Heads up people, in this episode I'm speaking with PRT therapist Caryn Sherbet about their pain + symptom recovery journey as well as their work with Exposure both in their clinical practice of ERP as well as in their private life with BDSM. We don't go into detail (so get your mind out of the gutter *wink*) but they speak about how the concepts of pain on purpose aka using exposure can decrease threat, fear + change the meaning of the symptoms. One of the incredible pieces of knowledge they drop is that anxiety is not an emotion, it's a coping mechanism. It's a strategy of the brain to keep us safe. We talk about all the various entry points to risk, there is in life and how pursuing freedom and our desires can lead us to creating more and more of a felt sense of safety using these tools. I hope this podcast helps you discover your embodied pathways to expansion, exposure and the ability to turn down the danger alarm bell and turn up freedom and fearlessness. Caryn is a Brooklyn-based psychotherapist who specializes in treating the intersection of OCD, chronic pain, and sexual trauma. They are trained in Exposure & Response Prevention (ERP) and in Pain Reprocessing Therapy (PRT), which they use to help clients create safety in moments of physical and emotional pain alike. Caryn is especially passionate about working with members of the LGBTQ+ community to heal from interpersonal and structural trauma.
Heads up people, in this episode I'm speaking with PRT therapist Caryn Sherbet about their pain + symptom recovery journey as well as their work with Exposure both in their clinical practice of ERP as well as in their private life with BDSM. We don't go into detail (so get your mind out of the gutter *wink*) but they speak about how the concepts of pain on purpose aka using exposure can decrease threat, fear + change the meaning of the symptoms.
One of the incredible pieces of knowledge they drop is that anxiety is not an emotion, it's a coping mechanism. It's a strategy of the brain to keep us safe. We talk about all the various entry points to risk, there is in life and how pursuing freedom and our desires can lead us to creating more and more of a felt sense of safety using these tools. I hope this podcast helps you discover your embodied pathways to expansion, exposure and the ability to turn down the danger alarm bell and turn up freedom and fearlessness.
Caryn is a Brooklyn-based psychotherapist who specializes in treating the intersection of OCD, chronic pain, and sexual trauma. They are trained in Exposure & Response Prevention (ERP) and in Pain Reprocessing Therapy (PRT), which they use to help clients create safety in moments of physical and emotional pain alike. Caryn is especially passionate about working with members of the LGBTQ+ community to heal from interpersonal and structural trauma.
carynsherbettherapy.com
https://www.psychologytoday.com/us/therapists/caryn-sherbet-brooklyn-ny/1043122
Caryn's offering a free Chronic Pain for Freaks Workshop
Wednesday, June 11, 7-8:30pm EST
RSVP link
https://docs.google.com/forms/d/e/1FAIpQLSf2tRhAJ_Swu79Cafv2ZNvhM_Z1dyWXdLT4e5ipyHWRUw-n8w/viewform
TCCEP51
[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, more of the time in the body you have today, and build the rich full life that you want to live.
[00:00:39] 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.
[00:00:56] Deb: I am starting out this episode with a little heads up. Caryn and I are going to talk about some adult themes, specifically BDSM. We are not talking about anything that is graphic, but I do want to let you know that at some point, those words and those concepts will be shared in conversation. So if that is something you are not at all interested in hearing two consenting adults talking about, then maybe this conversation isn't for you or choose to listen to it in a place where you feel like you have the privacy and the ability to listen to it without worrying about what the people around you might be thinking or if you are around, young children or young adults. So that's my little caveat. I hope you enjoy this episode. I really enjoyed this conversation.
[00:01:58] Thanks.
[00:01:59] Hello and welcome to The Curiosity Cure. Hello to all my feelers and healers and I am so excited to be here today with Caryn Sherbet, who is a newly minted PRT practitioner, I love that I'm getting back out in the world and going and being where other humans are and we found each other at the gym.
[00:02:20] That was like the best thing ever finding other pain reprocessing people out in the wild, is my total delight. So I'm not alone. You are not alone. There are more and more and more people who are out here doing this work, helping people with persistent pain and persistent symptoms, and I love that we're gonna get to have a conversation about the work that they do.
[00:02:45] So Caryn, why don't you introduce yourself to everybody listening.
[00:02:50] Caryn: Yeah. Well first of all, thank you for having me. I've never been on a podcast before, so this is very exciting. We can talk about it, but I actually got into lifting because of my chronic pain. So that's like a fun little full circle thing. I am a trans non-binary psychotherapist, sex therapist, now pain reprocessing therapist. I specialize in working with queer and trans folks, mostly at the intersection of OCD, chronic pain and sex therapy slash sexual trauma. And the thing I've been saying recently is yes, there's a big intersection there.
[00:03:28] Yeah, I really love exposure therapy. I had already been trained in exposure therapy for OCD, and then I got trained in PRT and I was like, oh, now we can do exposure for thoughts and feelings and physical sensations in our bodies. I've got the whole kind of circuit down.
[00:03:45] Deb: I love it. Thank you so much. Yes. When I encountered some work around OCD I was like, oh yeah, this is so relatable. I could see OCD tendencies inside of myself and like
[00:03:59] Caryn: mm-hmm.
[00:04:00] Deb: You know, sometimes having labels are like a blessing and a curse. You know, we have to name things to understand things. I just think how would we know what a table is if we didn't have a word to describe it? We would have like, flat, tall, holding things, and then sometimes, you know, labels or diagnoses or things like that can also then have this kind of, darker side based on our perceptions of these things being non-changeable.
[00:04:29] And what I love about exposure work is that it really shows us how changeable our experiences are, but without invalidating the experiences that we're having. That's where I went. But I'm also so excited to have more queer and trans people to bring in sex and sexuality into this.
