Beyond Kindness: Compassion Skills That Improve Pain Outcomes

[00:00:00]. Mark Kargela: I'm wondering where you see the biggest disconnect for clinicians?

Shelly Prosko: when we look at compassion, it's much more contextual and it is actually more of a wisdom that emerges from the context of the situation. It is a skill that can be developed.

Mark Kargela: Today's episode cuts to the heart of a hidden superpower in pain practice compassion, especially self-compassion. This is not simply be nice. Compassion is a context aware wisdom that transforms both clinicians and patients. I'm excited because with us today is Shelly Prosko a physical therapist, yogi researcher and co-editor of yoga and science and pain care who's explored how compassion shapes better outcomes

how self-compassion sustains us in the trenches. By the end of this conversation, you'll learn why compassion is a developable skill, not just a nice to have. How self-compassion quiets the inner critic and boosts resilience and care quality.

A real patient story where a simple letter writing prompt shifted pain, posture and presence, and stick around. Whether you're burned [00:01:00] out questioning your impact or striving to hold deeper presence for your patients will leave you with tools you can use tomorrow. Now onto the episode I..

This is the Modern Pain Podcast with Mark Kargela.

Where did compassion start coming into your practice? I know you, you spoke of burnout and that's a massive issue. I think we're seeing it more and more with some of the systemic demands that some of our healthcare systems definitely here in the states and I, I know speaking to some my Canadian friends like yourself, that there's some challenges there as well.

I'm wondering where you've come into that as your career's kind of spawned and developed,

Shelly Prosko: I have, obviously that question comes up a lot and it changes every time I answer it. And I try to make it concise because there's no one or two or even three things. It's just this convoluted kind of path and things converged and here I am. But one thing when I do reflect on that question one thing that comes to mind is, I don't know, it's just always kind of been in me.

Like, since I was a little [00:02:00] kid we could make this like a therapy session maybe for myself. But ever since I was a kid, it, it's like human connection has always been important and it would always be really disconcerting when, you know, people around me might be arguing or I couldn't connect with someone.

And this isn't a judgment call if that's a good quality or not. You can imagine that that can have some problems. Me always wanting to make peace and maybe even at my own expense and so forth. But, so that's the first thing is it's just, it, it's just innate somehow in me. I don't know why. But then kind of fast forward to more my professional life.

I think when I, it really, really started when I was doing these retreats for healthcare providers and these courses on burnout and on self-care. And a lot of that came from my yoga practice. So I started learning about yoga and practicing yoga and [00:03:00] around 1990 and then my physical therapy degree was in 98.

So the yoga came first and it's that yoga in and of itself, the more you learn about it and practice it in the principles, it's compassionate in and of itself. So I think that was a big part of it. But then when I was teaching these retreats and these courses, I started really learning more about, wow, this, this compassion thing and what it is.

And when we research and prepare and look at the science around compassion we start to see, wow, this really. There, there's something to this in all of my experiences as a clinician, so, you know, compassion for the, the people that I serve, compassion towards myself. What I was reading in the literature in preparation for these courses was really lining up with my life experience as a human being in the world and as a clinician.

So I think that's when it really started to take off was my preparation and just learning about it. And then I think [00:04:00] then the la there's, there's more, but the last one I'll land on here is when we decided to write our book. So I co-edited and co-authored that book yoga and Science and Pain Care, treating the Person in Pain with Neil Pearson and Marlisa Sullivan, two other PT yogis.

W. I decided I really wanted to write a chapter on compassion in pain care and all the different orientations around that, compassionate care for our patients and why that's so important besides just the obvious. It's probably a good thing to do, but there's some deeper layers that I learned about that.

And then com compassion towards myself as a clinician and all the benefits around that. And then helping our own patients or helping our patients cultivate their self-compassion, like towards themself and towards themselves. So then I knew I wanted to write a chapter about that. And then that was around 2015, so almost 10 years ago now.

Well, [00:05:00] somewhere around there. 16, 17. And so once I started to really dive into. Looking at the literature around that, that's when things really opened up as far as why am I so interested in this topic?

