 and welcome to the latest edition of Tell Health in Hawaii. I'm your host, Vikram Acharya. I'm the Chief Executive Officer of Cloud Well Health, an all in all virtual physician-founded telemedicine organization based in Hawaii. We have a very, very fun show for you today. I am very pleased to introduce to all of you Dr. Annie Rohr, psychologist. Hi Annie, how are you? Good, thank you. How are you? I'm doing good. I'm doing good. It's good to see you. Same. Nice to see you. Yeah. So on this episode in Tell Health in Hawaii, we're going to delve deeper into the subject of behavioral health and mental health. And you are a psychologist by background, which is great. And to get things started, tell me a little bit about yourself, where you're from, your role as a psychologist, and we'll go from there. Sure. Well, you can call me Annie. I'm known as Dr. Annie Rohr. I'm born and raised in Honolulu, Hawaii. And basically I started out as a marriage and family therapist, and then I went on to get my doctorate in clinical psychology. So I've worked for almost 15 years as a psychologist, aging me out, and worked in various fields, from military to students at the university, couples counseling, things like that. Also been a teacher for a while, do some self-help groups. So I have some knowledge and information in various fields. So that's a little bit about me, my whole family's in Hawaii. So we've been here for nine generations. So it's been a long time. Yeah. What brought you interest in wanting to pursue specifically psychology? Well, the absolute truth is I didn't. I sort of fell into it. And sometimes I wonder if that makes me a different kind of psychologist or a little bit more approachable in a way. But originally I wanted to go into obstetrics or natural medicine, but I sort of fell into this field. So my background was in biology and everything, but I sort of fell into this field and it just kind of stuck. I kept finding that I kept going and I kept finding other paths to learn from. And it sort of just stuck. So here I am. Especially with there's a lot of discussion around the significant need for behavioral health and mental health resources these days. What's the day in the life of a psychologist? What's it like if you were to take me through it? Well, the first thing that I want to say to people out there who are curious about what it's like to be a therapist is that we do worry about our clients a lot and we do have concerns. And I think a lot of people don't realize that. They see us as robotic or people who have our stuff together, but we are regular people who have our own issues and we learn like everybody else. And when you're looking for a therapist, finding someone who you can relate to and get rapport with is the main thing. So a day in the life of a therapist is basically you're talking to people all day and you're kind of taking on their information and their issues. And sometimes it's not issues at all. It's just to help someone be a better person, whatever their goal is. So you're basically working with someone and trying to figure out what their goal is or what their need is or what pain they have and trying to get it so they get better or feel better or know how to work through it. So I would take several calls a day. I'm doing mostly remote work now, but I used to do in person. And you're just speaking to people and working through things. And sometimes it's just simply connecting. Sometimes it's problem solving. Sometimes I'm also talking to family members, lots of referrals, getting people to where they need to go. But the absolute truth about being a psychologist is this need to connect and help people feel that they're not alone and they are able to connect and they can problem solve and they can be their best selves. That's the main thing. Yeah. People often think that going to a therapist means that something is wrong and that's not always the case. I mean anybody could use a therapist. Sometimes you just need someone by your side or you need to figure out what you need to do next or how to be better or, you know, the age old issue like how do we live happily. Yeah. Yeah. Now there's different types of resources that one can pursue to get support. So there's therapists, there's psychologists, psychiatrists. What are some of the differences between them, Annie? So most, so psychologists, let's see, let's start with psychiatrists because people often mistake psychiatrists and psychologists. A psychiatrist is an MD, they're a medical doctor and they can prescribe meds. They can do the same type of therapy that a psychologist does and they prescribe meds. However, usually it's shorter visits. There is some psychiatrists out there who do, you know, full therapy but usually it's shorter visits and med management. And then underneath that would be the psychologist and that's what I am. And a psychologist, we have a doctorate. So instead of a medical degree, we have a doctorate or a PhD or a SID. So it's extra schooling, extra training. Psychologists can do extra assessment. They're trained in certain things that maybe a master's level therapist wouldn't be. A lot more schooling, that's for sure, a lot more student loans. But so that's the psychologist level. And then the master's level therapist is someone who's trained strictly in therapy. Maybe they don't do as many assessments and, you know, it's a little bit less training, but they're equally as capable. So that's what I want to let people know is the key here is to not find someone who has the right letters behind their name but rather to find someone that you connect with. So if you're talking to a therapist and you don't feel a connection, look for another one. You want somebody who you can feel rapport with and that is the best kind of therapy. So master's level therapist or psychologist or psychiatrist, as long as you feel like you sort of buy into what they're saying, they support you, you have a good rapport, then things will go well. What's the what's the state of the availability and access to mental and behavioral health resources in Hawaii at the present time, especially during