[00:04:47] I mean, there are so many delicious, incredible parts about being alive and being human and having a human body. And yeah, we feel things and we don't only, we don't only feel bad things and negative things, and we only, don't only feel positive and pleasurable things either, but like how do we use our capacity of feeling things? And like creating then this sense of agency and understanding to live the lives that we wanna live. That wasn't a question. It was a soliloquy.
[00:05:21] Caryn: I was like, that is the question, isn't it? That is the question. That is the question.
[00:05:26] Deb: Yeah. So, I guess I'd like to start a little bit with your journey.
[00:05:31] 'cause I do feel like sometimes, you know, especially therapists, I only know like one person, Dave Clark is the only person who says he hasn't had his own kind of pain recovery story. And he's from the ATNS and he got up on stage at the conference and he is like, yeah, I am the outlier.
[00:05:47] Caryn: Yeah.
[00:05:48] Deb: And he's a leader in this field. So I feel like so much of this work comes through practitioners personal journeys, and I find that's, it's important for me because when I'm in any kind of psychodynamic experience. I hate feeling alone. Like I am the solitary, alone, broken human, and then this other person in front of me is like somehow Yeah.
[00:06:13] Has it all together.
[00:06:15] Caryn: The professional Yeah. Professional knows all, doesn't feel
[00:06:17] Deb: anything. Right. And like, so I, I kind of love this flavor in this work in which we also get to be human. Mm-hmm. And we usually arrive here having come through our own experience.
[00:06:30] Caryn: Mm-hmm.
[00:06:31] Deb: So it, at whatever level you feel comfortable sharing your pain recovery story or your encounter with, like, how did you land on the doorstep of pain reprocessing therapy?
[00:06:44] Caryn: Yeah. I mean, like most things it's like how much time do you have? As I've been doing this work, I should have come to realize that I have had some flavor of chronic pain my entire life. Or at least since I was like, you know, 10, 12. But the way that I came to PRT is kind of twofold.
[00:07:01] About a year ago I woke up one morning with pretty severe neck pain and I had had sort of episodes of that in the past and I would hang out for a week and then it would go away, but this time it would not go away. This was also two or three months after I had, again, woken up one morning with a whole host of really weird neurological symptoms, having tremors in my hands and brain fog and sensitivity to light and sound. And it felt like my whole body was like, felt like there were like bees under my skin. And this lasted for like three weeks and then it went away, and then it came back, and then it went away, and then it came back. And so I've been doing all these different doctor's appointments for both the neck pain and the weird neurological stuff.
[00:07:46] I was like getting MRIs, I was doing, you know, trigger point injections. I was doing PT and acupuncture and all these different things. And nobody could really find anything that was wrong with me. You know, just like a lot of other folks that got the oh, you have four herniated discs down your spine. And then I went to go see the doctor. And he was like, yeah, but these are all really mild, they shouldn't be hurting this much. So after almost six to eight months of both like the weird neuro stuff and the neck pain. I finally got diagnosed with a functional neurological disorder because I happened to have a coworker who specialized in it.
[00:08:20] And then a couple months later I sought out PRT, because I had gone to a doctor and they were like, we have no medical interventions left for you to try other than surgery. And I was like, okay, I'm an otherwise healthy 27-year-old, I'm not having spinal surgery, that's nuts. So I kind of tried PRT and I was like, alright, like screw it. We'll just see what happens. And now I'm here. So that, that's the abridged version of it.
[00:08:48] Deb: Yeah. Thank you. I think so many people will be able to really relate to waking up with some unusual symptoms. And I just, I wanted to say that sounded very scary.
[00:09:01] Caryn: Thank you. It it, it was, it really was. It was now that I have gone through the PRT training and continue to go through my own PRT work, I'm like, oh, I was having an incredibly stressful time when this was all happening. Like, yeah. Multiple different things happening at once.
[00:09:18] And so now I look back and I'm like, oh, it's a miracle that it didn't get any worse than it did, right? Mm-hmm. Um, but at the time, it was terrifying and the thing I've struggled with the most is there's sort of all these narratives about like when you're in pain mm-hmm implicitly it's your fault sometime explicitly, but like implicitly, it's your fault. You haven't found the right diagnosis, you haven't found the right treatment, you haven't found the right answer.
[00:09:44] And so just, there was also this like underlying I am failing in some capacity. Which the more I learn about PRT, I'm like, oh, okay. So that made it so much worse.
[00:09:55] Deb: Absolutely. And those beliefs about health can lead us down the wrong path. I mean, it's never a wrong path to get things ruled out.
[00:10:03] That's always the right step. Right?
[00:10:06] Caryn: Sure.
[00:10:06] Deb: Is to go to the doctor, get things ruled out when we do PRT, right? We're looking for the FIT criteria, by ruling out things we're ruling in neuroplastic pain. Yes. Essentially happening at the same time. Because if there had been seen something that needed some kind of medical intervention. That's so hard to say, right? Because some people say like those herniated discs, right. So I mean like a tumor. That's kind of what I meant, right?
[00:10:30] Caryn: Yeah, yeah, yeah.
[00:10:31] Deb: But that feeling of helplessness of when something is happening with our bodies to us, like Right. It feels like it's happening to us in a way in which we don't feel any kind of control or agency. That level of fear, overwhelm, helplessness, and then having to kind of navigate a, a system that doesn't know this work, but also Right, doesn't know how to support, would love it to be better.
[00:10:58] Right, right. Whoever's in charge. Do your job,
[00:11:02] Caryn: please.
[00:11:03] Deb: So when you discovered PRT, you'd gotten to the place where medical care was like, Hey, we don't have any other ways to help you and then you found pain reprocessing therapy, what was your first take on it?
[00:11:17] Some people's hot takes are, we talk about people getting Dr. Sarno's books on, healing back pain and throwing them across the room. It sounded like you were both ready and also maybe because of your other work, you had a understanding or a willingness to go in this direction.
