Have you ever considered the profound impact that trauma has on the body and the mind, and how manual therapists can provide a beacon of hope for those struggling in its aftermath? We're honored to have Brian Trzaskos join us to shed light on the transformative power of trauma-informed care within manual therapy. Our discussion transcends the traditional view of trauma by focusing on the body’s nervous system and its response to both catastrophic and minor stressors, which can accumulate and deeply affect an individual's sense of self. Learn how therapists are redefining their approach to care, ensuring they not only soothe physical ailments but also support the journey towards emotional and psychological healing.
Embarking on conversations about trauma can be like navigating a minefield, but this episode is a must-listen for healthcare professionals seeking to bridge the gap between knowledge and empathy, providing the necessary tools to engage with patients about their trauma histories constructively. Our commitment to fostering empathetic dialogue is unwavering, as we strive to enhance patient care through understanding and open communication.
Have you ever considered the profound impact that trauma has on the body and the mind, and how manual therapists can provide a beacon of hope for those struggling in its aftermath? We're honored to have Brian Trzaskos join us to shed light on the transformative power of trauma-informed care within manual therapy. Our discussion transcends the traditional view of trauma by focusing on the body’s nervous system and its response to both catastrophic and minor stressors, which can accumulate and deeply affect an individual's sense of self. Learn how therapists are redefining their approach to care, ensuring they not only soothe physical ailments but also support the journey towards emotional and psychological healing.
Embarking on conversations about trauma can be like navigating a minefield, but this episode is a must-listen for healthcare professionals seeking to bridge the gap between knowledge and empathy, providing the necessary tools to engage with patients about their trauma histories constructively. Our commitment to fostering empathetic dialogue is unwavering, as we strive to enhance patient care through understanding and open communication.
Hello everybody, welcome to another podcast with a sensor approach to manual therapy.
Speaker 1:I'm here today with my guest, brian Trascos, who is in New York, and I had the fortune to take class from him at the 2023 American massage therapy national convention, and he did a class on trauma and trauma informed care that I was really impressed by, and I wanted to learn a little bit about what he does and explore it, because I think this needs to be the next step in a lot of people's care, and this is actually a series. So I just did a podcast a couple about a month ago that was released, about a professional runner of mine For those who've already listened to it, but for you, brian, in case you haven't heard it who is a professional athlete. She was number one ranked in the world. She fell down 150 foot cliff, went through the trauma of surgery, of being an hospital abroad, and then we went through care and she went back to running, going back to being one of the best in the world, and so that was my first podcast with an athlete.
Speaker 1:This one's going to be with you, a clinician, and my next podcast, which will be done here in the end of April or in the end of March is going to be with a neuroscientist on the effects of trauma on a neurological neuroplasticity aspect of the brain, because that's what a lot of my listeners like listening to, so welcome.
Speaker 2:Yeah, thank you so much. Great being here, troy, really appreciate the invite.
Speaker 1:Yeah. So the first thing I want to ask you is for my listeners who aren't familiar with it and not everybody will be, because it's a relatively new concept, I think, in manual therapy, because historically, trauma-informed care has always been the realm of psychotherapy and things like that and it's making its way into manual therapy. Why don't you tell us a little bit about what trauma-informed care is for you as a clinician, in regards to your actual treatment?
Speaker 2:Yeah, absolutely Absolutely. So kind of the start of it is to understand a little bit about trauma prevalence and the word trauma gets bantered around quite a bit and so it's at the point now well, what is exactly a trauma? Is it that when someone yells at me, is that a trauma? Is a trauma falling down 150-foot cliff? Why does different people respond differently to things? So that kind of the whole word trauma has been bantered around. There's a lot of trauma judging that can go on nowadays around, like who actually has experienced trauma. So from a clinical point of view, I want to know what the nervous system has to say about trauma. That's how I use my determination on whether or not someone experienced trauma is what has their nervous system said about it in this particular way?
Speaker 1:Is that something that you specifically ask individual clients, or is that not a definition that you have given to you by the DSM few or SHAMSA, things like that, the substance abuse group, things like that?
Speaker 2:Yeah, so the SAMSA definition is basically saying when an individual experiences a life threatening, perceives a life-threatening event, and that perception could be at a physical, emotional, psychologically life-threatening event. So there's a pretty broad definition there, and two people can experience the same event and one of them will have a different response to it than another person. So I will ask, I will screen about hey, have you ever had an event in your life that you would consider to be life-threatening? And then I'll get a response from that. Some people will be like no, but still, their nervous system will tend to become and here's the key word dysregulated.
Speaker 1:Yeah. So when it comes to a life-threatening event, I mean most humans can understand what a life-threatening event is, but is it only life-threatening event, as in mortality, or is it also quality of life-threatening event? Because I was speaking with somebody earlier, just about an hour ago, who's going to be my next guest on the podcast, who's a neuroscientist, and we were talking about big T versus little T, the big trauma, the 150-foot cliff, the abuse, the life-threatening event of a car accident versus the repeated exposure that's not quote-unquote traumatic in its single experience but that in repetition becomes traumatic responses. Or the athlete who has an injury that's significant enough to drastically change the life. The actual moment's not traumatic, but the consequences of the moment are enough to create traumatic responses. So when you talk about life-threatening event, do you ask your clients to describe that only as mortality-based or do you describe it as, hey, life-threatening events and quality of life and quantity of life and joy of life, things like that?
Speaker 2:Yeah, and also it could be identity-threatening too, right? So life-threatening also equals identity threat. I've definitely worked with people that have been. Their nervous system has become dysregulated after having a profound identity threat. So what's an identity threat? They lose a job suddenly and their identity was wrapped up in that job, and then all of a sudden they end up with symptoms that look very much like PTSD after that occurs, right? So it can even be an identity threat as well, and so I try to as much as quickly as I can move away from what someone might label the generative start of quote-unquote, the traumatic event, and I look very quickly at what's their nervous system doing, because that's how I make my judgment on it. It doesn't matter to me. I mean, I care about people. It doesn't matter to me to a certain degree, if someone gets in a car accident or if someone's had complex trauma growing up. So when I say it doesn't matter to me, it doesn't, the story itself is important to the person I honor. That.
Speaker 1:But less to the clinician At the same time.
