Dr. Joan Chan and I had a great conversation on her podcast The Other Human in the Room about getting curious about chronic pain. IWhich is also the title of a workshop we are doing for healthcare humans next week on Tuesday November 28th, 2023. If you want to join this workshop, I'm offering it at 50% off the original fee. 50% off code is FIRSTFIVE https://www.joanchanmd.com/learnstore/p/getting-curious-about-chronic-pain-workshop
Dr. Joan and I discuss how GP's can understand chronic pain through a new lens can open up a whole new way of talking to patients and asking questions that can evoke a sense of safety and healing.
If you want to join this workshop, I'm offering it at 50% off the original fee.
50% off code is FIRSTFIVE
https://www.joanchanmd.com/learnstore/p/getting-curious-about-chronic-pain-workshop
Here's Joan's podcast - https://www.joanchanmd.com/podcast
And to book a free half hour curiosity call with me - https://calendly.com/paincoachdeb
Instagram - https://www.instagram.com/curiositycure.coach/
Website - https://www.thecuriositycure.coach/
[00:00:00] Welcome to the curiosity cure podcast. I'm your host, Deb Malkin, master certified life coach, body worker, hypnotist trained in pain reprocessing by the pain psychology center, queer elder fat human on planet earth here to help you evoke the power of simple neuroplasticity techniques rooted in shame free curiosity so you can feel more better.
[00:00:31] more of the time in the body you have today and build the rich, full life that you want to live. A quick disclaimer, this podcast is not a replacement for medical care. I am here to provide insights and techniques that can compliment your healthcare journey, but always consult with your healthcare provider for personalized advice.
[00:00:53] I'm excited to share with you this conversation that I had with Dr. Joan Chan on her podcast called the other human in the room. We're doing a workshop together next Tuesday, November 28th called getting curious about chronic pain. Which I'll be sharing discussing the new neuroscience of chronic pain. What we know about chronic pain from the Boulder back pain study and all of the work that people are now doing around neuroplasticity and rewiring the brain. If you are a healthcare human, or you are a healthcare human with your own chronic pain. That would be amazing if you joined us.
[00:01:34] And I hope that you enjoy listening to this episode. Thank you.
[00:01:38] Joan: Hello, Healthcare Humans. Thank you so much for coming back for another episode of The Other Human in the Room. I'm excited to invite back, I think my only repeat guest, and now three peat, so great honours to Deb Malkin here, but it's because I love her so much, and I, I just like talking to you, Deb, and so it's just fun to have excuses, to have more chats, um, and so Today, well, actually, before we start about what we're talking about today, one of the reasons that we are having this podcast recording and releasing it now is that Deb and I are going to be co facilitating a workshop.
[00:02:15] So right up front, I want you all to listen and save the date, Tuesday, October 28th at 8 p. m. Eastern. The topic is... November. November. Oh my gosh. Thank you so much. Tuesday. Yeah, it's already past October, isn't it? Tuesday, November 28th at 8 p. m. Ethern. The topic is getting curious about chronic pain. Is, is your interest already peaked?
[00:02:40] Chronic pain is a very challenging thing if you work in healthcare and what, how can we get curious about it? So that's one of the reasons we're here together. So before we dive into talking more about curiosity. Deb, would you like to introduce yourself to newer listeners?
[00:02:56] Deb: Sure. Thank you. So, um, my name is Deb Malkin.
[00:03:00] I am the host of the CuriosityCure podcast, which is a podcast that talks about pain, chronic pain, through the lens of mind body healing. And how we can use the skill of curiosity and, skills that we learned in pain, reprocessing to attend to our human experience of pain, and then help people rewire their brains to feel less pain or no pain.
[00:03:30] I mean, not no pain ever, obviously, but no chronic pain. And so, yeah, that's that's me.
[00:03:38] Joan: That's you. Oh, I'm so excited. So I was thinking, um, well, especially because you have been really centering curiosity in your work, even like part of like renaming some of your core things in your podcast and curiosity.
[00:03:54] And I will say, just as a bit of background, um, Deb is actually one of the first coaches that I worked with one on one. Um, And, um, I cannot identify someone who, like, lives with a heavy state of chronic pain, but I am someone, as a family physician, who works with folks who absolutely live with a lot of chronic pain.
[00:04:15] And so I saw a webinar of Deb's in, like, a shared coaching space we were both in, and it blew my mind, the idea of a whole new approach to chronic pain that felt quite liberating to me, exciting, and kind of broke down some ideas that I had previously picked up and internalized from my. Um, previous medical training, um, and I just, that's my segue into saying, so when we were working together, I was using my personal experiences of two kinds of intermittent pain.
[00:04:45] One was jaw pain, but the other one that we focused on more was my misophonia, which is that I get, I used to actually get a very intense physical discomfort, um, when people were chewing loudly near me and I live with other humans in my house. So it was a problem. And I will say that I think you were the first person who like introduced me to the idea that curiosity, I, I learned, heard the word curiosity before, obviously, but like that, first of all, it was something that had a feeling to it.
[00:05:17] Like it was a kind of an emotion and something that you could sort of put on or call in or call up from inside of yourself. And that would change your. Experience of what was happening around you by getting curious about it, not just like in your mind, but in your body. And that blew my mind like lots of things that are like six weeks.
[00:05:40] We actually blew my mind, but I will say that was one of the centering ones of like, Oh, getting curious about something. First of all, it's not just like asking questions in my brain, but it's like feeling something in my body. But then that, that, that changes. My experience of it. When I get curious about it, I love, I love how you described it.