[00:11:33] Caryn: A friend of mine had recommended PRT to me like months prior, and they had been diagnosed with complex regional pain syndrome. So I finally was kind of like, all right, if this could help them, I might as well, it probably could help me. I worked with and still work with a wonderful PRT therapist, Kristina Armenakis who is based in California. I got on the consult call with them and they started explaining my, symptoms back to me. And I just like sobbed on the consult call.
[00:12:08] 'cause I think it was such a relief to be like, oh, finally someone is giving me an explanation that actually, I could feel in my body was correct. I would go to all these doctors and they'd be like, well you could try this. And I'd be like, okay. But they weren't really convinced and so I wasn't really convinced.
[00:12:26] And I got on the call and Kristina was like I'm confident. I'm positive. Which like now I know is part of how it works, but it was such a relief to have that and to be like, oh, I don't have to be alone in this anymore. And I think something that is really cool about PRT is, there's a lot of clinical richness, let's say in sharing one's personal experience with pain.
[00:12:48] And so even just hearing this person who was trained in this type of therapy say, I had this experience, here's how PRT helped me, is incredibly comforting.
[00:12:58] Deb: Yeah, there's something that's powerful about somebody who knows more or can hold the vision longer.
[00:13:05] Caryn: Yeah. Right.
[00:13:06] Deb: So that mm-hmm. The person who's in a process can just be where they are.
[00:13:13] Caryn: Mm-hmm.
[00:13:13] Deb: And then feel held by the trust of the practitioner who understands the journey. For me, that's kind of what I'm trying to do with this podcast, which is like, yes, you are where you are, you are feeling what you're feeling.
[00:13:26] Your pain is absolutely real. Yeah. And also doesn't mean that it can't change. Right? Yeah. And this is how we create change in your brain and therefore in your body.
[00:13:39] I'm gonna do a sharp pivot as I, yeah. My podcast, I get to do whatever I want. So humans, in North America in this moment are having a particular experience, with politics, especially, queer and trans people, and anybody who's feeling, a certain level of increase in threat and fear and danger, there's a lot of things that have been happening, on a daily basis that can be triggering symptoms and also triggering fear and worry and all of those things. Let me actually get to what my question is.
[00:14:19] How do you see, and even before this moment in time, in this political moment. I feel like queer and trans bodies carry a certain kind of vulnerability of threat and danger. Mm-hmm. Because certainly there's a lot of experiences of violence, there's a lot of threats to our safety and there's a lot of feeling of needing a certain quality of state validation, right. Of like governmental validation of our existence. Mm-hmm. Mm-hmm. To have a sense of safety and all of that, I think leaves, it leaves me feeling kind of precarious.
[00:14:57] Caryn: Yeah.
[00:14:57] Deb: Um, and I'm wondering when you work with queer and trans folks on creating safety. Because I think that's a big foundational piece of pain reprocessing therapy. What do you notice for your clients? And obviously speaking in the whatever broad general terms, how are you noticing these themes coming up for your clients that are being somaticized into pain?
[00:15:20] Caryn: Yeah, I mean this is kind of also like the question, right? Um,
[00:15:26] Deb: I'm just asking really,
[00:15:28] Caryn: really just like
[00:15:29] Deb: small questions here. They're really easy ones.
[00:15:33] Caryn: Come on. So easy. Yeah, I think the thing that I have noticed probably the most in both, like my clients, my friends, myself, is just people in these kind of varying but pretty constant states of nervous system dysregulation.
[00:15:53] Mostly that is looking like anxiety, rumination. But also I think I thing that's really been really interesting to watch is, this is kind of anecdotal, but like anyone who spent time in queer trans Brooklyn knows that everybody is sick all the time. And this is something that I've been thinking about a lot and part of it is that like everybody in queer trans Brooklyn won't stop touching each other, but I know for myself, right? I have been sick a lot more in the past couple years than I ever have been really in my life. Everyone just seems to be switching off whose immune system is shut down. I've seen a lot of that and yes, there's lots of different fun respiratory things going around all the time.
[00:16:38] And of course Covid is still very much here and people take precautions to, in a variety of different ways, to no ways at all. But, I think for me the main thing is like, oh, at, at its very core people on the surface be like, I'm totally fine. And then they'll be sick four times in a six week period.
[00:16:58] And to me that's the connection of like your body is shutting down constantly.
[00:17:03] Deb: What you're touching on there is this concept of psychoneuroimmunology. Mm. Which is a Yeah scientific study around how our stress levels affect our immune system. Right. So our ability and capacity to fight off, germs and sickness, can be titrated by our capacity to manage stress, to regulate our nervous system, along with the other precautions of wearing masks and decreasing our interaction with other people's particles. Other people's particles, yes. Other people's particles. And there's a social responsibility and an individual responsibility. Mm-hmm. Yeah. And in the end of the day, we are the individual inside of our mind, body system.
[00:17:49] Caryn: Mm-hmm.
[00:17:50] Deb: It's interesting to look at without it being like our fault, right. Being able to explore how can we affect our own system mm-hmm. By using these tools.
[00:18:02] Caryn: Yeah.
[00:18:03] Deb: Yeah. What kinds of things have you helped people with in terms of your PRT work?
[00:18:09] Caryn: It's interesting. I'm still pretty early in my PRT career, but the thing that I feel like I've used it the most with is not necessarily pain, but physical manifestations of anxiety. Mm-hmm. You know, people whose heart is racing or their hands are shaking, or feeling a weird kind of spaciousness in their chest in a way that feels unwelcome.
[00:18:35] I've been doing a lot more somatic tracking specifically work with those kinds of sensations than explicit pain. Because I specialize in OCD, a lot of my clients, OCD is a form of anxiety, they're kind of one and the same.
[00:18:50] Will come into session with some kind of physical manifestation of anxiety going on, and especially if it's something that we've already dug into we kind of know why they're feeling anxious about this thing. I'm like, okay, the question of why isn't really helpful to us anymore and actually might be more harmful, can we just be with the sensations and see what happens?