Speaker 2:I'm working with their nervous system, that's where I'm working with, and there's a lot of good science I tried to show us and this is where manual therapy comes in is that for people who are re-experiencing post-traumatic symptoms? So we can also say there's a difference between post-traumatic stress disorder and having post-traumatic symptoms? Yeah, absolutely Right. And so someone who does not have PTSD diagnosed but experiences post-traumatic symptoms is still experiencing a lower quality of life than someone who does not have post-traumatic symptoms. And that's, by the way, a lot of people are in that boat.
Speaker 1:You can just go post-2020 and you can say, essentially anybody who was affected by COVID, which is going to be a pretty large percentage of population, would be in that boat. I love what you're saying, the encapsulating nature of it, because everybody has had those moments in life, especially the identity, because for me, so many people tend not to associate identity change with crisis in their life. They just say, oh, it's part of life, Everybody loses a job, everybody loses a loved one, everybody has good and bad things happen to them in their experience. But again, how they're nervous system in court. Like as a quick example, this past summer I got in a car accident with my two daughters in the car and we were driving down the road on an auto route, on a main highway, and on the opposite coming traffic a car lost its wheel, not its tire, told it and hit the median, bounced up in the air straight out of, like a fast and furious movie, and landed on our engine block and we had a moonroof and I remember thinking, oh, if I hadn't slid on the brakes, that would have landed on the roof, which was made out of glass and a window, and it would have hit my two girls and so my wife's not in the car. She was at home taking a back and I call her and I say, look, you know, I call 911, everyone's safe, everyone's happy, there was an accident, you gotta come get us. She picks us up. I go through maybe about five minutes of oh my God, that was intense a little bit of shock and my wife is in like tears and having this trauma response and my kids are having and I'm like it wasn't traumatic. The car did exactly what it's supposed to do. It protected us in an emergency. We'll go get a new car, we'll move on. And so there's that whole.
Speaker 1:How does your nervous system regulate it? Everybody's system is different. Everybody's system handles dressers differently, and so for me it's really interesting that you approach it that way. But my question would be is you know, when my clients come in the door into my clinic, I do an evaluation with them. We do assessments, we do an intake, but as a massage therapist and a body worker, not as a psychologist. Historically I've been taught that my language framing is specific to certain contexts the body, but not the mind. So how do you bridge this concept with your clients? Because it is valuable. We, as therapists, absolutely should be aware of trauma response. Every therapist who's been in the industry for an extended period of time has had clients have trauma responses on their table and we're always, we're always and we're always. You know we're taught various different ways to handle it, but how do you use that clinician? Stay within the scope of practice and bring up these subjects that are valuable and important, but stay within your, your wheelhouse.
Speaker 2:Yeah, there's. There's actually a really good paper and the author was written by a physical therapist and an MD and I can share it with you after we get off if you're interested.
Speaker 1:And it's really about how to get to that gap, because then I can put it in the link up the podcast so that people can look at it as well.
Speaker 2:Yeah, Matthew Matthew Herb, I think, is his name, is the PT that I spoke with about this and they've read a great paper and it's actually talk about how to start bridging some of that language. They've actually created a roadmap, a conversational roadmap, to start inviting people into that conversation to basically do trauma screening with people, and it's a really great way to do it. Of course, I will say I actually take this paper when I travel and I teach professionals this framework and I'm really surprised at how many professionals have a difficult time even practicing this conversation with a parter in the class. I mean, it tells you how uncomfortable people are with having this conversation at all. I do.
Speaker 1:I do an ethics class that all involves transference and counter transference about inner masks and outer masks, and you know the study that the part of classes will take about 30 minutes and most people are done in three and I'm like no, no, no. You need to take a deep breath and go deeper. You need to practice what you're uncomfortable with, because when the client shows up, they're going to give you it, whether you're comfortable with it or not. You know they're going to. They're going to react the way they're going to react.
Speaker 2:Yeah, it's really. It's really really interesting. So many people I work with say, well, I don't want to stir something up for this person. And I say the thing is is that it may already be stirred up for the person all of the time and no one's paying any attention to it, and so the person feels very unseen and unvalidated. Number one and number two wouldn't you rather be aware of it before you do a treatment with somebody, rather come up during a treatment? Because when it comes up during a treatment like that, in a lot of ways the toothpaste is kind of out of the tube and then you're really having to help someone become re-regulated, and that can become really difficult in a clinical setting and if you don't know if it's stirred up or not, you you know.
Speaker 1:For the people who say I don't want to stir it up, yeah, but if you don't know what it is, you don't know if you are stirring it up by, exactly Like, if you don't know what it is, you don't know how not to address it or how to avoid it. You know. It's like if you don't know they have a broken bone and you go and you give them traction, you're going to hurt them. It's better to know and then react to what you know. Ignorance is only bliss as long as you're ignorant.
Speaker 2:Exactly, exactly, until it becomes aware of it, and then you're like, oh my God, what do I do with it? Now? I do want to come back to your original question, though, about when people come in, like how do I screen? Basically. So some of the things I ask people are directly related to the treatment I'm going to be doing with someone, because that's the context within which we're working. I don't need to know about someone's their whole past and what their whole journey has been to this point.
Speaker 2:I mean, it's not that I don't care about those things, but in the context of working with someone within the scope of practice, let's say right. Then some of the questions I ask are basically have you ever had an unsettling or negative experience with receiving manual therapy in the past before? I just want to know, because what I'm trying to get a read on for the person is, in some way, have they had manual work done? Has someone else had their hands on that client that has caused dysregulation, nervousness and dysregulation for the person during the treatment session? I kind of want to get a read on that before we go in, and that's just a really simple question.
Speaker 1:I remember you mentioned that in the class at National and Phoenix last year and it's something that I had done occasionally, but it was something that I had already and I think most therapists probably do this, but they only do it in the and I'm going to use obvious in a very loose term in the obvious cases Somebody comes in and they're like, oh, you're the 10th therapist I've seen, I've had a shitty experience with everybody.
Speaker 1:Or, oh, don't touch my knee. Every therapist who touches it just hurts it more. And then you're triggered to say those things. But when you had mentioned that at National, I remember started thinking oh, every new client and all my clients who are with me for a long time I roughly every six or seven sessions I've started integrating to clients who see me repeatedly and for new clients, always one of the first things that they have have you ever had this area that you're complaining about treated by another therapist and go to our bad results? And why did you stop seeing them? Why have you continued seeing them? Things like or why are you seeing me instead of them If you had positive experiences, to try to get that understanding of what is their reaction to even being touched?
