S4 E10: Josh Ulrich on Virtual Therapy

Released November 30, 2021

Virtual intensive outpatient programs can provide flexibility for many in recovery due to busy schedules or not being comfortable physically being around other people. Josh Ulrich, Virtual Therapist for The Meadows Outpatient Center’s MBH Connect, says that it’s important to meet people where they are in order to put them on the right path to recovery. But if you choose a virtual option, could you be sacrificing care for the sake of convenience? 

Podcast Transcript

If anyone’s had a sprained ankle, you didn’t walk normally, did you? You limp because it hurts to walk on it, and you try and do everything to avoid the pain — put it up, ice it, anything — you just don’t want to walk on your sprained ankle. Well, if you’re emotionally hurt, if you’re emotionally sprained, if you suffer trauma, then you don’t want to do anything to feel the trauma. You want to numb out. 

Welcome to Beyond Theory, a podcast powered by Meadows Behavioral Healthcare that brings you in-depth conversations with firsthand insights from the front lines of mental health and addiction recovery. I’m Dominic Lawson.  

Virtual intensive outpatient programs can provide flexibility for many in recovery due to busy schedules or not being comfortable physically being around other people. Josh Ulrich, Virtual Therapist for The Meadows Outpatient Center’s MBH Connect, says that it’s important to meet people where they are in order to put them on the right path to recovery. But if you choose a virtual option, could you be sacrificing care for the sake of convenience?   

Let’s get out of the abstract and see how this applies in the real world. It’s time to go Beyond Theory.   

Josh Ulrich:  My name is Josh Ulrich, and I am the therapist, a virtual therapist for Meadows Behavioral Healthcare at the virtual IOP as an LPC from an independent license. And I’m a CSAT, which is a certified sex addiction therapist. And I’m happy to be here on this podcast. 

Dominic Lawson: Awesome. Thank you so much, Josh, for coming on the Beyond Theory podcast. If you would, Josh, kind of start with your background if you would. 

Josh Ulrich:  I have kind of a non-traditional background. I went to college at UC Santa Barbara — great school, fun, beaches. And I got my master’s in East Asian studies and minor in Japanese. I wanted to do business and sales. Father of a salesman, grandfather of salesman, I was always told that the best thing to separate yourself in the business world is that something unique most people don’t have. Everyone has a business degree. But another one has like Asian studies or a language degree. I decided to focus on that. I did sales for about 10 years, got burned out cause it’s only as good as your last month.  

And my wife suggested that I get into counseling. I’m really good with people. I like being around people. I love listening, and that was always the most fun part about sales, it was working with individuals to really to find out what are their needs? What are their wants? I then got my master’s in mental health counseling at Argosy University. And while I was there, I did my internship at Hospice of Arizona — I think they got bought out right now by Hospice of the Valley — Hospice of Arizona, and for a full year I worked with those that were actually dying. Because you have to have less than six months to be in hospice. And I worked with the family members of those that died. In Hospice we like to use the word: death, died, just passed away, better life, etc. After that, I think I got a job at Gila River Indian Reservation in their behavioral health department. Those of you in Arizona know that’s in Sacaton, south of the 202. Those who are international or national, it’s one of the largest reservations in Arizona. There’s 30,000 members of the Pima Maricopa as the primary tribe in Gila River. And they have a health department and I worked there in counseling and doing case management.

The clients I had were kids, little children. I had some like two-year-old patients, And then I also had elders, an elder is anyone 55 or older. I had a lot of those elders as patients. And the traumas, their experience with generational traumas. Been hearing the news about the boarding schools. One of the grandparent’s elders had gone to the boarding school with them. And the repercussions of their sons, daughters, and of course the grandkids — a lot on drugs, a lot of alcohol — so I worked with that.