[00:19:13] It's been a lot of that.
[00:19:13] Deb: Yeah, I think it's a great time for you to give a little, I mean, you just said OCD is a form of anxiety, so maybe like a little bit of a background on OCD, on exposure therapy. Yeah just those two things. But I love what you said, which is we're not digging into the why so much anymore.
[00:19:33] Once we understand that it's about now attending to the experiences that are literally happening in the body. Right? Right. The body's just like doing its thing.
[00:19:44] Caryn: Right.
[00:19:45] Deb: And yeah, how we treat that is so much of this work, right. Okay. So if I were to be like, tell me what OCD is, what would your answer be?
[00:19:54] Caryn: So the sort of spiel that I usually give is OCD is a form of anxiety, and anxiety is not actually an emotion, it's a coping mechanism. And it's a really avoidant one. So what happens is anxiety prevents you, or protects you from feeling any feeling that is getting categorized as a threat.
[00:20:18] So what happens is something will happen. You'll have a thought, you'll watch a movie, you'll have a breakup, whatever. That sort of external or internal stimuli will trigger some kind of an emotion. Usually it's grief or fear, are usually the main ones, but any emotion can be labeled threatening. Sometimes people feel happiness or calm and that gets labeled threatening. So a threatening emotion will get triggered and then the anxiety will kick on and be like, oh no, we don't want to feel that, that is dangerous. So we are going to generate some kind of response, whether that is rumination, right?
[00:20:56] Thinking about the same thing over and over again, whether that is a physical compulsion, checking a lock a million times, for example, as a way to avoid feeling the threatening thing. Now what happens is the more that you avoid feeling a feeling because your brain is perceiving it as a threat and the more threatening it becomes. And over time you get stuck in essentially like the pain and fear cycle, but with your feelings of fear, grief, sadness, happiness, whatever the threatening thing is so dangerous, I cannot let myself get close to it. That is how anxiety and OCD work.
[00:21:39] Deb: Amazing. That's such a beautiful description. I can see that. Yeah from the, Nicole Sachs Journal Speak View, like we talk about pain, is that protection from the emotions that we're not willing to feel. Yes. Then doing that journal speak practice is about creating that safe space for those feelings to be felt and met, and there's always more than one practice. There's more than one entry point. To me it's like the overarching work is about exposing ourselves in the way that feels the most safe or scaffolded or supported. Mm-hmm. Mm-hmm. To be able to start to dismantle that now automatic response. That automatic response of anxiety swooping in to come and save the day by giving you something else that's really hard to ignore.
[00:22:27] Caryn: Right?
[00:22:28] Deb: Yeah, exactly. Coping mechanisms work.
[00:22:31] Caryn: They really do.
[00:22:33] Deb: Coping mechanisms. Yeah. They you so much.
[00:22:36] Caryn: They really, really do. And it's interesting when I first started doing PRT as a client, we would be mid somatic tracking or whatever, and I would just start cracking up because I was like, oh, this is exposure therapy. I'm trained in exposure and response prevention or ERP, and I was like, this is literally ERP.
[00:22:55] Deb: Yeah. Tell me a little bit more about ERP.
[00:22:58] Caryn: So ERP is very similar to PRT in that it is essentially creating exposures to activities that will intentionally kick up the threatening emotion. And then working on being able to be present with that threatening emotion without engaging in some form of compulsion to make it go away. Very similar to somatic tracking in that, you're watching a physical sensation from this like neutral sort of detached energy, without trying to change it or make it go away. And ERP is very similar, except often you are doing some kind of an activity that kicks up the feeling.
[00:23:43] And you wanna do that activity without engaging in a compulsion. For example, maybe you have somebody who is afraid to use knives in their kitchen because they're afraid they might chop their fingers off. So what's happening is let's say you go to chop a carrot or something, going to chop the carrot triggers fear, right? And so what might happen is you might say, okay, well I'm just never gonna chop anything ever again. Or the response might be like, okay, I am going to chop carrots, but the whole time I'm chopping them, I have to say out loud to myself, I will not chop my fingers off, right?
[00:24:22] And the way that ERP would work is okay, we are going to work on chopping carrots without saying the thing out loud, or even just chopping the carrots in and of itself, depending on what the compulsion is, if you're just avoiding doing it all together, would be the exposure. Can you chop the carrots and be afraid essentially the whole time.
[00:24:45] And over time, the more that you practice that you learn, oh as long as I'm paying attention and using my knife handling skills correctly, it's actually perfectly safe to chop carrots. I probably won't chop my fingers off but I think the thing that's interesting about ERP is acknowledging yes, there is always some risk of the feared outcome might happen.
[00:25:05] Yes, there is a possibility that I might nick myself or cut myself accidentally. There's a possibility I might accidentally cut a finger off. It might happen. It probably won't. But it is a possibility. And so a lot of ERP is also exposing people to uncertainty, to risk, to vulnerability.
[00:25:26] Like these are also all things that are generally considered dangerous.
[00:25:31] Deb: Mm-hmm. Yeah. I think that's actually a beautiful segue into sex. Yeah sex full of vulnerability, uncertainty, unknown, anxiety. Mm-hmm. Lots of feelings. Yeah. What do you notice shows up for people in their bodies as we're looking at sex through this lens, right? Mm-hmm.
[00:25:55] Caryn: Yeah.
[00:25:56] Deb: Because nobody's going to, maybe at some point I'll edit this video, but nobody's seeing your face. I'm seeing your face, and your face is full of delight. And I love this because also, like sex and sexuality and intimacy are such important parts of our human birthright.
[00:26:16] Caryn: Mm-hmm.
[00:26:16] Deb: I'm glad to have this conversation with you about it. Yeah. Yeah. So how does it show up for people?
