An Interview with Psychotherapy Intern Debora de Souza
Debora de Souza is a clinical intern at Seattle Anxiety Specialists for 2022-2023, providing care to those in need within our low-cost therapy program. She is finalizing her Master's degree in Clinical Mental Health Counseling at Seattle University and specializes in helping clients work through grief, loss and trauma.
Tori Steffen: Hi everybody. Thank you for joining us today for this installment of the Seattle Psychiatrist Interview series. I'm Tori Steffen, a research intern at Seattle Anxiety Specialists. We're a Seattle-based psychiatry, psychology and psychotherapy practice specializing in anxiety disorders.
I like to welcome with us today, Clinical Mental Health Counselor, Deb de Souza. Deb is a clinical psychotherapy intern at Seattle Anxiety Specialists and she is currently earning her master's degree in clinical mental health counseling at Seattle University. She works with parents experiencing perinatal mood and anxiety disorder, known as PMAD. And she also worked as a grief hike guide, helping those grieving the death of a loved one to process their loss. So before we get started today, Deb, could you let us know a little bit more about yourself and what made you interested in studying mental health counseling and grief?
Debora de Souza: Hi Tori. Thank you so much for having me.
Sure, absolutely. This is a second career for me. I have been in the business world for quite some time locally here in Seattle in corporate settings. I always had an interest in the psychology when I first started college, that was definitely one of the careers I was... one of the schools that I was hoping to go into. Just life happens, it didn't happen. I ended up being program management and business operations for most part of my adult life. But when the opportunity came with COVID and things happened, I got laid off and I decided that it was the right time to go into counseling given that was something that I really wanted to do. And I had a lot of interest and passions, like you said, in the area of grief and PMAD and anxiety disorders, as well.
So I said, no time like the present. I had already applied to Seattle University and got accepted prior to COVID and I decided let's just make this a new career path for me. And it's been really enjoyable. I really am glad that I took the leap. It's a little bit threatening, but it was fun.
Tori Steffen: Yeah, that's amazing. It sounds like it just worked out time wise and you got to love that smooth transition.
Debora de Souza: Yeah, it was great. Meant to be.
Tori Steffen: Yeah, exactly. Well, can you describe for us how your time at SAS as a clinical intern has been so far for you?
Debora de Souza: I started in September and I have to say it's been really, really good for me. I feel very supported at SAS, that's one thing I really wanted. I applied to several sites and I actually had already accepted another site. And when I got an email from SAS to interview. And it just clicked, it really clicked with the folks that I talked to on my interview, the approach that they had to internship and also I like the low-fee model that was offered, that interns participate, where we provide service to folks that may be in that gap where they can't qualify for insurance, and they don't have private insurance or state insurance, and we can provide a service to that population. That otherwise may not even have access to care. So it's been really, really nice. It's a small group of interns, a lot of support from great supervisors and also from the staff. So I feel ... again, I think as a new person, as an intern, new person on the field learning how to become a counselor, the support is critical.
Tori Steffen: Absolutely. I would definitely agree with that. It's a lot of stuff to learn and I feel like you really learn it from experience. So having supervisors help you through a little bit is crucial.
Debora de Souza: It's vulnerable work.
Tori Steffen: Absolutely. What would you say has been the most challenging about being a clinical intern?
Debora de Souza: Well, I think the truth that come to mind right away is that I kind of expected, but experiencing it is a little bit different, is how vulnerable it is for me as a person sometimes, and how I can get flooded and overwhelmed, emotions when people share things that might be triggering for me and trying to differentiate what is mine, what is the client? So that's been a learning. And I knew from a scholastic standpoint, but it's different when you feel it, when you're in the room with someone. So that has been something.
