The Moos Room™

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Emily: Welcome, everybody to The Moos Room. OG3 is here and we are joined by another guest as a part of our May Mental Health Awareness Month series. I am really excited about the person that we have on today. I had the opportunity to meet her, it feels like a lifetime ago now, but it was probably back in 2018 or '19. Welcome Cynthie Christensen.
Cynthie Christensen: Thank you so much, Emily. Thanks for the opportunity to be here today. I appreciate it.
Emily: We are so excited to have you on. Cynthie just does a lot of amazing things. Is a retired psychiatric nurse, works as a therapist, and also has a really robust farming background as well. Cynthie, maybe you want to give us just your quick 32nd intro so our listeners know who we're talking to today.
Cynthie: I was raised on a farm in Iowa and did all the typical farm kids spans, bailing hay, chasing cattle. I was one of 13 kids. It was a family dynasty in my dad's side. There's really nothing they've ever done but farm, but as a girl, that was never kind of my mantle to carry forward. After being raised on the farm, I did go and be a nurse and some other things. I was also in a farming partnership with one of my brothers, a conventional corn-soybean operation. Now currently my farm is in CRP.
Emily: I'm excited to dive into a lot of different things today, but before we do that, we do have our two super secret questions that we ask all of our guests. Again, a reminder that there are no wrong answers. Don't listen to Joe and Bradley, who will tell you otherwise. Super secret question number one is what is your favorite breed of dairy cattle?
Cynthie: I would say Jerseys just because they're so cute. [laughter]
Bradley: Yes. The correct answer.
Cynthie: Oh, I'm off to a good start. The eyes and they're just a beautiful animal. There are other breeds. The Holsteins are great producers, but there's something about a Jersey.
Joe: Yes, there is something about a Jersey.
Bradley: We agree.
Joe: Totally agree.
Cynthie: Excellent.
Emily: Cynthie has started off strong getting on Joe and Brad's good side.
Joe: Yes, we needed that.
Emily: Let's see how it goes-- Well, no, wait. First, let's get the recap, Joe. What's the total count?
Joe: Yes, the totals. All right. Holsteins are at 17 now. Unfortunately, Jerseys are catching up though at 13. Brown Swiss at 6, Monb�liarde at 3, Dutch Belted at 3, Normande at 2, Milking Shorthorn at 1, and one Guernsey named Taffy.
Emily: Good old Taffy. All right. Now, our second question for you, Cynthie, which maybe you can guess is what is your favorite breed of beef cattle?
Cynthie: I would have to say Angus because one of my nephews raises Angus cattle in Iowa and I get beef from him and it is delicious. I'm going to go with Angus.
Emily: All right. Joe is happy.
Joe: The great day.
Emily: Bradley not so much.
Bradley: We'll leave that one slide but the Jersey one made my day. [laughter]
Joe: Hereford is Bradley's answer just in case you're wondering. All right. Totals running it down. Black Angus at 13, Herefords at 8, Black Baldy at 4, Scottish Highlander at 3, Belted Galloway at 2, Red Angus at 2, and all with 1, Stabiliser, Gelbvieh, Brahman, [unintelligible 00:03:39] Simmental, Nelore, Jersey, Normande, Shorthorn, Belgian Blue, and Brangus.
Emily: Lots of more variety on the beef side of things. Thanks so much, Cynthie. Now that we have all the fun stuff out of the way, we can get down to business here. A big reason that we wanted Cynthie to come on today is because of her work as a therapist. As I understand it, Cynthie, you specialize or have a fair number of patients that are farmers and in addition, you also do telehealth or video visits basically so people don't need to travel to get to you to get to an appointment. Could you just tell us a little bit more about your therapy practice and the types of people you serve and what you see as far as in-person versus telehealth?
Cynthie: I'd like to start by saying in 2015 when I started my business, I actually named my business Oak Ridge Teletherapy because I believed so strongly in providing access to really farmers and rural residents across the state. My dream was that I would sit at my kitchen table and I would just do therapy all day for people that couldn't travel to a therapist. It was going to be a lot of hours to drive there. When I created my business, it was really met with skepticism and nobody's going to come to therapy session via telehealth, I mean, you're not going to have any business. It's not as effective as face-to-face therapy, but I didn't change my name because I believe in the concept of telehealth.
