On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Kameelah Phillips on the show to discuss optimizing health during pregnancy. Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate. Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care.
In this episode, we discuss:
-The impacts of COVID-19 on pregnancy and post-partum
-Factors that impact the United States’ maternal mortality rates
-Six ways to optimize your health during pregnancy
-The importance of interprofessional collaboration
-And so much more!
For more information on Dr. Phillips:
Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate. Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care.
Dr. Phillips graduated from Stanford University with a degree in Human Biology with an emphasis in Women’s Health and Human Sexuality. After graduation, she worked at the San Francisco Department of Public Health in the AIDS office as a Research Assistant on HIV vaccine studies. She relocated to Los Angeles to attend the University of Southern California Keck School of Medicine.
During medical school, she received numerous community service awards. She was privileged to travel to Ghana, Cuba, and Tanzania on health missions during this time. Upon completion of medical school, she attended a competitive OB/GYN residency at the New York University School of Medicine. She also served on an emergency medical mission in Port-au-Prince, Haiti to provide women’s health care during the 2010 earthquake.
Dr. Phillips is an educator, mentor, and expert in women’s health issues. She loves to help women and girls feel comfortable with their bodies, so that they can be aware of changes or new developments. Her interests include Minority Women's Health and health care disparities, lactation, sexual and menopause medicine. Dr. Phillips is a member of the International Board of Lactation Consultants and speaks Spanish. She enjoys teaching residents and medical students.
Her guilty pleasures include reality T.V. As a Real World Alumnae, she has used this platform to travel nationwide to discuss domestic violence, smoking cessation, and other health-related issues. She loves a good bargain, flowers, and deep-tissue massages.
You can follow her on Instagram @drkameelahsays
Read the full transcript below:
Karen Litzy (00:01):
Hi, Dr. Phillips, welcome to the podcast. I'm excited to have you on. And this is the first time I'm having an OB GYN on the program. I've had lots of physical therapists who work with women's health and pelvic health. So this is really exciting to get a different point of view on women's health and on pelvic health. And now, before we get into the meat of the interview, we are still living in a pandemic, COVID-19 is still here. It has not mysteriously disappeared or vanished. And so there are a lot of women who are getting pregnant, who are living through pregnancy at this time and who might be a little nervous, a little concerned about what can happen during their pregnancy is COVID affected. So what I would love for you is any advice for those pregnant women in the time of COVID?
Kameelah Phillips (00:58):
Yeah, absolutely. You know, one thing I really try and impress on patients that is absolutely unique to OB GYN is despite what's going on in the world, whatever chaos is going on, women still have babies women still go into labor. Women still take healthy babies home. So for us in particular we've made some minor, not, I shouldn't say minor there there's significant, we've made some changes in how we deliver care and the hospital setting, but for us, it's really been, you know, not so huge of a change because you know, hurricane Sandy earthquakes in Haiti, I've been through both of those, we still deliver excellent care to women. So one thing I would ask them to do is just really take a deep breath and while things are going on around us remember that their primary concern is to take care of themselves so that they can take care of their baby.
Kameelah Phillips (02:11):
I have told patients that a little bit of their OB care is changing. So we might have fewer visits, but really the important things we will always make sure that we hit the important time points and hallmarks of a pregnancy. So you won't miss anything. I've been telling them that labor and delivery has changed a little bit. And I think this changes pretty much coming across country, but whereas it used to be a time where, you know, extended family was welcome. It's important that they recognize now that only one or maybe two people will be allowed to be present for labor and delivery. And our hospital in particular, both moms and support family are being asked to wear a mask. We do check moms for coronavirus. We use the nasal swab. The extended family is not tested, but they're expected to keep their mask on.
Kameelah Phillips (03:16):
And most of the time our moms are coming back negative, but if they do come back positive, you know, we have a discussion and education with them as to what it's going to be like, knowing that they're now corona virus positive and going to be taking home a newborn. So we talk about those things. But for all intents and purposes, women are coming in. They're having healthy, safe deliveries, both C-sections and vaginal deliveries. Their hospital stay we've shortened a little bit in New York, we're going back to keeping women two days or four days, but other places in the country are, are shortening. The hospital stays in an effort to get women home safely and so that they can use hospital resources for the people that need them. But we're having healthy and safe deliveries. There was a panic, I think, amongst the pregnant community at the beginning of the pandemic, and everyone wanted to have a home delivery that still continues to not be the best response to this.
Kameelah Phillips (04:28):
It is still safest to deliver in a hospital or birthing center, certainly not at home to have best outcomes. We still recommend that women breastfeed that's the best way to feed your baby despite Corona virus, even if you were previously infected. And when women go home, I just ask them to be considerate of the new immune system in their house, right? So limiting visitors, washing their hands. If people come over, keeping them not being afraid to say, Hey, keep your face mask on while you're with the baby or around the baby. And really using the technology that we have to their benefit. So while it's not what we're used to, the grandparents meet their babies over FaceTime or zoom now. And that's not going to be forever, but you know, if you have people who are unable to quarantine and can guarantee that they're negative, I asked them to defer visiting.
Karen Litzy (05:29):
Yeah. Thank you. That's all really great advice. And I should have mentioned in the beginning that we are both located in New York city. And so right now it's different.
Yeah. So obviously New York was the epicenter of the pandemic, certainly in the United States, if not the world at one point we have now our numbers have gone down, but the safety for the pregnant and new moms have, has not is right. Yeah. Right. So we are still on top of new infections, preventing infections in the hospital, the doctors, the nurses, the people who clean your rooms, we're all washing our hands, wearing gloves, keeping our mask on because it is our priority that you come in healthy and that you leave healthy.
Karen Litzy (06:33):
Yeah. Perfect. All right. Well, thank you for that. And hopefully if there's any pregnant moms or other healthcare practitioners that are working with pregnant women kind of give them a little bit more information to pass along or to kind of keep in their heads. So now let's switch gears slightly here. I'd love to talk about maternal mortality rates in the United States now in the United States. We know, unfortunately that we do have a very high maternal mortality rate amongst advanced countries, or what's the best word for that advanced countries? Is that the right developed countries, industrialized countries, like we know what you're talking about, you get it right. So the questions that I have are what populations are most effected. And then what, in your opinion, do you feel like needs to be done to improve those maternal mortality rates?
Kameelah Phillips (07:32):
I am firmly under the belief that we can as a nation, as a country walk and chew gum at the same time to make these rates better. So to answer your first part of your question we have plenty of data that show that black women, African American women in particular are most vulnerable during pregnancy labor and delivery. And postpartum times the rates of increased death can be anywhere from five to seven times higher than their white counterpart. And these rates are abysmal for a developed country to have such a discrepancy in healthcare is really saddening and frankly just discussing it's unacceptable. But there are other ethnic groups that are also at risk that, you know, we always talk about black and white and really this country is so diverse, but our native American population is also significantly affected by maternal mortality rates that are poor as well as Alaska.
Kameelah Phillips (08:57):
We always forget about Alaska. So African American women, native American women and Alaska women, and it's complicated. It is a combination of access to care. It's unfortunate that we seem like we're talking about the same things over and over, but access is a big issue. We live in the biggest city in the United States, but you know, Manhattan alone, what the Island of Manhattan has four hospitals there used to be more, there used to be more can you imagine? But some of our outlying communities that are more ethnically diverse or Latino or African American have far fewer hospitals. And certainly in those hospitals, the resources aren't comparable to anything that you would see in Manhattan. So along with, you know, access there's hospitals, there's doctors there's birthing centers, all of these are less often found in lower resource places.
Kameelah Phillips (10:06):
So access is a big one education both on the part of the health field and of patients themselves is a problem. I think we're starting to really get some traction on the African American population, helping them understand that this is a very critical time in their life. And so they have to be hypervigilant about blood pressure, weight gain, diabetes, all of things, all the things that can be triggers for issues in pregnancy. Those are the big things that stand out access and education.
And do you also find that, and I find this in other aspects of healthcare especially when it comes to feeling pain that oftentimes women are not believed as much as men are. And, that is in other parts of healthcare, certainly true. Do you find that women maybe during pregnancy or even post pregnancy, like maybe that the day they gave birth, if they're there trying to explain things that are going on and perhaps they're not being believed and are just yeah brushed to the side so that I think is absolutely the case for a lot of the issues that women experience around the maternal period.
Kameelah Phillips (11:22):
And it's not limited to women. It also crosses ethnic and socioeconomic boundaries. We have a real issue and I'm part of the establishment, right? I'm part of the medical community. So I feel free to air up our dirty laundry, that we have a real issue with bias and medicine and we talk about racial bias and how that can impact black people. But we have a bias against women. We have a bias against women and, you know, she's being hysterical, she's being dramatic or pain's really not that big women in our discomfort in our needs are routinely downplayed and even by other women, because we've sort of ingrained in our head that, you know, women tend to be more dramatic, whatever.
Kameelah Phillips (12:30):
We downplay the needs of poor patients who come in, Oh, you know, she's just being loud for no reason or, Oh, that's just how they're. So this isn't just an issue of women. It goes across class, it goes across ethnicities. But for us, when we're pregnant, it has to be addressed and highlighted because when a woman is saying something isn't right. Something isn't right. And that should be taken seriously because in the postpartum period we get lucky a lot of times because women are generally young and healthy, but when things go bad in obstetrics, they happen quickly and then its big. So for example, if a woman was like, my bleeding is kind of heavy and say, maybe she just delivered a baby, a woman could easily lose one to two liters of blood in like a few minutes. So we had a really bad postpartum hemorrhage the other day. And I was like, this is impressive when you see what the body can do. Especially in labor, it happens quickly. And so it's incumbent upon us as healthcare providers to take women seriously.
Karen Litzy (13:27):
And then I would also think there is, and again, I don't know if this is true or not, but I know kind of where I come from more looking at the pain world and from my own experiences, as I personally would downplay my own pain. So as not to bother someone. Right. And do you feel like in the world of OB GYN, if you're going for pregnancy, like, do you have to kind of really educate those patients to say, listen, if you're feeling something doesn't feel right, like you need to speak up, right. Well, like you're bothering us. Have you encountered that?
I have encountered that. And it's really incumbent upon all of us to relearn these narratives that we've picked up just growing up in the United States of like not being the complainer or not being the squeaky wheel, not rocking the boat. Like those all have negative connotations right.
Kameelah Phillips (14:47):
In the obstetric space. When you don't speak up, we can have really negative, horrible outcomes. So part of my experience with patients is to listen to what they're saying really repeat back what they're saying, like, okay, I hear you're having X, Y, and Z. Did I get that right? And if it's something that is quote unquote normal in the space of a, you know, a growing uterus or a growing body part of my job is to really provide education, to help them manage their expectations for what they should expect. Growing uterus, growing weight gain, swelling, what they should expect from their body. If it's the first time they've been pregnant or the sixth time they've been pregnant, you know, all the pregnancies are different. And if we have a clear understanding her giving me her complaint, me giving her feedback on what I think she's saying, and then giving her the anticipatory guidance, I think she needs, and we still have an issue. Then it's incumbent on me to escalate it and really make sure that there's nothing there that's going to hurt her.
Karen Litzy (16:01):
Yeah. Great. That's perfect. And I love the kind of handling of expectations and monitoring expectations because that goes such a long way when, especially if it's your first time or not, like you said, your first or your six times, but kind of knowing what to expect at certain times is very comforting. And so then as if you're the patient, then you can say, Oh, you know, she said, this might happen, but I'm not, you know, it's not happening or it's going above and beyond what she said. So maybe this is time that I reach out and contact my physician on this, there are times where you may need to reach out to your doctor. And so knowing when those times might be, is really helpful.
Kameelah Phillips (16:53):
Exactly. So when a woman leaves the office and you know, it'll be maybe a month before I see her again, I tell her, you know, this is what I think might happen. It's okay. If it doesn't happen to you, but in the next four weeks, you might expect, you know, your pants size to change general discomfort in this area. You might feel something fluttering in your belly, like giving her those points to look out for. And again, managing those expectations and I'll get a phone call, Hey, this is maybe more I'm having this. Plus this is this in the realm of normal. No, it's not come in. You know, we can really help women out by giving them education cause it's empowering. And it helps us do a better job taking care of you.
Yeah. And it also keeps people away I would think from dr. Google or far down the rabbit hole of how many doctor Googles do you get?
Kameelah Phillips (18:17):
You know what, I can't anymore. Just so many doctor Google's with doctor said, I can't even more. Or my Facebook friend Sally said, Stay off. And it's funny cause when their partner comes with them, the partner inevitably just looks at him and like glares at them because they know that they're on Google or they're on these, you know, small chat rooms where everyone is on the T level 10 when the patient's issue is actually maybe a one or zero. And so it freaks her out. Yeah. I encourage patients to stay off of Google. Because yes, there are some times when it might answer your question, but really we're aiming for individualized personalized care and Google doesn't offer that to you. And so I really ask my patients to stay off of it. That's what their visits are for to write down the questions as they go. And honestly, it's so funny. They'll come in with like, say there's five questions just in the scope of time, given them the anticipatory guidance.
Kameelah Phillips (19:17):
Like by the time they actually get to the appointment, they may only have two questions because they're like, Oh yeah, she said that was going to happen. They know exactly, exactly. It helps to stay off Google.
Yes, yes, yes, yes. And now I think we've touched a little bit, I think on this, but let's see if we can delve into this more and that are what are ways women can stay healthy throughout their pregnancy so that maybe it can contribute to a decrease in the maternal mortality rate, even if it's just chinking away at the tiny little bit, because like you said, it's a big bucket with a lot of stuff going into it. But if there are ways that women can, like you said, empower themselves to stay healthy and give themselves the best chance, what advice do you give to women to stay healthy?
Kameelah Phillips (20:04):
Yeah. So in thinking about this, I have six points that I usually share with patients. So I'll go over them really quickly. But my first point is to find a doctor that you trust. I'm really big on that. I'm really big on that. I tell people to find someone that they trust because inevitably, you know, most pregnancies are fine, but if we get into some mess, I need to know that you know that I am your advocate and I am on your side. And if you hesitate or you don't feel like you can trust me a hundred percent, I'm going to ask that you explore other op, find another doctor because I want you to the best experience possible. And I even say this with my GYN patients, like if I tell a patient, you know, I really think you need surgery for this.
Kameelah Phillips (20:56):
I don't sign them up for surgery that day. I've let them go into the world, do their due diligence, meet with three other doctors. And I promise you, I have not had a patient not come back because they trust me. So that's a big thing. Find someone you trust. I think it's really important that patients meet with their doctor frequently, meaning that you come to your visits, you got to show up, right? So we can get data from you like your blood pressure, your weight how you're feeling, checking the baby regularly, blood work, this data that we're collecting at every visit. And it might not sound like a lot 15 minutes, but it actually gives us a picture of where we're going with your health. So that's important. I asked my patients also to stay active and exercise. I am not sure why there's this misconception that you should be sedentary during pregnancy first trimester.
Kameelah Phillips (21:55):
I get it that progesterone knocks everyone out there on the couch. They can't, you know, they're nauseous. They don't want to, I get that. But for the most part, when you feel healthy in pregnancy, I need you take care of yourself. And that means exercise and eating healthy and patients are, Oh no, but the baby really wanted the chili cheese fries. No, no she didn't the baby requests. Yeah. Did she send you a text message to get that? So really encouraging, like if you would feed your six month old, you know, a Coke and chili cheese fries for lunch, that's a separate conversation, but you know, trying to do as best they can. In terms of staying active and eating healthy education is a big piece for me. Every time they leave, I'm like, okay, we're entering this phase. These are the major risks for this phase.