Mark Kargela: I'm wondering where you see the biggest disconnect for clinicians? I think it's a compassion. I think sometimes clinicians will implicit, of course, compassion, but as you mentioned, there's more layers to it than I think the average clinician recognizes. I'm wondering if you could talk to what you see as the misconceptions out there from just a everyday clinician that may not be in into the depths of maybe some of the literature and things that you've read, that maybe understanding some of these layers may help them in their own practice.

Shelly Prosko: So I think the first thing is that most people in general, but clinicians in particular, how this idea that compassion is, yeah, like just. Don't be a jerk, you know, it's let's just be kind, [00:06:00] you know, it might be challenging at times, but that's it. It's not that hard to do.

Maybe it is at times, but just be a good person. Be kind. That sound that's, that's good. That's a good idea. And we can all agree on that. But the actual, when we look at compassion, it's much more contextual and it is actually more of a wisdom that emerges from the context of the situation. So it, it is a skill that can be developed.

So it's not just this idea of being aware and recognizing that someone's struggling, whether it's yourself as the clinician or the person in front of you that's kind of a, of a given that they're struggling. But then also having the motivation to want to alleviate it. Of course, you could say, okay, that's kind of a given in what we do.

But then there's this, this other part that's behavioral, which is the actual action that's the. [00:07:00] Engagement part or the inactive part. And that is the part that we can develop. And that is the part that, like I said, is contextual. And there's many, many factors that depend on whether our response or our silence.

You know, our discernment of what to do, what not to do, what to say, what not to say. The whole context of that therapeutic interaction. What makes that a compassionate moment or a compassionate interaction depends on so many different factors, not just being kind. And we could even unpack being kind like what does that even mean?

And in compassion that entails. Looking at being aware of your own needs as a clinician and meeting those needs. So we need to be also regulated so that we can be more compassionate so the wisdom can emerge in, in the context right, of that situation. So that's part of compassion is how regulated [00:08:00] are we, how clear are we, how much can we take the perspective of another at, and especially at times when it's really, really challenging.

And then there's different barriers to that as well, of course, that we can get into. And then there's just the whole idea of being aware of. The person in front of us and, and their needs. And the more aware we are of our own state, physiological state emotions, we have research that shows the more aware we are of the other person's emotions even and their needs.

And then the better we are able to provide what might be this compassionate response and, and the response will, I mean or the the ingredients that prime for a compassionate response are we, we have a, a list of them and part of that is being attentive, being [00:09:00] present being aware of your own physiological state.

And then of course just being fully, fully, fully embodied, which, yeah. Yeah. Which can help prime for this compassion wisdom to emerge. So I think. Just to summarize that to your question really specifically, it's more about just being kind and we can even unpack what kindness means, which includes taking care of yourself and then really serving the other person in front of you, which is a whole skillset.

We could talk for years about what does that even mean? What does that look like, and is there a right or wrong? It can be maybe many different paths.

Mark Kargela: You mentioned some of the kindness to ourselves as clinicians, which I think sometimes I know for myself definitely was something that [00:10:00] was lacking. I had this immense amount of pressure and, harsh inner voice that would always tell me I was not enough, not couldn't fix. Fix people.

Which again, that was the thought process for a good chunk of my early career of thinking that was gonna be some sort of technical skill I was gonna, achieve to, to be able to, to reach some of these folks. also mentioned a little bit of some of the barriers, 'cause I, I am a huge fan of, of your work and compassion and, and have dug a little bit into Kristen Neff's work a little bit as well. What do you see as the barriers? Because I, clinicians sometimes the being present part and being like fully engaged, embodied, and being able to respond to the emotions and the context in the room and create a context where you are fully there and you're fully engaged with that person in front of you.

Obviously with some of the systemic challenges of productivity and various things. And that brings up barriers. But I wonder if you could speak to some of the barriers you see and maybe any thoughts or things you've, strategies you've helped clinicians develop to [00:11:00] best deal with some of them.

Shelly Prosko: So barriers, so there are, we can look, kind of divide this up into barriers to providing compassion for another person. So providing compassionate care to our patients and also barriers. To providing compassion to yourself as the clinician. So, and they overlap a little bit, but let's just start with the barriers to providing compassionate care.