[00:06:01] Deb: I have chills in my body. Cause for me, that's like the way that I teach people. Yes, I use science and actually, and these are all science back tools. There's a beautiful, you know, reprocessing and the power of it, which is the boulder back pain study. And more of that, we'll go over in the, in the webinar, but when we're talking about this inner conversation, oftentimes pain is a part of our protection system. It's a way that our body, our internal self alerts us to some kind of threat. And that threat is just things that we've contextualized over time. Like it's, it's a way that our body and our mind are taking care of us.
[00:06:46] And I even shared an article with you about misophonia as if like the, the brain is interpreting, like something is intruding and like violating your human envelope. Right. But at the same time, we're like, when we experience something as a threat or an attack. We're going to have one response.
[00:07:08] And what curiosity really does is it puts a pause in a separation and the ability to evaluate, right? To bring your like whole self. All of these like amazing cognitive powers that we have, right? To be able to assess In real time, actually, there is nothing dangerous here. And then we're rewiring our brains, understanding and meaning making of that sensory experience.
[00:07:35] So it's very much an embodied experience. It's not just an idea. And how do we take all of these things about? You know, what's happening in our brain, what we're experiencing our body and our perception of the world around us. And how do we like, kind of cultivate an experience of relating to it that is for us. That makes our lived experience feel better because it is very annoying to like, love people and want to, stab them for chewing. Like it's a pain, like there is, there's this like painful place. And when you feel helpless to an experience where it feels like it's just happening to you and you don't have any control, that actually makes pain feel worse when we don't feel like we have any control over what's happening around us or to us. So curiosity for me, but like, when I work with people and helping them do that and learn that and like, embody that, but then like. You can do it on your own. Once you kind of understand that's even something you can do.
[00:08:44] Um, it changes your experience of, of everything.
[00:08:48] Joan: Yeah, that's like, I remember kind of recognizing a few sessions into us working together that for me, like, I, I think I described to you, but, um, it, it, it just felt like my entire body was like on fire or something. It really felt physically pretty painful.
[00:09:05] And the thing I learned was that the, when I'm saying my misophonia. Yeah. But the thing I really learned was when I stopped resisting, even if I just started describing it to myself in neutral terms, like, I remember one of the things we came up with is like, my body is having a reaction to mouth sounds.
[00:09:22] Yeah. My body is rehab. Like, and so I was just describing it. Cause before I was like, stop
[00:09:26] it. This is silly. Like, You love him. He's your husband. He's your dad or whoever. It's like, you're like, I was, I had all this internalized resistance. Cause I, it was so bad, silly, stupid, like kind of insulting words that I was having this experience.
[00:09:41] It's just sounds just stop. Like, and I was just shushing myself and resisting it and actually. That was the most painful part. When I just went to neutral, it was still uncomfortable to be clear. It was still distracting and I noticed it, but it already turned down the volume so much to simply be like, I'm noticing I'm having a reaction to mouth sounds.
[00:10:04] I'm noticing mouth sounds are distracting me. I'm noticing that kind of noticing thing. Yeah. That changed how physically uncomfortable it was for me. And that was, It's just fascinating that that can happen.
[00:10:16] Deb: Isn't that fascinating when we, I have on one of my podcasts, the title is like, tell yourself the truth of what you're feeling. We often minimize. And I see this in medicine all the time, both from patients and providers where, where our experiences are minimized and told that they're either not happening or they're not that bad. And I mean, I'm sure we could talk about that forever. And then there becomes a conflict because there's a part of you that is actually screaming on the inside saying it is this bad.
[00:10:53] There's a lot of layers of complexity and paradox in pain reprocessing, because when we meet that part of ourselves that is truly suffering, and maybe that is a younger part, like people who do IFS work or inner child work. When we think of it as like meeting that part that is truly suffering, but not necessarily from like a medical diagnostic, like treatment place, right?
[00:11:22] Where we're like, So it's, it's hard, I think it's hard as a medical provider to listen on multiple levels, to acknowledge that there is true suffering, that the experience is happening, but some of it is the brain's perception of things and that brain's perception can be changed. Which I love what you said, which is like, just by acknowledging that there is suffering happening.
[00:11:48] And then, okay, now how can we tell the story of what is happening in a way that's not dismissing? Because if you're like, well, it's only somebody chewing. I mean, like. I just feel like I feel like a kid who's like, told like, yeah, well, you shouldn't feel, you know, Timmy didn't mean to hit you in the head.
[00:12:09] Right? Like, you shouldn't be feeling this way and that kind of conflict. You're like, but I am right. So when we can kind of diffuse that. Tell ourselves the truth of it. And then, and then be the ones to also bring in this assessment, like, okay, there is actually no threat. So what is, what is happening? I'm responding to mouth sounds.
[00:12:35] And sometimes, you know, we would be very playful in our sessions and not in a way that was like dismissive, but it's like, what else, what other feelings can we bring? Right. Like, so when we bring in like, Oh, actually, you know, there's some humor in here when we can stand back from the experience where we can see it more clearly.
[00:12:58] Right. When we can like, slow it down and we're never dismissing ourselves, but we're really embracing and sometimes for sensitive people. Yeah. I like, I'm very sensitive emotionally and physically. And I like, part of me is just like, you know, can I just trade in this body and this being for something else?
[00:13:18] But, but really when I love that part of me, um, you know, one, I just experienced more love, but then I'm able to get to that next level of curiosity and being like, okay, what, what is happening? What am I seeing? What am I feeling? What am I responding to? And then, and then it's like, what do I need? Is the next part of the kind of process and like, what do I need is on multiple levels.
[00:13:49] So there's some needs that are like me today. There's some needs that are like me as like a person in the world, you know, who's like trying to achieve things or whatever. And then some of it is like the me that has been, uh, in the past, right? So whether it's that child self, um, or the, you know, so sometimes my answer is like kind of what you were talking about, which is just, just acknowledge what's happening.