Also how imposter syndrome is real. Sometimes you sit with somebody explaining their circumstances and you're like, "I deal with that too and I'm still finding my way. How can I support you?" So that is real. I think just learning how to be a counselor or a therapist and sit with someone. One thing that I did not expect, I've always worked long hours and being tired. And I remember telling Case (Lovell), who is my supervisor, in the first week how completely exhausted I was after a full day. I think it was my first day with four or five people.
Tori Steffen: Wow.
Debora de Souza: And I was very emotionally and physically tired. I just wanted to come home and go to bed. That was surprising for me because it takes a lot of effort to really focus and listen. It's a different way of engaging with people that I wasn't used to. Because that's not how we do it in our lives.
Tori Steffen: Right. Yeah, that's something I wouldn't have expected either. But knowing that, it does make sense that it'd probably be drained, especially emotionally and need a good day of rest after your first week probably.
Debora de Souza: It's a learned skill I hope, it gets better over time as you-
Tori Steffen: Yeah. Yeah. I think it's one of those things that the more you practice, the more that you learn how to do it better. And-
Debora de Souza: Absolutely.
Tori Steffen: Deal with the feelings that come with it. Well, what would you say has been the most rewarding about being a clinical intern? Any specific moments come to mind for you?
Debora de Souza: Yeah, I keep going back to the... I guess, I'm surprised and touched a lot how vulnerable people get with you. And it sounds like cliche, but really genuinely honored that sometimes without not knowing much, two or three sessions maybe, people really share deep things that they may not have other spaces in their life outside of session to talk about. And I'm very honored by that. And I think that is one thing that I keep it in mind a lot, is that I get to do this job. I get to sit with folks and support them and how intimate it can be, the relationship in one way. When you are really vulnerable, and also how much trust they have on us to be themselves and not being judged.
And as for an example, one that I have a client that we have sessions where the camera's off. My camera's on, but the client's camera is off. I got used to it, that's how this client prefers to engage. And I remember the first time he turned the camera on and in the middle of a conversation and it was to show his dog, he was talking about his dog. And he kind of came into frame very briefly, but he turned the camera to himself and said “hi.” It was the first time I actually saw his face and I was almost a little bit emotional. It was so meaningful to me that he... because he trust me enough to be a little bit more vulnerable and just say hello. So we've been seeing each other for some time and he still keeps the camera off most of the time. But every once in a while he'll turn it on and say hi or bye.
Tori Steffen: Ah, that's amazing. Yeah, that's, I'd say, such a wonderful moment to have with the client and kind of just know that you've built that trust with them. So that's amazing.
Debora de Souza: It felt really good.
Tori Steffen: And it must have been amazing to see his dog, too.
Debora de Souza: Yes. He has a very close connection with his pet. We always talk about the dog. He always comes to the session with us.
Tori Steffen: Really? Ah. That's amazing. Well, kind of moving over to the outdoor grief groups that you work with. Can you explain how those work for the audience and maybe what activities you guys usually do?
Debora de Souza: Yes, I do, I do. I love ... it's a volunteer position with the local... not company, but with the local group called Wild Griefs in Olympia, Washington, it's a small group, they're expanding now. We are volunteer hike guides. And basically it's to partner the power of nature to process grief. It started off as initiative to support teens that were grieving. A lot of times the loss of a parent or a caretaker or maybe a sibling, and provide them opportunity in nature to bond with each other, to share their experiences. And that was how it first started.
Wild Grief has several programs, all nature related, all outdoors throughout the entire year. So it's not a summer/spring only. We go out in December, the day before Christmas sometimes.
Tori Steffen: Wow.
Debora de Souza: And they offer programs that are day programs, like hikes. Some are more nature walks, some are more hikes, like five hours or so. Also overnight programs, which is a four day backpack with teenagers and a group of us take teenagers out backpacking in mountains around Washington. And each day is framed, there is some process. Each day is framed to go... they use the four tasks of grief as a baseline, basically accepting grief, feeling your feels, adjusting to a life without the person that you lost, and then making a new relationship with that person. So we try to frame all... even if it's a short hike or if it's a four day camp, we try to do that.