[00:26:23] Caryn: Oh, man. How doesn't it, I know I keep responding to a bunch of questions that way, but there's so many different things. Obviously sexual trauma plays a huge role in this, but I'm just gonna put a pin in that for one second. But and acknowledging that I think everyone has experienced some degree of sexual trauma, whether that is a physical assault or whether that is just being a person who has grown up in a system where your body or sexuality has been devalued by different oppressive systems, or told that it doesn't exist at all. I sort of define sexual trauma super, super broadly. But even putting that aside, like even for folks who don't have traditional sexual trauma or who have worked through it and are ready to rebuild or build for the first time, their relationship to sexuality people are so scared of their desire.
[00:27:16] Mm-hmm. People are so scared of their desire, and of vulnerability and of looking stupid and of doing something wrong or bad. The way that I think about that is like, not just on the surface level, like I'm afraid to do something wrong, but like, I'm afraid that I will be rejected fundamentally, that like my inability to perform in a certain way will mean some kind of casting out mm-hmm.
[00:27:43] Of the community. And so the way that that shows up in people's bodies, I think is physical anxiety often, a pressure, a tension in people's chests, often dissociation, varying degrees of dissociation, just like not really being present in the moment or in your body.
[00:28:02] Feeling objectified, not even explicitly by a partner, but like my body is a thing that exists separately from me and a thing that exists for consumption as opposed to it being the vehicle through which I can experience this deep human connection, physical connection with another person or with myself.
[00:28:21] Sometimes it shows up as pain, even if there isn't a structural genesis for pain, sometimes it shows up as pain. When it comes to sex, when it's a moment of like, oh, right, like I'm supposed to quote unquote, let go and be free and be fully present. I think the vast majority of people are like, how the hell am I supposed to do that?
[00:28:43] Deb: Mm-hmm. Yeah. And there's a cost to freedom. I feel like Oh, yeah. That's the implicit message of like, yes. Freedom is really dangerous. Like being yourself. Yeah. And what you were talking about being cast out, right? Yeah. That fear of Yeah. Not being accepted.
[00:29:01] Yeah. It's really powerful and so we've got a lot of coping mechanisms to mitigate that fear. Let's talk about exposure and pleasure. How do you help somebody who's afraid in that regard? Obviously everybody's different, but
[00:29:17] Caryn: Sure.
[00:29:18] It's interesting because one of the biggest ways that ERP differs from PRT, for example, is ERP, at least the way that I was trained in it, is you structure exposure around pleasure specifically, or if not pleasure, some kind of necessity. A lot of the time it's like, okay, the questions that my boss Andrew Trica, who is a brilliant OCD therapist and person, the sort of his two questions are what do you want from life and how does OCD get in the way?
[00:29:48] And that's how he taught us to structure exposure work. To me exposure work is deeply tied into pleasure at the very core, you're doing this terrifying thing of being present sometimes with really deep existential fears. A lot of the time you do exposure around like fear of death, right? Fear of like capital I isolation. I don't think it's like, you should do these things just so that you're like not afraid of them. I don't really believe in that. You're doing these things because there is something that you want or there is something you were moving toward. The pleasure is the whole thing, in my understanding.
[00:30:23] Deb: Yeah, I think about dopamine, right? And the pursuit of desire.
[00:30:29] Caryn: Mm-hmm. Like that
[00:30:30] Deb: we want something.
[00:30:31] Caryn: Mm-hmm.
[00:30:32] Deb: And then sometimes we have to deconstruct this socialization around Yes. Why? We want something like what we think, sometimes we don't want actually the thing that we're told we should want.
[00:30:43] Right. So then there's that part which is like, hmm, but then there is still a want. Yes. Right? So it's like, what is that more true, authentic want and desire that you have? Yeah. And then like, okay, what does it mean to be greedy for that?
[00:30:59] Caryn: Yeah.
[00:31:00] Deb: Because then you're like, oh, it's really worth taking those risks.
[00:31:03] Caryn: Yeah. The thing that you said a few minutes ago of we got taught that freedom is dangerous. Like it is dangerous, you know, I think it's dangerous in kind of all the ways that we get taught, but I don't think that that danger is inherently a bad thing, if that makes sense. Mm-hmm. Right. You know, freedom is dangerous because like you can blow up your whole life around it, but also that doesn't have to be a bad thing necessarily.
[00:31:28] Mm-hmm. In my own experience in the past two or three years, I don't think I blew up my life, but certainly, I didn't look like this two years ago. Which is to say I wasn't trans. I was much less tattooed. I had a really different way of relating to myself and to other people.
[00:31:45] And I have taken a lot of interpersonal risks in the past couple of years. And a lot of them have flopped. Yeah. Or I have taken a risk and it has not quite panned out the way I wanted. And also, I have taken risks and they have worked out spectacularly. I don't know, I don't know if I have like the exact words that I want for it, but
[00:32:07] I guess maybe like freedom is full of risk, but it's not necessarily dangerous, if that makes sense.
[00:32:12] Deb: Yes. Oh, I love that. Oh, oh, shivering. I think because honestly, I feel like some of that is the gift that queerness and transness gives to the world. Yes. Just not always received as a gift.
[00:32:28] Caryn: Mm.
[00:32:30] Deb: This idea of breaking out of a binary mm-hmm. Breaking out of this mm-hmm. Social conditioning.
[00:32:35] Caryn: Mm-hmm.
[00:32:37] Deb: Which is all made up. Because like back in someday, boys wore pink and wore heels. Right. So these rules that bind us
[00:32:47] Caryn: mm-hmm.
[00:32:47] Deb: Are made by humans.