[00:14:17] One of the things I do with my clients is like, which part of the day are you just rolling over yourself? As a human being, just trying to like, get through the day because of course, capitalism doesn't really care about us as people, right? They care about our output and our productivity and like all the things, but like, so somebody has to care about us and, you know, it could be us, it
[00:14:42] Joan: could start at least with us, or we could be one of the people,
[00:14:47] Deb: the people, right?
[00:14:48] And then we could like, you know, if you have power in a, in a particular situation, you can actually, you know, You know, even bring other people in and create change, but it's like, yeah, we're human beings and we have needs and feelings and we have to go to the bathroom and all kinds of things. And it's like, you know, what are all the ways in which we are leaving our human selves behind so we can show up in the world and help people.
[00:15:14] You know, we're very focused on helping other people. And our, and our poor little bodies and minds are often being like, but what about me? I'm here. I'm also a person, right? Like literally the name of your podcast is the other human in the room. And um, so curiosity for me is always the place that we get to start.
[00:15:39] And I think curiosity is is like... there's a word, I don't know what it is, but it's like the counterpoint maybe to diagnosis, right? So you're, you're saying that you were taught to as a health care provider to do what?
[00:15:54] Joan: Yeah, I was really reflecting because, you know, I. We were taught, um, a kind, maybe what was even someone mentioned the word curiosity, and I think when it was taught best, it honestly did include modeling curiosity, and then the rest of the time, it was maybe not so much modeled that way, and sort of what was the other thing?
[00:16:16] What was the other pressures? Because for me, curiosity feels very open, and I will say that then, but my experience of being taught and then evaluated to listen to a patient, hear their concern, and then diagnose them did not feel open, it felt close, it felt like pressure, it felt like performance. And I was just thinking of some of the elements there, like, um, well, one of them for sure is the pressure to get to the answer.
[00:16:49] Period. And then especially to get to the answer at the end of a 10 minute encounter, right? There's a lot of pressure and, um, it can come from patients. It comes from your system when you're being. You know, taught, it comes from like, literally, that's like the span of time that you have in that one room before the bell rings and you move on to the next room.
[00:17:09] And so you're asking questions, but like you said, like, curiosity at its best, you pause, you think, you're open, it takes time, but instead it's just like, memorize the questions to narrow down the algorithm. And I would say like, that's a piece of it is like, um, you're taught to think in algorithms in medicine, which are helpful because they are like, What are the general categories of what could be going on?
[00:17:31] That's useful, so it's not just, like, infinite possibility. We're not starting at square one every time. We're like, where's the heart again? Like, you just, like, have no idea where you're even...
[00:17:42] Deb: Yeah, you have heuristics, right? We have things that, like, categories and things that we're looking... And things that go along with other things and absolutely
[00:17:51] Joan: so useful like all of this is not like it's this or that it's it's just noticing when maybe we've gone astray and lost the curiosity element and bring curiosity back in.
[00:18:01] You don't have to throw out the way that you learn to diagnose people, but like, in my opinion, it's really helped me take some of these pressures off. So the pressure to. To pressure to get the answer right away to, to know all of the things which is related, but separate just to have to be the knowledge holder in the room.
[00:18:19] Right. Versus that the patient has something and their bodies and their experience has knowledge for us. It's sort of just like, you know, you're like. Trying to press the right buttons on the vending machine so you're delivered. How long has it been going on for? Where is it in the body? Is it sharp or is it burning?
[00:18:35] And then you're going down your algorithm in your head. Therefore, what could it be? So then I can get you at the door to move on to the next person. So there's like all of these. So there's time pressure. There's judgment of other people. Like if your colleagues think you're smart or not smart. Like there's, there's a bunch of elements that make curiosity really hard to.
[00:18:56] take root in a session with a patient. There's also like the, the patient themselves, we are not taught to really know how to hold space to keep ourselves grounded and separate from, to witness the other person. So if the patient's like, you've got to fix me right now, I can't take it a minute longer. Like, you know, people can use very Inflammatory charge language because of their suffering, of course, and it, and if it's just bowling over you, then you feel like panicked as well and you've taken on their threat.
[00:19:26] So how can you get curious about something that now even feels like a threat to you in your body as the, you're not even experiencing the pain, you're experiencing the fear of pain and it's in your body too.
[00:19:39] And we're like on board with trying to help them not feel it. Yes. Right? Because of course.
[00:19:47] Deb: And I, what I love is like in coach training, because I've never been trained as a medical doctor yet, um, unlikely, but you never know.
[00:20:00] Um, I did say the other day, if I could like get in a time machine and like be me now, um, I would maybe go back and be a medical doctor, but that's, uh, I feel like maybe that ship has sailed, but to. What we do learn in like coach training is how to hold that coach space. And that coach relationship with the client, whereas like, when I think of myself as a coach, a lot of the times it's like, it's not that, like, I have vast knowledge in chronic pain, how the brain works, pain reprocessing, and I help lots of people, but the client's journey is theirs.
[00:20:50] Like, it's not, I don't lay this template on them and, or give it to them. And like, it's It's not a pill. Pills are super useful. This is not a pill. But I, but there's a part in the journey that curiosity really, really helps. Because when people are coming at you with an experience that they want to be different, they often cannot see how actually it's not just one blanket thing all the time, right? They're taking the very worst of it often and like kind of like Globalizing that and also because our medical system the way that we've designed medicine is people often don't get help Unless they are at their very worst, right? So of course people are coming for care and help When they have tried everything else, right when they cannot figure it out on their own or are feeling very desperate, scared, triggered all these things.
[00:22:02] And so as a medical provider, that's that's a lot to embody. Cause you're still a person, like we are affected by one another's emotions all the time, right? So to be able to hold that kind of nervous system space, one of the things that I think about is like holding that loving space and also sitting in the possibility of your client's wellness and wholeness.
