ANDY BAGGOT Insider

BY ANDY BAGGOT
UWBadgers.com Insider

MADISON, Wis. — One of the most emotional, impactful get-togethers involving Wisconsin student-athletes occurs weekly, in private, and lasts about an hour.

They're relatively small assemblies — typically five to eight participants with an unofficial max of 12 — and are open to men and women from all of the 23 sports.

The nightly meetings are built on the pillars of empathy, encouragement, vulnerability, trust and friendship. They are designed to be equal parts informative and therapeutic.

The only shared requirement is the pain of injury.

When Dr. Cassie Pasquariello was going through the hiring process to become the UW director of clinical and sport psychology, she had a conversation with long-time UW athletic trainer Ashley Parr. One of the ideas they discussed was that of a support group for student-athletes dealing with prolonged injuries.

"Science has shown that these long-term support groups help these athletes recover faster and they're more confident when they return," Parr said.

Shortly after Pasquariello was hired in January of 2019, the concept came to life. The confidential sessions debuted with in-person gatherings and carried on throughout the summer. They are now virtual meetings due to the COVID-19 pandemic with some participants checking in from the West Coast and overseas.

Pasquariello was involved with similar programs when she was in residence at UC-Santa Barbara and Washington. She believes their impact to be significant.

"Research suggests that for many college students, groups like this are as effective or more effective than individual therapy in the sense that just the peer support and feedback — with a licensed health facilitator — can make a profound difference," she said.

The student-athletes aren't the only beneficiaries. Pasquariello, Parr and Dr. Ramel "Kweku" Smith typically emerge from the sessions feeling emotionally fortified.

"We always leave saying to one another, 'That was the best or one of the highlights of our week,'" Pasquariello said. "It really is profound, humbling and an honor to be in this space with these elite athletes and see them work through things at their own pace and timeline."

All those currently taking part in the support group volunteered to participate. All have long-term injury issues — some are chronic; not all are surgical — that put the student-athlete on the sidelines for four-plus months. The injuries run the gamut, including shoulders, hips, back, knees and concussions.

Pasquariello said eight student-athletes attended the first meeting and eight to 10 consistently were on hand for the rest of the spring semester in 2019.

"I always hold my breath starting groups like this," she said. "Is anyone going to show up? What are the minimum numbers we can run? If only two show up it's going to feel like couple's therapy. Three is awkward. Four is better. Five is ideal."

Perhaps more important than the initial turnout is the number of those who return for the next meeting.

"I've never had someone not come back," Pasquariello said. "They all leave saying, 'I should have done this a while ago.' or 'My teammate needs this.' or 'I'm so glad you talked me into coming.'"

These are common themes of first sessions that Dr. Pasquariello has observed during the past few years.

The meetings typically follow two conversational paths. One, driven by Pasquariello and her colleagues, focuses on a specific concept, like emotional well-being, identity, meditation, sleep or personal advocacy for one's health care. The other, fueled by the student-athletes, is more free flowing.

"Wins and losses," Parr said, referring to individual victories and setbacks during recovery.

"They help each other more than (the UW group co-leaders) help them just because they've gone through it and they can say, 'Yeah, I know exactly where you're at,' whether it's a physical, mental or emotional standpoint.

"They lean on each other. It's really about empathy and vulnerability. They do a really good job of that."


Video: Dr. Ramel "Kweku" Smith, Wisconsin Clinical & Sport Psychology

There's a lot to be said for having the shared injury experience, for having been there and done that.

"Sometimes their teammates don't understand — they haven't been there — and sometimes they don't want to have to explain it," Parr said.

Pasquariello was growing up in Napa Valley, in Northern California, when she came across a newspaper article about sport psychology that piqued her interest and put her on a path to a diverse education. She played volleyball and basketball at Pacific Union College where she earned a degree in behavioral science. She secured master degrees in counseling psychology at Boston University and Virginia Commonwealth and a doctoral degree in counseling psychology with an emphasis on sport and exercise psychology at VCU.

Parr, from Miami, Florida, received her undergraduate degree in athletic training at Purdue and a master of education, sports and recreation administration at Temple before coming to Wisconsin in 2005.