We also have a camping program that I usually participate on, that I really like. It's with the family. So it's a family camp, everything's provided, literally from shoes to food to pants. The family just comes. So a parent or a caretaker and children that experience a loss within that family unit. And we spent three days together camping somewhere around Washington. And it's beautiful to see not only the parents relating and connecting, but how the kids really find support on finding another child that has lost their dad, for instance. And be able to just talk about it, which they don't have a lot of space, maybe, in their life outside, in school and other friends.
So both the family camp and the hikes are the longer programs. The other programs are day hikes. And they say something else like nature does the heavy lifting and we just really provide the safe space to share, it's optional. And it has been really beautiful to see. We don't know who's coming, they sign up and we meet up in the trailhead. And usually there's two, maybe three guides, depending on the number of people. And we start hikes and then we stop in some places we usually kind of case out hikes and spaces before. Because we have two or three stops where we do little small processing groups.
And we talk about our person and we share memories of that person, the impact of that person in their life. And we compare with nature sometimes the changes of seasons. How does that reflect on the changes that grief does throughout time. And the rebirth when we see a log and there's a whole bunch of new growth in that dead tree. And the same thing with our grief, after the loss, we adjust and we move forward, and we bring that person with us in a different capacity. And just being with other people. So you can talk about your feelings with no judgment.
Tori Steffen: Right. Yeah, it sounds like kind of the perfect safe space to provide people who are grieving. And you're right, you just have to get away from everyday life sometimes. Because work and school and all these responsibilities get in the way of processing the heavy emotions. So that's amazing. Yeah, it sounds good.
Debora de Souza: Being outdoors really helped.
Tori Steffen: Great program.
Debora de Souza: Yeah, it's very nice because being outdoors, I even feel myself just with the trees and the sounds of nature. You are walking, you're also moving. We do have strategic stop times, but they're brief. I think it's a great idea, I'm glad that the board, the founders, the couple people that found that decided to expand and move forward and be more inclusive.
Tori Steffen: Yeah, it sounds like they're doing a great job with being inclusive for all types of experiences, so that's amazing.
Debora de Souza: Absolutely.
Tori Steffen: What are the main benefits that you see the participants gaining from their experience in the hiking program?
Debora de Souza: I think it's community. We talk a lot about acceptance, just have a space. Grief can still be a taboo topic in a lot of places at work or people, maybe people rush you like, "Oh, it's been already six months or a year." You hear a lot of those terms so people feel like, oh, I should ... it's not okay for me to talk about it or to bring it up. So people push it down their emotions, so that's a space that they can do. And it's amazing that we were all strangers in the beginning of the hike, it's oftentimes by the end, people exchange numbers or want to keep in touch. Or people come to several, we have hikes once a month, at least. So we'll see people coming again and again and them bringing children or bringing a friend. So definitely community and acceptance. And being outdoors. Yeah, being outdoors is always good.
Tori Steffen: Right. Yeah, it sounds like just the perfect mixture of things to help you along that healing journey. Yeah. And that's amazing.
Well, if we could discuss the topic of grieving parents, specifically. There's a specific topic around it. So how it's become more acceptable for men to grieve where it was previously not really as accepted. Would you mind going into that a little bit?
Debora de Souza: Yeah, absolutely. I think it's even harder for men. I think sometimes men get forgotten. And especially around parenting, I think we're talking about specifically about... there's another volunteer position that I have with the Perinatal Support Washington. I'm a warm line for answering the phone on certain shifts during the day. And most of the callers are women who are experiencing PMAD, Perinatal Mental Anxiety Disorders. So postpartum depression, postpartum anxiety, some miscarriages, sometimes stillbirth or birth trauma is very common. So we do a lot of talking to them, just trying to assess their situation, how we can provide support.