[00:32:49] Yes. We don't get a choice per se when we're young and raised inside of a system that says you have to do this and look this way and be this way to be accepted. We stand in defiance of that and celebrate it. Make a fabulous party and have a good time and, I'm being a little bit simplistic, but there's a defiance. There's an expansion, right? Yes. Even just the idea of expanding beyond what your hair is allowed to look like. Right. Right. And also feminism, the roots of fighting to be able to wear a pair of pants at work. There's so much, history to stand on to be so grateful for, and it's like holding back the tide of oppressive regimes of authoritarianism, in whatever way, validating and savoring that quality of rebelliousness
[00:33:48] Caryn: Yeah.
[00:33:49] Deb: Is so powerful is such a pushback. We can't necessarily do all the things to fix everything right now. Sure. But there's an internal experience of saying no, in fact I am bigger and different and my difference is not dangerous. Yes. Right. Yeah. But it has risk and different people are socially located in risk in lots of different ways.
[00:34:16] Right. Course. Of course. So there's no one universal risk. Right. And there's no one universal way to hold that defiance inside of you. And that's where it's so dynamic, right? But when we have that ability to explore and question and be curious mm-hmm. And be playful.
[00:34:34] Caryn: Mm-hmm.
[00:34:35] Deb: There's just so much more room for all of that to emerge and yeah.
[00:34:40] So it sounds like you've been on a journey, expanding into more Oh
[00:34:45] Caryn: yeah.
[00:34:46] Deb: Who you are.
[00:34:47] Caryn: Yeah. It's it's been really interesting and okay, this is where I'm gonna have BDSM enter the chat
[00:34:55] Deb: BDSM hahahaha. Let's bring it on.
[00:34:58] Caryn: Because that has been such a crucial part of my experience and also I've learned so much from it that actually has gone hand in hand with PRT really beautifully.
[00:35:10] And in thinking about what my last two-ish years of pretty kind of radical transformation have been, like, so much of the way that I relate to my gender, my body, my relationship to other people has been really deeply informed by some of the politics of BDSM. And it's been interesting to come to this point and be like, oh, I actually don't know if I could have come to this point without if I was missing any one of these different pieces.
[00:35:42] You said something a few minutes ago about queerness as like expansion. And that has been really what it's felt like for me. I feel like there used to be this physical body that I existed in and then that was whatever size it was. And then like myself was, I kind of liken it to like Russian nesting dolls.
[00:36:01] Yeah. But like I'm missing all of the intermediate dolls, my body is the big one. And then there's like me and I'm like the teeny tiny little kind of messed up looking one in the center. And there's this vast gap between the two of us. And I think what my chronic pain journey and my gender and BDSM experiences have those dolls are ever getting closer to each other and are so much closer to each other than they ever have been, and it does feel like an expansion. You know, I did exposure therapy on myself to train myself to man spread on the subway. And now I just go on the subway and I like sit the way I sit. And I don't even think about it, but there was a period where I was like, oh my God, I feel so guilty, I feel so bad, sitting like this.
[00:36:45] And so much about questioning my relationship to desire and power and through BDSM, brought me to that like place in myself and my physical body.
[00:36:55] Deb: That sounds amazing. I feel like we should do a workshop on this. Yes. That would be amazing. We'll talk more about it.
[00:37:02] Yeah.
[00:37:03] Caryn: Down.
[00:37:04] Deb: I'm wondering if, so one, maybe we need a description of what BDSM is.
[00:37:10] Caryn: Sure.
[00:37:11] Deb: If you would like to share, because it's more like what your description of BDSM is. Yeah. Right. Yeah. Versus like some universal idea of it. Right. So I think that would be helpful. Mm-hmm. I guess my question is like it's informed your PRT work.
[00:37:26] Mm-hmm. Yeah. Right. It's not, I'm not saying like you're doing BDSM with your clients, so let's hahahha on
[00:37:33] Caryn: that Most definitely not. No.
[00:37:37] Deb: But we have now a different understanding of, for a
[00:37:40] Caryn: framework. Right.
[00:37:41] Deb: Of a framework. Right. So I'd love to hear that part hahaha.
[00:37:45] Caryn: Oh God. Trying to come up with a vaguely coherent answer about what is BDSM is always so difficult, but I think in my life, the very sort of broad definition I would give would be mutual consensual exchange of pain, power, pleasure.
[00:38:03] Deb: That sounded really concise.
[00:38:05] Caryn: Thank you. I was like, wow. As it was coming out I was like, damn, that's pretty good. It's been really interesting being in this community and in this world, and then also being in PRT because I don't think I know a single person in the BDSM or leather community who doesn't have chronic pain.
[00:38:21] Which, the more that I've learned about PRT I find actually kind of hilarious. Not hilarious that people are suffering, but the idea that PRT teaches, right? That like pain is happening because we're in danger or pain is a form of danger. I think about this with tattoos a lot because a lot of people are pretty heavily tattooed and I have tattoos and you have tattoos and Yeah.
[00:38:44] Um, the thing I always find funny is like with a tattoo, there is actual physical damage being done to your body. Yeah, there is actual structural tissue damage that's happening. And of course, getting a tattoo hurts, but also
[00:38:58] Deb: we're choosing it.
[00:39:00] Caryn: We're choosing it, and also it kind of doesn't. Depending on where you're getting it on your body, depending on how hydrated you are that day, like I've had tattoos where I'm like, oh, that actually didn't hurt at all.
[00:39:10] And then have I had tattoos where, I'm really stressed or I'm really tired, or the artist is like taking their sweet time and I'm like, oh my God, this is agony. Mm-hmm. I think it's kind of very similar with BDSM. I have a friend for example, who I'm like, I've seen you get the shit kicked out of you.
[00:39:27] Mm-hmm. No complaints. Right. Just like taking it and covered in bruises and stuff after, and happy as a clam, and then a couple days later them being like, oh, I have this chronic back pain and it's been really awful and I'm really feeling it. I'm like, that's hysterical. I mean, it's not, but you know, in the moment where there is again, actual damage being done to your body that you're feeling so safe, right? Yes. And held by whoever is beating you up and knowing that this person will stop before I actually come to harm.