After about seven years, I got an offer to work at The Meadows Behavioral Health at the IOP in Scottsdale, Arizona. I worked there for three-and-a-half years. The first two, I was working in the Claudia Black IOP for those from CBC. It’s a young adult group that’s for 18 to 26 years old. For six months I was there with a coed group. Then, unfortunately, as you might know, 18- to 26-year-olds tend to be a bit more romantically involved than they should, especially in a trauma program. So they cut that off and suggested that we do men-only and women-only. I ran the men’s group. But after two years, we decided to integrate the young adults since there was now a group system. I ran that for six months, our standard co-ed group working with the Meadows Model.  

After about six months, I then was offered the position from the men’s sex addiction group because I was starting to get my CSAT certificate, which is a certified sex addiction therapist. The reason for that is for lot of young adults, for 18-, 19-, 20-year-olds, the question always arises: Are you a sex addict, porn addict, or you are just hypersexualized? Is it society, is that what’s going on?” So, there’s a gray area. Since I was currently working with the one they had, we got trained and I also was getting training in that. As I got training in sex addiction, a therapy position opened up in the Gentle Path IOP. It’s the men’s sex addiction group.  

I joined that in March of 2020, so right before the pandemic, and did that for the entire year, running that group. I got my license (CSAT), and then I was offered the position for the Virtual IOP. Been running that group for Arizona, morning group, since March of this year, and now I’m on the podcast with you. 

Dominic Lawson: Yeah, and we are so glad that you are on the Beyond Theory podcast with us. I really appreciate your background. I want to go back to a few things you talked about in your background. Particularly, you talked about working with the Native American population for a while there. I’m curious, was there anything that was kind of eye opening for you, working with that population in regard to mental health? 

Josh Ulrich: Yes, what was eye opening was, one, you hear the term “generational trauma.” And you can’t tell from my name. I’m a white, middle-aged man. I’m definitely not one who’s in the generational trauma demographic. I hear that, going to school and so forth, and I’m wondering, really? Is it true? Is it not? You kind of read books, but to see it, and seeing actually how it works. When you have the young man and woman, either the boys or the girls, who are taken from their home and taken to these boarding schools and actually they were really were reeducation camps,  and it just, is “camps” the wrong word? Because a lot of people think Holocaust and some other stuff, and it’s not camps but reeducation schools. Now there’s a haircut. They can’t learn their language. They can’t dress [traditionally], and a lot of corporal punishments for failing to follow rules, and they go to that trauma. And then when they become adults, they leave the schools and then go back to the reservation to their homes.

And if anyone has suffered trauma, what you do if you have suffered, you have pain, and I like to equate it to a sprained ankle. If anyone has a sprained ankle, you don’t walk normally, do you?  You limp. Why? Cause it hurts to walk on it and you’re trying do everything to avoid the pain. Put it up, ice it, anything, you just don’t want to walk on your sprained ankle. Well, if you’re emotionally hurt, you’re emotionally sprained. If you suffered trauma, then you don’t want to do anything to feel the trauma. You want to numb out. So you drink alcohol.

Back in the ’40s, ’50s. Well, if you’ve only learned how to raise people by beating, by knocking them emotionally, by being shut off, by developing walls and you’re only coping skill is alcohol. Then when you have children, what are you doing? You’re raising them that way, and the children grow up during the ’60s and ’70s and they’re exposed to drugs, whether it’s marijuana or other more powerful drugs. Of course, they’re being raised. Mom raised me with the walls, no emotions, beatings. And then I have kids, and how am I going to raise them? Same thing. On drugs, I’m not there — alcohol, drugs, no affection. I don’t really know how to relate, and I’m trying to numb out from my own pain of childhood and I’m now your parent. And so you have three, then you get the fourth generation of people who is systemic addiction and pain and improper or unhealthy parenting skills. And unhealthy ways of communicating love, affection, and so that has become a generational trauma and trying to block that as much as you can. 