Sometimes every once in a while we get a dad or a grandfather calling to support someone that they love in their lives, who they're concerned about. So there's a lot of psycho-education, a little bit, like “Where do I go with this? How can I help my daughter or my wife?” And eventually, as you get to work with them, we have extended peer support. So if the person... until they get connected with some sort of therapist or service, they have the option to keep working with us and we can call them once a week. We can set up a cadence and we have brief calls with them. And I found that with fathers or with males, eventually it comes to their grief and their experience with, in the case of a miscarriage or stillbirth. And being able to express that because they think it's all around the woman, the mother, the expecting person.
Which makes sense and they feel a little bit lost or they say, "Oh, my wife just had a baby. And all the attention goes to her and I'm not feeling safe to say that because that's not cool. What kind of dad are you? What about me?" Or, "I'm grieving my wife because it used to be just me and her, and now there's this baby who's a newborn is very demanding." So we end up supporting and doing a lot of psycho-ed and just help and listening to both parents, to both caretakers. And grandparents do it the same and call and say, "I don't know how to help more or how to be present to my daughter, to my family member."
As far as personal experience with a male, a coworker, I did suffer a pregnancy loss and I was far along enough that people in my work knew. So I was away for recovery. And when I come back to the office a few weeks later, one of my coworkers, another gentleman that was in my team and asked me out to lunch, he wanted us to talk. And I think in the beginning, just to support me, “Welcome back, how can we be there for you?” But more in a private setting. And he got really emotional during that meeting with me and start crying and openly grieving a son that he lost, I believe it was like 30 years earlier. Because we talked about how weird was talking about pregnancy. But because I was so evidently pregnant, there was no way around it. And he just shared his own story that back when his wife lost their first child, he had nobody... men do not participate. They never talked about it. It was like they did the medical procedures, she came home. That wasn't even their first child, the second child was.
So it was just culturally different. I'm sure at the time, things were difficult. We have come a long way of normalizing not only perinatal mental health, but miscarriages and birth losses and challenges with IVF, challenges with fail adoption, the journey to become a parent can be riddled with challenges. And fathers feel it, too. And that gentleman really touched my heart, I will never forget because it end up kind of me making space for him and listening about his boy and how much that hurt him. That pregnancy wasn't viable and he didn't get to hold him. So it was a very powerful, and beautiful moment. And I'm very thankful that he felt safe to share with me.
Tori Steffen: Yeah. And it really brings to light that men experience the same grief. And it is more evidently the mother is physically going through it and that's definitely significant. But the father is in there just as much. It's their child, as well.
Debora de Souza: Absolutely. A lot of anxiety for dads when the first baby comes.
Tori Steffen: Oh yeah, I bet.
Debora de Souza: They're adjusting too. So it's nice to have a service like Perinatal Support Washington. So we have fathers volunteers, as well. So if you want to, you don't have to talk to a mom, you can also talk to a dad who has been through postpartum depression with their wives and whatnot. And it's really nice. It's a really great service.
Tori Steffen: It sounds like just such a great resource for new parents, anybody who's gone through it.
Debora de Souza: Oh, the landscape has changed. Even from my time of my losses, I really struggled to find someone, a therapist that was familiar with perinatal mental health, how that could support me. And I'm glad there's a lot more resources, I think, right now, nowadays.
Tori Steffen: Yeah, that's amazing. It's not something that I have seen be super common out there. But it's absolutely needed, I would think. So, that's amazing. So what are some good resources that you know of that grieving parents can look into maybe after losing a child or losing a loved one? Are there any good go-to resources that you know of?
Debora de Souza: There's several, like I said, the landscape did change. I will share the Wild Grief link and page, as well as the Perinatal Support Washington for Washington only. But there's also Perinatal Support International. A lot of resources, a lot of support groups are ran by those organizations and they're usually free of cost. And now since COVID, especially, they're online. They also list other ones, sometimes with churches or with community centers that people can find locally and connect. And they're a lot of support groups, which is wonderful. Because the safe spaces and the peer-to-peer support can be vital.