So That's right. I agree. There's systemic barriers and those are real, and we cannot just, you know, breeze, breeze past those. So we've got things like time, the, you know, rushing, seeing 15 to 25 patients a day or something like, you know, just the, the, the, the time can be a barrier. The lack of support maybe from the organization.

If you're working in a, in an organization where compassion isn't really looked at as something that's necessarily [00:12:00] worth or valued necessarily worth really cultivating or valued, that will really influence the type of care that you. Are able to provide if you don't have that support from the leadership, from the organization.

And of course every organization will have that on their mission statement. So every organization of course, will pay lip service to that. But then how, how do the inner workings, what do the inner workings look like? Is it a compassionate place? So that's, those are some real barriers. Productivity standards and so forth.

But then looking at, at more inner barriers. So. What the literature says, some of the barriers can be your own as a clinician, your own physiological state. So if we are dysregulated or we've got whatever going on in our own lives, neurobiologically, that changes a person's capacity to offer compassion.

And if you think about it, it just makes sense. If we are [00:13:00] in a state of stress, sympathetic nervous system maybe is up a little bit higher fear fright flight. And it doesn't mean you're pulling out your hair and you're really stressed, but a low level, you got a lot on your plate. What's gonna happen neurobiologically is the areas of the brain that are more likely to reach out to others.

To be caring and concerning for others, the prefrontal cortex, all our executive functioning, being creative, being able to problem solve and really be present for someone there. Those are all gonna reduce if our own physiological state is not regulated. So we do, there's lots of different things that we can try to do.

We're human, we're not perfect. It's gonna happen. But that is one thing. And to your point of, you know, what, what are some things, it doesn't have to be yoga. I'm not trying to turn everybody into a yogi, but some sort of reflective practice or presence, practice, you can, some kind of [00:14:00] mindfulness practice.

You can do it while you're eating, while you're going to the bathroom. You know, just something where you have a practice, where you work on focusing on maybe just your breath for three minutes, focusing on just scanning your body or anchoring. There's lots of different practices, obviously that one could do and lots of different depths.

Maybe some, maybe you wanna get really into it and spend 20 minutes a day meditating, or maybe something a little more simple, like just trying to be a little more mindful with your everyday activities. So that would be a barrier as your own state. Another one can also be the, this idea of

you, the clinician, not really believing that compassion is useful. And it's, it's this idea that compassion is a little, is gonna be letting [00:15:00] you off the hook, whether if, you know, if you're too nice to someone or too kind, or too nice to yourself. You're, you're gonna let the person off the hook. You're gonna let yourself off the hook, and maybe you really think it's unhelpful.

So how you would mitigate that. First and foremost, it, it's really looking at what you think about self-compassion or compassion in general and really exploring and reflecting on that. What do you think about that? What are some, some misconceptions or beliefs? And there's a few questions I have that you can reflect on.

Like, I think offering kindness towards myself as selfish or I think I need to be hard on myself so I can be the best I can be. I don't feel I deserve to be kind to myself. I fear if I become kinder to myself and less critical, then my standards will drop. I fear that [00:16:00] if I'm more self-compassionate, I will be a weak person.

And so just exploring those ideas to yourself and looking at what actually the research says is the opposite to a lot of these things. So being more compassionate towards yourself actually shows it. It is an inner source of strength and, and you become better at coping and you're more resilient and it's not selfish.

It actually allows you to be more caring and concerning to others. That's some fascinating research. The more compassion you have towards yourself, the more care and concern you have to others. Self-indulgent. A lot of people think, you know, I'm just gonna get too soft and just lay on the couch all day.

But again, it actually. The whole definition of self-compassion is not to harm yourself. If, if you are indulging that in and of itself, it's not self-compassion, but the idea that it [00:17:00] will reduce your motivation. Ha has in my own experience and in the literature has been debunked. It actually enhances your motivation and it's rooted in so much genuine care and concern for yourself that you want to do what you can to make healthier choices or, and really take care of yourself versus the self-critical point of view.

If your motivation to change is coming from a self-critical point of view, that's more associated with anxiety and it's rooted in fear, so it might help you in the short term, it might help change your behavior and motivate you, but in the long term, it's associated with that anxiety and, and you're doing it from a place of fear and being in competition with yourself or others.

