somatic training. That is not a requirement in my training, that is not talked about at all, at all.

Raquel: It's pretty horrific. Uh, it's pretty horrific, honestly.

Or even just like crying, allowing yourself to really ugly cry like, bitch, I have really ugly cried with my therapist. Like, for real, like mm-hmm. Mm-hmm. Have you ever been crying and it becomes like a out of body experience where you like see yourself and you're like, happy people. Like, bitch, you look ridiculous.

But then you're also just like, but I need to just like do something. I need to go there. But you're also like, if there was cameras in here, I would be so embarrassed, like embarrassing, but you just have to fucking do it. And it's like, and you, yeah. You have to be a, you also have to be a therapist who can sit across from that and like be with that.

Um. Mm-hmm. And most, yeah. Most therapists are regular people who have not felt their feelings and have not done that. Mm-hmm. And I think like the most healing. Things that I have done in therapeutic spaces or like adjacent to that are really ugly crying. Like for real, like attempting to be as, how do I even wanna say this?

Like not surveilling myself, like not surveilling myself, if that's even a word in a way that I, that my body can just do what it needs to do and not be thinking, not doing what I just said, which is like this out-of-box experience where I'm like, what are you doing? So like doing that in the moment, plus going to rage rooms and breaking a shitload of stuff and crying while I do it.

And on the way the way home like that has been the most hundred percent healing part of my like therapeutic. Journey.

Nicole: Yes. Yes. Absolutely. It reminds me of like that inner child moment where I can feel that bubble up. Yeah. And it, it always throws me for a loop, you know, because at least for me, I'll be in therapy talking about something and I'll feel fine, and then all of a sudden I get that like little like tickle of like tears coming and I'm like, oof, something's here.

And like, that's when I get that moment of do I wanna continue to go in that path and like open it or do I suppress it and say, oh no, now is not the time. Right. And I think what I've noticed has been interesting as, um, someone who Yeah. Is having clients now and becoming that role for other people. It's been interesting to step into the role with my own therapist and be like, yeah, I, I, I need to go to that ugly cry space and not hold on so tightly to being composed.

This is the space where it is literally. The controlled container where I am going there and having that moment where I can quote unquote, fall apart to my inner child's like rage and tears and pain there and be held with someone.

Raquel: Uh, have, do you, have you done both in-person and telehealth? Yeah. Do you see a difference in how you experience therapy based on in-person or online?

Nicole: For my clients or for me as a client?

Raquel: Maybe both.

Nicole: Yeah. So with me as a client, I started in-person and then the pandemic, and then we haven't gone back. So I think that that is an interesting relationship because we had years before the pandemic established. Right. But I would say that I think in person creates a different experience.

It's the same time I've put it through the frame of like FaceTiming a friend, right? Like, You. You feel them. You see them. But the reality is being in person and I do think you feel energetically, like I feel energetically connected to you cuz we're keeping eye contact. We're body language, mirror neurons are probably all going on.

But there is a different sense, I would say to being in person and feeling that person, seeing the whole body, seeing the embodied space instead of this flat screen. I think it does make a difference. What do you think?

Raquel: Yeah, I think so too. I was just thinking about when I have like full body cried, ugly cried and did it feel more like rewarding online versus in person?

And I think, I definitely think in person, and this is with the same therapist, like I've done both telehealth and in person and, and that's like a whole other conversation is just about like touch and how like as therapists we're taught like don't ever touch anyone ever. Which I know is like for the most part probably a good policy but also.

The, the moments that I had those, like needing to cry, it was not only safe because I was sitting across from this person who was very regulated and could hold Yeah. That for me. Right. It was also because like, she would like lean forward and she would with me kind of physically, and when we did emdr, she would tap my, my knees or tap the top of my knees uhhuh.

And so sometimes, and so during sets, she might just rust her hands on my knees. Mm-hmm. And, and, and I feel like to therapists in grad school that would be like, oh, they would freak the fuck out at that concept. Totally. But it felt good. Like, not only did I know that someone was there with me, there's, you know how like when someone like drags their hands, like you get like tingles?

Sure. Yeah. It also was that, and she wasn't like doing that, it was just her hands resting. Right. But there was something about the sensation that made my body feel good and like tingly. And not in a fucking sexual way, just in a, like, it allowed me to relax more. And, and so, and to be more focused on and to be grounded.