COVID really flipped the notion of face-to-face therapy being the most effective therapy on its head because as we all know, everybody just went to their homes and therapists left their offices and changed their practice virtually to almost all Zoom and telehealth visits. It really created the opportunity for the insurance companies to say, "Wait a minute. We are going to have to relax our guidelines on what we pay for." Now insurance companies do pay the same for whether it's face-to-face telehealth or audio only, which is a huge gift for rural mental health therapy because it just really does open the doors to equitable care.
Emily: I just want to reemphasize that piece that you brought up about insurance. We know that, unfortunately, influences our decisions in what type of care we get for ourselves far too often. I think it's really great that this has now become an option for more people because we know in our rural communities mental healthcare, behavioral healthcare can be sparse, and so being able to get that access virtually or digitally is really important. In the midst of COVID, I moved away but I wanted to keep seeing my therapist that was up in Central Minnesota.
I have been able to do that now for over two years. Thanks to telehealth and the fact that I can access that care and know that it will be covered. I think that you make a really good point, Cynthie, and how this has just really opened up the doors to help people get more access. I appreciate you finding the silver linings from COVID and what it allowed us to do. A lot of things changed and I think it's important to remember that they didn't all change for the worse. Some things changed for the better which is is really great.
Joe: I was on a call yesterday with farmers. Well, we know how late we are planting this year. Half of them were in the tractor. This is on the lighter side of things, but how often are you dealing with the background noise when you're having these sessions with farmers? Are they in the tractor? Are they driving down the road? How often are they multitasking and you're trying to battle that?
Cynthie: I've had a number of people that sit in their tractor cabs to do therapy just because it's a private place. In my experience, they've typically been focused on the therapy, but I think multitasking is-- Planting is so automated for some people now that it is almost like a, I'm not going to say a mindless thing, but you don't have to pay attention like in the old days, I think. I am open for any way, shape, or form somebody wants to come to therapy. If doing it while they're planting works for them, I'm open for it.
Joe: That's the best part of the telehealth. It's the time-saving aspect of it. We talked to Kevin last year about how he lives only an hour from Ames and it's still to go there, have therapy, then drive home. It's three-plus hours out of his day and pharmacists don't have that. We had heard rumblings that insurance was not going to cover telehealth once COVID had started to wind down. I'm really glad to hear that that is not the case.
Cynthie: I think we've really let the genie out of the bottle. I don't think that they'll be able to put it back in. I think the fact that so much physical health is being monitored over the telehealth connection strengthens the mental health aspect of it as well. Just as a healthcare industry, I think we're going to continue to go forward. The one concern that I have is with the audio aspects because as we know, broadband is not everywhere in Minnesota. A lot of people don't have a computer that can support Zoom. They don't know the technology.
Sometimes the phone is the best way to connect to therapy. I think we really need to battle for that to stay covered particularly for the rural and farming areas. In my area, we go through peaks and valleys and you lose connection. If you're talking on the phone, you say, "You know what? I'm going down in a dip and I'm going to lose you." We don't even have audio everywhere like other parts of the metro area. I think we just really need to advocate for just keeping that phone aspect out there as well.
Joe: That's always been a challenge for us and we talk about it a lot at extension because trying to reach the whole state is a challenge sometimes when we're trying to use either virtual means or even email at times. We totally get that. You touched on physical health and how they're doing that through virtual. I know one of the things that I've seen you talk about before and things I read before we got on here with you, is mental health is part of total health.
I think in the past, at least what I remember is that we struggled to even get dentistry a part of total health at one point. They were struggling to be like, "Oh, no, your teeth matter to the rest of your body. Your doctor and your dentist maybe should talk." How do you fight that same battle for mental health and really push forward and say, "No, this is really critical to your physical health as well"?
Cynthie: I'm going to warn you, Joe. You've just pulled out my soapbox, so you might have to get the hook out. Just as a psychiatric nurse and a therapist, I believe that whole health begins with mental health and that we've really got the card before the horse. My contention is that if someone can be mentally healthier, sleeping better, eating better, exercising, connecting with social support, having good self-esteem, caring for themselves better, I'm going to argue that almost every other medical issue would be improved. Diabetes, cardiac, obesity. The list just goes on and on.