[00:22:27] Even if that's not where they are right now. And as a provider, being able to bring that energy to whatever it is that shows up in the room, but also responding to then being curious and right. Going through that process. And cause there are things that are like really important to know that are going to inform your treatment plan.
[00:22:50] Joan: Yeah. It's not like I'm just now sitting and like. Only thinking curious emotions in my body, and then I'm like, okay, bye, like, I still ask the same questions, but yeah, they almost come from a different place. So instead of it being like, how can I learn enough facts quick enough to get to a probable answer so that I can satisfy this person.
[00:23:13] So like, they'll be happy with me. And I can do it in a short enough time that I'm not running behind. Honestly, those are like pressures and it would be somewhat acceptable to appear. Those are the three pressures.
[00:23:23] Deb: Okay. Wow. Yeah.
[00:23:25] Joan: Happy. Stay on time. That one's really true. Troubling, honestly. And, um, if a colleague was like, I think many of us have like a fictional, very mean judgmental colleague that was, it's probably an amalgam of like our meanest preceptor Well, whoever.
[00:23:43] Right. You know, and like, would it be an acceptable kind of thing? I, I wouldn't be seen as stupid that I thought it was this, you know? Right. And we're just solving for those things. Hmm. And so then you're asking questions from that place versus Mm-Hmm. if I'm like, Hmm, this person's just said they have pain.
[00:24:02] I wonder what their body is trying to tell them. And then a lot of the questions are the same, like, how long has it been going on? Where is it? I mean, those are the questions actually are the same questions. Yeah, but I'm asking them from a different place. And I will say not imperfectly. It's not like this isn't like before and after and I'm floating on a cloud.
[00:24:22] I also still have all those, you know, those Ds, especially the time one. They're little ghosties in there that are also putting pressure. But when I call up, especially for me, that question, just like thinking of pain as information, thinking of pain as a signal, as communication from your body, like all the things you've said, and a protective, a welcome system.
[00:24:45] They don't think it's welcome. They're feeling it. It's, it's spicy, but at least I can be like, Thank goodness this person has a pain system so we can investigate if there's something that needs tending to. Yep. You know, then I'm like, Hmm, what could be happening? And I would ask questions about what their capabilities of doing certain things are, you know what I mean?
[00:25:06] Like you asked many of the same questions, but, um, you, you asked them from a different energy. And, um, one thing I noticed is I'm a lot less. Mad at my patients. Their answers don't fix the algorithm. I learned in medical school. Oh,
[00:25:21] amazing. I want it
[00:25:24] irritable when they're like, it's hot, but it's cold on Tuesday.
[00:25:29] And sometimes it's in my left arm, but sometimes it's in my right arm. And then I'm just like, That's not something I learned in medical school and I would, I think, never express it out loud, though probably intuitive people could sense if I was at least just turning off emotionally, you know, I'd be just so I feel so frustrated.
[00:25:46] Like, how can I help them? How can I? Fix them. Like the thing that I thought I was there to do. If you're not even fitting in one of my heuristic boxes.
[00:25:54] Deb: Yeah. You're not fitting in my pain box and I don't know how to help you. And like, well, sorry.
[00:26:01] Joan: Wasting time. And you know, then you hear that, like, especially those, if anyone's listening to this, who's experienced this, I.
[00:26:09] I, I'm like, I'm describing the provider's experience and it's not okay when it comes out as for those that are inhabiting the role of patient. It's so hard. And so, yeah. And what I'm, what I empathize with though, as a healthcare provider, especially when you're super burnt out and you start to like blame the patient, be like the, the patient's wasting my time there, you know, they're a drain on this, like you start to really blame them.
[00:26:31] Yeah. As if the issue isn't like, you know, the boxes versus
[00:26:36] Deb: the boxes, the lack of time, the lack of actual understanding about pain, that pain is a learned experience by the brain. Like, of course, we're going to go down the wrong treatment roads if we don't actually understand what's happening. Yes. But, um, so sometimes I think about, and I know I shared with you like Dr.
[00:26:58] Howard Schubiner's FIT criteria, which is. Looking at chronic pain differently, and he has these quite like kind of boxes or not boxes, but categories of like functional, inconsistent and triggered. And these are ways to think about pain and then that helped, like, even just knowing. That these are kind of ways to think about pain informs the questions that you ask.
[00:27:27] So, right. So when you ask like, where's the pain, then any, or think about it's consistent, inconsistent. So some people have pain like on Sundays before they have to go back to work, right. Or they didn't have it on holiday or they write like it informs these questions and that helps you as a diagnostician be like, Oh, is this some kind of like, your body is sending you messages or is there like, is there a leg broken? Right? Like, and you're still probably going to go through the x ray and the MRI. You're still, you still want to go through and like rule things out. Right? So when we rule everything out, then what we have is mind body experience and also as a provider, being able to help people with the fear, because even in the session, the way you ask questions can help people relax and feel held. Cared for, connected with, right. And even then dropping that curiosity for people to get curious about their own experience. Oh, you know, sometimes people don't think like, well, what other stressors are going on in your life right now?
[00:28:39] Like what's happening? People would never think that like, Oh, these things are connected, but they absolutely are. They absolutely are. Yeah. And so, yeah. And even just, Inviting people in a way that takes what they're experiencing seriously, but also trying to expand this experience. Like, one of the things I often talk about is chronicity, which fuels fear, right?
[00:29:11] So catastrophizing and chronicity this, like, I'm having this pain today, but what is happening inside of you is your brain thinks it's going to be like this forever. So that will take a. Pain, intermittent pain and turn the experience up to a higher volume and that has to do with our attention system, has to do with emotions, has to do with, you know, the reality of living in a system that isn't not very caring.
[00:29:43] So of course we're worried about how am I going to take care of my family? You know, if I can't go to work, all of those things are what makes pain feel worse. So it's not a direct reflection of the experience in the body.