Like if I'm dissociating then I have this like kind of pe, you know? Anyway, so that's my long way of saying I definitely think that there are like limitations to online and I, but I all, I do all exclusively online at this point. Um, so I know, no, it's what it is. But there is, I think, something really beneficial about being able to feel your feelings and your big, big, scary feelings across from someone who is equipped.

To see them and to be okay with us.

Nicole: Yes, yes. Absolutely. And I think, at least for me, when we're having this conversation, I like can't get around the fact of thinking about capitalism and how healing happens in relationships. And my ideal world is a world where we wouldn't need that therapy room for these things because I think what we're hitting on is the reality that.

I would like to caveat that I think the therapeutic relationship and the perspective of it when it's not someone in your relational world is quite unique. And I do think that that is beautiful. But at the same time, I think that we need to be able to do this work with our community because our community could hold us, our community can be there, our community can do that.

And so, like, as you're saying all these things, I just feel really conflicted with the reality that like, this is the system we're under and then this is how we're trying to put a healing relationship into a professional context, right? Which we need with the system we're in. But then we find these like really hard limitations of like, maybe this person truly needs a hug because we're human beings and we need touch.

Raquel: Yeah. Deeply. Uh, the, the entire point is that the, the relational aspect of therapy is the most profound part of feeling and healing. And it is not focused on enough in our learning or in our professional development unless we choose it to be a perspective that we think is important personally.

Nicole: Right, exactly.

Which is why I've talked about on this podcast the importance of like people who do have a therapist, remembering that they're a human with their own existential lens. And you know, there's be might be times where you feel judgment from them and that could be coming from their own lens. And it's important to remember that, that like these therapists ourselves, we are human beings and we do not have the sense of like knowing all the information and the right way to live.

And I think when you kind of put therapists into that category, that's when we start to have problems like this because we don't understand the humanness of all of us.

Raquel: Yeah. These kinds of of conversations are my favorite because I love to talk shit about mental health. Totally.

Nicole: Well, cause it's a system.

It's a system that needs to be critiqued. And I really appreciate that conversation because I'm not taking the shit at face value. There's tons of problems. And I feel every single day when I'm in school, you know?

Raquel: I know, I know. And I, I did a, um, a lecture with graduate and PhD students, future counselors, talking about dynamics of abuse.

And one of the things that I said to them was, If, like, if you take nothing else just away from this conversation, I encourage you to like question everything that you learn in school. And one of the students was just like, how, how don't, like they were like the way that a studious person would ask for, like, give, can you give me the, like, how do I like the steps, the instructions?

Yes. Um, and it was, it was so funny because it, it's not that it's really just intuitive, but then it's hard, it's also hard to teach that on one hand, me being as like rebellious as I am has caused a lot of problems for me in my life, in, in academic spaces or otherwise. And I feel so lucky that I am like inherently.

Disruptive and question everything because it has led to this particular version of myself and it doesn't feel hard for me, or I don't need a manual or instructions to, to be able to identify like, that doesn't feel right. What the fuck is that? Let me ask a question. Yeah. And that is like, partnered with that I have never trusted or gave a fuck about authority, which is like another piece of the grad school thing is I'm learning a thing from a, a professor who must know and in a, in a program that must have the right information.

And it's like, no.

Nicole: Right, exactly. That's a right and that's a formalized system of, of learning that is patriarchal and says this is the way to do it. You know, like lived experience doesn't have anything to teach us. We can also go back to like ancient wisdom, right? Beyond our like paradigm of just like basic, uh, research and evide evidence-based things, right?

Maybe we go back to time-based things that have been going on before even the field of psychology was created. I don't know what a thought. I mean, I just, I share with you in that same level of like, I've always questioned things and it has created like a sense of rage in my body at times in class that has gotten me in, you know, not necessarily gotten me in trouble, but I do poke boundaries and push.

But I think it's so needed and especially for me right now I'm training in psychedelic assisted psychotherapy and so I have quite literally been in my classes specifically for, uh, psychopharmacology and gotten like one. Professor with a PhD saying one thing about the potential for causing psycho psychosis on psychedelics, and then my supervisor with a PhD telling me the exact opposite information.

Okay. What kind of position does that put me in as a student when I'm here getting this over here saying yes, and here saying, no, I can't, but help question all the systems at that point because yeah, I'm getting experts giving me opposite opinions and so someone's gotta sit in between that and like suss that out.