It’s hard when you’re dealing with a 14-year-old that’s living with their grandparents who still has poor parenting experience. So how do you, like, try to break that trauma? Now do you want to codify this or say my experience? I remember asking my supervisor because I didn’t want to like, ever, [give a] bad view of the Gila River Indian Reservation. I don’t want to sit there and be like not every single person we treat has alcohol addiction or any problems.

He said: “no,” and I said: “about roughly how many are we treating?” He said about 20, 30% of the population. Just to let you know that, as I’m saying this, not every single person at Gila River is an alcoholic. Not every single person has suffered trauma. Not every single person has done all that stuff or has been a bad parent or has had problems or issues or any criminal activity. It’s a smaller population, but it’s very common throughout the Native American history. I just like to say that, because I don’t want to paint them all with the same brush here. 

Dominic Lawson: I appreciate that. 

Josh Ulrich: Yeah, so that was my experience, that way he did, and really it came down to the biggest story that for me to change was you’re planting seeds. Now, when we talk with the other patients at The Meadows, I get to work with the families and change the family dynamics because as I said, I had a 14, 15-year-old who was in juvenile court and had to be sober. Had marijuana, had an alcohol problem. We started to get into that and he asked me, “How do I stay sober? My dad is smoking. My mom is drinking. My grandparent is drinking, one drinks, and one uses, and that’s where I’m going to go home to. Like, how do I stay sober when they ‘re offering me alcohol, when they’re offering me drugs?” And so it was one of those things, realizing that you have to give people, especially the young people, the tools that when they turn 18 or when they get to a point when they can’t break away, when they can’t say no and leave the toxic environment. they have the tools to succeed. But sometimes those family systems are so ingrained they should not get immediate results.

But it’s really important, working on the family system because just giving one person treatment.  I don’t care whether it’s The Meadows inpatient, where you have incredible treatment, but if you’ve been sent back into a toxic environment, a family system that belittles them, is negative, is counterintuitive to everything they’ve been taught, what they’ve learned in that 45 days of treatment doesn’t do anything. The 90-day system, they give them a little bit of tools but the family system, the environment has to change if they want anything long-term.            

Dominic Lawson: Thank you for sharing that, and now you’re here at The Meadows and you’ve been doing some great work here at The Meadows, and now you’re part of the VIOP program. Kind of talk about that experience there so far. 

Josh Ulrich:  Well, what a unique experience because Virtual IOP, you have a group setting, you know the therapist, you know the people in the group, but instead of being in a room and having like 8, 9 chairs, you have a monitor. You’re the one on your phone looking into the camera or you’ve got a desktop and webcam and so you see the people. But again, you’re not interacting. You can’t smell, see, the different touch and feel, and the key is to make it real, to really get that vulnerability. And what I learned was, I took my experience with the young adults at CBC and took my experience with the GP sex addiction and even the general to realize that kind of assignment here. Adam Savage from MythBusters.  

I saw a YouTube clip before I took the IOP job and someone asked him: “Are you really that nuts? Are you really that crazy in real life?” He’s like, “No.” He’s a really calm person, but you realized on TV you have to amp it up like 30%. So, whoever you are, taking like 30%. Instead, the one doing the video, like a YouTube, you only do 5%, maybe 10%. So, it took that to heart when I took the job, and I realized that you have to give more energy. Just like on dealing with like, 18-, 20-, 26-year-olds, cause they’ll totally sleep on you. So, you have to, like, give energy. A little bit of a performance. So, it’s not static. You need to give tasks.  

You need to be educational and need to be engaging, and by giving that energy to a camera, to a screen, it allows you to kind of drop off and kind of forget that I am just in the virtual environment, that you’re really not here. So that’s the ultimate thing, what I learned and what I worked on. But the main difference is, it really is pretty much a standard group. I mean, we have check-ins, people talk about what’s going on. People check-in on their anxiety, depression. They share their stories. They share good stories, bad stories, what they ate last night, movies, sports. They connect.  