Speaker 2:Yeah, it's so, so important because from a trauma informed framework, when you're working, from a trauma informed frame with a manual therapist, we basically make an assumption that everyone has experienced trauma. Not some people have it. That's your baseline. That's your baseline. They come in the door. Let's say everybody is aware of it.
Speaker 1:They may not even know it.
Speaker 2:Exactly and because as manual therapists we know that actually not only as manual therapists, but as manual therapists, as we're touching people's bodies, trauma is stored in the nervous system and in the body and as manual therapists we have a shortcut to potentially evoking a trauma response when you were doing didactic work with people solely. There's all kinds of cognitive defenses that people can put up in place to not let someone at the trauma responses.
Speaker 2:But when you're working to someone's body, like someone gets comfortable on the table, the music that's relaxing brainwaves drop into theta waves or alpha theta wave states. The defenses go away and then we have direct access to someone's subconscious mind as we're working on their body, because your body is your subconscious mind. Essentially, as a manual therapist, you're working directly on someone's subconscious and if there's something there it can pop up.
Speaker 1:I'm hearing some interesting language in the way that you're saying that and I think I remember reading this in your bio that you have quite a bit of an Eastern approach to it as well, because the way you're describing the unconscious mind is in the body, even though, conceptually, when you say that, there's a part of me that goes, yes, I fully understand what you mean, and even though there's a part of me that fully agrees, there's also the scientific portion of my brain that says that hasn't been shown to exist in a replicated environment where we consistently show that occurs. And yet we do know that the body hangs onto these stressors, that that's the manifestation of stress, some form of physical outcome, and so it's just interesting to say that so is someone that's guided from that mentality of the Eastern approach.
Speaker 2:And what would that be for you? Yeah, I think a lot of its influence from the Eastern approach, but also just the pure fact that right now, neither one of us is running our own liver right now, or our own kidneys or a cog. Consciously, we are not running our body. Our subconscious is running our body. That's fantastic.
Speaker 2:Everything from our organ function to our postural muscles. Like I'm not running my postural muscles right now, I mean I'm not even running my muscles of expression. You can see, I'm using my hands. I'm half Italian, right, so I use my hands a lot, and that's all unconscious too. I'm not planning to move my hands, they just happen to move. So anything that I'm not consciously, volitionally planning to do, my subconscious is doing. I love the way you say that.
Speaker 1:That's fantastic.
Speaker 2:So all those responses are held as a perfect example of how your subconscious mind is your body, and so all of those our habits are automatically run from our body too, right? All the habits drinking, brushing your teeth, everything you're not thinking about and still doing, driving, all those things are all subconscious. So your subconscious is running your motor control patterns also.
Speaker 2:And it's running motor control patterns that are either turning on and turning off, such as muscles of expression, but they're also running postural muscles, that cold chronic tension also, and that chronic tension is associated with protective patterns that have been set up by past trauma.
Speaker 1:So then this gets into an interesting portion, because now you're starting to bridge where the East and the West come into it together scientifically, but you're also starting to bridge this idea of the previous lectures. Let's use postural muscles as an example, because you mentioned that the old lectures around posture was that posture equals pain, and the new science is showing us quite conclusively that posture and pain have very little correlation, that pain is often result or posture is often result of pain, not the other way around, that we modify posture to accommodate our discomforts and so the chronic pain, the postural stuff, historically what we would look at. Somebody comes in, you do a posture analysis, you're looking for upper cross-singering pelvic tilt, which, again, all this stuff is being shown more and more and more to be naughty relevant. I don't want to throw biomechanics out, I don't want to throw the baby out of the bath water, but just not as relevant. It's not the end. All be all that. It used to be.
Speaker 1:But now, if somebody comes in, are you describing postural analysis as potentially more? I don't know, trauma analysis would be the correct term. But when you look at them, you're not necessarily looking for biomechanical behavior. You're looking more for cognitive, behavioral, emotional, protective behaviors in their posture, as opposed to you're hurting because you have upper cross syndrome, it's more. No, you have upper back tension because you're guarded from an emotional expression of feeling free through your ribcage or whatever, or your pectoral tissue, things like that.
Speaker 2:Yeah, I love how you're presenting that, troy. That makes perfect sense. I love the turnaround of posture. Is an adaptation to protection or threat or, quote unquote, pain, if we want to call it, but to something. The pain and threat are intimate and linked with one another. One of the things that we like to talk about is, if you had pain minus threat, you just have sensations.
Speaker 1:I teach a class called pain. The other four letter word Exactly.
Speaker 2:And I've got several podcasts on pain.
Speaker 1:My followers are very familiar or my subscribers are very familiar with pain as an idea. Yeah, yeah.
Speaker 2:So, however, we want to sort that out. But threat. So threat is going to change alone our physical motor control processes, right. So our neuromuscular patterns are going to change just with threat alone and if that persists long enough, we will generate what we will call pain and that will change our postural systems. It's really interesting that kind of pain posture correlation. I'm a physical therapist, also by training, and I remember vividly one time this client coming into my clinic and Troy his spine. He literally kind of looked like a question mark and that's how twisted his spine was. And I'm looking at my chart and I said I wonder if I have the right person, because it says wrist pain on here. And so comes in. I said, hey, what are you here for? It's like my wrist is bothering me. I'm like, is that all that's bothering you?
Speaker 1:It's like yeah, the biomechanical assumptions kicking. I'm like wow, okay.
Speaker 2:I mean I'm looking at this person and thinking, oh my God, like there's got to be so much spinal compression going on. They have to be miserable. And I'm like, well, how do you feel? In other parts of your body it's like I feel fine, like okay.
Speaker 1:I was speaking with a. There's a doctor, a neuroscientist, here at the university Sherwood here where I live, and him and I were having a coffee the other day talking, and he told me the story about a convention he was at where, like, there's this group of surgeons altogether they're looking at this patient with scoliosis and there's this really renowned surgeon who's showing, like look at the surgery I did in these fusions and on paper and the x-ray, like all the surgeons are clapping and they're amazed and it looks so good. And then the guy doing the presentation and his partner who's sitting in the audience there's just kind of like hands together and a giggling to himself, knowing what's about to happen. And the presenter goes oh, by the way, my client is still in the exact same level of pain. We fixed everything structurally. Nothing has changed pain wise whatsoever. Yeah, exactly.