And I think that that's like, that example is what happens on large scale with all of psychology is people have different lenses perspectives, they've seen different research, they've seen different things, and that creates our existential bias that we can never leave.

Raquel: Yeah. For. I'm so fascinated by the idea of any kinds of drugs in therapy.

Not from the perspective. I think it's bad from the perspective of my body cannot fucking tolerate drugs. Like all of my friends always in life have been like they do all the drugs and I'm, I'm the one who has a panic attack every fucking time. Absolutely. The first time I tried Coke had a panic attack.

Yeah. What if I smoked weed when I was like younger, but I always hated it. It always gave me anxiety. And like in my adult life when I've attempted to smoke weed full on panic, everything just makes me fucking panic. Yeah, yeah, yeah. So I have had friends who have done acid, who have done shrooms and they're like, you should do it.

It would be great. It'd be wonderful. And I'm like, I know for a fact if I did that I would die. And I also have a friend who like casually like, does ketamine. And I know that ketamine is one of the other, um, things that people are kind of experimenting with in terms of, of therapy. Mm-hmm. And. I just, I think, so what my fascination is, is I feel a sense of maybe jealousy because I can imagine how, how profound, uh, a healing experience could be, right.

With the assistance of substances. And that is not experience I'm probably would have because if I do any drugs besides fucking Xanax, I can handle, my body can tolerate Xanax and alcohol, and Xanax is literally the pill version of alcohol. So it makes sense why those two are like, good for me, but otherwise it's like I'll literally have a panic attack and die.


Nicole: yeah, yeah. So to clarify though, that experience is based off of cocaine and also weed, or have you tried the other substances?

Raquel: And also I have not tried acid. I have not tried shrooms. I have not tried ketamine. I have tried ecstasy, coke. Okay. Weed. Some pills, like, you know, Valium and Oxy. Right, right.

Like that. I think that that's it. So I have not tried the ones that I guess, that are being researched, but the, but the reality in my body and brain is that I shouldn't or can't because I've had such bad experiences with other drugs. Like, and so I know that that's like factually and logically and academically not true emotionally.

It feels true. Totally. Which the barrier.

Nicole: Totally. And it does, because then when we think about set and setting, right, if you're coming into it with that mindset, like you're almost priming it to happen in that same way. Right? Right, right. But I, I will say they're different. And, uh, I know specifically my supervisor, uh, has talked about how, which was fascinating to me, like knowing someone who works in a psychedelic space does all these things.

I'm a regular cannabis user, right? Someone who has anxiety and it primes things at certain times, but for the most part, I enjoy myself on it. I asked him about it and he was like, yeah, no, never. It causes complete like anxiety, all these things. But then like has explored. Other psychedelics to deep levels, which I was like, how?

Cuz I figured if you were anxious on one, you'd also be anxious on the other. But they create different experiences. And even something like ecstasy and M D M A is, is a amplifier, a stimulant, right? Like cocaine, like these other ones that are gonna get that the lenss are not good for me.

Raquel: Yeah. Are not good for me.

Nicole: Well I will say that mushrooms are not a stimulant. So you can take that information every way you want.

Raquel: And the thing is, I know that people also have mixed feelings about weed, whether it's a stimulant or depressant or rather than it could be both. And I personally experience weed as a stimulant.

Nicole: Totally. Totally right. It gets the neurons firing really quickly. So when you have anxiety that can just, you know, like hit that.

Raquel: Which is why I love Xanax and alcohol because.

Nicole: Not to be mixed together, to be clear. No. Not mixed together. Yeah. I'm like, hold on, to

Raquel: be clear, very dangerous together. Do not do them together.

Both separately. Yeah. But cause it, it brings, it's, it, I feel. Totally, and I think it's also, it might be like an autistic thing too. It's like with stimulants, and this is a joke that I've just like always made about weed and I never really got it until later in life, but I always say like, I don't know what to do with my hands like now.

Mm-hmm. It's like I've become so aware of my body Yeah. In a way that is like, I become robotic and it's like I'm overthinking and I'm, and, and my ability to mask is gone because I'm like, you put your hand here and then you talk like this and then you should say this thing next. And like, I'm already doing that when I'm sober is like trying to look like a normal human person.