Kameelah Phillips (22:53):
So I need you to go home and look at this website and read two minutes about diabetes, cause you're doing your diabetic test and this is why it's important. Being flexible is huge. Patients, I think often have the misconception that physicians or that I control their pregnancy. And really, I see myself as just like a tour guide, ushering your baby safely into this world. And so it's important that they're flexible to whatever the results come back as whatever the ultrasounds tell us, however, the baby is behaving in labor, that they're flexible. In my industry, I'm not sure what the corollary will be with physical therapy, but people who come in with very strict demands as to how they expect their process to be are the main people who have complications as opposed to just letting us do our job, to get you guys to the finish line.
Kameelah Phillips (24:02):
So being flexible is really important. And then my last one is to not refuse life saving treatments. We were, it was in the, I told you the other day I had a postpartum hemorrhage and I might back of my head. I was like, this woman's going to bleed. So as we were pushing or when she got admitted, I was like, you know, this is the type of situation where I see XYZ happening and when XYZ happens and she lost all that blood. When I came to her about needing a blood transfusion, she was already on board to not refuse treatment that could possibly save her life. So not refusing like blood products or blood pressure management, those are increased surveillance. Those are the big things that hurt and cause women to lose their life. So really not refusing important treatment.
Karen Litzy (24:58):
Yeah. And I think thank you, those are great ways that women can stay healthy. And you know, as you were saying, they need to be flexible. And I always go back to movies where they show the woman going in and she's got a birth plan and it has to be this and it has to be this. And there's no flexibility around that. So I could see how that could be really dangerous if you're going in with that kind of a mindset of, you know, I have to have this baby without any drugs and have to have it vaginally. When in fact there might be some complications where that's just not possible and it's just not possible. And, or advised or safe.
Kameelah Phillips (26:00):
And again, we don't decide that, right. The baby's position, the mom's uterus, the pelvis, like all of these things that are outside of our control decide that we're just here to make sure you both come out on the other side. Okay. And I can't underscore that. Cannot underscore that. Like I don't have anywhere to be there's this misconception that doctors always have like tickets. So like I have to be at the opera tonight. No, we don't have anywhere to be we're here for your baby, but you know, we have to have some flexibility, like let us just do our job and we'll get you through this.
Yeah. I think that's great. And then of course, I always love the third point, which is stay active and exercise and move during your pregnancy. And I think I'll give a quick plug for physical therapists. I think this is where physical therapists and women there are a lot of physical therapists who are pelvic health specialists and who work specifically with pregnant and postpartum women. And this is where I think we can actually maybe make an impact in that maternal mortality rate as physical therapists.
Kameelah Phillips (26:54):
Yeah. Yeah. I spent the first part of my career in a group dynamic and it was very hard for us to think outside the box with complimentary specialties that can help make this process of pregnancy, which is physically mindblowing. Like people, if you haven't necessarily been pregnant before or been in an intimate relationship with someone who's going through pregnancy, you can not imagine how physically difficult it is to have a baby. And so when I was bringing up the options of like physical therapy, no, no, no, she's fine. The body heals itself. I'm like, but it's not like, look at her walk. You know, I'm looking at her. Diane is like, like, let's think outside the box. So in my new practice, I'm making much more of an effort and actively establishing relationships with people that, okay, you're having this issue.
Kameelah Phillips (28:07):
Now let's connect with the physical therapist because you know, the hips give women the most trouble, the hips, maintaining flexibility labor and delivery, the act of pushing literally separates your pelvis. You know, it's not, of course you have issues with your pelvis afterwards. Lacerations, you know, women who undergo episiotomies that pelvic floor has literally hit the wall and back. So to not expect that pregnancy is a hundred percent, the most physical activity you can do with your body just really undermines and belittles the whole process. And so part of my process now is to send women to physical therapy, postpartum, even if it's just for one visit so they can have an idea of how to improve their core, how to keep their pelvic girdle in shape and engaged because most women have more than one kid.
Kameelah Phillips (29:11):
So that's a lot of, you know, trauma to the body. And we can do better. We know that it works, we know that it's available, but it's up to us to provide the education and the next steps for them to heal.
Yeah. Well said, well said I love it. And now as we wind things up here what would be, what would you like the audience to take away from our discussion today?
Kameelah Phillips (30:29):
I think that it would be helpful to really understand that most doctors do their best to provide women with excellent obstetrical and Gynecological care. I think that a good doctor is really open to receiving information from other specialties in this case PT, physical therapy as modalities that can compliment what we offer. That's not in opposition to what we do so that if we could somehow strengthen the relationship between obstetrics and physical therapists, everyone would win. Like it's for all of us, the patient the obstetrician, the physical therapist the patient's family. It's, you know, pregnancy is the deal. It affects literally you physically, emotionally, psychologically, and sometimes the physical impact of sometimes a lot of times the physical impacts the emotional and the psychological and your sense of wellbeing and health is so impacted by like how you physically look and feel. And you guys have a direct, you know, you have the keys to helping us, you know, improve women physically. So if we could strengthen that relationship and not see it as so oppositional, I think it's a triple win for everyone.
Yeah, I agree. And the last question I have is one that I ask everyone. And given where you are now in your life and in your career, what advice would you give to your younger self?
Kameelah Phillips (31:41):
So I'm out of residency 10 years, and I'm just starting my first private practice venture. And looking back, I probably should have done this five years ago. And yet I had a lot of other things going on. I was like birthing my own children and that kind of thing. But at the root of it, honestly, I was scared. I was scared of failing. I was scared of the unknown. I was scared of doing things that I'd never been taught before. Like formally I didn't consider myself an entrepreneur, all these like negatives, right? Negative, negative, never didn't have it. Shouldn't wouldn't, couldn't like, and I would give my younger self, like a kick in the butt to like, just get out there and you know, unless it seems so cliche, but you don't know unless you try. And when you're young, there's nothing to lose.
Kameelah Phillips (32:53):
Except the fear that's like this imaginary fear that's holding you back. It's a time to be brave and courageous and adventurous. And so I would probably give my younger self like the little push off the ledge the encouragement that I needed to have started this venture and experience earlier. And I would just tell her to be fearless. What do you got to lose? You can always, you know, move back in with your parents. That's what we're doing these days. Right. So like, why be afraid to fail like that just now it's so funny. Cause I think about it cause I'm in it now, but what did I have to lose? Nothing. Nothing. Yeah. Like time, but that would have been a learning, you know, you would have learned so willing to learn.
Kameelah Phillips (33:52):
So yeah, I would have jumped sooner.
Excellent advice. Thank you for that. And now where can people find out about you about your new practice? Where are you on social media? Where can we find you?
Kameelah Phillips (34:57):
So on social media? My main page is drKameelahsays, my practice page is Callawomenshealth, like the flower. I love the like beautiful erotic nature of the calla lily. So that's my practice Calla women's health. I'm on the upper East side of Manhattan, but also available for telehealth visits, physical visits throughout coronavirus. I've been on the grind in this office. So taking new patients of course also happy to see them.
And for everyone listening, we will have all of this information, one click straight to all of the practice and the social media at the podcast.healthywealthysmart.com. Under this episode, it'll all be in the show notes. So if you didn't get it, don't worry, you can get it that way. So thank you so much for coming on. This was a great episode and I think you've given a lot of wonderful advice to healthcare providers and to women who may be pregnant or want to be pregnant or maybe has already been pregnant. There's a lot of stuff here. So thank you so much. I appreciate it. And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Susie Gronski on the show to discuss chronic pelvic pain syndrome in men. Dr. Susie Gronski, licensed doctor of physical therapy and board-certified pelvic rehabilitation practitioner, is the author of Pelvic Pain: The Ultimate Cock Block, an international teacher, and the creator of several programs that help men with pelvic pain get their pain-free life back.
In this episode, we discuss:
-What is chronic pelvic pain syndrome/chronic prostatitis
-Sociocultural barriers unique to men receiving pelvic pain care
-Male expectations and reservations during a pelvic health treatment session
-Strategies to increase patient self-efficacy
-And so much more!
Men's Online DIY program: use code painfree20 for $20 off!
For more information on Susie:
Dr. Susie Gronski is a licensed doctor of physical therapy and a board certified pelvic rehabilitation practitioner. Simply put, she’s the doctor for ‘everything down there.’
Her passion is to make you feel comfortable about taboo subjects like sex and private parts. Social stigmas aren’t her thing. She provides real advice without the medical fluff, sorta' like a friend who knows the lowdown down below.
Dr. Susie is an author and the creator of a unique one-on-on intensive program helping men with pelvic pain become experts in treating themselves. Her enthusiasm for male pelvic health stretches internationally, teaching healthcare providers how to feel more confident serving people with dangly bits.
She’s determined to make sure you know you can get help for:
without needing to be embarrassed...
So whatever you want to call it, (penis, shlong or ding-dong), if you’ve got a problem ‘down there’, she’s the person to get to know. Dr. Susie is currently in private practice in Asheville, North Carolina specializing in men’s pelvic health.
Read the full transcript below:
Karen Litzy (00:01):
Hi Susie, welcome to the podcast. I'm happy to have you on. And now as the listeners may know, I've had a lot of episodes about pelvic health, pelvic pain, but most of them were centered around female pelvic health and pelvic pain. And today, kind of excited to have you on Susie because today we're going to be talking about chronic pelvic pain in men. And I think this is a topic that is not spoken about a lot. I don't know if it's still considered taboo in many places. We'll talk about that today as we go through this podcast. But before we get into it, can you tell the listeners what is chronic pelvic pain syndrome or chronic prostatitis, which I don't know why I have a hard time saying that word and I'm looking at it and still have a hard time. But anyway, that's neither here nor there. That's my problem, not yours. So go ahead and just give us what is it?
Susie Gronski (00:52):
Well that's okay about the not able to say the word prostatitis because it is a bit of a misnomer when we're talking about male chronic pelvic pain syndrome. So it's okay. I wish that word wasn't used as frequently anyway to describe what we're going to be talking about. So the official definition that one might read in the literature is that chronic pelvic pain syndrome or chronic prostatitis is having recurring symptoms lasting more than three to six months without a known cause or pathology. And that typically results in sexual health issues, urinary complaints, and obviously a lot of worry to say the least. So that's the official definition of chronic pelvic pain syndrome.
Susie Gronski (01:46):
Now the NIH or the national Institute of health classifies, I put in bunny quotes here, prostatitis into four categories and briefly those categories are an acute bacteria prostatitis, chronic bacterial prostatitis, chronic non bacterial prostatitis, both inflammatory and non-inflammatory, which is the realm that physical therapist will work in. And then you have a category, interestingly enough, asymptomatic inflammatory prostatitis. And I think that's really important to stress that you can have quote unquote inflammation in the prostate, but you still have individuals who are asymptomatic. So when it comes to the word prostatitis and itself to describe male pelvic pain, I think it is a bit of a misnomer because a lot of cases are not bacterial related or infection related. And actually in fact 90 to 95% are not infection related or bacteria related. So I think we need to shift from using prostatitis as the main umbrella term.
Susie Gronski (02:52):
Because you know, it puts the blame on the prostate when we know that's not the sole cause or what we're dealing with in the long run.
Got it. So that, that can be a little confusing for people. Cause I'm assuming if you're a man and you hear that diagnosis prostatitis that that's gotta be kind of unnerving to hear. Right? For one you don't know what it is.
Yeah. It's like, well, and I don't want to stereotype, but I think when guys really hear prostate, anything, what's the first thing that might come to mind? Cancer, cancer. Right. And so now you're freaked out like what's wrong with my prostate? Am I going to have cancer? We know it's highly prevalent. And so yeah, I think it is a bit of a misnomer in terms of when you have pain down there especially without a known cause that leaves the fear of, well, they must be dismissing something.
Susie Gronski (03:50):
There must be something really seriously wrong that the doctors are not just finding.
And what are some common symptoms? I know you mentioned a couple in the beginning there, but if you can kind of repeat those common symptoms that people may experience with chronic pelvic pain syndrome and is pain one of them. Yes. Right?
Yes. Most often it is a sensation that is not typically pleasurable. It's painful. It may or may not be associated with urinary issues. In general. You'll have any sort of pain or discomfort in the abdominal or genital region. It could even be around the tailbone or even pain with sitting, sitting around, you know, around the sit bones in the groin. It may or may not be associated with sexual function. So for some men they might experience pain after completion or with an erection.
Susie Gronski (04:46):
They might feel pain with bowel movements. It might be testicular pain. It might be pain between the scrotum and the anus, typically known as the taint area. So there's a lot of overlapping symptoms that one might have. Again, everyone's so unique, but those are some of the common themes that one might hear in the pelvic health world.
And so if you're experiencing these symptoms, let's say for more than a month, I mean, will people experiencing these symptoms for, let's say a couple of weeks before they go see a doctor or go to look up their symptoms and see what's going on?
I think that varies on the person and their personality in terms of like their health and healthy behavior in terms of men health seeking behavior. We know that when you compare it to, for example, women, they don't tend to kind of seek out the help of doctors as women might do.
Susie Gronski (05:50):
Right. and I think that's across the board in terms of international standards as well in terms of the seeking behavior, health seeking behavior. I don't think I can have like a, I don't have a stat or factored on that, but I do think that men tend to kind of like watch and see what happens or you know, I think many of us do. Like if you feel something you're like, well that'll just pass. Right? I don't know if I gave an answer that fully. I just know that sometimes people wait and sometimes people go right away cause they're afraid or whatever the case may be. But I do think that the sooner that you can get reassurance for what you're experiencing in term, and I mean reassurance from not just take these antibiotics and come back and see me in six weeks, it should go away.
Susie Gronski (06:42):
Because that's typically what will happen when a guy will seek help. And I think the main one of the main barriers too is that where does a guy go get help from when something like this happens? Cause for females we have a gynecologist or a woman's doctor, right. But guys, like I know my husband just, he's like, I would have no idea where to even go. Who do I seek for help for this kind of thing. And so I think when we're talking about barriers for seeking help, that's one of them. I just don't know where do I go. And then you'll go to your primary care physician who may or may not be familiar with, you know, chronic pelvic pain or being able to differentiate, you know, whether it's an infection and what tests to do.
Susie Gronski (07:26):
A lot of times men are given antibiotics without even having diagnostic tests to see if there's an infection, which is unfortunate. And they'll do this for several rounds too. And so I think the longer that happens, the more that we're making the situation worse in terms of, you know, we know we've got microbiome, we'll plan to those pictures. Well it may or may not have been an infection that triggered this. We know the immune system plays a role in chronic pelvic pain. So, you know, I think having a well versed, fuzzy healthcare professional who can really help this person say, Hey, this is what could be happening. We know a multifactorial and multi-modal treatment approaches is very helpful for what you're going through and that, you know, these symptoms shouldn't last forever. Here go see a pelvic therapist if we know that's not happening.
Susie Gronski (08:23):
And I see guys several years later or years later before they even have an appropriate diagnosis, which I guess brings me to say that chronic pelvic pain syndrome is a diagnosis of exclusion. So, before they even come see or get a referral to see and see if they're lucky to get a pelvic health referral, they'll go through a lot of invasive tests. Cystoscopies colonoscopies. I mean, you name it. So I just think that by the time they do get the help, the right care that they need for the issues that they're experiencing, they've gone down a really dark rabbit hole by that point.