[00:30:01] Joan: Yeah, I like the language I learned from you is like, it's not always reflective of the level of tissue damage that could be presently happening. Yeah. I use that language with patients now because it's okay. There's something there or they want to know if there's something wrong or not. And that's so, um, unhelpful binary. What did we even mean by that? Yes.
[00:30:27] Totally.
[00:30:28] Look to see if there's tissue damage, if there's Um, something maybe out of balance or, you know, something like that, the level of the tissue.
[00:30:38] If not, then we think about what other factors, you know, could be influencing or love that. Yeah. It changes your language, which, um, as we've talked about in the past language super matters because the way we speak about something shifts, how we think about it, therefore how we feel about it. That's kind of the whole game, right?
[00:30:59] Yeah, I was wondering, I guess, like, as so say, people are kind of hearing about these concepts for the 1st time. As providers, I think, um, for me, it always starts. With me, you know, in terms of so I can now try and make my patients curious, but that's never going to work. You know what I mean? Yeah, totally.
[00:31:21] And honestly, after we first started working together, several of my patients got mini Ted Talks about pain, and some, most of them were not ready for this. No, no, it's totally true.
[00:31:31] I can tell you, you're painting a complex experience and they're like, can I just get a refill of morphine for whatever, you know what I mean?
[00:31:40] Like they're, they're, they're on their Yes. So how, like, how would you coach me and those like me about the fear that we hold in our bodies about our patient's pain? Because I think you can start there, if we can find ways to slow down.
[00:31:58] Deb: I love that. So I will talk about this. I have been through that same exact experience when I was a massage therapist learning this work.
[00:32:07] And I wanted to like. You know, lecture everybody about pain and teach them and they were like, I really would like a massage. And I was like, great. So, so one of the things that I really is the foundational piece in all of this is evoking safety, the feeling of safety. And I feel like if that, you know, those, um, This may not happen in Canada, but it certainly happens in the United States.
[00:32:37] There are these things that are like, if you walk into the shopping mall or something, they like infuse the air with a scent. Oh, like cookies or something. Yeah. They try to like make it like, I don't know, make you happy by making the air kind of slightly scented. I don't know. It's like a, it's like a, uh, behavioral cue.
[00:32:58] Yeah. Um, so if you could infuse the air in your Room in your office. Like, can you find that way to evoke safety? So that starts in your body, right? so like feeling so whether that's it's it could be anything right really feeling trust in your expertise your ability to help people like even if you don't have the answer today knowing that with the right questions, with the right, like going through testing that you'll help people figure out and create a path towards healing.
[00:33:38] And also you're not a hundred percent responsible, like this is your patients got to pick this up and carry it forward. Right. So, but it coming from that place of really connecting to that sense of. Um, safety, maybe it's love and caring for your patients and yourself. Like even curiosity before this session starts being like, do I have to pee?
[00:34:05] Am I hungry? Am I grumpy? Like what's going to show up in this room in this interaction with this person and like, you know, taking care of our own needs. So that kind of like embodied curiosity. 'cause we're often just like a head on a stick, right? And especially your heads are full of knowledge , right? So it's like so much that you have to be able to access.
[00:34:33] So I would just start that kind of embodiment, that kind of curiosity process of with yourself and the, and just, I mean this is the truth of neuroplasticity is like the, just the more we do things, the better we get at them, right? So it's like. The more you practice taking somebody's, you know, heart rate and blood pressure, the more you get good at it.
[00:34:57] And also now I think there's technology that also makes it easier, probably. But all of those things. So yeah, just. Just starting to notice like what's here, what's present and then getting curious and being like, okay, and even like having an intention for your, for your sessions, for your client meetings, which are patient meetings, which is like, what do I like at the end of this?
[00:35:23] What do we want to try to achieve? I'm kind of knowing where you're going. And I used to do this with my clients. Maybe this is a helpful analogy. When I was a massage therapist, people would come in and they would tell me the story of their pain. And then as a massage therapist, I'm like, I'm here to help.
[00:35:41] I understand the bones and the muscles and the tissues and the fascia. And I would like go to work on the thing that they told me was. Didn't feel good. And they got a particular kind of massage experience. But I was noticing that either people wouldn't re book or they were kind of leaving Not well one like not always feeling better right because it's like you just keep rubbing the part that hurts It's like like maybe in a few days it will feel better But like in that moment, they've not had an experience experience that feels better.
[00:36:19] And when I think about the, now the nervous system and the role of like turning off that pain alarm or turning it down, I think about the whole being. And so one of the things that I started to ask my clients was at the end of this, so I'd listened to them. It wasn't like, Oh, don't tell me about your elbow.
[00:36:41] But I would listen to them, but I would like kind of listen lightly. And then I would say at the end of our session today, how would you like to feel? Like if you had a word or a phrase to describe how you'd like to feel at the end of this time, what would it be? And they would often say, I want to feel relaxed.
[00:36:59] I want to feel like I was floating on a cloud. I want to just like turn off my brain and forget whatever. And then that is what I would serve in the session with my clients and knowing that their elbow hurts. So when I'm at their elbow, I would be paying attention, right? But their whole massage wasn't elbow hurts, right?
[00:37:23] Their whole massage was there is a whole human being that has a desire to feel a particular kind of way, and I would really try to hold them in that and co create that. With them and that changed everything and then when I understood the mind body connection and how pain is created Then I was like, oh and I'm really here Also, then when I'm talking to people about homework whether I gave them movement practices or things to do or think about in between sessions I was always thinking about safety one, also just thinking about not being catastrophizing, not being like people in bed ideas about bodies and pain all the time.