Speaker 2:Yeah, yeah, yeah, like what a reveal right Amazing.
Speaker 1:So, so, all this. So I'm loving where this is going, but I want to so as a clinician. Your client comes in. You do this informational intake. You start with the assumption everybody has experienced trauma. Now I imagine that doesn't mean that all patients seeing you, or clients which is at New York because you're physical therapist as well right?
Speaker 2:Yeah, yeah, I refer to people as clients.
Speaker 1:Yeah, okay. So for your clients who are coming in to see you, I imagine you've built a practice around trauma and now they might be coming in specifically to seek treatment around trauma. But in the beginning, when you were just starting, when this is a new thing for you around trauma, they come in. You're assuming that they've experienced this trauma, but they're coming in for foot pain or plantar fasciitis or a diagnosed condition, at least a capsules, whatever it is. How do you then bridge the gap?
Speaker 1:Okay, well, you've told me that you have had positive or negative experiences around working your foot. Do you? If the client doesn't bring up the idea of a traumatic response or dysregulation in a nervous system, do you just treat them like what you would consider and traditional is a very vague term there, because everybody has their own version of treatment? But do you not go further into the trauma aspect? Because I remember you had mentioned at the National Convention that you asked them if they want the door open. You try not to stand between them and the door like seeking exits. There are modifications that you do, so do you bring that up to your clients so that they're aware of what you're providing them?
Speaker 2:If they don't offer anything that would make me think that they're experienced dysregulation that they've experienced in the past from a treatment. I don't like making an overt part of what we do, you know, and I actually don't specifically work with people who have experienced trauma People. Those people do find me, but all kinds of people find me Because it's a trauma informed practice. I assume everyone has trauma, but I don't probe for it, I don't look for it where it's not obvious to be. Also, again, part of the trauma informed framework is even if I don't know if that person has experienced overt trauma in the past or I don't know about their nervous system.
Speaker 2:Most people appreciate that. I asked them hey, door open, door closed, what would make you more comfortable? Yeah, you know, dress down to your level of most comfort, leave all clothes on. Where would you be most comfortable? I mean so you're just basically offering choice for the person and that's kind of a big key factor when you're doing any kind of trauma informed work with people is you're always offering choice and you're always getting consent all the way through the process and I think most people appreciate that, whether they've experienced a trauma or are living with trauma responses or not.
Speaker 1:Yeah, and I mean I love those and I've incorporated a lot of those things, like some of those pre-existed, in a lot of massage therapy education, like addressed to your level of comfort. You know, even though it's assumed, most people assume the massage will be naked, but I don't think I've given them a naked massage in close to 15 years. Yeah, things like that and like. So the door open thing is one that I've often wondered because I've asked clients and some nobody has taken me up on the offer yet. Some have questioned it but nobody's taken me up on the offer. And my question do you work in a clinic where you're alone or do you have other therapists? Because that would be one of the things for me that's most like. Right next to me is another room with an osteopath and an acupuncturist on Mondays and Tuesdays, and so that's one of those things that was always interesting to me with the door open concept.
Speaker 2:Yeah, so over time I've moved into where it's mostly me alone right, it used to be more than just me and other people in the gym and the workout space and that kind of stuff. And as I've developed my own practice over time it's become a little more quiet where.
Speaker 1:I like to practice. I went the exact opposite. I spent 15 years on my own and I was so happy to have colleagues. Oh my god, I'm at 20 years this year and the last five years have been the best compared to the previous 15 alone in a room.
Speaker 2:Yeah, so that's just where I practice. So at this point it might not even make a difference whether the door is open or is closed, and most of the time it's a private space regardless of that, but I still just make the offer. The question is how can we create an environment of as much psychological and emotional safety physical safety too as possible? I think a lot of us are aware of physical safety, or the rugs tacked down or there are wires that people could trip over and that kind of stuff. But it's also the emotional, psychological safety, like where can we continue baking those things in that everyone appreciates that allows someone to relax deeper into the experience, to help them have more, whatever going after A deeper session or more healing session, a more relaxing session, whatever it is that you're niches, I guess, are the way you like to think about it, but anytime you can create more safety for someone, the better results you're going to get every time.
Speaker 1:So, aside from, let's say, door open or not, standing between a client, between the door and their eyesight, essentially to give them an exit, asking them how they're going to stay clothed or undressed for this session, what are some other trauma-informed adaptations that therapists can begin incorporating into? Ok, so first is we assume everybody's experienced trauma, not necessarily a place to seek it out, but it's our place to assume that they have experienced it and we should try to address it, not keep our head in the sand, so that we know whether or not we're triggering it or not triggering it. Are there any other adaptations? So that if therapists I mean we're going to go into the whole education aspect of people who want to take classes on this later, but just if they're in their clinic tomorrow and they're like, well, what can I do? That's different.
Speaker 2:Yeah, so a couple of other things I just like to pay attention to are just in terms of question asking for people to get that clarification We've already talked about. If you've had body work before and you had something unpleasant happen, what happened? You have a lot of great questions around that for yourself body parts and all those kinds of things. Another great question I have for people is if you were getting uncomfortable with what we're doing, how would I know?
Speaker 2:That's a great one. I like that. How would the therapist know? How would I know if I'm pressing too hard? How would I know if you're starting to feel a little bit out of sorts, or uncomfortable.
Speaker 1:That's interesting. One of the techniques I teach in my classes. I have this whole two-day class called how Massage Therapy Works and it's essentially the science behind how the touch and the brain interact with each other and the neuroplasticity of brain relationship to touch and stuff. And one of the things we talk about a lot is allostasis, which is our ability to handle stress prior to being overwhelmed. And in our classes we do this technique where when we apply pressure your clients aren't allowed falling asleep to start with. They stay conscious and they tell you when it's enough pressure.
Speaker 1:You as a therapist don't assume to know it's enough pressure and as a therapist you also don't assume when the pressure is gone. So the client one has to tell you when it's enough pressure and they also have to tell you when it's not enough pressure. But at no point do I change my pressure without them being the ones to guide me. And I wonder if that fulfills that need of them feeling uncomfortable, because at one it makes them feel empowered, they feel in control much more, but two, they never get to that realm of complete discomfort, they never feel disassociated from. This is happening to me as opposed to I'm the one in charge of what's happening to me.