Yeah, and that's sort of looking at, I mean, it's not that they're healthcare providers are intentionally doing them wrong, right? They just don't know. Right. So we're talking about, I guess this more traditional view of a medical process for men who are coming in. Having these complaints is saying, well, let's check this, this, this, this, this, and this. Like you said, a diagnosis of exclusion. And then years down the road they come to see you and I can't imagine, forget about their physical wellbeing. I can't imagine their mental and emotional wellbeing is doing all right either. And now the pelvic physical therapist has a whole lot of comorbidities to deal with.
Susie Gronski (09:21):
Absolutely. Absolutely. And with any type of persistent pain, not just chronic pelvic pain syndrome in men, but I think with any type of persistent pain, we really have to be looking at the psychological and sociological aspects of that person's experience. Because at this point now we're dealing with an emotionally driven process versus a purely nociceptive in nature. You know, it may have started that, but now we're dealing with this like this cat yarn, I don't have cats, but a kid, I know they like to play with yarn and you have this big ball of yarn that you're really just taking one strand out at a time to really unravel and everyone is so unique and very different.
Susie Gronski (10:30):
So yeah, I think that's where we're dropping the ball with getting quality pain care for these individuals. Number one, just getting rid of some of these barriers of a lack of education on the practitioners, you know, perspective of what do I do in this situation? Why do we need to have all these invasive tests done? In my opinion. I don't think we need to do that, but they're really not getting the referral to see qualified, you know, pelvic therapists who can really rule out, you know, biological triggers and even work with the psychological and sociological aspects of that person's experience. Just to, again, calm things down. And to reassure that person that things are going to be okay. And to that extent, I think this would be worth noting as well is some men do not have positive medical experiences in that they're not being validated, often being dismissed.
Susie Gronski (11:23):
And no one's really actually looking at their genitals. To this day, I still have men say it's all about just finger, finger in the butt, checking out the prostate, and no one's really addressing like, take a look at my testicles, look at my penis, like treat it like any other part of my body. And then you're then that kind of plays into the blame and shame of one's body. And just again, not knowing, no one's really looking at it. I want somebody to look at it to tell me I'm okay. And I think that's really being missed as well in those early encounters with medical providers. I think that's so important.
And you know, you had touched on it a few minutes ago talking about not just what we see from a physical standpoint, but a socio cultural standpoint as well. So what are some common barriers that are unique to men from a sociocultural standpoint when receiving care for chronic pelvic pain?
Susie Gronski (12:25):
Well, the first one that I touched base upon as you said, was having an outlet to get medical care. So there isn't a, you know, male gynecologist per se for men. And so I think just having a lack of that awareness of where does a guy go get help for these types of things. Where would be the best physician, let's say for health urologist or urologist. But that isn't usually the first line of the encounter. It's usually an internist or primary care physician. And sometimes it could be even other healthcare professionals like a massage therapist or a chiropractor, an acupuncturist who's hearing these the symptoms or men feel comfortable enough with the trusted provider that they trust to talk about even what they're going through. Cause I think that brings me into the second, I think barrier is I think if I can say this, the masculine side of culture, right?
Susie Gronski (13:33):
Like, what should men like mentioned man up and not have these issues and what if something is going on down there? Like, you know, guys aren't really talking about their private parts in the locker room per se. And I speak, again, I'm speaking for the heterosexual male, but like, you know, I think it's just uncomfortable in terms of how the society that we live in to even have that conversation be brought up so that being one of the barriers is just, we're not really talking about sexual health issues and what could go wrong unless it's like, you know, erectile dysfunction. Right?
Well, that's all over TV, so you can't miss that one. Right, exactly. Here's a pill for that. We know how to fix that. You know, you got Snoop dog talking about like male enhancement products, Pandora. Yeah. And I think, I think in terms of, you know, what are the conversations that we're having around men's health and really comes down to what's selling and what's not selling, unfortunately.
Susie Gronski (14:38):
But yeah, I think that that's one of the biggest barriers as well as just we're not talking about it outlets. There are no you know, taking a stand for men's health essentially. And the second thing too, or the third thing is when a guy has pain down there and they look it up on the internet, cause that'll probably the first thing we do. Absolutely dr Google will be first they're there and to get help, everything is women's health, women's pelvic health, a women's clinic, baby and mom, you know, like things like that that are coming up where that in itself is like, wow, this is a quote unquote woman's issue. Why am I having it? What does that mean for me? Because again, guys and everyone, I think unless something is going on down there, like we really don't talk about our pelvises or how things work and we're not taught, we're not really taught about like you know, what to expect and how things work and that you have actually pelvic muscles down there.
Susie Gronski (15:39):
So until you know, something goes South literally and then you have to like look things up and there's enough of crap out there to scare anybody. And so I think, you know, again, I think Google is helpful but it also can be harmful because we know, we know that anything can really shape someone's prognosis when they're seeking treatment and you have scary forums and you have people talking about how I'm living with this for several years. And then you have this person who's just starting to experience these symptoms, reading through these forums and looking at, you know, it could be cancer or it could be this or that. You know, it's like a life sentence. And that's really scary. And that I think is what part of the picture that takes things from acute to chronic in my opinion.
Karen Litzy (16:48):
Yeah. And you know, when people are involved in, and this isn't across the board, but oftentimes in those kinds of forums, it's people are writing about their experiences that have gone wrong, right? Or that you said, I've been experiencing this for years or I tried X, Y, and Z and it was horrible. So when you read those kinds of forums, cause I've gone on those, I think we, you know, a lot of healthcare practitioners should go on some of these forums to see what's being spoken about. But I've gone on them for like chronic neck pain and you're like, Oh my God, goodness. Right. This is, this is frightening. It's really scary. And so I can't even imagine someone going on there who is experiencing, like you said, some of the symptoms that you had mentioned before. Maybe they've been experiencing these symptoms for a couple of years or a couple of weeks and they look on these forums, they're like, Holy crap. Yeah. Like this is what my life is going to be now.
Susie Gronski (17:35):
Right. I mean that is really scary. Exactly. Exactly. And that we know, doesn't matter what body part we're dealing with, right. Tends to make the situation worse. Yes. Just cause of that. And so I think I'm a huge proponent of, I don't think I am a huge proponent of having good information knowledge. And like I said, reassurance for this group of people to say like, Hey, this isn't forever. This is what you can do about it. We can really work with this. It's more common than you think. And, it happens in this area, just like any other part of our body, you know there's muscles down there, there's nerves down there, there's everyday function that happens, like pooping, having sex, you know, all these things are quite normal. And I think just even experiencing some discomfort down there, just like you would have some back pain once in a blue moon is not, you know, something that needs to be perpetuated I think for many, many years.
Susie Gronski (18:41):
But I think we're talking about is that it's unfortunate because they will go down a rabbit hole of, well we've checked everything, we've done every scan under the sun and there's nothing that's showing up on scans. I just don't know what else I can do to help you. And then at that point the conversation is, well now it's all in your head and then, and I'm a goner. Like I'm doing. Yes, I'm doomed. Like and then, yeah. You know, when we talk about the interpersonal context of pain for that individual, it's am I going to be able to have a family, you know, if they don't have any, you know, or be in a relationship or to have kids or how about my job, I have to sit for my work. I can't do that. Or what about my sport that I want to play?
Susie Gronski (19:27):
Does that mean I can't do that anymore. I mean, there's so many like what ifs and uncertainty and that's one of the themes that men will talk about it's this uncertainty, this roller coaster ride of the symptoms that they experiences. It's fine, you know, one week and then it's terrible the other week and they just don't know what to expect because there's no rhyme or reason for it, for their triggers. And that's really, I think that's a really hard mental, yeah. How do I say that? Like a lack of words. It's really hard. Mentally. It is.
Yeah. You know, you're absolutely right. And now let's say one of these guys they've been having these symptoms, they've gone to their doctor and miraculously their doctor said you need to go see a pelvic health therapist. Right. Yay. The doctors know what's up. So what are some reservations men might have before seeing that pelvic health therapist? And then we'll talk a little bit from the therapist background point of view after that. But let's talk about the men's point of view first.
Susie Gronski (20:26):
Yeah. So, the point of views that I'm going to be talking about are actually from the people that I've worked with. So I'm just reiterating or paraphrasing from their experience. But the number one thing is what is it? Cause the doctors aren't really telling them what to expect. So again, they'll go on to Google and they'll find like, you know, this is a woman's health issue and why am I going here? And you know, again that psychological aspects of I guess gender in general of what that means for me as a person. And that experience in itself might be one reservation.
Susie Gronski (21:17):
Like you know, this is a women's health issue. Like I don't want to go there. And so they might put that off. Which is common as well. I think the second thing is the actual procedure of having internal work or an internal examination. And this is one message I'd like to kind of get across to people is that you don't have to do internal work to get better. And I think there's this huge misunderstanding of like pelvic therapy being like, well, it's all about moving the genitals out of the way and just going for internal work and chasing trigger points. That's not really what it should be an in fact, I think unintentionally of course, I think that's more harm than good because we aren't really asking. Like if you ask the guy in front of you like is this something that you really like?
Susie Gronski (22:06):
First of all, what would be the purpose of doing internal work? Or even having that assessment, like why are you doing what you're doing? And number two is that in alignment with what that person wants, is that a goal of theirs? Is that functional for them? You know, why are we doing these things? Because we don't want, as for me, I'm speaking for myself, I don't want it to be another person to create medical trauma. I don't want to be that person that says, well this is what you need. When in fact like they're sitting up there on the table, you know, cringing and guarding and tensing. And I think it's funny for me, like it's not funny for the person on the table, but I think when they're pissed we'll say, Oh, you're really tight. You know, you're really tight.
Susie Gronski (22:51):
It's like, yeah, this is tightest I've ever seen. And I look at me and I'll tell my patients, cause they'll be told that. And I say, well, how did you feel on the table? Were you comfortable with what was going on? And they're like, no, you know, no. And I said, well, no wonder your muscles are tensing. And that would happen with anyone, you know, I'm like, but that doesn't mean that you're broken or that there's something wrong with you. And I think that's the message that's going across, not for every therapist. And I'm not speaking for every therapist, but it's just a theme that I see with men who come into my office who've had therapy in the past. And that's something that I think might be a huge reservation for someone seeking care as well, is having to have an internal assessment done.
Susie Gronski (23:36):
Although it is common, it doesn't have to happen. And if you're doing an internal, so now let's kind of go into the pelvic health therapist point of view. So this patient comes in, they've had chronic pelvic pain for, we'll say several months and why might you do internal work in or an internal assessment if the patient was okay with it, obviously. So what would a therapist be looking for? So if the person is agreeing to have this done, number one, I think it's, they want to have a thorough evaluation by a professional who works in this field. So that's reassurance. So you would do that because they're asking you to do that, to rule out whatever's putting their mind at ease, right? Again, if that's what they so, so want, I think that's the first thing that we're doing.
Susie Gronski (24:35):
Number two, if there's like pain with bowel movement or let's say that person's sexual preferences or pleasure has to do with anything anal that would also be applicable in order to just map out areas of tenders, tenderness, and then see if we can change that. So we're not, they're looking for golden nuggets, trigger points. We're there just to see, okay, can we change what you're feeling and can we give that person an experience of, Hey, it doesn't always have to hurt this way. And there are things that we can do to change things and essentially giving them back a sense of control of their own body. But I like to preface that it is a very awesome teaching opportunity for the person because you can say, well, how does it feel when somebody else touches you versus when you try to do this yourself and right then and there during the assessment, I will actually have, we'll compare, I'll say, okay, I want you to touch those areas at home and tell me what you feel.
Susie Gronski (25:39):
And then I'll say, if it's okay, I'm going to do the same thing and that might be my own individual hand. It might be hand over hand with that person's hand. It just depends on, you know, again, their comfort level. But essentially I'm just there to see if we can change their experience in their body and to prove that you don't have to hurt all the time and that things are changeable. So I love those moments. So that's the reason that I would do any internal work or any external work for that matter, is to see if we can change that person's experience in their body to create more safety and less danger. And so it makes sense. That's what I would do. So yeah, that's essentially why do that and it's not an hour long treatment session of you know, internal work.
Susie Gronski (26:31):
But, men do appreciate that you take the time to actually talk to them to address their body just like, or this part of their body just like any other part of their body. And that's a theme across every single man that I have worked with. I came into my office, you know, they'll say, I really appreciate how you just worked with me and worked with my intimate parts of my body but just considered it just like any other part of my body, like my nose. And they just felt like the sense of like they can feel vulnerable, they can be safe. They feel heard and validated because somebody is actually taking the time to work with them to ease their essential suffering around what it is they're experiencing.
And I think that's really important. And so if you are working with a patient with this diagnosis and they are not comfortable with internal work, cause like you said, you don't have to do it. So what might be some other evaluative procedures you might do as the therapist to help this patient? Like you said, feel more comfortable in their body and get a better sense of understanding of what's happening.
Susie Gronski (27:45):
So the first thing is really just getting to know their story. So going back to giving them time to talk about what's going on for them. I think for men, having an outlet to be heard is really important because men don't typically kind of talk about these things. So once they know that you are accepting and you're there to offer that space for them to express themselves and the difficulty that they're going through with this, I think that's therapy right there. Just to give them that opportunity. So, having a supportive outlet. And the other thing is just if it's movement related, if it's an activity that they're having difficulty with, for example, sitting as a very common one. I have all sorts of like gadgets and toys in my office and I just bring some playfulness into the conversation.
Susie Gronski (28:39):
I have them sit on various different surfaces to see what would be something they like would actually explore, you know, again, I'm trying to see if we can violate the expectancy of, well, it always hurts and it's constant. I can't change anything. And so my role is really to see like can we change things and if we can, let's do more of that. So I try to bring a little fun into it. I try to incorporate like the passions, their hobbies that they once had done but have stopped since because of all this happening. Sometimes we don't even do any hands on work or any, even a formal assessment on the first day because we're really going through the story and we're reestablishing a sense of that person, a sense of what that person, who that person is. Because a lot of times you lose who you are.
Susie Gronski (29:38):
You know, when you have pain, persistent pain, you've gone through something. So life changing. So I think, you know, for me and for that person is establishing, well, what would life look like? What would life look like if this were no longer a problem? Who do you want to get back to being? And so I do vision boards. I'll do some sort of visioning exercise of where we can get to like the why, you know, why is this important for you? What do you want to get back to doing? How do you want to feel in your body? And then that becomes essentially the treatment plan or the plan of care. Anything that we can do to collaborate together in more of a coaching relationship to help you move forward, to attain I guess living in a way that you see yourself living, but also a values based type of approach.
Susie Gronski (30:28):
In terms of treatment. So I know that was like a mouthful, if it's the Bible, you know, I'm doing a bio-psycho-social approach, but I'm really, really having a being patient centered and patient led and I'm just there guiding them. So for some people it is really more of this, I need to figure out who I am, I need to start doing something. Well we figure that out before we go on the table. Cause there might be a lot of fear with that or they might have had certain traumas associated with, you know, medical experiences that may have had that may be negative. And so there might be a lot of reservation.
And I think we as therapists need to recognize that that person might say yes, like yes, that's okay for you to do all these things like with touch. But we should also be responsible of actually paying attention to what their body is doing, what their autonomic nervous system is doing while you're touching them. Because they might say, yes, and I'm guilty of this too. I'll go for a massage and that person's touches firmer than I'd like. And they'll ask me, you know, how's my pressure? And I'll be like, Oh, it's good, it's good.