Even for post-surgery kinds of things where you have to go to physical therapy or you have to do exercises. If you have poor self-worth or poor self-esteem, it is just going to be harder to motivate yourself to do those exercises to improve your physical health. I think we just need to recreate the whole system and focus first on mental health and helping people have tools to manage their mental health. I am sure that the other aspects of health would improve. Then spiritual health I think is very important too, just as having a belief structure that things are going to get better and just that tool can help your overall outlook in life. Hopefully, that was a bit restrained, but I could really get going on that one.
Emily: I think it's so important that you brought that up, Cynthie, because I completely agree with you. As you were talking, I was just thinking, we call it the mind-body connection, not the body-mind connection. To me, our minds, our brains, those come first. I completely agree with what you're saying and that I think that mental health is really our gateway into whole health, overall health, total wellness. I just think that that's so important and that your experience, and I imagine, you've seen that in the clinical setting, in the hospital setting, the role that our mental health does play in keeping our bodies well.
Cynthie: Totally. I continue to be encouraged. I'm happy that you've even found that out about me, Joe, that's encouraging to me. I think there's so much economics behind disease and not being well. There's no money in telling somebody to eat their carrots and go for a walk. There's more economic engine behind fast food and the diet industry and just the whole disease chain, even pharmaceuticals. There are medications that are very important, don't get me wrong, but I think it's so much easier to prescribe a medication than prescribe a lifestyle change. All right. I felt myself getting back on the box.
Emily: All right. I want to keep going down this path a little bit because you just said something that coached my ears up talking about maybe it's easier to prescribe a pill versus a lifestyle change. I'm curious when you are working with your clients, your patients, and knowing that a lot of them are farmers and that farming in itself is a lifestyle. What are some suggestions that you might make to a patient in terms of a lifestyle change that isn't a whole like you need to start working out five days a week and eating clean and eating healthy every day? What are some of those smaller tweaks that you maybe encourage some of your farming clientele to do to help support that lifestyle change for better mental health?
Cynthie: These are not fancy, but sleep is critical to mental health, physical health, safety. When you're tired, your brain is not functioning like it does when it's rested. I think there's almost become a badge of honor that you can just during planting season. I get it, especially now when we've got rain and there's just so few days where they've been able to get in the fields. You've got to go when you can go. I think just watching out for yourself that you're dozing off. You've got to self-monitor this kind of thing, but I think just getting a good night's rest.
You think you're going to get ahead by being out in the field for 18 hours, but are you really kind of thing versus going home and just getting some sleep? I think with farming and being out in the rural areas, there's the ability to just stop and notice nature. Just the resilience and just the calm of being out in nature, I think is something that we take so for granted and it's all around us all the time. I don't think we always pause and just take a breath and take it in. Really appreciate the resilience of nature and how it can really teach us that life goes on.
We had a spring where all of a sudden the trees bloomed and then the next day the leaves popped out. I think in farming, just stopping a minute and taking in nature. Also, just staying connected. People feel like they don't have time to stop for supper if somebody brings it out to the field. I think it's really important to take those minutes. As a farm person, I love to take food to the field, but oftentimes people don't want to stop. I think it's important to just take the time to stop and eat and connect with your family. People love to come to the field when they're coming to the field and just really appreciating that.
I think those are probably good places to start. Also, I would just say too, there's so much stress in farming and so many things that you can worry about what-ifs. To improve your mental health, it's important to learn how to focus on what do I have control over and what do I not have control over and really practicing letting those things that you don't have any control over to go. You just have to let them go because if you try to control what you can't control, you're going to just create so much stress for yourself and so much angst and then really why farm if you just keep worrying about stuff you can't control?
Emily: All of those are so great, Cynthie. I like how you started it by saying, "None of these are fancy." I think that that's really, really important. All the things you mentioned are really simple and they are just these little changes that we make throughout the day that, again, it's not like tomorrow I'm going to start doing this and this and this and this, that it becomes this overwhelming chore more so than just these pieces you're doing to take care of yourself. I think that it's really great. Sleep, so important. Being social, so important, and controlling the controllables. Absolutely. I like what you said that we can create more stress for ourselves.