People share their emails and phone numbers and contact each other after, just like a normal group and be supportive. And the benefit of the virtual — it’s got a downside again. You can’t just go grab a coffee during break — the benefit is I’m reaching out to someone, right now in Arizona. So, I know someone in Tucson or maybe I know someone in Flagstaff, or maybe someone in Globe or Bisbee  — all over the state. And either I can’t travel because I’ve got immune deficiencies or may need a liver transplant or I’ve got some other disease or I can’t travel because my anxiety is too much, or my depression is too much to get out of bed, or I’m working a job or I can only get maybe two or three hours free, maybe three hours later than your program.  

So, I’m able to still engage, reach out, see other people and hear their stories, and the magic part of our group is, it was you and I doing the individual session, and I tell you you’re doing a great job. And I say: “Good job. I like what you’re doing. Look at the strings there. Look at the trauma you been able to get over, process, and you’ve been able to get out of bed. You’re doing self-care. You’ve been sober for X number of days. Really good job.” In the back of your mind, though: “You know what? I’m paying this guy. I mean, he’s my therapist, but yeah, I’m paying him and I’m paying him to say good things or if I’m critical. And I say …. I’m going into a meeting. I’m talking to your sponsors and I see you putting a lot of effort in this.” You can go: “Eh, whatever I don’t like it. I’ll go somewhere else.” But when you have a group, and you have 5, 6, 7, 8, 9, 10 other people all say good things about you, and the same good things, or they all say the same critical stuff about you, it’s kind of hard to ignore. You can’t say this group is being paid just to say nice things about you, and also you can’t say this group of people has it in for you. I mean you could, but it really breaks down those walls of denial.  

It helps reinforce a lot of the therapeutic information in the process that you go through. The group is much more powerful. So, if you still get that amazingly with the camera. Yes? 

Dominic Lawson: Josh, say, really quick, it seems like it also adds that extra layer of accountability as well? 

Josh Ulrich:  Yes, it does. The amazing thing is if you’re in a physical group setting. You can always see them claim, “I got a flat tire. I’m sick, migraine, kid’s sick, can’t do this.” Lots of excuses not to get to the group. Lots of excuses not to actually be involved. This one in your phone, your kid’s sick? You can still do it. Migraine? turn the light off. You’re still in the group. I don’t need them. I’m working hard as a group. I’ve been having much higher success of people attending, simply for the fact that there’s no excuse not to. Like why can’t you attend? Unless you’re physically not going to be in the state, there’s really no reason you can’t. Which is great. Because when you reach people where they’re at, they’re at home, doing their life, and they also get to buy into the program, and they’re in it longer for a sustained  amount of time for more intensity. I find it’s much more effective. You lose a little bit of the human contact, which will make it up through the presentation and through activities, just through the brutal honesty and vulnerability of the people in the group.  

Dominic Lawson: I appreciate you saying it because I was interested in that part, for like, how do you make up for that lack of not being face-to-face, especially with everything going on, so I appreciate that insight. One of the things I think that you guys do in virtual IOP that’s really amazing is that you have this rotating eight-week curriculum, which means that, like, newcomers can kind of join at any point of the process. Why was that important to have that as part of the process for the program?  

Josh Ulrich: Well, I’d love to take credit for that, but there’s something that Jim [Corrington] and Claudia Black developed for the IOPs. We just took the in-person and put it into virtual, all right? So there is the credit. The reason for that is if you’re going to have a closed group, you have to restart it every eight weeks, 10 weeks, or if it’s completely closed, then people, members can leave, and it doesn’t work very well. If you’re an open group, it will come in, come out. What do you talk about? One of the complaints I’ve heard, it will come up in group, is I’ve gone to the other treatment centers and it doesn’t seem like they have a plan.  

This is my favorite, like why we are doing this. What are we doing? Do we have any assignment? Do we have any meeting we’re talking about? It just ends up being a giant process group. Which people just sit there and just talk. Which is good, except if I can just go to group for the next six, seven, eight weeks and complain about the same thing over and over and over again and never feel like I’ve gotten any help or been called out or need to change when I get out of that process.  