Susie Gronski (31:37):
That's my point. Exactly. That's what the person that you're working with is going through the same thing. And I think it takes a sort of a bit of a skill to recognize or to be more mindful of, you know what, this isn't necessary. I noticed that you're sweating a little bit more, that you're tensing up more. I see your facial expressions, what are your eyebrows doing? And then I'll say, you know, we don't have to do this. I don't think this is right. You know, your body is saying one thing and I know you, you know, I know intellectually, yes, they want it. They want to make you happy. They want to please you, they want to make you happy. And I think part of the treatment too is giving them permission. That's self-efficacy, that's giving them a sense of agency to make that decision for themselves.
Susie Gronski (32:21):
Do I want, you know, I want to be able to say no. You know, and I tell them right off the bat, you know, that may know I have a lot of tools in my toolbox and if we try something where you're willing to try something and it doesn't work for you, just let me know cause there's many other things that we can do and try out. It doesn't have to be this one size fits all, which we know never works. So yeah. Anyway, I guess in the long run it just depends on the person who is sitting in front of me and essentially what they're telling me they need. And they'll actually, I have a very long intake form, but it's more reflective, very open-ended. And so I'll know from that of like what they're telling me. It's just so it's this awesome cause you can see it like they actually write it out.
Susie Gronski (33:04):
Like this is what I need. So I think is happening. Great. Well I'm going to facilitate this process and we have a conversation around that.
Yeah. And I think that's great. And I think it gives the listener, certainly other therapists listening have a better idea as to what a session treating someone, treating a man with chronic pelvic pain might look like. And now you had mentioned self-efficacy and we all know that as physical therapists one of our biggest jobs is to give people a sense of self efficacy and control over their body. So do you have any helpful strategies that you give to your patients for them to increase their self efficacy and to be able to manage their care when you're not there?
Susie Gronski (34:02):
Hmm. I love that question. So as you know, it probably depends on the person, but everything that we do together in a session, I make sure that they walk away with, well, here's what you can do for yourself. And it's really just a suggestion for them. I really want them to take it to experience it. So for example, I might say, you know, let's do some pleasure hunting. Probably if they've had experiences with you know, having an erection or participating in sexual activity, that was painful. We know that it's like all it takes is one time for things not to work and for things to be bad, to have a bad experience, to be worried about the next time and the next time and the next time. And unfortunately that's really strong for men and their, I guess their penis function, you know? And that's not uncommon to experience when you have pain down there. You know, the last thing you want to do is be like, yeah, I'm ready for sex. You know, it's a threat. Absolutely. and I think it's just educating, educating the person about like, this is completely normal what you're going through and it's common and it's not forever and let's see what we can do to start getting you to feel comfortable in your body again.
Susie Gronski (35:05):
And so, yeah, I think just having that kind of conversation, not being afraid to ask the questions and then asking them, well, what is it that you'd like to do or start with? Cause there's so many things we can do. What is it that you think is the most important thing to start with onto your recovery? Like I said, it could be sensory integration. So touching one's body, touching oneself and not being afraid and then having a recovery plan or a flare up plan. Cause we know that's common as well. So having some sort of structure around if I experienced this discomfort well what can I do next to help myself in this situation? Whether that's breath work a stretch you know, talking to a friend meditating, whatever it is for that person. Then we kind of put that into a plan to say, okay, next time, you know, if you try this cause you can't really, it's really hard to just, I think applied graded exposure techniques or graded activity to sexual function.
Susie Gronski (36:08):
Like you know, erections and having an orgasm and you're ejaculating. You can't like stop halfway. Like coming back from like, once you hit that climax, you know, and I think just letting them know that this is the process that happens in your body when you're having an erection and when you're ejaculating and here's what you can do to help yourself post. So, you know, I usually give things like recovery plan, but it's really collaborative with that person cause you know, everyone has their own way of living and their own lifestyle and whether or not it depends under relationship dynamics and sometimes we have to have a conversation around that. And then, you know, if any of those things are kind of coming into play, then we have to reach out to other, you know, a network of team members to help with all those dynamics that might be contributing to that person's experience.
Susie Gronski (37:01):
So, you know, like sex therapist or couples therapy or, you know, that sort of thing. So it just, you know, again, it depends on the person. So I actually want to do, I do want to make a comment about, you mentioned you know, so what is it that you give to your clients or to your patients? I think the other thing that I want to mention is that for therapists not to be afraid to address the genitals, this is one thing that I think is still common where female therapists will want to I think move male genitalia out of the way and just go to internal work. I think it's really important not to be afraid of, you know, addressing, we're touching a testicle or touching their penis. Because for them it's really important that you're doing that and then you're showing them what exactly, you know, showing them techniques or sensory integration techniques that you can do that they can do for themselves.
Susie Gronski (38:03):
So you don't have to do things. You're just showing them and then you're saying like, this is all completely normal or you know, or this is what we can work on. And having them experience, have an experience in their own body that's completely not sexually related at all. But I think as female therapists, we're afraid of like, well what if they have an erection right in front of me? You know, or like, and that's happened. You know, that does happen. I think that's one of the reservations is like, and speaking of reservations for the guy on the table, they're also afraid, maybe more so than you, that they're going to have an erection. Oh my gosh. You know, and then I always, I'm very candid about that too. I'm like, you know, we're touching parts of your body that have nerves and sense things and physiological reaction may occur.
Susie Gronski (38:47):
No big deal. If you need some time to yourself, I'll walk out of the room, you know? But you kind of address it before they even have a question about it. To put things at ease. So, sorry, I went on a tangent with that.
Karen Litzy (39:20):
I think that's important. That's really important to mention for sure. No, this is great. I mean, what great information. And so if you were to kind of take this conversation from let's say from the point of view of a man suffering from chronic pelvic pain syndrome, what would be your big takeaway for them?
Susie Gronski (39:23):
Big take away. How can I put this in one sentence? The big takeaway would be that this doesn't have to be forever. Like that this isn't permanent. That if there is something going on down there, don't be afraid to talk about it. I know you may not be surrounded by people who are very candid about talking about poop pee and sex. Like, you know, us as physical pelvic therapists. Anyway, we're so comfortable talking about that, that we forget that people, other people have reservations about talking about private parts. But yeah, not to be afraid to just, you know, reach out to a professional who understands what you're going through and who can relate to you because it doesn't have to be a lifelong sentence and a death sentence per se.
Susie Gronski (40:27):
You can get help for it and there's help for this. And yeah, I just, I guess that would be the main thing, just making, you know, having support and having that outlet for them to just be themselves and know that they're not alone.
And what about to the physical therapist who, let's say you, if you are a pelvic health therapist, you're probably a little bit more informed about this, but what if you're not a pelvic health therapist and someone is coming to you with these symptoms, what advice would you give to them? I mean, outside of, I have some that I could refer you to, who is more well versed in the treatment of this, but what advice would you give to the physical therapist?
You might be seeing a patient with chronic pelvic pain syndrome. I think just having more knowledge about what it is and what it isn't just as a practitioner so that you can have a conversation with this person who is experiencing pain because it in fact, you know, if the person you're working with has groin pain or the tailbone pain or sit bone pain, I think just being aware of like, there are other things that might be involved and asking questions, really not being afraid to ask questions.
Susie Gronski (41:48):
Maybe you put it in your questionnaire. I think there used to be Oswestry used to have a sex question in it. They took it out. So get the original one, keep the original one. But, yeah, just not being afraid to ask those questions and really just asking the person like, you know, I know asking permission without giving advice to, you know, just saying like, you know, I know a little bit about this. It's not within my scope, but how do you feel about having a consultation with a colleague of mine who works with men? Or who works in this field that can really help you out, we can really work together. It really is just opening up the conversation to say, Hey, you know, you're having these symptoms. There's something that we can do about it.
Susie Gronski (42:36):
It doesn't have to be, you know, it doesn't have to be like, well I don't know what to do for you, you know? Exactly, yeah. I think that's what it is. Like, you know, give them a resource or give them a website. There's so much free stuff out there. Like my website, I have all sorts of like blog posts and many others who work in this field have a lot of great literature on here's some things that you can do to just open up the conversation and what you can do to help yourself. So I think that's really the key. I think for PR professionals who are not pelvic health therapists but working with people who have pelvises that make a difference, you know, and you know they might be coming to you for low back pain but we know that low back pain and pelvic floor dysfunction and pelvic issues are correlated, highly correlated and in fact you know a lot of testicular pain can or can't originate because of low back issues and vice versa because of the connection there.
Susie Gronski (43:31):
And so just I think just having that conversation with your patients of saying like this is why it's all connected and this is what I think is what else is happening. How do you feel about getting, you know, getting a consult from so-and-so related to this because they might be, that person might be having many other struggles down there but not talking about it. Right. The first and foremost thing to do from a therapeutic perspective is let's have a conversation because we don't know what else might be going on for that person. And we can certainly be that gatekeeper, that liaison that says, Hey, I know I can get you to see so and so to help with these things issues. You don't have to just live with them.
Yeah. Great. Great advice. Thank you so much. This was such a good conversation. I think from the standpoint of the therapist and the standpoint of a man maybe experiencing some of these chronic pelvic pain symptoms. Thank you so much. And now last question is one that I ask everyone and that's knowing where you are now in your life and your career, what advice would you give to yourself as a new graduate out of PT school?
Susie Gronski (44:52):
Oh, that's a good question. Okay. So what advice would I give myself as a new graduate from PT school? Hmm. You don't have to be so serious. I think that would be the advice of knowing that we're humans are all very different and we're built differently. And what we thought was once quote unquote true is always evolving and just use your own experiences to make those determinations. Like you don't always have to be, I don't know, taking word for word when everyone tells you, experience it for yourself and then make that decision.
Excellent advice. So now let's talk about what you have coming up. So you've got podcasts, books, courses. So tell the audience where they can learn about what you're doing so that they can in turn help their patients or help themselves.
Susie Gronski (45:52):
Well, thank you for this opportunity to have a shameless plug. Here I am. Well, I'm currently working on the second edition or revised edition of my book, pelvic pain, the ultimate cock block, which is written for, you know, the average Joe who is suffering from pelvic pain. I have a podcast called in your pants that's also on YouTube. And I have several programs support programs for men who are suffering, who suffer from pelvic pain. Some are online DIY programs, others are support programs where myself and a psychologist and sex therapist have collaborated on. And I also have a course that I teach. It's called treating male pelvic pain eight bio-psycho-social approach. So I'm very busy. I have a lots of things go. It's awesome. But where can we find all of it on my website? drSusieg.com. I'm on Instagram @drSusieG. I'm also on Facebook and Twitter. Same handle.
Susie Gronski (46:54):
Awesome. Yeah, and we'll have the links to everything at podcast.healthywealthysmart.com under this episode. So one click will take you to all of Dr. Susie's really helpful information, whether you're the person living with a chronic pelvic pain syndrome or you're a health practitioner that wants to learn more. So Susie, thanks so much for coming on. This was great and I look forward to your revised book and all the fun stuff that you have coming out. So congrats. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jennifer Hutton on the show to discuss Anti-Racism & Allyship. Dr. Jennifer Hutton, aka Dr. Jpop, is a pediatric physical therapist from Nashville, TN. As a Black woman, Jennifer knows what it is like to identify as different, and it has helped in her quest to be an ally for children with disabilities inside and outside of the clinic. Now she is educating others on how to be effective allies to BIPOC and furthering her desire to create a diverse and inclusive space she calls Dr. Jpop’s Neighborhood.
In this episode, we discuss:
-How racial trauma impacts the biopsychosocial determinants of health
-The difference between an ally and a white savior
-Implicit bias in healthcare
-The lifelong process of Allyship
-And so much more!
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Jennifer:
Dr. Jennifer Hutton, aka Dr. Jpop, is a pediatric physical therapist from Nashville, TN. She became interested in PT when her youngest cousin was diagnosed with cerebral palsy. Jennifer spent time observing him in different therapies, and subsequently determined that she would work with children in a similar capacity.
She graduated from Loma Linda University with her Doctorate in Physical Therapy in 2008, and moved back to her hometown. She spent two years treating in an ortho setting before finally transitioning to her dream job with children. Jennifer enjoys treating the developmentally delayed population, as well as children with neurological and orthopedic diagnoses, both congenital and acquired. While the world reminds children with special needs of their limitations, she believes they are all capable of the impossible and helps them see that their special gifts will help them be their best selves. Jennifer loves to showcase her “pop stars” and share creative treatment ideas on Instagram. She is also an instructor for RockTape and is currently working on her own educational content for pediatric movement specialists.
As a Black woman, Jennifer knows what it is like to identify as different, and it has helped in her quest to be an ally for children with disabilities inside and outside of the clinic. Now she is educating others on how to be effective allies to BIPOC and furthering her desire to create a diverse and inclusive space she calls Dr. Jpop’s Neighborhood.
Read the full transcript below:
Karen Litzy (00:01):
Hey, Jennifer, welcome to the podcast. I am so happy to have you on. And now for those of you who are, maybe don't know you by your full first name on Instagram and social media, she is Dr. J Pop and last week you gave a wonderfully informative thought provoking webinar, and we will have the link to that in our show notes. Cause people can still watch the replay to that, correct? Yes, the replay is up and it will be for the foreseeable future. So what I'll have you do quickly because I don't want to put words into your mouth, but I would love for you just to tell the audience a little bit more about what that webinar was about and why you did it.
Jennifer Hutton (00:58):
Yeah, so it was anti-racism and allyship for rehab and movement professionals. And I went through from the beginning, literally started with the history of white supremacy in healthcare, through slavery. The Jim Crow era talked about racial trauma and the effects that it can have psychologically and physiologically. Then I went through the stages of allies and all of the things that you can do in each stage. And then I have portioned it out for the examination phase and for the action phase and kind of let people know in their different settings, be it education, be it healthcare or fitness, the action steps and the questions that they can ask themselves to be a better ally. I just, I wanted to do it. It's been a passion of mine for awhile talking about cultural competency and diversity, and I could tell people were awake in a way that they've never been awake before, so they were ready to receive the message.
Jennifer Hutton (01:57):
So when everything happened with, you know, Brianna Taylor, I'm not arbitrary and George Floyd, it was kind of like the cherry on top that everybody now is ready to listen. And so I found this was a great way to just get my thoughts across.
And obviously we're not going to have you retell that entire thing because people can go and watch the replay. Like I said, there'll be a link in the show notes but for me after watching it and I also watched the replay, so I sort of like went through it twice. Just because, you know, I want it to be really clear on what I didn't know. And good. Yeah. And so we're not going to go through all of it, but what I do want to touch upon today is, and you mentioned it in your description just now is racial trauma. And I also want to talk about allyship. So what can people specifically in healthcare do to be allies to our BIPOC community in healthcare?
Jennifer Hutton (03:00):
Right? So we'll get to that. But first, what I want to talk about is racial trauma. This was a very, very powerful part of the webinar for me. And it is certainly part of our social determinants of health. And as physical therapists, if we are treating under a bio-psychosocial lens, social is part of it. We need to be aware of what racial trauma is and how that may affect a person mentally, physically, and emotionally.
Jennifer Hutton (03:47):
Racial trauma is basically the cumulative effects of racism on an individual's mental and physical health. And I thought it was really important to highlight because we do a great job of talking about healthcare disparities. We do a great job of, you know, singling out the races and what you will see in the trends and the diseases. But we don't really look at the root cause of why this may be something that is more prevalent in different communities. So I kind of explained that racial trauma is likened unto PTSD. The only difference is we cannot separate ourselves from that toxic environment. So you start to see the manifestation of that stress. The weathering is one of the terms that you will hear when it just breaks down the body because of all of the stress that you are feeling and seeing. So you start to have increased suspicion, sensitivity to threat you know, physiological symptoms using other mechanisms like alcohol and drugs, increased aggression no thoughts of future.