So. Changing your behaviors being motivated to change your behaviors. If that's rooted in self-compassion, the literature shows it's a much healthier and more sustainable way forward. So I [00:18:00] think I went off track a little bit there on, on some of the barriers, but I think that just spoke to the barrier, which is a big one.

Mark, this is this, it's a big can of worms. I opened up you, one of the barriers to providing compassion for others, for the person in front of you and even for yourself is misconceptions that you may have about compassion and that, that's about all I'm gonna say there. 'cause as you imagine that, that's a whole practice that you, the clinician has to kind of do on their own and explore on their own.

Mark Kargela: I definitely can hear some of the voices in my head of some of those things that you, you hear clinicians and those misconceptions that go through. I'm gonna be soft if I'm too nice to myself and I don't deserve to be kind to myself. And it's interesting, I think some of the things that's been helpful as we've, I've embarked in act over the last five or so years is really that, how well that lands as far as this, voice that we all, this inner critic that we, we all have that I think it's been very helpful to [00:19:00] one, understand we all deal with it.

it, those voices aren't just unique to, it's just having some skills to be able to manage those difficult, inner harsh criticisms and, and give yourself some compassion, can be hard. I, I definitely was hard for myself. I don't, I'm not gonna say I'm perfect at all days, given myself some compassion.

But I'm wondering for you, was there like a pivotal moment, like in your career, be it with yourself, be it with a patient where you really. Felt like it, it, it really made a massive shift either for that patient or for you career-wise.

Shelly Prosko: Personally, again, without making this a, a therapy session for myself and for everybody to witness several years ago going through something very difficult. The feeling of the, my foundation, who I thought I was, what I valued, just kind of pulled from underneath me.

I dunno if, I'm sure many people have felt [00:20:00] something similar like that before, is yeah, it was just a, it was a challenging time. I almost felt like I lost myself. Like, who am I? It was, it was, it was a really challenging time and we'll just say that. And the self-compassion practices and the idea of self-compassion, I really put that to the test and.

Without making this sound, you know, linear, it, it worked, quote unquote, like, it was so helpful. And I'm sure there's many things that helped me get through that. Like support and other people and love from family, friends, but that inner work it just, it really, really was helpful. And the self-compassion piece of the Kristin Neff's work is being aware that you're really struggling, which sometimes we say that's a no-brainer, but.

Sometimes we don't. [00:21:00] We push it down so we can function in life and we don't really know we're struggling in this case, obviously I knew I was, but that's the first piece, the mindfulness and being aware. And then the second is knowing you're not alone. It's the common humanity. And that was really useful and that I was practicing.

You do a little self-compassion meditation, which if we have time, I can take you through that in your audience. But the self-compassion or the common humanity piece is just reminding myself I'm not alone. Like even if your situation is, is very, very unique, which all of ours are, we're all individuals.

We share around the world the similar feelings and emotions. And so I'm not alone in the mistake or what I said or didn't say or, you know, so that was helpful. And then the third part of the self-compassion piece is self-kindness. And that takes time. You can't just out of the blue say, oh, here's my go-to self-kindness act.

It's something that you can [00:22:00] cultivate over time and it shifts and, and in the moment you can figure out a little something that might work. And maybe it's just how you put your hands on your heart or maybe it's just a, something you say to yourself you got this, or I'm not alone, or whatever it is.

But those little self-kindness acts or little techniques they can, they come with with practice and explore exploration and being curious and being courageous to do this stuff. 'cause it can feel kind of weird, but you know, if you just go in and, and try it. So that would be the one personal experience and then clinically.

Mark, there has been so many transformative moments for my patients. I would say, I'll just one that pops in into mind. I don't, yeah, there's just so many. But thi this one really sticks with me and it was a man who had been [00:23:00] struggling with persistent pain, chronic pain for well over 20 years multiple surgeries.

And by this point we had developed a a strong therapeutic relationship. And one thing that came up was he was explaining to me. Something around the house that he wasn't able to do and the way he explained it. So by me trying to be present and give him the space and just be there and listen to understand, not to respond or to fix, but really just, I was just present.