And once when I'm on stimulants, it's like I cannot, I have no sense of control over that. Whereas when I'm on any kind of depressant, I don't give a fuck about it. That's nice to not have to have that internal thought process and. So there's, I think there's that piece of it too. I know it would be different in like a therapeutic setting where I'm not having to like look cool or perform in any, but um, yeah, I am so fascinated by that and I will be so interested as the years go on to see like what the research suggests and what people's experiences are.

Nicole: Right. Yeah. Cuz I mean, I think there's like so much nuanced conversation about psychedelics cuz there's different types and different things. Yeah. And then subsequently different experiences on these different medicines. And so it's not like one fits all for people, but, and I think this is where it all gets interesting.

The research isn't out there yet, so we don't know, but like, hearing accounts of how, you know, psilocybin use could be helpful for someone with O C D to be able to like, Because it helps them unlike weed or other things, to actually relax into that and feel a little bit less rigid and for a moment think like maybe I don't have to actually reenact that pattern because I feel a little bit calmer because of the medicine.

Right. So I mean, oh, I mean I am so excited to be in this space and to be navigating it. It's, it's full of a lot of questions and a lot of risks and a lot of all those things, but it is a hundred percent what has put me into that same space that you've talked about of like pushing the system and really asking deep questions.

Because the world where so many of us are on antipsychotics with heavy, heavy side effects, antidepressants, ones that I've been on myself with heavy side effects compared to these other medicines that we're still exploring. I think there's so much more to do in that space.

Raquel: Absolutely. Yeah, there's, there's so much room for growth and it is so fascinating.

And generally that's another piece of like the white supremacist. Like, I don't know, neurotypical or like respectability, whatever. Bullshit is just healing and drugs. And drugs as a coping resource. And what kind of drug means what in terms of like, someone who does coke, if they're white is like cool, but if someone who is black is, you know, does coke, then they're a fucking crack head.

And like, and just how all of those things inform how we understand drug and drugs and drug use, and specifically around drugs as a resource for coping, um, and drugs as a tool for healing. Mm-hmm. So it's really interesting and I know very, very little, but I am 100% on the like harm reduction, right? Yes.

To drugs. Right? Right. So that's my like,

Nicole: totally right cuz coffee every day is fine. My, my benzo every day is fine.

Raquel: And for me, I'll die if I drink coffee. Yeah. Because it's a fucking stimulant. I literally, if I have a I, I'm like, oh, I wanna be cute and get some Starbucks prepared to have a panic attack later tonight.

Nicole: Totally. I had to quit too. It's too much. It's too much. I can't do it. But it's, and it's so true, like bringing in that, like that liberation psychology that systemic, like look at it, you know, like someone who is living on the streets saying that I do meth. Right. And you ask that person, well, what about meth works for you?

Right? Harm reduction lens. Like what is it about meth that you are enjoying? Well, I have things to do outside and it allows me to go to work in that capacity and work outside and not have to feel the cold as much. Okay, y'all, we gotta talk about some systemic shit going on right here, because that person is using that medicine for them in that capacity to be able to live in cold environments outside.

And yet we'll say drug user. Yep. Addict. Yep. It's like, hold on. Look at their societal context and what they're doing to survive in that. And then look at the other people. Yeah. In a business job, stressed out beyond capacity goes to a psychiatrist who then is like, well, here's the benzo for your stress.

And that's okay. Cause that's, that's your, your social conditioning. Totally fine.

Raquel: Yep. Yeah. Yeah. Give me some Xanax.

Nicole: Yeah. Which is a great tool. So let's, so wonderful tool. And we need to see that context in a larger societal scale of what's going on, of why these medicines are helpful for people and what are the systemic factors that are leading to people needing to use these things because of this system.

Raquel: Yes. And those conversations, of course, aren't happening in grad school either. I mean, I, I remember taking, I don't even remember, I think the class was called like an addictions class. Yeah. And I remember we learned about like the 12 step programs and one of our, um, homework activities was to visit like an NA or an AA or whatever.

And that's horrifying. That's horrifying to know that that's the framework that clinicians are going into the world with, which is drugs are bad. People who do drugs are bad. That's that. Get everyone quote, clean. What a horrific lens for therapists to have, rather than, um, like how you very beautifully described how people use drugs as resources and for important reasons for survival or for leisure, or for recreation, or for coping or for pain or whatever.