Jennifer Hutton (04:54):
And I also have looked at research that where they look at the Holocaust survivors and how they actually saw changes in their DNA from the stress that they went through. And that's what they're starting to look at with our DNA as well, seeing that we pass these things down through generations, which is why it's called generational trauma. So to just say, Oh, well this, the African Americans are most likely to have these diseases. It's like, well, what are they dealing with outside of your clinic walls? That would cause this. And it was funny cause the students loved that part. The most, those were actually in professional school. Cause they're saying this would be extremely helpful to relate to patients when I actually go into the clinic or healthcare setting. So I focused on that and I also kind of showed way that you cope with racial trauma and all of the ways that you'll see in the communities is racial storytelling.
Jennifer Hutton (05:58):
So being able to tell you some of the experiences that I've had in this America validation, naming the trauma, understanding that the microaggressions that you're feeling are a part of the racial trauma that you're experiencing it. And the problem they're finding, even with some of these coping mechanisms is great for the moment. But what happens when the next event comes around, they're going right back through those stages of grief and stress. So I think it's important to see in every facet of life, there are the effects of racism, the effects of white supremacy. And so if you're hitting that on every facet of your life, you're more likely to present with physiological issues.
Karen Litzy (06:44):
And as a, let's say, as a clinician who might be treating someone who let's say does have high blood pressure or heart disease and is part of the African American community or BIPOC community, is it part of our job to then educate our patients on this? So cause they may say, well, you know, it runs in my family, right. I don't know why it runs in my family. So where does our job come in as the healthcare provider? What is our duty to those patients to address? Is it our duty to address that and to help with coping mechanisms? Or is it just a referral to someone else?
Jennifer Hutton (07:25):
Right. I think it's definitely our job to consider it when we are approaching different patients to consider that this may be something and a lot of times you'll hear it in their rhetoric. I think I had a student in the chat during the webinar say I have someone who said, he's afraid that if a cop actually comes and he can't put his hands up, that they'll feel like he's resisting. And it was because he couldn't get enough external rotation. Did you read that one?
Karen Litzy (07:56):
Yeah, I read that too. Yeah. Yeah.
Jennifer Hutton (07:58):
It was like, see that, that right there. That is something that probably wouldn't have come to your mind when you were thinking about his plan of care, but now maybe you need to change your approach because you're actually tapping into something that makes him feel outside. You feel something that just about the pain that outside and his wife. So I think we definitely have to keep it in mind and consider it. I also think we have access to and knowledge about so many different ways that we can take care of our body. So even if you were to start incorporating some of those into the treatment plan so that they can understand, these are things that you can use and you don't have to name it for them, you don't have to say this is because of racial trauma or give them all of the facts. But you, as a clinician recognize it might be something that's beneficial to them. So that's why I say to my Pilates instructors, to my yoga instructors, you know, you're a key to coping. You're a, something that could be helpful for them. And if they don't know that it, yeah, it is your job because you know about these things. So you can give them as a resource.
Karen Litzy (09:02):
Excellent. Thank you. And now, let's move on to the concept of being an ally. So before we start and get into how to be an ally certainly within the realm of healthcare, I would love for you to just, can you just define what an ally is?
Jennifer Hutton (09:25):
Yes. So an ally is a person group or nation that is associated with another group or others for a common cause or purpose. So that just means no, this is not something that affects your daily life personally, but you see that it does affect the way someone else's life is and you want to help make it better. So where you're using your privilege and your position to help further the cause.
Karen Litzy (09:51):
And how is that different than white savior racism?
Jennifer Hutton (09:56):
Yeah. So white saviors and still comes from the perspective that you are superior, that if you were not doing the work, then it would not be done and that you are absolutely needed. And I agree your voice is needed, but if you're still approaching it from a superior mindset, because you haven't done the work through those stages of allyship than it actually is a hindrance and it's not as effective.
Karen Litzy (10:25):
Got it. All right. Good, good change. They're good. Because I think oftentimes we maybe think we're an ally, but maybe we're not. And the concept of white saviorism, is that something that someone is consciously thinking or could that be an unconscious thing? Like you really think that you're there to help and you're trying to do your best, but you're may not be helping in the way you think you are.
Jennifer Hutton (10:58):
Right. And that's, to me, that's where the self-examination comes in. That's where those questions that you ask yourself about your upbringing, what you believed about black lives matter before all of this happened, what you thought about the killings that were happening in the people that were speaking out against them. How you viewed other races, the things that you said, the things that you've heard, because now you are able to see, yeah. Maybe you're not a racist, but you may have biases that are affecting your thought process, affecting your decisions. So I always say, check your intention. Like, don't just say, well, I intended to do good. Look at the impact that it had. If the impact does not measure the intention, then maybe we need to go back and do some homework on that intention. Because if you're doing something only to make yourself feel better, like, okay, I'm doing it. I'm that good person, not the best intention if you're doing it because like, Oh, they need me, like I talked about thinking that you have to give scholarships to all black people. Like they don't have the money to pay. That's why saviorism that is still coming from a bias mindset of, they are poor. They have less, they don't have the resources and I need to step in and save the day. But I don't think it's ever intentional. I still think it's just coming from your perspective and you really gotta check your perspective.
Karen Litzy (12:19):
Yeah. And I think we also hear the word implicit bias thrown around quite a bit. So do you want to define that and where that comes into play within this conversation?
Jennifer Hutton (12:29):
Yeah. So the official definition would be attitudes and stereotypes that affect your understanding, your actions and your decisions in an unconscious way. And I talked about thought viruses. And the way that I give a great example is the older person who only saw whites only signs and colored only signs everywhere that they went can, do you really think they couldn't have made some type of decision or thought about how black people are, how white people are based on what they experienced in their environment. So everything that you were taught and the things that you saw, the things that you heard, it forms your biases and that's on all sides and it mobilizes you. And it's how you act. So if you were surrounded by people who were racist, even if you think of yourself as a good person, you still may have things that were thought viruses that were planted that you have to check.
Karen Litzy (13:28):
Yeah. All right. Great. Okay. Now let's get into the stages of allyship. So stage one awareness. What does that mean? Does that just mean, Oh, I'm an ally. I'm aware. I'm sure it's much more complicated than that. So I'm just trying, I'm pointing out like the total ridiculous side of it, because that might be like what people think like I'm aware I watched the news. I know what's going on. I'm going to be an ally done. Yes.
Jennifer Hutton (13:57):
So awareness is that you see that there is a problem. You see the problem and you acknowledge the problem. You also acknowledge as an ally, your privilege in this world, the fact that you are viewed as different and sometimes better in your spaces. And then you say, I want to make this better. So the end of awareness is still an action step of committing and deciding and holding yourself accountable to learning and unlearning all of the things that have made you think this way so that you can be an effective ally. So the awareness, isn't just, yeah, I'm an ally. It's Oh, there's a problem. We got to do something about this. How do I help?
Karen Litzy (14:52):
Yeah. And could an action step in this awareness phase, be, you know, watching your webinar or watching 13th or reading a book or having conversations. And does that, would that fall into this category or is that sort of weave through?
I think awareness is probably the step that you will visit the most. That would, that's the thing because you, the more that you educate yourself, so webinars, podcasts, Ted talks, documentaries, those are part of your education. Just like any, I think I said, create your own curriculum. Just like you would learn anything. You have to go through all of the information, but as you learn, you'll start to see these things in other spaces and that seeing those things is still your awareness. So I always say, don't think that you're going to escape the phase I'd be done and not come back to it. You're going to start to see these things in all the facets of your life on it. So not just awareness on, like I took a week off and now I'm more aware it's being aware on a daily basis of what you're seeing in your community, within your family, your friends, your peers, your colleagues, and then just do so are you aware of it? And you just make a little mental note, or it's more of a high and it sticks because if you're educating yourself, then what you see will help you process. If that makes sense. The scenario that you are placed in the things that you watch, you'll be able to refer back to. Oh, I remember when I watched, Oh, I remember when I read, when I heard this person say, now you're connecting that after you've educated educator in the process of educating yourself.
Karen Litzy (16:02):
Yeah. Yeah. And then we sort of jumped the gun. So you've got awareness and education. Is that kind of second stage or do those just sort of inter sort of weave together? They can't have it. Can't have one without the other, right? Yeah. You cannot. Okay. And then next, so kind of moving through these stages here, here comes this, this is a tough one.
Karen Litzy (17:00):
Here comes the sticky one self interrogation. So can you explain that and also explain why it's sticky it can be difficult.
Yes, the reason self interrogation, this is when you really start to ask yourself a question, cause you're now trying to strip yourself or unlearn the things that have caused you to think the way that you have. So you really have to put your ego aside. And I always say, tell yourself, you're not a bad person. You just have thought viruses that you're trying to change. So you're asking yourself those questions. What were you taught about black people and people of color? Were there any times that you were in, you know, scenarios where there was racism and you didn't speak up or you feel like it was important to speak up? Have you allowed your privilege to mobilize you, but maybe not help someone else?
Jennifer Hutton (17:56):
Do you have friends of color? My favorite is, well, what were your thoughts about black lives matter 10 years ago in 2012, maybe when Trayvon Martin happened, what were you thinking about these same protests and these same people speaking out? Because if you can truly answer those questions, then you'll see that's where my bias is. That's where that was my blind spot. That is something that I didn't realize it was coming in, but it has affected me. So those were the personal questions and those are hard because it is really, you have to strip yourself of what you consider a part of you. A part of who you are a part of your upbringing. And if you're having those conversations with family members, I mean, I've heard people say, I didn't expect my parents to say the things that they said.
Jennifer Hutton (18:47):
I didn't expect my best friend to feel the way that she did about me posting my black square. And the conversation that we had was extremely uncomfortable for me and hurtful because I thought we were on the same page. So that's where the discomfort lies. And then it's in deciding, is this that important for me to continue? Even if other people don't continue with me asking yourself, that question is hard. Because you can't, you can't let go of family. That's not how it really works. I mean, of course, if it's toxic, I understand, but you really have to say, I might be doing this by myself and it is a tall task, so are you really ready for it? So that was the personal self interrogation.
Karen Litzy (19:34):
Yeah. It's sort of this cleaning out your cupboard, if you will, you know, and trying to see if you are ready to change your thoughts and your beliefs and what if you go through these questions and you're not ready. Okay.
Jennifer Hutton (19:59):
It's always comes back to the question. Once you get to that point of discomfort, you have to ask yourself why you're uncomfortable. You can't just escape the situation because you're going to end up coming back to it. If it was a part of your awakening, once you're awake, it's hard to not see things. It is really hard. So I always say, it's fine if you're not ready, but maybe the reason you're not ready is because you had an upbringing that taught you something that you can't shake. Maybe you need a therapist. Maybe you need to talk through some of those other things to actually help you get past this stage.
Karen Litzy (20:34):
And was there a point for you growing up where you had your first encounter with racism?
Jennifer Hutton (20:50):
My very first that I can recall it was mother's day out where you went like three days a week and I wanted to play with like, it's a daycare. It's kinda like daycare, but you don't go every day and you still learn things. So it's like a preschool thing pre K through year four or whatever you call it. But I wanted to play with the kids and I think there were two black kids and the entire mother's day out or my class. And I was told, no, we don't play with Brown kids
Jennifer Hutton (21:29):
I had another four year old. And so apparently went home. I remembered the act. I remember the kid. I could actually see his face even now, 30 something years later. But apparently I didn't want to tell one parent because I thought that parent would get upset and do something at the house. So I told my, I think I told my mom and that was when they first had to have that conversation of people are not going to like you because of your color and explain it. You imagine having to explain it to a four year old, like they're still processing how to count, pass a hundred, like, and you're telling them it's going to be a problem. Something that they identify with, that they see in the mirror everyday, they cannot shake is going to be a problem for people. So I think that was definitely the first time that I remember.
Jennifer Hutton (22:24):
And then I also remember the first time I said, Oh, this is unacceptable. And at that point I was like 14. And I had had an incident with a cop where I was profiled. And it was evident because I had white friends around me that were not treated the same for the same regulations I was given. And it was at that point that I said that I'm a fighter, it's time to go. I'm not going to accept this. And I'm not going to not be in these spaces because you don't like it either. I'm going to show up and you're going to see me and I'm going to speak and be loud about how I feel. Because I think my voice is extremely important.
Karen Litzy (23:05):
Yeah. Wow. I mean, I grew up in the most non diverse town in Pennsylvania and I went to a very non diverse school for college. It's much more diverse now. And when I moved to New York, so I'm in my twenties and it's the first time that I had a friend that I worked with. And he's awesome. But that's beside the point. And we were at work and he had said something about like he had to drive. He hated driving back out of the city at night. Sometimes I said, well, why I was like, is it, I was like, see, it wasn't a drinker or anything like that. It's like, he's drinking and driving. And I couldn't understand. And I was like, well, why wouldn't you, like, why would you worry about driving out of the city at night?
Karen Litzy (24:05):
And, and he was like, well, I wouldn't want to get pulled over. I'm like, why would you get pulled over? This is how like, night and I was not doing it. Like I was seriously wondering, why would you get pulled? Like, do you have a broken tail light? Did you do speed? And he was just looking at me and he was like, no, I'm like, well, why would they, why would the police pull you over then if you're doing everything right. And he was like, well, you know, when I was like, I don't, I don't know, like tell me why. And he was like, well, you know, because I'm black. And I was like, what? Yeah. And that was the first I was in my twenties. And that was the first time. And I was like, it's funny. I had a talking about, so that was the first time I ever had a conversation about that type of, about racism and how it affects someone who I only knew as like these. Awesome. I love him. He's my great, he's a great friend. He, to this day is still a great friend. And I just was like, I don't,
Karen Litzy (25:08):
I don't get it. I don't get it. Yeah, yeah,
Jennifer Hutton (25:10):
No, I didn't get in there. And I think part, my brother said it perfectly sometimes when you're in the same spaces with people, you think your experience is similar. So even if you had a black friend that was with you through all of those, you know, non diverse schoolings and situations, scenarios, and things that you were part of, you would still think our perspective has to be the same. Cause we're getting to do the same thing. So it kind of makes it harder for you to look outside of your experience.
Karen Litzy (25:43):
What a world. So that's a little bit on the self interrogation and what those questions when I asked myself those questions, I remember that incident. So clearly now and looking back on it, I was like, Oh boy. Yeah. I was just didn't know, I didn't know what I didn't know. And now I do. And now I do. Yeah. Period. Now let's go on. So we talked about self interrogation serve as a person, but let's talk about it now under the lens of being a healthcare provider. So how does that work?
So the self interrogation as a healthcare provider, to me, just like I said, we're educated on health disparities, but not with them. What was your professional opinion? How did you form your professional opinion based on the things that you were taught?
Jennifer Hutton (26:44):
And this can even a great example is when you hear the word Medicare, what do you do mentally physiologically? Do you grown? Because it's like another Medicare patient. If you're a clinic owner, or even if you are a clinician Medicare, Medicaid, workman's comp, like, what are your thoughts when you see that come through the door, chronic. So that kind of pain. What do you think about chronic pain? People like that? These are you've formed a bias. And how does that bias actually shape how you treat shape the way that you develop plans of care? Are you able to actually change things based on what you see? Just like that student said, well, how do I work on external rotation? There's a million ways that you could actually work on it without it triggering them. So those are the things that you really have to ask yourself and then privilege in outside of just the clinic.