post pandemic or, you know, I'm sure it's pretty tough. We're in a little bit of a crisis as far as availability for mental health providers. And what's happening is when when the pandemic happened, people got, I mean, people got anxious, you know, we got busy and practices shifted and changed. And you had someone who had an in-person private practice, and then it shifted completely to to telehealth, and then people were making shifts and all kinds of things, changed jobs, moved, got more clients. So at the current moment, it's hard to find a therapist. It is. And you'll you'll find someone who maybe your friend is seeing. And that's one of the number one ways to get a therapist is usually if a doctor says, hey, you know, I have this recommendation for you, people love hearing from their doctors. Or if it's a friend, a friend is saying, this is working for me, give it a try. That's the best, you know, often most common way we find a therapist. And what what happens is the person that you got recommended that they're full or they're not taking or they're not returning calls. So that's something that we have to work on and find the way, you know, to help people get get seen. So that's the main issue right now. As far as behavioral health goes, there's a lot of behavioral health crisis and mental health challenges in Hawaii as well. It's hard to tackle those things when you you can't find a provider. So that's something that that, you know, at Cloudworld that we're going to be priding ourselves on is that if someone calls us, we will get them referred. We will if it's not with us at someone, you know, we will find help for someone. So that's something that I'm proud of that we're going to be doing. Absolutely. The same day service. Are certain regions of the state of Hawaii more of an acute need than others from from your experience? Not not so much. I think I think what's happening for the most part is just this this idea of because not only was there the pandemic stress, but also high cost of living in Hawaii is causing a bigger issue, right? So the majority of the problems that that are coming through are just the, you know, a regular human being who is stuck, you know, or finding themselves financially stressed or finding themselves having a hard time communicating with their partner because life got hard. So I'm seeing a lot of that. So, you know, there's kind of just like anywhere else. I mean, we have the acute folks, the people who are in real real stress and real danger. But for the most part, the majority of people are, you know, regular run of the mill people who are looking for help. They're stuck. What's a common diagnosis that you find? Is it is it is a depression or anxiety? It's adjustment disorder. What is that? Yeah, so people people are usually thinking that a therapist would mostly see someone who's already, you know, got depression. And we do, you know, by all means, we want to help everyone. But one of the most common things we see is someone who's just struggling adjusting, adjusting with what's happening, adjusting to how their marriage change, adjusting to how their child is leaving the house, or a new mom, somebody who's trouble, you know, having trouble at work or struggling in the military. So this idea of adjustment, and then you get help and you try to get it settled. And if it doesn't get settled, then that's when we start seeing the depression and the anxiety. So that's sort of the usual is the adjustment disorder, this, you know, the anxiety of the depression. And then you start getting the heavier things, the things that need more work and more help over time, you know, where you get trauma, you know, bipolar people who have been struggling for a long time. Do you also do therapy with couples and groups as well? I've read that groups can be group therapy type of sessions can be very beneficial for those who participate. Couple sessions. So what's interesting is people always think about therapy, you know, the stereotypical old style therapy where you're just one on one. But as time goes on, we're starting to learn that when you work with a couple, for instance, you get to see more of the person. Because when we present ourselves in front of someone, we're only presenting what we want them to see in a lot of ways. And it's very telling when you've got your wife sitting next to you by her facial expressions and what she's thinking and why she's annoyed and her side of the story. So I do couples therapy. So individuals, couples, and then family therapy is even more wonderful because then you get to see the family dynamic. So I am, you know, by training a family therapist. So I have reached out to moms, dads, children to get, you know, to get a better story to get a better grasp of how things are going. But usually it's one on one or by a couple. And occasionally we get families. As far as groups go, groups are a wonderful thing because from the get go, you immediately see that you're not alone. And, you know, we all just want to connect and know that we're not completely crazy and that we're not alone in this world. And then right away, you're connecting with people who have issues that you have. Or seeing someone in your group struggle, and then you can reach out and help them because you figured something out. Or seeing someone in your group help you because they figured it out. It's a very powerful dynamic. So groups are pretty cool. Groups I always recommend for people who are grieving, substance abuse, or just somebody who just doesn't want to be alone anymore like that feeling of learning to communicate and connect. So there's groups for everything now. I'm sure some of the groups end up becoming friends too outside of the sessions once they find a good bond. Sometimes they get connected or at the very least, they have somewhere to go when they need something or they need to connect. You touched on it a little bit. Telehealth when it comes to behavioral health and mental health as a resource. Is that opening up access? Is that providing the same type of level of comfort for patients as the traditional kind of in-person model? I think