Like if you're with a friend hanging out, you're just, you're not being, you don't have your clinician hat on. You're just being there to listen. That's what I try to do with my patients. So with this man, I, I was there, I was just listening, giving him the space. And what I noticed was when he described this thing [00:24:00] around the house that he couldn't do, there was just a, an air of.

Disgust or contempt towards himself and the way his tone of voice, and I can't even do, like, it was just heartbreaking. And I, and I, I sensed it and, you know, could really sort of feel that and let obviously gave him the space to continue to share his story. And then I can't remember exactly what I said as you know, when you're in the moment as a clinician, it's hard to reproduce exactly the scenario.

But it was something to the effect of offering him an opportunity to, to be curious about the story he gave me or he just shared with me. And so I said something like do you think you're hard on yourself? Or not quite like that, but something had come out that I had said, do you think you can be hard on yourself at times?

Or what do you think about that? And. And [00:25:00] he sure enough said, well, probably, and, you know, went on about that. And anyways, to, to wrap this up what was very natural and organic that followed in the conversation was me to offer this idea of self-compassion. He didn't know what that word meant. And so I just introduced it and I said, well, you know, I do this work that I'm familiar with this self-compassion.

I gave him a little snippet of how it's helped me. I didn't go on as long as I'm going on with you right now. But I asked him if he was interested maybe in learning more, and I said, it can be helpful. It's shown in the research, it can be helpful for people's pain and, and for your movement when, 'cause he, he knew, he is very, he was, had a lot of guarding and bracing and we've been, had been working on that for quite some time, softening his breath and his body tension.

And so I said, you know, we have some research that shows self-compassion practices can actually help reduce some of the anxiety and maybe some [00:26:00] of that fear and, and soften. And we worked a lot on that word soften and in a very positive way in many different aspects of. You know, your mind and what you believe about yourself that might translate to your pain and to how you're moving and breathing and you wanna learn more kind of thing.

And of course, he was interested. So I shared with him those three components of self-compassion, briefly, concisely. And I said, here's one practice that you can do. And it's called letter writing. So you write a love letter to yourself. I said, you could be, it could be a friendship letter. And you know, and when we joke around and have some fun with it, and I make it light for him and not heavy, like, you know, this man in central, you know, part of, of the Alberta world that he's gonna be writing this love letter.

So he was all for it. And he said, I'll give it a try. Sounds kind of weird, but we'll see. Comes back. He wasn't [00:27:00] able to do, it was too awkward for him. But what he did. What he found himself doing was he wrote a letter to someone in his life that he needed to, that was long, long overdue. And I'm, I'm not kidding when I say when he came in for that session, he looked different.

He was his, his whole, his posture, his face, there was a softness, a tenderness beautiful and moving better and. Yeah, there was a, it was transformative, so that was pivotal. I, I do think even though we wrote a letter to someone else, there's a self-compassion component there. I'll stop. I, I, that was long, but it was beautiful.

And from then on, he understands what it is still working on it. Like you said, with yourself, mark and me as well. We're not perfect. Of course, we're still self-critical. That's our culture in North America anyways. We think that self-criticism is going to [00:28:00] help us in life. That's what we're taught, that if we don't do that, we're gonna not be excellent.

We're not gonna pursue excellence. And that's all been debunked by literature. In fact, that self-compassion makes you more resilient, makes you be able to sustain and strive for excellence. Not perfection, but excellence even better. So with this particular person that was. Transformational for him, for his pain, for the way he moves, for the courage to try something different.

.

Mark Kargela: I'm wondering, 'cause obviously you practice this and you do it with patients. I and I it's you amongst a few others have really, Bronnie and others have helped me think about this in my practice and, had a patient recently with who just very harsh, similar kind of takes on her situation and it was always this kind of tone and thing.

So, we'll have you do a little self-compassion exercise for us in a bit. I, I use the kind hand exercise that's comes from some of the ACT literature, but I'm curious if there's others you've used. But I want to bring it back [00:29:00] to a little bit. 'cause self-compassion isn't something on this standard physio examination form.

Right. That we get taught in university,

just

it should be right. I think we need to start bringing these things into the room a little bit more and, and helping students recognize and, and young physios and veteran physios who are maybe new to this, that. That can be a very helpful thing for, for you to recognize when somebody is just overly harsh and that inner critic is just beating 'em up and if, if you listen, you'll hear it like you said, like the tone, just how people are phrasing things.