Jennifer Hutton (27:34):
What is your governing organization look like when you are a part of these masterminds and part of these panels and these groups and discussions, do you see other voices? Do you see other people that don't look like you in the room? Are there ways that you could leverage your privilege to actually open the door so that there are more voices in the room? And then how do you view the table? Like there was one person I was talking to last week and she said, you know, even the thought of saying, let's give them a seat at the table said that you own the table and you don't, none of us do. So you want to create a diverse perspective or diverse group of people in all of your spaces. And so you really want to ask yourself, how can I do that? And then patients like nonverbal communication, when you are working with them, when they are hearing conversations that might be triggering or how do you respond? Do you want to just go in a corner and not say anything? Do you want to just ignore it and shift it to the side? How does discomfort in your coworkers look when you are talking about certain things. So that's some of the self interrogation you can do as a clinician.
Karen Litzy (28:43):
And, you know, you sort of mentioned, well, if you're having conversation with patients, what happens when let's say a patient in a clinic, whether you're one-on-one or you're in a gym with a lot of people, if they say something that's just not right. Right. And if they sit there talking racist talk, or even saying things that maybe aren't blatantly racist, but still you're like, yeah, no, that's not right. What do you, what do you say? No, we spoke about this a little bit before we went on the air. And we said, it's a little different because we can, we were talking about coronavirus before we got on the air and how, you know, cases are going up in some parts of the country. And it's not just because of more testing it's because more people are sick and you can point those facts and figures. So someone says to you cases, aren't going up, it's the testing you can say, no, no, no. Here are the facts and figures here it is. This is the truth with this. It's a little more abstract, right? So how do we handle those situations as healthcare providers?
Jennifer Hutton (29:53):
I think just like you handle your patients, it's going to be a case by case situation. I can't give you a cookie cutter copy and paste way because everybody, even if they present with an implicit bias, it's still going to be different from the next person. So depending on your position, if you are a clinic owner, then if this is something that is explicitly, someone's explicitly racist, then you have to make it clear what your business stands for. That is extremely important first. I think it's important to have procedures and policies in place. And maybe even we tolerate everybody like this. Isn't an open space. This is, we accept everyone as they are. And that's something you can give to them. The first time they walk in the door. Cause that lets them know, I don't know who's coming in here is clearly a diverse population and they are tolerable of everybody.
Jennifer Hutton (30:48):
So it sets the standard sets that precedence before you even get started. And then it's those simple conversations. No, you can't spend your whole session educating them on, you know, the history of healthcare. But you can say, you know, there are some resources that I've read that have helped change my perspective. And if they are open, then give them to them. If they are not, then you need to have something in place that says, Hey, I understand that everybody has different perspectives, but here we respect everyone. And we don't want to trigger anyone in how in our speech. So we would really appreciate it if you would respect that. And honestly, they're gonna be some people who don't like it. And that is this journey. This is literally the journey of being a black person and being an ally. There are not going there going to be people that don't agree with you. And you just have to decide what your stance is and continue to go inside for that every time you face these situations.
Karen Litzy (31:48):
And I love, and I want to point out that the responses you just gave did not, they weren't accusatory, they weren't aggressive. It was more, Hey, I found this for myself or this is what we, as a clinic, believe it wasn't you. Or how could you say that? Don't say, I mean, that is just the wrong way to go about it.
Jennifer Hutton (32:12):
Especially the clinician is not professional. Got to that point. You do, you might have to say, you know what, we might have to end our relationship and maybe able to give you some clinics that would be more suited for you. But this, if you are, if you continue to look at this as person against person, we're not going to get anywhere to me. If you look at it, as these are thought viruses, I'm trying to change, it's a lot easier to have grace for other people as well.
Karen Litzy (32:44):
Yeah. Excellent. All right. Now that was a little bit of an action step, right? So let's talk about a very, very important step in allyship and that's action. So that was one and that's a great action, but what are some other things that would fall into the action category?
Jennifer Hutton (33:01):
So I split them up into immediate action and longterm action. And mainly because we're telling you slow down, educate yourself, and that can be hard cause like, well there's stuff that needs to be done. So your immediate action is you're protesting, signing petitions in the emails informing yourself about, you know, the politicians that are statewide local, all of those. And then speaking up against remarks. If you hear them now, one thing I want to say do not wear yourself out in the comments section of social media, because I'm sorry that anyone who comes into those comments extras, they're really not looking to learn anything and you're not going to teach them. So you have to let the energy out of it.
Karen Litzy (33:45):
Energy vampires, it's not worth, it's not worth it.
Jennifer Hutton (33:48):
It's not worth it. So that's not the action I need you to take. I need you to take that off the dock. Long term action would be continuing to having those discussions in your clinics, in your gyms, in your educational setting, to see where your blind spots are and what you really would like to do to move forward. I think I said earlier, you may get stuck at a step. And if you feel like it's something deep, rooted, get a therapist to actually help you talk through these things recognize it's a learning process, encourage others to do that work that you are doing. And if we're doing it already as healthcare clinicians, we learn things. We believe things. And then we use them in our practice, whether it be something in the biopsychosocial model about chronic pain, about certain, you know, systems that we use, we do it already. And you just have to decide that this is something that's important to you. And that honestly will be your guide when you get to that longterm action.
Karen Litzy (34:55):
And something that you'd mentioned in the webinar that I want to bring up again, is that when you're talking about these, this longterm action that it needs to be authentic and then you don't want it to do, you don't want to subscribe to tokenism. So we didn't really define tokenism. So why don't you define what that is and why we want to be authentic and not subscribe to it.
Jennifer Hutton (35:18):
So tokenism, the long and short is you are going to get that one person to represent diversity. I think I said, when we were talking before we started recording about if you are in an all white community, don't just go get a black person and say, that's our representation that is not authentic and it's probably not comfortable for them. Would you need to be able to identify that? So if you're just picking the black person or the person who's Mexican or Asian to say you have that voice, that would be your tokenism.
Yeah. And, I think that we certainly see that in a lot of facets of society. Definitely. Definitely. All right. Any other actions that you want to cover or do you think we've hit everything?
Jennifer Hutton (36:20):
I think, I think we've hit everything. I know I did a lot of steps for examining in the webinar, which if they wanted to see it by setting, they're definitely able to go in there. But my biggest takeaway from this is, I know we're in a manic period still where everybody is happening on this quote trend. So don't burn yourself out. It is a marathon, not a sprint. And so it will, it might be sticky. It might be difficult. It might be uncomfortable, but you have to decide whether this is what you believe in to keep going.
Excellent. Well, thank you. I was just going to ask what are your final thoughts and beat me to it. So thank you. Okay. Well on that, I have one last question that I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to yourself straight out of physical therapy school?
Be patient be patient. I came out with the idea, I'm going to be a PT therapist and nothing's going to stop me and I'm going there and I'm doing this.
Jennifer Hutton (37:18):
And I had to take detours from the minute I graduated. My life did not look like what I thought it would, but where I am right now. I'm good. So it worked out how it was supposed to, so I would say, be patient.
Excellent. I'm still need to learn that one. I feel like things still need to be done yesterday. Thank you for that advice. And now where can people find your webinar?
Yes. So if you go to Instagram, dr. J-Pop, I actually have the link in my bio. I am probably by the time this comes out, it will be on my website as well. That replay is there and it will be there until that platform doesn't exist. So hopefully forever.
Excellent. Well, thank you so much. I appreciate this. Like I said, I learned a lot, it was very introspective for me to go through your questions and to kind of understand the privilege that I came from, just for the fact that I was born with the skin that I have. Right, right. And it has nothing to do with, you know, just that one singular thing. It has given me privilege and listening to you and educating myself has really allowed me to, to see that, that very singular fact very clearly. So thank you very much for your webinar and for coming on. I appreciate it. And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram and facebook to stay updated on all of the latest! Show your support for the show by leaving a rating and review on Apple Podcasts!
On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Laura Rathbone on the show to discuss Acceptance and Commitment Therapy. Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS. Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands.
In this episode, we discuss:
-What is Acceptance and Commitment Therapy (ACT)?
-How the ACT framework compliments a biopsychosocial approach to patient care
-The importance of promoting active over passive interventions for patients with persistent pain
-Why clinicians should integrate psychologically informed physical therapy into their practice
-And so much more!
A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!
For more information on Laura:
Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS. Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands.
She understands the need to see people from a 'whole-person' perspective and integrates modern, evidence-based physiotherapeutic and psychologically-informed approaches.
Laura is a UK chartered Physiotherapist and has a Masters Degree in Advanced Neuromusculoskeletal Physiotherapy from Kings' College London. She is part of the Le Pub Scientifique team which organise regular live learning sessions exploring the science of pain and produces a small podcast called “Philosophers chatting with Clinicians”. She runs her own courses on ACT and mentos clinicians regularly.
Read the full transcript below:
Karen Litzy (00:01):
Hi, Laura, welcome to the podcast. I'm very excited to have you here and today we're going to be talking about ACT. So thank you so much for being on the podcast.
Laura Rathbone (00:12):
Well, thank you for having me. I'm excited too. I like talking about something.
Karen Litzy (00:17):
All right. So now let's talk about ACT first, two questions. What is ACT and how did your interest in ACT come about?
Laura Rathbone (00:32):
So ACT stands for acceptance and commitment therapy. I suppose, you know, sort of efficiently, the way we talk about it is that it's a third wave cognitive and behavioral therapy. So it's born out of the behavioral movement and it's a psych it's essentially, it's a psychology framework. It came out of the world of psychology. And the aim of it is to recognize that when we are experiencing, you know, difficult unpleasant and invasive stuff, there's often a lot of all the aspects to that experience that add to the struggle and add to the suffering. And what we're working with from an ACT perspective is often can we compassionately and you know, empathetically and appropriately work with some of that, all the stuff that comes with the struggle and comes with a difficult experience. And does that help us manage our present moment experience?
Laura Rathbone (01:38):
Does that help us reduce some of the suffering so that we can move forward with some of the realities that are in our lives? Like for example if you're experiencing pain, which is where I come into it, you know, in the absence of having a really good predictable, effective cure for things like persistent pain, things like fibromyalgia, CRPS even chronic low back pain, which we, what we don't have these predictable sort of treatments that's going to take that away once the pain has started to become resistant, but in the absence of that, are we able to support people with their pain so that they can thrive. They can be a person who has pain and has a career and has a committed family life and has a social function and role, and they're able to thrive with it. And that's really what we're doing with ACT there.
Karen Litzy (02:38):
And where did your interest in ACT come from? How did you get involved?
Laura Rathbone (02:45):
Yeah, there were two answers to that really. First answer I guess, is that I just sort of fell into it like so many people, right. I graduated from university. I went into my first job. I had a really difficult first job experience in a difficult company and ended up working, noticing, I suppose, and working with people that had persistent pain. And so I was constantly seeking for better solutions and trying to figure out how we can do better by these people. And then I guess I just sort of navigate it that way naturally. And yeah, so I was interested in mindfulness, mindfulness, you know, you study things like the MBSR. So the mindfulness based stress reduction start thinking about how you can incorporate bits of that into practice. And before, you know, it, you end up into accepted therapy.
Laura Rathbone (03:41):
And then I was super lucky because I managed to get this brilliant job in the national center for pain at st. Thomas' hospital in London, where I was working at input, which is the pain center. And I was working underneath professor Lance McCrackin in their embedded ACT unit. So I got this great opportunity to really further my training and understand how it functioned as a framework and how we as physiotherapists could really be maximizing our therapeutic alliances and relationships and really integrating this model to create, you know, a psychologically informed approach, if you want to call it that or a compassion focused approach so that we just do better by people who are vulnerable and in pain.
Karen Litzy (04:26):
Well, that makes a lot of sense to me. Thank you so much.
Laura Rathbone (04:31):
If I was to give you a second answer, is that, you know, pain is a bit of a personal experience. It's a personal journey for me. My mom had chronic low back pain when I was younger. And I guess I'm only just now coming to terms with the influence of that on my career. Something that I haven't talked about a lot. But I do get asked about quite a lot. And you know, it would be silly to say that those early experiences of somebody with chronic pain, you know, didn't have an influence on me and seeing her go through a biomedical approach to treatment and not be heard and seeing her struggles and thinking, well, you know, and the injustice has probably built in me as the second generation and thinking, well, how do we restore some of that justice? And then how do we acknowledge that there is an imbalance here in terms of privilege, like clinician privilege versus patient privilege, and how do we start to restore that and make sure that we listen to the people we work with and do better.
Karen Litzy (05:36):
What sort of experiences did you see your mother go through that kind of led you into where you are today, when you say so for a lot of people, they might not be familiar with the biomedical approach and what that looked like, but what did that look like for her? And then what did that look like for you as a kid growing up?
Laura Rathbone (05:58):
Yeah. Like I say, something that I'm still really coming to terms with then, and the memories of what I saw my mom go through was still quite like emotionally charged. They're still very close. And we're talking about it, me and my mama talking about this more and trying to open it up a bit more and explain that. And then what I remember, you know, being in the car and my mom being unable to sit in the chair and the sound of her voice when we went over a bump or the car stopped that, that Yelp for pain, that, that real yeah. Terrorist pain really. And I remember her spending hours in the bedroom, not being able to get out of bed but, you know, she also, she was an amazing woman, you know, incredible first role model as a strong woman, really, because, you know, she's a nurse, she was working in the pediatric units, she's done everything really she's done a and a pediatrics domiciliary, which is community-based working.
Laura Rathbone (07:04):
And like, she used to get up every day, even in pain. And she would go to work in paid and, you know, do all these and just push and push and push until she was exhausted. And when she would be like posted on the weekend and then pushing herself and through the day, and I saw her just be hopeless. That was, I think the overriding feeling, if I really reflect quite personally, was that feeling of, there is no hope there is no way out of this. This is the norm and resigning to that. And that's because, you know, she'd tried physical therapy or physiotherapy in the UK. And, you know, she'd tried like acupuncture and she'd gone around the holistic meds you've been in and out of the doctors and things like that. And just really been told there's nothing that they can do, but yet also she had this image of why she had pain. So she was told that she had back pain because her Coccyx had dislocated during labor, which was my labor. So there's a bit of personal guilt as well.
Laura Rathbone (08:07):
And really those things where, like, she always felt that that image had stayed with her forever. Even now, probably if you talked to her and ASCO, which we were working through a little bit, which is hard to do an issue, mom, I, you know, trying to figure out what, how she views her body and her back is becoming a much stronger image, but she really had to find her own way out of that. And it was years later until she found a solution that she could, she felt she could predictively start to acknowledge and manage her pain. And, you know, it's not the traditional method that she found a kind of like a kind of massage tool, which is everything we wouldn't say right now, but it worked for her and it gave her a freedom. She felt all of a sudden I have something I can do when I have pain. And that was the most important moment for her. And it wasn't, you know, acceptance and commitment therapy or mindfulness. It was, it was a tool that gave her strength. It was a kind of extended part of her own ability to self manage. And she did that and it worked for her and I don't advocate those kinds of mechanisms and those approaches, but it worked for her. And there's something in that. There's something important in that. But yeah, I remember I remember her pain and yeah, it's still very personal.
Karen Litzy (09:27):
Yeah. And not easy, but thank you for sharing that. Cause I know that sharing personal experiences from my personal experience is not an easy thing to do, and it's not easy to put that out there where the world is going to hear that. So thank you. But I'm glad that you shared it because I guarantee you, there are going to be people listening to this podcast who are going to say to themselves, that's me. That was my mom. That's my sister, that's my friend, that's my patient. And so I think it's really important to allow the listeners to understand the magnitude of hope and of finding something that works for you, even if it's not physiotherapy or it's not XYZ doctor or whatever framework you're using. Because like I said, somebody out there is going through that same exact thing. And just to kind of hear that story and to hear how, not only did it affect your mother, but it affect you and your family and growing up and I think that's a really powerful share. So thank you.