[00:38:09] Right? So never being like, don't do this thing. That'll make your neck hurt. Like, make sure that you, you know, especially like with feet stuff, people are like, never, never walk barefoot, you know? I was like, okay. Um, right. So. Yeah. All of these like alarmist, you know, so I was always like trying to both give them the idea that pain is temporary.
[00:38:31] Their bodies send them a message. We're going to go through this process of like, also just notice like when, when you don't feel pain? Like what's everything that's not this. So going through a process of like kind of almost giving them a vision of themselves, not being in this experience that they're having right now. Yeah, doctors get to do that with language.
[00:38:55] Joan: I wrote down so many things there. Like, I, um, I have this little questionnaire that I emailed them ahead, and it has some of my favorite, um, questions that I think are, they're quite time saving questions, as well as patient connection questions. That's great.
[00:39:12] you know, how do you feel about your concern? What ideas do you have about what's going on? Expectations. Um, and these aren't my questions. Like we get taught them actually as a piece of this certain method, but everyone thinks of them as like, make sure you ask the five questions so you pass the exam, but in real life, most people don't actually center them. But I've learned you ask them first.
[00:39:32] And actually you get to the meat of what actually needs to happen in that encounter. But, and I added celebrations and that's what I was seeing was like, what do you want to celebrate? And it's just like, very fun to see what people write. Um, but I'm kind of like, I'm going to like consider how either verbally at the beginning of the session or in that questionnaire, say at the end of your appointment with the doctor, like, how do you want to feel?
[00:39:56] I think that's a really interesting question because it tells you so much about. And I know in, in that case, like, cause they're not coming to me thinking I'm going to change how they feel, um, cognitively usually, cause I'm not laying hands and having them, you know, sort of like massage therapy, but I think it's a really interesting thing to cue in them.
[00:40:18] Cause if someone might be say reassured or someone might say. Confident or something, you know, and that will tell you a bit about what their motivation is for actually booking and that's going to tell you everything about how it would be helpful for the conversation to go. Yes. Because sometimes I'm having a conversation assuming the person wants reassurance and they don't care their wife sent them.
[00:40:39] Yes. They're like, this could have been a two minute conversation and just give me this thing. And then I'm at here and they, and you're like,
[00:40:47] Deb: and then they're sitting in on like, Oh, I didn't know this is like a therapy session, like you're being so caring, right? Yeah.
[00:40:53] Joan: What they're there for. And I just think that's so, I'm going to experiment with that.
[00:40:59] Deb: I love that. Oh my God. I'm so excited. And also like it really, it again, it gives them agency, but it helps, you know, who they are and builds rapport and that they're there because they are unique and whole in and of themselves. They're not like an assembly line. So you're not always giving the same thing to every person, even if you're doing the same thing.
[00:41:23] Right. Yeah.
[00:41:24] The same general.
[00:41:25] The same general. The same general appointment, right? You're checking for these same things, but every person who shows up is different and has different needs. And it's very helpful, like, especially since you have very little time. Yeah. You find out as much as you can, as soon as you can.
[00:41:44] So like I work a lot with people with health anxiety and health anxiety absolutely shows up in the body and there are symptoms that like could be health anxiety or it could be something else. Right. And when you really know that somebody has health anxiety, you'll know.
[00:42:01] You know, how to talk to them and that talking is a part of a treatment plan. It's really important to see that as part of the treatment. Because you are the expert. So you are setting the entire experience. And when we hear things, right, and this is going back to the misophonia, when we hear things and we experience things in our body, we make meaning about it.
[00:42:31] And if we don't have the accurate information, then our meaning is incorrect, right? So if we're like, Oh my God, I feel anxiety. That means there's something that I'm to be afraid of. There is some threat, uh, We're going to experience that differently. We're going to have a different response in our bodies.
[00:42:53] Our heart rate will be up. We'll have shallow breathing. Maybe our stomach will, maybe our digestion will not be working as well, right? Because your body is shunting resources to places. This is, Things that happen in our bodies, our brain is the grandmaster, right? Like our brain and our nervous system is deciding in every moment what's happening in your body.
[00:43:20] Whether it's real or perceived. Perception is reality. If you are in fight or flight your ability to digest food really requires relaxation, like really requires your parasympathetic nervous system. Otherwise, it's just not that important right now. So all of these mind and body, we're one being, we're one system.
[00:43:44] So it's really helpful to think about the body through that lens, not just like what kind of disease is happening or potential disease is happening. So the way that. Dr. speaks is part of the treatment.
[00:43:59] Joan: Absolutely. And I name if that feels like pressure.
[00:44:03] Deb: Yes. Okay, good. So for you, cause I'm just like you are responsible.
[00:44:08] No, I don't.
[00:44:10] Joan: I think though it's useful to know and the place that then it really starts though, understanding that that's the role we're inhabiting and that's being projected onto us. Yes. So how do, how do we hold that with confidence? Yes. Is first of all, holding it lightly. Yes. And, and really, like you kind of said about the pain, like, notice the knowledge you do have, you know, or it's like, notice what you feel.
[00:44:34] It's like, notice the knowledge you do have because guaranteed everyone listening knows if someone absolutely should be going to the hospital or not, or absolutely is, you know, and then there's the gray where no one will know for sure. Absolutely. We have really solid in. Informed, um, hypotheses of, you can choose one and go with it.
[00:44:56] Like, we have all of that within our disposal and I think the thing that gets in their way is we think we've got to give people, uh. You know, money back guarantee, or they're going to sue us and hate us and all the things. But the more that we like, that's where it starts with us feeling safety, like you said, a personal sense of safety, irrespective of the outcome of any given patient appointment, then we can turn on curiosity and be like, what does this patient want?
[00:45:25] Ask them how they feel. And so like, including like, say I asked this question about like, How will the, you know, how are you hoping to feel at the end of the session and at the end of the session checking in. Like, so are you feeling closer to that way? And if they say no, yeah, that's okay. That's still information.