I just want to throw in, and I think that you were getting at this too, Cynthie, that that doesn't mean that you can't be annoyed when the weather's not cooperating. That doesn't mean that you have to just pretend everything is fine and dandy when you are delayed planting or delayed harvesting, whatever it might be. Still feel those emotions, still knowledge the fact that like, "This is a crappy situation and it's frustrating for me," but also keeping in mind, like, "I can't control what the weather's going to do though." I think that like you said, those things that aren't very fancy are really the most important.
Cynthie: Yes. It is frustrating. Don't get me wrong, I get it. The days are passing, but I would encourage people to focus on what can they control to get ready. When the conditions are right, they're ready to go and focus on that instead of just-- you can worry about it, but there's really not anything you can do about it. Just really recognizing that. Our bodies also recognize worry as real, whether it's true or not. You could make up a story and your body responds to that anxious story as though it were true. The more you worry, the more response you get going. Then you really end up getting into fight, flight, or freeze, and you're not rational, you're reactive. I think it's just so important to think about what are you thinking about, the what-ifs. You can tell yourselves all kinds of stories about the future and none of them may come true or they may come true. You don't know, but you're just making it up in the present day.
Joe: What you just said about concentrating on being prepared, that hit home for me. That is definitely my first thing that I do. If I can't do something yet, because something's preventing me from doing it, my immediate focus is how can I be as prepared as possible. That culminates in random things that drive my wife crazy. Before I pack to go somewhere and I'm anticipating a trip, there's a full layout of everything that I could possibly bring. Then I pair it down to what I actually need. I get really, really into the process of preparing for something.
I did that in practice too, where it's like, okay, I know I've got to go to this call and anything could happen once I get there. I don't know if I have all the information or not, but I'm going to quadruple-check my truck to make sure that I have two, maybe three of everything just in case. I'm going to have six different ways to do the same thing just in case. Just in case. I see farmers doing that a lot. Bradley probably does that with grazing. I don't know if you do that with grazing, Bradley, or you're waiting to get to grass and you probably check the waters eight times and do all these other things as well, right?
Bradley: Exactly. There's just so many things. One thing that's been resonating in my mind with all this listening to you describe some things is sleep. I've learned to maybe embrace that a little bit more. The old mantra of you can sleep when you're dead is maybe not such a good mantra from the olden days, but trying to just get more sleep has certainly helped me in all of that and alleviate things. As a young professor, it's always tough. You're getting five hours of sleep at night and just running ragged. I've learned to embrace that and it certainly helped just alleviating the stress and those angst, it's just sleep. I don't know how we can stress that more, but that's the thing that's been resonating with me here just listening is, that's one thing that I think will help all of us.
Cynthie: My dad, when he was a younger farmer, he would lay down every day after dinner and dinner at noon. He would lay down on the floor for 20 minutes and sleep every day 20 minutes and then get up and go. I think that's napping, that little short 20 minute doesn't take long. I think it's really refreshing. I'm glad you're picking up on that that sleep is so simple, but it's so helpful in making our fuse longer. You're not as irritable. It seems like you can tolerate the stress more. It's physically healing.
Joe: I have a logistics question, something that I thought of right away because you said that medications aren't the only solution. You can't just take a pill. There needs to be some behavior change. At some point, medications are in the toolbox that you have to use. How does that work with telehealth? Are there any barriers to prescribing medications without physically seeing the person?
Cynthie: I'm not a prescriber, but people can reach out to their primary care doctor typically to get on medication. I really want to point out that as a psychiatric nurse, I appreciate how important meds are. They're critically important. I think a lot of people think, "Okay, I'm going to take this until I feel better." Then once they start feeling better, then they go, "Okay, I don't think I need this anymore." They discount the fact that they're feeling better because they're taking a medication. There's some research that has shown that if you think about getting well as 100%, let's say 20% of it is medication, 80% is other stuff, but you really need the 20% sometimes.
It's critically important to be able to do the 80%. If you're struggling with serious depression anxiety and you're just trying stuff and practicing things and you're just spinning your wheels, I would say probably medication is the thing that you need just to get yourself able to gain some ground on having the skills be effective for you. I encourage medication if it's warranted. I think also the 80% is important, but I really want to say strongly that that 20% of antidepressants, anti-anxiety, anti-hypertensives, all of those medications are effective.