One that I like a lot myself and they offer trainings and they're very laid out website, it's called the Return to Zero. And they made a movie, they have a book. It's a couple talking about the experience when they lost their son, their first child. And from there, it kind of sprout into this beautiful website, where you can go in there as a parent grieving. And they really go the gamut, like I said, in fertility, IVF, anything in the Journey to Parenthood. Beautiful site, a lovely work, very well done and well set up. So you can get from referral to therapists, training classes. They have a lot of training classes for volunteers and people that work with parents and people in experiencing PMADs.
And it's just something that I wish I had access to back in the day because you just feel it can be very lonely. You go through very... and nobody wants to talk to you because people think that it's a baby and it's going to make you sad. Or they don't know what to say. I get it. It get all that. And when all you want to do is talk about it. And that's the funny part, all you want to do is ... especially when a baby. A baby is a baby and has a whole life already, the minute that you realize you're expecting.
Tori Steffen: Yeah.
Debora de Souza: It's amazing how you're already think the weddings, it's sounds silly. But a whole life become concrete. So that's another thing, as well. We used to have a miscarriage early on, sometimes people say, oh, at least try to do those kind of modifiers. “Well at least it was early enough. Or at least you can get pregnant again.” And for a parent, I think that life has already happened from conception on. So those are great support that folks can go to and get all kinds. And very cultural responsive too, and inclusive because different cultures... and I think I can speak from my culture, as well. It's very unique sometimes how you deal with the topic, how you deal with grief itself. So they do a very good job of having a multicultural approach and training and language that is inclusive to all parents. So Return to Zero, I will share the link, as well. They're excellent.
Tori Steffen: Perfect. Yeah, we'll make sure to link those in the notes later, but that's so helpful. Thank you for sharing the resources. I'm sure it'll be really helpful to hopefully some of our audience.
Debora de Souza: I hope so. Yeah.
Tori Steffen: Awesome. Well, are there any final words of advice or anything else you'd like to share with the listeners today?
Debora de Souza: No, it's been really a pleasure. I think I said my thing is about normalizing grief, normalizing sharing feelings. And even if we don't know what to say, sometimes not saying anything, just being there. Just letting the person know that you are there to say... and it sounds cliche again, but it's so important so you don't feel so lonely. You feel like it's okay, people understand. Because that's one common experience that we’re all going to have. At some point, we're going to lose someone.
But also other griefs, as well. It doesn't have to be a death of a person, ending of relationships. I mean, through COVID there were so many changes. And I always like to think about positive changes. Some people say positive changes, happy changes bring grief. And I'm like, oh, it's true. In order for something new to happen, something had to die or change. And I didn't think of that. I said, well, think about a wedding, there's a different life that you're entering now. But things are changing... sometimes and a lot of times bring grief with it. And I think it's uncomfortable, we don't like to talk about it.
Tori Steffen: Right and it's like-
Debora de Souza: We all feel it.
Tori Steffen: Exactly. And those big positive changes are great. You're having-
Debora de Souza: New jobs, moving to another country. I mean, there's so much that you can think, "Oh, this is so fun and exciting." But there's always some... the other side, that you're leaving something, there's a cycle ending in some way. And just honoring that and taking time to feel the feels just like the best... it's beautiful. Doesn't apply only to death, physical death.
Tori Steffen: Right. Yeah, just taking the time to process the change, I think will help you, lead you into the future and make it easier on you emotionally.
Debora de Souza: And be a kinder human being. Understand when other people go through their change, it promotes kindness. It's definitely a positive in my book.
Tori Steffen: Yeah, absolutely. Well, thank you so much for sharing your knowledge with us today, Deb. It was great talking to you.
Debora de Souza: Thank you so much. It's my pleasure.
Tori Steffen: All right. And thank you everybody for tuning in and we'll see you next time.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.