Laura Rathbone (10:35):
Welcome. And thank you to my mom who continues to be an incredible voice in my growth as a person and who went through that journey and who still goes through that journey. Although she doesn't identify now as somebody who has chronic pain and that's a great moment for her, like she's now able to do so much more and really doesn't have back pain very often anymore. So, I guess the, you know, yeah, it's hard for me to share, it's not my story.
Karen Litzy (11:11):
Yeah. Yeah. Well, and we're going to get back to pieces of that story in a little bit, but I heard you say in the beginning of this podcast, talking about ACT as a framework, I would like to kind of bust a myth because I think a lot of people look at it as a tool to put in the toolbox. So what do you say to someone who's like, Oh, ACT, this is a great tool. I put it in my toolbox. I'll take it out when I need it.
Laura Rathbone (11:45):
Yeah, this is, Oh, I'm glad, I'm glad we're talking about this. Cause this is something that this is probably my personal opinion and there's probably people out there are acceptance and commitment therapists. You may disagree with me and that's absolutely fine this space resolve, but I do not think that ACT is a tool that we pick up when we think it's appropriate. First of all, how do we know that? That's certainly another thing, isn't it? You know, we don't, you know, and what I would say that acceptance and commitment therapy is how we are. It's a way of being with your clients and the people who choose to work with you in the service of their pain. It happens. It's how we make decisions. It's how we think about and how we facilitate those decisions and how we are part of, you know, the next step in that person's journey.
Laura Rathbone (12:37):
It's not something that we say, Oh, we've exhausted the biomedical approach. Now we're going to pick up the ACT approach. And it's a bit later the biopsychosocial approach that it just doesn't work like that. This is just another way of, you know, clinicians getting out of doing the hard work, which is listening to people's stories and empathizing and putting themselves in somebody else's shoes and trying to, you know, trying to get more of their life experience as opposed to showing off what they know about a particular joint. Like this is not how we work in pain. Pain is a very personal, it's a very unique experience. It's built off of life experiences, as well as memories and, you know, learning and worries and fears and all of that plays out in our physiology.
And what can a clinician who's working with someone in pain and they are taking the ACT framework into the clinic. What does that look like?
Laura Rathbone (13:41):
Good question. Yeah. I mean, I guess it depends what your setting is, doesn't it really like if you’re setting is first line, so people are coming to see you and they have never seen anyone else with that problem, then of course, we're going to be thinking, okay, where is that person in the journey from that injury or the onset of their pain? Are they two years down the line? And this is the first person they see, or are they two weeks down the line? Cause that always is going to affect your approach to assessment and monitoring really. So it would make a difference in terms of where you start, but you're always thinking about okay, so if this person is two weeks from injury, then you're going to be doing your injury based assessments, your pathoanatomical approach to assessment.
Laura Rathbone (14:34):
And we want to want to make sure that this person hasn't done any serious injury. And we want to make sure that we, you know, use the most appropriate and effective science that underpins our physiotherapy framework. Right. But you're still thinking, how is this person managing this injury? You know, even though we might be assessing the tissue in some aspects that tissue belongs to a person it's in a human it's in a much wider system. So we're always going to be thinking, okay, and how is this person dealing with the fear of an injury? Are they able to make sense of this in a helpful way, are their behaviors of management helpful or unhelpful? And if they're unhelpful, then how can we facilitate an experience that allows them to update that behavior into a more helpful way?
Laura Rathbone (15:29):
And that's what we're doing with that all the time. So I guess in my setting, when people have probably been through lots of healthcare professionals, then I'm going to that it would probably look quite different. I would use ACT maybe in a more intense way from very early on. Whereas if you're in a very acute injury setting, you're going to be using it as part of your assessment. You are still going to be satisfying, those more traditional approaches to injury assessment and management, which is not my area. So I don't want to make assumptions.
Karen Litzy (16:24):
Right, right, right. Of course. And what is, let's say a patient has come to you and they've had a long history of pain and you're sitting down, then this is the first time that you are seeing them. What are some questions? I know this is, I'm using this very broad net here. We're casting a very broad net because obviously the answer is, it depends on the person. And I want everyone to know it depends on the person, but it depends on the person, but for people listening to this and not really quite grasping, that sort of ACT framework is there. I don't want to say an outline, cause I don't think that's the right word for it. It's just escaping my head at the moment. But can you give examples of maybe how that conversation might go or what you're trying to, to get from the person in front of you using this framework? And again, we're talking about people with more persistent or longterm pain problems.
Laura Rathbone (17:11):
Yeah. So when somebody comes in and sits down and starts telling me, you know, what their lived experiences of pain and they start in their story, wherever they feel is the most important place to start. And we give space for that to grow. I guess what I'm looking for, what I'm trying to pay attention to is you know how is this person making sense and applying meaning to that pain what is it that they're coming to me for guess is the first thing, like, what is it that they're here looking for? Are they here looking for something that I can't give them, in which case I need to be really open and honest about that? Or are they coming here because they're looking for they're wanting to move towards a particular goal.
Laura Rathbone (18:07):
So it, usually people come in and they're telling me about that pain. And of course that's really, really difficult as a person. Sometimes it's really difficult to listen to, to hear somebody else's pain. So I'm mostly working with my own resistance, but also thinking well, okay, what is it that how we want to find out? What is it that would, would give this person that would help this person find more joy, more meaning, what is it, what is the value that they want to move towards? And what is the struggle that they are coming up with? So, so where are they getting stuck? Like, what are they battling all the time? And I guess that's where the idea of acceptance comes in and an acceptance here is really not resignation. It's really not just, you know, getting on with it's an opening up of the experience to accept that there are difficult and painful and hard to look at experiences happening in the present moment. And so we're opening that opener and sort of acknowledging that those things are there. And also maybe giving space for the fact that there are other experiences beyond those as well, that there's a wider spectrum of experience here. And trying to find a way to be with those experiences and also be with the important things in your life. This is what we see commonly. And what we hear with in the clinic is that people who have, you know, people who are experiencing pain are also missing out on a loss.
Laura Rathbone (19:51):
And that's really, really, I think what a lot of people find the hardest. And when I listened to it, you know, what the people who choose to work with me say, it's actually that they're just grieving that they're unable to be part of their family moments or their community or their society, or, you know, the things that they really believe in and that they really want to be part of. And it's hard because when they go into more traditionally biomedical models, the clinicians are saying, Oh, well, when we've done this surgery, your pain will go and you can do that when we've done this injection, when we've done this treatment and, you know, yeah, great. If that works, then that's an absolute lesson relief and fantastic. But what if someone's been doing that for 10 years and the clinicians are still saying, well, when we do this treatment, your pain will go when we do this treatment, you know, you starting to chip away at someone's life.
Laura Rathbone (20:53):
You know, this is a lifetime that easily limited, you know, we don't have infinite lives to live infinite moments to be part of our job and probably the most significant part of our job, especially in persistent pain is helping people and facilitating opportunities for people to be part of those moments. And to make sense of their life in a wider spectrum, rather than just, how does my life make sense in pain? It's more like, how does my life make sense in the whole bio-psychosocial sphere? Am I able to be part of that? And that's what we're looking for, or certainly what I use acceptance commitment therapy for. It's a way of creating opportunities and creating space for us to support someone as they take their pain into really, you know, meaningful moments and find that there can be joy as well as pain. And that is a really, really difficult thing to acknowledge and to allow for when you have pain, because it means that in one aspect of your pain journey, you have to allow yourself to take a step forward with it. And that's really hard if you really want to get rid of it. And of course we should always be working towards that. That has to be a big part of our approach, but it might not be the only thing we focus on.
Karen Litzy (22:27):
I'm glad that you said that because you sort of jumped the gun on what I was about to say, because when people come especially to a physical therapist or physio, one of the main reasons they're coming is because they have pain, right? And so they're coming to us to quote unquote, fix it, fix the pain. I don't, once I don't have this pain, what's your goal. Zero out of 10 pain, no more pain. And so I think from the clinician standpoint, when you have those people sitting in front of you, it's very, very difficult to have those conversations of, and you say, well, what if you still had a little bit of pain, but you can do XYZ activity, or you can still take part in all of this stuff. And you can expand those areas of your life, even though you have pain.
Karen Litzy (23:26):
Is that the wrong thing to say to someone is, should that be a goal to work toward, or should the goal to work toward if their goal is 100% no pain, what does the clinician do? What do we do with that person in front of us when maybe we may think, well, but you can X, Y, and Z, and you can have this full life. If maybe you have a little bit of pain, but the person in front of you is very adamant and their goal it's no pain or nothing, no pain or bust. So, how do we, as the therapist navigate that? Cause that's very tricky because like you said, we're working towards reducing pain, but what if that's not enough?
Laura Rathbone (24:13):
Yeah. So this is a really difficult part of the conversation, isn't it? And I guess what happens probably more often is we come up against our own reflex to save everybody in front of us and our own reflex to be sure we know we are right, right. Our own privilege that we are the experts, but we have no idea what is right for that person in front of us and what is enough for them. And, you know, in the first few sessions, when you meet someone, you’re still in the process of relationship building and trust building. So those early conversations may well be communication of, you know, I am really struggling with this pain. I am really suffering and I need you to fully acknowledge that I am really suffering with this pain. And it may be a way, you know, and that might be that that's where that person is.
Laura Rathbone (25:14):
And it might not be that we can change that. And I put that in quotes because you know, what we're doing here is where we're with a second sense and commitment therapy specifically is we're coming from a place of no judging. So, what the behavior, the thoughts, the meanings of that person's coming off of, I have no idea if it is right or wrong for that person to keep seeking, you know, a hundred percent cure. I mean, I looked to my own, my own experiences and see how far people I love and in my direct family have come in their chronic pain journey and think, well, you know, I have no idea if it's going to be a cure or if it's not, if there is such a thing, I mean, we're thinking of cure. The word cure is almost decided that we know what the cause is.
Laura Rathbone (26:00):
And we don't fully know that yet. So we don't know what the end point of that person's journey is. All we can ask is right now, is this helping you in this moment as we take a step in this part of your journey. And if that's unhelpful, because it's not helping us to take a step in the direction that we've highlighted is a good one that you've decided you want to take, then we need to work with that urge that keeps coming in to go for a curative treatment, potentially curative treatment. If we've got one.
Laura Rathbone (26:36):
But I guess what I would suggest in that moment is that we as clinicians probably need to do the most work because our urge is to jump all over that and be like, no, no, no, no, no. The science says that you're never going to get that. And that's a cruel message and it's not accurate. We have no idea. You know, our urge is to educate the shit out of that person and make them feel better. Right. But we don't know. We don't know that. So maybe we need to sit with our allergies a little bit more. Maybe we need to pull ourselves back a little bit more in that moment and just hear what that person is saying and listen and acknowledge it and bring it into our decision making, bring it into our understanding about, you know, what that person is going through.
Laura Rathbone (27:19):
What in our experience might be a helpful step. And then we have that collaborative discussion. Do you think it's going to be a helpful step? Would you like to go in this direction and see what happens? See what comes out of it? It's hard because we are trained to know the answer. That's what that biomedical model is all about. Those, you know, assessment tools. We can tell you if you've got an impingement and you know, that the idea, the whole point of that is that we had an idea that we knew what was causing pain. We knew it was the musculoskeletal system, and we knew it was the nervous system. Then now we're starting to think, well, maybe it's the neuro immune system. And, you know, it's all this idea that we know what is the cause of a human beings pain. And I'm not sure I have seen any evidence that we're much closer. And that's just my opinion on what I see. So maybe in those moments, we need to check ourselves a little bit.
Karen Litzy (28:27):
And thank you for that. That makes a lot of sense. And you know, it brings me back to this idea that are we doing the best we can for the person in front of us at this time with the knowledge that we have and that has to be enough at that moment because that's what we have.
Laura Rathbone (28:53):
Yeah. And I think that's really an important thing to remember is that we are both two humans interacting on a human issue, which is the human experience of pain. And, you know, we are healthcare clinicians, not heroes, right? We're not the saviors, we're not in the, you know, the people that come to see us, they're not victims. They are humans trying to live their lives. And we are people who have studied physiology and people who have studied rehabilitation and people who hopefully are studying sort of communication and behavior change theory and the philosophy of just like a human experience. And, we're hoping that when those two things come together, something happens and the person who is struggling to come to terms with their pain, manage pain and find ways and solutions to their pain, right. We're hoping that the combination of these two things or these two people, these two worlds and worldviews come together and we can find and facilitate a way for that or the person, the person in front of us to move forward.
Laura Rathbone (30:03):
So, you know, yeah. We have to sort of remember that we are only doing our best and that has to be recognized on both sides, right. That there is also a responsibility for the people that choose to work with us to remember that we are people, we are humans. We do sometimes get it wrong. We are able to look back and say, Oh, that was not necessarily the thing that I would do now. And were able to change and update and evolve. Yeah, I guess that's where I come, that our job, our role is to make sure that we are reading the literature, that we are going to the podcast that we are listening and learning and evolving and evaluating our messages to say, is this still the best I can do? You know?
Laura Rathbone (30:52):
And to that end, I would say, I've had this conversation a few times with sort of new graduate clinicians who say, Oh, but you know, this person, I educate, I gave them the education and they just didn't get it because education has also been one session. And I say, okay, so you gave him the education. How did you deliver it? What was your approach to education delivery? You know, what training have you done in educating? And they touched, they took a weekend course, but if they've even done that, that's the point, isn't it. I try the CBT approach. Okay. So how did you train in CBT? What is the CBT approach? Yeah. You know, Oh, I've done mindfulness. Okay. So how do you integrate mindfulness since you're into your practice? And we say that we think that we know how to do these things, but we're not putting in the time and the effort to really fully train and upscale, you know, acceptance and commitment therapy is an entire psychological framework, right?
Laura Rathbone (31:53):
It's not a little bit that we just add in, it's an entire framework of being with the people that means you never finished learning. Right. I'm still learning. I still have people call me at my clinic and watch me. I still do peer review and make sure that people, people are listening and helping me understand how I apply ACT. And when I may say, or when I get it wrong. And so I can keep evolving, you know? And, that's the thing, isn't it, you know, we have to make sure that we are fully invested in our communication strategies, not just superficially, because otherwise we're not doing the best by the people that we work with. We're giving them a half-assed attempt at education, blaming them for not understanding what we were trying to say.
Karen Litzy (32:40):
Well, we don't even understand it. And, also being very cognizant of the fact that people communicate differently and people learn differently. So if you're giving quote unquote giving the education, well, I told them all about it. Well, maybe they're visual learners. Maybe they need to hear things in small chunks, not vomited all over with information, maybe they need follow-up. Maybe they need to watch videos. Maybe they need to take a test. Maybe I know I'm the kind of person who I like to take a test. It's a very weird thing. I took a continuing education course the other day on child abuse. And at the end, you know, they tell you to evaluate the course and I do. I'm like, well, where's the test, where's the test. How do they know? I know that I read. And my boyfriend was like, are you advocating for a test? Like you want to test?
Karen Litzy (33:32):
I'm like, yes, I want to test because I want to make sure that what I read that I understand it at least superficially right. So when you're talking, like I have had patients where I have explained things, explained pain, used a pain education approach to them. And I always try and follow that up with, you know, I'm going to send you a couple of videos. I'm going to send you some you know, and ask them like, do you understand? Can you kind of give me the highlights? What did you take away from that conversation? So you may educate them, but if you don't ask them well, what do you think? What did you understand from that? Does it matter what you said to them? If they can't understand a word that you just said?