Pasquariello said the most challenging aspect of the student-athlete experience when it comes to long-term injuries is related to identity.

"How do we help them embrace being more than a student-athlete; that they're a brother, sister, son, partner, student as well," she said.

An injury changes everything about their lives, from their self-esteem and sense of fulfillment to their confidence, happiness and identity. Complicating matters is the fact injured student-athletes, especially those with lengthy recovery periods, often feel estranged from their coaches and teammates.

Parr said conversations with the injured have to focus on the person, not the physical pain.

"Let's talk about how you are and then we'll get down to talking about whatever body part we're treating," she said. "They're thinking about (the injury) all the time and if you don't show them that they are more than just their injury — it's so in their face all the time that they start to take that on — we try to do a really good job of asking those questions."

Pasquariello described a typical pre-COVID session. Participants gather in the early evening in a conference room just down a long corridor from the UW football locker room. Tables are moved to the side and chairs are arranged in a circle so that Pasquariello, Parr and Smith — seated with different views of the group — can observe expressions and body language.

"At some point everybody's going to talk, even if it's just a little bit," Pasquariello said.

"Every few weeks we do a (specific topic) for the majority of the hour, but most of the time they prefer checking in and hearing how everyone's doing, giving each other feedback and support. There's a nice camaraderie."

Pasquariello said the discussions within the support group began taking a deeper tact when the coronavirus came to life, creating heightened levels of concern and unease. Uncertainty about their health and canceled sports seasons, the lack of in-person contacts as students as well as athletes, and worries about family in the age of COVID-19 have become more pronounced.

"I would say some of them during this pandemic have been more real — everybody's being more real — than maybe in the past," she said. "Part of it is just their time spent with one another and increased the level of trust. This is a really hard time and people are isolated and to be isolated and injured is a double-whammy. These athletes are being impacted on a bunch of different levels."

Pasquariello said the virtual meetings are well attended even though some student-athletes are abroad, requiring them to sign on early in the morning or late at night.

"The last few weeks we've had really authentic conversations that maybe the things that have happened the last couple months have allowed them to be even more open and real," she said.

Parr, who worked closely with UW softball for 15 seasons before switching to women's basketball this summer, compared a long-term injury situation to stages of grieving.

"Denial, anger, sadness," she said. "Whether it's a senior or freshman, whether it's a first-degree ankle sprain or an ACL tear, the same issues are there. They all think, "I can just push through this.' There's never a good time to be injured."

It's difficult because the student-athlete is contending with a lot of issues and emotions. They may be fighting for a starting spot. Their parents might be coming to see them play. They wonder what their teammates will think of them.

"It's hard for them to understand," Parr said, "especially if it's the first time they've been injured."

Parr was asked for the most challenging aspect of an injury case. She offered two.

"Sometimes the challenge is, 'How do I hold the reins back because, physiologically, they're not ready?' They may feel ready to do something, but physiologically, their body's not ready to do that thing," she said.

Parr used a torn anterior cruciate knee ligament — a classic long-term injury — as an example for the second aspect.

"You're at a month or six weeks and you're just grinding and you're doing the same thing over and over again, finding that motivation," she said.

Pasquariello said the culture of each of the 23 teams at Wisconsin plays a role in recovery.

"We want the team culture to be health-promoting and, if there's any way we can educate and support and promote that, these student-athletes are going to come back faster — more ready, less fearful," she said.

Pasquariello said there are more cultures than sports at UW. For example, football has its position groups on offense and defense and track has sprinters, long-distance runners and weight specialists. Coaches have different approaches, too. Sometimes one coach overlaps with another.

"It's so coached and facilitated and maintained and sustained," she said. "We have quite a few cultures running around."

The primary end game is the same for each student-athlete: Wellness.

"We want them to feel like they have ownership of their health care," Parr said.

Another big objective has to do with relationships.

"I want them to walk away having a new friend," Pasquariello said.

Parr and Pasquariello said being a part of the support group is a privilege.

"It's an honor," Pasquariello said.

"Just to see them evolve over the semester and know that they are forming friendships — these are really deep bonds that they have — and you can see how much they care about one another," Parr said. "It's really heart-warming.

"I'm grateful for what they teach me. It's a pretty incredible experience."