Speaker 2:Yeah, exactly. Again, I love that framework and I don't always have these over conversations with people. Sometimes I do, but as the manual therapist, I think about this as being an experience with somebody, not to somebody. I'm doing this with you, not to you, and I think that's a really important part. And the with tells me that there's going to be an exchange of information as we go along so that we both can have a good experience with this, and so I love what you're teaching around that idea with the pressure and that opening up the communication around that. That's really, really, I think, an important and overlooked aspect of being a really great and effective manual therapist.
Speaker 1:How do you feel about clients falling asleep on the table then? Because I know some therapists over time I've heard conversations on both end of the spectrum. Most just don't care. Most think falling asleep is the result they're looking for. Oh, they relaxed. But as a therapist I practice mainly on therapeutic. I don't do very much relaxation at all, even though I do an entire massage based around ASMR and replicating ASMR sensations, which is very relaxing, but I don't do. It's mainly.
Speaker 1:There's always an intent behind it and I've always had a thought about sleeping on the table, having clients fall asleep, and I know the two schools of thoughts are OK. One, it's the desired goal stress reduction. They're seeking escape, it's obviously what they needed, they're stressed. And the other is no, it's the opposite, it's escapism. It's them being guarded, it's a defensive mechanism to escape being overstimulated. And so, with the trauma-informed consent of them being having a sense of empowerment during the session and them being what is their version of being dysregulated, what would you qualify sleep as in a trauma scenario? Not in a scenario where they're seeking relaxation, but in a scenario where they're coming in and like I have an injury and I'm afraid of it.
Speaker 2:Yeah, I typically look at sleep as the first thing. I look at it as is a metabolic need for people, especially if they've experienced trauma. Oftentimes people do not sleep well, they're not getting enough rest, so the safety of the environment may evoke someone to be able to have that experience of sleep. I actually just had a client yesterday I was working with who fell asleep. Now I actually happen to know this person very well. I mean, we've worked together for 10 years or so, something like that.
Speaker 2:So when he fell asleep he doesn't do that all the time, but he's been traveling, I mean, so I knew all the context around it. So I didn't really just kept doing some work around our plan and then when it was time to turn over, it kind of just gave him a little nudge and he woke up and he turned over sort of thing. Now if it was a person that I was just started to work with like somebody I just maybe the first or second session and they fell asleep, I would probably, on the table, try to do something to create a level of wakefulness without waking them up. So I like to mean just stimulation wise, I like to do some rock. Just add some rocking in.
Speaker 2:Not fully conscious, but not fully gone either Exactly, and then have a conversation with them afterwards and say, hey, I'm curious for body work you've had in the past. You typically fall asleep and if they say no, not really, I say well, what's happening now? What's the context change? It might say I'd come back from traveling. I didn't sleep well, something like that.
Speaker 1:But I would kind of inquire about that.
Speaker 1:The context is always relevant and I like that you say is this something that typically happens to you? Because it could just be that, yes, it was a momentary thing, but it could be every single massage session I fell asleep, in which case, ok, like you said, maybe it's a lack of sleep, maybe it's over stress, maybe there's no regulation, but if it's a once in a lifetime moment, then it's hey, what did we trigger or what did we do that replicated this response so quickly, and things like that. That's interesting.
Speaker 2:Yeah, yeah. And even if it's an every time for someone, if someone says, yes, every time I fall asleep during a massage, I would think, well, why is that? Is that? Are you getting enough chronically, just from a chronic pattern? Are you getting enough sleep? What's your hydration? Like I would start asking some of those questions Because that would be really interesting. I don't want to feel safe enough to drop into a sleep zone here and not other? I would start asking those things for myself.
Speaker 1:I'm lucky here in the clinic in that I have we have two acupuncturists, or three acupuncturists, two acupuncturists that work with us, and so if they do start having those sleep things, I can say, ok, go see them for the sleep portion. You just keep seeing me for the other portion. You go see them for the sleep portion, right, yeah, exactly Awesome. So then I wanted to ask you as well what about having such a focus on trauma responses or trauma-informed care? Have you found that your secondary traumatic stresses have increased? I mean, obviously you've been doing this for a while and it sounds like you're grounded and that you're able to keep that separation.
Speaker 1:But for a lot of, first of all, new therapists, walking away with transference and counter-transference risk and it's a hard thing to manage. I know when I do mentoring that's easily the number one subject across the board. There's how to walk away, not bringing my clients stuff home with me. But if you're specifically bringing up the concept of trauma to the forefront of our imagination to not let it be this unconscious thing, to not let it be this unfed elephant in the room, you're specifically bringing it up. You also invite the door, I would assume, for clients to talk about their trauma.
Speaker 1:So you're not a psychologist, we're not in an environment where we're allowed giving them feedback. We have ears, so we're allowed listening to their experience, but we're not allowed to give feedback on their experience. But what that means is you're going to hear stories that you may not be prepared for or may not be wanting to hear. But because we've brought up the subject of trauma-informed care, that's really what it means in business and time to care. Do you have boundaries around explaining to your clients okay, just so you know, this is a trauma-informed care clinic, we're gonna. You know, here are my rules or my guidelines, whatever it is, but within those guidelines, here are my boundaries. Or do you leave your boundaries as an un-stead and walk away and just deal with it on your own?
Speaker 2:Yeah, you know this is a great question. I struggled with this a lot when I was younger. So when I was a new therapist, I fully and full transparency. This was hard for me. I I went home a lot of days after work and felt really unsettled, dysregulated, on my own right. I mean, I had some patients and patient families that I worked with in a trauma hospital that I actually was trained in. That was very, very difficult for me. Thank God at that time there were some really great neuropsychologists on staff. I had a really good professional support network that I was working, you know, with that really good social network. So I was able to manage that. But it was hard.
Speaker 2:Over time I've kind of got my own little routine right. So I have a daily grounding routine that I practice, somatic practices, that I do every single day Chi-Kung and Tai Chi right, chi-kung, tai Chi meditation. So I do a lot of that type of a lot of that type of work, you know, and honestly, for me the other thing that's really helped a lot is education, like I love. I love learning right and just kind of the whole idea of educating and understanding more about the nervous system. I can understand. I can actually create a separation from the story someone telling me from the nervous system function that they're experiencing and then, as I'm receiving the story, I have a better capacity to decide whether or not I want to integrate that story into my stories and what that'll do to my nervous system. So I really see us as having nervous systems and also our personas having stories that are kind of interwoven with those things. So for me I'm at a level now where I can make a choice of what I want to do with someone else's story and what it has to do with me or not do with me.