people at first were a little bit hesitant about telehealth and therapy. The main concern that everybody had was were we able to as clinicians be able to read the same energy or read the same facial expressions or mood? And actually I just listened to an amazing seminar and she said that the woman who was running it said that the biggest struggle was the person's ability to just leave. You know if something gets hard they could just literally just shut that screen. So in that way there are some challenges but also interestingly we also get to see a little bit of someone's life. We get to see because you know when you're talking to a mom the kids are interrupting. They do on my you know my child interrupts. But you know there there's you get to see a little bit about their life. So there we have some challenges but what we found you can hear my little girl. What we found is even more so we've opened access to people who didn't have it before and that is amazing. So for instance if there's someone who has agoraphobia or some kind of issue or high anxiety where they're afraid to leave their house I can see to those people. Someone who means yeah and you know for instance someone who's a caregiver and they can't leave their home because they're caring for a parent which is a big issue in Hawaii. Hawaii is family oriented and we're all taking care a very large majority of us are multi-generational homes and we're caring for our families too. I just went through that with my dad and I couldn't go anywhere because I was taking care of my dad and I had a young child. So I'm able to reach people like that. I can take care of them while they're caring for someone else. Seniors who are struggling people who are immobile or someone you know simply they had a work meeting and they couldn't get to me and they called me on lunch. So you know what I mean? We're getting everybody. So yeah there are some challenges but there are also some major benefits and it turned out when you look at the research there is no difference. We are able to you know read empathy. We're able to see movements and it works out just fine. So we are definitely being able to give access to people we couldn't before and more people are coming in that wouldn't because they prefer to be a little bit separate. Yeah they may feel they may like that privacy from home. Yeah even more so right and again right with the pandemic and all the things that we woke up. We woke up a lot of people's anxieties about connecting and germs and all the rest of it. I didn't get to lose any of those folks. I got to see them and help them and help them be better and this is one step right and then sometimes people end up wanting to go in person and that's great. Majority of people continue like this because it's very very convenient. Now with all the the intake that that a psychologist like yourself takes in every day how do you decompress and you know you have you have a young child you have your personal life but you're absorbing all of this you know all from patients every day how do you how do you do that balance that's that's that's a lot to take. Well I'm still learning it but I think that's the thing right and that's what I think I hope makes me helpful and relatable is that with every step that I take in my life I'm learning more and more you know as as I became a mother I was able to connect more with mothers on a different level as I became a caregiver I was able to connect more I lost my dad I understood grief in a different way so I'm learning balance too but what I try to do for the most part is I try to make sure that every day I wake up in the morning and I tell myself I'm going to have some good moments today and at the end of the day I review the day and I think about was I proud of who I was today and you know what do I need to fix what do I need to change and that's kind of what I encourage my clients to do every day is a new day to assess reassess change and grow so that's kind of how I roll some days are good some days are bad some days I get to go on the walk I want to and some days I don't but the whole point is to every day try to find what makes me happy even if it's something small and also try to connect with someone and then you know assess how I can do it better later so that's that's how that's how we got to do it you know you mentioned the subject of body language what do you look for in a virtual session when you're like okay this is going in the right direction what type of body language can you see literally through the screen to gauge is this going in the right direction with my patient or not that's an interesting subject so we're looking for engagement we're looking for they're leaning in you know they've stopped focusing on how they look now that's something to think about right when we're on screen I'm doing it myself and you know what I mean but there's a moment there's just this amazing connection moment where the person stops looking at how they look and they start focusing on what they're saying are they leaning in there's a little less distraction and sometimes even more important is when they disengage for a moment you know that you know that something went right because they're thinking you know they had to take a moment they had to take a step back so it's very very important you know body language what we're looking for but the most important thing is that connection that feeling that the two of you finally got to where you need to go and they want to talk and they want to open up or they want to hear more so it's kind of neat it's very similar to in person except in person the distractions are a little bit different right so I'll have someone who's fiddling with something in my office they're looking all around but at home their phone I don't know where their phone is you know and I don't know what they're what's happening and what they're looking at so it's easier to disengage so it's really easy to see that sense of engagement and it's okay to me all of these things are amazing when someone is doing what they need to do and seeing me that's okay I mean that's the whole point I'm