Almost that tone of disgust folks get with themselves. I'm wondering how you would re recommend a physio who's trying to figure out where to start as far as how do I bring this into my practice and have some utility with it versus it being this kind of nebulous, thing that I may be not fully grasping how I'm gonna make this something that's part of my intervention strategy with somebody.

Shelly Prosko: Yeah, I love that. And this is easy one. [00:30:00] Website answer, so you'll be happy. I won't go on and nod on this one. Kristin Neff, go to her website. I think it's self compassion.org, but basically just Google Neef, NEFF Self-Compassion Neef, her website comes up. There are so many resources and just start there.

Beautiful website. She's a researcher. She's our, basically the most prevalent researcher in self-compassion and just start there.

Mark Kargela: Yeah.

Shelly Prosko: Articles, podcasts, there's some practices.

Mark Kargela: yeah. And I think just as you recognize that, giving it some space to be like discussed in the room, a little bit of like opening up some discussions

Shelly Prosko: Yeah.

Mark Kargela: how, how, are there any other things, I know you mentioned like, it seems like you're, if I'm hearing it sounds like you're quite hard on yourself.

Is there any other, like discussion cues or anything you found that can open the door to somebody as a patient to maybe discuss that or [00:31:00] having pause and just saying, do you hear how you're talking about yourself

now Like we're Yeah,

Shelly Prosko: yeah, So many as, you know, these kinds of questions, there's you know, just put me in the context and wa and watch and then, it's so hard to translate this stuff. But couple, I do have a couple things. So the, the one tip I wanna offer clinicians right now is we, and we have a literature that shows this too.

I always like when the research backs things up. And this was in the book, in the book chapter that I wrote on compassion and pink care. So we have some research that shows. The more care and concern and true compassion, genuine. So not caring for your patient, but caring about them. So there's that deep work of, you know, really finding what that means and cultivating genuine care and concern for the person.

What we have some research that shows the more we, [00:32:00] the more we can do that and the more we really see the person. So see them, what, you've talked lots about this before on, on your podcast. So see the person, believe them, validate them really have them feel. Like they're a worthy human being. You can't fake this.

There's no script. You, you, you've cultivated in yourself. This is that compassionate care. So the more compassion wisdom or the more real compassionate care about the person that we have, the more likely they are to take steps towards caring for themselves. And one of the re research studies, it was a few years ago, and they had 10 women.

It was a year long study in this rehab hospital in I think it was Norway or. Somewhere over there. And what they found was, well, their aim was to improve or increase the, these women's self-care, self-management, self-care [00:33:00] kindness towards them, towards themselves. And what they found, what they did was just provide real, compassionate care and love to these women.

And they found that once that was, that happened first, only then were they able to care for themselves. And I did have a quote, I think it's somewhere here, but I don't think I have it anymore in front of me. But it's, it's a beautiful quote from that study saying, it wasn't until these women felt, and, and they said they felt believed and heard and seen, and then they felt worthy enough.

To take care of themselves. So that would be my first tip for clinicians, is work on that part first, show the person you know, that you, you don't, you're not judging them. And that can be challenging at times for us, for a variety of different reasons. But other tips? Getting back on track here to your question. Oh. On how to, [00:34:00] to offer the patient in front of us some tips to be more

Mark Kargela: How

Yeah, or just how to like bring it into their practice too, like Right. How to have a clinician to just be more purposeful with consideration of it. 'cause I think it just doesn't get considered for a lot. I know for my like especially. It's just not something that's educated on, and I think, it can be a huge piece when people are, can soften their stance on their own selves and their own situation, that it opens up some space for them to maybe do some things that,

Shelly Prosko: I think, you know, I think what I said was, it's a nice start and just, being aware and exploring self-compassion. I know that's an elusive, it's not like a good tact, you know, take home tangible thing. But it, that, that's what it is, is explore self-compassion on your own. Start to bring it into your own life.