Speaker 2:If it evokes something in me when I hear the story, then I will certainly investigate that later on. But there's certainly. So I really have boundaries around saying we're not going to talk about this, not talk about that. I mean I do. I'm very clear with my clients that you know I don't deal with trauma content. I'm happy to. I'm happy to if something comes up for you spontaneously during a massage session, because it does, because we're working directly in the body and it can evoke memories, can come up for people. Emotions, memories, all that kind of stuff come up. I kind of have a little batch of somatic inquiry questions that I kind of walk people through to help the whatever they're dealing with, to help the content kind of story kind of separate again from their nervous system, help them kind of on some level understand that the story that they're telling me has happened in the past and, without validating the story, saying what's important now is we deal with your nervous system in the present.
Speaker 1:Yeah, I think they call it 9010, right, like the 10%, the present, you 9010, your past, 90% your past. But the 90% is more influential than the 10%.
Speaker 2:Yeah, exactly. So it's really about so for myself, just to kind of think. You answer your question, hopefully answer your question for myself. I've just a really good centering practice that I do on a regular basis so that I feel really centered, and then the next thing I can do is think about my nervous system, someone else's nervous system and then what they're telling me. If it evokes something in my nervous system that that lets me know, it's something that I need to investigate. But when you do regular centering practices Qi Gong, tai Chi practices we call it core centering at the Sematic Coaching Academy when you do these practices regularly, what happens is your your own nervous system and your own energy system becomes more sensitive, not in a bad way. It becomes more sensitive that I can actually pick something up from somebody sooner so I can go with it sooner, rather than like feeling feeling attacked by it Exactly, exactly, so I can kind of notice it sooner.
Speaker 2:So it's sensitive in a good way, because then I can respond to it rather than not not realizing it's creeping into me or onto me. And then I deal with it later that night in the nightmare, or you take it out on my partner the next day or something like that.
Speaker 2:You know you pick up something and all of a sudden, two days later, I'm angry and I'm agitated. I'm like why am I so angry and agitated and by then there's such a gap between I don't trace it back to what you don't remember where I came from?
Speaker 1:Yeah, I used to do this. I used to do this exercise with some mentees of mine, which was everybody sits at a circle, everybody closes their eyes and takes a shoe off and puts it in the center of the circle and then, with your eyes closed, go grab a random shoe, keep your eyes closed and then, when everybody has a shoe, you open your eyes and you look at the shoe and you say is it yours? If it's yours, keep it, if it's not yours, put it back in the center. And it's said now replace your shoes with emotions. If it's yours, keep it, Not yours, put it back. The only downside is now you have to know what your emotions are, and that's my interest and ground. You know. Centering exercises coming to play in the whole other realm, yeah.
Speaker 2:I love that exercise. That's great. What a great exercise. I love that.
Speaker 1:It was a fun one to do. I still do it actually with groups every now and then, yeah, awesome. So once you, once you're, when you have found your clients coming to you and they have, let's say, they have, a trauma response on the table, which is really where trauma-informed care is going to give you the most value. You know, it's good to be informed of your care, but really it plays into it when somebody has a trauma response on the table. I remember when I went to school, which was the Boulder College of Massage Therapy, back in the early 2000s, I remember one of the things they often said was the first response that most therapists are going to have is oh my God. I take their hands off the body and they say I'm sorry, and so we were taught.
Speaker 1:You know you don't do that. The first thing you do is you just hold the moment, you hold the space and you say do you want me to continue? Do you want me to stop? Do you not want me to allow them? That you allow the client to dictate the behavior, because perhaps they want to move beyond this experience, perhaps they're afraid of it and they don't want to go near it. But what are some of the tricks that you have found where they have any experience on the table, especially for newer therapists who haven't encountered this very much. What are some of those responses that you, as a therapist who has experienced with this stuff, who's like okay, this is how I make sure the client doesn't feel judged, especially for having that response on the table, because they're going to feel embarrassed. Potentially not all clients will, but some will. They'll feel judged by having that response as uncontrollable.
Speaker 2:Yeah. So I'm totally agreement with you around. If something happens during the session, then stay like staying present, staying clear and validating the person's experience is really important. Now what I would actually say was even better is we go back to the beginning and ask those questions have you ever had an experience happen in massage that you didn't like, felt negative to you? I would say that kind of thing Tell me about that. And then, if I know that they had something happen before this is what makes it trauma informed, because we're screening it in the beginning. If they say, yeah, you know, I did this thing with this person and I felt really loopy during part of the massage and I started to cry, and so I cry a lot during massage or something, then I'd say let me ask you a question. If that comes up during our session, how would you like me to approach that with?
Speaker 1:you, you address it before it occurs.
Speaker 2:Dress it before it occurs.
Speaker 1:Yeah. And that assumption, however, is that the client is aware that this may occur or that it has occurred in the past.
Speaker 2:Right, yeah, so that's why we screen everybody with that question Like have you had massage before? If, did you have any unsettling experiences with it? And if they say yes, then I want to know more about it because it happens again. How would you like me to approach it? And then we both know how we're going to approach it together.
Speaker 2:I love that, I love that that's like the winner right there, and if you just put that question in the beginning, it literally takes away 99.9% of the chances that it's going to happen as a surprise.
Speaker 1:Most of you and the client are both kind of paying attention to it.
Speaker 2:Exactly Right, and if then something happens during the session, then you stay present, you validate. But literally once I started asking that question, I don't think I've ever been surprised since, Because if it does come up, we both know what we're going to do and I can say too for the person I could say so, if that's happened in the past what kinds of things help you feel more grounded or more settled or more centered. And they might say, oh, taking a few deep breaths would help me doing that. Oh, just like putting the sheet back over my, covering me back up and just holding your hands on my back so I feel safe.
Speaker 1:Or holding my seat, changing the music or moving to a different area.