By having that dedicated eight weeks of topics, we’re able to cover all the major issues someone needs to have a much more successful life and to be sober and happier and better through their treatment process, the eight-week process. Okay if I quickly go over what the eight weeks are? Then I’ll explains how they work, too, if we’ve got time? 

Dominic Lawson: Sure. 

Josh Ulrich: Week 1 is boundaries and communications; week 2 is trauma; week 3 is shame and vulnerability; week 4 is addiction; week 5 is mood disorders; week 6 is grief and loss; week 7 is emotions, and then week 8 is recovery management. Aside note reason why we allow rotating people coming in and out it. Again, if I start week 8-recovery management, I’m still going to get everything and learn by the time I get to week 7, or coming in at week 2-trauma, I’ll get everything in on week 1-boundaries. I still get all the information. It may not be the nice week one, but I still get everything and it builds upon themselves.  

So, anything I feel like I may be missing or gaps, it will be covered. After eight weeks, I will have full knowledge that whenever I start, in week 1 or week 8, I will have. The way it works, really quick: Boundaries and communication. When someone violates your boundaries, that’s physical boundaries, emotional boundaries, like being verbally abused, physical abuse, sexual abuse, that can cause trauma. Also, communication. Again, if someone is putting you down, saying that you’re nothing, worthless. So, week 2 is trauma. So again, we learn about the trauma. What is happening? How the trauma affects you chemically, neurochemically, physiologically, socially, and then, as you suffered trauma, then it leads to you having shame and vulnerability. Usually, you will have shame from the trauma you had. You are either invulnerable because you have to put up walls to deal with the trauma and deal with the lack of boundaries or you have no boundaries, and you are extremely vulnerable because you have so much trauma. And then that leads to addiction, as I said you had pain because again, shame, vulnerability, you’re in pain, you’re raw, you had trauma, you lack boundaries or unhealthy boundaries, unable to communicate your thoughts and feelings.  

So, you’re now using, its chemical addictions, behavioral addictions, could be gambling, could be porn, could be video gaming. Then they can also lead to mood disorders which is week 5. Mood disorder would be the depressionanxiety. Again, you’re depressed about what’s happening, anxiety about what could happen. Then that goes to grief and loss because you start to realize, what did you lose? You lost your childhood. You lost your innocence. Maybe you’ve lost jobs. What has the addiction cost you? What is your major depressive disorder you have throughout your life?  

And then goes to week 7, which is emotions, which is, now you have to connect to your emotion. You learned about grief and loss. You identified your traumas. You understand how addiction works and how is it affecting your mood disorders. And now you need to connect with emotions. Cause maybe you’ve only had anger or only had sad. So, what are the emotions? We have many emotions. Pia Melody talks about we have at least eight primary emotions, that between the eight, we have multiples within there. And then finally, after we connect with their emotions, we understand the trauma, the grief and loss, and the boundaries.  

You now can do recovery management. Which means you can now work on what is your plan to stay sober, to stay healthy, to get out of bed, to do self-care, to know who to call if you think about doing any self-harm, and so that’s how the program works. 

Dominic Lawson: You mentioned video gaming, and I know in my prep I saw that you’re a gamer. I’m a gamer ,and when we were met for the first time at our sales meeting not too long ago, you talked about the story about a young lady who is on Twitch. Could you share that story with us here on Beyond Theory?  

Josh Ulrich: Yes, I can. And first, shoutout Atari 2600 old school dude. Excitement playing Pacman. Anything with a plug, I’ve done it.  

Dominic Lawson: I heard that. 

Josh Ulrich: Atari 2600, NES, SEO Genesis. I become a Segaman, Sega Genesis, Sega Saturn, Dreamcast. I think like an Xbox, PlayStation 4, Wii. Now I have a [Nintendo] Switch because I got a little one. 

Dominic Lawson: Got you.    