It reflecting on it, maybe even practicing it. [00:35:00] And, and then from there it will. It will infiltrate. Like, I wouldn't even say you, you, you bring it in necessarily to the therapeutic interaction or it's just part, it's, it's just the, the foundation. It's just there. And so I, I would say that, and, and just knowing, just listening to this episode and just knowing that this is a thing I think it is, it is just the very first step and it will be there if you practice it, it will be there with you already.

And I'll repeat to treat the person in front of you. Here's a radical idea to love them. Humberto, not Maa, Chilean biologist definition of love is the act of allowing another to be a legitimate other. And I think if we can practice that in our clinical setting. Especially when there are barriers, especially when it's challenging, when you're maybe not connecting with someone when your values are different than [00:36:00] theirs.

We have, we have to practice that. What does that compassionate response look like? And when we cannot empathize with someone, we just, we can't, we can cognitively maybe try to take, see their perspective, but to really feel and experience what they're going through. Sometimes we just can't, we're the demographics, social demographics might be completely different, but we can still have, offer a compassionate response.

And then from there that self-compassion naturally emerges when the person experiences what it feels like to be really cared about and for, so yeah.

Mark Kargela: Hopefully folks are listening to. I just, I think so often, I just, our clinicians get so stuck on, the hard skills or the technical skills and not the, and this would be probably considered a soft skill, which honestly, I, I bothers me the way they term it, just because it's, it can be difficult to develop a little bit and it sometimes starts with ourselves, like you said, if you can't do it to [00:37:00] yourself, it's gonna be hard do it

somebody

Shelly Prosko: So let's change, let's rebrand. Soft skill to humanistic. Let's just, okay. Sorry I interrupted you, but

Mark Kargela: I think that's a good rebrand. I'm fully on board with that for sure. 'cause I, yeah, it's one of my pet peeves. 'cause I do think, and those are the skills that I would argue drive outcomes and drive your therapeutic alliance and drive a lot of what goes on and allows any of this supposed technical, and I'm not saying there's no benefits of being, skilled technically in certain things, but man, if it's behind somebody that doesn't have compassion and is not, shown that humanistic side, it's gonna be hard for that outcome.

I mean, you're missing a huge component of what could really make some outcomes positive with patients

Shelly Prosko: Oh, and we have research that shows that as well. And we could rebrand soft 'cause I've thought of this a lot. We could just say, well how about we just change what we think, what the word soft means? 'cause we think we're so negative around the word soft. Let's, that's good yielding and we could go on and on about that.

However, I think that's hard to [00:38:00] do with our culture. So I think just rebrand and just say humanistic skills. Also, before you go onto your next point or question. I have to insert this mark. For our profession, if this doesn't motivate the clinicians listening, I don't know what will for our profession.

I've been thinking a lot about this and learning a lot about AI and everything coming in. We know that there are lots of jobs that are, are going to be shifting over the coming years. And we already see things online in our profession that can, you can do the technical stuff online, whether it's, you know, what are these exercises or you can find a lot of things.

And I'm being very futuristic, but the, that will, I do believe infiltrate our profession where you, you don't need a human being. You can get may even better care, technical care from ai. And, and so what [00:39:00] do we bring? Well, these are the soft skills, the humanistic skills that AI won't be able to, to bring.

So there you go.

Mark Kargela: I've actually had a couple recent posts is like, AI should be stimulating us to lean into our humanity more than ever in, in clinical practice. Because if, if it's just the technical algorithmic stuff, you should be a little bit concerned if you don't have the ability to just bring that, authentic humanity to an encounter that people value. Right. I just did a talk for physio matters on this, about how the people's opinion, like people don't want AI to be driving the boat and long now, maybe that's changing. That was the three years ago research study of consumers. So maybe it's changed, but I think we, we still, as humans, that deeper connection that authentic caring, the authentic, ability to, to provide an atmosphere, someone to be seen, be heard, be listened to, and be validated.

I just think AI's gonna get to that

It can be very helpful. I think if we use AI the right [00:40:00] way, it's gonna, it can very much help us be more human. That's where I think AI could the most helpful. Take these stupid menial tasks that have us buried in our EMR and not being present with a person,

think could be

Shelly Prosko: I agree. Yeah, 100%. And and when we're looking at pain care, persistent or chronic pain care, we know the, the therapeutic relationship is key. So just even looking pedaling back and just saying, you know, this isn't, this isn't a, a just a, oh, this is a good thing to do. Or a luxury, like this is the essence of Im improving patient's lives, their pain, their, their outcomes.