[00:40:02] Mm-hmm. Right? Does so much for the body's pain receptors, psychologically that pain gets transformed. Not only does it hurt in a different way, it gets transformed into pleasure. Yeah. And so to me that kind of says so much about the body and the brain's relationship to pain. When you know that you are being held, when you know that there is no lasting harm that's happening internally, pain is actually really something quite different.
[00:40:30] Deb: Mm-hmm. And what we attribute it to.
[00:40:34] Caryn: Right,
[00:40:35] Deb: Somebody thinking about their chronic back pain probably has an entire narrative
[00:40:40] Caryn: Yes.
[00:40:41] Deb: Whether it was like, oh, 'cause I did gymnastics, when I was a kid.
[00:40:46] Caryn: Right.
[00:40:47] Deb: Or their body size. Mm-hmm. Whatever it gets attributed to. We have so many strong narratives about the causes of pain. Yeah. And, that it's structural and that the only ways that pain will go away is through some kind of intervention, whether that's a surgery, an injection, or a medication. Mm-hmm. Right.
[00:41:08] I had some pretty intense knee pain mm-hmm. While on a trip in the Galapagos Islands and went to orthopedic doctor. I was like let me get it looked at. Right. And he's like, well, I really only have these three things to offer you injections, medication and surgery. He wasn't really offering me surgery. He was just
[00:41:29] Caryn: Right. Right. These, yeah.
[00:41:30] Deb: These are what's available. Yeah, I don't really want any of those, I know all of this stuff. And I was like, okay, my body's gonna heal and my Yeah.
[00:41:37] Feels fine.
[00:41:38] Caryn: Yeah.
[00:41:39] Deb: So what we attribute pain to, but I think the part that you're talking about is the choice.
[00:41:45] Caryn: Mm-hmm.
[00:41:46] Deb: Safety.
[00:41:47] Caryn: Mm-hmm.
[00:41:48] Deb: Belief.
[00:41:49] Caryn: Mm-hmm.
[00:41:50] Deb: Right. And that sense of connection. Mm-hmm. Like on a Yes. Deep level.
[00:41:57] Caryn: Yeah.
[00:41:57] Deb: Connection. Yeah. And it's not just choice, but it's like choice. Like it's fun. Like there's something Yeah.
[00:42:03] Caryn: Yeah. Right.
[00:42:04] Deb: It's like play. It's not just about doing your dishes. Right. I mean, I guess it could be you could hahaha them your dishes or, and that would have a different quality Totally.
[00:42:16] To it. So there are all these things that that help transmute that physical experience. Right. But people aren't translating it then to their everyday life.
[00:42:26] Caryn: Right, right. Yeah. Yeah. That's been a really useful entry point for some of the folks that I work with.
[00:42:33] Mm-hmm. I have one client in particular who has a really complicated, both chronic pain and chronic illness history and like they definitely do have some structural mm-hmm. Stuff going on, but I think also a deep history of anxiety and OCD and trauma. So it's very clear to me that a lot of the pain is neuroplastic in addition to there being some structural stuff.
[00:42:55] And they are also pretty tattooed. I was like, okay, so you have the skills, right? We were talking about the tattoos and, and they were like, oh, but I don't have any like really crazy ones or whatever. And I was like, no, I see that you have color packing on the inside of your arm.
[00:43:09] I know how much of a bitch that is to get. And a phrase that one of my friends who is also in the leather world and is also extremely tattooed, they were talking about a tattoo that they were gonna get that was gonna take hours. And I was like, how do you do that?
[00:43:24] And they're like, oh, I just go in my little pain cave in my mind and I just hang out in there. And so the, this concept of the pain cave has also been really helpful in showing clients that you actually have this skill already to be present with the pain from a tattoo for example, that you're struggling to do with your chronic pain. You could do the same thing. The pain cave's not exclusive to tattoos.
[00:43:47] Deb: Right. People talk about the pain cave who are ultra marathoners. Mm-hmm. That's a big thing. So when pain rolls up, when they're doing their whatever, 50, a hundred mile run, they're not surprised.
[00:44:01] They're like, hello, I have been expecting you.
[00:44:04] Caryn: Right.
[00:44:05] Deb: Welcome. Right. We are going on this very long run together. Right. Why? Because I, we want to,
[00:44:12] Caryn: right. And, and there's the, and there's the exposure again, right? Because we want to do this thing. We are willing to risk pain and not just pain, but like vulnerability to pain, vulnerability to fear.
[00:44:27] Deb: Yeah. I think what you're describing also is the vulnerability, being able to be with is what creates transformation.
[00:44:36] Caryn: Yes. Yes. And I think that that is so core to, all of these things that we've talked about, but I think about, with BDSM specifically is like, why do people subject themselves to some like, kind of truly unhinged stuff sometimes?
[00:44:57] And it is that ability to be with vulnerability, with uncertainty, with risk, with the possibility of the cast outed ness is where all of the good shit happens. It's so scary. And also that is where, not to get so existential, but that's where all the stuff that makes life worth living is in those moments of uncertainty and vulnerability and risk and the unknown.
[00:45:25] Whether that is doing some crazy BDSM stuff, or it is chopping carrots without doing a compulsion or it's, being willing to ask your partner to try a new thing during sex. Like yeah. That's kind of everything.
[00:45:40] Deb: Yeah. That moment, that precipice moment of yes, I am not a hundred percent guaranteed the result that I want.
[00:45:49] Caryn: Right. Or even like, I'm on the precipice and there's no guarantee I won't fall.
[00:45:54] Deb: Yeah. Mm-hmm.
[00:45:55] Caryn: There's no guarantee I will fall. But there's also no guarantee that I won't.