[00:45:41] Yeah. You know what I mean? So it's like the whole thing gets to be Mm-Hmm. this sort of grand experiment, this co-creation. Yeah. But our safety isn't on the line. It has to start with Mm-Hmm. us feeling safe. Yeah. And therefore then we can inhabit and have this language, it'll come naturally to us. Yeah.
[00:46:00] Right?
[00:46:00] Deb: Mm hmm. Oh, I love that. I, yeah, I love that so much because you're like, at the end, you can, I even just love that you're checking in, which is like, are you feeling closer to that? Which is such a different question than, are you feeling that?
[00:46:14] Joan: Did I magic you to feeling total calm? Cause then it's like all about me again or something, but it's just like, checking in, how did this go for you?
[00:46:22] How are you feeling now? And, and it's more, um, I don't know if realistic, but like thinking of how things can shift. Right. We're not black and white. We have many experience. We feel pain in one of our part of our bodies and feel not pain in other parts. Like you're saying, right? So, and same with. In the room with the patient, I just think that's really,
[00:46:42] Deb: yeah and like you're not, you know, in these sessions, like unless you're doing kind of pain reprocessing work, you're not, you're doing diagnostic work or you're doing other kinds of things. And um, you know, and also just like understand, like I'm not a medical provider, so my language is. You know, please map all this on to what makes sense. I mean, you're a great translator. So I love having these conversations with you because when then when you say it, I'm like, oh, yeah, that totally makes sense for for people.
[00:47:13] Right back to our theme of curiosity, like letting it be iterative, letting yourself fumble, letting it be like really weird to say new things and just be like maybe even including the patient in it.
[00:47:27] Like, Hey, I'm trying out some like new things that I'm like noticing are really working for people so that this time can be really productive. You know, that'll help us figure things out. So if I just say some things and they kind of, like, I stumble with my words, like, just have patience with me. Cause I'm like, You know, working on doing it differently and just like invite them into the experience of letting it be new and being curious, like, okay, when I say it like this, this is like making much more sense. And it's like going in the right direction. It's flowing. And it's like letting ourselves like not do it perfectly.
[00:48:10] It's really, really important in that curiosity part, we can't evaluate what we've done if we don't let ourselves. Like have it, let it be messy in the beginning and
[00:48:22] um, yes. No, sorry. Yeah.
[00:48:25] Oh, no. And the other part of curiosity is I think it does bring with it a certain quality of slowing things down.
[00:48:33] So even just entering the state, the field of curiosity, it's like inviting it into the room and then all of a sudden I'm a big Dr. Who fan. And so all of a sudden it's like time slows down like in the room, right? So it's still the same amount of time, but it feels slower because time is, you know, relative in that way.
[00:49:00] And so the experience of spending that time together can feel less hurried, less rushed, more connected, more safe. And then both the provider and the patient feels differently in the session. Right? So even like noticing your patient's energy when they walk in the room. And if they're like, like this, maybe like there is like, I mean, I do have this like self directed neuroplasticity.
[00:49:32] Maybe it is like inviting them to like sit down and just take a breath with you and not matching. Right. Or even just the, having the intention of like not matching their energy. Yes. Right? So just kind of like being present, knowing that they, whatever they're bringing into the room is important to be there, is important to be connected with and touched in some way, but it is not the whole of them.
[00:49:59] Also, you're also seeing people in this like one kind of moment in their life, right? Where they're like coming to you for help. That's a lot of responsibility.
[00:50:11] Joan: I think that's like, and, but I find. It's so it's so helpful to think about the rest of their lives and that they 1 thing that's taken a lot of, like, kind of the internalized pressure off of me.
[00:50:22] Because I think, um, like, both somatic experiences and words that have been helpful for me to. Notice and find ways to release are like pressure and urgency, kind of the same thing said two different ways, you know, yeah, that's what it's like time pressure judgment pressure, even like, even, it seems helpful to have urgency and pressure for making this person feel better.
[00:50:43] But, um, most of the time, you cannot make the person feel all the way better in the 10 minutes. Like, like, What if they have an infection that just takes a week to get it? They're like, what are you going to do? I can't do that for them, right? So yeah, releasing those things. Um, I've, I've found that really helpful.
[00:51:03] Um, Oh, I had a thought and then it lost me about this. Ready to go. Well, maybe that was like the main thing I wanted to say. It was just like urgency and pressure are they it's hard for them to coexist with curiosity. Yeah. Like you said, because it's, it's like a speeding up sensation versus a slowing down sensation.
[00:51:22] Oh, yes. And so one thing that also helps that actually like literally helps me take less pressure on. Um, even when the patient themselves has a lot of urgency about it, it's like imagining how they, they did walk in here, how they have their whole lives, how they maybe waited a month between a visit and they, they, they got along somehow.
[00:51:44] I'm like, you're fine. Like, I'm not doing that thing, but I'm picturing that they're a whole person and this part is really bothering them and I'm here to hold that and see if we can shift it. Maybe I say it less out loud, but I at least say, think internally, like, look at how capable they also are, all are, look at how, you know, maybe they come in with family members, look how supported they are beyond me.
[00:52:08] Yep. That helps me feel, I guess, small enough in the picture to, to simply inhabit my one role versus thinking I've got to take on all of how they're suffering. It can feel like they're dumping it all on my lap, whether they mean to or not, but it can feel that way. Because we have all this internalized fixing kind of thing, but instead it's like, okay, so what's 1 question I can ask 1 experiment we can co conduct about this next period, whether it's let's try this new dose. Let's try this new medicine. Let's try it. Let's do. Are you interested in going for a walk and noticing how it feels like, like, whatever kind of thing we're going to try next together, but it doesn't have to be capital T, the capital a answer.