Speaker 2:Something like that. But we have a plan going in. It doesn't have to be some complex, complicated plan, it can just be something really simple. So if something comes up, okay, remember. So let's do the thing. We're just going to do that. We're going to stay settled here and what happens is when you both have that plan, whatever comes up for the person, you're validating it because it came up. This person feels validated, they feel like they're being attended to, they feel like you're being present with them. Oftentimes whatever happens clears pretty quickly and then, if you want, you can continue in the session. So I think I shared at that talk at the AMTA conference the last time I let that happen to me, when I didn't screen Well before I was actually doing any of the screening kind of thing, and I had a big surprise with someone on the table and the person ended up being dysregulated for an extended period of time and I said to myself I'm never going to let that happen again to either me and most certainly to a client of mine.
Speaker 1:And so I learned a big lesson. I think most therapists can relate to having a surprise moment and then never wanting it to happen again, because it's scary as a therapist when a client walks away and you can tell they're still not okay, but you're like I've got another client walking in the door. Do I have to cancel? Do I have to make sure they're safe? Yeah, it's always a scary moment when that kind of thing happens.
Speaker 2:Yeah, yeah, and it can also be a surprise for the client. And then there can be so much shame associated with that for a client, which creates more dysregulation in the nervous system, more difficulty communicating, less clear. How can I help you All that shame overwhelm can be so difficult for someone also, but we can clean a lot of that up just by right at the beginning understanding like, okay, so if this happens, by the way, it may never happen, but if it does, what would you like to do with?
Speaker 1:that. So let me go back to one of the things that I said at the beginning of the podcast, because the way we're talking about trauma here is we're both describing this dysregulation as this I'm not going to say catastrophic, but phenomenal experience. It's drastic in nature but looking at it like I used to want to play professional sports. I was a high-end soccer player. I had a big knee injury that I did my professional career. For me that would be. I still see injuries and I see them as traumatic because for me it reminds me okay, I changed, I had to literally change lifestyles, I had to challenge my identity and identity crisis.
Speaker 1:So let's say somebody comes in and they're not dealing with that single catastrophic moment, but they are dealing with that subtle small T, the small T trauma, where it's repetitive in nature and it's low back pain, to the point where they can't play with their kids with Legos on the floor and they're not creating those memories and they know that in five years those kids are going to be older than they want to play Legos and they're going to miss out on those moments. Or they're not going to the water park or they can't breast feed correctly because they've got biceps tendonitis and they're not able to do their face-to-face connection. So those little moments they're not necessarily the client's not going to walk away all the time. Sometimes they will, but they're not going to have that same dysregulated experience where they walk away with the big moment, whereas the therapist we're walking away pulling your hair or going oh my God, what if.
Speaker 1:I do those smaller moments. I imagine when you do your intake, like you might be saying, okay, if something comes up, how do we deal with it, but they're not going to correlate those micro traumas with red of nature to this single moment. So how do you, in trauma informed care, how do you bring up this concept of, hey, these small moments in time still influence your identity and influence you, and you may still experience that as we work the way I talk about it, with clients who have had, let's say, injuries that have prevented them from being active or changed their lifestyle, we talk about it always once this pain has disappeared or reduced or gone. What do you plan on doing in your life? Is the goal to go back to ideal levels of activity and ADLs or things like that, so they have this vision of where they can go with it? But we're in a trauma informed environment. How do you address this micro trauma that's repetitive in nature?
Speaker 2:Yeah, it's actually very, very similar to the way that you're discussing it too, and this is why I love bringing the idea of coaching actually into, why I think coaching and massage and massage and manual therapy they're so integral together. They're so integral together because, as a massage therapist, if you have coaching skills, you can actually bridge a lot of those gaps to help someone move towards what they want. I mean, one of the questions that I like to ask too it's on the intake is what would you most love the outcome of the session to be today? So it's like we're actually gearing it to the person.
Speaker 2:So if something comes up, even small, comes up for someone during the session say a little bit of dysregulation, a little bit of emotion comes up, a little bit of little agitation or a little under arousal, right, some people can get kind of hypo arous and kind of feel a little shut down during the session. And so if they said I want to leave here energized because I have a meeting coming up, and they end up getting kind of hypo arous during the session and I'm recognizing that, then I can course correct and I can say okay, remember. So I know you wanted to feel energized leaving the session today. So can we kind of change some things up a little bit? Are you okay with doing a different idea or a different session based on where you want to go with this? So we're always kind of course, correcting based on where the person wants to go at the end of the session.
Speaker 1:That's awesome, and again, in my classes we teach an entire portion of the class about how to engage in sympathetic comparison to the nervous system with directional strokeings away and to from the brain, which is really interesting new concept that's around. So then my last question would be around. So, like I'm a male therapist, you're a male therapist, you work in a clinic. That's essentially on your own Most of the time. I'm not on my own Most of the time. There are other therapists here, but on Wednesday nights I'm the only therapist normally in my clinic and I work quite late to around 9.30. And I have female clients. I have male clients.
Speaker 1:When I have my female clients on a Wednesday night where it's just her and I in the clinic, I always address the fact. I never let it go unsaid. I said I just want to make sure that you're aware like we're going to be alone in the clinic. I'm a male therapist here, female. I want to make sure you're comfortable with that, and it might be during the session before you know, before we close the door. It might be on the phone during an intake. Whatever it is. To make sure that they have that sense of safety or at least acknowledge that it's a potential discomfort. Is that part of what you're talking about, where you do that screening of just the original of what is it that might trigger you versus not trigger you?
Speaker 2:Yeah, I think that's a great 100% right on board with you, like that's so, so important to just kind of call that out right at the beginning and say, hey, just let you know, just so you're aware. Are you comfortable with that? And also saying you know, to me my objective right now is to make sure you feel safe, and if that means you want to reschedule this, I'm totally fine with that.
Speaker 1:Or have someone else in the clinic with you or someone else in the clinic like.
Speaker 2:It's like that. My dedication here is to make sure you feel safe, because then you're going to get what you need from our time together and that's just. You know I'm going to be, but are doing this with. Together is going to be better that way.
Speaker 1:So it sounds like a lot of trauma-informed care is essentially about bringing up all the unsaid elephants in the room that most people are aware of consciously or unconsciously, but they have a bias towards not talking about it Out of stress, comfort, silenorms, judgments whatever title you wanna put on it. It sounds like trauma-informed care is essentially saying we're not gonna leave those as unsaid quantities in this room. We're gonna make them, we're gonna bring them to the surface of our thought process to make sure that they can be addressed and then move beyond them.