[00:45:59] Deb: Right. One analogy I like to share about how your brain works. 'cause they feel like that can be so helpful for helping people understand that they're not like uniquely broken or uniquely alone, right? Mm-hmm. So for people who are afraid of driving over bridges, right? Mm-hmm. Their brain will offer them the image of driving off the bridge,
[00:46:19] Caryn: right?
[00:46:19] Deb: And that's terrifying when you think that your brain is telling you to drive off of a bridge,
[00:46:24] Caryn: right?
[00:46:25] Deb: And I was like, no, your brain is saying don't do that.
[00:46:28] Caryn: Right?
[00:46:28] Deb: That thing that we just showed you in our imagination, right? We would like to not do that. Thank you very much.
[00:46:35] Caryn: Right? Right.
[00:46:35] Deb: When, when we start to be able to look at exposure even more lightheartedly, right? Yeah. Like I'm here for all the existential stuff, in the sense of existential threat sometimes, it's nice to walk it back and be like life, death, like there are no guarantees. I think the playfulness and the lightheartedness can also really help mitigate Yes, yes. Right. Because we are not guaranteed very much. We go to bed assuming we're waking up the next.
[00:47:05] Right,
[00:47:06] Caryn: right.
[00:47:06] Deb: It's really great to do that, easier to go to bed, right. When you just are like, I'm getting up tomorrow. Right, right. If you're trying to go to bed and you're like in that existential threat of, I don't know if I'm waking up tomorrow, right.
[00:47:18] Going to bed is much harder, much harder. And then we have to fight that battle and I'm like, yeah, what if we just remove the battle?
[00:47:27] Caryn: Right? Yeah.
[00:47:28] Deb: Right. We don't need to be in constant battle. We can just be in partnership with our brain, you know? And our brain wants to be like, yep, every time I wanna drive over a bridge, it likes to tell me don't do that.
[00:47:42] Caryn: Right?
[00:47:42] Deb: And I'd be like, cool, thank you brain. Today is not that day. I definitely have no plans. I know how to drive. And I actually am really good at driving.
[00:47:53] Caryn: Right,
[00:47:53] Deb: right. I really know how to drive. Yeah. Driving on a bridge is actually no different than driving on any other day anywhere else.
[00:48:00] Yeah. Yeah. And so those moments of exposure, right, of playing through like, oh, I'm actually really good at sensing into pleasure. Oh, I'm really good at feeling connected with another person. Yeah. Right. So giving people something to come back to when fear is starting to like carry them away.
[00:48:21] Right,
[00:48:22] yeah. I'm sure that's a part of the exposure works since they're, the basis is in like pleasure and desire.
[00:48:29] Caryn: I think the thing that I come back to with folks a lot is the idea too of like choice and agency. Yeah. Just because your brain is showing you the image of you driving off the bridge doesn't mean that you have to choose to act on it. You always have choice.
[00:48:43] Sometimes you don't have agency, but you always have choice. You can choose to be afraid and to do a thing anyway. Yeah. I think that is at the heart of exposure is like doing things afraid. Mm-hmm. Um, and again, sometimes that's like a really big scary thing.
[00:48:58] And other times it is something that is like so silly, right? Being like, Hey, I'm so sorry I'm gonna be 20 minutes late to this podcast. Right. So I think that's the thing that I always like to come back to for folks is like, yeah. If you drive off the bridge, that will have been because of a choice that you made. You always have the choice and the ability to choose something new and something different.
[00:49:22] Deb: I love that. We should probably end it there, I guess we'll have to have another conversation
[00:49:26] Caryn: hahahaha. Thank you.
[00:49:27] Deb: This was delightful.
[00:49:28] Caryn: This is wonderful.
[00:49:29] Deb: I loved that conversation with Caryn and one of the things that I realized as I've been editing it is what was missing? What was missing is their recap on their experiences of both going through PRT and then going through PRT training, what their physical experiences are now. Um. And I was like, Ooh, that piece is missing.
[00:49:56] And that's an important piece of this larger conversation about pain reprocessing and symptom changing. And I didn't wanna assume anything, so I just asked them directly and they wrote me a paragraph, which I'm gonna read to you. So these are. Karen's words, here's where I'm at with my own chronic pain. I would say I'm mostly pain free these days.
[00:50:21] I actually just terminated with my PRT therapist last night. After months of working together, exclamation mark. I feel that even though I still sometimes have moments of pain, my way of relating to myself and my pain is radically different. I have learned in an embodied way that my body is not inherently dangerous, nor does it need to be in a place of fear.
[00:50:47] I think back on all that I've suffered the past few years and marvel at how different things are now, even when nothing has quote unquote structurally changed. I also don't kid myself. I know next time I go through a breakup or have a stressful conflict with a family member, I will likely have another pain flare, and that's okay.
[00:51:12] The pain is less scary and tends to go away faster now than it did before. A big part of my PRT journey has been moving away from perfectionism even, and especially as it relates to PRT. I do not need to be quote unquote perfect at PRT and having moments of pain does not make me a PRT failure.
[00:51:36] Sometimes I will be in pain. I can now trust that pain won't last forever and I don't need to be so afraid of it anymore. Mic drop. We could have had that conversation on the podcast in our interview, but there's something that's so beautiful and poetic and concise about those words, the way that they wrote them and the way that they shared them.
[00:52:02] So I really would love for you to soak that in. This idea of moving away from perfectionism, moving away from all or nothing, moving into this sense of embodied safety and expanding into just more, having more grace, more love, more patience. I loved this conversation so much and I am gonna share Caryn's information on the show notes, and of course my information is there on the show notes. Uh, if you would like to have a conversation about how using MINDBODY tools and this type of PRT informed approach might help you feel better more of the time, please book a curiosity call. I am really excited to talk to you. So thank you so much for listening.
[00:52:59] If you feel moved to give a five star review on Apple Podcasts that helps more people find this work. And in finding this work helps spreading the word and helping people realize that symptom transformation is possible for them. Okay. Thank you so much.