[00:52:55] One way I can draw that in is actually by noticing. everything that this person does have at their disposal and how capable they are outside of me. Yeah. You know, I find, and that's, it's, I just, I'm hearing a lot of mirroring of like what you offer in pain reprocessing, you offer that to the patient themselves, which I think is cool.
[00:53:17] And it's neat to think of like, if all clinicians sort of had this posture, even if they're not doing pain reprocessing therapy, but, but they have this posture of belief in the capability of patients and no pressure internally. To have all the answers, but instead being able to hold space to just work through this next step with them.
[00:53:41] I just wonder how how different health care would feel for everyone involved if that was sort of. The posture we were all modeling, you know.
[00:53:51] Deb: Yeah, there's a lot of complexity and a lot of parts of it that that you as providers don't have control over. I can imagine that's gotta be kind of infuriating.
[00:54:02] Yes. But at least in that room, yeah, being able to, and then it's like, then I'm sure there are other parts of that curiosity that can flow over in terms of like, when the patient is out of the room, following up on their labs, following up on the tests that you do, being really curious about like, Oh, what are the answers that we're getting?
[00:54:26] Right. And what's the journey that this is taking me on as they're the person who's holding the bigger picture together? That curiosity is the thread, right? Because when you're a patient and you know, you get sent for tests and you just like, you're the one doing the tests, but like you're fulfilling, you're part of the experience.
[00:54:47] You're not also reading your own labs. Sometimes we go on Dr. Google and that is sometimes helpful and not helpful, but, um, you know, when we get the responses back. So, so as the clinician, you still have that kind of curiosity that can feed the rest of the process of helping your patient know what is the next step.
[00:55:13] Joan: Yeah. And modeling like, Hey, these are the answers that we did get from these tests and here's what's still left unknown depending, right? Yeah. But even in like how you say that, that can, it can model like I'm in, I'm in it for the long game with you. Yeah, you know, and this, and this is the pieces that we actually did have clarity on this time, you know, so you can say it that way versus you're fine by or, or this is terrible or I don't know other ways you can say it right.
[00:55:39] But like, like instead kind of a communicating, like, you're like, I like the word journey. I think that's something. That's a useful almost idea to have in our heads with our patients, whether we actually say people listening, like to emerge or something, or something where it's like shortly, maybe only see a human once for one specific thing, but still you can picture how this person is on the journey.
[00:56:03] And here you are walking a certain piece of it. And then they go on their way again, it just, um, it makes us small enough that we can feel like we can hold the piece of it. That is ours versus thinking we were supposed to hold it all, which is impossible. Yep. You know? Yeah. And then we can get curious about it. Cause it's, it's our piece.
[00:56:24] Deb: Yeah. Right. And that feels. I mean, even just hearing you say that and the way that you said it, it feels so much less stressful. That's it. And we can't have, it's very hard to be curious when you're like stressed out when you're freaking out. Right. It's so, yeah. So good.
[00:56:41] I love curiosity. I know we talked about it forever. We actually went over time. Did we? We're good. We're good. Okay.
[00:56:47] Joan: Time, time is bent all the way. Okay. But to summarize, let's see, well, how do we want to summarize? Well, number one, if anything that we've listened, you've heard in our conversation today or in the past conversations with myself and or Deb about these topics, we would love if you would come Tuesday, November 28th at 8 p.
[00:57:09] m. Eastern. And just, it's a workshop style webinar. So we will all be on zoom together and I would love to kind of basically how we had this conversation. And I was like, Sparking off of like, oh, this is what makes the thing for me. I would love if folks heard stuff in here and they're like, but wait, how does this apply to me?
[00:57:28] Or like, this is my thing. That means it's too hard for me to get curious. Or this is what happens when I try to be patient, right? I would love for it to be a space where we can kind of. So hopefully we can hear more of the ideas about chronic pain and how maybe the ways we were trained missed some of the important beats of especially like neuroplastic chronic pain and mind body connections.
[00:57:49] And then, um, hopefully we can all just like get curious together about how we could shift the conversation around chronic pain and have an impact on our own experiences as healthcare providers and also very much our experience of patients who live with chronic pain. So that's my takeaway. What are your takeaways you want to leave the listeners with?
[00:58:09] Deb: Um, my takeaways are, I think that when we're talking about curiosity, thinking about it as a feeling and as a something that you can kind of infuse your space with, like both curiosity and safety, that those are experiences that both change people physically and emotionally and also as the provider, you can kind of bring into the conversation.
[00:58:36] Joan: And it feels better for you and also for the patient. So that's fun. Yeah. So that's good. Yay. As always Deb.
[00:58:46] Deb: Always a delight. Clearly we can just talk forever. Someday we'll have like a weekend workshop and it'll just be ours.
[00:58:54] Joan: Oh, so manifest that. That sounds real good. Super fun. Okay.
[00:59:00] Deb: Then we'll have karaoke.
[00:59:01] Joan: And then we'll have karaoke. That's right. Cause that's an essential part as we actually, that's another teaser. We'll have to make sure we recount the time that Deb and I. We're together in person in Texas of all places, doing a little karaoke because that was a good time. So come to the workshop only for that.
[00:59:18] Perfect. Amazing. All right. Well, thanks for listening and, um, tune in next week for another episode of the podcast.
[00:59:26] Deb: And if you are interested in exploring, working with me, please book a free 30 minute curiosity call and the link is in the bio. I think it's calendly.com/paincoachdeb. And I would love to chat with you about what coaching with me on neuroplastic pain would be like, and also I'm a general life coach.
[00:59:49] If I don't say that enough that is also true. So happy to coach on all things in your life. But especially if you are somebody who like has unpleasant, physical experiences going on and would love to have a broader framework around this mind, body situation we have as humans and bring that into your coaching framework, I love doing that with people. That is my invitation to you i hope to speak with you soon.