I think it's interesting, though, in psychiatry, we tend to think about taking meds for a short term, which sometimes is appropriate. If you have a high blood pressure situation, you typically don't think, "Okay, I'm going to get my blood pressure under control and then I'm going to stop taking my anti-hypertensives. I'll just get past the crisis and then stop it." It's a different mindset, and I think we need to shift that as well. If an antidepressant is working for you, you should take it until your prescriber tells you that it's not necessary.
Emily: Thank you for saying that, Cynthie. I've shared on this podcast before that I do take medication. For me, it is a tool. It is something that it makes me feel better. I'm a human. There are days where I forget to take it and I can absolutely tell. I really liked your example with that 100% that maybe it is just 20%, but I need that 20%.
Cynthie: Absolutely.
Emily: Because I want to be at 100%. I think that that's really important. Of course, last year we talked to Jason Meadows with Ag State of Mind, who's also a pharmacist. Him and I have talked about that a lot as well. These things are a tool. They help you feel better, but they can help you maintain feeling better. It's not just here a quick fix. I'm somebody that I've been medicated for a couple years now. My dosage has changed. At times in my life, it's had to be a little bit higher. Recently, we've been able to back it off a little bit. I remember my physician asked me, though, like, "Is your goal to get off of this?" I said, "No. Absolutely not."
I was like, "My goal is to get it to a dosage that I still feel well and can still function and be healthy and do the things I want to do in life." I just remember her being taken aback by that, like, "Oh," because most people are just like, the day they start it, they're thinking about when they can get off of it, which I don't think is a great way to view it because it doesn't need to be temporary. Being on something like that long term doesn't mean that you're bad or worse off or anything. I have an aunt who's a nurse and is very pro-medication for people who need it. She calls it better living by chemical means. I just always think that, I'm like, "I just need my chemical means for better living." That's what it is.
Cynthie: Yes. It's so great that you're sharing that too, Emily, because we are biology and there are different chemicals in the brain that regulate our mood. It's a biological tool.
Joe: One of the things that I've experienced with therapy is that often your therapist wants you to figure out what your goal for therapy is. What do you want to do? When I've felt like I needed therapy, I feel pretty lost in that moment. The overall goal is just, I just want to feel better, I want to feel better. I've always struck by that question of what's the goal of therapy? What do you want to accomplish with therapy? Do I need something more specific than I just want to feel better or is there a better goal to have the walking into therapy?
Cynthie: I think it just begins the conversation. I appreciate that. It's a tough thing to answer. I think in the struggle to answer it sometimes the therapist can get an idea of why you're coming. I guess the question that I ask oftentimes is why now? Because going to therapy takes a diligent behavior. You've got to go, "Okay, I need to find a therapist, I need a therapist, I need to find a therapist." I have to get the courage up to call them and ask for an appointment.
Then I have to find the office or connect about how we're going to do the sessions. There's a lot of steps to it. I'm always curious, why now? What's going on in your life that is causing this thought process for you? Then I tend to work on goals. I do little goals so that they're more manageable. I think a therapist needs to meet you where you are. If you say, "You know what, I don't really know," then that's an okay answer too.
Joe: Coming at the same question from the other direction, we talked about meds and how we can be on them forever and sometimes that's just the answer. For some people getting to the lowest dose might be the right way to go like Emily was talking about. Do you feel the same way about therapy itself? Is there ever the goal with a client or a patient to say, "Okay, we're going to give you enough tools, build you enough resiliency that you don't need therapy anymore?
Cynthie: Again, it just depends on the client. I have some clients who come for just a short period of time. Sometimes it's one session just talking about the thing that they've internalized. Just one hour can make them feel like, "You know what? Okay, I got this off my chest. I think I'm done." Then I have one client who the other day said, "I get the sense that you're trying to decide if I'm done." She said, "Let me just tell you I'm never going to be done because I don't ever want to stop this."
Then what I do in my practice is I really let the client lead. If they want to come every week for a while because they're in a stressful time or then they go to two weeks, sometimes they go to three weeks, sometimes they go to four weeks and then they just do once a month, they say it just keeps them on track. I typically assign homework, so it just is in the back of their mind on what they should be working on. For me, it's just whatever fits the client. I always ask them, "If you leave the office thinking that it was time well spent or on the phone time well spent, then it was probably time well spent. If you hang up the call and go, 'You know what? I don't think I really needed that," then we should talk about how do we shift things.