someone who's here to help you do you and anxiety people with anxiety people who have certain certain traits they need to be touching their phone they need to be looking around and that's okay that's what's so wonderful about this is it's all it's all alright and it takes the pressure off now most sessions your virtual sessions do they start kind of slower people a little uncomfortable and then after a while they open up or right off the bed many of your patients just really start to communicate with you how does that relationship evolve over time it depends on the person I think I think we have people who are ready and they've been doing zoom calls for a long time and they're ready to go and there's no problem and then you have people who are just awkward and I think in person and virtually it's the same you know this idea of like just getting to know and it's it's also a cultural thing it's a it's an internal thing how do you connect with someone else you know and everybody's different and some people need to warm up and get to know me as a therapist some people don't feel comfortable unless they know me a little bit and that's okay and some people don't want to know me at all and they want me to focus solely on them and that's the whole point is when you're working with a therapist you want them to be where you need them to be and follow your lead um and then they and then that wonderful thing happens where they guide you into this beautiful place where you know you feel better that's how it's supposed to work I'm sure a lot of your patients virtually once they know hey you know I'm I'm from Hawaii I was born here I think that that local rapport I would think really establishes a nice introductory connection I think so too I think um knowing culturally here I mean we can talk about that this is uh you know there's the Hawaiian people the Asian people we have a mixed pot we've got the people who are like me Portuguese who've been here for a long long time um you know we have this big ethnic mix of people and then we have people who we call them transplants where they move from somewhere else and they stay um and you want you generally want that vibe that the person who you're talking to understands where you're coming from so you don't have to necessarily be from the same place but they have to sort of get what you're saying and I I will say it does help when you're talking to someone and you're mentioning where you ate and they know where it is or you know that's a wonderful thing but in Hawaii there is there is this general need for privacy um because of the cultures that we have um you know and I'm not trying to be stereotypical by any means or or offend anyone but stereotypically um Asian populations are private and they you know they keep their their personal issues in um the you know and we can say that about Hawaiian people they're you know because of all that they've been through there's trust issues there's all these things happening here in Hawaii culturally um and you want to keep it private and you don't want to share and you don't want to tell people your problems and um that's what I hope therapists out there are doing is this idea this invitation that it's still private you know you you you are just finding someone who can help guide you or someone who can listen to you or someone who can you know help you feel heard um and it does remain private and you know what I mean there is this this wonderful connection that takes place sometimes you can't get the help you need from yourself or your family sometimes you just can't and you do need that outside help so um it does help absolutely that that I work with some local folks I love my I love Hawaii people um because you know the jokes come too right you're not only just talking about what's wrong you're also talking about what's going right and you can connect um for those that um are listening to this podcast and are going through some some issues internally um what are struggling with the concept of you know should I see somebody or not what what types of advice would would you give them the main thing to me is if you're coming to a place in your life where you feel like gosh do I need a little extra help then my answer is that you do um because to me on some level everyone could use a therapist not just someone who's struggling someone who's doing well could also sometimes use a therapist someone who's doing great the thing about life is right we we can be lonely in in moments where most people think we shouldn't be sometimes marriage is the loneliest place sometimes motherhood is the loneliest place um sometimes you know being on top in the business is a lonely place you don't know so from my perspective if there's a moment in time where you think gosh I might need a little help here I encourage someone to seek it and it all you got to do is try you might end up talking to someone you like and the worst case is you don't and then you just call someone else and and that's what I want to tell people is that it sometimes takes a while to find a good fit you want to talk to someone that you trust you want to talk to someone who makes you feel you know that you believe in what they're saying it takes two to three sessions to figure it out sometimes people I think they they get nervous and they they stop going to therapy too soon I always tell people give it two to three tries if that person doesn't fit it's okay they can help you find another one or you can go find another one that's a big deal is they always worry about like well what if I don't call them back you know if the person says what if I don't like her what if I don't call her back it's okay I'll be okay I just want you to get help and that you know that's something to think about is this is about the person calling and this is the person who needs help um and for me I openly encourage people to say hey this isn't working for me hey being on the phone and your daughter making noise isn't working for me whatever it may be and then we can fix it together or I can find someone I can find someone who can help them better um a lot of therapists most