Josh Ulrich: Yeah, never gotten a computer, never had a fast enough rig. All right, enough on me.  

Dominic Lawson: Got you. 

Josh Ulrich: What was really nice about virtual, where people can participate in group therapy that wouldn’t normally be able to participate, I had a new one. She was in her early 20s and she was a gamer. She actually did Twitch. She did some type of a streaming services and I think Twitch is her primary income. She also suffered from severe anxiety, social anxiety. She couldn’t leave the house. She’d been through a lot of trauma growing up, a lot of relationship trauma. When she got out and started dating and being with men, it made her want to isolate and just solely engage with us online.  

She was interesting, when we saw her. She had her whole gaming chair, the headset, two monitors and so here everything was set up. She was there not for any drugs or alcohol. She had used some stuff in the past, but it really was debilitating depression and anxiety, and because of that she didn’t want to go seek any type of therapy, couldn’t get out of the house, couldn’t go to a group setting. Basically, did the virtual. She’s been in therapy for, at least since she was, like, 12. She did a lot of therapy, she knew the ins and outs, probably could have a master’s in it. So, by the time she gets in the group, she starts to make connections because she was able to actually interact with the other people around and hear stories of other people who had abuse, that had had poor relationships and have anxiety and have depression. And she starts to make those connections to the point that when she had battles of depression and it was so bad she couldn’t get out of bed, instead of getting her gaming chair, she just grabbed her phone and just sat there from her bed. And she also had migraine, sometimes she’s be doing it with lights off, but she’s always aware.  She was always present. She is always talking. She even got into an accident, got her leg slice, but she was able to come back the next day and also got the stitches and kept going. When normally that would be an excuse: “I have to go to an outside therapist or outside group.”

When she left, she stated she got more out of this group experience than she did in all the individual therapists in other treatment centers before because she was able to develop real connection and it was always there. It was something she knew she got to always wake up to. You get out of bed. It was a reason to wake up. It was a reason to connect, and she would be able to hear voices. Our group is co-ed. She heard male voices, female voices. She was able to process one of the relationship issues she had both from trauma from other females, trauma from other males, and social anxiety. She did get out. She was able to start working on getting back into employment. Love to say we cured her social anxiety, we didn’t, but we definitely made a huge impact and she enjoyed the whole process and it meant a lot to her. The fact that she never gave up, never wanted to give up and she always contributed, it was a neat experience. 

Dominic Lawson: Thank you for sharing that story, Josh, because I’m curious because I imagined there are some people who say video games, whatever, or anything with depression or anxiety due to video games. I imagine sometimes there’s a stigma that, like, that’s not a real thing. I appreciate you kind of sharing that with that story, Josh. 

Josh Ulrich: Yeah, a game, like anything, can become an addiction. I think there, where a story like people like in Southeast Asia, there was a typhoon coming in. They’re still doing their gaming. But it’s also a way of connecting, being with others, their group, chat groups, the teams that you go on. But again, that’s usually through avatars. You mean we’re not really seeing someone, and the difference is you’re doing an activity. I mean, same thing you’re going outside and playing ball. Can sit there and have someone you can play hoop with and connect, but it’s not the same as sitting down and really talking about all the crap that’s going into your life, what you’ve done and why you can’t drink or you can’t use, or what’s happening when your age or what happens if someone passed away, that’s a different connection. There’s nothing wrong with games. It’s very healthy. But the fact that the virtual IOP allowed someone who used to that format to get the connection they need to process their trauma is huge. 

I hope you are enjoying this great conversation with Josh Ulrich, a virtual therapist at Meadows Behavioral Healthcare. Join us next week when we continue our conversation, this time discussing how to deal with grief and loss.   

Beyond Theory is produced and hosted by me, Dominic Lawson. You can discover more, including videos of some of our conversations, at BeyondTheoryPodcast.com.  
Finally, thank you for listening, and I hope you join us next time for another episode of Beyond Theory.