Emily: I'm so glad you just said that, Cynthie, because you literally described my experience with therapy. As the patient, I'm really steering the ship and my therapist wants me to be steering the ship. I have absolutely gone weekly. Right in the heart of COVID, I was going weekly because I just needed that anchor. Then sometimes I go every two weeks. Now, I'm really shifting to every three to four weeks, and like you said, that keep me on track or I call it my brain maintenance. I think that that's really important too, that when you are in therapy, there is a ton of flexibility with how you get it, how often you get it. I think that that's really important too for people to know.
It is your choice and you do get to decide what works for you. I have had times when I've told my therapist like, "You know what? I need to come back again next week. There's a lot going on and we maybe didn't get to everything today." It's so great that you mentioned that. I was just jumping out of my chair because that's a really important thing for people to remember too is it is a little bit choose your own adventure. You get to explore it in a way that works for you, which I think is what can make therapy so effective.
Cynthie: Absolutely. It's really individualized. I just want to mention too that you're in charge of your own therapy experience. I have some who are doing telehealth and they have their kids in the house because one of the benefits of telehealth is that you can be home in your own environment and we strategically plan it. Typically, the kids are going to be on their best behavior. They put in a movie or something and then they're able to do a therapy session in their home while their children are there but entertained.
As a therapist too, I think it's important just to tolerate some of those. Like if a child comes in and wants to ask a question, it's fine because we're able to accomplish the big goal of getting a therapy session in. I just want to encourage people to say what they need in therapy and find a therapist who will help you meet those needs so that you can get therapy because it's so important if you feel like you need it to be able to get it in a way that makes sense for you.
Emily: What I really like about that example is, also then here's a parent modeling this for their kids that like, "You know, mom or dad, I need to go to therapy and I do it to help keep me healthy and feel good." The kids are watching TV or engaged in some other activity, but kids are super aware. Even if they're doing something else, they know what you're up to. I think that that's really important and I think it's great that through telehealth, we're able to create that for families and to show kids, our next generation, what some of these healthy habits can look like and that therapy isn't bad. Therapy doesn't mean there's something wrong with you. I just think that's so great.
Cynthie: Actually, mom is better after talking to the therapist.
Emily: Yes, and I'm sure the kids, they see that, they sense that. It helps open things up for them to be able to talk about their feelings and stuff too.
Cynthie: Yes, exactly.
Emily: All right. Well, we've been having such a great conversation. I have one final question for you, and that is, we have our listeners listening to this episode. On an earlier episode this month, we did have Monica McConkey and I asked the same question to her. I like to ask this to our clinicians that we have on. What is the thing that you want to share to the listeners that are listening to this podcast and maybe they have been hemming and hawing about therapy and battling the things that they're feeling? What's the message you'd want to share with those listeners?
Cynthie: I would just encourage them to reach out for help. It's so isolating to think that you're the only person who's struggling with this or that there's no help for you, and it's really not the case. There is help. There is hope that things can be better. Have courage to make the call. I struggle with avoidance myself. I would say if you're scared to make the call, make the call in the evening when you're going to get an answering machine and then let the therapist call you back. It might just shift the energy a little bit. My point would be just to reach out, reach out to somebody, whether it's a therapist or a pastor, your doctor or a friend, or just somebody to share what's going on with you. It's so much better if we just can connect and support each other in our struggles.
Emily: I cannot think of a better way to wrap this episode. We are going to leave it at that. Cynthie, thank you so much for being on. This was a really energizing conversation for me. I am so grateful that you were able to join us and to share about your work and how you view therapy for farmers and everybody.
Cynthie: Thank you so much.
Emily: If you have any questions, comments, or skating rebuttals, you can email those to themoosroom@umn.edu.
Bradley: T-H-E-M-O-O-S-R-O-O-M@umn.edu.
Emily: If you'd like to call us and leave a voicemail and potentially have your voicemail played on a future episode of The Moos Room, you can call 612-624-3610. You can also find us on Twitter @UMNmoosroom and @UMNfarmsafety. Thanks so much for joining us this week and we look forward to speaking with you next week. Bye.
?Joe: Bye.
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