Quality of life like this is, it's non-negotiable really when we look at the, at the literature. And so it just makes sense. And then the other thing I just really wanna emphasize is, as a clinician. You do you, you [00:41:00] know what, what's your style? And you keep that style. This isn't about changing yourself and being some something you're not, like some lovey-dovey or, you know, it's just like as no, no, no, be yourself, do you?

And with these concepts, they, they can come together and it's, it's all about,

well, what we're here talking about, capital C, compassion, which means being aware of your patients' needs, your own needs, and then having the courage and the competency, the skills to be able to meet those needs of your patient and yourself in that interaction. And there you go. That's that. It's, that's.

That's the the skill which makes it better for both you and the [00:42:00] patient, both clinician and patient, and then therefore longevity in your career and just better outcomes for your patient

Mark Kargela: and we will link some of the amazing resources that Shelly has on her site and some of the things from Kristen Neff site in the show notes. So folks can check that out. But I would highly recommend developing these skills, not just more off, more for yourself. 'cause again, if you can do it to yourself, it's much more easy to to transfer that to a person in front of you who's, who's dealing with some difficult times.

Shelly Prosko: I wrote a note on that question you asked me of, of tips for the clinicians to bring self-compassion more into their clinical interaction. I did have one thing just to add is be I would suggest being. Allowing your, your patient to be curious. So what you can do is start by just asking them.

So instead of of telling them, I think this, or, you know, Hey, try this, [00:43:00] ask them. And like the story that I shared, that's what I had done. As I said, what, what do you think? Do you think you're hard on yourself? And then give, give the person the space to, to, to say what they think about that. And then that's why I find sometimes these questions are hard because I ask, for me, I ask, I always ask the patient the question, and then they have the space and then from that, and it inspires me what I'm gonna say next.

And, and so that's what I would say is start by being curious and giving your patient the floor to be curious as well is what, what did they think about self-compassion?

Mark Kargela: That's a great point. I think it's that whole kind of improvisational guided discovery process that we have with patients that as clinicians, we want to just gimme the tips. Shelly, I want the, the script I can read and just go through. And as you learn these skills, it is much more of a, in the moment, improvisational, read the person in front of you what might stim, stimulate [00:44:00] their curiosity, step back and take some perspective on how they're treating or talking to themselves and maybe see if they can explore it.

But again, not giving 'em the answers, hopefully helping them guide themselves to their, their own answers.

You can hear how like in exposure base work and different things like this, that that would be hugely beneficial for somebody. So a little, another variable to bring into the equation of when you're trying to help people that have, , difficult movements that they're fearful or have really struggled with, that you help them , tap into a little bit of that self-compassion and help guide them there with some of the.

Great strategies that Shelly has shared today. Shelly, I could talk to you probably for another three, four hours about this and hopefully we'll get another opportunity in the not too distant future to chat. It's been great talking to you in person and I wanted to thank you so much for your time and all the amazing work you're doing.

Could you give us a little idea where, if folks are looking to get into your work and see what you're doing and learn from you where they can find you?

Shelly Prosko: Yeah, I think the best is just go to my website. So it's physio yoga.ca, so physio like [00:45:00] P-H-Y-S-I-O-Y, oga.ca, and everything's on there. I've got a lot of free resources. You go to the offering section webinars on this topic and practices and videos, and I have some paid classes too. The self-Compassion and pain care series is a really lovely series, and I can give you your listeners a discount code.

Don't want money to be a barrier, so I'm, I can give lots of discounts and free if someone needs it, but they are sale to help me keep doing things like this.

Mark Kargela: And we appreciate all the work you're doing and definitely we will link all that in the show notes for you that are listening. For those of you who are listening, we'd love if you could subscribe or anybody you know, who's trying to figure out where self-compassion fits in their practice, or maybe some patients who are struggling to understand maybe the kindness they need to show to themselves . Share this episode.

We'd love if you could share it along. But we'll leave it there this week. We'll talk to you all next week.

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