Laura Rathbone (34:20):
Well, that, I mean, that is like one of the basic basic principles, isn't it of how do we communicate it? Does the other person even understand what we're saying? Are we using it an appropriate approach to communication? But I guess the other thing is, you know, the beauty of the ACT is that it came out of, you know, this struggle that we had in real time, behavior change, you know, like we can help people change their thoughts and they can change. They can, they can find a new narrative, but when pain comes, what do they do? What do we do when something difficult shows up, you know? And the skillset, in fact, the hex of flex, all the processes have changed at all. Within the hacks effects are there to be navigated and to be utilized in that moment, when pain comes, what do I do?
Laura Rathbone (35:19):
Is this helpful? Is this in service of something that I am working towards and not working towards, but that's, whatever the person in pain says it is, right. That's not all saying, Oh, we're in rehabilitation. Therefore we need to rehabilitate you to action. Or, yeah, I have no idea. You know, it might be that in that moment, the most important goal for that person is self care, right. That could be, I mean, and that's very legitimate and very, very valuable, you know, it's not, well, when pain comes, how do I push through it? It's what we're trying to figure out is okay, when your pain comes for you, what do you do? And is that helpful? And if it is, then all we want to do is facilitate that and to validate it. And if it's not helpful, then that's when we might say, okay, so how do we start opening this up?
Laura Rathbone (36:11):
How do we start finding a helpful thing? What do you think could be helpful? And our job is to facilitate that conversation so that the other person doesn't feel they are making all of the choices on their own. And they've all of a sudden, they've just had been dumped the responsibility of their own care on their lap. Our job is to compassionately titrate that conversation, what might be helpful, and to take our time, to explore it in a way that people feel they're able to meet in a way, not that people feel sorry, that isn't the right word in a way that people are able to make their own choices. And we are able to support them. That's it? And that's what ACT is.
Karen Litzy (36:55):
And to that end, I want to go back to the story of your mom and how you said she found this massager that really helped. And you know, you and I had a conversation the other day, and we had this conversation about the passive versus the active modalities and passive bad, bad, active, good only thing we should be doing. So let's talk about that within the ACT framework of your mom found a massager or whatever it is. And boy that really helped. So from an ACT framework, how do we make sense of that when we are supposed to be only advocating for active, active choices, not passive modalities, not a tens machine, not a massager.
Laura Rathbone (37:47):
Okay. So I would say this is probably the part of the podcast where I will, it's the most controversial part. Because if you are a person that advocates hands off therapy, then actually fit very nicely into your framework and you might be using it very X and you know, and doing great work. And if you are a hands on therapist, then you may have already decided the ACT is for the hands off people. So you're not going to go near him. And you know, my opinion on this probably changes quite often, but I would say that if a person is making an informed choice about how they, their pain that is helpful for them, that is active treatment, that is an active decision, but is that person and saying, this is helpful. So, I guess if we're going to use the way I would use ACT in that moment as somebody who typically doesn't use a lot of hands on therapy or a treatment delivery devices.
Laura Rathbone (38:58):
So we say, you know, I did my masters in sort of neuromusculoskeletal therapy. We did all the manual therapies stuff. I would say, okay, how much does it help? Let's talk about that helpfulness, because that's important because my job is not to make you feel bad about using something that helps you in your life. My job is to facilitate that and to support that and to see value in the bits that you might not be using, or the bits that you might not be doing. So if that person is able to say this right now is the only thing that is keeping me going, then we say, okay, it's helpful right now, helpful right now doesn't mean helpful forever. Right? Helpful right now means in this moment, in this context, with the knowledge that you have the skills that you have, the relationship that we are developing, this is very helpful.
Laura Rathbone (39:58):
So I'm not going to take that away because that's cruel, right? That's not nice. What we're going to do is we're going to work with that. I'm going to keep checking in and seeing, okay, is this still very helpful? If it's, and at some point it might not be, and it was, we're going to keep working on all this stuff, I would say, okay. So let's say, you know, a TENs machine, quite often, people that I work with are using tens machines, because it helps them to do something of value. That's it, that's what we're working for. But if they're saying I go to the physiotherapist or a particular physical health therapist, whatever, and they give me, let's say core exercises. That just for it, just rotate through their active therapies, right? These are hands off therapy, call exercises to strengthen my core.
Laura Rathbone (40:47):
And I do them. And I have worked with these people where they are doing them four or five times a day. And they're in pain when they do it. They're in pain after they do it, they're in pain the next day. And they've been doing it for months, some of them. And you're saying, well, actually, is that helpful? There's an active treatment. That's an active treatment in a way, that's the person doing it, but that is a passive approach to receiving therapy, right? Because they're not thinking and not enough. And don't feel like they're able to have the space for their own opinion on whether this is working for them. It hasn't been created in the therapeutic alliance. So, so that they're doing this in the hope that they get to the goal of the therapist that they're going to get, but they're not necessarily getting there, but they're still doing it cause they haven't the safety and the relationship hasn't been created. So that person can go back and say, actually, this isn't helping me. So we can say, okay, that's not helping. We can change. You don't need to do stuff that's not helping. If this is making your pain worse, then it's causing pain. Why are you doing it?
Karen Litzy (41:51):
Yeah. And it's so funny. I had that conversation a couple of weeks ago, the gentleman with chronic low back pain, it's been six months of low back pain. And the doctor said, we'll read this book and do these exercises. So he was doing press ups and press ups at an angle and press ups. And, and I said, well, how long have you been doing that? And he said, I've been doing for a couple months. I'm like, Oh, well, how does it feel? He's like really hurts when I do it. But you know, the doctor said to read the book and do what's in the book. So I'm just doing what's in the book. And I said the same thing. I'm like, well, there might be ways that we could alter this, or there might be other things that might be more helpful if you're doing this particular exercise.
Karen Litzy (42:38):
Exactly what you just said. Well, it hurts when I do it. It hurts more after I do it. And it hurts the next day more after. And I said, well, okay, let's explore this because I think there might be ways that we can make this work. And lo and behold, we found ways to make it work, but it's just, yeah, it's just that exact example of what you just said. And having the conversation was maybe a little uncomfortable at first, because this was something the doctor said to do. And so we had to do it.
Laura Rathbone (43:14):
Yeah. But I mean, that is a typical example where a clinician just has not invested in their communications strategy or their compassion for the person in front of them. They haven't even created a dialogue. They've just given somebody a book and said, your problem is so common that we've written a book on exactly how to get out of it. You just need to follow this. There is no dialogue that, and the thing is pain. Pain makes us very vulnerable, right? Pain creates a huge vulnerability in us. And we know that when we have pain, we are vulnerable and it's no different for the person in front of you. That's been living with it for years. They've just got more pain and had it longer, maybe feeling more vulnerable and more desperate to find a way out. And that's completely understandable. So shame on that clinician, because that is not okay.
Laura Rathbone (44:07):
We have got to invest in our dialogue abilities. We've got to commit to being good communicators and compassionate communicators and compassionate listeners. And, you know, really want to know about the human we're working with as opposed to dismissing their pain as something that a book can feel. And of course there are very helpful books out. There are helpful textbooks that have been written by very compassionate clinicians and some are better than others. And I'm not trying to say all self help tools are all bad because that's not, that's not the point here. The point here is that if there's no, there's no way, there's no space for the person who is living with pain to explore with you, the solutions that you're putting up, then, then it's very difficult for people to know what to do next. And it's very easy for them to feel like they're doing it wrong or that they're somehow not committed enough. So then they'll might do it twice as many times and more often and more days, and with more effort, because that's the only solution we've given them.
Karen Litzy (45:18):
Yeah. And then I think it also brings on for the patient sort of coming from my own experience is that, well, I can't even get this right? Like you failed yourself. You don't even know your own body. It takes you. I think it disembodies you even more than perhaps you already are out of protective purposes. And it just takes you further away from yourself and your person, if you will, because if you can't, you know, you read the book, you're doing it. The doctor said, you're doing what the therapist said, and you still can't get it right. Then you're just a failure. And it, again goes back to feeling hopeless. Like you said, like your mom felt like she didn't have any hope and she felt very hopeless. And I think these sort of faulty communications and inability to tune into what the patient is telling you leads to that feeling of hopelessness and failure from the patient point of view. And so I can totally see how using ACT as a framework and being able to acknowledge the person and what they're doing. And, are there some alternatives that can be used, maybe not now, but maybe in the future or where you are now and what can we do at this point? And it was working now, but let's keep in mind that there are some other things that we might be able to augment your program with.
Laura Rathbone (46:58):
Yeah. And I always say that brings me on to probably the next thing that really, I think, feel very, very passionate about. And there are many new ones to watch my Facebook page, but you know, this is, I think one of the big misunderstandings we have about integrating psychologically informed physiotherapy, right. Is that we still think that it's something we do to other people. And that's why I don't really like the term psychologically physiotherapy, because it's still, although I think it's the best one we've got right now. And I think that, you know, it's a lovely way of thinking about how we therapize people, but it still puts the workload and the part of our identity that is physiotherapists. It's still what we do when we put the uniform on or when we go into our clinical encounter.
Laura Rathbone (47:51):
And it's still something that we do as a thing to all the people. But, you know, if we think really and truly reflect on the idea of the biopsychosocial model and the hierarchy of natural systems, this idea that a human is embedded within their environment, then the clinician is a part of the external environment and the patient or the person that's chosen to work with us is a part of our external environment and has an influence on us. And we have an influence on them and we need the real richness with acceptance and commitment therapy is that it is something that we're thinking about, okay, what is happening in my present experience that I might be struggling with that might be coming up in me that might be having an influence on somebody else?
Laura Rathbone (48:45):
What is my reaction to that person's story or that person's behavior, or that person's diagnosis, right. You know, what's happening in me so that we can also remember that work with our own resistance and become aware, especially now become aware of our own privilege and how that might influence and take away from somebody else's privilege or equity or equality or justice or access. And this is something that we need to reflect on very, very deeply as clinicians working in an area like healthcare, where access is very, very important. And it's our role to make sure that we're delivering high quality care with open access. And so acceptance and commitment therapy is a way for us to also take that moment and be like, okay, well, what's going on in me here? How am I helping this person what's happening in my reactions and my emotions and my sense of self and is that always helpful? So if my goal is to deliver an open and evidence-based and compassionate approach to experiencing any resistance or challenges to doing that in this situation, and maybe I need to work with that.
Laura Rathbone (50:02):
I think that can be true. Across musculoskeletal health, when, you know, people see, you know, patients or people with pain coming in and they have persistent pain, and it's not going to get better in six sessions, three to six sessions, and we've all got those targets, right. And they're going to need more than 30 minutes. So we're going to have to explain to our manager why actually did more than 30 minutes. You know, all these sorts of things what's happening is our instinct to push them away to somewhere else, or to create departments where we, you know, where we don't accept people who have pain for more than three months, or, you know, then there are those departments out there that push the access away to somewhere else.
Laura Rathbone (50:49):
So there's a bottleneck in all the parts of our clinical approach. Actually, maybe we could just upscale a little bit and recognize that persistent pain is a very big part of our musculoskeletal population. And we all have a duty to be better at it.
Yes, very well said. And like you said, especially in these times, so listen, Laura, I want to thank you for coming on, but before we wrap things up and get to a good, and now a nice announcement from you and what you're doing in regards to ACT, I'm going to ask you one more question that is knowing where you are now in your life and in your career, what advice would you give to yourself straight out of university?
Laura Rathbone (51:52):
Gosh yeah, I would say what I am learning is that I'm not always the right person at that moment. And sometimes my desire and urge to fix people quickly as well, and to do right the injustice of having pain and to really get rid of that pain as quickly as possible. Sometimes that has I think, taken away from the therapeutic potential in some environments and in some experiences. So, and also has just caused me in a lot of pain, you know, and we have to remember that we are humans in this, that we are not, clinicians are people that go home and try to, you know, keep going after hearing some very difficult stories of all the people and, you know, we're also not immune to when the people we work with don't get better in the way we want them to, you know, we take that on. Yes. One of the most important skills that I have been learning is to be more forgiving of myself.
Laura Rathbone (52:51):
And to remember that life is complicated and people are coming into our clinics with a whole lifetime of experiences that I am not aware of and not privileged to. And they are not aware of or privileged to mine and being slower, taking more time, being more gentle, not only with people who choose to work with me, but also with myself actually has brought me to a place where I am having a better relationship with my job. I'm getting better relationships with the people that I work with. And I just, yeah, I am able to sustain this work now for longer than I would have been, you know, eight years ago when I first started in particularly working with longterm pain, it was very hard for me and I went through my own version of a burnout when I was constantly finding, trying to find more information and be better and upskill, upskill, upskill. Yes. We need to upskill. Yes. We need to learn about these things, but we also need to find good supportive mentors and good environments that we can next explain and explore what we're going through and ask for help. If we're feeling very effected by what we're hearing every day, you know, good relationships with our colleagues, physiotherapists, occupational therapists, psychologists, social workers, help us to, you know, share our experiences and our load. And be more forgiving of that, I guess. I don't know if that's a good answer.
Karen Litzy (54:27):
That's an excellent answer. Are you kidding me? Fantastic. And now speaking of gaining skills in service of others, what do you have coming up? Cause I know you have like a course that you have put together. So can you talk about that and where people can find more information?
Laura Rathbone (54:52):
Yeah. So about six months ago, I started putting together and planning a two day course, right? Typical 15 hour, two day course, people would come to our room and we would do two days of ACT. And then, you know, the situation with COVID-19 and all of our lives changed, and that didn't seem like it was gonna make most sense. So it shifted into a sort of online collaborative learning and it's still, we're still figuring out how this is going to work, but instead it's going to be four sessions of three hours of contact and collaboration over four weeks. And then there's going to be like support and forums in between. And that will be going live hopefully at the end of July, if I can get the luck. But if people do want to come on a course with me, or they're interested in exploring ACT and they just got some questions, best thing they can do is go to my website for information for even better, because I'm basically always on social media, find me on Facebook or Twitter, whatever, flip me a DM.
Karen Litzy (56:03):
And now, so we'll have links to all of that under the show notes at podcast.healthywealthysmart.com, but can you just shout out your social media handles?
Laura Rathbone (56:17):
If I can remember them. @laurarathbone (twitter) @laurarathbonevanmeurs (facebook) @laura.paincoach (Insta) Yeah, that's more of a patient facing platform for me. So that's Laura.pain coach which is the title that I tend to prefer. So sort of working as a coach, as opposed to as under the strict title of physiotherapy yet. So that was, yeah, those are the three social medias I use the most.
Karen Litzy (57:02):
Awesome. Well, Laura, thank you so much. This is a great conversation. It's certainly got me thinking of the way that I work with my patients and my clients, and maybe how I need to do a little more introspective work and try and really check my biases, whether they're conscious or unconscious biases at the door and really see what I can do for the person at the moment and listen to them and see what I can facilitate for them. So thank you so much for coming on the podcast and sharing all of this information. Thank you.
Laura Rathbone (57:40):
Oh, no, you're welcome. There's lots of books and websites and patient information out there. Just want to give a shout out to Steven Hayes who really is responsible for the framework of acceptance and commitment therapy and the association for contextual and behavioral science, I think it is, but I'll make sure that you get linked with that and why there are you know, resources on there for people to learn about acceptance and commitment therapy, because you know, this work isn't being done, the research hasn't been done by me, it's been done by lots of other people. So I would like to just direct people to look that up as well.
Karen Litzy (58:21):
Awesome. Well, thank you so much for coming on and everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.
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