Speaker 2:Yeah, that's very true. So there's five, the five trauma-informed care principles I mean. Well, some people say they're six and depending who you talk to, right, these are the basic five Safety, number one, trustworthiness number two, choice number three, collaboration number four and empowerment, number five. And if you see, they kind of build on each other.
Speaker 1:You can't really have trustworthiness without a safe. That's the substance abuse group, right.
Speaker 2:Yeah. So some other people, the last one they say kind of racial and gender equity. I put that under safety. I say safety is physical, psychological, emotional, gender, racial, all that. We need to make sure that everyone feels safe on every level of their being in order to move on to the next one, which is trustworthiness. So that's trustworthiness. Is that point where we'd make no assumptions? Right, we're not making any assumptions. We're clarifying and validating again and again, and again.
Speaker 1:That's a tough place for me and any other human to go to. Yeah, I mean, it's an aspirational line for sure. It's like I'm not saying.
Speaker 2:I've never achieved no assumptions, because as humans we just assume and project and all those kinds of things. But as much as we can, we're clarifying and re-clarifying even the things that people are like why are you asking me that? Or why are you telling me that? It's just I'm just verifying that. But when you do that, you create a lot of trust in communication between two people. And there's a little saying I like to say about trustworthiness. Earning trustworthiness isn't about liking what's going to happen, it's about knowing what's gonna happen.
Speaker 1:It's funny in ASMR. There's a concept in ASMR. Are you familiar with ASMR? No, it's called Autonomous Sensory Meridian Response and it's this really cool thing and it's only happens to about 20% of the global population. I happen to have it, which is really cool, and look it up. It's a really cool concept and if you look at ASMR, most of what you're gonna come across are videos of people holding laundry or popping temples or whispering into a microphone or touching them with the fingernails, and visual and auditory stimulus to ASMR is very high.
Speaker 1:But the number one response that people get is from tactile stimulus and one of the key components.
Speaker 1:Like you said, you're very expressive with your hands. I don't know if you noticed, but when I move my hands it's not rigid, they're flowy, and one of the reasons is when I offer massage, I always move my hands in this kind of format and because it is a one, it's from Tai Chi background. But two, there's this visual component to ASMR where it's soft and smooth, but then there's predictable. So in the sessions we always tell them this is where we're going next, this is what we're doing next. Is that enough pressure? Tell me when it's enough so they can predict behavior. And it's funny because predictive context behind trustworthyness makes so much sense. But it's also this there are these feel good endorphin and dopamine responses that happen with chills and free song, which a lot of people talk about in massage, and those are like just like a step down for ASMR responses. And those feel good responses tend to have are only available with context, and that context involves chestworthiness and predictive behavior.
Speaker 2:So that's really interesting that you talk about that yeah. It's all intermingled in the end.
Speaker 2:Oh, very cool, Very cool. So doing I know the trauma-informative approach for people feel like, oh my God, that feels like so much, you feel so invasive. I'm asking people, but it's a different conversation. You definitely have to learn to have a different kind of conversation with someone. And when you're starting with new clients it can feel a little. When you're starting practicing it it can feel a little clunky, and the first two or three sessions of getting to know someone can feel a little bit awkward and clunky.
Speaker 2:But I'll tell you what, when you continue seeing somebody, after that that clunkiness kind of goes away and because you get to know people on a whole different level and there really is a whole different level of trust worthiness between the client and yourself. Because even asking some of these things of the client and them sharing little things, there's enough to share their whole trauma background. But they're revealing small parts of themselves just to you that they probably have never revealed to anybody else. They're just small parts, maybe little idiosyncrasies that they think are just weird about them or these kinds of things. But when it's met with a level of course, we have a little thing. We practice like hand and fist and the idea is, of course. Of course. That's what's happening to your nervous system. Why would it be any other way?
Speaker 1:It's the same idea and I'm improv, right Like the first response is supposed to be yes, and improv you always say yes. So here it's like of course that's happening. Why would I doubt what you're telling me? It's your experience.
Speaker 2:Yeah, it can create and that creates so much more safety over time for clients and within session five or four, five, six, seven you're doing even deeper and better work with a person because you set that up on the front end and they allow the work to happen on a whole different level and I've seen just some amazing experiences and healing experiences that people have gone through simply because you've set up those processes on the front end.
Speaker 1:Well, this is all fantastic. Thanks so much, brian. I'm really happy with it. I would love for you to give us a moment to talk about yourself and if you have any coaching, or if you have any I know you're at the New Health. If you have anything that you want to ask my follower or subscribers know to listen to trainings that you offer, if they can follow you on social media, anything like that.
Speaker 2:Yeah, well, I really appreciate that, troy. Thanks again for having me. I can be found at the Sematic Coaching Academy and you can find us on Instagram, linkedin, facebook. You can listen to our podcast, all the kinds of trainings that we have. We have a lot of free trainings, a whole library full of information on bringing Sematic coaching techniques and skills into manual therapy and all kinds of other options that people have.
Speaker 2:But a lot of the work we do is on bridging that gap from manual therapy, physical therapy, occupational therapy, health and wellness, helping clients be able to resource their own nervous systems in a different way so that they can, number one, learn how to regulate their nervous systems, because that's the root of emotional regulation is be able to regulate your own nervous system and then being able to help people get even more out of their lives, help people move through the barriers, the resistance, to create the things that they really want, and their bodies are a huge part of that, which is why, again, the manual therapy piece is so important. If you can help someone move through something in their body experience, you can actually help someone create a whole life that they want, and it's really, really amazing. I can go on and on about that. We're at the Sematic Coaching Academy and if you want to drop us a line over there and say hi, we'd love to meet.
Speaker 1:Awesome. Thanks so much, brian, for having me or for being a guest here today. I really appreciate it. It's a great conversation. It's really good information. I personally think almost every massage therapist should have some introductory or advanced training into a trauma-informed care, because it really opens the door, like you said, for teaching a class at the Canadian Massage Conference coming up in June, called I Am Placebo Positive, and placebos don't happen without trust and like there's just so many components that come into it that when a client feels safe, I think it's fantastic. So I love hearing what you guys are doing and thanks so much for coming on today.
Speaker 2:Yeah, thanks so much, troy, I really appreciate it.
Speaker 1:Have a great day, brian. You too, thank you.