And totally ignoring the systemic context around it. So it's like the, the, the message from this conversation is the mental health system and grad school as a. Piece of that is just, oh my gosh. It's horrific. It's limited. It's, it's just reductive. It is archaic. It is, needs to be critiqued and questioned every step of the way.

Nicole: Yes, absolutely. And I think that's the future is being able to critique it and have a whole new world, a different sort of curriculum where, yeah, maybe having therapy be a part of your training as a requirement makes sense. I think that makes sense personally. Uh, How do you feel about time, by the way?

Raquel: Um, this is a good stopping point for me.

Nicole: Okay. Sounds good. So then usually I hold a little bit of space in case there was anything else that you wanted to share in our conversation. Otherwise, I do have a closing question that I could Cool. Yeah. That's the closing question. Okay. So the closing question that I ask everyone on the podcast is, what is that one thing that you wish other people knew was more normal?

And for me, this, this question has always come from that space of like, Yahoo answers. Like, what is that thing you were Googling going like, fuck, am I the only one? Like, yeah.

Raquel: Wow. That's such a, like I have so many things and I'm thinking of things that could be like fun and silly, and then I'm thinking of things that are like really deep and depressed.

Yeah. But when you just said like, things that I have Googled, what came up for me really was kind of what we were talking about earlier, which is this, I believe it is normal. To have a deep sense of loneliness and emptiness. This includes for people who would consider or say that they otherwise have fulfilling lives and good relationships and jobs that they feel passionate about, or hobbies and, and still feeling this, like what I would describe and what I describe to my therapist is like a really deep, well that's just like pitch black that I just cannot fill regardless of how many achievements I have, regardless of Yeah, what I try to do to fill, you know, put water in it or put dirt in it or whatever, fill that like hole.

And I think that that deep sense of loneliness, like this chronic emptiness is much, much more normal than we ever discuss or acknowledge and. I think there's many reasons for it. You know, like lack of emotional connection and feeling seen in, in childhood particularly, I think is what leads most adults to have that even when they have like otherwise fulfilling lives and it, and you feel, it feels confusing because no one's really talking about it or no one's talking about it in this way.

Yeah. Or maybe even it's like a, a cycle is not having relationships that allow you to feel seen fully and that's what would feel the emptiness and, and the, the loneliness. And we have relationships that I think we think are attempting to do that, but really they aren't. And it's hard I think, for most of us to figure out where, where to find those relationships or what to look for or how to do it.

So I think I would say that cuz that's something that I like, literally have Google. It's something that I talk about with my therapist a lot. Something that I'm navigating constantly is like, I have a good life. Now, like now that I'm an adult and I have my autonomy and agency and I have set up my life in a way that I want, I have a good life and I feel like chronically unseen.

Yeah. Like not able to fully be myself with other people. Mm. So I think I would say that, yeah. And maybe just even the acknowledgement of that I think can be helpful. Like knowing that you, that's not an unusual thing, that, that is really normal can be a good like starting place.

Nicole: Totally, totally. As you were saying it, I um, looked up into the corner cuz there's a post-it note that I have that talks about the four existential givens of all humans of what we face.

Right. And it's death existence, isolation and meaning. Yeah. And I think when we think about the reality of isolation, it. No matter how good your relationships are. Cause I think we could have a very nuanced conversation about relationships that aren't meeting us. Right? When you're going to the office and you come up and people are like, how are you?

Good. How's your weekend? Great. And then you go through, you come home, you live alone or you come home and that's the kind of dynamic you have with your partner, partners. Any sort of space where it's that I would say surface that's isolating. And even if we go to the space where you have great supports, you're really there, really vulnerable no matter what.

No one is ever going to see what you see of the world, because that is a given of our existential limitations. Like, I'm experiencing you. No one else can experience this conversation through what I'm experiencing. So I can share, try and share it with so many different people, but no one's gonna get it because no one is myself.

And I think we all sit with that, that we wanna be seen, we wanna be seen. But the reality of our existential given is that that is always gonna be limited.

Raquel: Yeah. Mm-hmm. That leaves me with a question to think about, which is if we have all of those other things in place, a life that we would consider good otherwise, right?

And that we would consider good otherwise, but we have this reality that our unique lens. Is also uniquely isolating. Is it possible to really be seen then That would be my reflection question for the day. Totally. That's my, that's interesting to think about is like ultimately, even if we have these things in place, we still have Yeah.