therapists not all um when you call them if they're not a good fit for whatever reason we'll give you more referrals um and I I encourage people to keep calling and keep trying um I'm really good at that you know I'm really good at helping someone match to their therapist so um I always encourage people just call you know call me if you need help and I'll help you find somebody um so I that's the main thing is this idea of just trying it out because the worst that happens is you don't you had a conversation that didn't go well and okay you know what I mean it's all right and then you can find someone else but usually it's pretty helpful just talking and expressing yourself and getting to the place where you're brave enough to say you might need someone is already a start and you feel better it's interesting you mentioned you know it's going to take a couple sessions for people to really determine if it's a good connection with your therapist it's interesting mm-hmm um so I know that we previously when I talked I wanted to talk a little bit about what Hawaii stuff um Hawaii people are going through at the moment so if people are listening and watch this they can think oh you know this this is a good reason I'm not crazy I'm not going through something horrible but some of the things that are challenging the people in Hawaii right now you know that might be adding stress is that high cost of living um is finding out that all of a sudden they can't afford the home that they were in or how life you know life is costing them um is is as we age we are starting to take on more care for our family um caregiving so these are things that Hawaii people are going through like this idea of cost is getting really high um can we even afford preschool can we afford the house we're in do we have to move so that I'm finding has gone up significantly over the last few years that panic uh taking care of more than one family member as they get sick caregiving so I encourage people to understand what I'm saying because sometimes this idea of I don't need a therapist I'm not depressed I don't need a therapist I'm functional comes up but the truth is you might be going through something that's making you feel stuck that's making you feel uncomfortable that's making you feel alone or things are going well and you want them to be better or things are just okay and you want to be happy right and that's your knowledge of your knowledge of all those issues the dynamics in play and the and the variables in play in Hawaii makes you that much more effective because you understand exactly where your patients are coming from because wait I mean and and so speaking to that a little bit more also there's been a lot have changed here recently I mean when when the pandemic happened we lost like a lot of mom and pop stores things started getting very different so that unrecognizable vibe has been causing some anxiety small business owners are struggling so the high anxiety of things are coming and on top of it crime is up here in Hawaii like in a major way and it's not just a little bit of crime we're looking at violent crime we're looking at our neighbors getting robbed we're looking at you know these things that we thought only happen on the mainland and that's what you hear every day when we're talking to other locals like wow I'm watching the news and it's like what what's happening on the mainland and I'm bringing it up because these are things that are causing a little bit of anxiety a little bit of hesitation a little bit of adjustment and that's where we start getting stuck that's where we start feeling like you know when you drive down that road and you're like where's that restaurant I used to know or where's that you know things become a little different and that causes a little bit of hesitation a little bit of anxiety people are uneasy right now so that's the general state of Hawaii is this kind of sense of uneasiness and that's why I'm telling people if you feel that at all if you I just want you to know that you're okay everybody's feeling it and reach out if you need a little bit of help because there is there there are things shifting things have shifted and it is I can speak from personal experience as a small business owner as someone who became a mom as someone who had caregiving issues um and also someone whose house got that case and we did you know security cameras picked up someone trying to come in things are shifting here you know and therapists are there to help you manage those feelings too and how to get through them and what to do I know I um I can't thank you enough Annie for being on the show you know your insight into the not only behavioral mental health but also behavioral mental health in Hawaii um is is really I mean I appreciate all the details that you've provided but also for people to know that there is resources there are resources there's support available you know for people God well health access on demand when you need it when you feel like you need it what are the trigger points that you feel like you need to reach out and there is help available people if they need it and I I can't thank you enough in the great work you do people every day you know it's not a new job and thank you for everything sure and I I do want to encourage people that if they sorry I am a mom who works um but I I definitely want to encourage people that if they're ever stuck or they don't know just give us a call you know you can end up talking to me or one of the therapists on staff and we can help you even just sort it even get a referral um and that's the thing sometimes we're a good fit and sometimes not and we do promise that we'll get you a referral so you're not alone out there you know things are a little bit tough but but we're here to help absolutely absolutely thank you Annie thanks for your time thank you thank you so much for watching think tech Hawaii if you like what we do please like us and click the subscribe button on youtube and the follow button on vimeo you can also follow us on facebook instagram twitter and linked in and donate to us at think.kawaii.com mahalo