This reality that my experience is unique and, and you will never get it because it is mine only. And so then how do we remedy that?

Nicole: Hmm, exactly. Maybe the idea at that moment, I was thinking about how we're all one in some way too, right? Like I will never understand your experience, but in some ways we all want the same things.

Mm-hmm. We all crave the same attachments. We all crave those. And so there is that like shared, like when you're talking about feeling lonely, like. I know what that feels like cuz I felt that way. Right. Like I can't know your experience, but I do have the same humanness. Yeah. And to know that. Right. And so maybe that's where it comes through.

And also I'd be curious like what are our expectations of life? Like, life is not always Yeah. Happy rainbows. What, what are the parts that we have to sit with that are, that are hard and difficult?

Raquel: Yeah, I know, and this is the last thing I'll say cuz I could probably go on forever. But I was also just thinking about how in the US different, like locations, value different things and how I think being someone who lives in the US is so fucking isolating and disconnecting because at the core of like our culture and our values like is money and capital and growth and like work, which means that built into our culture, there is no prioritizing connectedness.

So it's, it, it's, it's even like, Even if I have all of those things set up, I'm still not gonna feel connected because we don't even prioritize or, or value that in any capacity in this culture. Whereas like in some other cultures or even just thinking about, oh my God, I can go on forever.

Nicole: You can do it.

I'm here for you. I love this

Raquel: Last thing. Even just thinking about, um, like this concept of most people, I would say like our desires in life are like, To get more, to make more money or to become famous or to reach a higher height professionally. And so, and part of that leads to us culturally not having support systems that support folks who don't have a lot of money, because the idea individually is, well, I'm not gonna be that person.

I'm gonna make more money and I'll access the supports when I get there. Whereas in other cultures, they really deeply value everyone being taken care of financially. Communally, whatever the fuck. Because people are not actively, consistently ongoingly seeking more. They are born into this particular financial system, whatever the fuck.

Or like, not caste system, but like socioeconomic status. And that's the one they know that they're gonna stay in. So they're wanting to figure out how to make this life meaningful and enjoyable rather than up, up, up, up, up. It is, I'm here. How can I make the best of it so that, so that there are resources and things that make existing in that socioeconomic status livable.

Yeah. So I feel like that's just the, the last thing I'll say. But the, yeah, the other piece here is we don't have systems in place that make life like quality of life in terms of connectedness, because the focus in the US at least, is more, more, more, more, more rather than, And the focus is just always on.

Yeah. Like money and wealth rather than connectedness. So it's just, I think that this is just a really deeply lonely cultural fucking society. So it's a, it's a hard, it's hard, but I, that's all I'm gonna say.

Nicole: It's so good. And I appreciate you saying that because that's all part of this conversation. Right.

And again, when our whole running theme of this conversation, I think was like the relationality that we all need when that's the world that we're living in, in our society, again, it is no wonder that so many people are on these very. Medicines, um, anti-psychotics, these antidepressants because our culture is framed in that lens.

Right? Again, that's why I'm always saying like we need to be looking at these upstream systemic factors, the culture, the things going on that are creating this, because the problem is frequently not us, it is frequently the relationships that we've been in through our history, generational trauma, and then the societal things that are going on.

And if we're not having that nuanced conversation about those things, we're placing the blame on us, on our clients and saying that you are the reason when I would say that there are other reasons that are making us suffer.

Raquel: Absolutely.

Nicole: Ugh. Yeah. It was such a pleasure to share space with you. Where would you wanna plug so that people can find out about the equitable care work that you're doing and other things so that they can stay connected with you?

Raquel: Yeah, so, um, you can follow me on Twitter, Raquel, that's R a Q u e l Savage or Instagram, Raquel Savage. Um, you can support my nonprofit, Zep Wellness Z like Zebra, E P P P, like Peter Zep Wellness, um, across any social media platforms. And also send donations where community based and don't have a lot of funding.

So money is very helpful. And then the Equitable Care certification, similarly, you can just Google that and it'll come up and register for it. Um, the first cohort will be in July and then the second will be in October as a 12 week thing. And then you have the requirement to actually see sex workers as clients for free.

So yeah, any of those things would be really helpful.

Nicole: Hell yeah. I'll have all of the links below so people can follow it directly and connect with you. Thank you so much. Yeah. Thank you for coming on the show.

Raquel: Awesome.


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